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Index Sr. No. Particulars Page No. 1 General Billing Rules 2--11 2 Packages Detail 12--23 3 Room Rent 24--25 4 Consultation Charges. 26--32 5 CTVS PACKAGE ROCEDURES 33--35 6 CTVS PEDIATRIC 36--37 7 CATH ADULT PROCEDURES 38--39 8 EP STUDY PACKAGE PROCEDURES 40--41 9 PEDIATRIC CATH PROCEDURES 42--43 10 UROLOGY PROCEDURES 44--46 11 NEPHROLOGY PROCEDURES 47-52 12 VASCULAR SURGERY 53--54 13 GENERAL SURGERY PROCEDURE 55--62 14 NUEROLOGY PROCEDURES 63--67 15 UROLOGY 68--71 16 DENTAL PROCEDURES 72--78 17 DERMATALOGY PROCEDURES 79--82 18 ENT PROCEDURES 83--87 19 NEPHROLOGY 88--89 20 GYNECOLOGY PROCEDURES 90--93 21 LABORATORY TEST CHARGES 94-120 22 ONCOLOGY PROCEDURES 121-126 23 OPTHALMOLOGY PROCEDURES 127-130 24 PULMONOLOGY PROCEDURES 131-134 25 PAIN CLINIC CHARGES 135-136 26 PLASTIC SURGERY 137-141 27 PHYSIOTHERAPY CHARGES 142-144 28 MISC. & OTHER SERVICES 145-148 29 CARDIAC DIAGNOSTIC CHARGES 149-151 30 CT PROCEDURES 152-155 31 MRI PROCEDURES 156-162 32 X RAY PROCEDURES 163-166 33 ULTRASOUND PROCEDURES 167-169 34 DIAGNOSTIC NEUROLOGY 170-172 35 DIANG-HIS 173-174 36 BLOOD BANK 175-176 37 GASTROENTEROLOGY PACKAGES 177-178 38 GASTROENTEROLOGY 179-184 39 TRANSPLANT CHARGES 185-186

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40 ORTHOPAEDIC PACKAGES 187-189 41 ORTHOPAEDICS PROCEDURES 190-199 42 MAXILLOFACIAL SURGERY 200-206 43 ONCO SURGERY 207-209 44 INTERVENTIONAL RADIOLOGY & CARDIOLOGY 210-211 45 ANESTHESIA PROCEDURES 212-214 46 PSYCHOLOGY 215-216

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GENERAL BILLING RULES & GUIDELINES

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Registration and Admission Charges

a) Onetime Registration charges of INR.100/- shall be charged to all new patients coming to Hospital for the first time. b) Onetime Admission charges of INR.2000/- shall be charged in all admission.

Follow-up Visit policy for IPD patients

a) One follow-up OPD Consultation of a surgical case shall be billed as zero consult. b) All patients coming for follow up in OPD within 6 days (to discuss the reports) shall be billed as zero consult.

Triage Billing Policy

a) Triage Bed Charges: Triage stay (Emergency) charges @ 1000/- per hour (First Hour Free) up to a maximum of eight hours. Beyond 8 hrs if the patient stays in the ER, charges shall be applicable as per Sharing Deluxe/opted room category. b) Triage stay shall not be more than 8 hours without justified approval from Head Emergency / Critical Care/Medical Superintendent. c) Patient is admitted as inpatient from Emergency, Triage bed charges shall not be levied. d) Patient is admitted as inpatient from Emergency, EMO charges shall not be levied. e) If patient getting discharge directly from triage and patient stay is less than 8 hours, all services shall be levied as per OPD rates. f) Triage tariff do not include EMO/ SR/ Specialty doctor Visit/ Investigation / Procedure/ Consumables / Medicines, which will be billed additionally. g) Visit charges of in house EMO will be INR. 500/-. If a Consultant visits Triage, the charges are as per the Pricing Policy and only one consultation visit either EMO/SR or Consultant shall be charged.

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Billing Cycle

a) Billing cycle will start from time of admission and is from 11:00 am to 11:00 am. Therefore 11:00 am is the checkout time for discharge. This policy however is not applicable in case of Day Care. b) First day charge as full day at the time of admission only. (Minimum 1-day charges applicable). c) Minimum half day charge is applicable for any admission (stay from 11 AM to 5 PM). Upto 5 PM of Stay will be billed1 as Half Day Stay and after 5 PM shall be billed as Full Day.

Room Policy

a) Room tariff includes standard fittings in the room according to the type of Occupancy / Laundry Services / House-keeping services. b) Room rent charges do not includes any professional fees like RMO Fee, Diet Charges, Dietician Visit, MRD charge and Equipment charges etc. c) Any additional Food & Beverage for anybody (Patient/Attendants) will be charged on MRP Basis. d) If the Patient’s Attendant retains the room while the Patient is in HDU / ICU /CRITICAL CARE AREAS, additional charges for the Room and Food & Beverage would be levied separately. e) In such cases Room would be provided subject to availability & approval from Admin Head. f) ICU Tariff does not include Specialty Doctors Visit / Ventilator / Investigations / Procedures / Consumables and Medicines. g) The Room charges do not include any Therapeutic procedure / Ventilator or Ventilator Initiation charges and Oxygen charges. h) When a patient is admitted through Emergency and the desired type of room is not available, then whichever type of room is available will be offered to Patient and charges will be applicable as per offered room type.

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Room Charges

Room Rent RATE CORONARY CARE UNIT ( CCU ) CHARGE 15800 DELUXE SUITE CHARGE 35000 GENERAL WARD CHARGE 6500 TWIN / DOUBLE SHARING 9000 SINGLE DELUXE ROOM 21500 SUITE 30200 PRESIDENTIAL SUIT 85000 HIGH DEPENDECY UNIT ( HDU ) CHARGE 10000

Medical History Assessment Charges

One time charges of INR.1600 to be charged from all IP admissions except those who are admitted in Triage (Non admissions).

TPA Evaluation Charges

One time charges of INR.800 to be charged as TPA Evaluation charges from all IP admissions routed through TPA.

Therapeutic Diet Charge

Therapeutic Diet charges of INR. 1000 will be applicable once in every day during patient Stay in the hospital from each Inpatient.

Sample Collection Charge

Sample collection charges of INR. 500/- will be applicable daily during patient Stay in the hospital from each Inpatient and subject to the investigations.

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IP Consultation policy

a) Two consultations during the day will be applicable in addition to other specialty consultations if required. b) IPD Doctor Team Visiting Charge will vary depending upon bed category and seniority of the doctor. c) Emergency visits shall be charged at 2100 /- per visit (in between 8pm to 8am, holiday and Sundays) d) In case of ICU/Critical Areas: Critical Care Charges of Rs. 4500 per day will be charged in addition to the routine consultation charges. e) The charge of the other specialty consultation will be charged as actuals apart from the admitting doctor charges.

Bed Transfer policy

a) In the event of Bed Transfer during course of treatment, the higher category of bed charges will be charged. b) In case the Patient is transferred from Lower to Higher category of Room following the Surgery/ Procedure charge would be revised according to higher bed category. The bed charges and the doctor’s visit charges would be charged as per the higher room category from the day of admission. c) In case the Patient is transferred from Higher to lower category of room following surgery / procedure would be charged as per Higher Bed category. The bed charges and the doctor’s visit charges would be charged as per the higher room category from the day & time of transfer. d) If the patient is transferred to ICU during the course of IP stay, then the surgery / procedure charges shall remain same as per original Bed occupied charges. However, ICU charges will be levied during actual duration of stay in the ICU. e) In case, due to non-availability of room if patient is shifted to higher category in that case also charges will be applicable as per desired category and when the desired category becomes available, patient gets shifted there. f) Where a patient admitted to ICU bed directly then the charges for procedure and surgery will be in line with the rates applicable in sharing room, however if patient opted for higher category the surgery/procedure will be charged as per charges applicable to higher category of bed.

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Policy Related to Surgery/Package/Procedure

a) Packages are prepared after all permissible discounted minimal usage items for normal conditions cases wherein there is no detailed prescription. b) In case more than one or multiple package/procedure is performed in single/different sitting, will attract the full procedure/package charges. c) Package/Procedure will be charged as per opted bed category. d) In case of PTCA , if done in two sitting, procure charge of second sitting will be charged extra rest other component like drugs, consumables, investigation etc. will be charged on actuals. e) Packages are non-discountable f) Multiple procedure in different region will attract full procedure charges. g) Rs.20,000 is charges in case of emergency/holidays for Angioplasty. h) Rs.30,000 is charged additional to package cost in case of adult patient admitted under pediatric surgery. i) Bed side Procedure (Minor Procedures) would be charged as per rates defined for various room Categories in the price list.

Advance Policy

a) For Planned procedures 100% of the estimate amount to be collected as advanced. If 100% of the estimated amount has not been cleared / deposited then surgery clearance shall not be given. Surgery clearance shall be issued post the deposit of requisite advance. b) For Emergencies and non-procedure observation patients following advances to be taken, (Unless the consultant fills an estimate in this case 80% of estimate):

Room Type Advance Amount slab Single INR. 30,000/- Double INR. 20,000/- ICU INR. 50,000/-

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c) (TPA) Retail Customers/ Individual policy Holders: Advance to be taken (as per policies / Protocols set up by units) where in patients walks in without authorization letter. Even in case of authorization letter nominal deposits can be asked to recover non-medical items. d) The advance should be refunded (on the basis of authorization / after deducting for the items which are not covered by the TPA’s) to the customer at the time of discharge by cash or cheque/RTGS. e) For TPA or Corporate patients, hospital may ask Patient to deposit advance money as per policy of the patient; or INR. 5000/- for Corporate patients and INR. 10000/- for Individual policy holders to cover cost of non-medical / admissible items, which are not paid by TPAs. Unutilized amount should be refunded at the time of discharge. The Patient needs to sign a consent letter promising that in case TPA denies the payment of treatment, the entire payment will be made by the patient and the issues with TPA will be sorted by Patient. f) Interim bill to be informed to the patient whenever the balance advance amount is less than INR. 10,000/-. At any given time we should have a credit of INR.10,000/-. For ICU patient’s available balance must be INR.50, 000/- . g) Face sheet is to be signed by the patient only. In case of minor or Unconscious Patient attendant or guardian has to sign the face sheet.

Equipment Charges

Any specific equipment hired from outside the Hospital would be charged additionally, subject to

usages.

Mode of payment and Refund Policy

a) All cash refunds of Rs 20000 & above and Payment made through Credit card for Rs. 5000 & above will be refunded through cheque. b) We accept payment by cash, credit/Debit cards and drafts. c) Demand drafts should be in favour of “Escorts Heart Institute and Research Centre Limited, Okhla”. d) All cash refunds of INR. 20000 will be refunded through cheque/RTGS within 7 working days.

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Financial Clearance for Surgery

a) Full advance (100%) of Estimate or as per protocol for TPA/ Corporate patients. b) Undertaking should be given before the surgery from the operating surgeon. c) Emergency surgery should be certified by the surgeon and recorded in the patient’s file, due approval should be taken from Medical Superintendent before giving the financial clearance.

Tax Instruction

Service Tax will be changed extra as applicable on all cosmetic procedures as prescribed by Govt. Notification.

Most Important Points related to Tariff for TPA/Companies

a) MOU Discount is applicable on approved credit amount, i.e. Payor’s share and not on the full cost of treatment. b) MOU Discounts are calculated after removing charges for Implants, Drugs, Medical Consumables, Blood bank, Equipment and outsourced services. c) In case the Payor/TPA makes short payments, Fortis Escorts hospital have the right to recover the balance money from the Patient. d) The latest approval from Payor, before the discharge of patient shall be considered for preparing Payor’s share of bill. Once the patient has left the hospital, any revised approval shall be considered null and invalid. Payor in such case shall be liable to pay as per the approval received before the discharge. e) In case of rejection of cashless service by Payor, The Patient shall be treated as Walk-In patient and his/her bill shall be prepared as per prevailing tariff of hospital which is applicable for all Walk-In patients. f) There shall be no discount on the prices of Govt. regulated services and products like Blood Bank products covered under NACO, Drugs & Consumables covered under NPPA/DPCO/NLEM. g) The hospital reserves the right to take deposit and hold it till the Payor makes payment to hospital. In case of short payment received from Payor, balance money shall be

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deducted from patient deposit and remaining money shall be refunded through cheque/RTGS. h) In case of expiry of MOU or agreed Tariff, billing shall automatically be done on prevailing tariff of hospital till MOU is again agreed with Payor. i) If any services/items are not available in provided SOC (introduced after MOU) shall be charged as per prevailing tariff of the hospital. j) All films be sent to TPA/ Corporate but if the Patient needs a copy of the film, the same can be provided but charged separately to Patient.

General Rules

a) No separate package breakup will be provided for any packages, Packages are non- refundable, non-discountable and non-adjustable. b) All promotional tariffs are only for cash patients admitted during the duration. Packages are as per rates mentioned in the tariff list.

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Package Inclusions and Exclusions

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

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ASD/VSD /PDA Device Closure/Repair & BMV VALVULOPLASTY

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

Investigation All Routine Tests such as complete haemogram BT.CT,Electrolytes .Urea Creatinine Blood Groping Urine PT, Drugs & consumables All Routine drugs& consumables upto 8 days of package

Procedure ASD/VSD /PDA Cardiologists fee ,Cath Lab charges Device Closure/Repair & MBV /Valvuloplasty Consultation Covered till Package days of Three Days Exclusions Implant /Devices/Patch will be chargeable on actual Drugs& consumables will be charged extra if pre & post stay is more than package days Investigation not covered within the package will be charged Extra All services to be charged on actual if the patient stay exceeds beyond package days CT/MRI/ Thallium & IABP if done or used will be extra Any cross consultation will be charged at actual Admission/Documentation & Critical care charges

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EPS/RFA Carto Procedure Inclusions

Room 1 Day Package as per opted room category

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

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TAVI/TAMVI Inclusions Room Total 5 Day Room charges as per opted Package 2CCU& 3 Room Investigation All Routine Tests such as complete haemogram BT.CT,Electrolytes .Urea Creatinine Blood Groping Urine PT, Drugs & consumables All Routine drugs& consumables

Procedure TAVI/Transcatheter Cardiologists fee ,Cath Lab charges Aortic Valve Replacement Procedure. Consultation Covered till Package days Exclusions Stay beyond package days Implant /Devices/Patch will be chargeable on actual Drugs& consumables will be charged extra Investigation not covered within the package will be charged Extra All services to be charged on actual if the patient stay exceeds beyond package days Vascular surgeon Charges will be extra if required CT/MRI/ Thallium & IABP if done or used will be extra Any cross consultation will be charged at actual Any additional procedure as per patient medical treatment will be charged at actual Admission/Documentation & Critical care charges

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ICD implantation Combo/Biventicular Pacemaker Inclusions

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

Investigation All Routine Tests such as complete haemogram BT.CT,Electrolytes .Urea Creatinine Blood Groping Urine PT, Drugs & consumables All Routine drugs& consumables upto 8 days of package

Procedure Cardiologists fee ,Cath Lab charges Consultation Covered till Package days of Three Days Exclusions Implant /Devices/Patch will be chargeable on actual Drugs& consumables will be charged extra if pre & post stay is more than package days Investigation not covered within the package will be charged Extra All services to be charged on actual if the patient stay exceeds beyond package days CT/MRI/ Thallium & IABP if done or used will be extra Any cross consultation will be charged at actual Admission/Documentation & Critical care charges

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CAG+PTCA Inclusions

Room 2 Day room rent & 1 day ICU Package as per opted category

Investigation All Routine Tests such as complete haemogram BT.CT,Electrolytes .Urea Creatinine Blood Groping Urine PT, Drugs & consumables Exemption against Drugs& Consumable’s with limit of Rs30000/- Procedure CAG+PTCA Cardiologists fee ,Cath Lab charges Consultation Covered till Package days of Three Days Exclusions Beyond the limit Drugs& consumables will be chargeable extra Beyond package days Investigation also will be chargeable All services to be charged on actual if the patient stay exceeds beyond package days CT/MRI/ Thallium & IABP if done or used will be extra 2nd sitting PTCA Procedure will be charges @ 25000/-additional Any cross consultation will be charged at actual Balloon & Stent, Devices & Adjunctive anticoagulant Injections Admission/Documentation & Critical care charges

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SINGLE/DOUBLE/TRIPLE VALVE REPAIR/REPLACEMENT Inclusions Room Total 8 Day Room charges as per opted Package Investigation All Routine Tests such as complete haemogram BT.CT,Electrolytes .Urea Creatinine Blood Groping Urine PT, Drugs & consumables All Routine drugs& consumables up to 8 days of package

Procedure CAG+PTCA surgeons fee ,OT charges& Anesthesia charges Consultation Covered till Package days Exclusions Stay beyond package days Implant /Devices/Patch will be chargeable on actual Drugs& consumables will be charged extra if pre & post stay is more than package days Investigation not covered within the package will be charged Extra All services to be charged on actual if the patient stay exceeds beyond package days CT/MRI/ Thallium & IABP if done or used will be extra High Risk Surgery charges Any cross consultation will be charged at actual Any additional procedure as per patient medical treatment will be charged at actual Admission/Documentation & Critical care charges

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CTVS Pediatric package details

Inclusions Room Total Days as per Package & Procedure as per opted room category Investigation All Routine Tests such as complete haemogram BT.CT,Electrolytes .Urea Creatinine Blood Groping Urine PT,& others Drugs & consumables All Routine drugs& consumables

Surgery surgeons fee ,OT charges& Anesthesia charges Consultation Covered till Package days Exclusions Drugs& consumables not covered in the package will be chargeable extra Implant /Devices/Patch will be charged on actual Investigation not covered within the package will be charged Extra All services to be charged on actual if the patient stay exceeds beyond package days CT/MRI/ Thallium & IABP if done or used will be extra High Risk Surgery charges Any cross consultation will be charged at actual Rs 30000/- will be charged additional to surgery charges if patient is adult Admission/Documentation & Critical care charges

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PPI SINGLE CHAMBER AND DOUBLE CHAMBER

Inclusions

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

Investigation All Routine Tests such as complete haemogram BT.CT,Electrolytes .Urea Creatinine Blood Groping Urine PT, Drugs & consumables All Routine drugs& consumables upto 8 days of package

Procedure PPI Cardiologists fee ,Cath Lab charges SINGLE/DOUBLE CHAMBER Consultation Covered till Package days of Three Days Exclusions Implant /Devices/Patch will be chargeable on actual Drugs& consumables will be charged extra if pre & post stay is more than package days Investigation not covered within the package will be charged Extra All services to be charged on actual if the patient stay exceeds beyond package days CT/MRI/ Thallium & IABP if done or used will be extra Any cross consultation will be charged at actual Admission/Documentation & Critical care charges

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BENTALL Procedures.

Inclusions Room Total 8 Day Room charges as per opted Package Investigation All Routine Tests such as complete haemogram BT.CT,Electrolytes .Urea Creatinine Blood Groping Urine PT, Drugs & consumables All Routine drugs& consumables upto 8 days of package

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LIVER TRANSPLANT Procedures. Inclusions Room Rom Rent: Recipient : 21 Days ( ICU : 7 Days + Single Room: 14 Days) + Donor: 10 Days ( ICU: 3 Days + Single Room: 7 Days) Room Pre-Work up: Recipient : 3 - 4 days, Investigation Donor: OPD basis, Up to two Dialysis Investigation One Re-exploration Procedure charge Investigation One Donor evaluation only included in package. In case if second donor, every services on actual. Drugs & consumables Drugs, Consumables, Investigations, Blood bank all together ( D&C + Investigation + Blood Bank) Consultations Liver, Nephrologist, Hepatologist consultations part of package Physiotheraphy part of package Discharge medicine for Recipient and Donor for 3 days

Exclusions Re-exploration expenses related to Drugs & O.T consumables (Drugs and O.T Consumables will be charged separately) Interventional Radiology procedure if any (Check angiography etc) The patient will be re-admitted as new admission after closing package bills. All services will be billed on actual beyond package days. International Patients no mark up beyond package days. All services not related to Liver Transplant will be charged additional on actual. All consultation other than Liver, Hepatologist & Nephrologist will be charged additional on actual.

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Kidney Transplant Package (KTP)

KTP PACKAGE (OPEN SURGERY)- RS. 4.5 LAKH

KTP PACKAGE (ROBOTIC SURGERY)- RS. 6.00 LAKH

Package will include the following:

1. Kidney Transplant Cost. 2. Surgeon’s Fee (Only related to KTP). 3. Initial work up and investigations (related to KTP) of the Recipient. 4. Stay of 9 days for the patient and 4 days for the donor in the hospital. 5. Post-surgery there is some additional investigations which are included in the package. 6. All meals (vegetarian) for the patient and donor in the hospital during the transplant programme.

The above package strictly covers only the Kidney Transplant Procedure and will not include the following: -

1. Stay beyond the above mentioned period. 2. Any other disease/complication. 3. Investigations for any other complication/disease. 4. Professional charges of any other consultant not related to KTP. 5. Any other additional procedure. 6. Use of special drugs/consumables if not part of KTP. 7. Any other personal expense incurred by the patient/donor would not be covered under the package. 8. Anti-rejection injection. 9. Dialyses before the transplant.

Donor Investigations.

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ROOM RENT

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 CORONARY CARE UNIT ( CCU ) CHARGE 14000 14000 14000 2 DELUXE SHARING CHARGE 8000 8000 8000 3 GENERAL WARD CHARGE 7000 7000 7000 4 HIGH DEPENDECY UNIT ( HDU ) CHARGE 11500 11500 11500 5 TRIAGE OBSERVATION CHARGE 1150 1150 1150 6 MEDICAL SUPERVISION (1-6 HRS) 1150 1150 1150 7 TWIN / DOUBLE SHARING 8000 8000 8000 8 SINGLE DELUXE ROOM 16500 16500 16500 9 SUITE 30200 30200 30200 10 PRESIDENTIAL SUIT 85000 85000 85000 11 CRITICAL CARE CHARGES 4025 4025 4025

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CONSULTATION

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 DOCTOR / VISIT CHARGE - IPD 1265 1898 2530 2 INITIATION OF VENTILATOR 1150 1150 1150 3 CONSULTATION ( DIETETICS ) 345 518 690 4 PHC - CONSULTATION - GENERAL SURGERY 1150 1725 2300 5 PHC - CONSULTATION - INTERNAL MEDICINE 1150 1725 2300 6 PHC - CONSULTATION - LIFESTYLE MANAGEMENT 345 518 690 7 PHC - CONSULTATION - MEDICAL ONCOLOGY 1150 1725 2300 8 PHC - CONSULTATION - NEPHROLOGY 1150 1725 2300 9 PHC - CONSULTATION - OBSTETRIC & GYNECOLOGY 1150 1725 2300 10 PHC - CONSULTATION - OPTHALMOLOGY 230 345 460 11 PHC - CONSULTATION - ORTHOPAEDICS 1150 1725 2300 12 PHC - CONSULTATION - CARDIAC SURGERY 1150 1725 2300 13 PHC - CONSULTATION - PAEDIATRIC SURGERY 1150 1725 2300 14 PHC - CONSULTATION - PSYCHIATRY 1150 1725 2300 15 PHC - CONSULTATION - PSYCHOLOGY 345 518 690 16 PHC - CONSULTATION - PULMONOLOGY 1150 1725 2300 17 PHC - CONSULTATION - UROLOGY 1150 1725 2300 18 PHC - CONSULTATION - CARDIOLOGY 1150 1725 2300 19 PHC - CONSULTATION - DENTAL 1150 1725 2300 20 PHC - CONSULTATION - DERMATOLOGY 1150 1725 2300 21 PHC - CONSULTATION - E N T 1150 1725 2300 22 PHC - CONSULTATION - ENDOCRINOLOGY 1150 1725 2300 23 PHC - CONSULTATION - GASTROENTEROLOGY 920 1380 2070 24 PHC - CONSULTATION - ONCOLOGY 1150 1725 2300 25 DOCTOR CHARGES 1265 1898 2530 26 Consultation Urology 1150 1725 2300 27 CLINICAL NUTRITIONIST FEE 575 575 575 28 CONSULTATION - LIVER TRANSPLANT 1150 1725 2300 29 CONSULTATION HEPATOLOGIST 1150 1725 2300 30 RADIOLOGY STUDY 4600 6210 6900 31 CONSULTATION OPTHAL - SR 960 1296 1750 32 DIABETOLOGIST CONSULTATION 1150 1725 2300 33 CONSULTATION PHYSIOTHERAPY 1265 1898 2530 34 CONSULTATION - GENERAL PHYSICIAN 1150 1725 2300 35 CHILD ASSESSMENT PSYCHOLOGISTS 7800 10530 14216 36 IQ AND DEVELOPMENTAL ASSESSMENT. 3960 5346 7217 37 ADULT ASSESSMENT PSYCHOLOGISTS 7200 9720 13122 38 NEUROPSYCHOLOGICAL ASSESSMENT PSYCHOLOGISTS 7200 9720 13122 39 PSYCHIATRY CONSULT + PSYCHOMETRIC EVALUATION 4080 5508 7436

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40 CONSULTATION PSYCHIATRY (Dr. RASHI KAPOOR) 1150 1725 2300 41 CONSULTATION OPTHAL - FOLLOWUP 506 759 1012 42 CONSULTATION GEN SURGERY - DAY 1150 1725 2300 43 ENDOCRINOLOGIST CONSULTATION 1150 1725 2300 CONSULTATION NEUROLOGY AND SLEEP MEDICINE (DR. MANVIR 1150 1725 2300 44 BHATIA ) CONSULTATION NEUROLOGY AND SLEEP MEDICINE REVISIT (DR. 1150 1725 2300 45 MANVIR BHATIA ) 46 DIABETIC MANAGEMENT CHARGES 1150 1150 2300 47 CONSULTATION - DR. AJIT SINGH NARULA 1800 1800 2640 48 PSYCHOTHERAPY /CBT/MARITAL THERAPY/IPT 2520 3402 4593 49 CONSULTATION PSYCHIATRY -(15 MINS) 1725 1725 3450 50 CONSULTATION PSYCHIATRY -(30 MINS) 2530 2910 3347 51 CONSULTATION PSYCHIATRY -(60 MINS) 2875 4313 5750 52 RESIDENT MEDICAL OFFICER (RMO) FEES PER DAY 1150 1725 2300 53 CONSULTATION HAEMATOLOGY (DR MITU P SHRIKHANDE) 1150 1725 2300 54 CONSULTATION HAEMATOLOGY REVISIT(DR MITU P SHRIKHANDE) 1150 1725 2300 55 CONSULTATION - LIVER TRANSPLANT & GI SURGERY TEAM 1150 1725 2300 56 CONSULTATION ICD CLINIC 1150 1323 1521 57 CONSULTATION HEART FAILURE CLINIC 1150 1323 1521 58 CONSULTATION SYNCOPE 1150 1323 1521 59 CONSULTATION ARRHYTHMIA AND PACEMAKER 1150 1323 1521 60 CONSULTATION PAEDIATRIC AND CONGENITAL CARDIOLOGY 1150 1323 1521 61 CONSULTATION PAEDIATRIC AND CONGENITAL SURGERY 1150 1323 1521 62 CONSULTATION ENT - DAY 1150 1725 2300 63 CONSULTATION GASTROENTROLOGY- DAY 1150 1725 2300 64 CONSULTATION NEURO - DAY 1150 1725 2300 65 CONSULTATION GYNAE - DAY 1150 1725 2300 66 CONSULTATION ORTHOPEDICS - DAY 1150 1725 2300 67 DENTAL SURGICAL EXTRACTION 1380 2070 2760 68 CONSULTATION BRONCHOSCOPY 1150 1725 2300 69 CONSULTATION PAED GASTRO 1150 1725 2300 70 CONSULTATION PAED GEN SURGERY 1150 1725 2300 71 CONSULTATION PLASTIC SURGERY 1150 1725 2300 72 CONSULTATION RHEUMATOLOGY 1150 1725 2300 73 CONSULTATION SPEECH THERAPY 1150 1725 2300 74 CONSULTATION THORACIC SURGERY 1150 1725 2300 75 CONSULTATION HAEMATOLOGY - DAY 1150 1725 2300 76 VISION TEST 863 1294 1725 77 CONSULTATION PERIPHERAL & VASCULAR 1150 1725 2300 78 CONSULTATION VASCULAR SURGERY - DAY 1150 1725 2300 79 CONSULTATION PAEDATRIC NEUROLOGY 1150 1725 2300 80 CONSULTATION OPHTHALMOLOGY FOLLOWUP 460 690 920

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81 CONSULTATION NEPHROLOGY-NIGHT 1725 2588 3450 82 CONSULTATION NEPHROLOGY-HOLIDAY 1725 2588 3450 83 CONSULTATION NEPHROLOGY DAY 1150 1725 2300 84 INTERNATIONAL SOS - OPD CONSULTATION 2875 4313 5750 85 CONSULTATION WITH CHIEF CARDIOLOGIST 3450 3968 4563 86 CONSULTATION FOR SKIN 1150 1323 1521 87 CONSULTATION BY DIRECTOR ORTHOPEDICS 1150 1725 2300 88 CONSULTATION BY SENIOR ORTHOPEDICS 1150 1725 2300 89 CONSULTATION ONCOLOGY - DAY 1150 1725 2300 90 CONSULTATION ONCOLOGY - NIGHT 1725 2588 3450 91 CONSULTATION ONCOLOGY - HOLIDAY 1725 2588 3450 92 CONSULTATION DENTAL - NIGHT 1725 2588 3450 93 CONSULTATION DENTAL - HOLIDAY 1725 2588 3450 94 CONSULTATION DERMATOLOGY - NIGHT 1725 2588 3450 95 CONSULTATION DERMATOLOGY - HOLIDAY 1725 2588 3450 96 CONSULTATION DIABETOLOGY - NIGHT 1725 2588 3450 97 CONSULTATION DIABETOLOGY - HOLIDAY 1725 2588 3450 98 CONSULTATION ENT - NIGHT 1725 2588 3450 99 CONSULTATION ENT - HOLIDAY 1725 2588 3450 100 CONSULTATION GASTROENTROLOGY - NIGHT 1725 2588 3450 101 CONSULTATION GASTROENTROLOGY - HOLIDAY 1725 2588 3450 102 CONSULTATION GYNAE - NIGHT 1725 2588 3450 103 CONSULTATION GYNAE - HOLIDAY 1725 2588 3450 104 CONSULTATION OPHTHALMOLOGY - NIGHT 1725 2588 3450 105 CONSULTATION OPHTHALMOLOGY - HOLIDAY 1725 2588 3450 106 CONSULTATION NEURO - NIGHT 1725 2588 3450 107 CONSULTATION NEURO - HOLIDAY 1725 2588 3450 108 CHAIRMAN CONSULTATION ORTHOPEDICS 1150 1725 2300 109 CONSULTATION ORTHOPEDICS - HOLIDAY 1725 2588 3450 110 CONSULTATION PLASTIC SURGERY - NIGHT 1725 2588 3450 111 CONSULTATION PLASTIC SURGERY - HOLIDAY 1725 2588 3450 112 CONSULTATION PSYCHIATRY - NIGHT 1725 2588 3450 113 CONSULTATION PSYCHIATRY - HOLIDAY 1725 2588 3450 114 CONSULTATION PSYCHOLOGY - DAY 1150 1725 2300 115 CONSULTATION PSYCHOLOGY - HOLIDAY 1725 2588 3450 116 CONSULTATION PSYCHOLOGY - NIGHT 1725 2588 3450 117 CONSULTATION PULMONOLOGY - NIGHT 1725 2588 3450 118 CONSULTATION PULMONOLOGY - HOLIDAY 1725 2588 3450 119 CONSULTATION UROLOGY - NIGHT 1725 2588 3450 120 CONSULTATION UROLOGY - HOLIDAY 1725 2588 3450 121 CONSULATATION ENDOCRINOLOGY - DAY 1150 1725 2300 122 CONSULATATION ENDOCRINOLOGY - NIGHT 1725 2588 3450 123 CONSULATATION ENDOCRINOLOGY - HOLIDAY 1725 2588 3450 28

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124 CONSULTATION GEN SURGERY - NIGHT 1725 2588 3450 125 CONSULTATION GEN SURGERY - HOLIDAY 1725 2588 3450 126 CONSULTATION RHEUMATOLOGY - NIGHT 1725 2588 3450 127 CONSULTATION RHEUMATOLOGY - HOLIDAY 1725 2588 3450 128 CONSULTATION ELECTRO - DAY 1150 1725 2300 129 CONSULTATION ELECTRO - NIGHT 1725 2588 3450 130 CONSULTATION ELECTRO - HOLIDAY 1725 2588 3450 131 CONSULTATION SPEECH THERAPY - NIGHT 1725 2588 3450 132 CONSULTATION SPEECH THERAPY - HOLIDAY 1725 2588 3450 133 CONSULTATION THORACIC SURGERY - NIGHT 1725 2588 3450 134 CONSULTATION THORACIC SURGERY - HOLIDAY 1725 2588 3450 135 CONSULTATION CARDIOTHORACIC - DAY 1150 1725 2300 136 CONSULTATION CARDIOTHORACIC - NIGHT 1725 2588 3450 137 CONSULTATION CARDIOTHORACIC - HOLIDAY 1725 2588 3450 138 CONSULTATION EUROLOGY - DAY 1150 1725 2300 139 CONSULTATION EUROLOGY - NIGHT 1725 2588 3450 140 CONSULTATION EUROLOGY - HOLIDAY 1725 2588 3450 141 CONSULTATION VASCULAR SURGERY - NIGHT 1725 2588 3450 142 CONSULTATION VASCULAR SURGERY - HOLIDAY 1725 2588 3450 143 CONSULTATION CCM 1150 1725 2300 144 VISITING CONSULTATION ORTHO 1380 2070 2760 145 CONSULTATION PAED GEN SURGERY HOLIDAY 1725 2588 3450 146 RECTAL / GENTIAL EXAM 1150 1725 2300 147 CONSULTATION BRONCHOSCOPY - DAY 1150 1725 2300 148 CONSULTATION BRONCHOSCOPY - NIGHT 1725 2588 3450 149 CONSULTATION BRONCHOSCOPY - HOLIDAY 1725 2588 3450 150 CONSULTATION CANCER - DAY 1150 1725 2300 151 CONSULTATION CANCER - NIGHT 1725 2588 3450 152 CONSULTATION CANCER - HOLIDAY 1725 2588 3450 153 CONSULTATION CARDIOTHORACIC 1150 1725 2300 154 CONSULTATION DENTAL - DAY 1150 1725 2300 155 CONSULTATION DERMATOLOGY - DAY 1150 1725 2300 156 CONSULTATION DIABETOLOGY - DAY 1150 1725 2300 157 CONSULTATION ELECTRO 1150 1725 2300 158 CONSULTATION EYE - DAY 1150 1725 2300 159 CONSULTATION EYE - NIGHT 1725 2588 3450 160 CONSULTATION EYE - HOLIDAY 1725 2588 3450 161 CONSULTATION VASCULAR SURGERY 1150 1725 2300 162 CONSULTATION HAEMATOLOGY 1150 1725 2300 163 CONSULTATION HAEMATOLOGY - NIGHT 1725 2588 3450 164 CONSULTATION HAEMATOLOGY - HOLIDAY 1725 2588 3450 165 CONSULTATION HOMEOPATHY 1150 1725 2300 166 CONSULTATION NEURO 1150 1725 2300 29

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167 CONSULTATION OPHTHALMOLOGY - DAY 1150 1725 2300 168 CONSULTATION UROLOGY - DAY 1150 1725 2300 169 CONSULTATION PAED GASTRO - DAY 1150 1725 2300 170 CONSULTATION PAED GASTRO - NIGHT 1725 2588 3450 171 CONSULTATION PAED GASTRO - HOLIDAY 1725 2588 3450 172 CONSULTATION PAED GEN SURGERY - NIGHT 1725 2588 3450 173 CONSULTATION PAED GEN SURGER - DAY 1150 1725 2300 174 CONSULTATION PLASTIC SURGERY - DAY 1150 1725 2300 175 CONSULTATION PAEDATRIC NEUROLOGY - DAY 1150 1725 2300 176 CONSULTATION PAEDATRIC NEUROLOGY - NIGHT 1725 2588 3450 177 CONSULTATION PAEDATRIC NEUROLOGY - HOLIDAY 1725 2588 3450 178 CONSULTATION PULMONOLOGY - DAY 1150 1725 2300 179 CONSULTATION RHEUMATOLOGY - DAY 1150 1725 2300 180 CONSULTATION SPEECH THERAPY - DAY 1150 1725 2300 181 CONSULTATION THORACIC SURGERY- DAY 1150 1725 2300 182 CONSULTATION CENTRE FOR SIGHT(REVISIT) 173 259 345 183 CONSULTATION PSYCHIATRY - DAY 1150 1725 2300 184 CONSULTATION TEAM PULMONOLOGY 1150 1725 2300 185 CONSULTATION TEAM PULMONOLOGY - DAY 1150 1725 2300 186 CONSULTATION TEAM PULMONOLOGY - NIGHT 1725 2588 3450 187 CONSULTATION TEAM PULMONOLOGY - HOLIDAY 1725 2588 3450 188 SMOKING CESSATION CLINIC 690 1035 1380 189 CONSULTATION STAR OPHTHALMOLOGY 1150 1725 2300 190 CONSULTATION SENIOR OPHTHALMOLOGY 690 1035 1380 191 CONSULTATION STAR OPHTHALMOLOGY (REVISIT) 805 1012 1047 192 CONSULTATION WITH SENIOR PULMONOLOGIST 1150 1725 2300 193 CONSULTATION PAIN & PAC 1495 1719 1977 194 ONLY INSOLE PREPARATION 2875 3306 3802 195 CONSULTATION INTERNAL MEDICINE - DAY 1150 1725 2300 196 CONSULTATION INTERNAL MEDICINE - NIGHT 1725 2588 3450 197 CONSULTATION WITH HEAD PSYCHIATRISTS 1725 2588 3450 198 PSYCHIATRY (30 MIN SESSION) 1610 2415 3220 199 CONSULTATION CARDIOLOGY-TEAM DOCTOR 575 661 760 CONSULTATION /COUNSELLING PSYCHOLOGIST INDIVIDUAL 920 1058 1217 200 THERAPY (30 MIN) CONSULTATION /COUNSELLING PSYCHOLOGIST INDIVIDUAL 1725 1984 2282 201 THERAPY (ONE HOUR) CONSULTATION /COUNSELLING PSYCHOLOGIST MARITAL /FAMILY 2070 2381 2738 202 THERAPY 203 CONSULTATION/COUNSELLING ( PSYCHOLOGIST ) IPD 1150 1323 1521 204 SECOND OPINION CHARGES LEVEL 3 8050 9258 10647 205 SECOND OPINION CHARGES LEVEL 1 3450 3968 4563 206 SECOND OPINION CHARGES LEVEL 2 5750 6613 7605

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207 CONSULTATION - OPTHALMOLOGY 1150 1323 1521 208 NEPHROLOGY TEAM 1725 1984 2282 CONSULTATION NEPHROLOGY DR. TANMAY PIYUSHCHANDRA 1725 1984 2282 209 PANDYA 210 AFP PHYSIOTHERAPY CONSULTATION 1725 1984 2282 211 CONSULTATION CARDIAC SURGERY (DR. Z .S MEHARWAL) 2300 2645 3042 CONSULTATION CARDIAC SURGERY – (DR. Z. S MEHARWAL ,TEAM 1150 1323 1521 212 DOCTOR) 213 CONSULTATION GENERAL PHYSICIAN DR. G S GREWAL 1150 1323 1521 CONSULTATION GASTROENTEROLOGY DR. SUBRAT KUMAR 2300 2645 3042 214 ACHARYA 215 CONSULTATION ORTHOPEDICS DR. NITIRAJ OBEROI 1150 1323 1521 216 CONSULTATION NEURO DR. GAURAV BANSAL 1150 1323 1521 217 CONSULTATION - GENERAL SURGERY - DR SANJAY VERMA 1150 1323 1521 218 PRIME CONSULTATION CHIEF CARDIOLOGIST - DR ASHOK SETH 5750 6613 7605

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CTVS

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 CABG ( OFF PUMP ) 381225 427225 530725 2 CORONARY ARTERY BYPASS GRAFTING ( CABG ) + VALVES - (P) 450225 524975 616975 3 CORONARY ARTERY BYPASS GRAFTING ( CABG ) + OTHERS - (P) 430650 502150 590150

Coronary Artery Bypass Grafting ( CABG ) + Carotid 450225 524975 616975 4 Endarterectomy 5 SINGLE VALVE (REPAIR/REPLACEMENT) - (P) 369725 427225 530725 6 DOUBLE VALVE (REPAIR/REPLACEMENT) - (P) 415725 473225 588225 7 Triple Valve ( Repair / Replacement ) 488750 562063 646372 8 VALVE + PERIPHERAL VASCULAR - (P) 488750 562063 646372

Aortic Valve Replacement + Aortic Wrap (Ascending / Descending 507725 552575 651475 9 Aorta) 10 BENTALL PROCEDURE - (P) 496225 553725 645725 11 CABROLL - BENTALL / AORTIC DISSECTIONS - (P) 496225 553725 645725 12 PERICARDIECTOMY - (P) 161000 178250 189750 13 ASD/VSD CLOSURE (A) 369725 427225 530725 14 Carotid Bypass Grafting 201250 218500 258750

AORTIC ARCH REPLACEMENT/DESCENDING THORACIC 391000 449075 519225 15 AORTA/THORACOABDOMINAL ANEURYSM REPAIR - (P) 16 Heart Port Surgery 415725 473225 588225 17 Heart Port Surgery for Atrial Septal Defect Repair 415725 473225 588225 18 Atrial Septal Defect ( ASD ) Closure 369725 427225 530725 19 MYXOMA / ANEURYSMECTOMY - (P) 362250 416588 479076 20 SEPTAL MYECTOMY 373750 437000 747500 21 Ruptured Sinus of Valsalva (RSOV) repair(Normal) 362250 416588 479076 22 Descending Aorta Replacement 496225 553725 645725 23 DEBRANCHING - (P) 402500 462875 532306 24 Heart Transplant* 2300000 2645000 3041750 25 PRE-HEART TRANSPLANT EVALUATION - (P) 46000 52900 60835 26 LVAD SURGERY* 9545000 9545000 19090000 27 Pacemaker Lead ( Replacement ) 23000 34500 46000 28 PPI / LEAD REMOVAL 23000 34500 46000 29 Aorto Iliac Bypass 62100 79350 96600 30 Aorto Iliac Or Aorto Femoral Bypass Grafting -Primary 42550 50600 55200 31 AORTIC BIFEMORAL - (P) 149500 224250 270250 32 Carotid Endarterectomy ( CTVS ) 57500 74750 92000 33 FEM FEM BYPASS OPERATION - (P) 224250 241500 287500 34 ILIO-FEM POP BYPASS 57500 74750 92000 35 LLIO-FEM-FEM BYPASS 46000 57500 74750 36 FEM POP - (P) 224250 241500 287500

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37 Axillary Brachial Cross Over Bypass 201250 231438 266154 38 Fem - Fem Cross Over Graft ( Vascular Surgery ) 224250 241500 287500 39 VENTRICULAR SEPTAL RUPTURE (VSR) - (P)*** 69000 79350 91253 40 Wound Resuturing 172500 198375 228131 41 Sternal Rewiring 11500 15525 23288 42 STERNAL WIRE REMOVAL (P) 115000 132250 152088 43 HIGH RISK CHARGES LEVEL-1*** 69000 79350 91253 44 HIGH RISK CHARGES LEVEL-2*** 69000 79350 91253 45 HIGH RISK CHARGES LEVEL-3*** 69000 79350 91253 46 MINIMALLY INVASIVE - (P)*** 57500 66125 76044 47 ROOT ENLARGEMENT - (P)*** 57500 66125 76044 48 MAZE Procedure*** 69000 79350 91253 49 Vein Harvesting ( Endoscopic )*** 46000 52900 60835 50 AVR + REDUCTION AORTOPLASTY - (P) 431250 495938 570329

DOUBLE VALVE REPLACEMENT ( DVR )+ REDUCTION AORTOPLASTY 500250 575288 661581 51 - (P) 52 PULMONARY THROMBOENDARTERECTOMY - (P) 488750 562063 646372 53 PEDIATRIC SURGERY (ADULT PATIENT)*** 34500 46575 46575 54 Abdominal Aortic Aneurysm Repair 74750 92000 109250 55 Abdominal Aortic Aneurysm ( Bifurcated ) Repair 264500 322000 373750 56 ECMO PROCEDURE 230000 287500 373750 57 FLUROSCOPY. 2875 3881 5750 58 AQUAPHERESIS THERAPY 119700 179550 239400

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CTVS PEDIATRIC

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Gen. Single Sl Description Ward/DDX Dlx Suite No. Room Room 1 Patent Ductus Arteriosus Ligation ( PDA ) 149500 172500

Major AortoPulmonary Collateral Artery ( MAPCA ) Ligation -Left ( 149500 172500 2 Pediatric ) 3 Banding Pulmonary Artery ( Pediatric ) 149500 172500 4 Blalock Taussig ( BT ) Shunt Procedure 224250 247250 5 Intra Cardiac Repair ( TAPVC / VSD + PS ) 316250 339250 6 Tetrology Of Fallot (TOF) Correction 316250 339250 7 AortoPulmonary Window Repair ( Pediatric ) 316250 339250 8 Atrial Septectomy ( Pediatric ) 270250 293250 9 Atrio ventricular Canal Repair ( Pediatric ) 316250 339250 10 Glenn shunt BD (Bi-directional) Without Bypass( Pediatric ) 270250 293250 11 Coarctation Of Aorta Repair ( Pediatric ) 224250 247250

Partial anomalous pulmonary venous connection (PAPVC) 316250 339250 12 Rerouting- Pediatric 13 Subaortic Membrane Resection ( Pediatric ) 316250 339250 14 Blalock Taussig ( BT ) Shunt On Bypass 224250 247250

REV Procedure ( Transposition of Great Arteries with VSD) - 316250 339250 15 Pediatric 16 Ventricular Septal Defect ( VSD ) Surgery ( Pediatric ) 316250 339250 17 Aterial Septal Defect ( ASD ) closure - Pediatrics 270250 293250 18 Aortic Valve Repair ( Pediatric ) 316250 339250 19 VALVE REPLACEMENT - (P) 316250 339250 20 ASD SURGICAL CLOSURE (INTRACARDIAC REPAIR) 270250 293250 21 COARCTATION AORTA REPAIR WITH GRAFT 224250 247250 22 TRICUSPID V REPAIR (PAEDIATRIC) 316250 339250 23 Alcapa Procedure ( Pediatric ) 316250 316250 24 Senning Operation ( Pediatric ) 316250 316250 25 MITRAL VALVE REPAIR (PAED) - (P) 316250 316250 26 Arterial Switch Procedure ( Pediatric ) 345000 368000 27 Truncus Arteriosus Repair ( Pediatric ) 345000 368000 28 Total CavoPulmonary Connection ( TCPC ) Repair ( Pediatric ) 345000 368000 29 Conduit Repair ( CTVS ) 345000 368000 30 Double Switch Operation ( DSO ) 345000 368000 31 FONTAN PROCEDURE ( PEDIATRIC ) 345000 368000 32 Rastelli Procedure ( Pediatric ) 345000 345000

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CATH ADULT

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 CORONARY ANGIOGRAPHY (CAG) 18975 25875 36225 2 CHECK ANGIOGRAPHY - (P) 18975 25875 36225 3 CAROTID ANGIOGRAPHY - (P) 18975 25875 36225 4 PERIPHERAL/RENAL ANGIOGRAPHY - (P) 18975 25875 36225 5 PERIPHERAL CHECK ANGIOGRAPHY 18975 25875 36225 6 ANGIOGRAPHY ( VENOGRAPHY ) - (P) 17250 19838 22814 7 CARDIOVERSION PACKAGE 23000 39100 57500 8 SINGLE VESSEL DISEASE-(P) 162725 191475 220225 9 DOUBLE VESSEL DISEASE-(P) 162725 191475 220225 10 COMPLEX/TRIPLE VESSEL-(P) 185725 191475 257600 11 PRIMARY PTCA (ANGIOPLASTY) - (P) 185725 191475 257600 12 PERIPHERAL ANGIOPLASTY - (P) 162725 191475 220225 13 Carotid Stenting 162725 191475 220225 14 RENAL STENTING - (P) 162725 191475 220225 15 IVC FILTER IMPLANTATION - (P) 97750 109250 115000 16 AORTIC STENT GRAFT INSERTION - (P) 178998 210623 283360 17 TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) 431250 495938 570329 18 LEFT ATRIAL APPENDAGE CLOSURE DEVICE (P) 115000 132250 152088 19 BMV / BPV - BALLOON - (P) 108000 162000 216000 20 MYOCARDIAL BIOPSY 17250 19838 22814 21 OCT - (P) 46000 52900 60835 22 FRACTIONAL FLOW RESERVE ( FFR ) - POSTIVE - (P) 11500 13225 15209 23 Fractional Flow Reserve ( FFR ) 23000 34500 51750 24 Intravascular Ultrasound ( IVUS ) Procedure 34500 39675 45626 25 STAGED ANGIOPLASTY - (P) 28750 38813 58219 26 TRANSCATHETER MITRAL VALVE IMPLANTATION (TMVI) 431250 495938 570329

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EP STUDY

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 ELECTROPHYSIOLOGY ( EP ) STUDY - (P) 32200 36800 46000 2 E P STUDY - COMPLICATED - (P) 41400 46000 57500 3 RADIOFREQUENCY ABLATION (RFA) - (P) 111550 116150 132250 4 3D ABLATION PROCEDURE 92000 109250 143750

CARTO ELECTROPHYSIOLOGY PROCEDURE WITH THERMOCOAL 126500 138000 172500 5 CATHETER 6 Carto Electrophysiology Procedure ( with Carto Catheter ) 126500 155250 201250

ELECTROPHYSIOLOGY PROCEDURE WITH ENSITE NAVX WITH 126500 138000 172500 7 VELOCITY 8 Radiofrequency Ablation ( Thermocool / Halo / Lasso ) 126500 143750 161000 9 SEPTAL ABLATION - (P) 108445 124712 143419 10 LEAD EXTRACTION - COMPLEX 162725 191475 220225 11 PACEMAKER - SINGLE CHAMBER - (P) 109250 120750 143750 12 PACEMAKER - DOUBLE CHAMBER - (P) 120750 132250 155250 13 Pacemaker Implantation Biventricular ( Permanent ) 132250 155250 178250 14 ICD / AICD - (P) 126500 166750 178250 15 TEMPORARY PACEMAKER INSERTION ( TPI ) - (P) 10350 11903 12420 16 BRONCHIAL ARTERY EMBOLIZATION - (P) 72404 82271 115184 17 EP + RF ABLATION - (P) 108100 127650 166750 18 AICD (IMPLANTATION) - Double Chamber (P) 126500 166750 178250 19 RENAL NERVE DENERVATION THERAPY 2070 2795 4192 20 COMBO Device Implantation 132250 198375 210000

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PEDIATRIC CATH

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 BALLOON VALVULOPLASTY - (P) 108000 138000 184000 2 PDA COIL CLOSURE ( PED ) - (P) 108000 138000 184000 3 PDA DEVICE CLOSURE- (P) 126000 146625 195500 4 PEDIATRIC DIAGNOSTIC STUDY (PAED) - (P) 25473 35535 42895 5 PEDIATRIC DIAGNOSTIC CHECK STUDY (PAED) - (P) 17423 27485 34845 6 BALLOON DILATATION OF RVOT (PEDIATRIC) 74750 94300 115000 7 BALLOON DILATATION PULMONARY ARTERY (PEDIATRIC) 74750 94300 115000 8 BALLOON DILATATION OF CONDUIT (PEDIATRIC) 74750 94300 115000 9 BALLOON DILATATION OF LVOT (PEDIATRIC) 74750 94300 115000 10 BALLOON DILATATION OF THE ASD (PEDIATRIC) 74750 94300 115000

BALLOON DILATATION OF SYSTEMIC VENOUS PATHWAY 74750 94300 115000 11 (PEDIATRIC) 12 BALLOON TRICUSPID VALVOTOMY (PEDIATRIC) 74750 94300 115000 13 VALVULOPLASTY WITHOUT ANESTHESIA 97750 117300 143750 14 BALLOON MITRAL VALVULOPLASTY - (HIGH RISK) 74750 94300 115000 15 BALLOON AORTIC VALVULOPLASTY - (HIGH RISK) 74750 94300 115000 16 BALLOON PULMONARY VALVULOPLASTY - (HIGH RISK) 74750 94300 115000 17 BALLOON TRICUSPID VALVULOPLASTY - (HIGH RISK) 74750 94300 115000 18 Aortic Valvotomy Open 74750 94300 115000 19 Mitral Valvotomy Open ( OMV ) 74750 94300 115000 20 Balloon Atrial Septostomy - ( Pediatrics ) 72000 86250 115000

Cardiac Catheterization + Major AortoPulmonary Collateral Artery ( 36000 44400 60000 21 MAPCA ) Coiling - Pediatrics 22 Pulmonary ArterioVenous ( AV ) Fistula Coiling - Pediatric 74750 88550 109250 23 Coronary ArterioVenous ( AV ) Fistula Device Closure - Pediatric 86250 105800 132250 24 Mitral Paravalvular Leak Device Closure - Pediatrics 86250 105800 132250 25 Ventricular Septal Defect ( VSD ) Device Closure - Pediatrics 86250 105800 132250 26 Coarctation Of Aorta Stenting ( Pediatrics ) 86250 105800 132250 27 Conduit Stenting ( Pediatrics ) 86250 105800 132250 28 Pulmonary Artery Stenting ( Pediatrics ) 86250 105800 132250 29 Systemic Venous Pathway Stenting ( Pediatrics ) 103500 123050 143750 30 Surgical Pacemaker Implant ( Pediatric ) 155250 155250 155250 31 ATRIAL SEPTAL DEFECT ( ASD ) DEVICE CLOSURE - PEDIATRICS 97750 117300 143750 32 BALLOON PULMONARY VALVOTOMY 74750 94300 115000 33 Patent Ductus Arteriosus ( PDA ) Device Closure - Pediatrics 97750 117300 143750 34 PAED. CHECK ANGIO 17998 28060 35420

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UROLOGY

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 CYSTOSCOPY ( DIAGNOSTIC) UNDER LA IN DAY CARE - (P) 17250 17250 17250 2 PERCUTANEOUS NEPHROLITHOTOMY ( PCNL ) - (P) 23000 34500 46000 3 URETEROSCOPY ( STONE REMOVAL ) - (P) 19205 28750 38410 4 AV FISTULA - (P) 38500 49500 77000 5 DJ STENTING B/L - (P) 9200 13800 18400 6 DJ STENTING U/L - (P) 7705 11500 15410 7 AV FISTULA IN DAYCARE - (P) 34500 34500 34500 8 ORCHIDECTOMY- UNILATERAL - PKG 69000 79350 91253 9 ORCHIDECTOMY- BILATERAL - PKG 92000 105800 121670 10 MEATOTOMY - PKG 31680 47520 63360 11 NEPHERCTOMY RADICAL 240000 360000 480000 12 LAPAROSCOPIC RADICAL PROSTATECTOMY-(P) 57500 86250 115000 13 PELVIC FLOOR REPAIR (MAJOR) 30705 46000 61410 14 CYSTOSCOPY UNDER GA DAYCARE - (P) 29900 29900 29900 15 Retrograde IntraRenal Surgery ( RIRS ) 26795 40250 53590 16 Nephrectomy Partial 57500 86250 115000 17 Retroperitoneal Lymph Node Dissection ( RPLND ) - Urology 57500 86250 115000 18 Lithotripsy ( for Stone >1 Cm ) 37950 56925 75900 19 CYSTOSCOY + BIOPSY WITH GA DOUBLE (P) 5750 8625 11500 20 LITHOTRIPSY <1 CM STONE (ESWL) DAYCARE - (P) 29900 29900 29900 21 CATHETER REMOVAL TRAIL DAYCARE - (P) 2875 4313 5750 22 LASER LITHOTRIPSY 51750 77625 103500 23 Percutaneous Nephrolithotomy ( PCNL ) 34500 51750 69000 24 Transurethral Resection Of Prostate ( TURP ) > 100 gms 57500 86250 115000

RADICAL CYSTECTOMY WITH ILEAL CONDUIT - 57500 86250 115000 25 OPEN/LAPAROSCOPIC/ROBOTIC 26 Nephrectomy Simple 38295 57500 76590 27 BLADDER NECK INCISION ( BNI ) / TUIP - (P) 19205 28750 38410 28 Pyeloplasty 30705 46000 61410

Bladder Neck Suspension ( Sling Procedure ) - Tension Free Vaginal 23000 34500 46000 29 Tape - Obturator ( TVT - O ) 30 Retrograde Intra Renal Surgery (RIRS) (U/L) (Holium Laser) (P) 26795 40250 53360 31 TURBT . 97750 112413 129275 32 HOLMIUM URETEROSCOPY - STONE REMOVAL - (P) 20700 31050 41400 33 PELVIC FLOOR REPAIR (MINOR) 19205 28750 38410 34 DJ STENT REMOVAL 5750 8625 11500 35 B/L DJ STENT REMOVAL 22000 42000 56000 36 Extracorporeal Shock Wave Lithotripsy ( ESWL ) 37950 56925 75900 37 KIDNEY BIOPSY (P) 4600 34500 51750

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Transurethral Resection Of Prostate ( TURP ) Upto 100 gms ( 204600 276100 409200 38 Holmium Laser )

Transurethral Resection Of Prostate ( TURP ) > 100 gms ( Holmium 256300 344300 512600 39 Laser )

TRANSURETHRAL RESECTION OF PROSTATE ( TURP ) ABOVE 100 176000 248600 352000 40 GMS (P)

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NEPHROLOGY

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 KIDNEY BIOPSY (P) 4600 34500 51750 2 KIDNEY BIOPSY + ELECTRON MICROSCOPY (P) 46000 69000 92000 3 Kidney Transplant 517500 517500 517500 4 KIDNEY TRANSPLANT (ROBOTIC SURGERY) 747500 747500 747500 5 Abdomen Examination Under Anesthesia ( Pediatric ) 6325 7653 8419 6 Anorectal Malformation (High) Pull Through ( Pediatric ) 37950 45920 50511

31625 38266 42093 7 Posterior sagittal anorectoplasty (PSARP) - Complete - ( Pediatric ) 8 Posterior sagittal anorectoplasty ( PSARP) - Limited - ( Pediatric ) 25300 30613 33674 9 Pleural Tap ( Pediatric ) 2530 3061 3367 10 Ascitic Tap ( Pediatric ) 2530 3061 3367

Kasai's Procedure - Hepato-Portoenterostomy for Biliary Atresia ( 49335 59695 65665 11 Pediatric ) 12 Rectal Biopsy ( Pediatric ) 6325 7653 8419 13 Bone Marrow Aspiration Without Biopsy ( Pediatric ) 2875 3881 5822 14 Cleft Palate Repair - Complete Cleft ( Pediatric ) 31625 38266 42093 15 Cleft Palate Repair - Incomplete Cleft ( Pediatric ) 25300 30613 33674 16 Clitorovaginoplasty (Feminizing Genitoplasty) - Pediatric 37950 45920 50511 17 Cystolithotomy ( Pediatric ) 10120 12245 13470 18 Hydatid Cyst Intraperitoneal Drainage ( Pediatric ) 37950 45920 50511 19 Psoas Abscess Drainage ( Pediatric ) 11385 13776 15157 20 Dressing Wound ( Deep ) - Pediatric 6900 22960 25256

Esophageal Atresia With Tracheo Esophageal Fistula Repair - 37950 45920 50511 21 Primary ( Pediatric ) 22 Exomphalos Repair ( Pediatric ) 37950 45920 50511 23 Mass (Head Neck) Excision ( Pediatric ) 15180 18368 20204 24 Hypospadias Chordee Correction ( Pediatric ) 18975 22960 25256 25 Hypospadias Correction (1st Stage) - Pediatric) 18975 22960 25256 26 Hypospadias Correction (2nd Stage) - Pediatric 22770 27552 30307 27 Hypospadias Fistula Repair ( Pediatric ) 15180 18368 20204 28 Liver Partial Resection - Lateral Segmentectomy ( Pediatric ) 31625 38266 42093 29 Pyeloplasty Laparoscopic ( Pediatric ) 41745 50511 55562 30 Ladds Band Resection Laparoscopy ( Pediatric ) 24035 29082 31991 31 Hemangioma Excision ( Pediatric ) 23000 34500 46000 32 Marsupialization ( Pediatric ) 18975 22960 25256 33 Pilonidal Sinus Excision ( Pediatric ) 18975 22960 25256 34 Suturing Secondary ( Pediatric ) 12650 15307 16837 35 Stricturoplasty ( Pediatric ) 12650 15307 16837 36 Wound Suturing Minor ( Pediatric ) 6325 7653 8419

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37 Vaginoplasty ( Pediatric ) 31625 38266 42093 38 Nail Bed Reconstruction (Single Finger) - Pediatric 25300 30613 33674 39 NephroUreterectomy ( Neonatal ) 40480 48981 53879 40 Tracheostomy ( Pediatric ) 20240 24490 26940 41 Paronychia Surgical Treatment ( Pediatric ) 6325 7653 8419 42 Imperforate Hymen Excision ( Pediatric ) 8855 10715 11786 43 Ovarian Torsion Repair ( Laparoscopic ) - Pediatric 25300 30613 33674 44 Cleft Lip Repair ( Left ) - Pediatric 22770 27552 30307 45 Cleft Lip Repair ( Bilateral )- Pediatric 27830 33674 37042 46 Columella Lengthening ( Pediatric ) 18975 22960 25256 47 Lip Secondary Deformity Correction ( Pediatric ) 14421 17450 19195 48 Palate Fistula Repair ( Pediatric ) 22770 27552 30307 49 Z - Plasty (Single)- Pediatric 10120 12245 13470 50 Z - Plasty (Multiple)- Pediatric 20240 24490 26940 51 Bronchoscopy ( Pediatric ) 12650 15307 16837 52 Bronchoscopy + Foreign Body Removal With Lavage ( Pediatric ) 22770 27552 30307 53 Chest Tube Insertion ( Pediatric ) 8855 10715 11786 54 Thoracoscopy (Diagnostic)- Pediatric 25300 30613 33674 55 Intercostal Drainage ( Pediatric ) 7590 9184 10103 56 Lung Abscess Surgery ( Pediatric ) 31625 38266 42093 57 Lung Biopsy ( Pediatric ) 16445 19898 21888 58 Pleurodesis ( Pediatric ) 7590 9184 10103

Thoracotomy + Excision Of Mediastinal Bronchogenic Cyst ( 37950 45920 50511 59 Pediatric ) 60 Thoracotomy + Segmental Resection Of Lung ( Pediatric ) 31625 38266 42093

Thoracotomy + Pleurectomy + Excision Of Emphysematous Bullae ( 44275 53573 58931 61 Pediatric ) 62 Renal Abscess Drainage - Percutaneous ( Pediatric ) 8223 9948 10942 63 Augmentation Cystoplasty ( Pediatric ) 32890 39797 43777 64 Nephrostomy Tube Change ( Pediatric ) 4428 5358 5894

12650 15307 16837 65 Cystoscopy With Retrograde Catheterization ( Bilateral )- Pediatric

Cystocopy With Retrograde Ureteric Catheterization ( Right )- 8855 10715 11786 66 Pediatric 67 Stent Removal (Cystoscopic) -Pediatric 6325 7653 8419 68 Cystoscopy ( Pediatric ) 10120 12245 13470 69 Stricture (Urethral) Dilatation + Calibration ( Pediatric ) 6325 7653 8419 70 Double J Stent Placement In Ureter ( Bilateral ) - Pediatric 16445 19898 21888 71 Double J Stent Placement In Ureter ( Left ) - Pediatric 11385 13776 15154 72 Epispadias - Exstrophy Complex Repair ( Pediatric ) 31625 38266 42093 73 Epispadias Repair ( Pediatric ) 18975 22960 25256 74 Meatoplasty ( Pediatric ) 8855 10715 11786 75 Mitrofanoff Appendicovesicostomy - Pediatric 29095 35205 38725 48

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76 Permacath Removal ( Pediatric ) 9488 11500 12650 77 Pyelolithotomy ( Pediatric ) 25300 30613 33674 78 Pyeloplasty ( Pediatric ) 31625 38266 42093 79 Paraphimosis Reduction ( Pediatric ) 3795 5750 7590 80 Bladder Repair (Major) - Pediatric 18975 22960 25256 81 Bladder Repair (Minor) - Pediatric 10120 12245 13470 82 Cystectomy (Total) - Pediatric 18975 22960 25256 83 Ureteric Implantation Bilateral ( Pediatric ) 37950 45920 50511 84 Ureteric Implantation ( Right ) - Pediatric 25300 30613 33674 85 Ureterocoele Excision ( Pediatric ) 12650 15307 16837 86 Ureterolithotomy ( Pediatric ) 18975 22960 25256 87 Perianal Abscess Drainage ( Pediatric ) 16445 19898 21888 88 Polydactyly Correction ( Pediatric ) 12650 15307 16837 89 Polydactyly (Single Skin Tag) -Pediatric 6325 7653 8419 90 Cystogastrostomy - for Pseudopancreatic Cyst ( Pediatric ) 31625 38266 42093 91 Ramstedt's Operation ( Pediatric ) 25300 30613 33674 92 Rectal Myomectomy ( Pediatric ) 18975 22960 25256 93 Sternocleidomastoid Muscle Release ( Pediatric ) 18975 22960 25256 94 Sclero Therapy Rectum ( Pediatric ) 8855 10715 11786 95 Sigmoid Colon Myomectomy ( Pediatric ) 18975 22960 25256 96 Splenorrhaphy ( Pediatric ) 25300 30613 33674 97 Heineko Miculicz Procedure (Neonates) 25300 30613 33674 98 Bishop Koop Procedure (for Ileal Atresia) - Pediatric 25300 30613 33674

Iliostomy with End To End Anastomoses (for Ileal Atresia) - 31625 38266 42093 99 Pediatric 100 Syndactyly Release ( Pediatric ) 12650 15307 16837 101 Thierschs Operation / Wiring ( Pediatric ) 8855 10715 11786 102 Thoracotomy + Decortication ( Pediatric ) 37950 45920 50511 103 Tongue Tie Correction ( Pediatric ) 8855 10715 11786 104 Urethroplasty (Single Stage) for Distal Hypospadias - Pediatric 9200 13800 18400 105 Central Umbillical Cutdown for Venous Access ( Pediatric ) 7590 9184 10103 106 Venesection for Venous Access ( Pediatric ) 7590 9184 10103 107 Esophageal Dilatation ( Pediatric ) 16445 19898 21888 108 Resuscitation ( Pediatric ) 2530 3795 5060 109 Ventriculo Peritoneal Shunt Placement 31625 38266 42093 110 Wound Debridement - Large ( Pediatrics ) 11385 13776 22770 111 Wound Debridement - Medium ( Pediatrics ) 8223 9950 10945 112 Wound Debridement - Small ( Pediatrics ) 4428 5358 5894 113 Gynaecologial Examination Under Aanesthesia ( Pediatric ) 6325 7653 8419 114 Dressing Wound ( Small ) - Pediatrics 288 432 576 115 Central Line Placement ( Neonatal ) 6900 9315 13973 116 Suture Removal ( Pediatric ) 920 1242 1380

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Tissue Extraction / Fluid Aspiration For Biopsy/ Lab. Study ( 1610 2415 3220 117 Pediatric ) 118 Testicular Biopsy ( Pediatric ) 7705 11500 15410 119 Suturing - Upto 3 Single Layer ( Pediatric ) 1610 2415 3220 120 Gastric Lavage / Stomach Wash - Poisoning ( Pediatric ) 311 466 621 121 Stomach Wash ( Pediatric ) 311 466 621 122 Sclerotherapy (Injection) - ( Pediatric ) 10350 17250 25300 123 Torn Ear Lobule ( Repair ) - Bilateral ( Pediatric ) 5520 8280 11040 124 Recurrent Thyroglossal Fistula/Duct/Cyst ( Pediatric ) 15410 23115 30820 125 Pulmonary Hydatid Cyst ( Pediatric ) 20470 30705 40940 126 Pharyngoplasty ( Pediatric ) 35420 42858 47144 127 Bronchoscopy ( Rigid ) - Diagnostic ( Pediatric ) 6325 9488 12650 128 Neck Sinus ( Excision ) ( Pediatric ) 17710 21429 23572 129 Muscle Biopsy ( Pediatric ) 4025 6038 8050 130 Ureteric Reimplantation ( Laparoscopic ) ( Pediatric ) 30705 46000 61410 131 Laminectomy - Spina Bifida Occulta ( Pediatric ) 28750 43125 57500 132 Toe Nail ( Ingrowing ) Excision - Pediatric 5693 7130 11385 133 Face Wound ( Repair ) - Minor ( Pediatric ) 1725 2588 3450 134 Face Wound ( Repair ) - Medium ( Pediatric ) 2645 3968 5290 135 Debridement ( Large > 5 Cm ) ( Pediatric ) 8855 13283 17250 136 Contracture ( Release ) And Z- Plasty ( Pediatric ) 15813 18659 20050 137 Ascites Tapping ( Pediatric ) 5750 8625 11500 138 Decortication ( Pediatric ) 26220 34155 39905 139 Suprapubic Aspiration ( Pediatric ) 2300 3450 4600 140 Abdominoplasty - Small ( Pediatric ) 27945 41918 51750 141 Anterior Repair / Anteroid Palate With Bone Grafting 24035 28273 30360 142 Scalp Avulsion Injuries - Skin Grafting 10753 12650 13599 143 Hand Bone Fracture - Bone Plating ( Per Fracture ) 22770 26818 28842 144 Ear / Nose Cartilage Graft 40250 60375 80500 145 Nasal Bone Fracture - Closed Reduction 1035 1553 2070 146 Entropion Correction - Left Eye 17250 25875 34500 147 Eyelid Reconstruction - Major ( Right Side ) 17250 25875 34500 148 Nerve Repair -Facial Paralysis 11132 13156 14168 149 Free Flap 43355 56580 66010 150 Full Thickness Graft - Medium 14260 21390 28750 151 Urethra Reconstruction - Hypospadias ( 2nd Stage) 22770 27552 30307 152 Malar Fracture - Closed Reduction 10753 12650 13599 153 Suprapubic Cystolithotomy - Pediatrics 6900 10350 13800 154 Tube Drainage ( for Empyema / Pneumothorax ) 4715 7073 9430 155 Hand / Feet Polydactly Correction ( Bifid ) 18975 22960 25256

Visceral Reconstruction by Colon Transplant / Gastric Tube ( Post 37950 45920 50511 156 Head & Neck Cancer Surgery ) 157 Wedge Biopsy ( Pediatrics ) 4715 7073 9430 50

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158 Cystoscopy - Diagnostic ( Pediatrics ) 11500 15525 23288 159 Debridement - Minor ( Pediatrics ) 5693 6768 7274 160 Esophageal Substitution ( Pediatrics ) 22770 34155 45540 161 Suturing ( Single layer ) - Upto 3 ( Pediatrics ) 414 621 828 162 Varicocele - Right ( Pediatrics ) 9200 13800 18400 163 Central Venous Catheter ( CVC ) Insertion - Pediatric 3795 4592 5051 164 Chest Tube Drainage - Pediatric 11500 17250 23000 165 Intubation + Initiation Of Ventilation ( Pediatric ) 1725 2588 3450 166 Peritoneal Fluid Aspiration - Diagnostic ( Pediatric ) 725 1087 1449 167 Pleural Fluid Aspiration - Pediatric 1150 1553 2329 168 Intravenous Cannulation ( Pediatric ) 575 776 1165 169 Bronchopleural Fistula Repair - Cervical (Pediatric Surgery) 25300 37950 50600 170 Bronchoscopic Biopsy (Pediatric Surgery) 10925 16388 21850 171 Change Of Catheter (Pediatric Surgery) 2645 3968 5290 172 Check Cystoscopy (Pediatric Surgery) 2300 3450 4600 173 Chemoport Insertion (Pediatric Surgery) 9488 11500 12650 174 Cystectomy And Urinary Diversion (Pediatric Surgery) 11500 17250 23000 175 Ureteroceles - Cystoscopic Deroofing (Pediatric Surgery) 9200 13800 18400 176 Esophagoscopy (Pediatric Surgery) 2645 3968 5290 177 Retained Stent - Exploration & Removal (Pediatric Surgery) 2185 3278 4370 178 Laminectomy & Repair Of Meningomyelocele (Pediatric Surgery) 37950 45920 50511 179 Laparoscopic Salpingo-Ophorectemy (Pediatric Surgery) 13685 20528 27370 180 Liver Biopsy (Pediatric Surgery) 2990 4485 5980 181 Nephrectomy Open (Pediatric Surgery) 17250 25875 34500 182 Secondary Suturing - Major (Pediatric Surgery) 7705 11500 15410 183 Secondary Suturing - Wound (Pediatric Surgery) 3795 5750 7590 184 Testicular Prosthesis (Pediatric Surgery) 15295 23000 30590 185 Esophageal Dilatation (Pediatric Surgery) 11385 17078 22770 186 CIRCUMCISION - PAED - LEVEL 1 4715 7073 9430 187 ANOPLASTY - PAED - LEVEL 5 20873 25256 27779 188 HEAD - NECK CYST/MOLE/SCAR 7590 9184 10103 189 MISCELLANEOUS PROCEDURES OPD MISCELLANEOUS MINOR 10120 12245 13470

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VASCULAR SURGERY

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room

63250 86250 103500 1 Femoro Popliteal Bypass With Synthetic Graft ( Vascular Surgery ) 2 Subclavian Artery Bypass ( Vascular Surgery ) 46000 63250 80500 3 Varicose Veins ( Open Surgery ) - Bilateral ( Vascular Surgery ) 46000 63250 80500 4 Varicose Veins ( Open Surgery ) - Unilateral ( Vascular Surgery ) 34500 51750 69000

46000 63250 80500 5 Axillary - Brachial Bypass With Synthetic Graft ( Vascular Surgery )

Transcutaneous Oxygen Pressure TCPO2 Measurement ( Vascular 1800 2400 3600 6 Surgery ) 7 AVM EMBOLIZATION 83042 94358 132101 8 WOUND DEBRIDEMENT MINOR - PLASTIC - LEVEL 2 15180 27830 40480 9 STEMCELL THERAPY - NEURO - LEVAL 4 28750 46000 63250 10 UNILATERAL VARICOSE VEIN STRIPPING - VASCULAR - LEVEL 5 9200 19550 31050 11 FEMORO- FEMORAL BIPASS - VASCULAR - LEVEL 9 221375 240350 284625 12 AORTO PERIPHERAL BYPASS 69000 86250 103500 13 FEMOROPOPLITEAL BIPASS GRAFT 57500 74750 92000 14 FISTULAS FOR HEMODIALYSIS LOW LEVEL ( VASCULAR SURGERY ) 23403 28318 31149 15 VEIN TO VEIN BYPASS/PATCHPLASTY 40250 57500 74750 16 VARICOSE VEINS (SURGICAL AS WELL AS LASER) - LASER - PKG 123050 141508 162734 17 VARICOSE VEINS (SURGICAL AS WELL AS LASER) - SURGICAL - PKG 123050 141508 162734

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GENERAL SURGERY

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 LAPAROSCOPIC APPENDICECTOMY - (P) 24035 29082 31991 2 LAPAROSCOPIC CHOLECYSTECTOMY - (P) 20700 31050 41400 3 LAPAROSCOPIC HERNIOPLASTY B/L - (P) 22770 34155 45540 4 LAPAROSCOPIC HERNIOPLASTY U/L - (P) 18400 24840 37260 5 LAPROSCOPIC VENTRAL / INCISIONAL/UMBLICAL HERNIOPLASTY 96000 108000 192000 6 GASTRIC BYPASS - (P) 322000 434700 483000 7 LAP GASTRIC BYPASS COMPLEX (P) 345000 396750 456263 8 LAP PARTIAL GASTRECTOMY-(P) 230000 264500 304175 9 LAP SLEEVE GASTRECTOMY COMPLEX (P) 322000 434700 483000 10 LAPAROSCOPIC SLEEVE GASTRECTOMY - (P) 322000 434700 483000 11 SINGLE INCISION LAPAROSCOPIC CHOLECYSTECTOMY ( SILS ) - (P) 105800 129950 198950 12 HAEMORRHOIDECTOMY STAPLED - (P) 11960 17940 23920 13 LAPROSCOPIC FUNDOPLICATION 172500 198375 228131 14 LAPROSCOPIC SPLEENECTOMY 240000 300000 480000 15 LAPRSCOPIC ADRENALCOTMY 240000 300000 480000 16 LAPROSCOPIC CHOLECYSTECTOMY WITH CBD EXPLORATION 120000 180000 240000 17 LAPROSCOPIC HERNIA ( DIAPHRAGMATIC ) REPAIR 140000 160000 180000 18 HYDROCOELE REPAIR ( U/L ) 9500 14250 19000 19 HYDROCOELE REPAIR ( B/L) 19000 28500 38000 20 THYROID LOBECTOMY 143750 165313 190110 21 THYROIDECTOMY (SUBTOTAL/TOTAL) 21360 32040 42720 22 Exploratory Laparotomy - (P) 172500 198375 228131 23 APR 300000 360000 1080000 24 Hepatectomy (Simple ) 300000 360000 1080000 25 Hepatectomy (Minor ) 420000 525600 840000 26 Hepatectomy (Major ) 540000 675600 1080000 27 Hepatectomy (Complex ) 660000 825600 1320000 28 Radical Cholecystectomy (Simple ) 138000 158700 182505 29 Radical Cholecystectomy (Minor ) 300000 360000 840000 30 Radical Cholecystectomy (Major ) 540000 675600 1080000 31 Radical Cholecystectomy (Complex ) 360000 420000 1320000 32 Biliary Tract Surgeries (Simple ) 300000 375600 600000 33 Biliary Tract Surgeries (Minor ) 420000 525600 840000 34 Biliary Tract Surgeries (Major ) 540000 675600 1080000 35 Pancreatic Surgeries (Simple ) 300000 375600 600000 36 Pancreatic Surgeries (Minor ) 420000 525600 840000 37 Pancreatic Surgeries (Major ) 540000 675600 1080000 38 Pancreatic Surgeries (Complex ) 660000 825600 1320000 39 Oesophagectomy (Minor ) 300000 360000 840000

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40 Oesophagectomy (Major ) 360000 420000 1080000 41 Oesophagectomy (Complex ) 420000 480000 1320000 42 Gastrojejunostomy (Simple ) 240000 300000 600000 43 Gastrojejunostomy (Minor ) 300000 360000 840000 44 Gastrojejunostomy (Major ) 360000 420000 1080000 45 Gastrojejunostomy (Complex ) 420000 480000 1320000 46 Ileostomy/Colostomy/Closure 240000 300000 600000 47 Hemicolectomy 287500 330625 380219 48 Abdomino Perineal Resection (Intermediate)- (P) 230000 264500 304175 49 Abdomino Perineal Resection (Major)- (P) 258750 297563 342197 50 Anterior Resection With Ileostomy/Colostoy (Intermediate) - (P) 235750 271113 311780 51 Anterior Resection With Ileostomy/Colostoy (Major) - (P) 253000 290950 334593 52 Exploratory Laparotomy + Resection Anastaomosis - (P) 172500 198375 228131

Exploratory Laparotomy + Simple Closure Of Perforated 172500 198375 228131 53 Ulcer/Repair Of Bleeding Duodenal Ulcer - (P) 54 Hemicolectomy, Ileostomy/Colostomy (Intermediate) - (P) 287500 330625 380219 55 Hemicolectomy, Ileostomy/Colostomy (Major) - (P) 316250 363688 418241 56 Oesophagectomy Reconstruction & FJ (Intermediate) - (P) 258750 297563 342197 57 Oesophagectomy Reconstruction & FJ (Major) - (P) 287500 330625 380219 58 Partial Gastrectomy & FJ (Intermediate) - (P) 258750 297563 342197 59 Partial Gastrectomy & FJ (Major) - (P) 287500 330625 380219 60 Roux Eny Hepatico Jejunostomy (Intermediate) - (P) 230000 264500 304175 61 Roux Eny Hepatico Jejunostomy (Major) - (P) 258750 297563 342197 62 Surgery For Intestinal Obstruction - (P) 172500 198375 228131 63 Surgery For Pancreatic Necrosectomy (Intermediate) - (P) 230000 264500 304175 64 Surgery For Pancreatic Necrosectomy (Major) - (P) 258750 297563 342197 65 Surgery For Pseudopancreatic Cyst (Intermediate) - (P) 230000 264500 304175 66 Surgery For Pseudopancreatic Cyst (Major) - (P) 258750 297563 342197 67 Total Gastrectomy & FJ (Intermediate) - (P) 258750 297563 342197 68 Total Gastrectomy & FJ (Major) - (P) 287500 330625 380219 69 Whipples & FJ (Intermediate) - (P) 258750 297563 342197 70 Whipples & FJ (Major) - (P) 287500 330625 380219 71 HYDATID CYST EXCISION - LAPAROSCOPIC 230000 264500 304175

LAPROSCOPIC HELLERS CARDIOMYTOMY ( SURGERY FOR 172500 198375 228131 72 ACHALASIACARDIA) 73 RESUTURING UNDER GENERAL ANESTHESIA - (P) 17825 26738 35650 74 BREAST LUMPECTOMY - PKG 63250 72738 83649 75 MODFIED RADICAL MASTACTOMY 172500 198375 228131

22885 34328 45770 76 Abdominoperineal Pull Through Resection + Colonic Anastomosis 77 Amputation Penis - Partial ( General Surgery ) 7705 11558 15410 78 Lords Procedure - Anal Dilatation 2070 3105 4140 79 Anal Sphincter Repair ( General Surgery ) 17480 26220 34960 56

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80 Hernia ( Strangulated - Any Except Incisional Hernia ) Repair 15410 23115 30820 81 Appendicular Abscess Drainage 20125 23144 26616 82 Bone Marrow Biopsy - Open 3450 5175 6900 83 Breast Lumpectomy Small (For Benign Disease) 11615 17423 23230 84 Cervical Sympathectomy - General Surgery 16330 24495 32660 85 Cholecystectomy ( Open ) 15410 23115 30820 86 Cholecystectomy + Choledocholithotomy 22885 34328 45770 87 Loop Colostomy Closure 10925 16388 21850 88 Finger Nail Removal (Complete) 1380 2070 2760 89 Wound Debridement + Suturing ( Large ) 1610 2415 3220 90 Debridement Of Wound (Medium) 1242 1863 2484 91 Devascularization ( General Surgery ) 36800 42320 48668 92 Laparoscopy Diagnostic ( General Surgery ) 13225 15209 17490 93 Thoracoscopy ( Diagnostic ) + Biopsy 11385 17078 22770 94 Digital Rectal Examination + Manual Evacuation 1725 2588 3450 95 Abdominal Wall Hematoma Drainage 17250 19838 22814 96 Dressing - Minor ( General Surgery ) 575 863 1150 97 Duodenostomy 19550 22483 25855 98 Varicose Veins Excision ( Endoscopic ) - Bilateral 34155 51233 68310 99 Varicose Veins Excision ( Endoscopic ) Left 40250 46288 53231 100 Hernia (Epigastric) Repair 17250 19838 22814 101 Branchial Cyst Excision 19550 22483 25855 102 Callosity Excision 725 1087 1449 103 Carbuncle Excision 12650 14548 16730 104 Tumor Excision ( Large - Superficial ) - General Surgery 13225 15209 17490 105 Cyst Excision ( General Surgery ) 9775 11241 12927 106 Cystic Hygroma Excision ( Major ) 23575 27111 31178 107 Cystic Hygroma Excision ( Minor ) 18400 21160 24334 108 Dermoid Cyst Excision 10925 12564 14449 109 Lingual Thyroid Excision 15525 17854 20532 110 Lipoma Excision 9775 11241 12927 111 Lipoma (Multiple) Excision 10925 16388 21850 112 Scrotal Cysts ( Multiple ) Excision - General Surgery 5520 8280 11040 113 Adrenal Gland Neoplasm Excision 23920 35880 47840 114 Pilonidal Sinus Excision 14375 16531 19011 115 Sebaceous Cyst Excision 8050 9258 10647 116 Tumor Excision ( Small - Superficial ) - General Surgery 9775 11241 12927 117 Thyroglossal Cyst Excision 28750 33063 38022 118 Varicose Veins Excision ( Bilateral ) 28750 33063 38022 119 Varicose Veins Excision ( Left ) 23000 26450 30418 120 Retroperitoneal Tumor Excision 19665 29498 39330 121 Fasciotomy - Large ( General Surgery ) 16100 18515 21292 122 Fissurectomy 6670 10005 13340 57

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123 Fistula In Ano ( High Level ) Repair / Fistulectomy 25875 29756 34219 124 Fistula In Ano ( Low Level ) Repair / Fistulectomy 13225 15209 17490 125 Gastrectomy (Subtotal) 15410 23115 30820 126 Gastrectomy (Total) 22885 34328 45770 127 Transverse vaginal Septum Excision (for Hematocolpos) 6785 10178 13570 128 Hemi colectomy (Transverse) - General Surgery 15410 23115 30820 129 Vagotomy ( Highly Selective ) 15410 23115 30820 130 Hirschsprung's disease Resection 22885 34328 45770 131 Hernia (Incisional) Repair - General Surgery 28750 33063 38022 132 Hernia ( Inguinal ) Repair - General Surgery 17250 19838 22814 133 Insulinoma Excision 22885 34328 45770 134 Intestinal Fistula Repair 22885 34328 45770 135 Intussusception Surgical Reduction 15410 23115 30820 136 Ischiorectal Abscess Surgical Drainage 10925 12564 14449 137 Jejunal Interposition (Post Poly Gastrectomy) 22885 34328 45770 138 Cholecystectomy + Choledochoduodenostomy ( Laparoscopic ) 39675 45626 52470 139 Pancreatic Pseudocyst Surgery ( Laparoscopic ) 46000 52900 60835 140 Hernia ( Ventral / Incisional ) Repair - Laparoscopic 17135 25703 34270 141 Liver Abscess Drainage ( Open ) 20125 23144 26616 142 Breast Lump (Fibroadenoma) Excision with Sector Mastectomy 11500 13225 15209 143 Lymph Node Biopsy ( General Surgery ) 10350 11903 13688 144 Mesenteric Cyst Excision 23000 26450 30418 145 Pancreatic Abscess Necrosectomy And Drainage 39675 45626 52470 146 Thoracotomy + Lung Biopsy ( Open ) 10925 16388 21850 147 Orchidectomy ( Left ) - General Surgery 15525 17854 20532 148 Orchidopexy ( Left ) - General Surgery 18400 21160 24334 149 Paracentesis - General Surgery 1955 2933 3910 150 Parathyroidectomy - General Surgery 32775 37691 43345 151 Parotidectomy Superficial ( General Surgery ) 34500 39675 45626 152 Parotidectomy (Total) - General Surgery 36800 42320 48668 153 Liver Partial Resection (Lateral Segmentectomy) 19665 29498 39330 154 Pectoralis Flap Reconstruction 18400 24840 37260 155 Aneurysmectomy Peripheral Vascular (Large) 32200 49450 66700

Pleural Aspiration / Tap ( Thoracocentesis ) < 200 ml - Diagnostic ( 1840 2760 3680 156 General Surgery) 157 Proctocolectomy 41975 48271 55512 158 Pyloromyotomy 20125 23144 26616 159 Neck Dissection Radical ( General Surgery ) 22885 34328 45770 160 Ranula Excision ( General Surgery ) 7705 11558 15410 161 Hernia (Spigelian) Repair - General Surgery 15410 23115 30820 162 Rectal Prolapse Repair 15410 23115 30820 163 Hernia ( Inguinal - Recurrent ) Repair 26450 30418 34981 164 Permacath Removal ( General Surgery ) 9488 11500 12650 58

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Submandibular Duct Calculus Removal - Intraoral ( General Surgery 5520 8280 11040 165 ) 166 Burst Abdomen Repair 17250 19838 22814 167 Hernia ( Diaphragmatic ) Repair - General Surgery 34500 39675 45626 168 Ear Lobule Repair ( Left ) - General surgery 17250 19838 22814 169 Intestinal Resection And Anastomosis 28750 33063 38022 170 Common Hepatic Duct Resection + Repair 25070 37605 50140 171 Abscess (Retroperitoneal) Drainage - General Surgery 17250 19838 22814 172 Rib Resection + Drainage ( General Surgery ) 13225 15209 17490 173 Scalene Node Biopsy 2645 3968 5290 174 Scalenotomy ( Scalenus Anticus Syndrome ) 8855 13283 17710 175 Hernia ( Incisional - Strangulated ) Repair - General Surgery 15410 23115 30820 176 Salivary Gland ( Submandibular ) Removal / Sialadenectomy 23575 27111 31178 177 Suprapubic Drainage - General Surgery 4600 5290 6084 178 Hernia (Hiatus) Repair - General Surgery 36800 42320 48668 179 Portal Hypertension Surgery 22885 34328 45770 180 Testicular Prosthesis 15295 23000 30590 181 Thiersch Operation 5520 8280 11040 182 Vagotomy ( Total ) + Drainage 15410 23115 30820 183 Esophageal Transection ( EEA Stapler Use ) 17135 25703 34270 184 Tube Caecostomy 7705 11558 15410 185 Umbilectomy 7705 11558 15410 186 Hernia ( Ventral / Incisional ) Repair 28750 33063 38022 187 Colectomy + Ileorectal Anastomosis 40250 46288 53231 188 Colon Replacement Surgery 21850 32775 43700 189 Gastrojejunostomy ( General Surgery ) 23000 26450 30418 190 Hemorrhoidectomy ( Open ) 20125 23144 26616 191 Colectomy Sigmoid 36800 42320 48668 192 Perforated Peptic Ulcer Closure ( Simple ) 23575 27111 31178 193 Volvulus (Sigmoid colon) Untwisting 28750 33063 38022 194 Volvulus ( Colon ) Resection + Anastomosis 22885 34328 45770 195 Cholecystojejunostomy 20700 23805 27376 196 Abdominal hysterectomy ( General Surgery ) 51750 74750 112125 197 Abdominal Abscess Drainage 26450 30418 34981 198 Breast Abscess Drainage 10350 11903 13688 199 Colectomy + lleorectal Anastomosis ( Laparoscopic ) 41400 47610 54752 200 Rectopexy Stapled 28750 33063 38022 201 Suture of Pancreas 15985 23978 31970 202 Mucosa Biopsy 2070 3105 4140 203 Groin Dissection - Right side 15985 23978 31970 204 Groin Dissection - Bilateral 22770 34155 45540 205 Nephrectomy Laparoscopic ( General Surgery ) 39675 45626 52470 206 Jejunostomy 18400 21160 24334 59

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207 Gastrojejunostomy ( Laparoscopic ) 35650 40998 47148 208 Hernia Incisional ( Recurrent ) Repair - Laparoscopic 34500 39675 45626 209 Total Laparoscopic Hysterectomy 51750 74750 112125 210 Gastrostomy 18400 21160 24334 211 Adhesiolysis Laparoscopic ( General Surgery ) 21275 24466 28136 212 Cold Abscess / Tubercular Abscess Aspiration 1840 2760 3680 213 Axillary Clearance ( General Surgery ) 17250 19838 22814 214 Parathyroidectomy ( Laparoscopic ) 36800 42320 48668 215 Thyroidectomy ( Subtotal ) - Endoscopic 33925 39014 44866 216 Urinary Bladder ( Ruptured ) - Repair 13915 20873 27830 217 Foley's Catherization 1725 2588 3450 218 Hernia ( Spigelian ) Repair ( Laparoscopic ) 33925 39014 44866 219 Foreign Body ( Esophagus ) Removal - Open 10925 16388 21850 220 Intercostal Chest Tube Insertion 11500 13225 15209 221 Nephrectomy Radical - Laparoscopic ( General Surgery ) 230000 264500 304175 222 Tubal Recanalization - Laparoscopic ( General Surgery ) 22770 34155 45540 223 Varicocelectomy Laparoscopic - Bilateral ( General Surgery ) 23575 27111 31178 224 Varicocelectomy ( Laparoscopic ) Left Side 18400 21160 24334 225 Penile Implant Surgery ( General Surgery ) 38295 57500 69000 226 Ureteroscopy 11500 17250 23000 227 Vascular Procedure - Major 63250 74750 86250 228 Video Assisted Thoracoscopic Surgery ( VATS ) - Pleural Biopsy 11500 17250 23000

Video Assisted Thoracoscopic Surgery ( VATS ) - Thymectomy / 25300 37950 50600 229 Mediastinal Mass 230 Diaphragm Repair ( Laparoscopic ) 39675 45626 52470 231 Axillary Node Biopsy 13685 20528 27370 232 Coagulation Profile 738 1107 1477 233 Hydatid Cyst ( Liver ) Excision - General Surgery 36800 42320 48668 234 Ileostomy / Jejunostomy Closure 19550 22483 25855 235 Amputation - Penis ( Total ) + Block Dissection 36800 42320 48668

Decortication + Pleurectomy + Empyema Excision ( Without Lung 16330 24495 32660 236 Resection ) 237 Adhesiolysis / Division of Bands 23000 26450 30418 238 Duodenal Perforation Closure ( Laparoscopic ) 35650 40998 47148 239 Dental Cyst / Tumor Excision ( General Surgery ) 10925 16388 21850 240 Cholecystojejunostomy ( Laparoscopic ) 25875 29756 34219 241 Jejunojejunostomy 19550 22483 25855 242 Jejunojejunostomy ( Laparoscopic ) 24150 27773 31939 243 Triple Bypass Surgery 49450 56868 65398 244 Herniorrhaphy Femoral 17250 19838 22814 245 Meckel's Diverticulum Excision ( Gastrointestinal Surgery ) 25875 29756 34219 246 Pleural Fluid Aspiration ( Diagnostic ) 5750 6613 7605 247 Abscess ( Small ) Incision and Drainage 10350 11903 13688 60

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248 Anterior Nasal Packing - Unilateral ( General Surgery ) 3220 4830 6440 249 Pleural Tap / Pleural Effusion Aspiration 5750 6613 7605 250 Pleural Tapping with Chest Tube Drainage 4025 6038 8050 251 Polypectomy Single/Small without anesthesia 15180 18630 20700 252 HEMATOMA EVACUATION SMALL 17250 25875 34500 253 EXAMINATION UNDER ANESTHESIA (EUA) 9200 13800 18400 254 PERIANAL / ISCHIORECTAL / GLUTEAL ABSCESS DRINAGE 10925 12564 14449 255 BILIARY STENTING 6388 9583 12777 256 ANKLE PERFORATORS LIGATION (BOTH) 28750 40250 51750 257 DRESSING CHARGES(OPD)-SMALL/MINOR 575 661 760 258 DRESSING CHARGES(OPD)-MEDIUM 1150 1323 1521 259 DRESSING CHARGES(OPD)-LARGE/MAJOR 1725 1984 2282 260 DRESSING CHARGES(OPD)-X LARGE 2300 2645 3042 261 ACCESSORY BREAST REMOVAL - UNILATERAL 17250 19838 22814 262 ACCESSORY BREAST REMOVAL - BILATERAL 23000 26450 30418 263 ELOESSER FLAP WINDOW 11385 17078 22770 264 LAPAROSCOPIC CHARGES 4025 6038 8050 265 LARYGOPHANGO ESOPHAGEAL WITH GASTRIC PULL UP 39905 59858 79810

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NUEROLOGY

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 Avulsion Suturing 4025 6038 8050 2 Balloon Test Occlusion 24380 36570 48760 3 Burr Hole 34949 40191 46220 4 Cervical Corpectomy ( Multi Segment ) + Reconstruction 88010 103305 122441 5 Cervical Discectomy 32200 48300 64400 6 Cervical Discectomy + Fusion 65631 77039 91310 7 Cervical Instrumentation 39100 58650 78200 8 Chronic Intradural Hematoma Surgery 34500 51750 69000 9 Craniotomy ( Emergency ) - Cardiovascular Accident ( CVA ) 57500 86250 115000 10 Craniotomy ( for Extradural Lesion ) 36685 55028 73370 11 Craniotomy - Microvascular Decompression 50715 76073 101430 12 Craniotomy ( Elective ) - for Tumors 50715 76073 101430 13 Craniotomy - Vascular Malformation Repair 57500 86250 115000 14 Craniotomy - Head Injury 43700 65550 87400 15 Craniotomy - Intracerebral Hematoma Evacuation 46000 69000 92000 16 Cerebrospinal Fluid ( CSF ) Diversion Procedures 56109 65861 78062

Cerebrospinal Fluid ( CSF ) Diversion Procedures - Laparoscope 54752 64274 76176 17 Assisted

109584 128651 152467 18 CranioVertebral Junction Anomaly Surgery ( Anterior + Posterior ) 19 Spine Decompression ( Anterior ) 71530 107295 143060 20 Neuroendoscopic Procedure ( Diagnostic ) 44045 51704 61272 21 Cervical / Lumbar / Dorsal Discectomy ( Microscopic ) 56109 65861 78062 22 Discography 6118 7176 8510 23 Duraplasty 18400 27600 36800 24 External Ventricular Drainage ( EVD ) 13363 15367 17672 25 Arterial Embolization (Extracranial) 21620 32430 43240 26 Vasodilatation IntraAarterial 13570 20355 27140 27 Intracranial Aneurysm Surgery - Single 36915 55373 73830 28 Laceration Suturing - Large ( Neurosurgery ) 4600 6900 9200 29 Laceration Suturing - Small ( Neurosurgery ) 3450 5175 6900 30 Laceration Suturing ( Neurosurgery ) 4370 5129 6072 31 Laminoplasty 56109 65861 78062 32 Lumbar Discectomy + Fusion 36800 55200 73600 33 Meningomyelocoele Surgery 23000 34500 46000 34 Neurolysis 27600 41400 55200 35 Parent Vessel Occlusion 15295 22943 30590 36 Pedicle Screw Fixation 39100 58650 78200 37 Posterior Fossa Surgery 52900 79350 105800

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38 Skull Bone Surgery ( Neurosurgery ) 52900 79350 105800 39 Spinal Angiography ( Neurosurgery ) 13812 16215 19217 40 Spinal Dysraphism Surgery 56109 65861 78062 41 ThecoPeritoneal Shunt ( TP Shunt ) 23000 34500 46000 42 Pituitary Tumor Excision ( TransSphenoidal ) 46000 69000 92000 43 Trigeminal Neuralgia Block 43700 65550 87400 44 Venous Stenting ( Neurosurgery ) 27025 40538 54050 45 Vertebral Biopsy ( Percutaneous ) 18630 27945 37260 46 Vertebroplasty 24817 28540 32821 47 Aneurysm ( Complex ) Management ( Neurosurgery ) 52325 78488 104650 48 Myelomeningocele Surgical Treatment ( Pediatric ) 31625 38266 42093 49 Shunt Revision ( Pediatric ) 12650 15307 16837 50 VentriculoAtrial ( VA ) Shunt - Hydrocephalus ( Pediatric ) 31625 38266 42093 51 Ventricular Puncture ( Pediatric ) 6325 7653 8419 52 Cerebral Digital Subtraction Angiography ( DSA ) 13662 15711 18068 53 Scalp Suturing ( Major ) 8729 10247 12144 54 Intracranial Pressure Monitoring by Twist Drill Procedure 6118 7176 8510 55 Lumbar Disc Surgery Revision ( Done Outside ) 50715 76073 101430 56 Craniotomy Redo ( for Procedures Done Outside ) 57500 86250 115000 57 Intracranial Aneurysm Surgery - Two ( Same Session ) 52325 78488 104650 58 Scalp Swelling Excision ( Large ) 8729 10247 12144 59 Stereotaxy 27600 41400 55200 60 Shunt Removal 8993 10342 11893 61 Cervical Laminectomy ( Single level ) 29900 44850 59800 62 Decompression Anterolateral + Spinal Fusion 79465 119198 158930 63 Burr Holes - Multiple 41136 47306 54402 64 Vertebroplasty Percutaneous ( > 2 ) 53889 61972 71268 65 Cerebro Spinal Fluid (CSF) Leak Closure 754 1130 1508

Aneurysms + ArterioVenous Malformation Repair ( Small / 50600 75900 101200 66 Localized / Uncomplicated ) - Intermediate 67 Cervical Microdisectomy without Fusion 65631 77039 91310 68 Disc Replacement ( Cervical / Lumbar ) - Level I 88010 103305 122441 69 Thoracotomy + Decompression Anterior ( D6 Body Tumor ) 14835 22253 29670 70 Lumbar Laminectomy ( Neurosurgery ) 29900 44850 59800 71 Botox Injection for Faterpasticity 3450 5750 9200 72 Thrombolysis Intravenous 27025 40538 54050 73 Burr Hole - Single 7280 8372 9628 74 Peripheral Artery Embolization 29095 35765 53648 75 Intraarterial Recanalization 47438 54556 71156 76 Intracranial Aneurysm Embolization 64975 79925 119888 77 Spinal Aretriovenous Malformation ( AVM ) Embolization 64975 79925 119888 78 Aneurysm Embolization - Complex 89010 109480 164220 79 Shunt Revision ( Level A ) 33063 38022 43725 64

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80 Cerebral Revascularisation - Level A 73140 84111 96728 81 Cerebral Revascularisation - Level B 96278 110720 127328 82 Cerebrospinal Fluid Diversion - Level A 46288 53231 61216 83 Cerebrospinal Fluid Diversion - Level B 73140 84111 96728 84 Chronic Subdural Haematoma Removal- Level A 62422 71785 82553 85 Chronic Subdural Hematoma Removal- Level B 73140 84111 96728 86 Craniotomy - Level D 96278 110720 127328 87 Craniotomy - Level A 52900 60835 69960 88 Craniotomy Level B 73140 84111 96728 89 Craniotomy Level C 80282 92324 106173 90 CSF Rhinorrhea - Level A 50600 75900 101200 91 Entrapment Neuropathy Decompression - Level A 23276 26767 30782 92 Entrapment Neuropathy Decompression - Level B 44574 51260 58949 93 Sacroiliac Joint Injection 2300 2645 3042 94 Shunt Revision - Level B ( Neurosurgery ) 44574 51260 58949 95 Spinal Decompression - Level A ( Neurosurgery ) 33063 38022 43725 96 Spinal Decompression - Level B ( Neurosurgery ) 44574 51260 58949 97 Spinal Decompression - Level C ( Neurosurgery ) 62422 71785 82553 98 Spinal Decompression - Level D ( Neurosurgery ) 80282 92324 106173 99 Spinal Fusion Level A ( Neurosurgery ) 46288 53231 61216 100 Spinal Fusion Level B ( Neurosurgery ) 62422 71785 82553 101 Spinal Fusion Level C ( Neurosurgery ) 80282 92324 106173 102 Spinal Fusion Level D ( Neurosurgery ) 96278 110720 127328 103 Bronchial Embolization 44850 55200 82800 104 IMPLANT REMOVAL 23000 34500 46000 105 NERVE BIOPSY (NEURO) 5060 7590 10120 106 PERCUTANEOUS BIOPSY 5520 8280 11040 107 SPINAL AVM 56661 66516 78833 108 TRANS ORAL DECOMPRESSION FOR CV JUNCTION ANOMALY 77694 91195 108089 109 TUMOR EMBOLISTION SIMPLE 15295 22943 30590 110 TUMOR SPINAL EXTRADURAL 56109 65861 78062 111 TUMORS EMBOLISATION COMPLEX 27025 40538 54050 112 TUMORS SPINAL INTRADURAL 77694 91195 108089 113 LUMBAR CANAL STENOSIS 32200 48300 64400 114 DORSAL ANTEROLAT APPROACH 59800 89700 119600 115 BRONCHIAL PLEXUS 48300 72450 96600 116 NERVE REPAIR 32200 48300 64400 117 PUMP IMPLATATION 34500 51750 69000 118 DISCECTOMY - ENDOSCOPIC ( CERVICAL /LUMBER) 65631 77039 91310 119 DECOMPRESSION POSTERIOR & FUSION SPINE (LEVEL I) 77694 91195 108089 120 POSTERIOR FUSION FOR CV JUNTION 65631 77039 91310 121 REVISION OF LUMBER DISC SURGERY(DONE OUTSIDE) 77694 91195 108089 122 THERAPEUTIC SPINAL INJECTIONS FOR PAIN 22460 26370 31246 65

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123 TOMORS FORAMEN MAGNUM/ SPINAL INTRA MEDULLARY 88010 103305 122441 124 TRANSPHENOIDAL PROCEDURE FOR PITUITARY/ CSF RHIRRORHEA 77694 91195 108089 125 LUMBAR PUNCTURE + CSF MANOMETRY 8970 13455 17940 126 ANESTHESIA / SEDATION FOR NEUROLOGY PROCEDURE 1725 2645 3450 127 LONG TERM EPILEPSY MONITORING (P) FOR 1 DAY 22195 33350 44390 128 LONG TERM EPILEPSY MONITORING (P) UPTO 12 HRS.[] 15985 24035 31970 129 LONG TERM EPILEPSY MONITORING (P) FOR 2 DAYS 40020 60030 80040 130 ELECTROCORTICOGRAPHY (ECOG) 6900 10350 13800 131 LUMBAR PUNCTURE + CSF TAP TEST 10695 16100 21390 132 POST-SURGERY REHAB 1150 1323 1521 133 SWALLOWING ASSESSMENT 1495 1719 1977 134 PRE SURGERY ASSESSMENT VOICE 1150 1323 1521 135 VP SHUNTING [COST OF SHUNT EXTRA] - PKG 89700 103155 118628 136 VERTEBROPLASTY(New Servies) 25896 38844 51792 137 CHRONIC BACKACHE 1840 2760 3680 138 Intracranial Angioplasty ( Neurosurgery ) 36915 55373 73830 139 Intracranial Angioplasty ( Vasospasm ) 36915 55373 73830

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UROLOGY

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 Adrenalectomy ( Open ) - Urology 30705 46000 61410 2 Anderson Hynes Pyeloplasty ( Urology ) 22770 34155 45540 3 Urinary Sphincter Creation - Artificial 28750 33063 38022 4 BCG Instillation ( Bladder ) 2875 4313 5750 5 Bladder Diverticulectomy 30705 46000 61410 6 Boari Flap Procedure 38295 57500 76590 7 Urethral Calibration 1725 2588 3450

Continuous Ambulatory Peritoneal Dialysis (CAPD) Catheter 7705 11500 15410 8 Removal 9 Catheter Removal ( Urology ) 575 863 1150 10 Urethral Catheterization ( Urology ) 1725 2588 3450 11 Nephrostomy Tube Change 3795 5750 7590 12 Cystectomy (Radical) + Orthotopic Bladder 34730 52095 69460 13 Detrusor Seromyotomy 19205 28750 38410 14 Diverticulectomy / Bladder Diverticulum Excision 19205 28750 38410 15 Endopyelotomy 26795 40250 53590 16 Epispadias / Exostrophy Repair 30705 46000 61410 17 Hypospadias Repair ( Two Stage ) - 1st Stage ( Urology ) 15295 23000 30590 18 Inguinal Lymphadenectomy (Superficial) Bilateral 34500 51750 69000 19 Inguinal Lymphadenectomy (Superficial) Right 23000 34500 46000 20 Meatal Dilatation 1725 2588 3450 21 Cystolithotomy Percutaneous 19205 28750 38410

Scrotal Exploration + Microsurgical Vasoepididymal Anastomosis ( 30705 46000 61410 22 Right )

Scrotal Exploration + Vaso-vasal Anastomosis - Microsurgical ( 46000 69000 92000 23 Bilateral )

Scrotal Exploration + Vaso-vasal Anastomosis - Microsurgical ( Right 30705 46000 61410 24 side ) 25 Suturing Secondary ( Large ) 7705 11500 15410 26 Catheterization Suprapubic 7705 11500 15410 27 Testicular Biopsy ( Urology ) 7705 11500 15410 28 Testicular Prosthesis ( Bilateral ) 23000 34500 46000 29 Basilic Vein Transposition ( for ArterioVenous Fistula ) 46000 63250 80500 30 Ureteric Reimplantation ( Bilateral ) 46000 69000 92000 31 Ureteric Reimplantation ( Right ) 30705 46000 61410 32 Ureterolysis ( Bilateral ) 46000 69000 92000 33 Ureterolysis ( Right ) 30705 46000 61410 34 Urethral Diverticulum Repair 19205 28750 38410 35 Urethroplasty (Single Stage) 30705 46000 61410

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36 Urethro vaginal Fistula Repair 30705 46000 61410 37 Urethral Fistula Repair 11500 17250 23000 38 Video Urodynamics 11500 17250 23000 39 Webbed Penis Release 17595 26393 35190 40 Prostate Biopsy - TransRectal Ultrasound ( TRUS ) Guided 19205 28750 38410 41 Uroflowmetry 1150 1725 2300 42 Nesbit's Procedure 15295 23000 30590 43 NMP22 Bladder Check Test 5750 8625 11500 44 Anatrophic Nephrolithotomy 38295 57500 76590 45 Cystocele / Rectocele Repair 19205 28750 38410 46 Laparoscopic Cyst Deroofing 23000 34500 46000 47 Permacath Insertion 11500 17250 23000 48 Sling / Burch / Raz / Stamey - 23000 34500 46000 49 Intra Lesional Injection for Peyronie's Plaque 2300 3450 4600

Testicular Fine Needle Aspiration Cytology ( FNAC ) - Under Cord 2300 3450 4600 50 Block 51 VesicoVaginal Fistula (Simple) 22770 34155 45540 52 Lymphatic Ligation - Laparoscopic ( Urology ) 30705 46000 61410 53 Augmentation Ileocystoplasty 46000 69000 92000 54 Foreign Body Removal ( Cystoscopic ) 15295 23000 30590 55 Kidney Biopsy ( Percutaneous ) - Urology 6325 7653 8419 56 Urethral Caruncle Excision 11500 17250 23000 57 Penis Fracture Repair 15295 23000 30590 58 Vesicostomy 19205 28750 38410 59 Prostate Biopsy ( Transrectal ) 19205 28750 38410 60 Vasectomy ( Urology ) 18400 18400 18400 61 Autotransplantation 76705 115000 153410 62 Peyronnie Plaque Excision& Vein Grafting 23000 34500 46000 63 Ureteroureterostomy / Boari Flap 38295 57500 76590 64 Extracorporeal Shock Wave Lithotripsy ( ESWL ) 37950 56925 75900 65 Abscess Drainage ( Urology ) 3795 5750 7590 66 Nephrectomy Radical with Level III / IV Thrombectomy 57500 86250 115000 67 Neobladder Construction ( Urology ) 46000 69000 92000

7705 11500 15410 68 Percutaneous Nephrolithotomy (PCNL) - Second Stage ( Urology ) 69 Bladder Scan 690 1035 1380 70 ED SHOCK WAVE THERAPY 74290 96945 161575 71 CIRCUMCISION FRENULOPLASTY 9200 13800 18400 72 CYSTOSCOPY - DIAGNOSTIC - UROLOGY - LEVEL 2 7705 11500 15870 73 PENILE EXPLORATION WITH REPAIR OF FRACTURE PENIS 23000 31050 34500 74 CYSTOSCOPY WITH BOTOX INJECTION 15295 23000 30590 75 URETHROPLASTY - STAGE 2 15295 23000 30590 76 PARTIAL PENECTOMY 26795 40250 53590 69

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77 TURP AND BILATERAL ORCHIDECTOMY 36340 47495 79120 78 RADICAL CYSTECTOMY WITH ILLEAL CONDUCT 57500 86250 115000 79 HIGH INGUINAL ORCHIECTOMY 19205 28750 38410 80 URETHRDDAL DILATATION 2300 3450 4600 81 LAP ASSISTED TOTAL CYSTECTOMY 18975 22960 25256 82 LITHOTRIPSY ( FOR RESIDUAL STONE - POST PCNL ) DAYCARE - (P) 18400 18400 18400 83 PENILE BIOPSY DAYCARE - (P) 9200 9200 9200 84 PESA/ TESA/ TESTICULAR BIOPSY DAYCARE - (P) 23000 23000 23000 85 DRESSING - MAJOR (UROLOGY) 1150 1725 2300 86 DRESSING - MINOR (UROLOGY) 575 8625 1150 87 CSYTOGRAM 3450 5175 6900 88 RETROGRADE PYELOGRAM (RGP) 11500 17250 23000 89 PIPE TEST 2300 3450 4600 90 RELOOK URETEROSCOPY (URS) + DJ STENT REMOVAL 7705 11500 15410 91 PROSTATE BIOPSY - MRI/TRUS FUSION 30705 46000 61410 92 LITHOTRIPSY FOR ERECTILE DYSFUNCTION 38295 57500 76590 93 UROFLOWMETRY + BLADDER SCAN 1840 2760 3680 94 RGU (RETROGRADE URETHROGRAM) 3450 5175 6900 95 MCU(MICTURATING CYSTOURETHROGRAM)[] 3450 5175 6900 96 PELVIC FLOOROSTIMULATION 1150 1725 2300

CONTINUES INTERMITTENT CATHETERIZATION SELF- 1380 2070 2760 97 CATHETERIZATION (CIC) 98 PELVIC FLOOR REHABILITATION 1725 1725 3450

PELVIC FLOOR REHABILITATION (UROSTYM) – PACKAGE (8 11500 11500 23000 99 SITTINGS) 100 NEPHROSTOMY ( PERCUTANEOUS - PCN ) 11500 17250 23000

SCROTAL EXP. + MICROSURGICAL VASOEPIDIDYMAL ANASTOMOSIS 46000 69000 92000 101 (BILATERAL) 102 Voiding Cystometry(Urodynamics) 7475 11213 14950 103 PERMA CATH REMOVAL 9488 11500 12650 104 CATHETERISATION BY UROLOGIST 1725 2588 3450

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DENTAL

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 Bone Graft Grade 1 ( Per Tooth ) 9258 10647 12244 2 Bone Graft Grade 2 ( Per Tooth ) 13225 15209 17490 3 Bone Graft Grade 3 ( Per Tooth ) 19838 22814 26236 4 Bone Grafting( Per Tooth ) 6613 7605 8746 5 Crown / Bridge Placement ( Per Abutment ) 1150 1725 2300 6 Dental Implant ( Anterior Teeth ) 51750 77625 103500 7 Dental Models ( Orthodontics ) 1150 1725 2300 8 Impacted Tooth Surgical Extraction 9925 11414 13126 9 Impacted Tooth Surgical Extraction ( Grade 1 ) - Per Tooth 13225 15209 17490 10 Impacted Tooth Surgical Extraction ( Grade 2 ) - Per Tooth 19838 22814 26236 11 Impacted Tooth Surgical Extraction ( Grade 3 ) - Per Tooth 26450 30418 34981 12 Crown ( Low Fusing Ceramic ) - Per Crown 17250 25875 34500 13 Nickel- Chromium Post ( Custom Made ) 6900 10350 13800 14 Night Guard Appliance ( Dental ) 5750 8625 11500 15 Crown Ceramic Vita - Normal ( Per Crown ) 6900 10350 13800 16 Perforation Repair Surgery ( Grade 1 ) - Oral Surgery 9200 13800 18400 17 Pin Retained Fillings 2300 3450 4600 18 Porcelain Fused To Metal Bridge - Unit 8050 12075 16100 19 Bone Grafting ( Posterior Teeth ) 69000 103500 138000 20 Crown Precious Metal Ceramic ( HG ) - Per Unit 9200 13800 18400 21 Removable Partial Denture Plate 1725 2588 3450 22 Root Canal Treatment ( RCT ) + Post - Grade 1 5750 8625 11500 23 Root Planing ( Per Quadrant ) 1150 1725 2300 24 Scaling 1725 2588 3450 25 Scaling ( Grade 1 ) 1150 1725 2300 26 Dental Sealants 575 863 1150 27 Selective Grinding ( Lower Teeth ) 288 431 575 28 Selective Grinding ( Upper Teeth ) 288 431 575 29 Sinus Lift + Bone Graft ( Per Tooth ) 23000 34500 46000 30 Sinus Lift + Bone Grafts ( Grade 1 ) 23000 34500 46000 31 Sinus Lift + Bone Grafts ( Grade 2 ) 46000 69000 92000 32 Sinus Lift + Bone Grafts ( Grade 3 ) 69000 103500 138000 33 Tooth Surgical Extraction ( Grade 2 ) 2300 3450 4600 34 Impacted Tooth Surgical Extraction (Inverted) 17250 25875 34500 35 Temporary Crown ( Per Crown ) 1150 1725 2300 36 Temporary Filling ( Per Tooth ) 575 863 1150 37 Tooth Extraction ( Grade 2 ) 1725 2588 3450 38 Tooth Jewellery ( Per Diamond ) 8050 12075 16100 39 Upper Full Denture With Three Implants 230000 345000 460000

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40 Temporomandibular joint ( TMJ ) Surgery ( Right ) 66125 76044 87451 41 Temporomandibular joint ( TMJ ) Surgery ( Bilateral ) 99188 114066 131176 42 Post And Core ( Grade 3 ) 3450 5175 6900 43 Scaling ( Grade 3 ) 2300 3450 4600 44 Alar Adjustment ( Nose ) 9258 10647 12244 45 Alveolar Bone Grafting 26450 30418 34981 46 Incisional Biopsy ( Oral ) 5290 6084 6997 47 Cephalometric Analysis 3174 3650 4198 48 Hemangioma Excision - Small ( Oral Surgery ) 11500 23000 34500 49 Hemangioma Excision - Medium ( Oral Surgery ) 23000 34500 46000 50 Oral Cyst Removal ( Grade 1 ) 39675 45626 52470 51 Oral Cyst Removal ( Grade 2 ) 59513 68440 78706 52 Oral Cyst Removal ( Grade 3 ) 72738 83649 96196 53 Zirconium Crown 13800 20700 27600 54 Complete Denture ( Flexible Tooth ) 28750 43125 57500 55 Vidian Neurectomy - Dental 6900 10350 13800 56 Polishing 431 647 863 57 Oral Cyst Removal ( Grade 4 ) 99188 114066 131176

Zygomatic Complex Fracture With Open Reduction (with help of 52900 60835 69960 58 Bone plates)

Zygomatic Complex Fracture With Open Reduction (with help of 59513 68440 78706 59 Bone plates) Grade I

Zygomatic Complex Fracture With Open Reduction (with help of 66125 76044 87451 60 Bone plates) Grade II 61 Dental Implant - Basic 46288 53231 61216 62 Dental Implant - Basic (Grade 1) 75187 86465 99435 63 Dental Implant - Basic (Grade 2) 59513 68440 78706 64 Dental Implant - High End 72738 83649 96196 65 Dental Implant - High End (Grade 1) 85963 98857 113686 66 Dental Implant - High End (Grade 2) 99188 114066 131176 67 Dental Implant - High End (Grade 3) 112413 129275 148666 68 Dental Implant - High End with Bone Graft 132250 152088 174901

Mandible Fracture Reduction + Fixation - Capsplint & Circum 42320 48668 55968 69 Mandibular Wiring

Mandible Fracture Reduction + Fixation - Capsplint & Circum 59513 68440 78706 70 Mandibular Wiring (Grade 1)

Mandible Fracture Reduction + Fixation - Capsplint & Circum 72738 83649 96196 71 Mandibular Wiring (Grade 2) 72 Mandible Comminuted Fracture Open Reduction + Fixation 55545 63877 73459

Mandible Comminuted Fracture Open Reduction + Fixation (Grade 64803 74523 85701 73 1) 74 Panfacial Fracture Maxilla 85963 98857 113686 75 Panfacial Fracture Maxilla (Grade 1) 99188 114066 131176 73

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52900 60835 69960 76 Oroantral Fistula Plastic Repair + Closure - Grade 1 ( Oral Surgery )

66125 76044 87451 77 Oroantral Fistula Plastic Repair + Closure - Grade 2 ( Oral Surgery ) 78 Mandible Fracture Open Reduction and Fixation ( Oral Surgery ) 26186 30114 34631 79 Mandible Compound Fracture Open Reduction + Fixation 42320 48668 55968

52900 60835 69960 80 Mandible Compound Fracture Open Reduction + Fixation (Grade 1) 81 Maxilla Fracture (LE FORT I) ( Oral Surgery ) 40009 46010 52912 82 Maxilla Fracture (LE FORT 2) ( Oral Surgery ) 52900 60835 69960 83 Maxilla Fracture (LE FORT 3) ( Oral Surgery ) 68770 79086 90949 84 Mandible Fracture - Closed Reduction ( Oral Surgery ) 16997 19547 22479 85 Facial Bones Fracture Closed Reduction Maxilla ( Oral Surgery ) 46288 53231 61216 86 Condylar Fracture (Unilateral) 19838 22814 26236 87 Condylar Fracture (Bilateral) 26450 30418 34981 88 Mandibular Fracture - IMF Screws ( Grade 1 ) 46288 53231 61216 89 Mandibular Fracture - IMF Screws ( Grade 4 ) 59513 68440 78706 90 Neurectomy Maxilla ( Grade 1 ) 39675 45626 52470 91 Neurectomy Maxilla ( Grade 2 ) 66125 76044 87451 92 Neurectomy Maxilla ( Grade 3 ) 92575 106461 122430 93 Neurectomy Mandible ( Grade 1 ) 66125 76044 87451 94 Neurectomy Mandible ( Grade 2 ) 92575 106461 122430 95 Neurectomy Mandible ( Grade 3 ) 112413 129275 148666 96 Tumor Resection ( Grade 1 ) 52900 60835 69960 97 Tumor Resection ( Grade 2 ) 72738 83649 96196 98 Tumor Resection ( Grade 3 ) 92575 106461 122430 99 Tumor Resection ( Grade 4 ) 112413 129275 148666 100 Treatment Osteomyelitis ( Grade 1 ) 39675 45626 52470 101 Treatment Osteomyelitis ( Grade 2 ) 52900 60835 69960 102 Treatment Osteomyelitis ( Grade 3 ) 66125 76044 87451

Alveolar Bone Grafting (Excluding Bone Graft & Membrane Cost) ( 52900 60835 69960 103 Grade 1 )

Alveolar Bone Grafting (Excluding Bone Graft & Membrane Cost) ( 66125 76044 87451 104 Grade 2 )

Alveolar Bone Grafting (Excluding Bone Graft & Membrane Cost) ( 79350 91253 104941 105 Grade 3 ) 106 Orthognathic Surgery ( Grade 1 ) 79350 91253 104941 107 Orthognathic Surgery ( Grade 2 ) 119025 136879 157411 108 Orthognathic Surgery ( Grade 3 ) 158700 182505 209881 109 Orthognathic Surgery ( Grade 4 ) 198375 228131 262351 110 Alveolar Bone Grafting ( Grade 1 ) 33063 38022 43725 111 Alveolar Bone Grafting ( Grade 2 ) 39675 45626 52470 112 Oral Cyst Removal - Small ( Dental ) 11903 13688 15741 74

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113 Oral Cyst Removal - Small Grade 1 ( Dental ) 15870 18251 20989 114 Oral Cyst Removal - Small Grade 2 ( Dental ) 19838 22814 26236 115 Alveoloplasty ( Per Segment ) Tooth Area 3968 4563 5247 116 Incisional Biopsy - Small ( Dental ) 3968 4563 5247 117 Incisional Biopsy - Medium ( Dental ) 4635 5330 6130 118 Incisional Biopsy - Large ( Dental ) 5957 6851 7879 119 Excisional Biopsy - Small ( Dental ) 5290 6084 6997 120 Excisional Biopsy - Medium ( Dental ) 6613 7605 8746 121 Excisional Biopsy - Large ( Dental ) 7935 9125 10494 122 Incisional Biopsy - With Laser ( Dental ) 7935 9125 10494 123 Incisional Biopsy - With Laser ( Grade 1 )( Dental ) 9258 10647 12244 124 Incisional Biopsy - With Laser ( Grade 2 )( Dental ) 10580 12167 13992 125 Excisional Biopsy - With Laser ( Dental ) 9925 11414 13126 126 Excisional Biopsy - With Laser ( Grade 1 )( Dental ) 11247 12934 14874 127 Excisional Biopsy - With Laser ( Grade 2 )( Dental ) 13225 15209 17490 128 DENTAL IMPACTED TOOTH REMOVAL (PER TOOTH) GRADE 1 5750 8625 11500 129 DENTAL IMPACTED TOOTH REMOVAL (PER TOOTH) GRADE 2 8625 12938 17250 130 DENTAL IMPACTED TOOTH REMOVAL (PER TOOTH) GRADE 3 11500 17250 23000 131 DENTAL IMPACTED TOOTH REMOVAL (PER TOOTH) GRADE 4 17250 25875 34500 132 DENTAL ROOT CANAL (MOLAR) 3450 5175 6900 133 DENTAL SCALING (PER SITTING) 575 863 1150 134 DENTAL X-RAY 115 173 230 135 DENTAL AMALGAM FILLING (SILVER) 575 863 1150 136 DENTAL DENTURE(METAL) 11500 17250 23000 137 DENTAL DENTURE ADDL TOOTH 575 863 1150 138 DENTAL ORTHO GNATHIC SURGERY (DENTAL SURGERY) 120750 181125 241500 139 DENTAL COSMETIC TREATMENT OF GUMS GRADE III 1380 2070 2760 140 DENTAL I.M.F(INTRAMAXILLARY FIXATION)GRADE II 6900 10350 13800 141 DENTAL AMALGAM REPLACEMENT (PER TOOTH) 4600 6900 9200 142 DENTAL AMALGAM REPLACEMENT WITH LINER 5750 8625 11500 143 DENTAL BITEWING X RAY 288 431 575 144 DENTAL BLEACHING (PARTIAL) 5750 8625 11500 145 DENTAL BLEACHING OF TEETH BY TRAY METHOD AND SUPPLY 9200 13800 18400 146 DENTAL BRIDGE CAST(UNITS) 4600 6900 9200 147 DENTAL CAST PARTIAL DENTURE(PER TOOTH) 2300 3450 4600 148 DENTAL COMPOSITE FILLINGS ONE SURFACE 1150 1725 2300 149 DENTAL COMPOSITE FILLINGS TWO SURFACE 1725 2588 3450 150 DENTAL COMPOSITE FILLINGS-THREE SURFACE 2300 3450 46000 151 DENTAL CROWN PLACEMENT ( LUTING ) 1150 1725 2300 152 DENTAL CURRETTAGE(PER QUAD) GR-I 2875 4313 5750 153 DENTAL CURRETTAGE(PER QUAD) GR-II 3450 5175 6900 154 DENTAL CURRETTAGE(PER QUAD) GR-III 4025 6038 8050 155 DENTAL CURRETTAGE(PER QUAD) GR-IV 4600 6900 9200 75

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156 DENTAL DENTASCAN 1150 1725 2300 157 DENTAL DENTURE ADJUSTMENT MINOR) 288 431 575 158 DENTAL DENTURE REPAIR GR I 1150 1725 2300 159 DENTAL DIASTEMA CLOSURE 9200 13800 18400 160 DENTAL DIASTEMA CLOSURE GRADE II 11500 17250 23000 161 DENTAL DIGITAL OPG WITH CD 633 949 1265 162 DENTAL DYCAL LINER 575 863 1150 163 DENTAL FILLING SILVER ALLOY ONE SURFACE------575 863 1150 164 DENTAL FILLING SILVER ALLOY-THREE SURFACE------1150 1725 2300 165 DENTAL FILLING SILVER ALLOY-TWO SURFACE------920 1380 1840

DENTAL FIXED ORTHODONTIC APPLIANCES TRANSPARENT 57500 86250 115000 166 BRACKET- - - - - 167 DENTAL FLAP OPERATION (PER SEGMENT)- - 5750 8625 11500 168 DENTAL FULL MOUTH CURETTAGE GR-II 13800 20700 27600 169 DENTAL FULL MOUTH CURETTAGE GR-III 16100 24150 32200 170 DENTAL FULL CAST CROWN------4600 6900 9200 171 DENTAL GLASS IONOMER FILLINGS CLASS FIVE------1150 1725 2300 172 DENTAL GLASS IONOMER FILLINGS CLASS ONE------1150 1725 2300 173 DENTAL GLASS LONOMER LINER 575 863 1150 174 DENTAL GUM CURRETTAGE (PER TOOTH)- - - 288 431 575 175 DENTAL I.M.F(INTRAMAXILLARY FIXATION) GRADE I 1035 1553 2070 176 DENTAL I.M.F(INTRAMAXILLARY FIXATION) GRADE III 23000 34500 46000 177 DENTAL I.M.F(INTRAMAXILLARY FIXATION) GRADE IV 34500 51750 69000 178 DENTAL IMMEDIATE LOADING IMPLANTS(PER IMPLANT) 86250 129375 172500 179 DENTAL IMPACTED TOOTH EXTRACTION- - - - 5750 8625 11500 180 DENTAL INLAYS------3450 5175 6900 181 DENTAL INSTA BLEACH------11500 17250 23000 182 DENTAL INSTABLEACHING GRII 5750 8625 11500 183 DENTAL INSTABLEACHING GRI 6900 10350 13800 184 DENTAL LAMINATED VENEER (CERGO) 23000 34500 46000 185 DENTAL LATERAL CEPHALOGRAPH 1380 2070 2760 186 DENTAL LOWER FULL DENTURE WITH THREE IMPLANT------230000 345000 460000 187 DENTAL MINOR SURGERY GRADE I 3450 5175 6900 188 DENTAL MINOR SURGERY GRADE II 4600 6900 9200 189 DENTAL MINOR SURGERY GRADE III 5175 7763 10350 190 DENTAL MINOR SURGERY GRADE IV 6900 10350 13800 191 DENTAL ORTHODONTIC TREATMENT (AMERICAN BRACKETS) 57500 86250 115000 192 DENTAL ORTHODONTIC TREATMENT (INST) 5750 8625 11500

DENTAL REDUCTION AND FIXATION OF MAXILLARY FRACTURES 11500 17250 23000 193 GRADE I

DENTAL REDUCTION AND FIXATION OF MAXILLARY FRACTURES 17250 25875 34500 194 GRADE II

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DENTAL REDUCTION AND FIXATION OF MAXILLARY FRACTURES 23000 34500 46000 195 GRADE III

DENTAL REDUCTION AND FIXATION OF MAXILLARY FRACTURES 34500 51750 69000 196 GRADE IV

DENTAL REMOVABLE ORTHODONTOC APPLIANCE RETAINERS 6900 10350 13800 197 EACH------198 DENTAL SURGICAL PROCEDURE UNDER SEDATION GRADE 1 28750 43125 57500 199 DENTAL SURGICAL PROCEDURE UNDER SEDATION GRADE 2 34500 51750 69000 200 DENTAL SURGICAL PROCEDURE UNDER SEDATION GRADE 3 40250 60375 80500 201 DENTAL BLEACHING ZOOM TECH GRADE 1 23000 34500 46000 202 DENTAL SINGLE SITTING RCT POSTERIOR 8050 12075 16100 203 DENTAL GRADE I 23000 34500 51750 204 DENTAL GRADE II 34500 46000 63250 205 DENTAL GRADE III 46000 57500 74750 206 DENTAL GRADE IV 57500 69000 86250

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DERMATALOGY

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 Botox Injection ( Per Unit ) 288 431 575 2 Carbon dioxide (CO2) Laser for Large Lesion - per session 58 86 115 3 Comedone Extraction ( 5 Sessions ) 621 932 1242 4 Injection Intradermal ( more than 5 Lesions ) - Dermatology 1035 1553 2070 5 Injection Intradermal ( 1 to 5 Lesions ) - Dermatology 575 863 1150 6 Patch Test - Dermatology 4140 6210 8280 7 Punch Grafting ( Per Punch ) 1035 1553 2070

Chemical Cauterization with TriChloroAcetic Acid ( TCA ) for 575 863 1150 8 Xanthelasma - Each Additional Lesion after 2 )

Chemical Cauterization with TriChloroAcetic Acid ( TCA ) for 1035 1553 2070 9 Xanthelasma - Upto 2 Lesions 10 Electric Cauterization ( for Plantar Warts ) 1840 2760 3680 11 Acne Treatment 1346 2018 2691 12 Phototherapy 575 863 1150 13 Iontophoresis 1150 1725 2300 14 Skin Polishing - Face 1150 1725 2300 15 Iontophoresis - Power Patch 2300 3450 4600 16 Facelift ( Non - Surgical ) 1150 1725 2300 17 Acne Surgery - Single Sitting 2875 4313 5750 18 Anti - Acne Peel ( Single Sitting ) 1725 2588 3450 19 Anti - Acne Peel ( 6 Sitting Course ) 9200 13800 18400 20 Anti - Acne Plus Peel ( Single Sitting ) 2300 3450 4600 21 Anti - Scar Peel ( Single Sitting ) 2300 3450 4600 22 Anti - Scar Peel ( 6 Sitting Course) 11500 17250 23000 23 Anti - Tan Peel ( Single Sitting ) 1150 1725 2300 24 Anti - Tan Peel ( 6 Sitting Course ) 5750 8625 11500 25 Anti - Tan Plus Peel ( Single Sitting ) 2300 3450 4600 26 Anti - Tan Plus Peel ( 6 Sitting Course ) 11500 17250 23000 27 Anti - Wrinkle Peel ( 6 Sitting Course ) 5750 8625 11500 28 Anti - Wrinkle + Peel For Dynamic Wrinkles ( Single Sitting ) 3450 5175 6900 29 Anti - Wrinkle Plus Peel ( 6 Sitting Course ) 17250 25875 34500 30 Body Peel ( Complete ) - Single Sitting 11500 17250 23000 31 Body Peel ( Complete ) - 6 Sitting Course 57500 86250 115000 32 Cryosurgery for Kelloid - Single Sitting 2875 4313 5750 33 Dermarollers - 6 Sitting Course 17250 25875 34500 34 Skin Biopsy ( Excisional ) - Diagnostic 2300 3450 4600 35 Patch Testing - Diagnostic 2300 3450 4600 36 Wood's Lamp Test - Diagnostic 345 518 690 37 Enucleation ( 5 Lesions ) 1150 1725 2300

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38 Enucleation ( Per Lesion ) 230 345 460 39 Fractional Erbium Technology ( FET ) Therapy 28750 43125 57500 40 Hair Restoration Surgery ( Strip ) 68 103 137 41 Hair Restoration Surgery - Follicular Unit Transplant ( FUT ) 92 138 184 42 Interstitial Laser Therapy ( for Alopecia Areata ) 1150 1725 2300 43 Iontophoresis ( Single Sitting ) 1150 1725 2300 44 Micro Dermabrasion ( 6 Sitting ) 8625 12938 17250 45 Nail Surgery - Complete 5750 8625 11500 46 Nail Surgery - Partial 2875 4313 5750 47 Iontophoresis ( Power Patch ) - Single Sitting 2300 3450 4600 48 Peel - Purple 3450 5175 6900 49 Radiofrequency ( Multiple Lesion ) 1150 1725 2300 50 Radiofrequency ( Per Lesion ) 460 690 920 51 Skin Polishing - Single Sitting 1150 1725 2300 52 Stem Cell Therapy - Single Sitting 5750 8625 11500 53 Dimple Creation Surgery - Temporary 5750 8625 11500 54 Cryosurgery ( Large ) - Dermatology 6095 9143 12190 55 Cryosurgery ( Medium ) - Dermatology 4140 6210 8280 56 Cryosurgery ( Small ) - Dermatology 2530 3795 5060 57 Dermatopathology ( Single Lesion ) 1035 1553 2070 58 Advanced Peel - Face ( Fine Wrinkles ) Single Sitting 2875 4313 5750 59 Chemical Peeling Basic 1150 1725 2300 60 Dermarollers Treatment 11500 17250 23000 61 GLYCOLIC PEEL (4 SITTING) 4554 6831 9108 62 Treatment Melasma (Medium) (Per Sitting)(Radiance Aesthetics) 1150 1725 2300 63 HAIR REDUCTIONS BIKINI LINE (PER SITTING) 23000 34500 46000 64 HAIR REDUCTIONS CHIN (PER SITTING) 1725 2588 3450 65 HAIR REDUCTIONS UPPER LIP (PER SITTING) 1725 2588 3450

HAIR REDUCTIONS FULL FACE (SIDE BURNS + CHIN + UPPER LIP) 5750 8625 11500 66 (PER SITTING) 67 TREATMENT VASCULAR IPL - LARGE (PER SITTING) 288 431 575 68 TREATMENT FINE WRINKLE (PER SITTING) 1150 1725 2300 69 TREATMENT AGE SPOTS (PER SITTING) 11500 17250 23000 70 LASERS FRAXEL (FACE) 5750 8625 11500 71 WHOLE BODY (SINGLE SITTING) 575 863 1150 72 REMOVAL OF MOLLUSCUM CONTAGIOSUM FIRST 5 LESION 932 1397 1863 73 REMOVAL OF MOLLUSCUM CONTAGIOSUM PER LESION 207 311 414 74 BIOPSY SKIN 2070 3105 4140 75 CALORIC TEST 1346 2018 2691 76 CHANNEL ATRESIA RECANALISATION 19090 28635 38180 77 KOH EXAM (DERMA) 621 932 1242 78 WOUND STITCH REMOVAL (7 TO 12) 414 621 828 79 WOUND STITCH REMOVAL (LESS THAN 7) 311 466 621 80

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80 WOUND STITCH REMOVAL (MORE THAN 12) 621 932 1242 81 WOUND STITCHING (< 6 STITCHES TWO LAYERS) 1242 1863 2484 82 DERMAROLLOERDERMAROLLOER - FIRST SITTINGS 2300 3450 4600 83 MICRODERMARASION 1725 2588 3450 84 BOTOX MULTIPLE SIDE INJ. 5750 9200 13800

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ENT

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 FRACTURE SETTING NASAL BONE 8280 12420 16560 2 RECONSTRUCTION OF EAR (CLOSE) 16675 25013 33350 3 RECONSTRUCTION OF EAR (OPEN) 22310 33465 44620 4 TOTAL MAXILLECTOMY 31740 47610 63480 5 PARTIAL MAXILLECTOMY 25415 38123 50830 6 MODIFIED RADICAL MASTOIDECTOMY 19090 28635 38180 7 LIMITED GLOSSECTOMY 9085 13628 18170

ELECTRIC CAUTERY FOR WART/DPN/GRANULOMA PYOGENICERM 932 1397 1863 8 PER 3 LESIONS

ELECTRIC CAUTERY FOR WART/DPN/GRANULOMA PYOGENICERM 311 466 621 9 PER LESIONS 10 MILIA EXTRACTION FIRST 5 LESIONS 932 1397 1863 11 MILIA EXTRACTION FIRST PER LESIONS 207 311 414 12 CORTICAL MASTOIDECTOMY,MODIFIED RADICAL 19090 28635 38180 13 HEMI GLOSSECTOMY WITH RADICAL NECK DESECTION 25415 38123 50830 14 HERNIA LARYNGECTOMY 15180 22770 30360 15 CONTRACTURE RLEASE MILD 8855 13283 17250 16 TOTAL GASTRECTOMY FOR Z-E SYNDROME 27370 41055 54740 17 COBLATION PACKAGE 22770 34155 45540 18 ENDOSCOPIC SPA 10925 16388 21850 19 EXCISION HEMANGIOMA 9085 13628 18170 20 FESS EXTENDED BILATERAL 23920 35880 47840 21 FESS EXTENDED UNILATERAL 18170 27255 36340 22 FOREHEAD EXPLORATION 19205 28808 38410 23 EAR LOBE REPAIR - ONE 1725 2588 3450 24 GLOMUSJUGULARE TUMOR 25415 38123 50830 25 HA TRIAL FITING 621 932 1242 26 HEARING AID CONSULTATION 345 518 690 27 HYPOPHARYNGOSCOPY EXAM 3680 5520 7360 28 MYRINGOTOMY DOUBLE 7820 11730 15640 29 MYRINGOTOMY SINGLE 5520 8280 11040 30 NASAL PACKING POST. 3220 4830 6440 31 OAE 725 1087 1449 32 OBLITERATION 15180 22770 30360 33 OSSICULAPLASTY 25415 38123 50830 34 PLAY AUDIOMETRAY 621 932 1242 35 RETRO -PHARYNGEAL ABSCESS DRANAGE 15180 22770 30360 36 SELECTIVE GRINDING GRADE-II (PER TOOTH) 56925 85388 113850 37 SPECILAL TESTS 311 466 621

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38 SPEECH SESSION FOLLOW UP 311 466 621 39 SPEECH SESSION IST 414 621 828 40 SPLINT REMOVAL 2645 3968 5290 41 SPLIT EAR LOBULE BOTH 10120 15180 20240 42 SRT/SDS 414 621 828 43 SUBMUCONS DIATHERMY 3680 5520 7360 44 SURGERY FOR PARAPHARYNGEAL ABSCESS 7820 11730 15640 45 TONSILLER FLORA 5750 8625 11500 46 UP3 LAZER 20470 30705 40940 47 UP3 RFA 1ST SITTING 9775 14663 19550 48 UP3 RFA SUBEQUENT SITTING 5175 7763 10350 49 Antral Wash Out ( Right ) 1610 2415 3220 50 Biopsy ( ENT ) 1346 2018 2691 51 Cauterization Chemical (Silver Nitrate) for Epistaxis 828 1242 1656 52 Cauterization Electric ( Epistaxis ) 2070 3105 4140 53 Nasal Turbinate Injection ( for Sub Mucosal Fibrosis ) 414 621 828 54 Microlaryngeal Surgery 15180 22770 30360 55 Turbinectomy Middle ( Bilateral ) 3450 5175 6900 56 Nasal Sinus Endoscopy ( Diagnostic ) 2530 3795 5060 57 Nasal Pharyngolaryngoscopy 1725 2588 3450 58 Pinna Piercing ( Bilateral ) - ENT 621 932 1242 59 Pinna Piercing ( Left ) - ENT 414 621 828 60 Foreign Body Ear ( Left ) Removal 621 932 1242 61 Ear Suction Clearance ( Bilateral ) 414 621 828 62 Syringing Ear ( for Wax Removal ) -Bilateral 414 621 828 63 Tracheal Reconstruction 15180 22770 30360 64 Tympanoplasty 17250 28750 43125 65 Tympanomastoidectomy 19090 28635 38180 66 Suction Clearance of Tracheostomy ( Each Time ) 414 621 828 67 Turbimectomy Lower ( Bilateral ) 3450 5175 6900 68 Tone Decay Test ( TDT ) 311 466 621 69 Alternate Binaural Loudness Balance ( ABLB ) 403 604 805 70 Audiometry Electrocochleography Thresholds ( ECochG ) 4025 6038 8050

Microscopic Laryngeal Surgery (MLS) Diagnostic / Nodule / Polyp 12075 13886 15969 71 Excision 72 Probing & Syringing - Both Eyes 11500 17250 23000 73 Suture Removal ( ENT ) 104 155 207 74 Audiometry - Pure Tone ( Special Tests ) 288 431 575 75 Paracentesis ( ENT ) 6900 10350 13800 76 Neck Dissection ( Modified ) 58190 87285 116380 77 Fibreoptic Laryngoscopy ( FOL ) 2530 3795 5060 78 Examination Under Microscope ( EUM ) + Suction - Both Ears 621 932 1242 79 SEPTOPLASTY - (P) 17250 25875 34500 84

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80 Nasal Cautery 1346 2018 2691 81 Laryngoscopy Flexible 1725 2588 3450 82 Oroantral Fistula Repair with Flap 12765 19148 25530 83 Incision and Drainage( ENT ) 9200 13800 18400 84 Tinnitus Assessment 3450 3968 4563 85 AUDIOMETRY PTA 288 431 575 86 AUDIOMETRY SPEECH THARAPHY 575 863 1150 87 AUDIOMETRY FFT 460 690 920 88 AUDIOMETRY SPEECH AUDIOMETRY 403 604 805 89 AUDIOMETRY DLI 403 604 805 90 AUDIOMETRY REFLEX DECAY 575 863 1150 91 AUDIOMETRY BERA 3450 5175 6900 92 AUDIOMETRY AIDED ASSR 4025 6038 8050 93 AUDIOMETRY EABR 4600 6900 9200 94 AUDIOMETRY OAE: DPOAE, TEOAE 920 1380 1840 95 BEHIN THE EA R (OTHER ACC.) 17250 25875 34500 96 FIBEROPTIC LARNYGOSCOPY 4025 6038 8050 97 HEARING AID 287500 431250 575000 98 FESS BILATERAL 17250 25875 34500 99 FESS UNILATERAL 13800 20700 27600 100 PTA 414 621 828 101 SPEECH THARAPHY 414 621 828 102 ANTI MEL PEEL (SIX SITTING COURSE) 5750 8625 11500 103 ANTI POM PEEL (SIX SITTING COURSE) 5750 8625 11500 104 ANTI POM PEEL(SINGLE SITTING) 1150 1725 2300 105 HANDS & FEET (SINGLE SESSION) 345 518 690 106 HANDS & FEET (SIX SESSION COURSE) 1725 2588 3450 107 LASERS CO2 LASER (UPTO TWENTY SHOTS) 1725 2588 3450 108 LASERS Q SWITCH LASER (UPTO TWENTY SHOTS) 1725 2588 3450 109 LASERS Q SWITCH PER SHOT 58 86 115 110 WHOLE BODY (SIX SITTING COURSE) 2875 4313 5750 111 MINI TRACHOSTOMY 828 1242 1656 112 CLW SUTURING FACE SINGLE LAYER 1035 1553 2070 113 CLW SUTURING LOWER LIMB MULTIPLE LAYER 932 1397 1863 114 CLW SUTURING LOWER LIMB SINGLE LAYER 575 863 1150 115 CLW SUTURING SCALP STAPPLING 575 863 1150 116 CLW SUTURING UPPER LIMB MULTIPLE LAYER 1035 1553 2070 117 CLW SUTURING UPPER LIMB SINGLE LAYER 621 932 1242 118 EAR SUCTION CLEARANCE ( RIGHT ) 414 621 828 119 RFTVR ENT 69000 86250 115000 120 TONGUE BIOPSY UDER LOCAL ANAESTHEIA 10350 12938 20700 121 SPEECH THERAPY (10 SESSIONS) PAEDS 6900 10350 13800 122 EAR LOBE PIERCING 2300 3450 4600 85

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FESS WITH SEPTOPLASTY AND TURBINECTOMY OR POLYPECTOMY - 115000 132250 152088 123 UNILATERAL - PKG

FESS WITH SEPTOPLASTY AND TURBINECTOMY OR POLYPECTOMY - 149500 171925 197714 124 BILATERAL - PKG 125 MASTOIDECTOMY - PKG 166750 191763 220527 126 ADENOTONSILLECTOMY - PKG 105800 121670 139921 127 TYMPANOPLASTY - PKG 118450 136218 156651 128 MASTOIDECTOMY & TYMPANOPLASTY - PKG 195500 224825 258549 129 TONSILLECTOMY - PKG 78200 89930 103420 130 CORTICAL MASTOIDECTOMY WITH MYRINGOPLASTY - PKG 69000 79350 91253 131 PERITONSILAR ABSCESS DRAINAGE - PKG 59800 68770 79086 132 MYRINGOTOMY WITH GROMMET INSERTION - UNILATERAL - PKG 51750 59513 68440

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NEPHROLOGY

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room

Catheter Insertion In Chronic Ambulatory Peritoneal Dialysis ( CAPD 15295 23000 30590 1 )

Continous Ambulatory Peritoneal Dialysis ( CAPD ) Catheter 15295 23000 30590 2 Placement 3 Dialysis with F8 Dialyzer 3968 5951 7935 4 Sustained Low Efficacy Dialysis ( SLED ) Upto 8 Hrs 9775 9775 14663 5 Continuous Renal Replacement Therapy ( CRRT ) Initiation 34500 34500 34500

Continuous Renal Replacement Therapy ( CRRT ) - Daily 4600 4600 6900 6 Maintenance 7 Slow Low Efficiency Dialysis ( SLED ) 13800 13800 20700

575 863 1150 8 CONTINOUS AMBULATORY PERITONEAL DIALYSIS ( CAPD ) PER DAY 9 HAEMODIALYSIS (ONLINE HDF) WITH New Servies DIALYZER 5520 7200 9600 10 HEMODIALYSIS (ISOLATION) 4600 4600 4600 11 PERMACATH PACKAGE (PALINDROME) 34500 34500 46000 12 PERMACATH PACKAGE (OTHERS) 23000 23000 23000 13 DIALYSIS WITH SINGLE USE OF DIALYSER(EMERGENCY) 5175 5175 5175 14 Adequacy Test 1725 1725 2588 15 HEMODIALYSIS UPTO 4HRS 3680 5175 5175 16 DOUBLE LUMEN CATHERISATION 2070 3105 4140 17 INTERMITTENT PD 6900 10350 13800 18 IV + PAC + SEDATION BY ANESTHESIOLOGIST 1139 1708 2277 19 SUB. CLAVIAN CATHETERISATION/ IJ CATHERISATION 2070 3105 4140 20 HEMODIALYSIS UP TO 4 HOURS (WITH HIGH FLUX) 4945 4945 6676 21 HEMODIALYSIS UP TO 4 HOURS (WITH LOW FLUX) 4945 4945 6676 22 DIALYSIS HIGH FLUX IPD 4945 4945 6676 23 SUSTAINED LOW EFFICACY DIALYSIS ( SLED ) 12 HRS 15870 18251 20989 24 DIALYSIS WITH FX60 DIALYZER - HIGH FLUX 1265 1265 1265 25 TRIPLE LUMEN CATHERISATION 2070 3105 4140 26 CATHETERISATION 920 1380 1840 27 PERITONAL DIALYSIS CATHETER INSERTION 2415 3623 4830 28 Peritoneal Equilibrium Test (PET) 1725 1725 2588 29 KIDNEY GRAFT BIOPSY BY ULTRASOUND GUIDANCE - (P) 3220 4830 6440 30 HEMODIALYSIS WITH LOW FLUX (REUSE) - UP TO 4 HOURS 2875 3306 3802 31 DIALYSIS WITH F8 DIALYZER (REUSE) - UP TO 4 HOURS 3163 3637 4183 32 DIALYSIS WITH HOLLOW FIBER DIALYZER 978 1125 1294

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GYNAECOLOGY

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 Amnioinfusion 4600 6900 9200 2 Vaginal Repair ( Anterior + Posterior ) 12535 18803 25070 3 Colposcopy 2415 3623 4830 4 Cervical Cone Biopsy 5750 8625 11500 5 Cervical Cryocautery 11500 15525 23288 6 Hysteroscopy Diagnostic ( With / Without Biopsy ) 7935 11903 15870 7 Labial Cyst Excision 4025 6038 8050 8 Fenton's Procedure ( Vaginal Reconstruction ) 6785 10178 13570 9 Vaginal Foreign Body Removal 3565 5348 7130 10 Curettage Fractional 4025 6038 8050 11 Hydrotubation 3335 5003 6670 12 Hymen Incision 3450 5175 6900

30245 45368 60490 13 Laparoscope Assisted Vaginal Hysterectomy ( LAVH ) + Adhesiolysis 14 Biopsy ( Laparoscopic ) 7935 11903 15870 15 Burch Colposuspension ( Laparoscopic ) 22770 34155 45540 16 Fimbriolysis ( Laparoscopic ) 15985 23978 31970

Lost Intra Uterine Contraceptive Device ( IUCD ) Removal - 11385 17078 22770 17 Laparoscopic 18 Salpingostomy ( Laparoscopic ) 17135 25703 34270 19 Tuboplasty ( Laparoscopic ) 22770 34155 45540 20 Large Loop Excision of Transformation Zone (LLETZ) 5750 8625 11500 21 Le Forts Operation (Genital Prolapse) 10235 15353 20470 22 Sling Procedure (for Urinary Stress Incontinence) 20010 30015 40020 23 Vault Repair ( Post Hysterectomy ) 19320 28980 38640 24 Vulval Biopsy 3680 5520 7360 25 Endometriotic Spots Ablation ( Laparoscopic ) 13685 20528 27370 26 Sterilization Abdominal 5750 8625 11500 27 End To End Anastomosis ( Bilateral ) 17135 25703 34270 28 Marsupialization ( Obstetrics & Gynaecology ) 4025 6038 8050 29 Abortion - Midtrimester 7475 11213 14950 30 Episiotomy Repair 3450 5175 6900 31 Vaginoplasty ( for Vaginal Agenesis ) 22770 34155 45540 32 Vulval Haematoma ( Post Delivery ) Evacuation 4025 6038 8050 33 Ventral Suspension Of Uterus ( Laparotomy ) 11960 17940 23920 34 Hematocolpos Drainage 3450 5175 6900 35 Hysterectomy Laparoscopic ( for Severe Emdometriosis ) 28520 42780 57040 36 Cystocoele Repair 6785 10178 13570 37 Cervical Biopsy 5750 8625 11500

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38 Tubal Cannulation ( Open ) 20010 30015 40020 39 Neosalpingostomy ( Laparoscopic ) 15985 23978 31970 40 Suction and Evacuation 6440 9660 12880 41 McDonald's Suturing 4025 6038 8050 42 Laparotomy ( Obstetrics and Gynecology) 17135 25703 34270 43 Thermachoice Uterine Balloon Therapy 12535 18803 25070 44 Venterosuspension ( Laparoscopic ) of Uterus alone 11960 17940 23920 45 Cryotherapy/Cautery 2300 3450 4600 46 Laparatomy ( for Ovarian Cancer ) 34155 51233 68310 47 Vaginal Exploration 3450 5175 6900

Laparoscope Assisted Vagina Hysterectomy (LAVH) + Salpingo 30245 45368 60490 48 Oophorectomy 49 Revision Surgery ( for Wide Local Excision of Breast Lump ) 20470 30705 40940 50 Vaginectomy Partial 15525 23288 31050 51 Tubal Ligation ( Laparoscopic ) 6325 9488 12650

Examination Under Anesthesia ( EUA ) + Needling ( Obstetrics and 3450 5175 6900 52 Gynecology ) 53 Uterus Evacuation 4025 6038 8050 54 Cervical Polypectomy 6325 9488 12650 55 Tubal Cannulation ( Hysteroscopic ) 17135 25703 34270 56 Rectocoele - Repair 6785 10178 13570 57 Hysteroscopic Myomectomy ( Large ) 17135 25703 34270 58 Hysteroscopic Myomectomy ( Small ) 17135 25703 34270

Total Abdominal Hysterectomy + Salpingo Oophorectomy ( Right 22770 34155 45540 59 side ) - Complex 60 Salpingo Oophorectomy Laparoscopic - Right 17135 25703 34270 61 Rectovaginal Fistula Repair - 3rd Degree 13685 20528 27370 62 Perineal Tears ( 3rd Degree ) Repair 3450 5175 6900

Medical Termination of Pregnancy ( MTP ) + Sterlization ( 13685 20528 27370 63 Laparoscopic ) 64 Hysteroscopy Adhesiolysis 13685 20528 27370 65 Total Abdominal Hysterectomy Laparoscopic ( TLAH ) 17135 25703 34270 66 Vulval Hematoma Drainage + Vaginal Injury Repair 4025 6038 8050 67 Cu - T Insertion 3450 5175 6900 68 Polypectomy Endometrial ( Per Vaginal ) 3450 5175 6900 69 Ovarian Cystectomy - Single ( Laparoscopic ) 15985 23978 31970 70 LAPAROSCOPIC STERILIZATION - (P) 5750 8625 11500 71 Wertheim's Hysterectomy ( Cervical Cancer ) 28865 43298 57730

Uterine / Ovarian Artery Mapping For Embolization ( Obstetrics and 20873 23713 33201 72 gynecology ) 73 Urethral Caruncle Excision ( Obstetrics and Gynecology ) 3450 5175 6900 74 LAPROSCOPIC MYOMETCOMY 19320 28980 38640 75 E - BIOPSY GA 4600 6900 9200 91

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76 LAPAROSCOPIC OVARION BIOPSY 10235 15353 20470 77 OPEN HYSTRECTOMY (ABD/VAG) LEVEL 1 51750 74750 112125 78 OPEN HYSTRECTOMY (ABD/VAG) LEVEL 2 51750 74750 112125

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LABORATORY

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 ABS TO EXTRACTABLE NUCLEAR AG: SS-A & SS-B (1007-SRL) 4888 7334 9778 2 MENOPAUSAL MONITORING PANEL (1008-SRL) 1956 2934 3912 3 HIRSUTISM EVALUATION PANEL (1010-SRL) 5806 8709 11612 4 INHIBIN B, LH, FSH & PROLACTIN (1013-SRL) 3178 4766 6356 5 BOH PANEL (1014-SRL) 5500 8250 11000 6 THYROID ANTIBODIES, SERUM (1016-SRL) 2506 3759 5012 7 IBD SCREENING PANEL (1020-SRL) 4034 6050 8066 8 IMMUNOGLOBULIN, SERUM (1045-SRL) 1894 2841 3788 9 ACUTE MYELOID LEUKEMIA PANEL (1047-SRL) 10878 16316 21756 10 BONE MARROW ASPIRATION (1054-SRL) 942 1411 1882 11 BETA CROSSLAPS (BETA CTX), SERUM (1058-SRL) 2475 2475 4950 12 TOTAL P1NP, SERUM (1059-SRL) 1772 2659 3544 13 CELIAC PROFILE (1073-SRL) 7944 11916 15888 14 ANTI-NUCLEAR AB-IFA, HEP2, SERUM (1100-SRL) 1881 2822 3762 15 ANTI PARIETAL CELL ANTIBODIES (APCA) (1101-SRL) 2566 3850 5134 16 ANTIMITOCHONDRIAL ANTIBODIES, AMA (1102-SRL) 2078 3116 4156 17 ANTISMOOTH MUSCLE ABS (IFA), SERUM (1106-SRL) 2078 3116 4156 18 ASCA IGG, SERUM (1108-SRL) 2934 4400 5866 19 ANTI-THYROGLOBULIN ANTIBODIES, SERUM (1110-SRL) 1815 2723 3630 20 ASCA IGA, SERUM (1111-SRL) 2934 4400 5866 21 LIVER-KIDNEY-MICRO ABS, SERUM (1115-SRL) 2078 3116 4156 22 COOMBS TEST, DIRECT, BLOOD (1120-SRL) 471 706 942 23 INDIRECT COOMBS TEST, SERUM (1121-SRL) 538 806 1076 24 AFB BACTEC CULTURE (1464-SRL) 1848 2772 3696 25 G-6-PD ACTIVITY, EDTA WHOLE BLOOD (1126-SRL) 1009 1513 2016 26 ERYTHROPOIETIN, SERUM (1160-SRL) 2109 3163 4216 27 ANTI-ISLET CELL ANTIBODIES, SERUM (1166-SRL) 2688 4034 5378 28 ANTI OVARY ANTIBODIES (AOA) (1180-SRL) 3362 5041 6722 29 ENDOMYSIAL IGA ANTIBODIES (IFA) (1181-SRL) 4822 4822 9645 30 DSDNA (WITH TITRES) (1199-SRL) 1344 2016 2688 31 ANTI CENTROMERE ANTIBODIES, SERUM (1202-SRL) 2688 4034 5378 32 ANTI HISTONES ANTIBODIES, SERUM (1203-SRL) 2934 4400 5866 33 ABS TO EXTRACTABLE NUCLEAR AG: SS-A, SERUM (1204-SRL) 2566 3850 5134 34 ABS TO EXTRACTABLE NUCLEAR AG U1SNRNP, SERUM (1215-SRL) 2566 3850 5134 35 EXTRACTABLE NUCLEAR ANTIGENS (1234-SRL) 7456 11184 14912 36 ABS TO EXTRACTABLE NUCLEAR AG: SCL-70, SERUM (1235-SRL) 2530 3416 5124 37 ANTIBODIES TO EXTRACTABLE NUCLEAR ANTIGENS (1236-SRL) 6966 10450 13934 38 TOTAL IGE (1245-SRL) 909 1362 1816 39 PLATELET ABS (1258-SRL) 7798 11696 15596

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40 ANTIGLIADIN IGG ANTIBODIES, SERUM (1260-SRL) 3484 5225 6966 41 TRIPLE TEST (1267-SRL) 2872 4309 5744 42 DOUBLE MARKER TEST, SERUM (1268-SRL) 3278 4917 6556 43 PAPANICOLAOU SMEAR (1272-SRL) 618 927 1236 44 LIQUIPREP CYTOLOGY (1274-SRL) 1463 2195 2926 45 ECHINOCOCCUS IGG, SERUM (1279-SRL) 2262 3391 4522 46 ANTIGLIADIN IGA ANTIBODIES, SERUM (1287-SRL) 3484 5225 6966 47 OLIGOCLONAL BANDS, CSF (1316-SRL) 4168 6251 8336 48 ACETONE, URINE (1336-SRL) 268 404 538 49 HLA B27 BY PCR (1348-SRL) 3362 5041 6722 50 HLA-B27, FLOW CYTOMETRY, BLOOD (1350-SRL) 2322 3484 4644

MYCOBACTERIUM CULTURE - BACTEC EXTRA PULMONARY 1392 1898 2530 51 (1464EP-SRL) 52 MALARIA ANTIGEN DETECTION, WHOLE BLOOD (1395-SRL) 1056 1584 2112 53 LE CELL EXAMINATION, BLOOD (1398-SRL) 322 484 646 54 SICKLING TEST, BLOOD (1400-SRL) 242 363 484 55 COMPREHENSIVE ALLERGY PANELS - ADULTS (1404-SRL) 12012 18018 24024 56 COMPREHENSIVE ALLERGY - INFANCY, SERUM (1408-SRL) 7212 10816 14422 57 ECHINOCOCCUS DETECTION (1409-SRL) 793 1190 1586

ACETYLCHOLINE RECEPTOR AUTOANTIBODIES,SERUM/PLASMA 4644 6966 9288 58 (1411-SRL) 59 LEPTOSPIRA DETECTION (1417-SRL) 605 908 1210 60 NON VEG PANEL (1425-SRL) 4462 6691 8922 61 FIBRINOGEN, PLASMA (1426-SRL) 1344 2016 2688 62 INDOOR PANEL (1428-SRL) 5194 7791 10388 63 B2-MICROGLOBULIN, SERUM (3143-SRL) 497 746 994 64 AFB SUSC. SIRE PANEL (1490-SRL) 5194 7791 10388 65 L.DONOVONI BODIES DETECTION (1492-SRL) 1210 1815 2420 66 MICROFILARIA DETECTION, BLOOD (1493-SRL) 389 585 780 67 THYROID PANEL II, SERUM (1499-SRL) 2035 3053 4070 68 HISTOPATHOLOGY REPORT (1500-SRL) 1925 2888 3850 69 HP - SKIN BIOPSY (1502-SRL) 1100 1650 2200 70 ELECTRON MICROSCOPY - TISSUE (1503-SRL) 14056 21084 28112 71 LARGE SPECIMEN (ONE BIG/TWO SMALL), TISSUE/PB (1507-SRL) 3575 5363 7150 72 BONE HISTOPATHOLOGY (1509-SRL) 806 1210 1614 73 MEDIUM BIOPSY SPECIMEN, TISSUE/PARAFFIN BLOCK (1511-SRL) 2761 4142 5522

FINE NEEDLE ASPIRATION (CYTOLOGY SMEARS), SMEARS (1515- 693 1040 1386 74 SRL) 75 NERVE BIOPSY (1532-SRL) 4888 7334 9778 76 COMPLEMENT C1q (1555-SRL) 1222 1834 2444 77 PHENOBARBITAL, SERUM (1560-SRL) 966 1449 1932 78 FERTILITY PANEL, SERUM (1578-SRL) 2872 4309 5744 79 LIPID ELECTROPHORESIS (1587-SRL) 4487 5160 5934 95

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80 CH-50 (COMPLEMENT, TOTAL), SERUM (1599-SRL) 4235 5718 8576 81 ACUTE LYMPHOBLASTIC LEUKEMIA PANEL (1606-SRL) 10878 16316 21756 82 ACUTE LEUKEMIA PANEL (1608-SRL) 9166 13750 18334 83 CHRONIC LYMPHOPROLIFERATIVE DISORDERS (1609-SRL) 11916 17875 23834

LYMPHOCYTE SUBSET(CD4% & ABSOLUTE COUNT), BLOOD (1659- 873 1311 1748 84 SRL) 85 LYMPHOCYTE ENUMERATION (1669-SRL) 6655 9075 12100 86 PNH DIAGNOSIS (FLOW CYTOMETRY), BLOOD (1672-SRL) 7944 11916 15888 87 ANTI ?2 GLYCOPROTEIN 1 IGM, SERUM (1719-SRL) 605 908 1210 88 ANTI ?2 GLYCOPROTEIN 1 IGG, SERUM (1720-SRL) 605 908 1210 89 GALACTOMANNAN, SERUM (1728-SRL) 5194 7791 10388 90 SERUM FREE LIGHT CHAINS (KAPPA & LAMBDA) (1732-SRL) 6722 10084 13444 91 HPV TYPING BY SEQUENCING (1819-SRL) 2078 3116 4156 92 HPV DNA DETECTOR (1820-SRL) 2628 3941 5256 93 HPV DUO (1821-SRL) 2750 4125 5500 94 PAP DUO-LBC+HPV DNA DETECTOR (1822-SRL) 2812 4216 5622 95 ANTINEUTROPHIL CYTOPLASMIC AB(ANCA), SERUM (1862-SRL) 2078 3116 4156 96 FACTOR VIII ACTIVITY, PLASMA (1947-SRL) 2688 4034 5378 97 FACTOR IX ACTIVITY, PLASMA (1949-SRL) 2322 3484 4644 98 FACTOR XIII ACTIVITY, PLASMA (1957-SRL) 1466 2200 2934 99 EBV TETRA PANEL (2066-SRL) 7088 10634 14178 100 ALLERGY PANEL 2 (29 ALLERGENS) (2109-SRL) 17061 17061 22330 101 HETEROPHILE ANTIBODIES (HA), SERUM (2116-SRL) 1100 1650 2200

N-TERMINAL PRO B-TYPE NATRIURETIC PEPTIDE, SERUM (2121- 5159 7739 10318 102 SRL) 103 METHYLMALONIC ACID, URINE (2124-SRL) 1956 2934 3912 104 EBV DNA PCR (2136-SRL) 6751 6751 13501 105 ALLERGY PANEL 3 (19 ALLERGENS) (2179-SRL) 12540 12540 16720 106 ASPERGILLUS ANTIBODIES, SERUM (2326-SRL) 2812 4216 5622 107 ASPERGILLUS FUMIGATUS DNA DETECTION (2327-SRL) 1004 1507 2009 108 CANDIDA ALBICANS DNA DETECTOR (2331-SRL) 8556 12834 17112 109 RAAS SCREENING (2333-SRL) 5622 8434 11244 110 STOOL - HANGING DROP METHOD (2368-SRL) 229 343 458 111 B2-MICROGLOBULIN, URINE (3143U-SRL) 1956 2934 3912 112 MYCOBACTERIUM SPECIATION (2402-SRL) 3933 5363 7150 113 H.PYLORI CULTURE (2403-SRL) 1210 1815 2420 114 LEGIONELLA SPP.CULTURE (2404-SRL) 1210 1815 2420 115 CULTURE: NEISSERIA GONORRHOEAE (2414-SRL) 966 1449 1932 116 MYCOREAL (2434-SRL) 2566 3850 5134 117 TB PCR (MYCOTECT) (2439-SRL) 2138 3209 4278 118 HEPATITIS A IGM, SERUM (2451-SRL) 1253 1879 2506 119 HEPATITIS B CORE ANTIBODIES (TOTAL), SERUM (2452-SRL) 1191 1788 2384 120 HEPATITIS B E ANTIBODY, SERUM (2455-SRL) 873 1311 1748 96

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121 HEPATITIS B E ANTIGEN, SERUM (2456-SRL) 873 1311 1748 122 HEPATITIS B CORE IGM, SERUM (2457-SRL) 1131 1696 2262 123 HEPATITIS DELTA IGG ANTIBODIES, SERUM (2458-SRL) 2628 3941 5256 124 HEPATITIS A ANTIBODIES, SERUM (2460-SRL) 2138 3209 4278 125 HEP B VIRUS EVALUATION (2461-SRL) 3912 5866 7822 126 HEP B EVALUATION (2462-SRL) 1528 2291 3056 127 HEP A & B EVALUATION (2463-SRL) 7334 11000 14666 128 HGV RT-PCR (2464-SRL) 4584 6875 9166 129 HAV RNA PCR (2478-SRL) 3912 5866 7822 130 ALPHA THALASSEMIA MUTATION DETECTION (2479-SRL) 2688 4034 5378 131 BETA THALASSEMIA MUTATION DETECTION (2482-SRL) 5543 6374 7330 132 SICKLE CELL PCR (2488-SRL) 2750 3713 5569 133 CHIKUNGUNYA IGM ANTIBODIES RAPID, SERUM (2492-SRL) 672 1009 1344 134 HIV ABS, WESTERN BLOT, SERUM (3012-SRL) 3544 5316 7088 135 VITAMIN B12 LEVEL, SERUM (3020-SRL) 1815 2723 3630 136 BREAST MONITOR I, SERUM (3022-SRL) 2200 3300 4400 137 ALLERGEN - FOOD PANEL 2 (3031-SRL) 3116 4675 6234 138 ALLERGEN - DUST PANEL (3033-SRL) 2781 4171 5562 139 ALLERGEN - MILK, SERUM (3037-SRL) 1320 1980 2640 140 ALLERGEN - ALTERNARIA TENUIS, SERUM (3050-SRL) 1573 2145 2860 141 ALLERGEN - ASPERGILLUS FUMIGATUS, SERUM (3053-SRL) 1210 1815 2420 142 ANTI-THYROID PEROXIDASE ANTIBODIES, SERUM (3062-SRL) 909 1362 1816 143 ALLERGEN - GLUTEN, SERUM (3065-SRL) 1210 1815 2420 144 ALLERGEN - FOOD PANEL 3 (3074-SRL) 3116 4675 6234 145 ALLERGEN - FOOD PANEL 7 (3075-SRL) 3238 4859 6478 146 ALLERGEN - BANANA, SERUM (3087-SRL) 1573 2145 2860 147 ALLERGEN - BARLEY, SERUM (3094-SRL) 1573 2145 2860 148 ALLERGEN - GREENPEPPER, SERUM (3097-SRL) 1320 1782 2673 149 ALLERGEN - ALMOND, SERUM (3101-SRL) 1573 2145 2860 150 ADRENOCORTICOTROPIC HORMONE, PLASMA (3102-SRL) 2016 3025 4034 151 ACTH STIMULATION TEST, 1-HOUR, SERUM (3103-SRL) 2384 3575 4766 152 ALDOSTERONE, SERUM (3105-SRL) 2812 4216 5622 153 ALPHA-FETOPROTEIN, SERUM (3109-SRL) 806 1210 1614 154 ALLERGEN - ACACIA, SERUM (3111-SRL) 1573 2145 2860 155 ANDROSTENEDIONE, SERUM (3113-SRL) 2384 3575 4766 156 ALLERGEN - JAPANESE CEDAR, SERUM (3115-SRL) 714 821 944 157 CA 19-9, SERUM (3120-SRL) 1454 2181 2908 158 CA 125 (OVARIAN CANCER MONITOR), SERUM (3121-SRL) 1246 1870 2494 159 IMMUNOFIXATION EP, SERUM (3125-SRL) 7028 10541 14056 160 CALCITONIN (THYROCALCITONIN), SERUM (3126-SRL) 2688 4034 5378 161 CORTISOL, SERUM (3128-SRL) 847 1271 1694 162 ADENOSINE DEAMINASE (3131-SRL) 659 988 1318 163 CA 15-3, SERUM (3134-SRL) 2695 4043 5390 97

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164 C PEPTIDE, SERUM (3140-SRL) 1332 1999 2664 165 DEHYDROEPIANDROSTERONE, SERUM (3146-SRL) 3025 4125 5500 166 CYSTATIN C (QUANTITATIVE), SERUM (3149-SRL) 1284 1925 2566 167 DEHYDROEPIANDROSTERONE-S, SERUM (3150-SRL) 1069 1604 2138 168 ESTRADIOL, SERUM (3155-SRL) 572 858 1144 169 ESTRIOL,UNCONJUGATED, SERUM (3156-SRL) 1284 1925 2566 170 PROGESTERONE, SERUM (3163-SRL) 739 1109 1478 171 FERRITIN, SERUM (3170-SRL) 1155 1733 2310 172 FOLLICLE STIMULATING HORMONE, SERUM (3174-SRL) 505 757 1010 173 ALLERGEN: AMOXICILLIN, SERUM (3181-SRL) 1573 2145 2860 174 GROWTH HORMONE, SERUM (3182-SRL) 806 1210 1614 175 HCG, SERUM (3184-SRL) 825 1238 1650 176 ALLERGEN: AMPICILLIN, SERUM (3187-SRL) 1573 2145 2860 177 17-A-HYDROXYPROGESTERONE, SERUM (3190-SRL) 1748 2621 3496

GLUTAMIC ACID DECARBOXYLASE(GAD-65) IGG ANTIBODIES (3193- 7028 10541 14056 178 SRL) 179 INSULIN LIKE GROWTH FACTOR - I, SERUM (3194-SRL) 4338 6509 8678 180 LUTEINIZING HORMONE, SERUM (3198-SRL) 505 757 1010 181 PROLACTIN, SERUM (3206-SRL) 538 806 1076 182 ALLERGEN - APPLE, SERUM (3210-SRL) 1573 2145 2860 183 PLASMA RENIN ACTIVITY (3216-SRL) 5316 7975 10634 184 SEX HORMONE BINDING GLOBULIN, SERUM (3218-SRL) 2628 3941 5256 185 ALLERGEN - SPINACH, SERUM (3225-SRL) 1320 1782 2673 186 PROCALCITONIN, SERUM (3226-SRL) 3850 5775 7700 187 TESTOSTERONE,FREE/TOTAL, SERUM (3248G-SRL) 3594 4133 4753 188 TSH 3RD GENERATION ULTRA( TSH3 - UL), SERUM (3250-SRL) 803 1205 1606 189 THYROGLOBULIN, SERUM (3251-SRL) 1822 2731 3642 190 DRUG ALLERGENS (3257-SRL) 3513 5271 7028 191 CARCINO EMBRYONIC ANTIGEN, SERUM (3258-SRL) 739 1109 1478 192 PREGNANCY ASSOCIATED PLASMA PROTEIN A, SERUM (3300-SRL) 1686 2530 3374 193 ANTI - CCP ANTIBODIES, SERUM (3301-SRL) 2849 4274 5698 194 ANTI SOLUBLE LIVER ANTIGEN, SERUM (3303-SRL) 1834 2750 3666 195 CATECHOLAMINES, PLASMA (3304-SRL) 8312 12466 16622 196 PARVOVIRUS B19 DNA (3305-SRL) 4950 4950 9900 197 IMMUNOREACTIVE TRYPSINOGEN, DRIED BLOOD SPOT (3307-SRL) 404 605 806 198 TOTAL GALACTOSE, DRIED BLOOD SPOT (3309-SRL) 322 484 646

17-ALPHA-HYDROXYPROGESTERONE, DRIED BLOOD SPOT (3311- 304 454 606 199 SRL) 200 METANEPHRINES, URINE (3317-SRL) 2078 3116 4156 201 INHIBIN B, SERUM (3339-SRL) 2176 3264 4352

New ServiesBORN SCREENING FOR ACYLCARNITINE- 5600 8400 11200 202 AMINOACIDS,DBS (3358-SRL) 203 CARDIOLIPIN ANTIBODIES, SERUM (3371-SRL) 1528 2291 3056 98

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204 ALLERGEN - AUBERGINE (BRINJAL) (3372-SRL) 1573 2145 2860 205 ECZEMA / GIT (VEG) PANEL (3375-SRL) 4706 7059 9412 206 ECZEMA / GIT (NON-VEG & VEG) PANEL (3376-SRL) 6416 9625 12834 207 COMPREHENSIVE RHINITIS / ASTHMA MINI PANEL (3377-SRL) 5194 7791 10388 208 VITAMIN A, SERUM/ EDTA PLASMA (3511-SRL) 3544 5316 7088 209 VITAMIN B1, SERUM/ EDTA PLASMA (3512-SRL) 2444 3666 4888 210 VITAMIN B2, SERUM/ EDTA PLASMA (3513-SRL) 2688 4034 5378 211 VITAMIN B6, SERUM / EDTA PLASMA (3514-SRL) 2994 4491 5988 212 VITAMIN C, EDTA PLASMA (3516-SRL) 2812 4216 5622 213 FOLIC ACID, SERUM (3522-SRL) 1210 1815 2420 214 RBC FOLATE, BLOOD (3523-SRL) 2262 3391 4522 215 ENTEROQUICK (3525-SRL) 1320 1518 1746 216 FREE PSA, SERUM (3545-SRL) 2026 2026 4052 217 PSA FREE & TOTAL, SERUM (3547-SRL) 1772 2659 3544 218 MYOGLOBIN,SERUM (3612-SRL) 1956 2934 3912 219 HAMS (ACIDIFIED-SERUM) TEST, BLOOD (3832-SRL) 1284 1925 2566 220 HEMOGLOBIN VARIANT ANALYSIS, BLOOD (3834-SRL) 1793 2690 3586 221 PROTEIN C ACTIVITY, PLASMA (3836-SRL) 3972 5959 7944 222 PROTEIN S ACTIVITY, PLASMA (3837-SRL) 3972 5959 7944 223 PARANEOPLASTIC DISORDER PROFILE (3861-SRL) 5194 7791 10388 224 HEMOPHILIA PANEL (3897-SRL) 3666 5500 7334 225 FRUCTOSAMINE, SERUM / PLASMA EDTA (3935-SRL) 1131 1696 2262 226 CYFRA 21-1, SERUM (3938-SRL) 3429 5143 6856 227 PARATHYROID HORMONE (INTACT), SERUM/PLASMA (3944-SRL) 2431 3647 4862 228 CHROMOGRANIN A, SERUM (3951-SRL) 7212 10816 14422 229 IGF-BP3, SERUM (3960-SRL) 4278 6416 8556 230 RSV-RESPIRATORY SYNCYTIAL VIRUS -IGG (SERUM,EIA) (3963-SRL) 3666 5500 7334 231 RSV-RESPIRATORY SYNCYTIAL VIRUS -IGM (SERUM,EIA) (3964-SRL) 3666 5500 7334 232 ORGANIC ACIDS SCREEN, URINE (3966-SRL) 7028 10541 14056 233 INHIBIN A, SERUM (3983-SRL) 2138 3209 4278 234 FLEXI ALLERGY PANEL (ANY 5 ALLERGENS) (4010-SRL) 5858 5858 7810 235 FLEXI ALLERGY PANEL (ANY 10 ALLERGENS) (4012-SRL) 10890 10890 14520 236 ALCOHOL (ETHANOL), URINE (4100-SRL) 2621 3933 5244 237 TETRAHYDROCANNABINOL, URINE (4101-SRL) 1210 1815 2420 238 PHENYTOIN, SERUM (4103-SRL) 909 1362 1816 239 CARBAMAZEPINE, SERUM (4116-SRL) 909 1362 1816 240 CA 72-4, SERUM (4117-SRL) 2138 3209 4278 241 METHAMPHETAMINE, URINE (4130-SRL) 1210 1815 2420 242 DRUGS OF ABUSE - 9 DRUGS (4131-SRL) 8866 13299 17732 243 DRUGS OF ABUSE - 6 DRUGS (4132-SRL) 3178 4766 6356 244 DRUGS OF ABUSE - 5 DRUGS (4133-SRL) 2432 3649 4864 245 URINE - PCP (PHENCYCLIDINE), URINE (4139-SRL) 1210 1815 2420 246 COCAINE - URINE (4140-SRL) 1210 1815 2420 99

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247 PORPHOBILINOGEN, URINE (4170-SRL) 2083 3126 4168 248 D-DIMER, PLASMA (4200-SRL) 1540 2310 3080 249 METHAEMOGLOBIN ESTIMATION, BLOOD (4202-SRL) 1038 1559 2078 250 FIBRINOGEN DEGREDATION PRODUCTS (FDP), PLASMA (4208-SRL) 1588 2384 3178 251 URINARY OXALATE, 24HRS URINE (4332-SRL) 2066 3099 4132 252 ALLERGEN -PHADIATOP ADULT, SERUM (4430-SRL) 1155 1560 2339 253 LITHIUM, SERUM (4871-SRL) 384 575 768 254 URINE SUPERSATURATION PANEL (5002-SRL) 2353 3529 4706 255 SCLERODERMA DIAGNOSTIC PROFILE (5003-SRL) 7260 10890 14520 256 STD DIAGNOSTIC PANEL (5005-SRL) 11573 11573 23146 257 ARTHRITIS PANEL (RHEUMATOID ARTHRITIS PANEL) (5008-SRL) 2262 3391 4522 258 GASTRIN, SERUM (3175-SRL) 1712 2566 3422 259 SPERM ANTIBODIES, SERUM (5225-SRL) 1344 2016 2688 260 HAEMOPHILUS INFLUENZAE TYPE B ANTIGEN, SERUM (9606-SRL) 1210 1815 2420 261 FUNGAL STAIN (5323-SRL) 780 1169 1560

PHILADELPHIA CHROMOSOME (BCR / ABL QUALITATIVE) (5350- 5806 8709 11612 262 SRL) 263 TNF ? ALPHA (SERUM) (5433-SRL) 5750 6613 7605 264 AFB SUSC. SIREP PANEL (5649-SRL) 5622 8434 11244 265 FUNGAL SUSCEPTIBILITY (5660-SRL) 5434 6249 7186 266 CAMPYLOBACTER CULTURE (5704-SRL) 1650 2475 3300 267 ANAEROBIC CULTURE (5708-SRL) 978 1466 1956

CHROMOSOME ANALYSIS: HEMATOLOGICAL DISORDERS (5800- 4034 6050 8066 268 SRL) 269 CHROMOSOME BREAKAGE TEST ? FANCONI?S ANEMIA (5812-SRL) 7638 11459 15278 270 NEONATAL KARYOTYPING (5815-SRL) 3238 4859 6478 271 PHILADELPHIA CHROMOSOME (5834-SRL) 4828 7241 9656 272 ACTIVATED PROTEIN C RESISTANCE (APC-R), PLASMA (5901-SRL) 4828 7241 9656 273 TACROLIMUS (5950-SRL) 4125 6188 8250 274 ANTITHROMBIN ACTIVITY, PLASMA (5951-SRL) 4216 6325 8434 275 ANTI THROMBIN III ANTIGEN, PLASMA (5952-SRL) 6112 9166 12222 276 LUPUS ANTICOAGULANT (5964-SRL) 1894 2841 3788 277 HEPATITIS A VIRUS IGG ANTIBODY (HAV IGG), SERUM (6014-SRL) 1284 1925 2566 278 COMPREHENSIVE DIGESTIVE STOOL ANALYSIS (CDSA) (7006-SRL) 37510 51150 68200 279 HAPTOGLOBIN GENOTYPING - PCR (7375-SRL) 3606 5409 7212 280 C TRACHOMATIS DNA DETECTOR (7437-SRL) 3362 5041 6722 281 HEPATITIS C VIRUS RNA GENOTYPING (7473-SRL) 24200 36300 48400 282 HBV GENOTYPING BY PCR (7474-SRL) 7028 10541 14056 283 HBV BASAL CORE PROMOTER MUTATION (7475-SRL) 5324 7260 9680 284 HBV PRECORE MUTATION (7476-SRL) 5324 7260 9680 285 HCV RNA QUANTITATIVE (7486-SRL) 9166 13750 18334 286 LEPTOSPIRA IGG, SERUM (7551-SRL) 1454 2181 2908 287 CYTOMEGALOVIRUS DNA DETECTOR (7575-SRL) 6655 6655 13310 100

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288 CMV VIRAL LOAD REAL TIME PCR (7576-SRL) 6416 9625 12834 289 CMV VIRAL LOAD/ GCV RESISTANCE - CMV COMBI TEST (7578-SRL) 12100 16500 22000 290 HERPES SIMPLEX VIRUS DNA DETECTOR (7581-SRL) 3972 5959 7944 291 ADENOVIRUS PCR (7589-SRL) 3972 5959 7944 292 DENGUE RNA PCR 600 600 600 293 LEPTOSPIRA IGM, SERUM (7621-SRL) 1454 2181 2908 294 DENGUE VIRUS IGM, SERUM (7646-SRL) 660 660 660 295 DENGUE NS1 ANTIGEN TEST, SERUM (7648-SRL) 2354 3531 4708 296 CRYPTOSPORIDIUM ANTIGEN DETECTION (7661-SRL) 1344 2016 2688 297 HELICOBACTER PYLORI IGA ANTIBODIES, SERUM (7736-SRL) 2812 4216 5622 298 ACUTE HEPATITIS VIRUS EVALUATION - II (7755-SRL) 5500 8250 11000 299 HEPATITIS ACUTE EVALUATION 1, SERUM (7756-SRL) 3544 5316 7088 300 ACUTE HEPATITIS VIRUS - EVALUATION - III (7757-SRL) 5806 8709 11612 301 HELICOBACTER PYLORI IGG ANTIBODIES, SERUM (7761-SRL) 2812 4216 5622 302 HTLV I & II ANTIBODIES, SERUM (7781-SRL) 3912 5866 7822 303 HELICOBACTER PYLORI IGM ANTIBODIES, SERUM (7986-SRL) 2812 4216 5622 304 FLU REAL TIME PCR (8008-SRL) 4950 4950 4950 305 HERPES SIMPLEX VIRUS 1&2 IGG & IGM, SERUM (8051-SRL) 2188 3281 4376 306 HBV DNA QUANTITATIVE (8136-SRL) 10362 15543 20724 307 HEPATITIS B VIRUS DNA DETECTOR (8141-SRL) 10416 10416 20832 308 JAK2 V617F MUTATION DETECTION (8386-SRL) 7865 10725 14300 309 HDV RT-PCR (8400-SRL) 4584 6875 9166 310 BISMUTH, BLOOD (8407-SRL) 4584 6875 9166 311 ENTAMOEBA HISTOLYTICA ANTIBODIES, SERUM (8441-SRL) 1834 2750 3666 312 MYCOPLASMA PNEUMONIAE IGG ANTIBODIES, SERUM (8746-SRL) 2384 3575 4766 313 VARICELLA ZOSTER IGG, SERUM (8761-SRL) 1956 2934 3912 314 VARICELLA ZOSTER IGM, SERUM (8766-SRL) 1956 2934 3912 315 MEASLES IGG & IGM (8771-SRL) 3056 4584 6112 316 MEASLES IGG ANTIBODIES, SERUM (8776-SRL) 1772 2659 3544 317 MEASLES IgM ANTIBODIES, SERUM (8781-SRL) 1610 1852 2130 318 25 - HYDROXYVITAMIN D, SERUM (8823-SRL) 2398 3597 4796 319 1, 25 DIHYDROXY VITAMIN D, SERUM (8825-SRL) 4851 7277 9702 320 ANTI DIURETIC HORMONE (VASOPRESSIN), PLASMA (8827-SRL) 5324 7260 9680 321 BRUCELLA IGG & IGM ANTIBODIES, SERUM (8831-SRL) 3025 4125 5500 322 T. PALLIDUM HEMAGGLUTINATION, SERUM (9020-SRL) 806 1210 1614 323 VWF ANTIGEN, PLASMA (9050-SRL) 9378 12788 17050 324 VON WILLEBRAND FACTOR, PLASMA (9052-SRL) 15462 23191 30922 325 RAPID KALAZAR TEST, SERUM (9074-SRL) 1650 2475 3300 326 RAPID TYPHI IGM, SERUM/PLASMA EDTA/EDTA WB (9075-SRL) 792 1188 1584 327 ARSENIC, BLOOD (9141-SRL) 3606 5409 7212 328 LEAD, BLOOD (9142-SRL) 2078 3116 4156 329 CADMIUM, BLOOD (9143-SRL) 3606 5409 7212 330 COPPER, SERUM (9144-SRL) 1681 2521 3362 101

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331 ZINC, SERUM (9145-SRL) 2572 3507 4675 332 CRYPTOCOCCUS NEOFORMANS DNA DETECTOR (9188-SRL) 8250 12375 16500 333 CRYPTOCOCCUS ANTIGEN, SERUM (9189-SRL) 2384 3575 4766 334 MYOGLOBIN, URINE (URINE SPOT, ECLIA)) (9273-SRL) 3025 4125 5500 335 TISSUE TRANSGLUTAMINASE IGA, SERUM (9362-SRL) 1980 2970 3960 336 CHLAMYDIA TRACHOMATIS ANTIBODIES, SERUM (9404-SRL) 6944 6944 13889 337 CHLAMYDIA TRACHOMATIS IGG, SERUM (9406-SRL) 2314 2314 4629 338 CHLAMYDIA PNEUMONIAE IGG ANTIBODIES, SERUM (9408-SRL) 2200 3300 4400 339 CHLAMYDIA PNEUMONIAE IGM ANTIBODIES, SERUM (9409-SRL) 2200 3300 4400 340 CHLAMYDIA TRACHOMATIS IGM, SERUM (9411-SRL) 2314 2314 4629 341 RUBELLA RNA PCR (9415-SRL) 2934 4400 5866 342 CYTOMEGALOVIRUS IGG, SERUM (9431-SRL) 909 1362 1816 343 RUBELLA IGG AVIDITY, SERUM (9434-SRL) 1815 2475 3300 344 HERPES SIMPLEX VIRUS-1 IGG, SERUM (9451-SRL) 927 1392 1856 345 HERPES SIMPLEX VIRUS-1 IGM, SERUM (9456-SRL) 927 1392 1856 346 HERPES SIMPLEX VIRUS-2 IGG, SERUM (9461-SRL) 927 1392 1856 347 HERPES SIMPLEX VIRUS-2 IGM, SERUM (9466-SRL) 927 1392 1856 348 BACTERIAL ANTIGEN DETECTION, SERUM (9601-SRL) 5744 6606 7597 349 PANFUNGAL DETECTION AND IDENTIFICATION PANEL (9602-SRL) 20125 23144 26616 350 STREPTOCOCCUS PNEUMONIAE ANTIGEN, SERUM (9636-SRL) 1320 1518 1746 351 STREPTOCOCCUS GROUP B ANTIGEN, SERUM (9641-SRL) 1226 1410 1622 352 MUMPS IGG & IGM ANTIBODIES (9711-SRL) 3544 5316 7088 353 MUMPS IGG ANTIBODIES, SERUM (9716-SRL) 1956 2934 3912 354 MUMPS IGM ANTIBODIES, SERUM (9721-SRL) 1956 2934 3912 355 NEISSERIA GONORRHOEAE DNA PCR (9801-SRL) 5980 5980 11959 356 MTHFR GENE MUTATION (9802-SRL) 9166 13750 18334 357 BACTERIAL MENINGITIDIS MULTIPLEX PCR (9883-SRL) 3484 5225 6966 358 HIV 1 VIRAL LOAD (9885-SRL) 5866 8800 11734 359 BACTERIAL PNEUMONIA PANEL (9886-SRL) 5744 8616 11488 360 VIRAL PNEUMONIA PANEL - I (9887-SRL) 5316 7975 10634 361 VIRAL PNEUMONIA PANEL II (9888-SRL) 9075 9075 18150 362 HEPATITIS B VIRUS DNA QUANTITATIVE (9890-SRL) 9343 14016 18688 363 HEPATITIS C VIRUS RNA QUANTITATIVE (9891-SRL) 10362 15543 20724 364 FACTOR II (PROTHROMBIN) MUTATION DETECTION (9893-SRL) 7088 10634 14178 365 FACTOR V MUTATION DETECTION (9894-SRL) 5837 8754 11672 366 TORCH IGG & IGM ABS (EIA) (9901-SRL) 3300 4950 6600 367 B-CELL GENE REARRANGEMENT PCR (9907-SRL) 14666 22000 29334 368 T-CELL GENE REARRANGEMENT BY PCR (9909-SRL) 14666 22000 29334 369 TORCH IGM [5 PARAMETERS] (9912-SRL) 1822 2731 3642 370 HLA ?C LOCUS TYPING (9913-SRL) 10285 14025 18700 371 HLA ?DQ LOCUS TYPING (9914-SRL) 10285 14025 18700 372 HLA DQ TYPING - CELIAC DISEASE (9920-SRL) 12538 12538 25076 373 CYSTINE, URINE (9923-SRL) 9350 12623 18934 102

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374 HIV DRUG RESISTANCE REPORT (9930-SRL) 24200 33000 44000 375 JC/BK DNA PCR (9937-SRL) 6292 8580 11440 376 INTERLEUKIN 6, SERUM (9949-SRL) 3594 4133 4753 377 MDR-TB RAPID GENOTYPIC TEST (9950-SRL) 1834 2750 3666 378 5-HYDROXY- 3-INDOLE ACETIC ACID (5-HIAA), URINE (9952-SRL) 6751 6751 13501 379 MYCOBACTERIUM SPECIATION ? EXTENDED (9955-SRL) 7865 10725 14300 380 MYCOBACTERIUM SPECIATION - COMMON (9956-SRL) 7865 10725 14300

GENOTYPIC ASSAY ? TB SECOND LINE DRUG RESISTANCE (9957- 7865 10725 14300 381 SRL) 382 TETANUS IGG ANTIBODY, SERUM (9963-SRL) 10320 10320 20640 383 DIPTHERIA IGG ANTIBODY, SERUM (9964-SRL) 7715 7715 15431 384 HLA A, B, DR LOCI TYPING PCR (9971-SRL) 20570 28050 37400 385 ALKALINE PHOSPHATASE ISOENZYMES, SERUM (9992-SRL) 835 1253 1670 386 ACETONE, SERUM (0011LS-SRL) 538 806 1076 387 HOMOGENTISIC ACID URINE (0017LS-SRL) 659 988 1318 388 AUTOIMMUNE HEPATITIS PANEL 1 (1019A-SRL) 4584 6875 9166 389 AUTOIMMUNE HEPATITIS PANEL 2 (1019B-SRL) 3637 5454 7272 390 ANTIPHOSPHOLIPID EVAL (1080A-SRL) 5748 7838 10450

ANTI-GLOMERULAR BASEMENT MEMBRANE IGG ANTIBODIES 1987 2979 3972 391 (1135I-SRL) 392 CRYOGLOBULIN, SERUM (1158CG-SRL) 1088 1631 2176 393 CULTURE BODY FLUID - BACTEC PLUS ANAEROBIC (1195NP-SRL) 752 1130 1506 394 C DIFFICILE TOXIN A/B (1218T-SRL) 2444 3666 4888 395 ANTI MPO AUTOANTIBODIES, SERUM (1295I-SRL) 1772 2659 3544 396 ANTI PR3 AUTOANTIBODIES, SERUM (1296I-SRL) 1698 2549 3398 397 INSULIN, FASTING SERUM (3192-SRL) 927 1392 1856 398 ALDOLASE, SERUM (1391D-SRL) 1210 1815 2420 399 INSULIN, SERUM (POST-PRANDIAL) (3192A-SRL) 1640 1640 3280 400 MYCOBACTERIA DETECTION A-R SMEAR (1122-SRL) 265 265 265 401 MYCOBACTERIA IGA, SERUM (1414C-SRL) 840 1262 1682

ACID FAST BACILLI CULTURE ( BLOOD & / BONE MARROW) 1331 1997 2420 402 (1464BA-SRL) 403 AFB SUSCEPTIBILITY - MGIT 960 (5 DRUGS) (1464R1-SRL) 6234 9350 12466 404 AFB SUSCEPTIBILITY - MGIT 960 (10 DRUGS) (1464R2-SRL) 9656 14484 19312

RAPID GROWING MOTT DRUG SUSCEPTIBILITY TEST (1464RGM- 14850 14850 19800 405 SRL) 406 AFB STAIN & BACTEC CULTURE (3 SAMPLES) (1464S-SRL) 2893 2893 5786 407 AFB STAIN & BACTEC CULTURE (5 SAMPLES) (1464U-SRL) 1882 2824 3764 408 C4D IMMUNOFLUORESCENCE (1500CD-SRL) 2122 2122 4244 409 RETURN OF PARAFFIN BLOCK/ SLIDE (1500R-SRL) 134 201 268 410 COMPLEMENT C3, SERUM (1501D-SRL) 659 988 1318 411 COMPLEMENT C4, SERUM (1504D-SRL) 659 988 1318 412 TOTAL IGG, SERUM (1505D-SRL) 840 1262 1682 103

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413 TOTAL IGA, SERUM (1506D-SRL) 873 1311 1748 414 TOTAL IGM, SERUM (1508D-SRL) 1476 2214 2952 415 ALPHA-1-ANTITRYPSIN, SERUM (1512D-SRL) 2138 3209 4278 416 CERULOPLASMIN, SERUM (1516D-SRL) 1222 1834 2444 417 TRANSFERRIN, SERUM (1519HD-SRL) 1332 1999 2664 418 DIRECT LDL CHOLESTEROL, SERUM (1533D-SRL) 376 564 752 419 HIGH SENSITIVITY C-REACTIVE PROTEIN, SERUM (1537D-SRL) 1111 1667 2222 420 RHEUMATOID FACTOR QUANTITATIVE, SERUM (1540D-SRL) 1294 1294 1294 421 DIGOXIN, SERUM (1548H-SRL) 966 1449 1932 422 THEOPHYLLINE, SERUM (1563I-SRL) 909 1362 1816 423 ELECTROPHORESIS, CSF (1580C-SRL) 773 1161 1548 424 ELECTROPHORESIS,URINE (1580U-SRL) 773 1161 1548 425 LYMPHOCYTE SUBSET (T-CELLS), BLOOD (1656B-SRL) 1815 2723 3630 426 LYMPHOCYTE SUBSET ENUMERATION, BLOOD (1657B-SRL) 2262 3391 4522 427 CD25 (IL2 RECEPTOR) (1674BM-SRL) 4822 4822 9645 428 CD38-PERCENT (1674BQ-SRL) 2757 4134 5512 429 CD19-PERCENT, BLOOD (1675BA-SRL) 4050 4050 8100 430 CD20-PERCENT (1675BB-SRL) 4050 4050 8100 431 CD-5, PERCENT (1675BD-SRL) 3388 4620 6160 432 ANTI PHOSPHOLIPID IGG ANTIBODIES (1711T-SRL) 175 262 350 433 ER/PGR,IHC (ESTROGEN RECEPTOR), TISSUE/PB (1830K-SRL) 2291 3438 4584 434 APOLIPOPROTEIN - A1, SERUM (1901D-SRL) 639 959 1278 435 APOLIPOPROTEIN - B, SERUM (1903D-SRL) 639 959 1278 436 PARVOVIRUS B19 IGG ANTIBODIES, SERUM (2067I-SRL) 3300 4455 6683 437 PARVOVIRUS B19 IGM ANTIBODIES, SERUM (2068I-SRL) 3300 4455 6683 438 BORRELIA BURGDORFERI IGG, SERUM (2069I-SRL) 1834 2750 3666 439 BORRELIA BURGDORFERI IGM ANTIBODIES, SERUM (2070I-SRL) 1894 2841 3788 440 EBV (VCA) IGG, SERUM (2116EG-SRL) 2138 3209 4278 441 EBV (VCA) IGM, SERUM (2116EM-SRL) 3087 3087 6173 442 EBV (EA) IGG, SERUM (2126EG-SRL) 1956 2934 3912 443 TORCH IGM EVALUATION, SERUM (2231M-SRL) 1650 2475 3300 444 TOXOPLASMA ANTIBODIES, SERUM (2261M-SRL) 1331 1997 2662 445 EBV (NA) IGG, SERUM (2266EG-SRL) 1956 2934 3912 446 EBV (NA) IGM, SERUM (2266EM-SRL) 1956 2934 3912 447 NEISSERIA MENINGITIDIS ANTIGEN, SERUM (9611-SRL) 2096 2410 2772 448 HEPATITIS B SURFACE ABS (QUANT), SERUM (2453QN-SRL) 773 1161 1548 449 HEPATITIS E IGG, SERUM (2466G-SRL) 1681 2521 3362 450 HEPATITIS E IGM, SERUM (2466M-SRL) 1650 2475 3300 451 RUBELLA IGM, SERUM (2475M-SRL) 909 1362 1816 452 CYTOMEGALOVIRUS IGM, SERUM (2486M-SRL) 909 1362 1816 453 COXSACKIE ANTIBODY - IGG, SERUM (2547I-SRL) 7427 7427 14854 454 COXSACKIE ANTIBODY - IGM, SERUM (2548I-SRL) 7427 7427 14854 455 ALDOSTERONE 24 HR,URINE (3104U-SRL) 6171 8415 11220 104

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456 ALPHA FETOPROTEIN, AMNIOTIC FLUID (3109AF-SRL) 1029 1403 1870 457 ANGIOTENSIN CONVERTING ENZYME CSF (3114C-SRL) 2200 3300 4400 458 ANGIOTENSIN CONVERTING ENZYME, SERUM (3114D-SRL) 1162 1741 2322 459 IMMUNOFIXATION ELEC,CSF (3125C-SRL) 8250 12375 16500 460 IMMUNOFIXATION EP,URINE (3125U-SRL) 8250 12375 16500 461 CORTISOL,FREE,24HR URINE (3128U-SRL) 672 1009 1344 462 OSMOLALITY, 24 HRS URINE (3231U24-SRL) 1725 1984 2282 463 TOTAL TSH, SERUM (3250C-SRL) 935 1403 1870 464 CATECHOLAMINES, URINE (3304U-SRL) 8312 12466 16622 465 VANILLYL MANDELIC ACID, URINE (3318U-SRL) 3850 5775 7700 466 NEONATAL SCREENING PANEL - 3 (3328IC-SRL) 538 806 1076 467 VALPROIC ACID, SERUM (3360H-SRL) 909 1362 1816 468 LIPASE, SERUM (3369D-SRL) 1045 1568 2090 469 ANTI CARDIOLIPIN ANTIBODIES IGG, SERUM (3371G-SRL) 773 1161 1548 470 ANTI CARDIOLIPIN ANTIBODIES IGM, SERUM (3371M-SRL) 773 1161 1548 471 LIPOPROTEIN (A), SERUM (3446D-SRL) 1284 1925 2566 472 AMPHETAMINE, URINE (4134U-SRL) 1210 1815 2420 473 BARBITURATES, URINE (4135U-SRL) 1210 1815 2420 474 BENZODIAZEPINES, URINE (4136U-SRL) 1210 1815 2420 475 CANNABINOIDS, URINE (4137U-SRL) 1210 1815 2420 476 OPIATES,URINE (4138U-SRL) 1210 1815 2420 477 CYCLOSPORINE, EDTA/HEPARIN WHOLE BLOOD (4314I-SRL) 3238 4859 6478 478 THALASSEMIA PROFILE (4970B-SRL) 1576 2365 3154 479 AFB SMEARS - 3 SAMPLES (5320S-SRL) 825 1238 1650 480 PNEUMOCYSTIS CARINII DETECTION (7745S-SRL) 2566 3850 5134

PHILADELPHIA CHROMOSOME (BCR/ABL - QUANTITATIVE) 7272 10909 14544 481 (5350QN-SRL) 482 BLOOD LYMPHO CULTURE (5814B-SRL) 3238 4859 6478

DOWNS SYNDROME/ AMBIGUOUS EXTERNAL GENITALIA (5814F- 3238 4859 6478 483 SRL) 484 BCR-ABL T(9;22) BY FISH (6001F-SRL) 5806 8709 11612 485 HER 2/ NEU (6006F-SRL) 12834 19250 25666 486 EGFR (FISH) (6016F-SRL) 7212 10816 14422 487 DELETION 13Q BY FISH (6017F-SRL) 5806 8709 11612 488 MYELODYSPLASTIC SYNDROME EVALUATION (FISH) (6018F-SRL) 15525 17854 20532 489 L-LACTATE, CSF (7441CD-SRL) 1210 1815 2420 490 L-LACTATE, FLUORIDE PLASMA (7441D-SRL) 1210 1815 2420 491 HCV RNA QUALITATIVE PCR (7516A-SRL) 9992 9992 19985 492 DENGUE DUO RAPID SCREENING TEST, SERUM (7599R-SRL) 600 600 600 493 TOXOPLASMA IGM, SERUM (7661M-SRL) 793 1190 1586 494 RAPID FILARIA ANTIGEN (7664R-SRL) 519 779 1038 495 MYCOPLASMA PNEUMONIAE IGM, SERUM (8746M-SRL) 2384 3575 4766 496 BRUCELLA IGG ANTIBODIES, SERUM (8831G-SRL) 1466 2200 2934 105

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497 BRUCELLA IGM ANTIBODIES, SERUM (8831M-SRL) 1466 2200 2934 498 SYPHILIS ANTIBODIES, SERUM (9020E-SRL) 1162 1741 2322 499 ARSENIC, 24 HRS URINE (9141U24-SRL) 2812 4216 5622 500 CADMIUM, 24 HRS URINE (9143U24-SRL) 3606 5409 7212 501 COPPER, RANDOM URINE (9144U-SRL) 3235 3720 4278 502 COPPER, 24 HRS URINE (9144U24-SRL) 2016 3025 4034 503 COBALT, 24 HRS URINE (9149U24-SRL) 3606 5409 7212 504 CRYPTOCOCCUS ANTIGEN, CSF (9189C-SRL) 2384 3575 4766 505 ANA POSITIVE REFLEX TO ENA PROFILE (9206RFX-SRL) 3630 4950 6600 506 ANCA POSITIVE REFLEX MPO, PR3 ANTIBODIES (9207RFX-SRL) 3362 5041 6722

CSF BACTERIAL CULTURE REFLEXS TO ANTIGEN DETECTION 5866 8800 11734 507 (9208RFX-SRL) 508 CSF FUNGAL CULTURE REFLEX ANTIGEN DETECTION (9209RFX-SRL) 776 776 776 509 RUBELLA IGG ANTIBODIES, SERUM (9416M-SRL) 909 1362 1816 510 RUBELLA IGG & IGM, SERUM (9421M-SRL) 1528 2291 3056 511 TOXOPLASMA IGG, SERUM (9426M-SRL) 793 1190 1586 512 HSV 1&2 IGM ABS COMBINED (9471P-SRL) 1210 1815 2420 513 BACTERIAL ANTIGENS, CSF (9601C-SRL) 5744 6606 7597 514 INFLUENZA VIRUS B IGM, SERUM (9607I-SRL) 2444 2811 3233 515 INFLUENZA VIRUS A IGM, SERUM (9610I-SRL) 2444 2811 3233 516 NEISSERIA MENINGITIDIS ANTIGEN, CSF (9611C-SRL) 2174 2500 2875 517 STREPTOCOCCUS PNEUMONIAE ANTIGEN, CSF (9636C-SRL) 1226 1410 1622 518 STREPTOCOCCUS GROUP B ANTIGEN,CSF (9641C-SRL) 1226 1410 1622 519 STREPTOCOCCUS GROUP B ANTIGEN, URINE (9641U-SRL) 1226 1410 1622 520 CYSTICERCUS IGG ANTIBODIES, SERUM (9816S-SRL) 1894 2841 3788 521 HIV P24 ANTIGEN (9882-SRL) 404 605 806 522 HIV DNA DETECTOR (9885B-SRL) 3362 5041 6722 523 TORCH IGG EVALUATION, SERUM (9911M-SRL) 1698 2549 3398 524 INTRINSIC FACTOR IGG, SERUM (9919I-SRL) 2262 3391 4522 525 ADENOVIRUS IGG, SERUM (9921I-SRL) 1588 2384 3178 526 ADENOVIRUS IGM, SERUM (9924I-SRL) 1588 2384 3178 527 ADRENALIN, PLASMA (9951P-SRL) 3637 5454 7272 528 ADRENALIN, URINE (9951U-SRL) 6210 6210 6210 529 NOR-ADRENALIN PLASMA (9953P-SRL) 3606 5409 7212 530 NOR-ADRENALIN, URINE (9953U-SRL) 5175 5951 6844 531 AFB LJ SUSC - CYCLOSERINE (CY5653-SRL) 1134 1134 2268 532 VACCICHEQ (DT3203-SRL) 7938 10824 14432 533 HIV EARLY SCREEN (DT4201-SRL) 1009 1513 2016 534 HIV MONITOR (VIRAL LOAD, CD4 / CD8), BLOOD (DT4202-SRL) 6234 9350 12466

HIV ROCHE COBAS MONITOR (VIRAL LOAD, CD4 / CD8) (DT4204- 12705 17325 23100 535 SRL) 536 HIV-1 MONITOR (DT4206-SRL) 7260 9900 13200 537 OBEY - CT PANEL II (DT8102-SRL) 3666 5500 7334 106

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538 OT SURVEILLANCE (LC001-SRL) 1128 1522 2284 539 OT SURVEILLANCE - AEROBIC CULTURE (LC002A-SRL) 3025 4125 5500 540 WARFARIN SENSITIVITY BY GENOTYPING (RD1302-SRL) 13310 18150 24200 541 HBV DRUG RESISTANCE (RD1305-SRL) 8470 11550 15400 542 FOOD INTOLERANCE TEST (RD1306-SRL) 29700 29700 39600 543 KRAS MUTATION DETECTION (RD1307-SRL) 8470 11550 15400 544 CYP2C19 GENOTYPING (RD1311-SRL) 7986 10890 14520 545 KRAS CODON 61 MUTATION DETECTION (RD1315-SRL) 6413 8745 11660 546 XPERT MTB/RIF - PULMONARY (RD1324-SRL) 4345 6518 8690 547 DRPLA (ATN1) GENE ANALYSIS (RD1326-SRL) 6469 7439 8555 548 EGFR MUTATION DETECTION (RD1405-SRL) 7028 10541 14056 549 CUSTOM LEUKEMIA PANEL (SP1144-SRL) 5194 7791 10388 550 HER-2/NEU ONCOPROTEIN (IHC), TISSUE/PB (Z004K-SRL) 1956 2934 3912 551 KI-67, TISSUE/PARAFFIN BLOCK (Z006K-SRL) 3762 5643 7524 552 CUSTOM IHC PANEL (Z009K-SRL) 5177 7764 10352 553 CD45 IHC, TISSUE/PARAFFIN BLOCK (Z021K-SRL) 2444 3666 4888 554 CEA IHC, TISSUE/PARAFFIN BLOCK (Z043K-SRL) 2444 3666 4888 555 CK HMW IHC, TISSUE/PARAFFIN BLOCK (Z045K-SRL) 2554 3831 5108 556 VIMENTIN IHC, TISSUE/PARAFFIN BLOCK (Z047K-SRL) 2783 3795 5060 557 PAN CYTOKERATIN IHC, TISSUE/PB (Z055K-SRL) 2444 3666 4888 558 CA 125, TISSUE/PARAFFIN BLOCK (Z057K-SRL) 2444 3666 4888 559 CALRETENIN (Z058K-SRL) 2444 3666 4888 560 HEB B SURF AG IHC, TISSUE/PB (Z076K-SRL) 2783 3795 5060 561 CHROMOGRANIN A,IHC, TISSUE/PARAFFIN BLOCK (Z081K-SRL) 2444 3666 4888 562 ADRENOCORTICOTROPIC HORM, TISSUE/PB (Z161K-SRL) 2444 3666 4888 563 SPECIAL STAINS, TISSUE/PARAFFIN BLOCK (Z203K-SRL) 672 1009 1344 564 LEUCOCYTE ALKALINE PHOSPHATASE (LAP) SCORE (Z207K-SRL) 1528 2291 3056 565 ALK1 (Z209K-SRL) 3267 4455 5940 566 LYMPHOMA DIFFERENTIAL DIAGNOSIS (Z219-SRL) 7150 10725 14300 567 NON-HODGKINS LYMPHOMA VS HODGKINS DISEASE (Z220-SRL) 11411 13123 15091 568 ASPARTATE AMINOTRANSFERASE, SERUM (1345H-SRL) 385 578 770 569 ALANINE AMINOTRANSFERASE, SERUM (1347H-SRL) 385 578 770 570 ALBUMIN+GLOBULIN+A/G RATIO, SERUM (1580H-SRL) 188 283 376 571 AMYLASE, SERUM (3844D-SRL) 438 657 876 572 AMYLASE, 24HRS URINE (3844UHD-SRL) 559 838 1118 573 BILIRUBIN (TOTAL, DIRECT, INDIRECT), SERUM (1527H-SRL) 306 459 612 574 BILIRUBIN, TOTAL, SERUM (1088H-SRL) 306 459 612 575 UREA NITROGEN, 24HRS URINE (1079UH-SRL) 440 660 880 576 CALCIUM, 24HRS URINE (4836UH-SRL) 296 443 592 577 CHLORIDE, 24HRS URINE (1182UHD-SRL) 296 443 592 578 CHOLESTEROL, SERUM (3350HD-SRL) 220 330 440 579 HDL CHOLESTEROL, SERUM (1124HD-SRL) 318 476 636 580 CREATININE, 24HRS URINE (1320UH-SRL) 296 443 592 107

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581 CREATININE CLEARANCE, SERUM AND URINE (1322-SRL) 559 838 1118 582 CREATINE KINASE (CPK), SERUM (3976H-SRL) 538 806 1076 583 ELECTROLYTES (NA/K/CL), SERUM (1568HD-SRL) 875 1312 1749 584 ELECTROLYTES (NA/K/CL), 24HRS URINE (1568UHD-SRL) 525 787 1048 585 ORAL GLUCOSE TOLERANCE TEST - GESTATIONAL (1126BH-SRL) 909 1362 1816 586 GAMMA GLUTAMYL TRANSFERASE, SERUM (1294H-SRL) 392 586 782 587 GLUCOSE CHALLENGE TEST (1302GCT-SRL) 101 152 202 588 GLUCOSE, URINE (1302UH-SRL) 242 363 484 589 GLYCOSYLATED HEMOGLOBIN, EDTA WHOLE BLOOD (3180-SRL) 1287 1931 2574 590 IRON, SERUM (3532D-SRL) 443 666 888 591 TOTAL IRON BINDING CAPACITY, SERUM (3533HD-SRL) 957 1436 1914 592 MAGNESIUM, SERUM (4866H-SRL) 814 1221 1628 593 MAGNESIUM, 24HRS URINE (4866UH-SRL) 404 605 806 594 MICROALBUMINURIA, URINE (3441UD-SRL) 1001 1502 2002 595 PHOSPHORUS, SERUM (1591H-SRL) 329 494 658 596 PHOSPHORUS, 24HRS URINE (1591UH-SRL) 222 333 444 597 POTASSIUM, URINE (5311UHD-SRL) 255 383 510 598 SODIUM, URINE (5306UHD-SRL) 296 443 592 599 TOTAL PROTEIN, SERUM (1324H-SRL) 318 476 636 600 TOTAL PROTEIN, CSF (1324C-SRL) 592 888 1184 601 PROTEIN, 24HRS URINE (1324U-SRL) 296 443 592 602 URIC ACID, 24HRS URINE (1310UH-SRL) 283 424 564 603 ASCITIC FLUID, ROUTINE (5194-SRL) 518 778 1036 604 CEREBROSPINAL FLUID, ROUTINE (5195-SRL) 518 778 1036 605 FNAC, SLIDE EXAMINATION (1515A-SRL) 1650 2475 3300 606 PLEURAL FLUID, ROUTINE (5196-SRL) 518 778 1036 607 STOOL FOR OCCULT BLOOD (2367-SRL) 147 222 296 608 STOOL: OVA & PARASITE (2361-SRL) 155 233 310 609 SYNOVIAL FLUID, ROUTINE (5191-SRL) 518 778 1036 610 URINALYSIS (5200U-SRL) 341 512 682 611 ABS EOSINOPHIL COUNT, EDTA WHOLE BLOOD (1262-SRL) 108 162 216 612 ACT PARTIAL THROMBO PLASTIN TIME(APTT), PLASMA (3895-SRL) 814 1221 1628

BLEEDING TIME & CLOTTING TIME, EDTA WHOLE BLOOD (1090- 256 385 514 613 SRL)

COMPLETE BLOOD COUNT, EDTA WHOLE BLOOD/SMEAR (5110E- 726 1089 1452 614 SRL)

COMPLETE BLOOD COUNT, EDTA WHOLE BLOOD/SMEAR (5110A- 672 1009 1344 615 SRL)

CBC WITH ESR (CBC+PS+ESR) EDTA WHOLE BLOOD/SMEAR (5111- 990 1485 1980 616 SRL) 617 ERYTHRO SEDIMENTATION RATE, BLOOD (1569B-SRL) 146 220 294 618 HEMOGLOBIN & HEMATOCRIT, EDTA WHOLE BLOOD (5112-SRL) 242 363 484

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MALARIAL PARASITE (M.P), EDTA WHOLE BLOOD/SMEAR (1397- 462 693 924 619 SRL) 620 PERIPHERAL SMEAR EXAM, EDTA WHOLE BLOOD (5162-SRL) 268 404 538 621 PROTHROMBIN TIME, PLASMA (3892-SRL) 660 990 1320 622 RETICULOCYTE COUNT, EDTA WHOLE BLOOD (5170-SRL) 250 374 498 623 WHITE CELL COUNT AND DIFFERENTIAL, EDTA WB (5122-SRL) 396 594 792 624 BUCCAL SMEAR (2438C-SRL) 304 454 606 625 GONOCOCCAL SMEAR (2438B-SRL) 337 504 672 626 GRAM STAIN (2438-SRL) 172 256 342 627 LEPRA SMEAR (2438E-SRL) 222 333 444 628 ANTISTREPTOLYSIN O, SERUM (1332-SRL) 389 585 780 629 C-REACTIVE PROTEIN, SERUM (1535H-SRL) 550 825 1100 630 CDC-CROSSMATCH (1351G-SRL) 2812 4216 5622 631 PREGNANCY TEST, URINE (3189-SRL) 216 322 430 632 RHEUMATOID FACTOR, SERUM (1328-SRL) 309 464 618 633 SEMEN FRUCTOSE, SEMEN (1265A-SRL) 471 706 942 634 SKIN TEST-MANTOUX (1256-SRL) 134 201 268 635 WIDAL TEST, SERUM (9076-SRL) 201 303 404 636 BLOOD COAGULATION PROFILE (1389CO-SRL) 707 1059 1412 637 CORONARY RISK PROFILE (LIPID PROFILE), SERUM (1209AD-SRL) 1353 2030 2706 638 LIVER FUNCTION TEST (WITHOUT GGT) (1387-SRL) 700 1048 1398 639 THROMBOCHECK PANEL (1253G-SRL) 20416 30624 40832 640 QUADRUPLE MARKER (1275G-SRL) 3226 4840 6454 641 ACID FAST BACILLI SMEAR (5320-SRL) 646 968 1290 642 BRCA -NEXT (RD1421-SRL) 46292 46292 92585 643 CRP, SEMI-QUANTITATIVE, SERUM (1535S-SRL) 389 585 780 644 CYTOLOGY FOR MALIGNANT CELLS (1515SF-SRL) 404 605 806 645 FLUID, ROUTINE (5197-SRL) 525 787 1048 646 HLA TYPING CLASS I (SEROLOGY ) & CLASS II (PCR) (1309-SRL) 24200 33000 44000 647 HUNTINGTON DISEASE MOLECULAR ANALYSIS (RD1409-SRL) 8086 9299 10694 648 JAPANESE ENCEPHALITIS VIRUS- RT-PCR (RD1420-SRL) 3362 5041 6722 649 PERICARDIAL FLUID ANALYSIS (5192-SRL) 438 657 876 650 PERITONEAL FLUID, ROUTINE (5193-SRL) 175 262 350 651 TOTAL PROTEIN,ALBUMIN,GLOBULIN, SERUM (1324A-SRL) 235 354 472 652 URINARY PROTEIN CREATININE RATIO (1324UC-SRL) 268 404 538 653 CARCINO EMBRYONIC ANTIGEN, BODY FLUID (3258F-SRL) 840 1262 1682 654 HIV 4TH GEN ASSAY (P24AG + HIV AB), SERUM (9916-SRL) 1870 2805 3740 655 GESTATIONAL GLUCOSE TOLERANCE - 3 (1127BS-SRL) 471 706 942 656 GLUCOSE TOLERANCE TEST (GTT-2) (1126BS-SRL) 201 303 404 657 TBFERON (M TUBERCULOSIS IGRA) (2406-SRL) 2566 3850 5134 658 FROZEN SECTION {4(122)} (1503FZ-SRL) 4175 5693 7590 659 HEPATITIS B SURFACE ANTIGEN, SERUM (2470-SRL) 1221 1832 2442 660 SEMEN ANALYSIS, SEMEN (1265-SRL) 268 404 538 109

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661 SPOT URINE ALBUMIN CREATININE RATIO (3441UACR-SRL) 1010 1162 1336 662 STOOL FOR PH AND REDUCING SUBSTANCE (2361R-SRL) 108 162 216 663 TROPONIN I (3393R-SRL) 942 1411 1882 664 URINE FOR BILE PIGMENTS & SALTS (5200BPS-SRL) 216 248 285 665 BICARBONATE, SERUM (1030HD-SRL) 484 660 880 666 AMMONIA (3507-SRL) 1143 1714 2286 667 BLOOD CULTURE - BACTALERT AND SUSCEPTIBILITY (1193VTK-SRL) 2068 3102 4136 668 BLOOD CULTURE FUNGUS (1212VTK-SRL) 994 1493 1990 669 DAY CATH-BIOCHEMISTRY VIRAL MARKER (1169-SRL) 2541 3812 5082 670 FLU REAL TIME PCR (8007-SRL) 5806 8709 11612 671 GLUCOSE TOLERANCE TEST, PLASMA FLUORIDE (1126GT-SRL) 899 1227 1635 672 DENGUE NS1 ANTIGEN, SERUM (7648R-SRL) 600 600 600 673 HCV IgM (2448-SRL) 1281 1473 1694 674 URINARY EOSINOPHILS (1262U-SRL) 147 222 296 675 VENOUS BLOOD GAS ( VBG ) 1133 1700 2266 676 STANDARD INTEGRATED TEST (1277-SRL) 5500 8250 11000 677 HISTOPATH + IGG, IGA, IGM, C3 (1528-SRL) 3666 5500 7334 678 MYELOMA PANEL (1607-SRL) 12538 12538 25076 679 NATURAL KILLER PANEL, BLOOD (1611-SRL) 4278 6416 8556 680 ROTAVIRUS ANTIGEN DETECTION (7662-SRL) 2508 2508 5016 681 HISTOPATHOLOGY REPORT WITH PHOTO (1528P-SRL) 8969 8969 17939 682 SPINAL CEREBRAL ATAXIA TYPE - 1 (RD1412-SRL) 2262 3391 4522 683 SPINAL CEREBRAL ATAXIA TYPE - 2 (RD1413-SRL) 2262 3391 4522 684 SPINAL CEREBRAL ATAXIA TYPE - 3 (RD1414-SRL) 2262 3391 4522 685 SPINAL CEREBRAL ATAXIA TYPE - 6 (RD1415-SRL) 2262 3391 4522 686 SPINAL CEREBRAL ATAXIA TYPE - 7 (RD1416-SRL) 2262 3391 4522 687 PARAFFIN BLOCK H&E SLIDE, TISSUE/PB (Z201K-SRL) 1222 1834 2444 688 PARAFFIN BLOCKS/H& E SLIDE, TISSUE/PB (Z202K-SRL) 1650 2475 3300 689 OSTEONECTIN (Z0150K-SRL) 3665 3665 7330 690 HAPTOGLOBIN (1519I-SRL) 4278 6416 8556 691 VITAMIN E, SERUM/ EDTA PLASMA (3517-SRL) 3606 5409 7212 692 KIDNEY STONE ANALYSIS (4161-SRL) 793 1190 1586 693 ALBUMIN, FLUID (1510HF-SRL) 109 149 198 694 CHEMISTRY PROFILE, SERUM/ PLASMA (1390-SRL) 1708 1964 2259 695 GLUCOSE, FLUID (1302F-SRL) 108 162 216 696 LACTATE DEHYDROGENASE, FLUID (1009HF-SRL) 337 504 672 697 TOTAL PROTEIN, FLUID (1324F-SRL) 41 61 80 698 ALPHA-GALACTOSIDASE, S (8784-SRL) 42240 42240 84480 699 BRUCELLA TOTAL ANTIBODIES, SERUM (8836-SRL) 1210 1650 2200 700 CARNITINE, P (8802-SRL) 28703 43056 57408 701 EGFR,PHOTO, TISSUE/PARAFFIN BLOCK (Z005KP-SRL) 2444 3666 4888 702 ENDOMYSIAL IGA ANTIBODIES (IFA) WITH TITRE (1181T-SRL) 8680 8680 17360 703 FLUORIDE, PLASMA (8641-SRL) 13697 18678 24904 110

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704 GABAPENTIN, PLASMA OR SERUM (80826-SRL) 15669 18019 20722 705 GENTAMICIN, PEAK/POST (84695-SRL) 23958 23958 31944 706 HEMOSIDERIN, URINE (8582-SRL) 10998 16497 21996 707 LDL SUBFRACTIONATION, PLASMA (81913-SRL) 20561 20561 41122 708 MUSK ANTIBODY (91445-SRL) 11612 17416 23222 709 HIV VIRAL LOAD BY REAL TIME PCR (9974-SRL) 4598 6270 8360 710 MYOGLOBIN, SERUM (4989-SRL) 793 1190 1586 711 PARATHYROID HORMONE-RELATED PEPTIDE PLASMA (81774-SRL) 10426 15639 20852 712 POTASSIUM, SERUM (5311HD-SRL) 462 693 924 713 CALCIUM, SERUM (4836H-SRL) 407 611 814 714 TRIGLYCERIDES, SERUM (3346HD-SRL) 323 486 648 715 GLUCOSE RANDOM, PLASMA (1302R-SRL) 129 193 256 716 SODIUM, SERUM (5306HD-SRL) 473 710 946 717 CHLORIDE, SERUM (1182HD-SRL) 222 333 444 718 URIC ACID, SERUM (1310H-SRL) 374 561 748 719 SERUM BLOOD UREA NITROGEN (1079H-SRL) 471 706 942 720 HELICOBACTER PYLORI ANTIGEN DETECTION (9981-SRL) 1344 2016 2688 721 LACTATE DEHYDROGENASE, SERUM (1009H-SRL) 397 596 794 722 CREATININE, SERUM (1320H-SRL) 484 726 968 723 ALKALINE PHOSPHATASE, SERUM (3930H-SRL) 256 385 514 724 ALBUMIN, SERUM (1510H-SRL) 194 264 352 725 TESTOSTERONE, TOTAL, SERUM (3244-SRL) 706 1059 1412 726 LIVER FUNCTION PROFILE, SERUM (1388-SRL) 1991 2987 3982 727 HEPATITIS C ANTIBODIES, SERUM (2446-SRL) 2354 3531 4708 728 VDRL, SERUM (2366-SRL) 134 201 268 729 DIHYDROTESTOSTERONE, SERUM (3151-SRL) 2824 4235 5646 730 PROSTATE SPECIFIC ANTIGEN, SERUM (3546-SRL) 1463 2195 2926 731 PLATELET COUNT, EDTA WHOLE BLOOD (5160-SRL) 330 495 660 732 HOMOCYSTEINE, SERUM/PLASMA (3344-SRL) 1162 1741 2322 733 BILIRUBIN, DIRECT, SERUM (1526H-SRL) 306 459 612 734 HEMOGLOBIN BY CYANMETHEMOGLOBIN (5112DR-SRL) 122 184 244 735 TPMT GENOTYPING (8030-SRL) 7178 7178 14355 736 HYBRID CAPTURE 2 HIGH RISK HPV DNA TEST (1823-SRL) 5207 5207 10415 737 DIGEORGE SYNDROME, 22Q11.2 DELETION , FISH (6022F-SRL) 6050 9075 12100 738 BRINJAL (SOLANUM MELONGE), SERUM (3383-SRL) 1573 2145 2860 739 ANIMAL MIX (EX1), SERUM (3384-SRL) 1573 2145 2860 740 FREE TESTOSTERONE (3248FTE-SRL) 1894 2841 3788 741 PCOD PANEL (1011-SRL) 4278 6416 8556 742 FREE THYROXINE (FT4), SERUM (3228-SRL) 538 806 1076 743 FREE TRIIODOTHYRONINE (FT3), SERUM (3234-SRL) 538 806 1076 744 TESTOSTERONE,FREE/TOTAL, SERUM (3248-SRL) 2286 3429 4572 745 WATER TESTING (1221W-SRL) 1320 1782 2673 746 GRAFT NEPHRECTOMY (1766-SRL) 15431 15431 30862 111

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747 SCRUB TYPHUS ANTIBODIES RAPID, SERUM (1739-SRL) 935 1403 1870 748 CLOSTRIDIUM DIFFICILE DNA REAL TIME PCR (RD1430-SRL) 3630 4950 6600 749 PORPHYRIN SPECIATION, 24 HRS URINE (9999-SRL) 6270 9405 12540 750 TRYPTASE, SERUM (4185-SRL) 12540 12540 25080 751 KIDNEY STONE ANALYSIS (4162-SRL) 793 1190 1586 752 IMMUNOHISTOCHEMISTRY : FIVE MARKER (5027-SRL) 5940 8910 11880 753 IMMUNOHISTOCHEMISTRY : SEVEN MARKER (5029-SRL) 8910 13365 17820 754 IMMUNOHISTOCHEMISTRY : SINGLE MARKER (5030-SRL) 3267 4455 5940 755 IMMUNOHISTOCHEMISTRY : TEN MARKER AND ABOVE (5031-SRL) 9900 14850 19800 756 IMMUNOHISTOCHEMISTRY : THREE MARKER (5032-SRL) 5500 8250 11000 757 RADICAL RESECTION HISTOPATHOLOGY (5033-SRL) 17360 17360 34720 758 TROPONIN T, HS (4051-SRL) 2783 4175 5566 759 TOTAL CHOLESTEROL (SP2745-SRL) 220 330 440 760 RENAL BIOPSY HE + SPECIAL STAINS (1500S-SRL) 2262 3391 4522 761 IGG4 SUB CLASS (SERUM, NEPHELOMETRY) (1315-SRL) 8168 11138 14850 762 HTTG/DGP SCREEN, SERUM (9979-SRL) 1936 2640 3520 763 WEIL-FELIX TEST, SERUM (9121-SRL) 1009 1513 2016 764 FECAL CALPROTECTIN, STOOL (9980-SRL) 3025 4125 5500

BLOCK REVIEW/SLIDE REVIEW UPTO 8 BLOCKS-COE HISTO (4055- 7944 11916 15888 765 SRL) 766 VANCOMYCIN, SERUM (4197-SRL) 6722 10084 13444 767 ANTI-PHOSPHOLIPID IGM ANTIBODY, SERUM (1735-SRL) 1344 2016 2688 768 EVEROLIMUS, EDTA/HEPARIN WHOLE BLOOD (7165-SRL) 15045 15045 30089 769 SIROLIMUS, EDTA/HEPARIN WHOLE BLOOD (7166-SRL) 9438 12870 17160 770 HBV VIRAL LOAD BY REAL TIME PCR (9973-SRL) 6751 6751 13501 771 XPERT MTB/RIF - EXTRAPULMONARY (RD1324EP-SRL) 4345 6518 8690 772 MUSK ANTIBODY (SERUM,RIA) (4065-SRL) 11612 17416 23222 773 CHLORIDE, FUILD (1182HDF-SRL) 175 262 350 774 TOTAL LEUKOCYTE COUNT, FLUID (5101F-SRL) 171 197 227 775 SDLDL, SERUM (7153-SRL) 2965 4043 5390 776 CYSTIC FIBROSIS DELTA F508 GENE MUTATION (RD1446-SRL) 14641 19965 26620 777 ANTI-NMDA RECEPTOR ENCEPHALITIS IGG ABS BY IFA (2244-SRL) 8800 11880 17820 778 HLA CLASS I PRA QUALITATIVE (9101-SRL) 30162 45243 60324 779 HLA CLASS II PRA QUALITATIVE (9104-SRL) 13444 20166 26888

New ServiesBORN SCREENING FOR ACYLCARNITINE & AMINO 5040 7560 10080 780 ACIDS (3358A-SRL) 781 HEREDITARY PANCREATITIS PANEL (RD1449-SRL) 108900 148500 198000 782 FLUID BETA -2 TRANSFERRIN (4952-SRL) 7763 8927 10266 783 ANTI-AQUAPORIN-4 (NMO-IGG) ANTIBODIES (1000-SRL) 6112 9166 12222 784 HUMAN EPIDIDYMIS PROTEIN -4 (HE4), SERUM (4113-SRL) 5112 5112 10223 785 SCRUB TYPHUS IGM, SERUM (1739E-SRL) 935 1403 1870 786 CREATINE KINASE - MB, SERUM (3615DCM-SRL) 1298 1947 2596 787 CIRCULATING TUMOR CELLS (RD1454-SRL) 153450 153450 204600 112

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788 CMV IHC MARKER - COE HISTOPATHLOGY (7198-SRL) 1736 1736 3472 789 JAPANESE ENCEPHALITIS VIRUS IGM ANTIBODIES (7987-SRL) 1222 1834 2444 790 PROSTATE SEXTANT CORE BIOPSY (1539-SRL) 3496 5244 6992

HISTOPATHOLOGY REFLEX TO CUSTOM IHC -ENDOMETRIUM 1100 1485 2228 791 (9233RFX-SRL)

HISTOPATH REFLEX TO CUSTOM IHC-ENDOBRONCHIAL BX 1848 2495 2772 792 (9235RFX-SRL)

HISTOPATH REFLEX TO CUSTOM IHC-GI ENDOSCOPIC BX (9236RFX- 1848 2495 2772 793 SRL)

HISTOPATH REFLEX TO CUSTOM IHC PANEL - PROSTATE (9239RFX- 2244 3029 3366 794 SRL)

HISTOPATH REFLEX TO CUSTOM IHC PANEL -BRAIN BIOPSY 4488 6059 6732 795 (9242RFX-SRL)

HISTOPATH REFLEX TO CUSTOM IHC PANEL -LIVER BIOPSY 11858 16170 21560 796 (9243RFX-SRL)

HISTOPATH REFLEX TO CUSTOM IHC PANEL - OTHERS (9244RFX- 11858 16170 21560 797 SRL) 798 NEUROTROPIC VIRUS PANEL (RD1462-SRL) 4840 6534 7260 799 MICROSATELLITE INSTABILITY (MSI) (RD1461-SRL) 31460 42900 57200 800 HOMEOSTATIC MODEL ASSESSMENT (HOMA) 2 (7561-SRL) 1150 1568 2090 801 MULTIPLE MYELOMA PANEL FISH (6031F-SRL) 31248 31248 62495

4175 5693 7590 802 ECHOSENS FIBROMETER VIRUS (BIOMARKERS & SCORE) (4590-SRL) 803 KAPPA LIGHT CHAIN QUANTITATIVE, RANDOM URINE (1661U-SRL) 2688 6600 8800 804 CITRATE, URINE 24 H ENZYMATIC (8425-SRL) 4400 5940 8910 805 BK VIRUS DNA QUANTITATIVE (RD1470-SRL) 8228 11220 14960 806 SEPSISCREEN (RD1474-SRL) 15026 20285 30428

HOLOTC (HOLOTRANSCOBALAMINE), ACTIVE B12, SERUM (9315- 1650 2228 3342 807 SRL) 808 CALR GENE MUTATIONS (RD1476-SRL) 12538 12538 25076 809 FILARIA ANTIBODIES, SERUM (9337-SRL) 1694 2310 3080 810 BODY FLUID ? AEROBIC CULTURE (1194VTK-SRL) 1903 2855 3806 811 RESPIRATORY SAMPLE CULTURE & SUSCEPTIBILITY (1214VTK-SRL) 685 1029 1372 812 SPUTUM CULTURE (1217VTK-SRL) 404 605 806 813 THROAT SWAB (1219VTK-SRL) 404 605 806 814 AEROBIC CULTURE & SUSCEPTIBILITY ( 1221VTK-SRL ) 806 1210 1614 815 URINE CULTURE (1285VTK-SRL) 1485 2228 2970 816 STOOL CULTURE (5700VTK-SRL) 404 605 806 817 HLA - A B DR LOCI TYPING PCR DUO (6150-SRL) 20570 28050 37400 818 FUNGUS CULTURE & SUSCEPTIBILITY (5322VTK-SRL) 2046 3069 4092 819 ALCOHOL (ETHANOL) , SERUM (4105S-SRL) 2965 4043 5390 820 SCA PANEL (4593-SRL) 14036 19140 25520 821 METANEPHRINE-FREE, PLASMA BY EIA (3315P-SRL) 6655 9075 12100

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822 RHINITIS/ASTHMA SCREENING PANEL (4094-SRL) 7523 7523 15046 823 NON-INVASIVE PRENATAL SCREENING (NIPS) (7572-SRL) 65773 65773 131547

LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2 ACTIVITY (5966- 26278 39416 52556 824 SRL) 825 MRD FOR B ALL (4801-SRL) 18700 28050 37400 826 ALUMINIUM, PLASMA (9148-SRL) 2134 3201 4268 827 COMPREHENSIVE ALLERGY SCREENING PANEL ADULT (4075-SRL) 7027 10540 14054 828 FIBROMETER NAFLD (4512-SRL) 4175 5693 7590 829 DENGUE VIRUS IGG, SERUM (7601DL-SRL) 690 794 913 830 DENGUE VIRUS IGM, SERUM (7646DL-SRL) 600 600 600 831 DENGUE NS1 ANTIGEN TEST 600 600 600 832 PLATELET COUNT, EDTA WHOLE BLOOD (5160DL-SRL) 330 495 660 833 DENGUE DUO ANTIGEN AND ANTIBODY TEST (7647DL-SRL) 2070 2381 2738 834 SPINOCEREBELLAR ATAXIA TYPE 12 (RD1456-SRL) 4471 5142 5913 835 HLA PANEL REACTIVE ANTIBODIES (PRA) CLASS I (4807-SRL) 18150 24750 33000 836 HLA PANEL REACTIVE ANTIBODIES (PRA) CLASS II (4808-SRL) 18150 24750 33000 837 HLA PANEL REACTIVE ANTIBODIES (PRA) SCREEN (4809-SRL) 9680 13200 17600 838 DSA (DONOR SPECIFIC IGG ANTIBODIES TO CLASS I&II) (4810-SRL) 18150 24750 33000 839 LUNG CANCER PANEL (4817-SRL) 37034 37034 74067

ANTI-PHOSPHOLIPASE A2 RECEPTOR (PLA2R) IGG,SERUM (4601- 6171 8415 11220 840 SRL) 841 GLIOMA PANEL (4551-SRL) 23595 32175 42900 842 THROMBOCHECK TOTAL (1751-SRL) 31218 42570 56760 843 CYSTIC FIBROSIS EXTENDED MUTATION PANEL (RD1460-SRL) 34485 47025 62700 844 COLORECTAL CANCER PANEL (4550-SRL) 16698 22770 30360 845 SPINOCEREBELLAR ATAXIA TYPE 17 ( RD1457-SRL) 5346 5346 10692 846 SRY DELETION, FISH (6025F-SRL) 4244 4244 8488 847 PV JAK2 REFLEX PANEL (RD1310RFX-SRL) 16202 16202 32404 848 MPN RELFEX PANEL (RD1322RFX-SRL) 26738 30749 35361 849 SV40 (Z269K-SRL) 3858 3858 7715 850 LBC-PAP SMEAR REFLEX HRHPV (9230RFX-SRL) 3703 3703 7405 851 URINE GLYCOSAMINOGLYCANS (4333-SRL) 1208 1389 1597 852 SUREPATH CYTOLOGY FULLY AUTOMATED (1284G-SRL) 1388 1388 2776 853 IGG4, SERUM (9548C-SRL) 9801 13365 17820 854 EBV VIRAL LOAD REAL TIME PCR (4554-SRL) 14081 14081 28162 855 RECIPIENT ANTIBODY STATUS (POS/ NEG) (8881-SRL) 11880 11880 27775 856 COAGULATION STUDIES (1305-SRL) 1227 1227 1638 857 JC VIRUS DNA QUANTITATIVE (RD1471-SRL) 8228 11220 14960 858 CLASS II ANTIBODY DETECTION (PRA %) (8883-SRL) 27775 27775 55550 859 HLA ?A B DR LOCI TYPING BY LUMINEX (9971GL-SRL) 43978 43978 87956 860 SINGLE ANTIGEN BEAD CLASS I (8884-SRL) 53237 53237 106473 861 SINGLE ANTIGEN BEAD CLASS II (8885-SRL) 39600 39600 79200 862 ADENOVIRUS VIRAL LOAD REAL TIME PCR (4553-SRL) 3972 5959 7944 114

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863 CLASS I ANTIBODY DETECTION (PRA%) (8882-SRL) 27775 27775 55550

FISH 7Q DELETION & MONOSOMY/NUMERICAL ABNORMALITY 4140 4761 5475 864 (7642-SRL) 865 FIBROMETER ALD (4511-SRL) 7523 7523 15046 866 DENGUE IGM, SERUM (7646R-SRL) 1155 1560 2339 867 IMMUNOFLUORESCENCE ASSAY (1527VK-SRL) 4278 6416 8556 868 FLOWCYTOMETRY CROSSMATCHING (7540-SRL) 18517 18517 37035 869 HLA - DQ & DP LOCI TYPING BY HISTOSPOT (4849-SRL) 25410 34650 46200 870 ACUTE LEUKEMIA-MRD PANEL (1745-SRL) 9166 13750 18334 871 CHIKUNGUNYA IGM - RAPID (2492DL-SRL) 672 1009 1344 872 CHIKUNGUNYA RNA PCR (7630FH-SRL) 1500 1500 1500 873 CHIKUINGUNIYA RNA PCR (7630DL-SRL) 1650 1650 1650 874 NATIVE KIDNEY BIOPSY(LIGHT MICROSCOPY+IFA) (1761-SRL) 13503 13503 27005 875 TRANSPLANT KIDNEY BIOPSY WITH C4D + IFA (1762-SRL) 13503 13503 27005 876 KIDNEY BIOPSY SLIDES REVIEW (SLIDE/BLOCK) (1765-SRL) 7715 7715 15431 877 RAPID KIDNEY BIOPSY (1763-SRL) 16396 16396 32791 878 KIDNEY BIOPSY SLIDES REVIEW (1764-SRL) 3858 3858 7715 879 LIVER TRANSPLANT PANEL 1 (3939-SRL) 3267 4455 5940 880 TOTAL IRON BINDING CAPACITY (TIBC) (3533H-SRL) 957 1436 1914 881 GASTRIC FLUID PH (5200UG-SRL) 24 36 48 882 URINE pH (5200UP-SRL) 24 36 48 883 SODIUM (24HRS / SPOT URINE) (5306P-SRL) 296 443 592 884 POTASSIUM (24HRS / SPOT URINE) (5311P-SRL) 255 383 510 885 CARBOHYDRATE DEFICIENT TRANSFERRIN (CDT) (4521-SRL) 1876 2558 3410 886 CELL BLOCK (4531-SRL) 1910 1910 3819 887 BENCE-JONES PROT, 24HRS URINE (1589U-SRL) 605 908 1210 888 ACID PHOSPHATASE (1255D-SRL) 672 1009 1344 889 ALLERGEN: APRICOT (4008-SRL) 1573 2145 2860 890 TUMOUR NECROSIS FACTOR (TNF) - ALPHA, SERUM (5432I-SRL) 7394 11091 14788 891 URINE KETONE (QUALITATIVE) (9935-SRL) 41 61 80 892 HIV-P24 ANTIGEN DETECTION, SERUM (9881I-SRL) 404 605 806 893 FLOWCYTOMETRY CROSSMATCH (7511-SRL) 15431 15431 30862 894 DRVV SCREEN TIME, PLASMA (5964B-SRL) 1715 2572 3430 895 DRVV CONFIRM, PLASMA (5964C-SRL) 1715 2572 3430 896 URINE OLIGOSACCHARIDE SCREEN (7201-SRL) 15125 20625 27500 897 CD117 / C-KIT & PHOTO, TISSUE/PARAFFIN BLOCK (Z117KP-SRL) 2444 3666 4888 898 PANCREATIC ELASTASE (3884-SRL) 5500 5500 5500 899 GLUCOSE POST-PRANDIAL, PLASMA (1302GP-SRL) 146 220 294 900 ALLERGEN - ASCARIS, SERUM (3382-SRL) 1573 2145 2860 901 ANTI - P63 (Z255K-SRL) 2783 3795 5060 902 CYSTATIN C & GFR (CALCULATED FROM CYSTATIN C) (4032-SRL) 1748 2621 3496 903 ABO GROUP & RH TYPE, EDTA WHOLE BLOOD (5100A-SRL) 539 809 1078 904 PEPSINOGEN I & II, SERUM (4112-SRL) 13613 18563 24750 115

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905 OSMOLALITY, URINE (3231UMD-SRL) 322 484 646 906 CYP3A4*22 GENOTYPING (RD1439-SRL) 6292 8580 11440

3872 5280 7040 907 URINARY GLYCOSAMINOGLYCAN (GAG) QUANTITATION (4953-SRL) 908 SMALL DENSE LDL COMBO (7139-SRL) 5112 5112 10223 909 TRANSSPOT ASSAY (RD1451-SRL) 24200 33000 44000 910 C.DIPTHERIA TOXIN A AND B PCR (RD1450-SRL) 4278 6416 8556 911 SAAG FOR ASCITIC FLUID (1715H-SRL) 315 429 572 912 ANIMAL DANDER PANEL (4073-SRL) 5445 7425 9900 913 IC SURVEILLANCE (MISCELLANEOUS) (1881-SRL) 1100 1485 2228 914 LH, FSH & PROLACTIN, SERUM (2021HM-SRL) 1284 1925 2566 915 GLUCOSE, FASTING, SERUM (1302S-SRL) 242 363 484 916 GLUCOSE RANDOM, SERUM (1302RS-SRL) 242 363 484 917 CARDIAC ENZYME PANEL, SERUM (1164C-SRL) 3300 4950 6600 918 PRE?DIALYSIS BUN (7611-SRL) 743 743 1485 919 POST-DIALYSIS BUN (7613-SRL) 743 743 1485 920 PRE?DIALYSIS CREATININE EGFR (7612-SRL) 530 530 1060 921 POST-DIALYSIS CREATININE EGFR (7614-SRL) 530 530 1060 922 HLA ?A B C DR DQ DP LOCI TYPING (4848-SRL) 61723 61723 123446 923 ANTI GBM ANTIBODY (7645-SRL) 4398 4398 8796

EBER (BY IN SITU HYBRIDIZATION)-COE HISTOPATHLOGY (7210- 4629 4629 9258 924 SRL) 925 PROSTATE BIOPSY REVIEW (SLIDES & BLOCK) (1773-SRL) 11573 11573 23146 926 PROSTATE BIOPSY REVIEW (SLIDES ONLY) (1774-SRL) 5787 5787 11574 927 RADICAL CYSTOPROSTATECTOMY - HISTOPATH (1775-SRL) 17360 17360 34720 928 RADICAL NEPHRECTOMY - HISTOPATH (1776-SRL) 15431 15431 30862 929 TESTICULAR TUMOR (ORCHIDECTOMY) - HISTOPATH (1779-SRL) 15431 15431 30862 930 TURBT (URINARY BLADDER) - HISTOPATH (1780-SRL) 5787 5787 11574 931 TURP (PROSTATE) - HISTOPATH (1781-SRL) 5787 5787 11574 932 ABDOMINAL TUMOR RESECTION - HISTOPATH (1769-SRL) 15431 15431 30862 933 ADRENALECTOMY - HISTOPATH (1770-SRL) 11573 11573 23146 934 PARTIAL NEPHRECTOMY - HISTOPATH (1771-SRL) 11573 11573 23146 935 PENECTOMY - HISTOPATH (1772-SRL) 11573 11573 23146 936 CHIKUNGUNYA IGM ANTIBODY, SERUM (2491DL-SRL) 660 660 660 937 LIVER BIOPSY WITH SPECIAL STAIN AND REFLEX IHC (1663-SRL) 5787 5787 11574 938 EXPLANT LIVER WITH SPECIAL STAINS AND REFLEX IHC (1664-SRL) 6751 6751 13501 939 SINGLE ANTIGEN BEAD CLASS I & II (4627-SRL) 67510 67510 135021 940 TRUS GUIDED PROSTATE BIOPSY WITH REFLEX IHC (1634-SRL) 14466 14466 28932 941 SALICYLATE, SERUM (9442-SRL) 13068 17820 23760 942 KIDNEY PANEL OKH (7586-SRL) 858 1158 1738 943 RENAL TRANSPLANT PANEL OKH (7587-SRL) 1320 1320 2640 944 DIALYSIS PANEL OKH (7588-SRL) 2970 2970 5940 945 DIALYSIS PANEL OKHLA 2 (4621-SRL) 10725 10725 21450 116

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946 DIARRHEA PANEL (IMMUNOCOMPROMISED) (4515-SRL) 3850 5775 7700 947 ANTI-VGKC ANTIBODIES, CSF / SERUM (2245-SRL) 17820 17820 35640 948 AUTOIMMUNE ENCEPHALITIS PANEL, CSF / SERUM (2246-SRL) 39600 39600 79200 949 NMDA PLUS (NMDA+VGKC) (2247-SRL) 29700 29700 59400 950 MRI CERVICO DORSAL SPINE SCREENING CONTRAST (36354) 12222 18334 24444 951 MRI DORSO LUMBAR SPINE SCREENINGCONTRAST (29296) 12222 18334 24444 952 MRI LUMBO SACRAL SPINE SCREENING CONTRAST (29297) 12222 18334 24444 953 LIDOCAINE 15694 23540 31386 954 URINE MICROSCOPIC 110 165 220 955 HCT 98 146 196 956 RBC. 62 91 122 957 ASCITIC FLUID -GRAM STAIN 196 294 392 958 ARTERIAL BLOOD GAS (FEHI) 1133 1700 2266 959 SUGAR RANDOM (BY GLUCOMETER) 115 132 152 960 BONE MERROW ASSESSMENT 703 1054 1406 961 ACID PHOSPHATASE TOTAL + PROSTATIC-LAL 158 239 318 962 ANTI HBEAB-SRL 770 1155 1540 963 ALPHA -1 ANTITRIPSIN-SRL 2042 3061 4082 964 POLARIZING MICROSCOPY 294 440 586 965 VEIN BLOOD GAS 873 1311 1748 966 SPINOCEREBELLAR ATAXIA TYPE 10 (RD1455-SRL) 5346 8019 10692 967 AMH / MIS, SERUM (1705R-SRL) 2200 3300 4400 968 GIST C-KIT GENE MUTATIONS (RD1444-SRL) 15813 18185 20913 969 OSMOLALITY, SERUM (3231SD-SRL) 551 827 1102 970 KIDNEY BIOPSY NATIVE (1761G-SRL) 10925 12564 14449 971 KIDNEY BIOPSY TRANSPLANT (1762G-SRL) 10925 12564 14449 972 EXTENDED ECZEMA PANEL (3386-SRL) 19602 19602 26136 973 EXTENDED RHINITIS/ASTHMA PANEL -ADULT (3405-SRL) 11550 11550 15400 974 EXTENDED RHINITIS/ASTHMA PANEL -CHILD (3404-SRL) 19800 19800 26400 975 MSI IHC MARKERS - COE HISTOPATHLOGY (9323-SRL) 31460 42900 57200 976 E-CADHERIN (Z121K-SRL) 3881 4463 5132 977 UGTA1 GENE MUTATION (RD1479-SRL) 18688 21491 24715 978 AMINO ACIDS, PLASMA (4631-SRL) 12375 12375 24750

GALACTOMANNAN, BRONCHOALVEOLAR LAVAGE FLUID (BAL) 5194 7791 10388 979 (1728B-SRL) 980 LIPID PROFILE - NON FASTING, SERUM (1209ADNF-SRL) 1238 1238 1650 981 G-6-PD, QUANTITATIVE, BLOOD (1146QT-SRL) 1869 2149 2471 982 LAMOTRIGINE (4063-SRL) 9653 14479 19305 983 AUTOIMMUNE HEPATITIS MINI (ANCA , SLA) (4895-SRL) 4968 5713 6570 984 EXPERT HISTOPATHOLOGY WITH SPECIAL STAINS (4992-SRL) 1771 2037 2343 985 EXPERT OPINION IN HISTOPATHOLOGY (7632-SRL) 6325 7274 8365 986 KINSHIP ANALYSIS (RD1502-SRL) 34500 39675 45626 987 URINE FOR CHYLE (4892-SRL) 1104 1270 1461 117

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988 ABPA (2710-SRL) 5089 5852 6730 989 ADMARK PHOSPHO-TAU/TOTAL-TAU/AB42 (FADMK-SRL) 316922 364460 419129 990 AMINO ACIDS, RANDOM URINE (4631U-SRL) 14231 16366 18821 991 AMINO ACIDS, 24HRS URINE (4631U24-SRL) 11860 13639 15685 992 HYPERSENSITIVITY PNEUMONITIS PANEL (7831-SRL) 12938 12938 12938 993 ABPA MINI (7833-SRL) 4313 4313 4313 994 ASPERGILLUS. FUMIGATUS-SPECIFIC IGG (3261-SRL) 3105 3105 3105 995 TTG ADVANCED (NEO EPITOPES) (7904-SRL) 2875 2875 2875 996 IBD PLUS PANEL(ASCA/ANCA/CALPROTECTIN) (7832-SRL) 5750 5750 5750 997 SEPSIS (7907-SRL) 35938 41329 47528 998 CREATININE EGFR- EPI (1320HGFREP-SRL) 405 405 405 999 ILD SCREEN(RH,ANA REF,ANTI CCP,CRP,ACE,AF IGG) (8023-SRL) 10781 12398 14258 1000 ILD TOTAL (RH,ANA REF,ANTI CCP,CRP,ACE,HP PANEL) (8024-SRL) 17969 17969 17969 1001 BIOFIRE RESPIRATORY PANEL (8054-SRL) 20125 20125 20125 1002 BIOFIRE BLOOD PANEL (8055-SRL) 20125 20125 20125 1003 BIOFIRE CSF PANEL (8056-SRL) 20125 20125 20125 1004 BIOFIRE GI PANEL (8057-SRL) 20125 20125 20125 1005 TRANSMISSION TEM ELECTRON MICROSCOPY (TEMG-SRL) 12829 12829 12829 1006 KINSHIP ANALYSIS (RD1511-SRL) 10781 10781 10781 1007 PROTEIN ELECTROPHORESIS, SERUM (1580M-SRL) 869 999 1149 1008 COMPREHENSIVE MYELOMA PROTEIN PANEL (5040M-SRL) 11500 11500 11500 1009 BIOFIRE PNEUMONIA PANEL PLUS (8161-SRL) 34500 34500 34500 1010 TTG ANTIBODY-IGG, TISSUE TRANSGLUTAMINASE (4834-SRL) 3594 3594 3594 1011 SARS COV -2 REAL TIME PCR 2400 2400 2400

NEWBORN SCREENING FOR ACYLCARNITINE-AMINOACIDS,DBS 5134 7700 10266 1012 (3358-SRL) 1013 ALLERGEN -PHADIATOP INFANT, SERUM (4432-SRL) 1884 2826 3768 1014 LYMPH ENUM,T & B CELL, BLOOD (1658B-SRL) 3938 5907 7876 1015 LYMPHOCYTE SUBSET ENUMERATION, BASIC, BLOOD (1671B-SRL) 6760 10140 13520 1016 FREE PROTEIN S, PLASMA (3839I-SRL) 10360 15540 20720 1017 GLUCOSE, FASTING, PLASMA (1302H-SRL) 213 320 426 1018 RAPID GIARDIA LAMBLIA ANTIGEN TEST (7663-SRL) 2402 3603 4804 1019 PORPHOBILINOGEN, URINE 24HRS (1652-SRL) 14913 22370 29826 1020 ANTI DNASE B, SERUM (3885-SRL) 5573 8360 11146 1021 ANTI DNASE B, SERUM (3885-SRL) 5573 8360 11146

NEWBORN SCREENING FOR ACYLCARNITINE & AMINO ACIDS 4620 6930 9240 1022 (3358A-SRL) 1023 AFB SUSCEPTIBILITY - MGIT (13 DRUGS PANEL) (1464R3-SRL) 21977 32966 43954 1024 PERCUTANEOUS BIOPSY-GASTRO 17267 25901 34534 1025 MISMATCH REPAIR GENE (IHC) (9336-SRL) 10518 15777 21036 1026 VITAMIN PLUS (9509A-SRL) 3062 4593 6124 1027 APLA TOTAL (4640-SRL) 7771 11657 15542 1028 PANCREATIC ELASTASE, STOOL (3884-SRL) 8901 13352 17802 118

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1029 NOR -METANEPHRINE-FREE PLASMA BY EIA (4488-SRL) 7064 10596 14128 1030 PIVKA II TOTAL (7796-SRL) 6279 9419 12558 1031 AIH PLUS (2720-SRL) 12558 18837 25116

POST TRANSPLANT/ FEBRILE NEUTROPENIA/PNEUMONIA (7985- 66715 100073 133430 1032 SRL) 1033 POST TRANSPLANT/ FEBRILE NEUTROPENIA + ABR (7984-SRL) 91046 136569 182092 1034 SEPSIS + ABR (8021-SRL) 63575 95363 127150 1035 ANTIBIOTIC RESISTANCE MARKERS (ABR) (8020-SRL) 39244 58866 78488 1036 DCP-DECARBOXY PROTHROMBIN PIVKA-II, SERUM (4827-SRL) 8634 12951 17268 1037 BIOFIRE PNEUMONIA PANEL PLUS(8161-SRL) 37674 56511 75348 1038 TOTAL IGE ADVANCED (8220-SRL) 1806 2709 3612 1039 ALLERGY SCREEN INFANT (8238-SRL) 1570 2355 3140 1040 ALLERGY SCREEN ADULT (8239-SRL) 1570 2355 3140 1041 MSI TEST (131AR00-SRL) 9576 14364 19152 1042 THROMBOCHECK ADVANCED (8276-SRL) 39244 58866 78488 1043 XPERT CARBA-R (8722-SRL) 15698 23547 31396

25116 37674 50232 1044 BIOFIRE COMPREHENSIVE MENINGITIS/ ENCEPHALITIS (8056F-SRL) 1045 BIOFIRE COMPREHENSIVE RESPIRATORY PANEL (8054F-SRL) 25116 37674 50232 1046 BIOFIRE BLOOD CULTURE IDENTIFICATION (BCID) (8055F-SRL) 25116 37674 50232 1047 BIOFIRE COMPREHENSIVE GI PANEL (8057F-SRL) 25116 37674 50232 1048 BIOFIRE PNEUMONIA PLUS PANEL (8161F-SRL) 37674 56511 75348 1049 COMPREHENSIVE VASCULITIS PANEL (8724-SRL) 15698 23547 31396 1050 CARDIOMYOPPATHY PANEL (7126-SRL) 2417 3626 4834 1051 MYOCARDITIS PANEL (7124-SRL) 12935 19403 25870 1052 POST TRANSPLANT CARDIAC BIOPSY PANEL (7125-SRL) 14505 21758 29010 1053 THROMBOSIS (HITT) 2355 3533 4710 1054 HEPARIN INDUCED THROMBOCYTOPENIA (HIT) 3767 5651 7534 1055 VANILMANDELIC ACID, 24HRS URINE (3316U-SRL) 6907 10361 13814

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ONCOLOGY

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 Intensity Modulated Radiation Therapy ( IMRT ) 151800 189750 253000 2 Chemotherapy (Bolus) - Multi Drug 621 932 1242 3 Chemotherapy (Oral) 828 1242 1656 4 Chemotherapy (Planning + Counselling) 1150 1725 2300 5 Chemotherapy (Infusional) - Single Drug (per day) 1346 2018 2691 6 Chemotherapy IntraArterial - Per Day ( Oncology ) 2300 3450 4600 7 Chemotherapy Intrapericardial - Per Day 1380 2070 2760 8 HemiMandibulectomy ( Oncosurgery ) 45770 57270 76360 9 Laryngectomy Total + Neck Dissection ( Bilateral ) - Oncosurgery 49910 62445 83260 10 Pelvic Lymph Node Dissection - Left ( Oncosurgery ) 18170 22770 30360 11 TransArterial ChemoEmbolization ( TACE ) 58190 72795 97060 12 Gastrectomy Partial - Palliative ( Oncosurgery ) 29095 36455 48530 13 Parotidectomy Total + Neck Dissection ( Oncosurgery ) 45770 57270 76360 14 Inguinal Lymph Node Dissection - Left Side ( Oncosurgery ) 22540 28175 37490 15 Hepaticojejunostomy ( Oncosurgery ) 33120 41400 55200 16 Intestinal Resection Multiple + Anastmosis ( Oncosurgery ) 33120 41400 55200 17 Mastectomy Simple + Axillary Clearance 29095 36455 48530 18 Tumor Wide Excision ( Superficial - Large) 12535 15698 20930 19 Supportive Care - SBP Filter Infusion ( Per Day ) 1932 2415 3220

Thyroidectomy + Neck Dissection ( Level II-IV ) + Level VI / MND / 45770 57270 76360 20 RND 21 Intraabdominal Abscess Drainage 16790 21045 28060 22 Cyst Aspiration ( Deep ) 1380 1725 2300 23 Bone Marrow Aspiration ( Oncosurgery ) 4002 5003 6670 24 Bone Marrow Biopsy ( Oncosurgery ) 3565 5348 7130 25 Bone Marrow Biopsy with Aspiration 7590 9488 12650 26 Chemo Port Insertion ( Permanent ) 12535 15698 20930 27 Chemo Port Removal ( Oncosurgery ) 12535 15698 20930 28 Chemotherapy Counselling 1932 2415 3220 29 Chemotherapy High Dose ( Per Day ) 2300 3450 4600 30 Chemotherapy Multiple Dose ( Per Day ) 3036 3795 5060 31 Chemotherapy Single Dose ( Per Day ) 2484 3105 4140 32 Chest Tube Drainage 12535 15698 20930 33 Choledochojejunostomy 29095 36455 48530 34 Circumcision ( Early Carcinoma ) 9936 12420 16560 35 Loop Colostomy Closure ( Oncosurgery ) 20585 25760 34270 36 End Colostomy ( Oncosurgery ) 15640 19550 25990

Composite Resection ( Buccal Mucosa / GB Sulcus / Floor of Mouth 70610 88320 117760 37 / Tongue ) + Neck Dissection - Bilateral ( MND / RND )

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Composite Resection ( Buccal Mucosa / GB Sulcus / Floor of Mouth 58190 72795 97060 38 / Tongue ) + Neck Dissection - Unilateral ( MND / RND ) 39 Craniofacial Resection 70610 88320 117760 40 Laparoscopy Diagnostic ( with Biopsy ) 29095 36455 48530 41 Dressing - Small ( Oncosurgery ) 414 518 690 42 Enucleation ( Oncosurgery ) 15640 19550 25990 43 Esophagectomy Transhiatal - Total 53015 66240 88320 44 Esophagectomy Transthoracic - Total 70610 88320 117760 45 Esophagogastrectomy Partial 58190 72795 97060 46 Lesion Excision ( Superficial - Large ) 4968 6210 8280

Laparotomy Exploratory with Adhesiolysis and Trial Resection ( for 24150 30245 40250 47 Tumor Removal ) 48 Laparotomy Exploratory with Adhesiolysis ( Mild ) 18170 22770 30360 49 Supraomohyoid Neck Dissection ( Extended ) 29095 36455 48530 50 Feeding Jejunostomy ( Oncosurgery ) 13915 17480 23230 51 Gastrectomy Radical Total ( D2 Gastrectomy ) 45770 57270 76360 52 Gastrectomy Radical Subtotal ( D2 Gastrectomy ) 41515 51980 69230 53 Gastrojejunostomy Palliative 16790 21045 28060 54 Gum Biopsy 4692 5865 7820 55 Gun Biopsy - Intraabdominal 4968 6210 8280 56 Gun Biopsy - Intrathoracic 4968 6210 8280 57 Gun Biopsy ( Multiple - Deep ) 6900 8625 11500 58 Gun Biopsy ( Superficial Tumor ) 3036 3795 5060 59 Hysterectomy Radical ( Carcinoma Cervix ) 34155 51233 68310 60 ICD Placement 13915 17480 23230 61 End Ileostomy ( Oncosurgery ) 15640 19550 25990 62 Intestinal Fistula Surgery 29095 36455 48530 63 Malignant Tumor Surgery ( Laparoscopy Assisted ) 58190 72795 97060 64 Liver Segmentectomy Lateral ( Left ) 41515 51980 69230 65 Leucopheresis 20585 25760 34270 66 Thyroid Excision ( Lingual ) 7337 11006 14674 67 Trisegmentectomy - Liver ( Oncosurgery ) 73025 91310 121670 68 Liver Biopsy ( Oncosurgery ) 9936 12420 16560 69 Liver Tumor Wide Excision ( Large Tumor ) / Complex Resection 41515 51980 69230 70 Liver Tumor Wide Excision ( 2-4 ) 49910 62445 83260 71 Lymph Node Biopsy ( Deep ) - Neck 9936 12420 16560 72 Metastasectomy Lung ( Upto 4 ) 58190 72795 97060 73 Metastasectomy Lung ( More Than 4 ) 70610 88320 117760 74 Mandibulectomy Marginal ( with Neck Dissection ) 45770 57270 76360 75 Liver Cyst Marsupialization / Excision ( Small ) 24150 30245 40250 76 Maxillectomy + Neck Dissection 58190 72795 97060 77 Mediastinal Tumor Excision ( Large ) 58190 72795 97060 78 Mediastinal Tumor Excision ( Small / Medium ) 45770 57270 76360 122

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79 Mesenteric Cyst Excision ( Oncosurgery ) 20585 25760 34270 80 Microlaryngosurgery ( MLS ) with laser 29095 36455 48530 81 Necrosectomy + Pancreatic Abscess Drainage - Open 22540 28175 37490 82 Esophagectomy 70610 88320 117760 83 Examination Under Anesthesia ( EUA ) - Oral 2484 3105 4140 84 Pancreatectomy Total ( Oncosurgery ) 70610 88320 117760 85 Parapharyngeal Tumor Excision (Oncosurgery) 29095 36455 48530 86 Glossectomy Partial ( with Neck Dissection ) 45770 57270 76360 87 Cementoplasty Percutaneous 20585 25760 34270 88 Percutaneous Transhepatic Biliary Drainage ( PTBD ) 20585 25760 34270 89 Vertebroplasty Percutaneous 48450 56874 67399 90 Pleural Tap - Therapeutic ( Oncosurgery ) 6900 8625 11500 91 Pleurodesis ( Oncosurgery ) 8556 10695 14260 92 Pneumonectomy Extrapleural 80270 100395 133860 93 Lobectomy Pulmonary ( Two ) 73025 91310 121670 94 Pancreaticoduodenectomy Radical 70610 88320 117760 95 Neck Re-Exploration ( Chyle Leak / Bleeding ) 12535 15698 20930 96 Abdominal Tumor ( Recurrent ) Resection 41515 51980 69230 97 Parotid Tumor ( Recurrent ) Resection 29095 36455 48530 98 Small Bowel Tumor Resection + Anastomosis 22540 28175 37490 99 Retroperitoneal Tumor Excision - Large 41515 51980 69230 100 Retroperitoneal Tumor Excision - Medium 22540 28175 37490 101 Wound Closure ( Secondary ) - Large 12535 15698 20930 102 Wound Closure ( Secondary ) - Medium 4692 5865 7820 103 Suturing Secondary ( Burst Abdomen ) 15640 19550 25990 104 Mandibulectomy Segmental 45770 57270 76360 105 Sigmoidoscopy ( with / without Biopsy ) 4692 5865 7820 106 Mastectomy Simple ( Large Tumor ) 20585 25760 34270 107 Mastectomy Simple ( Small Tumor ) 16790 21045 28060 108 Soft Tissue Tumor Excision ( Central - Large ) 41515 51980 69230 109 Soft Tissue Tumor Excision ( Peripheral - Medium ) 22540 28175 37490 110 Soft Tissue Tumor Excision ( Peripheral - Small ) 18170 22770 30360 111 Submandibular Gland Tumor Excision 16790 21045 28060 112 Tumor Excision ( Superficial - Large ) 9936 12420 16560 113 Tumor Excision - Face ( Superficial - Medium ) 18170 22770 30360 114 Tumor Excision - Face ( Superficial - Small ) 15640 19550 25990 115 Tumor Wide Excision ( Superficial - Small ) 6900 8625 11500 116 Neutropenia Management - Supportive Care ( Per day ) 4002 5003 6670 117 Supraomohyoid Dissection ( Bilateral ) 29095 36455 48530 118 Suturing - Medium ( 6-15 Cms ) 8556 10695 14260 119 Suturing - Large ( >15 Cms ) 12535 15698 20930

Total Abdominal Hysterectomy ( TAH ) + Bilateral 41515 51980 69230 120 Salpingoophorectomy ( BSO ) + Pelvic Lymph Node Dissection 123

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Total Abdominal Hysterectomy ( TAH ) + Bilateral 24150 30245 40250 121 Salpingoophorectomy ( BSO ) - Oncosurgery 122 Thyroidectomy Subtotal ( Oncosurgery ) 22517 33776 45034 123 Amputation Penis ( Total ) + Ilioinguinal Dissection Bilateral 58190 72795 97060 124 Glossectomy Total ( with Neck Dissection ) 58190 72795 97060 125 Maxillectomy Total ( Oncosurgery ) 45770 57270 76360 126 Parotidectomy Total ( Nerve Preserving ) 25174 37760 50347 127 Proctocolectomy Total + Ileostomy 41515 51980 69230 128 Trocar Cystostomy ( Oncosurgery ) 6900 8625 11500 129 Ulcer / Wound Debridement ( Large >15 Cms ) 8556 10695 14260 130 Venesection ( Oncosurgery ) 4692 5865 7820 131 Liver Tumor Wide Excision - More Than 4 70610 88320 117760 132 Orchidectomy Left ( Oncosurgery ) 12535 15698 20930 133 Axillary Lymph Node Dissection - Left 18170 22770 30360 134 Supraomohyoid Dissection ( Left ) 22540 28175 37490 135 IntraArterial Port Placement ( Oncosurgery ) 22540 28175 37490 136 Abscess Drainage - Large ( Oncosurgery ) 4692 5865 7820 137 Abscess Drainage - Medium ( Oncosurgery ) 3036 3795 5060 138 Adrenalectomy Subtotal ( Oncosurgery ) 37490 46920 62560 139 Adrenalectomy Total ( Oncosurgery ) 37490 46920 62560 140 Ascitic Tap - Therapeutic ( Oncosurgery ) 4692 5865 7820 141 Colectomy Radical ( Total ) 33120 41400 55200 142 Thoracoscopy Diagnostic ( with Biopsy ) 37490 46920 62560 143 Dorsal Slit ( Oncosurgery ) 3036 3795 5060 144 Dressing - Medium ( Oncosurgery ) 1380 1725 2300 145 Neck Hematoma Evacuation 6900 8625 11500 146 Lesion Excision ( Superficial - Small ) 4002 5003 6670 147 Thoracotomy Exploratory 33120 41400 55200 148 Gastrectomy Radical Partial ( D2 Gastrectomy ) 37490 46920 62560 149 Gun Biopsy - Chest / Abdominal Wall 4692 5865 7820 150 Insulinoma Excision ( Oncosurgery ) 33120 41400 55200 151 Liver Tumor Wide Excision ( Small -Single ) / Simple Resection 33120 41400 55200 152 Lymph Node Biopsy ( Superficial ) - Inguinal 4692 5865 7820 153 Lumbar Puncture ( Oncosurgery ) 4002 5003 6670 154 Muscle Biopsy ( Oncosurgery ) 4692 5865 7820 155 Pancreatectomy Partial ( Oncosurgery ) 33120 41400 55200 156 Pancreaticojejunostomy ( Oncosurgery ) 37490 46920 62560 157 Pleural Tap - Diagnostic ( Oncosurgery ) 3036 3795 5060 158 Proctoscopy 1380 2070 2760 159 Proctoscopy wih Biopsy 4002 5003 6670 160 Wound Closure ( Secondary ) - Small 2484 3105 4140 161 Soft Tissue Tumor Excision ( Central - Medium ) 37490 46920 62560 162 Soft Tissue Tumor Excision ( Peripheral - Large ) 29095 36455 48530 124

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163 Suture Removal ( Oncosurgery ) 828 1035 1380 164 Suture Removal ( Complex ) 1932 2415 3220 165 Suturing - Small ( Upto 5 Cms ) 4002 5003 6670 166 Thyroidectomy + Neck Dissection ( Level II-IV ) 37490 46920 62560 167 Ulcer / Wound Debridement ( Small - Upto 5 Cms ) 1380 1725 2300 168 Wedge Biopsy ( Superficial ) 1932 2415 3220

Chemotherapy IntraArterial ( Including Chemoport Insertion - 12535 15698 20930 169 Temporary ) 170 MUPIT Application Pelvis Radiotherapy 24840 31050 41400 171 MUPIT Application Pelvis Radiotherapy Procedure 41400 51750 69000

Chemoport / Hickman Cather Insertion (GA) Day Care Package - 10436 12650 13915 172 (P) 173 Infusion Chemotherapy - Multiple Drugs 2300 3450 4600 174 Radiation Oncology Simulation with Contrast 7176 8970 11960 175 Radiation Oncology Simulation without Contrast 4968 6210 8280 176 ILR, IMPLANTABLE LOOP RECORDER 34500 39675 45626 177 EXTRACORPOREAL RADIOTHERAPY (ECRT) 48300 60375 80500 178 INTRALUMINAL BRACHYTHERAPY PLANNING – BRONCHUS 8280 10350 13800 179 INTRALUMINAL BRACHYTHERAPY – BRONCHUS 8280 10350 13800

INTENSITY MODULATED RADIATION THERAPY (IMRT) 82800 103500 138000 180 PREPLANNING 181 IMAGE GUIDED RADIATION THERAPY (IGRT) PREPLANNING 110400 138000 184000 182 INTRALUMINAL BRACHYTHERAPY PLANNING - ESOPHAGUS 8280 10350 13800 183 INTRALUMINAL BRACHYTHERAPY - ESOPHAGUS 8280 10350 13800 184 DAYCARE (4-8 hrs.) 2875 3306 3802 185 DAYCARE (0-4 hrs.) 1725 1984 2282 186 BLOOD IRRADIATION 1-3 UNITS 2760 3450 4600 187 OVOID REDIOTHERAPY PLANNING 8970 11213 14950 188 OVOID REDIOTHERAPY 8970 11213 14950 189 RT SIMULATION (H) 20700 25875 34500 190 RT SIMULATION (L) 6900 8625 11500

TRANSARTERIAL RADIOEMBOLISATION (TARE) - RHENIUM 230000 287615 383410 191 LIPIODOL 192 RHENIUM HEDP BONE PAIN PALLIATION THERAPY 18400 23000 30590 193 INTRA OPERATIVE RADIOTHERAPY 69000 86250 115000 194 VENOUS ACCESS DEVICE (VAD ) FLUSHING 2760 3450 4600 195 VENOUS ACCESS DEVICE REMOVAL (VAD) 13800 17250 23000 196 VENOUS ACCESS DEVICE INSERTION (VAD) 17250 21620 28750 197 ABC (ACTIVE BREATHING COORDINATOR) ASSISTED BREATH 55200 69000 92000 198 ASCITIC (PERITONEAL) TAP-THERAPEUTIC 5520 6900 9200 199 Interstitial Radiotherapy (Brachytherapy) 103500 129375 172500

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OPTHALMOLOGY

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 CATARACT SURGERY WITH PMMA IOL - (P) 11500 13225 15209 2 MICS WITH INDIAN IOL - (P) 39963 45957 52851 3 MICS WITH IMPORTED IOL - (P) 50600 58190 66919 4 MICS WITH IMPORTED IOL (PREMIUM) - (P) 55200 63480 73002 5 MICS WITH ERV IOL - (P) 105800 121670 139921 6 MICS WITH ERV TORIC IOL - (P) 132250 152088 174901 7 MICS WITH INDIAN TORIC IOL - (P) 65550 75383 86690 8 MICS WITH IMPORTED TORIC IOL - (P) 72450 83318 95816 9 MICS WITH INDIAN MULTIFOCAL IOL - (P) 75900 87285 100378 10 MICS WITH IMPORTED MULTIFOCAL TORIC IOL - (P) 128800 148120 170338 11 MICS WITH IMPORTED TRIFOCAL IOL - (P) 126500 145475 167296 12 OUTREACH CATARACT SURGERY WITH IOL - (P) 16100 18515 21292 13 PHACO WITH INDIAN IOL- (P) 22253 25591 29430 14 PHACO WITH INDIAN IOL (PREMIUM) - (P) 29044 33401 38411 15 PHACO WITH IMPORTED IOL - (P) 38318 44066 50676 16 Squint Surgery ( Multiple Horizontal Muscle ) 46575 69863 93150 17 Squint Surgery ( Single Horizontal Muscle ) 49450 74175 98900 18 Squint Surgery 52325 78488 104650 19 Squint surgery ( Vertical Muscle ) 34500 51750 69000 20 SQUINT SURGERY HORIZONTAL MUSCLES (LA) 34500 51750 69000 21 MICS WITH IMPORTED MULTIFOCAL IOL (P) 94300 108445 124712 22 Applanation Tonometry ( Both Eyes ) 115 173 230 23 Keratometry Automated ( Right Eye ) 115 173 230 24 Diurnal Variation Study 1380 2070 2760 25 Gonioscopy ( Both Eyes ) 460 690 920 26 Gonioscopy ( Right Eye ) 288 431 575 27 Gonioscopy ( Left Eye ) 805 926 1065 28 Ophthalmoscopy Indirect ( Right Eye ) 173 259 345

Pachymetry for Central Corneal Thickness (CCT) measurement - 748 1121 1495 29 Both Eyes

Pachymetry for Central Corneal Thickness (CCT) measurement - 460 690 920 30 Right Eye 31 Pachymetry Map ( Ultrasonic ) Both Eyes 1035 1553 2070 32 Pachymetry Map ( Ultrasonic ) Right Eye 690 1035 1380 33 Probing + Syringing 8050 12075 16100 34 Retinal Laser ( Right Eye ) 17250 25875 34500 35 Lacrimal Syringing ( Right Eye ) 230 345 460 36 A Scan Biometry Ultrasound ( Left Eye ) 805 926 1065 37 A Scan BIOMETRY Ultrasound ( Both Eyes ) 1035 1553 2070

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38 B Scan Biometry Ultrasound ( Both Eyes ) 1725 2588 3450 39 YAG Capsulotomy ( Right Eye ) 4600 5290 6084 40 YAG Capsulotomy ( Left Eye ) 4600 5290 6084 41 YAG Capsulotomy ( Bilateral ) 9200 10580 12167 42 Corneal Perforation Repair 34500 39675 45626 43 Injection Intravitreal ( Lucentis ) 43700 50255 57793 44 Iris Refractors 5750 7763 8625 45 Pterygium Excision + Conjunctival Autograft ( without Glue ) 28750 43125 57500 46 Barrage laser / Cryo ( Multiple Quadrant ) 11500 17250 23000 47 Lower Eyelid Retraction Correction 23000 34500 46000 48 B Scan 1725 2588 3450 Optical Coherence Tomography ( OCT ) / Retinal Nerve Fiber Layer ( RNFL ) For Glaucoma ( Subsequent Scan + Change Analysis ) - Both 3680 4968 5520 49 Eyes 50 Autorefractometry 58 86 115 51 Pachymetry 2875 4313 5750 52 Pterygium Surgery + Conjunctival Autograft 29325 33724 38783 53 Chalazion Excision ( Bilateral ) 11500 17250 23000 54 Chalazion Incision and Curettage 5750 8625 11500 55 Retina Surgery - Avastin Intravitreal Injection - (P) 17250 25875 34500 56 Lasik (One Eye) 2875 4313 5750 57 FFA (BOTH EYES) 4025 5434 6038 58 OPTICAL COHERENCE TOMOGRAPHY ( OCT ) ONE EYE 2645 3042 3498 59 COLOUR VISION (ISHIHARA)-BOTH EYE 173 259 345 60 SYRINGING (LACRIMAL)-BOTH EYE 403 604 805 61 SQUINT SURGERY UNDER GA (0 TO 30 MINS) 43700 65550 87400 62 VISUAL FIELDS(BOTH EYES) 2875 3881 4313 63 ND YAG IRIDOTOMY ( PER EYE) 4600 6210 6900 64 ND YAG SYNECHOLYSIS/SWEEPING ( PER EYE) 5750 8625 11500 65 EXCISION OF WARTS 4025 5434 6038 66 DCR WITH MMC 21850 32775 43700 67 DCR WITH MMC WITH INTUBATION 34500 51750 69000 68 DCR WITH FISTULECTOMY 34500 51750 69000 69 DCR WITH FISTULECTOMY WITH INTUBATION 34500 51750 69000 70 DCR WITH FISTULECTOMY WITH INTUBATION WITH MMC 34500 51750 69000 71 SYRINGING UNDER ANESTHESIA - ONE EYE (LA) 1150 1725 2300 72 GENERAL ANESTHESIA CHARGES (0-30 MIN) 9200 13800 18400 73 GENERAL ANESTHESIA CHARGES (1 HRS.) 14950 22425 29900 74 YAG PERIPHERAL IRIDOTOMY - ONE EYE 5290 6084 6997 75 YAG PERIPHERAL IRIDOTOMY - BOTH EYES 10005 11506 13232 76 OPTICAL COHERENCE TOMOGRAPHY (OCT) - BOTH EYES 4255 4893 5627 77 FOLLOW UP CONSULTATION OPHTHALMOGY 920 1058 1217 78 PERIMETRY (VISUAL FIELD TEST) - ONE EYE 1955 2248 2585 128

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79 PERIMETRY (VISUAL FIELD TEST) - BOTH EYES 3450 3968 4563 80 A SCAN BIOMETRY ULTRASOUND ( RIGHT EYE ) 805 926 1065 81 IOL MASTER (AK + NON CONTACT BIOMETRY-BOTH EYES 1725 2588 3450 82 AUTO KERATOMETRY-BOTH EYES 173 259 345 83 AUTO KERATOMETRY-ONE EYE 115 173 230 84 BANDAGE LENS FITTINGS (BCL)-BOTH EYES 575 863 1150 85 BDE CLEANING & LM -BOTH EYES 345 518 690 86 BDE CLEANING & LM -ONE EYE 230 345 460 87 R.B STAINING/LG STAINING -BOTH EYES 58 86 115 88 R.B STAINING/LG STAINING -ONE EYE 58 86 115 89 RETINAL LASER INTERFEROMETRY-BOTH EYES 230 345 460 90 RETINAL LASER INTERFEROMETRY-ONE EYE 230 345 460 91 SPECIAL ORTHOPTIC -ONE EYE 288 431 575

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PULMONOLOGY

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 Lung Needle Biopsy ( Pulmonology ) 3450 5175 6900 2 Pleural Biopsy ( Pulmonology ) 6785 10178 13570 3 Bronchoscopy - ( Pulmonology ) 5060 7590 10120 4 Complete Bronchoscopy Including Brush Biopsy 8970 13455 17940 5 Pleural Biopsy - Thoracoscopic ( Pulmonology ) 11500 17250 23000 6 Lung Biopsy Thoracoscopic ( Pulmonology ) 11500 17250 23000 7 Bronchoscopy Rigid - Diagnostic ( Pulmonology ) 13800 15870 18251 8 Rigid Bronchoscopy ( Therapeutic ) 19550 22483 25855 9 Pleural Aspiration ( Tap ) - Therapeutic 10350 11903 13688 10 Thoracoscopy Diagnostic ( Pulmonology ) 10350 11903 13688 11 Clot Evacuation By Thoracoscopy 17250 25875 34500 12 Thoracoscopy for Chylothorax 23000 34500 46000 13 Multiple Sleep Latency Test ( MSLT ) - after COP use 2875 4313 5750 14 Multiple Sleep Latency Test ( MSLT ) 5175 7763 10350 15 Pulmonary Function Test ( PFT ) with Diffusion Studies 3195 4792 6389

Transbronchial Needle Aspiration - Endobronchial Ultrasound 17250 19838 22814 16 Guided ( EBUS - TBNA ) 17 Pleurodesis ( Pulmonology ) 5060 5819 6692

Fine Needle Aspiration Cytology ( FNAC ) Procedure - CT Guided ( 7475 8596 9885 18 Pulmonology ) 19 Fluoroscopy - Chest 2300 2645 3042 20 Pericardial Aspiration ( Thoracic Surgery ) 3680 5520 7360 21 Lung Biopsy Open ( Thoracic Surgery ) 6325 9488 12650 22 Mediastinal Lymph Node Biopsy ( Thoracic Surgery ) 7475 11213 14950 23 Breast Lump Excision + Sentinel Node Biopsy 13685 20528 27370 24 Breast Lump ( Benign ) Excision 6785 10178 13570 25 Bronchoplastic Resection 27830 41745 55660 26 Bullectomy 17135 25703 34270 27 Carinal Reconstruction 25070 37605 50140 28 Chest Wall Resection + Reconstruction 11385 17078 22770 29 Decortication + Lobectomy ( Lung ) 17135 25703 34270 30 Diaphragmatic Reconstruction 22770 34155 45540 31 Empyemectomy 18170 27255 36340 32 Benign Tumors Enucleation (Thoracic Surgery) 20470 30705 40940 33 Esophageal Diversion ( Thoracic Surgery ) 17135 25703 34270 34 Esophageal Stenting ( Thoracic Surgery ) 17135 25703 34270 35 Hemothorax Evacuation ( Thoracic Surgery ) 18170 27255 36340 36 Cervical Rib Excision ( Thoracic Surgery ) 14835 22253 29670 37 Esophageal Diverticulum Excision ( Thoracic Surgery ) 17135 25703 34270

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38 Mediastinal Tumor Excision ( Thoracic Surgery ) 20470 30705 40940 39 Parathyroid Adenoma Excision ( Thoracic Surgery ) 20470 30705 40940 40 Lobectomy Lung ( Thoracic Surgery ) 25300 37950 50600 41 Lung Abscess Surgery ( Thoracic Surgery ) 22770 34155 45540 42 Lung Resection + Chest Wall Resection 29555 44333 59110

Lung Resection + Mediastinal Node Dissection + Chest Wall 31855 47783 63710 43 Reconstruction 44 Lung Volume Reduction Surgery ( Bilateral ) 25070 37605 50140 45 Mediastinal Lymphadenectomy 6785 10178 13570 46 Parathyroid Autotransplantation ( Thoracic Surgery ) 9085 13628 18170 47 Pericardial Tube Drainage 6325 9488 12650 48 Pleurectomy + Empyema Excision ( Without Lung Resection ) 15985 23978 31970 49 Pleurectomy + Air Leak Obliteration 20470 30705 40940 50 Pleuro Pericardial Window Creation 11385 17078 22770 51 Pleuro Peritoneal Shunt 11385 17078 22770 52 Mastectomy Radical 19090 28635 38180 53 Mastectomy Modified Radical ( Thoracic Surgery ) 22770 34155 45540 54 Scalenotomy ( For Scalenus Syndrome ) 5750 8625 11500 55 Lung Resection ( Segmental ) 20470 30705 40940 56 Sentinel Node Biopsy ( Bilateral ) 12535 18803 25070 57 Sentinel Node Biopsy ( Left ) 10235 15353 20470 58 Sternal Debridement + Muscle Flap Rotation 25070 37605 50140 59 Sternal Resection + Reconstruction 22770 34155 45540 60 Achalasia Cardia Surgery 20470 30705 40940 61 Carcinoid Tumor + Metastasis Surgery 22770 34155 45540 62 Gastroesophageal Reflux ( GER ) + Hiatus Hernia Surgery 22770 34155 45540 63 Hydatid Disease Surgery - Right ( Thoracic Surgery ) 17135 25703 34270 64 Mamillary Duct Fistula Surgery 10235 15353 20470 65 Parathyroid Hyperplasia Surgery 22770 34155 45540 66 Bronchogenic Cyst Surgery 20240 30360 40480 67 Tracheoesophageal Fistula ( TEF ) Surgery 22770 34155 45540 68 Sympathectomy ( Bilateral ) for hyperhydrosis 29555 44333 59110 69 Thoracic Outlet Obstruction Surgery 18630 27945 37260 70 Thoracotomy ( for Perforating / Penetrating Injury ) 14835 22253 29670 71 Thoracic Duct Excision - Total ( Thoracic Surgery ) 10235 15353 20470 72 Lung Volume Reduction Surgery ( Right ) 22770 34155 45540 73 Tumor Wide Excision 15985 23978 31970 74 Wide Local Excision + Axillary Dissection 15985 23978 31970 75 Removal And Flap Insetting (Small) (Plastic Surg) 20470 30705 40940 76 Fibreoptic Bronchoscopy ( Diagnostic ) 5750 6613 7605 77 Plication Diaphragm 20470 30705 40940 78 Mastectomy Simple ( Thoracic Surgery ) 11385 17078 22770 79 Mastectomy ( Simple ) + Axillary Dissection ( Thoracic Surgery ) 14835 22253 29670 132

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80 Lymph Node Dissection - Retroperitoneal 22770 34155 45540 81 Bronchoscopy Fiberoptic 14375 16531 19011 82 Bronchoscopy Fibreoptic + TBB + TBNA 6325 9488 12650 83 Pleural Aspiration - Therapeutic ( Thoracic Surgery ) 2875 4313 5750 84 Pleurodesis ( Thoracic Surgery ) 5175 7763 10350 85 Rigid Bronchoscopy ( Thoracic Surgery ) 10120 15180 20240 86 Rigid Bronchoscopy + Electrocoagulation ( Thoracic Surgery ) 15180 22770 30360 87 Rigid Bronchoscopy + Laser Ablation ( Thoracic Surgery ) 15180 22770 30360 88 Six Minute Walk Test (SMWT) 690 794 913 89 TRACHEAL DILATATION 17135 25703 34270 90 SLEEP STUDY COMPLETE(HOME BASED) 18400 91 BIOPSY PLEURA 3220 9000 12000 92 STENT INSERTION BRONCHOSCOPIC 13800 21600 28800 93 INTRAPLEURAL FIBRINOLYSIS 3450 5400 7200 94 PIGTAIL CATHETER INSERTION PULMONOLOGY 8625 13500 18000 95 DRAIN INSERTION 8050 12600 16800 96 FIBEROPTIC VIDEO LARYNGOSCOPY 3450 5400 7200 97 FIBEROPTIC BRONCHOSCOPIC INTUBATION 6325 9900 13200 98 FIBEROPTIC BRONCHOSCOPY WITH BRONCHOALVEOLAR LAVAGE 8625 13500 18000 99 FIBEROPTIC BRONCHOSCOPY - FOREIGN BODY REMOVAL 17250 27000 36000 100 ENDOBRONCHIAL GLUE THERAPY BRONCHOSCOPIC 8050 12600 16800 101 BRONCHOSCOPIC BALLOON DILATION 12650 19800 26400 102 THORACOSCOPY THERAPEUTIC 13800 21600 28800

FIBEROPTIC BRONCHOSCOPY WITH BRONCHOALVEOLAR LAVAGE + 11500 18000 24000 103 BIOPSY 104 CHEST TUBE REMOVAL + DRESSING 2875 4500 6000 105 TRUCUT BIOPSY (PULMONOLOGY) 8050 12600 16800 106 CARDIO PULMONARY RESUSCITATION 1242 1944 12150 107 USG GUIDED PLEURAL TAPING 2300 3600 4800 108 PERITONEAL/ ASCITIC TAP 8050 12600 16800 109 Chest Wall Flap Reconstruction ( Thoracic Surgery ) 11385 297000 396000 110 THORACIC PULMO PACKAGES COMPLEX - (P) 227700 392040 522720

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PAIN CLINIC

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 CAUDAL EPIDURAL STEROID INJECTION 1725 2588 3450 2 COELIAC PLEXUS BLOCK DIAG/THER (USG) - (P) 2875 4313 5750 3 SPINAL LIGAMENT INJECTION ( DIAGNOSTIC ) 1150 1725 2300 4 FACET JOINT INJECTION 2875 4313 5750 5 JOINT INJECTION 1150 1725 2300 6 LOCAL INFILTRATION 2957 4435 5914 7 EPIDURAL INJECTION ( LUMBAR ) 2070 3105 4140 8 ACUPUNCTURE ( PER SITTING ) 403 604 805 9 PERIPHERAL NERVE BLOCK 920 1380 1840 10 RADIOFREQUENCY ( RF ) RHIZOTOMY 23000 34500 46000 11 SPINAL NERVE ROOT BLOCK 4600 6210 6900 12 STELLATE GANGLION BLOCK 1150 1725 2300 13 EPIDURAL INJECTION ( THORACIC ) 2875 4313 5750 14 TRIGGER POINT INJECTION - (P) 920 1380 1840

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PLASTIC SURGERY

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 Alar Adjustment 9258 10647 12244 2 Replantation ( Scalp Avulsion Injuries ) 62043 71349 82051 3 Breast Augmentation 22770 34155 46000 4 Cleft Lip ( Complete ) Repair - Bilateral 29429 33843 38919 5 Cleft Lip Revision 26830 30855 35483 6 Cleft Palate Repair ( Plastic Surgery ) 26830 30855 35483 7 Rhinoplasty Cosmetic 47426 54540 62721 8 Cranial Bone Grafting 33833 38908 44744 9 Dermabrasion Face ( Full Face ) 40423 46486 53459 10 Dermabrasion Face ( Partial ) 29429 33843 38919 11 Ear Reconstruction ( 1st Stage ) 19090 28635 40250 12 Ear Reconstruction ( 2nd Stage ) 19090 28635 40250 13 Facial Nerve Repair 33615 38657 44456 14 Facial Sling Procedure ( Facial Paralysis ) 17434 20049 23056 15 Fasciocutaneous Flap Procedure ( Large ) 19090 28635 40250 16 Fasciocutaneous Flap Procedure ( Small ) 26841 30867 35497 17 Flap Detachment + Final Inset 14260 21390 28750 18 Foreign Body Removal Wound ( Deep ) - Plastic Surgery 16008 18409 21170 19 Foreign Body Removal Wound ( Superficial ) - Plastic Surgery 8004 9205 10586 20 Skin Graft - Full Thickness ( Medium ) 17239 19825 22799 21 Skin Graft - Full Thickness ( Small ) 10649 12246 14083 22 Hemangioma Excision - Medium ( Plastic Surgery ) 19631 22576 25962 23 Hemangioma Excision - Small ( Plastic Surgery ) 15640 17986 20684 24 InterMaxillary Fixation ( IMF ) - Plastic Surgery 14835 17060 19619 25 Lipectomy - Cosmetic 22034 25339 29140 26 Lipoma Excision - Small ( Plastic Surgery ) 12432 14297 16442 27 Liposuction ( Medium ) - Per Region 17055 19613 22555 28 Liposuction ( Small ) - Per Region 14237 16373 18829 29 Tongue Tie Release ( Plastic Surgery ) 4807 5528 6357 30 Nerve Grafting ( Secondary Repair ) 43217 49700 57155 31 OrbitoZygomatic Fracture ( Complex ) Repair 27945 41918 51750 32 Ptosis Correction - Both Eyes ( Plastic Surgery ) 17607 20248 23285 33 Rhinoplasty Reconstructive 32005 36806 42327 34 Scar Revision ( Large ) 28750 33063 38022 35 Split Skin Graft ( Large ) 23000 26450 30418 36 Split Skin Graft ( Medium ) 17250 19838 22814 37 Split Skin Graft ( Small ) 11500 13225 15209 38 Nerve Repair ( Plastic Surgery ) 16008 18409 21170 39 Torticollis Release 29647 34094 39208

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40 Wound Debridement - Large ( Plastic Surgery ) 20700 29900 41400 41 Wound Debridement - Small ( Plastic Surgery ) 9223 10606 12197 42 Z - Plasty ( Small ) 12432 14297 16442 43 Dressing Change - Small ( Plastic Surgery ) 2070 3105 4140 44 Suture Removal - Small ( Plastic Surgery ) 1231 1416 1628 45 Suture Removal - Medium ( Plastic Surgery ) 2024 2328 2677 46 Lipoma Excision - Medium ( Plastic Surgery ) 17434 20049 23056 47 Scar Revision ( Small ) 12432 14297 16442 48 Scar Revision ( Medium ) 18653 21451 24669 49 Lip Rejuvenation 29429 33843 38919 50 Fat Pad ( Buccal ) Removal 29429 33843 38919 51 Rhinoplasty Reconstructive ( Limited ) 24012 27614 31756 52 Rhinoplasty Reconstructive ( Partial ) 16008 18409 21170 53 Wound Debridement - Superficial ( Plastic Surgery ) 5543 6374 7330 54 Tissue Expander Insertion - Single 20010 23012 26464 55 Tissue Expander Insufflation ( Per Sitting ) 4807 5528 6357 56 Expander Removal + Contouring ( Multiple ) 30027 34531 39711 57 Expander Removal + Contouring ( Single ) 20010 23012 26464 58 Facial Bones ( Maxillary ) Fracture Closed Reduction 17607 20248 23285

Facial Bones ( Frontal Bone ) Fracture Repair - Bilateral ( Plastic 23644 27191 31270 59 surgery )

Facial Bones ( Frontal Bone ) Fracture Repair - Right side ( Plastic 17055 19613 22555 60 surgery ) 61 Neurotization ( Facial Paralysis ) 26841 30867 35497 62 Cross Facial Nerve Grafting ( Facial Paralysis ) 26841 30867 35497 63 Functional Free Muscle Transfer ( Facial Paralysis ) 43436 49951 57444 64 Tongue Flap Procedure 21034 24189 27817 65 Cleft Palate Repair - Soft Palate ( Plastic Surgery ) 23621 27164 31239 66 Cleft Palate Fistula Repair ( Plastic surgery ) 23621 27164 31239 67 Cleft Lip + Cleft Palate Repair ( Plastic surgery ) 29831 34306 39452 68 Skin Graft - Full Thickness ( Half Face - Very Large Area ) 28440 32706 37612 69 Iliac Crest Bone Grafting 17607 20248 23285

Wound ( Other Than Burn ) Cover with Split Thickness Skin Graft - 11040 12696 14600 70 Small

Wound ( Other Than Burn ) Cover with Split Thickness Skin Graft - 19838 22814 26236 71 Medium 72 Muscle Flap ( for Facial Paralysis ) 35041 40297 46342 73 Rhinoplasty Augmentation ( Plastic Surgery ) 32005 36806 42327 74 Abbe Flap Surgery 24438 28104 32320 75 Benign Lesion Excision ( Small ) 4807 5528 6357 76 Benign Lesion Excision ( Medium ) 10017 11520 13248 77 Benign Lesion Excision ( Large ) 14226 16360 18814 78 Canthopexy 41837 48113 55330 138

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79 Maxillary Osteotomy 46633 53628 61672 80 Burn Grafting ( Small ) 13616 15658 18007 81 Burn Grafting ( Medium ) 22816 26238 30174 82 Nasal Pack Removal ( Plastic Surgery ) 3634 4179 4806 83 Arch Bar Removal ( Plastic Surgery ) 5221 6004 6905 84 Fasciocutaneous Flap Procedure ( Medium / Intermediate ) 29429 33843 38919 85 Arch Bar Wiring - Intermaxillary Fixation ( IMF ) 13616 15658 18007 86 Facial Nerve Decompression 19090 28635 38180 87 Lipectomy ( Abdomen ) 14260 21390 28750 88 Botox Injection ( 20 Units ) 5026 5780 6647 89 Botox Injection ( 50 Units ) 10017 11520 13248 90 Brow Lift 28750 43125 57500 91 Craniofacial Surgery - Complete Defect Correction 200031 230036 264541 92 Craniofacial Surgery - Partial Defect Correction 150041 172547 198429 93 Expander Insertion - Multiple 30027 34531 39711 94 Laceration Repair - Large 14260 21390 28750 95 Laceration ( Multiple ) Repair 19090 28635 40250 96 Laceration ( Single ) Repair - Medium 13639 15685 18038 97 Laceration ( Single ) Repair - Small 8855 13283 17250 98 LipoInjection ( Small Area ) 15640 17986 20684 99 Nose Reconstrution ( Extensive ) 48013 55215 63497 100 Rhinoplasty ( Secondary ) 29429 33843 38919 101 Nose Tip Plasty ( Major ) 29429 33843 38919 102 Nose Tip Plasty ( Minor ) 20045 23052 26510 103 Aesthetic Rhinoplasty ( Complete ) - Nose 32005 36806 42327 104 Bimaxillary Procedure ( Orthognathic Surgery ) 79649 91596 105335

Maxillary / Mandibular Distractor Placement ( Orthognathic 40009 46010 52912 105 Surgery ) 106 Nerve Repair ( Peripheral ) 22034 25339 29140 107 Arthroplasty - TemporoMandibullar ( TM ) Joint ( Bilateral ) 50842 58468 67238 108 Arthroplasty - TemporoMandibullar ( TM ) Joint ( Left ) 42263 48602 55892 109 Trigger Finger Release - Bilateral ( Plastic Surgery ) 5693 6768 7274 110 Cleft Lip Repair ( Plastic Surgery ) 18021 20724 23833 111 Dental Cyst Excision + Jaw Reconstruction ( Plastic Surgery ) 22885 34328 45770 112 Palate Cyst / Tumor ( Benign ) Excision 6670 10005 13340 113 Y - Plasty / Z - Plasty 13639 15685 18038 114 Scar ( Simple Medium ) Revision 8625 9919 11407 115 Scar ( Simple Small ) Revision 6038 6944 7986 116 Adjacent Flap - Large 26841 30867 35497 117 Adjacent Flap - Medium 21034 24189 27817 118 Adjacent Flap - Small 13858 15937 18328 119 Lip Reconstruction ( One Third Loss ) 24438 28104 32320 120 Lip Reconstruction ( Two Third Loss ) 32005 36806 42327 139

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121 Lip Reconstruction ( Total Loss ) 36812 42334 48684 122 Burn Dressing ( Face ) / Category 6 8004 9205 10586 123 Dressing ( Small - Simple ) 1840 0 0 124 Wrinkles Glycolic Acid Treatment ( Face ) 3105 4658 6210 125 Dermal Fillers - Lip Augmentation 17250 25875 34500 126 Platelet Rich Plasma ( PRP ) - Small Area 10914 12551 14434 127 Mandible Fracture - Closed Reduction ( Plastic Surgery ) 14260 21390 28750

Ulnar Collateral Ligament Reconstruction - Thumb ( Plastic Surgery 26485 31085 36846 128 ) 129 Penile Lengthening ( Plastic Surgery ) 46000 52900 60835

35305 52958 70610 130 Wide Excision Of Lesion In Head And Neck - Major ( Plastic Surgery ) 131 Free Style Free Flap ( Plastic Surgery ) 63250 94875 126500 132 Hair Transplant ( Level 1 ) 13225 15209 17490 133 Hair Transplant ( Level 2 ) 19838 22814 26236 134 Hair Transplant ( Level 3 ) 26450 30418 34981 135 Hair Transplant ( Level 4 ) 39675 45626 52470 136 Hair Transplant ( Level 5 ) 52900 60835 69960 137 Hair Transplant ( Level 6 ) 66125 76044 87451 138 Hair Transplant ( Level 7 ) 79350 91253 104941

VACUUM ASSISTED CLOSURE (VAC) DRESSING - LARGE (PLASTIC 9775 11241 12927 139 SURGERY)

VACUUM ASSISTED CLOSURE (VAC) DRESSING - MEDIUM (PLASTIC 7705 8861 10190 140 SURGERY) 141 PENILE FAT GRAFTING 34500 39675 45626 142 PENILE RECONSTRUCTION - LOCAL ADVANCEMENT FLAP 23000 26450 30418

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PHYSIOTHERAPY

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 Physiotherapy Chest 345 518 690 2 Diathermy Short Wave (Physiotherapy) 144 216 288 3 Neuro Exercise Therapy 690 1035 1380 4 Paraffin Wax Bath 144 216 288 5 Supervised Exercises 20 Minutes 1150 1323 1521 6 Initial Evaluation ( Upto 45 mins. ) 575 776 1165 7 Cervical Traction (Physiotherapy ) 144 216 288 8 Lumbar Traction (Physiotherapy ) 90 135 179 9 Continuous Passive Motion ( CPM ) 173 259 345 10 Electrical Stimulation ( Type 1 ) 144 216 288 11 Breathing Exercises + Postural Drainage 173 259 345 12 Muscle Testing Diagnostic ( Physiotherapy ) 144 216 288 13 Post Polio Exercise ( Physiotherapy ) 345 518 690 14 Hot Pack 230 265 305 15 Cold Pack 115 173 230 16 Laser Therapy - ( LLLT ) ( Physiotherapy ) 173 259 345 17 Ultrasound Therapy - Bed Side (Physiotherapy) 144 216 288 18 Cardiac Rehabilitation 575 575 575 19 Gait Training 104 120 138 20 TENS 230 265 305 21 NEURO PHYSIOTHERAPY EVAL 690 794 913 22 NEURO REHABILITATION 1150 1323 1521 23 ORTHO SINGLE JOINT TREATMENT OR SINGLE COMPLAINT 345 518 690 24 ANY ADDITIONAL JOINT TREATMENT OR ADDITIONAL COMPLAINT 173 233 350 25 ANY ADDITIONAL MODALITY PER SITTING 115 173 230 26 SINGLE JOINT TREATMENT OR SINGLE COMPLAINT 575 776 1165 27 U. V. THERAPEUTIC DOSE 144 216 288 28 CHEST PHYSIOTHERAPY 345 518 690 29 CHEST & LIMB PHYSIOTHERAPY 920 1058 1217 30 CLASS IV LASER: PHYSIOTHERAPY 920 1242 1863 31 DRY NEEDLING CHARGES 230 311 466 32 SPORTS TAPPING PER JOINT 115 155 233 33 AFP FUNCTIONAL ASSESSMENT 11500 13225 15209 34 AFP POSTURAL ASSESSMENT 11500 13225 15209 35 AFP FULL ASSESSMENT 23000 26450 30418 36 AFP REHABILITATION - PER SESSION 4025 4629 5323 37 AFP SUBASSESSMENT 2875 3306 3802 38 AFP REHABILITATION - PACKAGE 30 SESSION 92000 105800 121670 39 AFP REHABILITATION - PACKAGE 20 SESSION 63250 72738 83649

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40 AFP REHABILITATION - PACKAGE 10 SESSION 34500 39675 45626 41 SUPERVISED EXERCISE TRAINING (1 SESSION ) 1150 1323 1521 42 SUPERVISED EXERCISE TRAINING (3 SESSION ) 3105 3571 4107 43 SUPERVISED EXERCISE TRAINING (9 SESSION ) 7245 8332 9582 44 SUPERVISED EXERCISE TRAINING (24 SESSION ) 17250 19838 22814

AFP-FEBJI PRE & POST ASSESSMENT WITH 10 REHABILITATION 28750 33063 38022 45 SESSIONS-(P) 46 AFP-FEBJI FULL ASSESSMENT-(P) 11500 13225 15209

AFP-FEBJI PRE & POST ASSESSMENT WITH 20 REHABILITATION 46000 52900 60835 47 SESSIONS-(P) 48 HOME PHYSIOTHERAPY FOR 6 SESSION - (P) 6900 7935 9125 49 AFP REHABILITATION + PHYSIOTHERAPY 2300 2645 3042 50 AFP BIOMECHANICAL ASSESSMENT 6900 7935 9125 51 JOINT MOBILIZATION 104 120 138 52 EXERCISES 104 120 138 53 UPPER LIMB EXERCISES 104 120 138 54 LOWER LIMB EXERCISES 104 120 138 55 BALANCE & COORDINATION EXERCISES 104 120 138 56 REHABILITATION 30 MINUTES 575 575 575 57 CARDIAC REHAB-OPD-(P) 4025 4629 5323

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MISC. & OTHERS SERVICES

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 Arterial Line Insertion 2415 2777 3194 2 Clean Lacerated Wound ( CLW ) Suturing ( Plastic Surgery ) 4140 6210 8280 3 Ryles Tube Insertion 1725 1984 2282 4 Skin Biopsy ( Besdside ) 1725 2588 3450 5 Nebulization 288 331 381 6 Sternal Puncture 1840 2760 3680 7 Foley's Catheter Removal 575 863 1150 8 Caloric Test ( Bedside ) 828 1242 1656 9 Radiofrequency ( RF ) Rhizotomy 23000 34500 46000 10 Continuous Subcutaneous Insulin Infusion ( CSII ) 1278 1917 2555 11 Body Fat Analysis 639 958 1278 12 INJECTION CHARGES OPD/ER 288 331 381 13 SAMPLE COLLECTION CHARGES 250 250 250 14 REGISTRATION CHARGES 200 200 200 15 Doctor with Ambulance (Local) 2300 16 AMBULANCE CHARGES LOCAL 3450 17 JUNIOR CONSULTANT AND ABOVE CHARGES WITH AMBULANCE 3450

JUNIOR CONSULTANT AND ABOVE CHARGES WITH AMBULANCE 9200 18 (OUTSTATION)

JUNIOR CONSULTANT AND ABOVE CHARGES WITH AIR 23000 19 AMBULANCE 20 NURSE/TECH FEE AMBULANCE (LOCAL) 1150 21 NURSE/TECH FEE AMBULANCE (OUTSTATION) 2300 22 AIR AMBULANCE CALL WITH IABP 23000 23 DOCTOR CHARGES WITH AMBULANCE (OUTSTATION) 9200 24 AMBULANCE CHARGES ( OUTSTATION ) PER KM 82 25 AMBULANCE CALL WITH IABP (NCR/OUTSTATION) 17250 26 ADMISSION CHARGE 1000 1000 1000 27 CD CHARGES CARDIOLOGY 1100 1100 1100 28 PULSE OXIMETER 1500 1500 1500 29 NIMBUS II 372 372 372 30 24hr Insulin Initiation / Modification 1015 1524 2032 31 Intralesional Injection 621 932 1242 32 GRAMS STAIN (GM SMEAR) EACH (LAB CHARGES)-ONE EYE 80 80 80 33 KOH SLIDE PREP. (EACH) (LAB CHARGES)-ONE EYE 80 80 80 34 CHANGE OF ARTICULAR SURFACE 23030 23030 23030 35 DOSE ADMINISTRATION CHARGES 1725 1984 2282 36 Urethral Calibration - Bedside 1725 2588 3450 37 Casts Application ( Below Elbow ) - Bedside 1610 2415 3220

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38 Casts Application - Full ( Below Knee ) - Bedside 2070 3105 4140 39 Slab Application ( Below Knee ) - Bedside 1610 2415 3220 40 Plaster Of Paris ( POP ) Full Plaster - Fingers ( Bedside ) 725 1087 1449 41 Intubation Charges 1725 1984 2282 42 Glue Insertion 5750 8625 11500 43 INJECTION INTRAARTICULAR ( OPD-PKG ) 725 1087 1449 44 REHABILITATION CHARGES 11500 13225 15209 45 Suturing / Resuturing charges (Small) 1150 1323 1521 46 Suturing /Resuturing charges (Large) 3450 3968 4563 47 DIETICIAN CHARGES 264 264 264 48 CARDIAC MONITORING 1150 1150 1150 49 MEDICAL RECORDS PHOTOCOPY CHARGES FOR INSURANCE 360 360 360 50 OTHER MISCELLANEOUS SURGERY 11500 13225 15209 51 PLICATION OF LV ANEURYSM 18400 24840 37260 52 DECOMPRESSING FLAP VALVE 11500 15525 23288 53 ROBOTIC PYCLOPLASTY 256450 315675 512900 54 EXCISION OF AVM 27600 46000 63250 55 BM ASPIRATION 207000 276000 304750 56 BIPAP (PER DAY)-CCM 2875 2875 11385 57 CARDIO VASCULAR PROCEDURE - MAJOR LEFT 63250 74750 86250 58 CT - EXTRA FILM 690 794 913 59 INJECTION CHARGES SUBCUTANEOUS (OPD) 115 132 152 60 TREATMENT ROOM CHARGES 575 661 760 61 STANDBY SURGEON 5750 6613 7605 62 COMMON ITEM CHARGES IN OT 1725 1984 2282 63 Catheterization ( Subclavian / External Jugular / Internal Jugular ) 10350 10350 20700 64 Change of Tracheostomy Tube 115 115 115 65 Enema Administration 173 173 345

ADVANCED HEMODYNAMIC MONITORING (CRITICAL CARE) 173 173 345 66 (134469) 67 BAIR HUGGER / PATIENT WARMER CHARGE (1970) 431 431 863 68 Urine Testing (Glucose / Ketones) 431 431 863 69 Bowel Wash (25164) 173 173 345

Peripherally Inserted Central Catheter ( PICC ) Line Insertion - 10350 10350 20700 70 Bedside (147757)

Peripherally Inserted Central Catheter ( PICC Line Removal ) 10350 10350 20700 71 (143003) 72 CT ORAL CONTRAST CHARGES 345 397 457 73 CT IV CONTRAST CHARGES 2013 2315 2662 74 VENTILATOR CHARGES ( 0 - 6 HRS ) 1750 1750 1750 75 HARMONIC SCALPEL ( MINOR ) 5750 6613 7605 76 ALPHA BED (MEDITECH) 325 325 325 77 HARMONIC SCALPEL ( MAJOR ) 11500 13225 15209 146

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78 AIR MATTRESS 200 200 200 79 Infusion Charges 270 270 270 80 DVT SWELL CURE 1000 1000 1000 81 DAILY ECMO CHARGES 1500 1500 1500 82 Tracheostomy Percutaneous ( Critical Care ) 3450 5175 6900 83 Tracheostomy Decannulation ( Critical Care ) 1242 1863 2484 84 External Jugular Cannulation ( Critical Care ) 10350 11903 13688 85 EMERGENCY CHARGES 23000 23000 23000 86 BODY COMPOSITION MONITORING (BCM) 1725 1725 2588 87 SWANGANZ LINE 2070 3105 4140 88 LAP RADICAL NEPHRO URETERECTOMY 57500 86250 115000 89 TRACHEAL RESECTIONS 25070 37605 50140 90 MULTI LOAD 575 863 1150 91 GARMENTS PUMP (ONE TIME) 311 466 621 92 EPLEYS MANEUVERS 4313 6469 8625 93 PV THERAPY 9200 12650 17250 94 ULTRASOUND GUIDED BIOPSY 5520 8280 11040 95 ULTRASOUND GUIDED ASPIRATION 3450 5175 6900 96 ULTRASOUND GUIDED DRAINAGE 6900 10350 13800 97 ULTRASOUND GUIDED DRAINAGE - TUBE CHANGE 3450 5175 6900 98 ANGIOGRAPHY(Gastro) 10350 15525 20700 99 ULTRASOUND GUIDED TUMOR ABLATION - CHEMICAL 11500 15525 17250 100 RADIOEMBOLIZATION, COILING & SHUNT EVALUATION 57500 86250 115000 101 RADIOEMBOLIZATION THERAPY INFUSION 25300 37950 50600 102 TIPSS+EMBOLIZATION 92000 138000 184000 103 PAIR (PERCUTANEOUS ASPIRATION, INJECTION) - HYDATID 11500 17250 23000 104 PORTAL VEIN DILATATION 34500 51750 69000 105 PORTAL VEIN STENTING 34500 51750 69000 106 FEEDING ASSESSMENT 2415 2777 3194 107 FEEDING MANAGEMENT 2415 2777 3194 108 COGNITIVE REHABILITATION 2415 2777 3194 109 REHABILITATION - AUDITORY PROCESSING DISORDERS 2415 2777 3194 110 NEURO REHABILITATION - NONMOTOR DISORDERS 2415 2777 3194 111 TINNITUS RETRAINING THERAPY (TRT) 2990 3439 3955 112 SWALLOWING MANAGEMENT 2415 2777 3194 113 RENAL REHABILITATION STAGE 1 - (P) 4025 4629 5323 114 RENAL REHABILITATION STAGE 2 - (P) 4025 4629 5323 115 RENAL REHABILITATION STAGE 3 - (P) 4025 4629 5323

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CARDIAC DIAGNOSTIC

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 Electrocardiography ( ECG ) 12 Lead 583 875 1166 2 2D Echocardiography + Color Doppler 3630 5445 7260 3 Ankle Brachial Index ( ABI ) / Pulse Wave Velocity ( PWV ) 612 916 1222

Ankle Brachial Index ( ABI ) + Carotid Intima Media Thickness 1222 1834 2444 4 Measurement 5 Cardiovascular Profile Assessment 1222 1834 2444 6 Carotid Intima Media Thickness Measurement 916 1375 1834 7 2D Echocardiography ( Contrast ) 9166 13750 18334 8 Stress Echocardiography ( Digital ) 6050 9166 12222 9 Stress Echocardiography ( Dobutamine ) 6545 9818 13090 10 3D Echocardiography 3630 5500 7334 11 2D Echocardiography ( Pediatric ) 3666 5500 7334 12 2D Echocardiography ( Screening ) 2640 3960 5280 13 Echocardiography Transesophageal ( TEE ) 5665 8498 11330 14 Flow Mediated Dilatation ( FMD ) Assessment 612 916 1222 15 Internal Mammary Artery ( IMA ) Duplex Scan 1834 2750 3666 16 Echocardiography Screening ( Pediatric ) 2444 3666 4888 17 Transesophageal Echocardiography ( TEE ) - Pediatric 3666 5500 7334 18 Femoral Artery Sizing ( Pre Procedural ) 612 916 1222 19 Tissue Doppler Echocardiography Study 3056 4584 6112 20 Vascular Doppler Study 2444 3666 4888 21 Stress Echocardiography 6259 9389 12518 22 Cardiac Event Recorder ( 1 Week ) 2444 3666 4888 23 Holter Monitoring 4114 6171 8228 24 Tread Mill Test ( TMT ) 3465 5198 6930 25 Head Up Tilt Test ( HUTT ) 8250 8250 11000 26 Cardioversion 22000 37400 55000 27 Intermittent Pneumatic Compression 935 1263 1893 28 Cardiac D - Dimer Test 1399 2099 2798 29 Pulmonary Function Test ( PFT ) - Simple - NIC 1859 2789 3718 30 Pulmonary Function Test ( PFT ) Complete - NIC 2750 4125 5500 31 Pulmonary Function Test ( PFT ) with Bronchodilator - NIC 2444 3666 4888 32 Pulmonary Function Test ( PFT ) with Exercise - NIC 2200 3300 4400 33 Ambulatory Blood Pressure ( BP ) Monitoring 4278 6416 8556 34 DOPPLER ILEO-FEMORAL 2420 3300 4400 35 R/O PSEUDOANEURYSM 856 1284 1712 36 EXTERNAL LOOP RECORDING PKG 7Day 20625 20625 20625 37 GATED CT CALCIUM SCORING (NEW) 3300 4950 7700 38 DOBUTAMINE STRESS ECHOCARDIOGRAPHY (DSE) SCREENING 4200 6300 8400

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39 Colonic Transit Study 7920 11880 15840

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CT SCAN

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 Bone Densitometry ( DEXA Scan ) Two Sites 3190 4785 6380 2 DEXA Bone Densitometry ( Whole Body Bone Mineral Density ) 5060 7590 10120 3 Abdomen CT Pelvimetry 6112 9166 12222 4 Upper Abdomen CT for Liver ( Triple Phase ) 11122 16684 22244 5 Upper Abdomen CT for Liver ( Dual Phase ) 8800 13200 17600 6 Lower Abdomen + Pelvis CT ( Plain ) 6722 10084 13444 7 Lower Abdomen CT ( Plain + Contrast ) 11366 17050 22734 8 Upper Abdomen CT ( Contrast ) 6722 10084 13444 9 Upper Abdomen CT ( Plain ) 6722 10084 13444 10 Upper Abdomen CT ( Plain + Contrast ) 11366 17050 22734 11 Whole Abdomen CT ( 3 Phase ) 17112 25666 34222 12 Whole Abdomen CT ( Contrast ) 11366 17050 22734 13 Whole Abdomen CT ( Plain ) 9438 14157 18876 14 Whole Abdomen CT ( Plain + Contrast ) 14938 22407 29876 15 Abdominal Aorta CT Angiography 18944 28416 37888 16 Both Jaws CT 3D 8066 12100 16134 17 Brain CT Cisternography 9778 14666 19556

Brain CT Dual Energy (For Differentiating Fresh / Old intracranial 10388 15584 20778 18 Bleed) 19 Brain CT Dual Energy Perfused Blood Volume 16134 24200 32266 20 Brain CT - CranioVertebral ( CV ) Junction ( Plain ) 5500 8250 11000 21 Brain Perfusion CT ( Contrast ) 12222 18334 24444 22 Sella ( Pituitary Fossa ) / Pituitary CT ( Contrast - Non Ionic ) 6722 10084 13444 23 Sella (Pituitary Fossa) / Pituitary CT ( Plain ) 1 4766 7150 9534 24 CT Dual Energy For Stone Characterisation 10388 15584 20778 25 Cardiac CT Calcium Scoring 7456 11184 14912 26 Carotid Artery CT Angiography 16134 24200 32266 27 Cerebral Arteries CT Angiography 13444 20166 26888 28 Cervical Spine CT Myelogram ( Plain ) 7944 11916 15888 29 Chest CT (Plain + Contrast) - Pediatric 10388 15584 20778 30 Chest + Abdomen CT Angiography 24200 36300 48400 31 Chest CT ( Contrast - Non Ionic ) 7944 11916 15888 32 Chest CT ( Plain + Contrast ) 10388 15584 20778 33 Chest HRCT 6112 9166 12222 34 Chest HRCT ( Contrast ) 7612 11418 15224 35 Coronary Artery CT Angiography 16412 24618 32824 36 Aspiration CT Guided ( Diagnostic ) 7456 11184 14912 37 CT Guided Biopsy (Only Equipment Use) 6112 9166 12222 38 Catheter Drainage CT Guided 8922 13384 17844

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39 Pulmonary Angiography CT ( Pediatric ) 14788 22184 29578 40 Pulmonary Angiography With Indirect Peripheral Venogram CT 26888 40334 53778 41 KUB Region CT (Oral + IV Contrast) 9020 13530 18040 42 CT Urography ( Contrast ) 12834 19250 25666 43 Colonoscopy Virtual CT ( Plain ) 14666 22000 29334 44 CT Virtual Bronchoscopy 10084 15125 20166 45 Dentascan CT 6112 9166 12222 46 Limb Extremities CT ( Contrast ) 6722 10084 13444 47 Limb Extremities CT ( Plain ) 5378 8066 10756 48 Gated CT Calcium Scoring 8800 13200 17600 49 CT Dual Energy ( Uric Acid Deposits - Gout Detection ) 10388 15584 20778 50 Head CT ( Contrast ) 5378 8066 10756 51 Head CT ( Plain ) 4278 6416 8556 52 Head CT ( Plain + Contrast ) 7334 11000 14666 53 Hip CT 3D ( Bilateral ) 11856 17784 23712 54 Hip / Acetabulum CT 3D ( Right ) 8188 12284 16378 55 Hip Joints CT 5378 8066 10756 56 PNS HRCT ( Axial + Coronal ) Plain 6457 9686 12914 57 PNS CT ( Axial + Coronal ) Contrast 6722 10084 13444 58 Joints CT ( Contrast ) 6722 10084 13444 59 KUB CT ( Plain ) 7645 11468 15290 60 Larynx CT ( Contrast ) 6722 10084 13444 61 Larynx CT ( Plain ) 5500 8250 11000 62 Lower Jaw ( Mandible ) CT 3D Plain 4766 7150 9534 63 Lumbar / Dorsal Spine CT ( Plain ) 6722 10084 13444 64 Lumbosacral Spine CT 5500 8250 11000 65 Lungs Perfused Blood Volume CT Dual Energy 10388 15584 20778 66 Maxillofacial CT 3D ( Plain ) 4766 7150 9534 67 Myocardial Perfusion CT Angiography (Dual Energy) 24508 36762 49016 68 Orbits CT ( Contrast ) 6722 10084 13444 69 Pelvis ( Both Hips ) CT 3D 11856 17784 23712 70 Pelvis CT Direct ( Contrast ) 7456 11184 14912 71 Peripheral / Extremity CT Angiography ( Contrast ) 19525 29288 39050 72 Posterior Fossa CT ( Contrast ) 4888 7334 9778 73 Posterior Fossa CT ( Plain ) 3666 5500 7334 74 Pulmonary CT Angiography 18612 27918 37224 75 Reconstruction Only CT 3D 8066 12100 16134 76 Renal Vessels CT Angiography 13444 20166 26888 77 Sacro Iliac Joints (both) CT 3D Plain 8066 12100 16134 78 Spine ( 3 Vertebral Levels ) CT 3D Plain 8066 12100 16134 79 Spine (5 Vertebral levels) CT Plain 5500 8250 11000 80 Cervical Spine CT ( Plain ) 6722 10084 13444 81 Spine CT Contrast (Per Region) 7059 10588 14116 153

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82 Temporal Bone CT ( Plain ) 5134 7700 10266 83 Tendon ( Any ) CT Dual Energy 10388 15584 20778 84 Thoracic Aorta CT Angiography ( Plain ) 16134 24200 32266 85 Upper Jaw ( Maxilla ) CT 3D Plain 4766 7150 9534 86 Wrist CT 3D 8066 12100 16134 87 Thoracic Spine CT ( 5 Vertebral levels ) 6722 10084 13444 88 Abdomen CT ( Adrenals ) 6112 9166 12222 89 Neck ( Thyroid Tissue ) CT - Plain 5500 8250 11000 90 CT Scanogram ( Plain ) 2475 2475 3300 91 Lower Abdomen (Pelvis) CT Contrast 6722 10084 13444 92 CT Urogram 11561 17342 23122 93 CT Head ( Plain + Contrast ) - Pediatric 6875 10313 13750 94 CT Orthopantogram ( OPG ) 2016 3025 4034 95 CT Guided Bone Biopsy 8800 13200 17600 96 Hip Joint CT ( Right ) 8188 12284 16378 97 Head Contrast Enhanced CT ( CECT ) - Direct Contrast 6722 10084 13444 98 Polytrauma CT 5500 8250 11000 99 Head CT ( Special Investigation ) - Plain 5378 8066 10756 100 Extremities ( Upper ) CT Angiography 21388 32084 42778 101 Dorso Lumber Spine CT ( Contrast ) 7334 11000 14666 102 CONTRAST CHARGES (PER CT) 1438 1654 1902 103 CT GUIDED PROCEDURES 9900 13365 14850 104 CT CHEST PLAIN 7205 10808 14410 105 GATED CT CORONARY ANGIO/CALCIUM SCORING 7456 11184 14912 106 CT ABDOMEN - EXCRETORY UROGRAM CONTRAST 14666 22000 29334 107 CT-CHARGES FOR FILMS(PER FILM) 734 1100 1466 108 CT ANGIO-ABD AORTA CT ANGIO 16134 24200 32266 109 CT PROCEDURES-CHARGES FOR ANAESTHESIA/SEDATION 4034 6050 8066 110 CT ANGIOGRAPHY RENAL VESSELS(DONOR) 13444 20166 26888

CT ANGIO TRIPLE RULE OUT FOR CORONARY ARTERY PULMONARY 32266 48400 64534 111 AMBULISM AND AORTIC DISSECTION 112 CT CD CHARGES 605 605 605 113 CT ONE ANATOMICAL PART PLAIN 4950 6683 7425 114 CT ONE ANATOMICAL PART CONTRAST 6600 8910 9900 115 CT GUIDED FNAC 6325 9488 12650 116 ANESTHESIA FOR MRI/ CT 725 1087 1449 117 CT GUIDEDc BIOPSY 8050 12075 16100 118 CT GUIDE ASPIRATION 6325 9488 12650 119 CT GUIDED DRAINAGE 8050 12075 16100 120 CT GUIDED CELIAC PLEXUS BLOCK 11500 17250 23000

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MRI

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 Abdomen + Urogram MRI ( Contrast ) 13444 20166 26888 2 Abdomen + Urogram MRI ( Plain ) 8556 12834 17112 3 Renal MRI Angiography 11000 16500 22000 4 MRI Angiography ( Contrast ) 15888 23834 31778 5 MRI Angiography ( Without Contrast ) 11000 16500 22000 6 Abdominal Aorta MRI Angiography 11000 16500 22000 7 Abdominal Aorta MRI Angiography ( Contrast ) 15888 23834 31778 8 Peripheral MRI Angiography ( Contrast ) 19556 29334 39112 9 Renal Arteries Angiography MRI ( Contrast ) 15888 23834 31778 10 Thoracic Aorta MRI Angiography 11000 16500 22000 11 Thoracic Aorta MRI Angiography ( Contrast ) 15888 23834 31778 12 Ankle Joint MRI ( Bilateral ) Contrast 20166 30250 40334 13 Ankle Joint MRI ( Bilateral ) Plain 18334 27500 36666 14 MRI Arthrography 18334 27500 36666 15 Whole Abdomen MRI ( Plain ) 13444 20166 26888 16 Brachial Plexus MRI ( Plain ) 9778 14666 19556 17 Brachial Plexus MRI ( Contrast ) 14666 22000 29334 18 Brain MRI + CSF Flow Study ( Contrast ) 19556 29334 39112 19 Brain MRI + CSF Flow Study ( Plain ) 14666 22000 29334 20 Brain MRI ( Contrast ) 18535 27803 37070 21 Brain MRI Contrast (Diffusion Weighted Imaging) 12222 18334 24444 22 Brain MRI - Contrast ( Epilepsy Protocol ) 17112 25666 34222 23 Brain MRI - Plain ( Epilepsy Protocol ) 12222 18334 24444 24 Brain MRI Plain + Diffusion Weighted 7334 11000 14666 25 Brain MRI ( Plain ) 10388 15584 20778 26 Brain MRI + Cisternography 8556 12834 17112 27 Brain MRI Venography 9778 14666 19556 28 Brain MRI Contrast (Diffusion + Perfusion imaging ) 19556 29334 39112 29 Breast MRI ( Contrast ) 15888 23834 31778 30 Breast Dynamic MRI Contrast ( Right ) 19556 29334 39112 31 Breast Dynamic MRI Contrast ( Left ) 14666 22000 29334 32 Breast MRI ( Plain ) 11000 16500 22000 33 Cardiac MRI ( Contrast ) 22000 33000 44000

Cervical Spine With Sequence In Flexion And One In Extension ( 15278 22916 30556 34 Contrast ) 35 MRI Cisternography ( Contrast ) 13444 20166 26888 36 Fetal MRI ( Plain ) 12222 18334 24444 37 Foot MRI ( Contrast ) 15278 22916 30556 38 Sella (Pituitary Fossa) / Pituitary MRI ( Contrast ) 17112 25666 34222

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39 Sella (Pituitary Fossa) / Pituitary MRI ( Plain ) 12222 18334 24444 40 Hip Joint MRI ( Contrast ) 15278 22916 30556 41 Knee Joint MRI Both Sides ( Contrast ) 20166 30250 40334 42 Knee Joint MRI Both Sides ( Plain ) 18334 27500 36666 43 Lumbar Spine MRI ( Contrast ) 11000 16500 22000

Magnetic Resonance Cholangiopancreatography ( MRCP ) Contrast 15278 22916 30556 44 - for Transplantation 45 MRI Contrast + Diffusion Study (One Body Part) 17112 25666 34222 46 MRI Plain And Diffusion Study (One Body Part) 12222 18334 24444 47 Orbit MRI ( Contrast ) 17112 25666 34222 48 Orbit MRI (Plain) 12222 18334 24444 49 Lower Abdomen + Pelvis MRI ( Contrast ) 11000 16500 22000 50 PNS MRI ( Contrast ) 15278 22916 30556 51 Spine MRI Screening - One Region ( Plain ) 9778 14666 19556 52 Shoulder Joint MRI Contrast ( Both Joints ) 20166 30250 40334 53 Shoulder ( Gleno Humeral ) Joints MRI Plain ( Both Joints ) 18334 27500 36666 54 Lumbo Sacral Spine MRI ( Contrast ) 15278 22916 30556 55 Lumbo Sacral Spine MRI ( Plain ) 10388 15584 20778 56 Spine Myelography MRI ( Contrast ) 18334 27500 36666 57 Spine Myelography MRI ( Plain ) 13444 20166 26888 58 Thoracic Spine MRI ( Plain ) 11000 16500 22000 59 Temporo Mandibular Joint MRI Contrast (Both Sides) 20166 30250 40334 60 Temporo Mandibular Joint MRI Plain (Both Sides) 15278 22916 30556 61 Whole Spine MRI Contrast (for Metastatic Work Up) 17112 25666 34222 62 Cartilage Imaging MRI ( Contrast ) 15278 22916 30556 63 Cartilage Imaging MRI ( Plain ) 10388 15584 20778 64 Wrist Joints MRI Contrast ( Bilateral ) 20166 30250 40334 65 Atlantoaxial Dislocation ( AAD ) MRI 10388 15584 20778 66 Brain MRI - Contrast ( Stroke Protocol ) 15888 23834 31778 67 Brain MRI - Plain ( Stroke Protocol ) 11594 17391 23188 68 Magnetic Resonance Cholangiopancreatography ( MRCP ) 10659 15989 21318 69 Face MRI ( Contrast ) 17112 25666 34222 70 Face MRI ( Plain) 12222 18334 24444 71 Hip Joint MRI ( Plain) Both Side 10388 15584 20778 72 Whole Body MRI ( Metastatic Plain ) 14666 22000 29334 73 Elbow MRI ( Bilateral ) Contrast 20166 30250 40334 74 Elbow MRI ( Bilateral ) Plain 18334 27500 36666 75 Foot MRI ( Bilateral ) Contrast 20166 30250 40334 76 Foot MRI ( Bilateral ) Plain 18334 27500 36666 77 Hand MRI ( Bilateral ) Contrast 20166 30250 40334 78 Hand MRI ( Bilateral ) Plain 18334 27500 36666 79 Wrist MRI ( Bilateral ) 18334 27500 36666 80 Cervical Spine MRI Screening 5500 7425 8250 157

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81 Dorsal Spine MRI Screening 6112 9166 12222 82 DorsoLumbar Spine MRI ( Contrast ) 19556 29334 39112 83 Neck MRI 14666 22000 29334 84 MRI Enteroclysis 12222 18334 24444 85 Sacroiliac Joints MRI 10388 15584 20778 86 MRI Sinogram 9778 14666 19556 87 MRI Enteroclysis ( Contrast ) 17112 25666 34222 88 MRI Defecogram ( Contrast ) 17112 25666 34222 89 PNS MRI ( Coronal ) - Plain 10388 15584 20778 90 Sacroiliac Joints MRI 3D ( Plain ) 18334 27500 36666 91 Sacroiliac Joints MRI 3D ( Contrast ) 20166 30250 40334 92 MRI Myelography 9166 13750 18334 93 Brain MRI + Functional MRI ( Two Activities ) - Plain 18334 27500 36666 94 Brain MRI + Functional MRI ( Two Activities ) - Contrast 23222 34834 46444 95 MRI VERTIGO PACKAGE (PLAIN ) -INCL C.SPINE SCREENING 11000 16500 22000 96 MRI Aortogram ( Contrast ) 19556 29334 39112 97 MRI Aortogram 14666 22000 29334 98 MRI CERVICAL SPINE(FLEXION/EXTENSION) 10857 16286 21714 99 MRI THORAX 17325 17325 23100 100 MRI- ONE ANATOMICAL PART - SCREENING 5500 7425 8250 101 MRI CERVICODORSAL SPINE SCREENING 6600 8910 9900 102 MRI SCAN OF WHOLE SPINE METASTATIC 11000 14850 16500 103 MR MYOCARDIAL PERFUSION IMAGINING 19800 26730 29700 104 MRI UPPER ABDOMEN 11000 16500 22000 105 MR PERIPHERAL ANGIOGRAPHY 14666 22000 29334 106 MRI DORSAL SPINE (THORACIC SPINE) CONTRAST 14938 22407 29876 107 MRI CERVICO DORSAL CONTRAST 19556 29334 39112 108 MRI WHOLE SPINE CONTRAST 23222 34834 46444 109 MRI BRACHIAL PLEXUS BILATERAL 14666 22000 29334 110 MRI BRACHIAL PLEXUS BILATERAL CONTRAST 19556 29334 39112

MRI VERTIGO PAKAGE INCLUDING CERVICAL SPINE SCREENING 15888 23834 31778 111 CONTRAST 112 MR MYELOGRAPHY PER SITE CONTRAST 14056 21084 28112 113 MRI BRAIN - IRON OVERLOAD 7334 11000 14666 114 MRI BRAIN - IRON OVERLOAD CONTRAST 12222 18334 24444 115 MRI BRAIN - GREY-WHITE MATTER EVALUATION 8556 12834 17112 116 MRI BRAIN - GREY-WHITE MATTER EVALUATION CONTRAST 13444 20166 26888 117 MRI BRAIN - INNER EAR EVALUATION 10388 15584 20778 118 MRI BRAIN - INNER EAR EVALUATION CONTRAST 15278 22916 30556 119 MRI BRAIN - CP ANGLE 10388 15584 20778 120 MRI BRAIN - CP ANGLE CONTRAST 15278 22916 30556 121 MRI BRAIN - INTERNAL AUDITORY MEATUS 10388 15584 20778 122 MRI BRAIN - INTERNAL AUDITORY MEATUS CONTRAST 15278 22916 30556 158

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123 MRI DIFFUSION TENSOR IMAGING 14666 22000 29334 124 MRI DIFFUSION TENSOR IMAGING CONTRAST 19556 29334 39112 125 DSA BRAIN 12222 18334 24444 126 DSA BRAIN CONTRAST 17112 25666 34222 127 DSA NECK VESSELS 14666 22000 29334 128 DSA NECK VESSELS CONTRAST 19556 29334 39112 129 DSA BRAIN+NECK VESSEL 18334 27500 36666 130 DSA BRAIN+NECK VESSEL CONTRAST 21175 31763 42350 131 BRAIN+DSA BRAIN+NECK VESSELS CONTRAST 26888 40334 53778 132 MRI-MR SPECTROSCOPY OF BRAIN 9778 14666 19556 133 MRI-MR SPECTROSCOPY OF BRAIN CONTRAST 14666 22000 29334 134 MRI-BRAIN+DIFFUSION WEIGHTED IMAGING 12222 18334 24444 135 MRI-BRAIN+DIFFUSION WEIGHTED IMAGING CONTRAST 17112 25666 34222 136 MRI-BRAIN+DIFFUSION + PERFUSION IMAGING 14666 22000 29334 137 MRI BRAIN + IAM (INTERNAL AUDITORY MEATUS)/EAR 13444 20166 26888 138 MRI BRAIN + IAM (INTERNAL AUDITORY MEATUS)/EAR CONTRAST 18334 27500 36666 139 MR CRANIO VERTEBRAL JUNCTION (CVJ) 10388 15584 20778 140 MR CRANIO VERTEBRAL JUNCTION (CVJ) CONTRAST 15278 22916 30556 141 MRI AORTA GRAPHY (VESSELS) - THORACO ABDOMINAL 14666 22000 29334

19556 29334 39112 142 MRI AORTA GRAPHY (VESSELS) - THORACO ABDOMINAL CONTRAST 143 MRI ANGIOGRAPHY - PULMONARY 12540 18810 25080 144 MRI ANGIOGRAPHY - PULMONARY CONTRAST 15888 23834 31778 145 MR ABDOMEN + MR UROGRAPHY 12222 18334 24444 146 MR ABDOMEN + MR UROGRAPHY CONTRAST 17112 25666 34222 147 MRI DEFECOGRAM 12222 18334 24444 148 MRI ABDOMEN - LIVER MASS EVALUATION 12222 18334 24444 149 MRI ABDOMEN - LIVER MASS EVALUATION CONTRAST 17112 25666 34222 150 MRI ABDOMEN - RENAL 11275 16913 22550 151 MRI ABDOMEN - RENAL CONTRAST 17112 25666 34222 152 MRI ABDOMEN - RENAL + ANGIO 14666 22000 29334 153 MRI ABDOMEN - RENAL + ANGIO CONTRAST 19556 29334 39112 154 MRI ABDOMEN - PROSTATE 11000 16500 22000 155 MRI ABDOMEN - PROSTATE CONTRAST 15888 23834 31778 156 MRI ABDOMEN - FEMALE PELVIS MRI 11000 16500 22000 157 MRI ABDOMEN - FEMALE PELVIS MRI CONTRAST 15888 23834 31778 158 MRI ABDOMEN - MRI TESTES 11000 16500 22000 159 MRI ABDOMEN - MRI TESTES CONTRAST 15888 23834 31778 160 MRI ABDOMEN - MR VENOGRAM 11000 16500 22000 161 MRI ABDOMEN - MR VENOGRAM CONTRAST 15888 23834 31778 162 MRI FETAL CONTRAST 17112 25666 34222 163 MRI BREAST SPECTROSCOPY 12222 18334 24444 164 MRI BREAST SPECTROSCOPY CONTRAST 17112 25666 34222 159

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165 MRI SEDATION/ ANAESTHESIA CHARGES 1834 2750 3666 166 MRI EXTRA CD CHARGES 306 459 612 167 MRI EXTRA FILM CHARGES PER FILM 184 275 366 168 MRI 3D EXTRA CHARGES 2444 3666 4888 169 MRI SHOULDER U/L CONTRAST 15278 22916 30556 170 MRI HIP JOINTS B/L 18334 27500 36666 171 MRI HIP JOINTS B/L CONTRAST 20166 30250 40334 172 MRI JOINT - SOFT TISSUE-(ONE REGION) U/L 10388 15584 20778 173 MRI JOINT - SOFT TISSUE-(ONE REGION) U/L CONTRAST 15278 22916 30556 174 MRI JOINT - SOFT TISSUE-(ONE REGION) B/L 18334 27500 36666 175 MRI JOINT - SOFT TISSUE-(ONE REGION) B/L CONTRAST 20166 30250 40334 176 MRI JOINT - SOFT TISSUE LESION LOCAL ANGIO U/L 10388 15584 20778 177 MRI JOINT - SOFT TISSUE LESION LOCAL ANGIO U/L CONTRAST 15278 22916 30556 178 MRI JOINT - SOFT TISSUE LESION LOCAL ANGIO B/L 18334 27500 36666 179 MRI JOINT - SOFT TISSUE LESION LOCAL ANGIO B/L CONTRAST 20166 30250 40334 180 MRI FOR CARTILAGE EVALUATION B/L 18334 27500 36666 181 MRI FOR CARTILAGE EVALUATION B/L CONTRAST 20166 30250 40334 182 MRI JOINT - ATLANTO AXIAL CONTRAST 15278 22916 30556 183 MRI JOINT - ARTHROGRAPHY ONE JOINT CONTRAST 23222 34834 46444 184 MRI NECK CONTRAST 19556 29334 39112 185 MRI FACE - MR SAILOGRAPHY 11000 16500 22000 186 MRI FACE - MR SAILOGRAPHY CONTRAST 15888 23834 31778 187 MRI FACE - OTHER 12222 18334 24444 188 MRI FACE - OTHER CONTRAST 17112 25666 34222 189 CARDIAC MRI FOR MORPHOLOGY 22000 33000 44000 190 CARDIAC MRI FOR FUNCTIONAL ASSESSMENT 22000 33000 44000 191 CARDIAC MRI FOR FLOW DYNAMICS 22000 33000 44000 192 CARDIAC MRI FOR ISCHEMIC HEART DISEASE 22000 33000 44000 193 CARDIAC MRI FOR ARVD 22000 33000 44000 194 CARDIAC MRI FOR CARDIOMYOPATHY 22000 33000 44000 195 CARDIAC MRI FOR MYOCARDITIS 22000 33000 44000 196 CARDIAC MRI FOR COLLATERALS 24444 36666 48888 197 CARDIAC MRI FOR VALLULAR ASSESSMENT 22000 33000 44000 198 CARDIAC MRI FOR PERICARDIAL ASSESSMENT 22000 33000 44000 199 CARDIAC MRI STRESS REST 24444 36666 48888 200 CARDIAC MRI OTHERS 22000 33000 44000 201 MRI WHOLE BODY (FOR ONCOLOGICAL WORKUP) CONTRAST 23222 34834 46444 202 MRI WHOLE BODY METASTATIC PLAIN CONTRAST 19556 29334 39112 203 MR SPV(SPLENO PORTOVENOGRAPH) 9778 14666 19556 204 MR SPV(SPLENO PORTOVENOGRAPH) CONTRAST 14666 22000 29334 205 MRI BRAIN SCREENING 6112 9166 12222 206 MRI CERVICAL SPINE (PLAIN) 9350 12623 14025 207 ANKLE JOINT MRI CONTRAST ( U/L ) 13750 18563 20625 160

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208 ANKLE MRI -U/L 9350 12623 14025 209 ELBOW JOINT MRI CONTRAST ( U/L ) 13750 18563 20625 210 ELBOW MRI -U/L 9350 12623 14025 211 FOOT MRI -U/L 9350 12623 14025 212 HAND MRI CONTRAST ( U/L ) 13750 18563 20625 213 HAND MRI -U/L 9350 12623 14025 214 KNEE JOINT MRI CONTRAST ( U/L ) 13750 18563 20625 215 KNEE JOINT MRI PLAIN ( U/L ) 9350 12623 14025 216 SHOULDER JOINT MRI ( CONTRAST ) - U/L 13750 18563 20625 217 SHOULDER MRI - U/L 9350 12623 14025 218 TEMPORO MANDIBULAR JOINT MRI CONTRAST ( U/L ) 13750 18563 20625 219 TEMPORO MANDIBULAR JOINT MRI PLAIN ( U/L ) 9350 12623 14025 220 WRIST MRI -U/L 9350 12623 14025 221 WRIST JOINT MRI CONTRAST ( U/L ) 13750 18563 20625 222 LUMBAR SPINE MRI ( SCREENING CONTRAST) 9900 13365 14850 223 MRI LUMBO SACRAL SPINE SCREENING 7334 11000 14666 224 BRAIN+DSA BRAIN+NECK VESSELS (PLAIN) 19800 26730 29700 225 CERVICAL SPINE MRI ( SCREENING CONTRAST) 9900 13365 14850 226 CERVICAL SPINE ( CONTRAST ) 13750 18563 20625 227 DORSO LUMBER SPINE SCREENING 6600 8910 9900 228 DORSOLUMBER SPINE MRI ( PLAIN ) 13200 17820 19800 229 SPINE MRI SCREENING - WHOLE ( PLAIN ) 8800 11880 13200 230 SPINE MRI SCREENING - WHOLE ( CONTRAST ) 13200 17820 19800 231 THORACIC SPINE MRI ( SCREENING CONTRAST ) 9900 13365 14850

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X – RAY

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 Barium Enema 3362 5041 6722 2 Barium Meal Follow Through 3362 5041 6722 3 Barium Meal Study 2688 4034 5378 4 Barium Swallow 1712 2566 3422 5 Bone Densitometry ( Whole Body ) 4034 6050 8066 6 Sinography ( Iconos ) 2016 3025 4034 7 Intravenous Pyelography ( IVP ) 3362 5041 6722 8 Micturating Cystourethrography ( MCU ) 2688 4034 5378 9 Nephrostogram 2750 4125 5500 10 Retrograde Urethrography ( RGU ) 2688 4034 5378 11 Abdomen X-ray ( Erect + Supine ) 550 825 1100 12 Abdomen X-ray ( Routine ) 550 825 1100 13 Hand X-ray ( AP View ) Both side 550 825 1100 14 Knee Joint X-ray ( AP Standing + Lateral View ) Both Side 672 1009 1344 15 Knee Joint X-ray ( AP View ) Both Side 550 825 1100 16 Cervical Spine X-ray ( AP + Lateral + Oblique View ) 1100 1650 2200 17 Cervical Spine X-ray ( Lateral View ) 366 550 734 18 Chest X-ray ( Lateral View ) Left 306 459 612 19 Chest X-ray ( PA View ) 562 844 1124 20 Chest X-ray ( PA + Lateral View ) 734 1100 1466 21 Coccyx X-ray ( AP View ) 550 825 1100 22 Dorsolumbar ( Thoracolumbar ) Spine X-ray ( Lateral View ) 550 825 1100 23 Femur X-ray ( AP + Lateral View ) Right Side 495 743 990 24 X-ray Fluoroscopy for Diaphragm 916 1375 1834 25 Foot X-ray ( AP + Lateral View ) Right Side 990 1337 1485 26 KUB X-ray 366 550 734 27 Leg X-ray ( AP View ) 892 1339 1784 28 X-ray Mammography ( Bilateral ) 3697 5546 7394 29 X-ray Mammography ( Right ) 1320 1980 2640 30 Mastoid X-ray ( Towne's View ) 366 550 734 31 Mastoids X-ray 550 825 1100 32 Nasal Bone X-ray ( Both Lateral View ) 488 734 978 33 Soft Tissue Neck X-ray ( Lateral View ) 366 550 734 34 Paranasal Sinuses ( PNS ) X-ray ( AP View ) 244 366 488 35 SacroIliac Joint X-ray ( Oblique View ) Both Side 550 825 1100 36 Shoulder Joint X-ray ( AP View ) Right Side 330 495 660 37 Skull X-ray ( Any 1 View ) 366 550 734 38 Skull X-ray ( AP View ) 550 825 1100 39 Skull X-ray for Styloid Process 366 550 734

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40 Mandible X-ray Special View ( AP View ) 550 825 1100 41 Lumbar Spine X-ray ( AP + Lateral View ) 990 1337 1485

Temporomandibular Joint X-ray ( Oblique View - Open + Closed 1100 1650 2200 42 Mouth ) Both Sides 43 Bone Densitometry ( Three Sites ) 4510 6765 9020

Retrograde Urethrography ( RGU ) + Micturating 5500 8250 11000 44 Cystourethrography ( MSU ) 45 Forearm X-ray ( AP + Lateral View ) Left Side 990 1337 1485 46 Elbow Joint X-ray ( AP + Lateral View ) Left Side 1337 1337 2673 47 Knee Joint X-ray ( AP View ) Left Side 880 1320 1760 48 Foot X-ray ( AP + Lateral View ) Left Side 990 1337 1485 49 Shoulder Joint X-ray ( Lateral View ) Right Side 330 495 660 50 Bronchography 13200 19800 26400 51 Bronchography ( Pediatric ) 13200 19800 26400 52 Bone Densitometry ( DEXA Scan ) Whole Body Fat Assessment 5060 7590 10120 53 Hand X-ray ( PA View ) Both 366 550 734 54 Wrist X-ray ( PA + Lateral View ) 990 1337 1485 55 Voiding Cystourethrogram ( VCU ) 7150 10725 14300 56 DEXA Bone Densitometry ( Single Site ) 2530 3795 5060 57 Histosalpingography ( HSG ) 594 891 1188 58 CHEST X-RAY ( AP VIEW ) - PORTABLE 734 1100 1466 59 Pelvis X-ray ( AP View ) 495 743 990 60 Cervical Spine Lateral Extension view 495 743 990 61 Foot x-ray A P , Oblique view 990 1485 1980 62 Lumbo-sacral spine x-ray A P, Lateral view 990 1485 1980 63 Ankle x-ray A P Lateral 990 1485 1980 64 Heel Bilateral 495 743 990 65 Cervical Spine Lateral Flexion view 495 743 990 66 Chest AP View 495 743 990 67 Chest Lateral View 495 743 990 68 Pelvis with both hips AP View 495 743 990 69 Dorsal Spine AP View 495 743 990 70 Dorsal Spine Lateral View 495 743 990 71 Coccyx x-ray A .P. Lateral 990 1485 1980 72 Dorso-Lumbar spine X-ray A.P , Lateral 990 1485 1980 73 Hand x-ray A P , Oblique view 990 1485 1980 74 Knee joint x-ray A P, Lateral View 990 1485 1980 75 Leg x-ray A P , Lateral view 990 1485 1980 76 Para nasal sinuses x-ray P A view 495 743 990 77 Hip x-ray AP view 495 743 990 78 Hip x-ray AP, Lateral view 990 1485 1980 79 Humerous x-ray A P , Lateral view 990 1485 1980 80 Dorsal spine X-ray Lateral Flexion and Extention 990 1485 1980 164

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81 X-RAY CERVICAL SPINE A.P, LATERAL VIEW 990 1485 1980 82 ABDOMEN (ROUTINE) 581 871 1162 83 ABDOMEN - ERECT & SUPINE (PORTABLE) 1038 1559 2078 84 CT BRAIN -CV JUNCTION (CONTRAST) 6112 9166 12222 85 MICTURATING CYSTOURETHROGRAM (MCU) 3450 5175 6900

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ULTRASOUND

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 Breast Ultrasound ( Bilateral ) 2222 3333 4444 2 Arterial Peripheral Color Doppler Ultrasound ( Right Lower Limb ) 4389 6584 8778 3 Arterial Peripheral Color Doppler Ultrasound ( Right Upper Limb ) 4389 6584 8778 4 Brain Ultrasound 1834 2750 3666 5 Chest Ultrasound 1571 2356 3142 6 Obstetric Color Doppler Ultrasound 2145 3218 4290 7 Vascular Color Doppler Ultrasound 2688 4034 5378 8 Abdominal Aorta Color Doppler Ultrasound 3056 4584 6112 9 Carotids Color Doppler Ultrasound 4785 7178 9570 10 Penile Color Doppler Ultrasound 4278 6416 8556 11 Venous Peripheral Color Doppler (Lower Limb) Ultrasound 4389 6584 8778 12 Venous Peripheral Color Doppler (Upper Limb) Ultrasound 4389 6584 8778 13 Renal Color Doppler Ultrasound 4202 6303 8404 14 Venous Color Doppler Ultrasound (Upper Limb Both Sides) 4389 6584 8778 15 Follicular Study Ultrasound 2688 4034 5378 16 Biopsy (Multiple) Ultrasound Guided 6112 9166 12222 17 Prostate Biopsy (Multiple) Ultrasound Guided 3850 5775 7700 18 KUB Ultrasound 1617 2426 3234 19 Lower Abdomen Ultrasound 1466 2200 2934 20 Neck Ultrasound 1466 2200 2934 21 Pelvis Transvaginal Ultrasound 1466 2200 2934 22 Pregnancy Ultrasound 1712 2566 3422 23 Small Parts Ultrasound 916 1375 1834 24 Upper Abdomen Ultrasound 1859 2789 3718 25 Whole Abdomen Ultrasound 3124 4686 6248 26 Transrectal Ultrasound ( TRUS ) Guided Biopsy 11275 16913 22550 27 Ultrasound for Biophysical Profile Score ( BPS ) 2016 3025 4034 28 Transrectal Ultrasound 1650 2228 2475 29 AMNIOCENTESIS (USG GUIDED) 5500 8250 11000 30 Scrotal Doppler Ultrasound 1320 1782 1980 31 CAROTID COLOR DOPPLER ULTRASOUND 4785 7178 9570 32 USG GUIDED PROCEDURES 7700 10395 11550 33 ULTRA SOUND UPPER / LOWER ABDOMEN 1859 2789 3718 34 ULTRASOUND DOPPLER 2444 3666 4888 35 ULTRA SOUND SCROTAL 1320 1782 1980 36 ULTRASOUND LEVEL-II PREGNANCY 2200 2970 3300 37 ULTRASOUND GUIDED FNAC 3450 5175 6900 38 Renal Color Doppler Ultrasound ( Bilateral ) 6600 9900 13200 39 SPLENOPORTAL AXIS DOPPLER 4950 7425 9900

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40 CAROTID COLOR DOPPLER ULTRASOUND – BILATERAL 9900 14850 19800 41 LOWER LIMB DOPPLER ULTRASOUND (BILATERAL) 6600 9900 13200

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DIAGNOSTIC NEUROLOGY

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 Nerve Conduction Study ( NCS ) 5500 8250 11000 2 Brainstem Auditory Evoked Potential ( BAEP ) Test - Neurology 4313 4960 5704 3 Electroencephalogram ( EEG ) 4278 6416 8556 4 Nerve Conduction Velocity ( NCV ) Study 6112 9166 12222 5 Electoencephalogram ( EEG ) - Sleep Deprived 5031 5786 6654 6 Somatosensory Evoked Potential Study ( SSEP ) 5750 6613 7605 7 Sympathetic Skin Response ( SSR ) 3594 4133 4753 8 Visual Evoked Potential ( VEP ) Study 4313 4960 5704 9 Facial Nerve Blink Reflex Test 2200 3300 4400 10 Botox Injetion - Electromyography ( EMG ) Guided ( One Limb ) 440 660 880 11 Repetitive Nerve Stimulation Test ( RNST ) 5750 5750 5750 12 EMG (ELECTRO MYOGRAPHY) 2300 3450 4600 13 Adenosine Thallium test 14666 22000 29334 14 Whole Body Bone Scan 8118 12177 16236 15 Dobutamine /Adenosine/ Thallium Gated Spect Myo Perfusion 16500 24750 33000 16 Dobutamine / Isometric Stress MRI Ventriculography 6722 10084 13444 17 Gallium Scanning 11612 17416 23222 18 Isotope Venography 5500 8250 11000 19 Lung Perfusion Scintigraphy 5378 8066 10756 20 Meckel Diverticulum Scintigraphy 6722 10084 13444 21 Coronary Imaging MRI 11000 16500 22000

6112 9166 12222 22 Parathyroid Scintigraphy (Dual Isotope subtraction) Static imaging 23 Parotid Scintigraphy 5378 8066 10756 24 Post Enhanced External Counterpulsation (EECP) Thallium study 4706 7059 9412 25 Renal Dynamic Study With GFR (DTPA Study) 5500 8250 11000 26 Rest Muga Radionuclide / MRI Ventriculography 5500 8250 11000 27 Redistribution Thallium / MR Myocardial Perfusion - Rest 16500 24750 33000 28 Tumor Sestamibi Scintigraphy 7334 11000 14666 29 Myocardial Perfusion Study - Stress Thallium 16500 24750 33000

Glomerular Filtration Rate ( GFR ) Determination by Plasma Sample 1272 1906 2542 30 Method 31 Scintigraphy ( for Gastro Intestinal Bleeding ) 6112 9166 12222 32 Thyroid Scintigraphy (Technetium - TC 99M) 4290 6435 8580 33 Myocardial Perfusion Scan ( Rest ) 13444 20166 26888 34 ADENO.THALLIUM GTD-SPECT MYO PERFUSION 16500 24750 33000 35 SPECT MYO.PERFUSION 13444 20166 26888 36 DMSA SCINTIGRAPHY 5500 8250 11000 37 GATED CT CALCIUM SCORING (New Servies) 3600 5400 7200

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38 CT CORONARY ANGIOGRAPHY WITHOUT CALCIUM SCORING 14850 17050 22000 39 SHOULDER Y-VIEW 990 1337 1485 40 CHEST AP & LATERAL VIEW 990 1337 1485 41 LUMBAR SPINE LATERAL FLEXION EXTENSION VIEW 990 1337 1485 42 FETAL ECHO 4520 6779 9039

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DIANG-HIS

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 INTEM 2750 4125 5500 2 EXTEM 2750 4125 5500 3 FIBTEM 4125 6188 8250 4 APTEM 4125 6188 8250 5 HEPTEM 4125 6188 8250 6 TRAPTEM 7150 10725 14300 7 ADPTEM 7150 10725 14300

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BLOOD BANK

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 Cross Matching 210 210 210 2 Platelet Apheresis 11000 11000 11000 3 Platelet Concentrate (Random Donor) 920 920 920 4 Exchange Transfusion 4000 4000 4000 5 Antibody Screening (Donor) 300 300 300 6 ANTIBODY SCREENING 300 300 300 7 PLATELET APHERESIS (IN PAS) 11000 11000 11000 8 THERAPEUTIC PHLEBOTOMY 600 600 600 9 APHERESIS TESTING 250 250 250 10 ANTIBODY TITRE 2300 2645 3042 11 ANTIBODY DETECTION 1000 1000 1000 12 TRANSFUSION REACTION 3550 3550 3550 13 BB - CRYOPRECIPITATE 886 1019 1172 14 FRESH FROZEN PLASMA (With NAT) 660 660 660 15 IRRADIATED BLOOD 1725 1984 2282 16 BLOOD ADMINISTRATION CHARGES 1250 1250 1250 17 NAT + LEUCO DEPLETED BLOOD 4550 4550 4550 18 PLASMA EXCHANGE PROCESS 24445 24445 24445

Plasma Exchange Procedure (Double-filtration Plasmapheresis 60000 60000 60000 19 ,DFPP)

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GASTROENTEROLOGY PACKAGE PROCEDURES

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) 150000 225000 300000 2 Transjugular Intrahepatic Portosystemic Shunt ( TIPS ) 506250 562500 750000 3 Balloon Occluded Retrograde Transvenous Obliteration ( BRTO ) 175500 195000 260000 4 ENDOSCOPIC FULL THICKNESS RESECTION (EFTR) 225000 337500 450000

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GASTROENTEROLOGY

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ERCP- PROCEDURE

Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 ERCP Diagnostic without anesthesia 19305 21450 28600 2 ERCP Therapeutic without anesthesia 24503 27225 36300

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY 44550 49500 66000 3 (ERCP) - ADVANCED

Endoscopic Retrograde CholangioPancreatography ( ERCP ) + Biliary 32670 36300 48400 4 Stenting

Endoscopic Retrograde CholangioPancreatography ( ERCP ) + Stone 37125 41250 55000 5 Extraction

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY 44550 49500 66000 6 (ERCP) WITH STONE EXTRACTION + STENT PLACEMENT

Endoscopic Retrograde Cholangiopancreatography ( ERCP ) 59400 66000 88000 7 Mechanical Lithotripsy

Endoscopic Retrograde CholangioPancreatography ( ERCP ) + 34898 38775 51700 8 Pancreatic ESWL 9 BILIARY BRUSHING 7425 8250 11000 10 Sphincterotomy ( Gastroenterology ) 7425 8250 11000 11 Biliary Balloon Dilatation 8910 9900 13200

Endoscopic Retrograde CholangioPancreatography ( ERCP ) + Nasal 34155 37950 50600 12 Biliary Drainage

Endoscopic Retrograde CholangioPancreatography ( ERCP ) 44550 49500 66000 13 Pseudocyst Drainage 14 SPYGLASS LASER LITHOTRIPSY 111375 123750 165000 15 SPYGLASS+BIOPSY 89100 99000 132000

EUS-PROCEDURE

Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 Endoscopic Ultrasound ( EUS ) 16200 24300 48600 2 Endoscopic Ultrasound ( EUS ) + Fine Needle Aspiration ( FNA ) 24300 36450 72900 3 ENDOSCOPIC ULTRASOUND (EUS) GUIDED LAMS 33750 50625 101250

ENDOSCOPIC ULTRASOUND (EUS) GUIDED COILING/GLUE 27000 40500 81000 4 INJECTION

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BREATH TEST

Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 Hydrogen Breath Test 8910 13365 17820 2 H pylori Breath test 7425 11137.5 14850 3 HYDROGEN BREATH TEST (D-XYLOSE) 8910 13365 17820 4 HYDROGEN BREATH TEST (FRUCTOSE (IBS) ) 8910 13365 17820 5 LACTULOSE BREATH TEST 8910 13365 17820 6 Capsule Endoscopy 22275 33412.5 44550 7 Manometry 11880 17820 23760 8 Colonic Transit Study 8910 13365 17820 9 Biofeedback (package four sittings) 29700 44550 59400 10 MANUAL EVACUATION OF FECAL IMPACTION 1782 2673 3564 11 Ryles Tube Insertion 1782 2673 3564 12 Infusion Charges 3713 5569.5 7426

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OTHER PROCEDURE

Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 Liver Biopsy Percutaneous ( Gastroenterology ) 16335 24503 32670 2 PERCUTANEOUS BIOPSY-GASTRO 16335 24503 32670 3 Large volume paracentesis 8910 13365 17820 4 Pigtail Drainage 18563 27845 37126 FINE NEEDLE ASPIRATION CYTOLOGY (FNAC) - 5 GASTROENTEROLOGY 8910 13365 17820 6 Transjugular Liver Biopsy 66825 100238 133650 7 HVPG+TRANSJUGULAR LIVER BIOPSY 81675 122513 163350 8 TUMOR EMBOLIZATION (TACE/TAE) 371250 556875 742500 9 PERCUTANEOUS TRANSHEPTIC BILIARY DRAINAGE ( PTBD ) 44550 66825 89100 PERCUTANEOUS TRANSHEPTIC BILIARY DRAINAGE (PTBD) 10 INTERNALIZATION 26730 40095 53460 11 PTBD INTERNALIZATION/STENTING 81675 122513 163350 12 Transjugular Intrahepatic Portosystemic Shunt ( TIPS ) 556875 835313 1113750 13 Balloon Occluded Retrograde Transvenous Obliteration ( BRTO ) 193050 289575 386100 14 Upper Abdomen Ultrasound 2673 4010 5346 15 Whole Abdomen Ultrasound 3564 5346 7128 16 SPLENOPORTAL AXIS DOPPLER 4455 6683 8910 17 Breast Ultrasound ( Bilateral ) 3778 5667 7556 18 Pelvis Transvaginal Ultrasound 1889 2834 3778 19 KUB Ultrasound 1889 2834 3778 20 Renal Color Doppler Ultrasound 3935 5903 7870 21 RENAL COLOR DOPPLER ULTRASOUND ( BILATERAL ) 5940 8910 11880 22 CAROTID COLOR DOPPLER ULTRASOUND - BILATERAL 8910 13365 17820 23 LOWER LIMB DOPPLER ULTRASOUND (BILATERAL) 5940 8910 11880 24 FIBROSCAN 5940 8910 11880 25 LIVER BIOPSY + GELATING PLUG 17820 26730 35640 Radiofrequency Ablation ( RFA ) CT Guided ( Interventional 26 Rdiology ) 259875 389813 519750 Radiofrequency Ablation ( RFA ) Ultrasound Guided ( Interventional 27 Rdiology ) 222750 334125 445500 28 Hepatic Venous / IVC Angioplasty (Radiology) 141075 211613 282150 29 SPLENIC EMBOLIZATION THERAPEUTIC ( PARTIAL ) 185625 278438 371250

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LGI-PROCEDURE

Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 Sigmoidoscopy ( Diagnostic ) 4455 6683 8910 2 Sigmoidoscopy with Biopsy 6683 10025 13366 3 DIAGNOSTIC COLONOSCOPY (LIMITED) 6683 10025 13366 4 Colonoscopy With Biopsy 2228 3342 4456 5 Colonoscopy ( Full Length ) 13365 20048 26730 6 UPPER GASTROINTESTINAL (UGI) ENDOSCOPY - BEDSIDE 22275 33413 44550 7 SIGMOIDOSCOPY BANDING FOR HEMORRHOIDS 10395 15593 20790 8 Colonoscopy + Argon Plasma Coagulation ( APC ) 17820 26730 35640 9 DECOMPRESSION COLONOSCOPIC 23760 35640 47520 10 Colonoscopy Metal Stent Placement 22275 33413 44550 11 Polypectomy 29700 44550 59400 12 Polypectomy - Multiple Polyps 44550 66825 89100

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UGI-PROCEDURE

Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 UGI Endoscopy 7425 11138 14850 2 MUCOSAL BIOPSY (ENDOSCOPIC) - BEDSIDE 2228 3342 4456 3 UPPER GASTROINTESTINAL ENDOSCOPY + BIOPSY 9653 14480 19306 4 RAPID UREASE TEST ( RUT ) FOR HELICOBACTER PYLORI 446 669 892 5 NASOJEJUNAL TUBE PLACEMENT UNDER FLUOROSCOPY 17820 26730 35640 6 Endoscopic Ryles Tube Placement without anesthesia 11880 17820 23760

UPPER GASTROINTESTINAL (UGI) ENDOSCOPY + PEG TUBE 22275 33413 44550 7 PLACEMENT

PERCUTANEOUS ENDOSCOPIC GASTROSTOMY ( PEG ) TUBE 4455 6683 8910 8 REPLACEMENT 9 SENGSTAKEN BLAKMORE TUBE PLACEMENT 7425 11138 14850 10 ESOPHAGEAL VARICES BAND LIGATION ( ENDOSCOPIC ) 11880 17820 23760 11 FOREIGN BODY (GIT) REMOVAL 14850 22275 29700 12 Side Viewing Endoscopy without anesthesia 10395 15593 20790 13 Savary - Gilliard ( SG ) Dilatation 16335 24503 32670 14 SCLEROTHERAPY ENDOSCOPIC (EST) 14850 22275 29700 15 Sclerotherapy (EST) without anesthesia 20790 31185 41580 16 ENTEROSCOPY + ARGON PLASMA COAGULATION ( APC ) 11880 17820 23760 17 Achalasia Dilatation without anesthesia 22275 33413 44550 18 Colonoscopy Metal Stent Placement 22275 33413 44550 19 HEMOCLIP WITHOUT ANESTHESIA 11880 17820 23760 20 Enteroscopy 51975 77963 103950

ENDOSCOPIC MUCOSAL RESECTION ( EMR ) - ( 37125 55688 74250 21 GASTROENTEROLOGY ) 22 INTRAGAASTRIC BALLOON PLACEMENT WITHOUT ANESTHESIA 29700 44550 59400 23 Endoloop.. 7425 11138 14850

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LIVER TRANSPLANT PACKAGE

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 LIVER TRANSPALNT PACKAGE (PRE WORK UP) 180000 180000 180000 2 LIVER TRANSPLANT PACKAGE 2185000 2185000 3018750

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ORTHOPAEDICS PACKAGES

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 TOTAL KNEE REPLACEMENT ( TKR ) - UL - (P) 242000 286000 484000 2 TOTAL KNEE REPLACEMENT ( TKR ) - BL - (P) 379500 539000 671000 3 REVISION OF TOTAL KNEE REPLACEMENT ( TKR ) - UL - (P) 308000 374000 616000 4 TOTAL HIP REPLACEMENT ( THR ) - UL - (P) 242000 286000 484000 5 TOTAL HIP REPLACEMENT ( THR ) - BL - (P) 429000 517000 858000 6 Total Hip Replacement ( THR ) Revision 324500 374000 649000 7 TOTAL ELBOW REPLACEMENT (U/L) - (P) 210000 282000 324000 8 UNICOMPARTMENTAL ARTHOPLASTY UL - (P) 240000 258000 480000 9 UNICOMPARTMENTAL ARTHOPLASTY BL - (P) 319000 478500 638000 10 SHOULDER REPLACEMENT - (P) 228000 342000 456000 Posterior Cruciate Ligament ( PCL ) Reconstruction - 11 Arthroscopic 126500 189750 253000 12 Arthroscopy ( Operative ) 114000 138000 228000 13 Bone Grafting 55000 82500 110000 14 Closed Reduction + Internal Fixation 88000 132000 176000 15 Bipolar Hemiarthroplasty 165000 247500 330000 16 Fracture Open Reduction and Internal Fixation ( ORIF ) 121000 181500 242000 ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION ( ACL 17 ) - (P) 121000 181500 242000 18 DEBRIDEMENT LARGE 78000 117000 156000 19 ORIF Intra Articular 148500 222750 297000 20 IMPLANT REMOVAL - LARGE 96000 144000 192000 21 IMPLANT REMOVAL - SMALL 78000 117000 156000 22 COMPLEX TENDON/LIGAMENT RECONSTRUCTION - (P) 156000 234000 312000 23 PLIF/TLIF LEVEL -1 - (P) 300000 450000 600000 24 ACETABULAR FRACTURE BICOLUMNAR - (P) 270000 405000 540000 25 K - WIRE FIXATION - (P) 60000 90000 120000 26 PLIF/TLIF LEVEL -2 - (P) 330000 495000 660000 27 PLIF/TLIF LEVEL -3 - (P) 390000 585000 780000 28 SOFT TISSUE RELEASE - (P) 54000 81000 108000 ACDF LEVEL -1 (ANTERIOR CERVICAL DISCECTOMY & 29 FUSION) - (P) 300000 450000 600000 30 STEM CELL - (P) 78000 117000 156000 ACDF LEVEL -2 (ANTERIOR CERVICAL DISCECTOMY & 31 FUSION) - (P) 330000 495000 660000 32 SPINAL DISCECTOMY /LAMINECTOMY - (P) 168000 252000 336000 33 KYPHOPLASTY / VERTEBROPLASTY - (P) 150000 225000 300000 34 NERVE ROOT INJECTION - (P) 42000 63000 84000 35 NERVE ROOT + EPIDURAL - (P) 54000 81000 108000 187

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36 POSTERIOR DECOMPRESSION & FIXATION - (P) 258000 387000 516000 37 ORIF METAPHYSEAL - (P) 144000 216000 288000 38 CLOSED REDUCTION OF DISLOCATION - (P) 81600 122400 163200 39 EXTERNAL FIXATION - (P) 90000 135000 180000 40 DEBRIDEMENT SMALL - (P) 60000 90000 120000 DECOMPRESSION ANTERIOR & POSTERIOR ( SIMUTANOUS) & RECONSTRUTION WITH ANT. &/ OR 41 POST. FUSION OF SPINE 114348 134244 159096 42 ACETABULAR FRACTURE SINGLE WALL / COLUMN - (P) 210000 315000 420000 43 SPINAL FIXATION LUMBAR /CERVICAL - (P) 222000 333000 444000

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ORTHOPAEDICS

PROCEDURES

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 POP Cast Application - Full ( Above Elbow ) 14400 21600 28800 2 POP Cast Application - Full ( Above Knee ) 14400 21600 28800 3 Strapping Ankle 1620 2430 3240 4 Arthrodesis ( Large Joint ) 57600 86400 115200 5 Arthrodesis ( Small Joint ) 28800 43200 57600 6 Arthroscopy Wrist 49500 74250 99000 7 Arthroscopy ( Diagnostic ) 54000 81000 108000 8 Arthrotomy 36000 54000 72000 9 Casts Application ( Below Elbow ) 9900 14850 19800 10 Casts Application - Full ( Below Knee ) 9900 14850 19800 11 Fractures Closed Reduction + POP Application 63000 94500 126000 12 Core Decompression - Hip 29700 44550 59400 Congenital Talipes Equinovarus ( CTEV / Club Foot ) 13 Corrective Surgery 54000 81000 108000 14 Wound Debridement ( Large ) 50400 75600 100800 15 Nail Dynamization 6600 8280 13200 16 Ganglion Excision ( Orthopedics ) 19800 29700 39600 17 Femoral Nailing ( Proximal ) 49500 74250 99000 18 Arthrodesis ( Triple ) 54000 81000 108000 19 Arthroplasty ( Girdle Stone ) 45000 67500 90000 20 K Wire Fixation ( Small Bones ) 18000 27000 36000 21 K Wire Removal 7200 10800 14400 22 Injection IntraArticular ( Local ) 6480 9720 12960 Congenital Talipes Equinovarus ( CTEV / Club Foot ) 23 Manipulation 4500 6750 9000 Open Reduction and Internal Fixation ( ORIF ) - 24 Acetabulum 67500 101250 135000 Open Reduction and Internal Fixation ( ORIF ) - Complex 25 Fractures 45000 67500 90000 Open Reduction and Internal Fixation ( ORIF ) - 26 Periprosthetic Fractures 72000 108000 144000 27 Periprosthetic Fracture Repair 72000 108000 144000 28 Exostosis Removal 35100 52650 70200 29 Total Hip Replacement (THR) Revision - One Stage 49500 74250 99000 30 Skeletal Traction Application 6912 10368 13824 31 Strapping 648 972 1296 32 Arthroplasty Ankle ( Total ) Left 72000 108000 144000 33 Total Wrist Joint Replacement 81000 121500 162000 190

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34 Amputation ( Large ) 45000 67500 90000 35 Amputation ( Small ) 27000 40500 54000 36 Fracture Closed Reduction 18000 27000 36000 37 Fracture Open Reduction 54000 81000 108000 38 Strapping Ball Bandage 1620 2430 3240 39 Strapping Cuff And Collar Sling 1620 2430 3240 40 Strapping Elbow 1620 2430 3240 41 Strapping - Figure Of 8 Bandage 1620 2430 3240 42 Strapping Finger 1134 1702 2268 43 Strapping Knee 1620 2430 3240 44 Strapping Shoulder 2520 3780 5040 45 Strapping Toes 1134 1702 2268 46 Strapping Wrist 972 1458 1944 47 Open Reduction and Internal Fixation ( ORIF ) - Patella 50400 75600 100800 48 Nerve Repair ( Orthopedics ) 49500 74250 99000 49 Hemiarthroplasty Shoulder 72000 108000 144000 50 Arthrodesis Elbow 58500 87750 117000 51 Arthrodesis Shoulder 19800 29700 39600 52 Joint Aspiration 19800 29700 39600 53 POP Slab Application ( Above Elbow ) 14400 21600 28800 54 POP Slab Application ( Above Knee ) 14400 21600 28800 55 POP Slab Application ( Below Elbow ) 9900 14850 19800 56 Open Reduction and Internal Fixation ( ORIF ) - Pelvis 45000 67500 90000 Open Reduction and Internal Fixation ( ORIF ) - Olecranon 57 Process 48600 72900 97200 Open Reduction and Internal Fixation ( ORIF ) - Radius 58 Head 59400 89100 118800 59 Open Reduction and Internal Fixation ( ORIF ) - Scaphoid 54000 81000 108000 60 Paravertebral Abscess Drainage ( Orthopedics ) 17820 26730 35640 61 Injection IntraArticular ( Orthopedics ) 5400 8100 10800 62 Arthrotomy Hip 29700 44550 59400 63 Arthroscopy Wrist ( Diagnostic ) 43200 64800 86400 64 Open Reduction Internal Fixation ( ORIF ) - Clavicle 48600 72900 97200 65 Open Reduction Internal Fixation ( ORIF ) - Talus 63000 94500 126000 66 Total Joint Replacement - Elbow ( Left ) 72000 108000 144000 67 Total Knee Replacement ( TKR ) Revision - One Stage 54000 81000 108000 68 Closed Reduction + Interlocking Nailing ( Femur ) Left 59400 89100 118800 69 Carpal Tunnel Release ( Orthopedics ) 21600 32400 43200 70 Cannulated Screw Insertion 36900 55350 73800 71 TendoAchilles ( TA ) Lengthening 36000 54000 72000 72 Tennis Elbow Release 45000 67500 90000 73 Elbow Reconstruction 43200 64800 86400 74 Dressing Small ( Orthopedics ) 360 540 720 191

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75 Dressing Large ( Orthopedics ) 480 720 960 76 Bone Tumors Excision 29700 44550 59400 77 Hip Dislocation Closed Reduction 19800 29700 39600 78 External Fixator Application 19800 29700 39600 Open Reduction and Internal Fixation ( ORIF ) - Humerus 79 Intercondylar Fracture 63000 94500 126000 80 Dressing ( Orthopedics ) 2160 3240 4320 81 Subacromial Decompression ( Arthroscopic ) 29700 44550 59400 82 Joint Dislocation Open Reduction 54000 81000 108000 83 Arthrodesis Of Major Joints - Pantalar 63000 94500 126000 84 Radial Head Replacement 58500 87750 117000 85 Total Elbow Joint Replacement - Revision 81000 121500 162000 86 Hallux Valgus / Bunion Surgery 16200 24300 32400 87 Medial Collateral Ligment ( MCL ) Recontruction 69300 103950 138600 88 Arthrodesis - Metatarsophalangial ( MTP ) Joint 45000 67500 90000 89 ORIF + Bone Grafting - Nonunion Clavicle 59400 89100 118800 90 POP Slab Application ( Below Knee ) 9900 14850 19800 91 Shoulder Spica Application 7200 10800 14400 92 Weaver Dunn Procedure - Acromioclavicular Joint 49500 74250 99000 93 Wound Debridement - Small ( Orthopedics ) 29700 44550 59400 94 Dressing - Medium ( Orthopedics ) 720 1080 1440 95 Arthrodesis Ankle 50400 75600 100800 96 Osteotomy - Tibia 56700 85050 113400 97 Nail Bed Repair - Hand ( Pediatric Orthopedics ) 23760 35640 47520 98 PLATELET RICH PLASMA ( PRP ) - ORTHOPEDICS 9900 14850 19800 99 Injection - Shoulder Joint 3600 5400 7200 PRP INJECTIONS/ VISCOSUPPLEMENTATION ( SPORTSMED 100 ) - PKG 10800 16200 21600 101 Open Reduction With Iliac Bone Grafting 45000 67500 90000 102 Open Reduction + Soft Tissue Reconstruction 59400 89100 118800 103 Recurrent Dislocation - Open Stabilization 54000 81000 108000 104 Bristow Procedure - Latarjet 49500 74250 99000 105 Bristow Procedure Modified - Latarjet 63000 94500 126000 106 Eden - Hybinnet Procedure 63000 94500 126000 107 Mclaughlin Procedure 66600 99900 133200 108 Arthroscopic Bankart Repair 63000 94500 126000 109 Arthroscopic Latarjet 57600 86400 115200 110 Open Reduction + Osteotomy 72000 108000 144000 111 Arthroscopic Remplissage Procedure 59400 89100 118800 112 Arthroscopic Capsular Release 57600 86400 115200 113 Arthroscopic SAD + Excision Lateral End Clavicle 54000 81000 108000 114 Arthroscopic Cuff Tear Repair - Small 63000 94500 126000 115 Arthroscopic Cuff Tear Repair - Medium 63000 94500 126000 192

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116 Arthroscopic Cuff Tear Repair - Large 63000 94500 126000 117 Arthroscopic Cuff Tear Repair - Massive 66600 99900 133200 118 Arthroscopic Slap Repair 72000 108000 144000 119 Arthroscopic Ganglion Cyst Debridement 54000 81000 108000 120 Arthroscopic Suprascapular Nerve Release 57600 86400 115200 121 Arthroscopic Debridement 70200 105300 140400 122 Arthroscopic Anterior Stabilization 46800 70200 93600 123 Arthroscopic Posterior Stabilization 57600 86400 115200 124 Shoulder Resurfacing ( Humeral Side ) 59400 89100 118800 125 Total Shoulder Arthroplasty 57600 86400 115200 126 Reverse Shoulder Arthroplasty 67500 101250 135000 127 Implant Removal - Shoulder 72000 108000 144000 128 Implant Removal ( Shoulder ) + Refixation 31500 47250 63000 129 Proximal Humeral Plate Fixation - Simple 63000 94500 126000 130 Proximal Humeral Plate Fixation - Complex 57600 86400 115200 131 Humeral Fracture Repair Non-Union 63000 94500 126000 132 ORIF + Bone Grafting - Nonunion Humeral 54000 81000 108000 133 Fracture Clavicle - K Wire 63000 94500 126000 Open Reduction and Internal Fixation ( ORIF ) - Clavicle 134 Fracture ( Complex ) 54000 81000 108000 135 Shoulder Tumour Excision 69300 103950 138600 136 Shoulder Reconstruction - Complex 59400 89100 118800 137 Scapulo-Thoacic Bursoscopy 72000 108000 144000 138 Scapular Osteotomy 45000 67500 90000 139 Tendon Transfer - Complex 63000 94500 126000 140 Posterior Shoulder Instability Repair ( Arthroscopic ) 54000 81000 108000 141 Rotator Cuff Tears Open Repair with ACJ Excision 59400 89100 118800 Open Reduction and Internal Fixation ( ORIF ) - Ankle 142 Fracture ( Bimalleolar ) 54000 81000 108000 Open Reduction and Internal Fixation ( ORIF ) - Ankle 143 Fracture ( Trimalleolar ) 54000 81000 108000 144 ECHINOCOCCUS DETECTI0N 1298 1948 2597 BROSTROM PROCEDURE (LATERAL LIGAMENT 145 RECONSTRUCTION) 45000 67500 90000 OPEN REDUCTION INTERNAL FIXATION (ORIF) - GLENOID/ 146 SCAPULA 63000 94500 126000 147 ELBOW RECONSTRUCTION (COMPLEX) 54000 81000 108000 HIP DISLOCATION CLOSED REDUCTION + LOCAL 148 EXAMINATION UNDER SEDATION/ANESTHESIA 15300 22950 30600 OPEN REDUCTION AND INTERNAL FIXATION (ORIF) - 149 ILIUM 49500 74250 99000 150 OSTEOTOMY - MALUNION OF WRIST 57600 86400 115200

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OPEN REDUCTION AND INTERNAL FIXATION (ORIF) WITH 151 LOCKING PLATE - FOREARM FRACTURE (BOTH BONES) 54000 81000 108000 152 PATELLAR TENDON AVULSION RE-REPAIR 54000 81000 108000 153 ACCESSORY NAVICULAR EXCISION 21600 32400 43200 OPEN REDUCTION AND INTERNAL FIXATION (ORIF) - 154 CORONOID FRACTURE 59400 89100 118800 155 SMALL JOINT REPLACEMENT (MORE THAN TWO JOINTS) 58500 87750 117000 156 FLAT FOOT - FDL TRANSFER 27000 40500 54000 157 K WIRE FIXATION - FINGER 17100 25650 34200 158 ACCESSORY NAVICULAR EXCISION + KIDNER PROCEDURE 27000 40500 54000 OPEN REDUCTION AND INTERNAL FIXATION (ORIF) WITH 159 INTRAMEDULLARY NAILING - HUMERUS 48600 72900 97200 ILLIZAROV FIXATOR APPLICATION + OSTEOTOMY AND 160 BONE GRAFTING 63000 94500 126000 OPEN REDUCTION AND INTERNAL FIXATION (ORIF) - 161 MALLET FINGER 36000 54000 72000 162 CANNULATED SCREW FIXATION (CLOSED) 40500 60750 81000 163 ARTHRODESIS - MIDFOOT 50400 75600 100800 OPEN REDUCTION AND INTERNAL FIXATION (ORIF) - 164 WRIST 54000 81000 108000 165 SKIN GRAFTING - SMALL 23400 35100 46800 166 DEBRIDEMENT + POLYETHYLENE EXCHANGE 59400 89100 118800 167 WRIST FRACTURE CLOSED REDUCTION + K WIRE FIXATION 54000 81000 108000 OPEN REDUCTION AND INTERNAL FIXATION (ORIF) WITH 168 LCDCP/NAIL - FOREARM FRACTURE (BOTH BONES) 54000 81000 108000 169 DHS/DCS (COMPLEX) 30600 45900 61200 170 FLAT FOOT - FDL TRANSFER + CALCANEAL OSTEOTOMY 45000 67500 90000 171 ELBOW ARTHROLYSIS - BONY BLOCK REMOVAL 54000 81000 108000 172 OSTEOTOMY - FEMUR 56700 85050 113400 OPEN REDUCTION AND INTERNAL FIXATION (ORIF) WITH 173 LOCKING PLATE - OLECRANON 43200 64800 86400 174 ELBOW ARTHROLYSIS (COMPLEX) 64800 97200 129600 PERIPROSTHETIC FRACTURE REPAIR AND POLYETHYLENE 175 EXCHANGE 76500 114750 153000 176 FINGER RECONSTRUCTION 40500 60750 81000 177 SMALL JOINT REPLACEMENT (ONE JOINT) 45000 67500 90000 OPEN REDUCTION AND INTERNAL FIXATION (ORIF) - 178 ELBOW (COMPLEX) 58500 87750 117000 179 FINGER RECONSTRUCTION (COMPLEX) 49500 74250 99000 180 SMALL JOINT REPLACEMENT (TWO JOINTS) 49500 74250 99000 OPEN REDUCTION INTERNAL FIXATION ( ORIF ) TALUS - 181 SINGLE APPROACH 46800 70200 93600

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OPEN REDUCTION AND INTERNAL FIXATION (ORIF) WITH 182 LOCKING PLATE - FOREARM FRACTURE (SINGLE BONE) 36000 54000 72000 183 TIBIALS POSTERIOR TENDON EXPLORATION + REPAIR 27000 40500 54000 FLAT FOOT RECONSTRUCTION - COMPLEX (WITH 184 MULTIPLE OSTEOTOMIES) 57600 86400 115200 185 PLANTAR PLATE RECONSTRUCTION - MTP JOINT 36000 54000 72000 186 TENDON TRANSFER 63000 94500 126000 187 ARTHROSCOPY WRIST (COMPLEX) 58500 87750 117000 OPEN REDUCTION INTERNAL FIXATION (ORIF) - 188 STERNOCLAVICULAR DISLOCATION 59400 89100 118800 OPEN REDUCTION AND INTERNAL FIXATION (ORIF) - 189 PHALANX 54000 81000 108000 OPEN REDUCTION AND INTERNAL FIXATION (ORIF) - 190 WRIST (COMPLEX) 58500 87750 117000 191 PLANTAR FASCITIS RADIOFREQUENCY ABLATION 18000 27000 36000 OPEN REDUCTION AND INTERNAL FIXATION (ORIF) - 192 PUBIS 54000 81000 108000 OPEN REDUCTION AND INTERNAL FIXATION (ORIF) - 193 METACARPAL 54000 81000 108000 OPEN REDUCTION AND INTERNAL FIXATION (ORIF) WITH 194 LCDCP/NAIL - FOREARM FRACTURE (SINGLE BONE) 36000 54000 72000 195 HAGLUND DEFORMITY EXCISION + FHL TRANSFER 36000 54000 72000 196 ARTHROSCOPY + JOINT LAVAGE 45000 67500 90000 197 PERONEAL TENDON EXPLORATION + REPAIR 27000 40500 54000 PROXIMAL HUMERUS FRACTURE CLOSED REDUCTION + K 198 WIRE FIXATION 32400 48600 64800 199 DHS/CANNULATED SCREW FIXATION - PROXIMAL FEMUR 45000 67500 90000 OPEN REDUCTION AND INTERNAL FIXATION (ORIF) - 200 HAND (COMPLEX) 58500 87750 117000 201 SOFT TISSUE PROCEDURE (SIMPLE) 9900 14850 19800 202 EXAMINATION UNDER ANESTHESIA 2160 3240 4320 DEBRIDEMENT + EXTERNAL FIXATION - TIBIA COMPOUND 203 FRACTURE 45000 67500 90000 PATELLAR DISLOCATION - LATERAL RETINACULAR 204 RELEASE + MEDIAL PLICATION 54000 81000 108000 HAMMER TOE/CLAW TOE SOFT TISSUE PROCEDURE 205 (SINGLE TOE) 16200 24300 32400 206 ACUTE TENDON REPAIR (SINGLE) 29700 44550 59400 207 TENDON GRAFTING (SINGLE STAGE) 45000 67500 90000 208 PLICA EXCISION (ARTHROSCOPIC) 31500 47250 63000 209 ARTHROSCOPY - SMALL JOINT 54000 81000 108000 210 HALLUX VALGUS - SOFT TISSUE PROCEDURE 16200 24300 32400 211 BONY BANKART REPAIR (ARTHROSCOPIOC) 66600 99900 133200

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OPEN REDUCTION AND INTERNAL FIXATION (ORIF) - 212 TIBIAL PLATEAU 63000 94500 126000 HAMMER TOE/CLAW TOE BONY PROCEDURE (SINGLE 213 TOE) 21600 32400 43200 HALLUX VALGUS - BUNIONECTOMY + DISTAL SOFT TISSUE 214 PROCEDURE (DSTP) 32400 48600 64800 OPEN REDUCTION AND INTERNAL FIXATION (ORIF) - 215 ACETABULUM (COMPLEX) 59400 89100 118800 216 ARTHROSCOPY - ANKLE 39600 59400 79200 217 MINI-OPEN ANKLE ARTHRODESIS 50400 75600 100800 CLOSED REDUCTION AND INTERNAL FIXATION - TIBIAL 218 PLATEAU 54000 81000 108000 OPEN REDUCTION AND INTERNAL FIXATION (ORIF) WITH 219 LOCKING PLATE - PROXIMAL HUMERUS 63000 94500 126000 HAMMER TOE/CLAW TOE BONY PROCEDURE (MULTIPLE 220 TOES) 28800 43200 57600 OPEN REDUCTION AND INTERNAL FIXATION ( ORIF ) - 221 PELVIS (COMPLEX) 54000 81000 108000 222 SKIN GRAFTING - LAGRE 36000 54000 72000 223 EXTERNAL FIXATOR - FOOT 45000 67500 90000 OPEN REDUCTION INTERNAL FIXATION (ORIF) - PILON 224 FRACTURE 54000 81000 108000 225 ACL / PCL AVULSION FIXATION (OPEN) 64800 97200 129600 226 BONE AND SOFT TISSUE BIOPSY 18000 27000 36000 OPEN REDUCTION AND INTERNAL FIXATION (ORIF) WITH 227 K WIRE - CALCANEUM 45000 67500 90000 228 HAND RECONSTRUCTION (COMPLEX) 54000 81000 108000 229 SACROILIAC JOINT FIXATION (COMPLEX) 49500 74250 99000 230 OSTEOCHONDRAL FRACTURE - PINNING 59400 89100 118800 231 WRIST RECONSTRUCTION 54000 81000 108000 232 INTRAARTICULAR FRAGMENT EXCISION 39600 59400 79200 233 CLOSED REDUCTION + INTERLOCKING NAILING - TIBIA 63000 94500 126000 234 POSTEROMEDIAL CORNER RECONSTRUCTION 72000 108000 144000 235 TOE NAIL EXCISION - PARTIAL 7200 10800 14400 236 EXTERNAL FIXATOR - ANKLE 45000 67500 90000 237 OSTEOTOMY - LOWER LIMB 29700 44550 59400 238 CARPAL TUNNEL RELEASE (ENDOSCOPIC) 29700 44550 59400 239 RHEUMATOID FOREFOOT RECONSTRUCTION 54000 81000 108000 240 WRIST RECONSTRUCTION (COMPLEX) 59400 89100 118800 241 ELBOW ARTHROLYSIS (ARTHROSCOPIC) 59400 89100 118800 OPEN REDUCTION AND INTERNAL FIXATION (ORIF) WITH 242 PLATING - TIBIA 59400 89100 118800 243 TOE NAIL EXCISION - TOTAL 8100 12150 16200

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244 CABLE GRAFTING 57600 86400 115200 245 MORTON'S NEUROMA EXCISION 27000 40500 54000 246 FOOT AND ANKLE DEFORMITY CORRECTION (COMPLEX) 63000 94500 126000 247 ELBOW ARTHROLYSIS - SOFT TISSUE 43200 64800 86400 248 ARTHROSCOPY - ELBOW 49500 74250 99000 OPEN REDUCTION AND INTERNAL FIXATION (ORIF) WITH 249 PLATING - SUPRACONDYLAR FRACTURE (FEMUR) 59400 89100 118800 OPEN REDUCTION AND INTERNAL FIXATION (ORIF) WITH INTRAMEDULLARY NAILING - SUPRACONDYLAR 250 FRACTURE (FEMUR) 59400 89100 118800 251 BUNIONETTE EXCISION 19800 29700 39600 252 RADIAL TUNNEL RELEASE 45000 67500 90000 253 PROXIMAL HUMERUS FRACTURE FIXATION 63000 94500 126000 OPEN REDUCTION AND INTERNAL FIXATION (ORIF) WITH 254 LOCKING PLATE - HUMERUS 54000 81000 108000 255 FOOT AND ANKLE DEFORMITY CORRECTION 54000 81000 108000 256 TENDOACHILLES LENGTHENING (PERCUTANEOUS) 27000 40500 54000 OPEN REDUCTION INTERNAL FIXATION (ORIF) - LISFRANC 257 FRACTURE 45000 67500 90000 OPEN REDUCTION AND INTERNAL FIXATION (ORIF) - 258 PUBIC RAMI 49500 74250 99000 259 KNEE CONTRACTURE RELEASE 43200 64800 86400 OPEN REDUCTION INTERNAL FIXATION ( ORIF ) TALUS - 260 DOUBLE APPROACH 54000 81000 108000 261 INTERLOCKING NAIL DYNAMIZATION 13500 20250 27000 262 SOFT TISSUE PROCEDURE (COMPLEX) 19800 29700 39600 263 CURETTAGE + BONE GRAFTING 49500 74250 99000 264 MENISCAL TRANSPLANT 49500 74250 99000 265 TENDON GRAFTING (STAGE 2) 54000 81000 108000 266 HAND RECONSTRUCTION 44100 66150 88200 OPEN REDUCTION INTERNAL FIXATION (ORIF) + K WIRE 267 FIXATION - CALCANEUM 63000 94500 126000 268 BONY/SOFT TISSUE RECONSTRUCTION 31500 47250 63000 PELVIS FRACTURE CLOSED REDUCTION AND EXTERNAL 269 FIXATION 29700 44550 59400 270 ACL / PCL AVULSION FIXATION (ARTHROSCOPIC) 64800 97200 129600 271 JOINT LEVELING - WRIST 36000 54000 72000 272 HALLUS VALGUS - OSTEOTOMY 36000 54000 72000 273 DELTOID LIGAMENT RECONSTRUCTION 50400 75600 100800 274 SACROILIAC JOINT FIXATION 39600 59400 79200 OPEN REDUCTION AND INTERNAL FIXATION (ORIF) - 275 FEMORAL CONDYLE 57600 86400 115200

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FIRST METATARSOPHALANGEAL (MTP) JOINT RESECTION 276 ARTHROPLASTY 35100 52650 70200 LUNATE REVASCULARIZATION WITH VASCULARISED BONE 277 GRAFT 49500 74250 99000 278 HAMSTRING LENGTHENING 45000 67500 90000 HALLUX VALGUS - OSTEOTOMY + BUNIONECTOMY + 279 DISTAL SOFT TISSUE PROCEDURE (DSTP) 45000 67500 90000 280 CARPAL TUNNEL RELEASE + MEDIAN NERVE NEUROLYSIS 45000 67500 90000 OPEN REDUCTION AND INTERNAL FIXATION (ORIF) WITH 281 LCDCP - HUMERUS 54000 81000 108000 LATERAL LIGAMENT REPAIR + PERONEAL TENDON 282 TRANSFER 54000 81000 108000 283 DISTAL RADIOULNAR JOINT (DRUJ) STABILIZATION 49500 74250 99000 284 ACUTE TENDON REPAIR (COMPLEX) 39600 59400 79200 285 OSTEOTOMY 34200 51300 68400 FRACTURE REDUCTION + PERCUTANEOUS FIXATION 286 (ARTHROSCOPIC) 63000 94500 126000 287 OSTEOTOMY - COMPLEX 45000 67500 90000 288 POSTEROLATERAL CORNER RECONSTRUCTION 72000 108000 144000 289 SHOULDER TUMOUR EXCISION - COMPLEX 68400 102600 136800 290 ROTATOR CUFF TEARS OPEN REPAIR (SMALL) 49500 74250 99000 ACROMIOCLAVICULAR JOINT RECONSTRUCTION (WITH 291 PLATE) - GRADE III 49500 74250 99000 ACROMIOCLAVICULAR JOINT ANATOMIC 292 RECONSTRUCTION 54000 81000 108000 SACROILIAC JOINT DISRUPTION CLOSE REDUCTION AND 293 FIXATION 45000 67500 90000 HAGLUND'S DEFORMITY / POSTERIOR HEEL SPUR 294 EXCISION (OPEN) 27000 40500 54000 295 INJECTION - KNEE JOINT 3600 5400 7200 296 INJECTION - ANKLE JOINT 3600 5400 7200 297 Soft tissue Injection ( Rheumatology ) 1200 1800 2400 298 KNEE JOINT ASPIRATION – DIAGNOSTIC 1200 1800 2400 299 ANKLE JOINT ASPIRATION - DIAGNOSTIC 1200 1800 2400

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MAXILLOFACIAL SURGERY

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 Alar Adjustment (Nose) 11110 16668 22224 2 Alveolar Bone Grafting 31740 47616 63480 3 Alveolar Bone Grafting (Grade 1) 39676 59508 79356 4 Alveolar Bone Grafting (Grade 2) 47610 71412 95220

Alveolar Bone Grafting (Excluding Bone Graft and Membrane Cost) 63480 95220 126960 5 (Grade 1)

Alveolar Bone Grafting (Excluding Bone Graft and Membrane Cost) 79350 119028 158700 6 (Grade 2)

Alveolar Bone Grafting (Excluding Bone Graft and Membrane Cost) 95220 142836 190440 7 (Grade 3) 8 Alveoloplasty (per segment) tooth area 4762 7140 9528 9 Bone Graft/tooth (Grade 1) 11110 16668 22224 10 Bone Graft/tooth (Grade 2) 15870 23808 31740 11 Bone Graft/tooth (Grade 3) 23806 35712 47616 12 Bone Graft/tooth 7936 11904 15876 13 Cephalometric Analysis 3809 5712 7620 14 Condylar Fracture (Bilateral) 31740 47616 63480 15 Condylar fracture (Unilateral) 23806 35712 47616 16 Crown/Bridge Placement (Per Abutment) 3174 4764 6348 17 Dental implant-Basic 55546 83316 111096 18 Dental implant-Basic (Grade 1) 90224 135336 180444 19 Dental implant-Basic (Grade 2) 71416 107124 142836 20 Dental implant-High End 87286 130932 174576 21 Dental implant-High End (Grade 1) 103156 154728 206316 22 Dental implant-High End (Grade 2) 119026 178536 238056 23 Dental implant-High End (Grade 3) 134896 202344 269796 24 Dental implant-High End with Bone Graft 158700 238056 317400 25 Excisional Biopsy-Large 9522 14280 19044 26 Excisional Biopsy-Medium 7936 11904 15876 27 Excisional Biopsy-Small 6348 9528 12696 28 Excisional Biopsy- With laser 11910 17868 23820 29 Excisional Biopsy- With laser (Grade 1) 13496 20244 26988 30 Excisional Biopsy- With laser (Grade 2) 15870 23808 31740 31 Facial Bones Fracture Closed Reduction Maxilla 55546 83316 111096 32 Impacted Tooth Surgical extraction 11910 17868 23820 33 Impacted Tooth Surgical extraction (Grade 1) 15870 23808 31740 34 Impacted Tooth Surgical extraction (Grade 2) 23806 35712 47616 35 Impacted Tooth Surgical extraction (Grade 3) 31740 47616 63480 36 Incisional Biopsy- Large 7148 10728 14292

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37 Incisional Biopsy- Medium 5562 8340 11124 38 Incisional Biopsy- Small 4762 7140 9528 39 Incisional Biopsy- with Laser 9522 14280 19044 40 Incisional Biopsy- with Laser Grade 1 11110 16668 22224 41 Incisional Biopsy- with Laser Grade 3 12696 19044 25392 42 Incisional Biopsy- Oral 6348 9528 12696 43 Mandible Comminuted Fracture Open Reduction + Fixation 66654 99984 133308

Mandible Comminuted Fracture Open Reduction + Fixation (Grade 77764 116640 155532 44 1) 45 Mandible Compound Fracture Open Reduction + Fixation 50784 76176 101568

63480 95220 126960 46 Mandible Compound Fracture Open Reduction + Fixation (Grade 1) 47 Mandible Fracture Closed Reduction 20396 30600 40788 48 Mandible Fracture Open Reduction + Fixation 31423 47136 62844

Mandible Fracture Reduction + Fixation-Cap splint & circum 50784 76176 101568 49 mandibular wiring

Mandible Fracture Reduction + Fixation-Cap splint & circum 71416 107124 142836 50 mandibular wiring (Grade 1)

Mandible Fracture Reduction + Fixation-Cap splint & circum 87286 130932 174576 51 mandibular wiring (Grade 2) 52 Mandible Fracture- IMF Screws (Grade 1) 55546 83316 111096 53 Mandible Fracture- IMF Screws (Grade 4) 71416 107124 142836 54 Maxilla Fracture Lefort 2 63480 95220 126960 55 Maxilla Fracture Lefort 3 82524 123792 165048 56 Maxilla Fracture Lefort 1 48011 72012 96024 57 Neurectomy Mandible (Grade 1) 79350 119028 158700 58 Neurectomy Mandible (Grade 2) 111090 166632 222180 59 Neurectomy Mandible (Grade 3) 134896 202344 269796 60 Neurectomy Maxilla (Grade 1) 47610 71412 95220 61 Neurectomy Maxilla (Grade 2) 79350 119028 158700 62 Neurectomy Maxilla (Grade 3) 111090 166632 222180 63 Oral Cyst Removal- Small 14284 21420 28572 64 Oral Cyst Removal- Small Grade 1 19044 28572 38088 65 Oral Cyst Removal- Small Grade 2 23806 35712 47616 66 Oral Cyst Removal Grade 1 47610 71412 95220 67 Oral Cyst Removal Grade 2 71416 107124 142836 68 Oral Cyst Removal Grade 3 87286 130932 174576 69 Oral Cyst Removal Grade 4 119026 178536 238056 70 Oroantral Fistula Plastic Repair + Closure- Grade 2 79350 119028 158700 71 Oroantral Fistula Plastic Repair + Closure- Grade 1 63480 95220 126960 72 Orthognathic Surgery (Grade 1) 95220 142836 190440 73 Orthognathic Surgery (Grade 2) 142830 214248 285660 74 Orthognathic Surgery (Grade 3) 190440 285660 380880 201

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75 Orthognathic Surgery (Grade 4) 238050 357072 476100 76 Panfacial Fracture Maxilla 103156 154728 206316 77 Panfacial Fracture Maxilla (Grade 1) 119026 178536 238056 78 Temporomandibular Joint Surgery (Bilateral) 119026 178536 238056 79 Temporomandibular Joint Surgery (Unilateral) 79350 119028 158700 80 Treatment Osteomyelitis (Grade 1) 47610 71412 95220 81 Treatment Osteomyelitis (Grade 2) 63480 95220 126960 82 Treatment Osteomyelitis (Grade 3) 79350 119028 158700 83 Tumour Resection (Grade 1) 63480 95220 126960 84 Tumour Resection (Grade 2) 87286 130932 174576 85 Tumour Resection (Grade 3) 111090 166632 222180 86 Tumour Resection (Grade 4) 134896 202344 269796 87 Zygomatic Complex Fracture with Open reduction 63480 95220 126960 88 Zygomatic Complex Fracture with Open reduction Grade 1 71416 107124 142836 89 Zygomatic Complex Fracture with Open reduction Grade 2 79350 119028 158700 90 Abbe Flap Surgery 29326 43992 58656 91 Adjacent Flap-Large 32209 48312 64416 92 Adjacent Flap-Medium 25241 37860 50484 93 Adjacent Flap-Small 16630 24948 33264 94 Aesthetic Rhinoplasty (Complete) 38406 57612 76812 95 Alar Adjustement 11110 16668 22224 96 Arch Bar Removal 6265 9396 12528 97 Arch Bar Wiring (IMF) 16339 24504 32676 98 Arthroplasty Temporomandibular Joint (Bilateral) 61010 91512 122016 99 Arthroplasty Temporomandibular Joint (Unilateral) 50716 76068 101436 100 Benign Lesion Excision-Large 17071 25608 34140 101 Benign Lesion Excision-Medium 12020 18036 24036 102 Benign Lesion Excision-Small 5768 8652 11532 103 Bimaxillary Procedures (Orthognathic) 95579 143364 191160 104 Botox Injections (20 Units) 6031 9048 12060 105 Botox Injections (50 Units) 12020 18036 24036 106 Burn Dressing Face 9605 14412 19212 107 Burn Grafting-Medium 27379 41064 54756 108 Burn Grafting-Small 16339 24504 32676 109 Canthopexy 50204 75312 100404 110 Cleft Lip (Complete) Repair- Bilateral 35315 52968 70632 111 Cleft Lip Repair+ Cleft Palate Repair 35797 53700 71592 112 Cleft Lip Repair 21625 32436 43248 113 Cleft Lip Revision 32196 48300 64392 114 Cleft Palate Fistula Repair 28345 42516 56688 115 Cleft Palate Fistula Repair-Soft Palate 28345 42516 56688 116 Cleft Palate Repair 32196 48300 64392 117 Cranial bone grafting 40600 60900 81204 202

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118 Craniofacial surgery (Complete defect correction) 240037 360060 480072 119 Craniofacial Surgery (Partial defect correction) 180049 270072 360096 120 Cross facial nerve grafting (Facial paralysis) 32209 48312 64416 121 Dermabrasion Face (Full) 48508 72756 97020 122 Dermabrasion Face (Partial) 35315 52968 70632 123 Expander Insertion-Multiple 36032 54048 72060 124 Expander Removal+ Contouring (Multiple) 36032 54048 72060 125 Expander Removal+ Contouring (Single) 24012 36024 48024 126 Facial bone (Frontal Bone) fracture repair-Bilateral 28373 42564 56748 127 Facial bone (Frontal Bone) fracture repair-Unilateral 20466 30696 40932 128 Maxillary fracture closed reduction 21128 31692 42252 129 Facial nerve repair 40338 60504 80676 130 Facial nerve sling (Facial paralysis) 20921 31380 41844 131 Fasciocutaneous flap-Medium/Intermediate 35315 52968 70632 132 Fasciocutaneous flap-Small 32209 48312 64416 133 Fat pad (buccal) removal 35315 52968 70632 134 Foreign body removal-deep 19210 28812 38424 135 Foreign body removal-superficial 9605 14412 19212 136 Functional Free Muscle transfer (facial paralysis) 52123 78180 104244 137 Hair Transplant (Level 1) 15870 23808 31740 138 Hair Transplant (Level 2) 23806 35712 47616 139 Hair Transplant (Level 3) 31740 47616 63480 140 Hair Transplant (Level 4) 47610 71412 95220 141 Hair Transplant (Level 5) 63480 95220 126960 142 Hair Transplant (Level 6) 79350 119028 158700 143 Hair Transplant (Level 7) 95220 142836 190440 144 Hemangioma Excision-Medium 23557 35340 47112 145 Hemangioma Excision-Small 18768 28152 37536 146 Iliac Bone Graft 21128 31692 42252 147 Intermaxillary Fixation 17802 26700 35604 148 Laceration (Multiple) Repair 36502 54756 73008 149 Laceration (Single) Repair- Medium 16367 24552 32736 150 Laceration (Single) Repair- Small 9163 13740 18324 151 Laceration (Single) Repair- Large 26980 40464 53964 152 Lip Reconstruction (One-third loss) 29326 43992 58656 153 Lip Reconstruction (Total loss) 44174 66264 88344 154 Lip Reconstruction (Two-third loss) 38406 57612 76812 155 Lip Rejuvenation 35315 52968 70632 156 Lipectomy-Cosmetic 26441 39660 52884 157 Lipoinjection-Small 18768 28152 37536 158 Lipoma Excision-Medium 20921 31380 41844 159 Lipoma Excision-Small 14918 22380 29832 160 Liposuction-Medium region 20466 30696 40932 203

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161 Liposuction-Small region 17084 25632 34164 162 Maxillary/Mandibular distractor placement (Orthognathic) 48011 72012 96024 163 Maxillary Osteotomy 55960 83940 111924 164 Muscle Flap (Facial paralysis) 42049 63072 84096 165 Nasal pack removal 4361 6540 8724 166 Nerve grafting (secondary repair) 51860 77796 103716 167 Nerve repair (peripheral) 26441 39660 52884 168 Nerve Repair (plastic) 19210 28812 38424 169 Neurotization (Facial paralysis) 32209 48312 64416 170 Nose Reconstruction(Extensive) 57616 86424 115236 171 Nose Tip plasty (major) 35315 52968 70632 172 Nose Tip plasty (minor) 24054 36084 48108 173 Platelet Rich Plasma-Small area 13097 19644 26196 174 Ptosis Correction-both eyes 21128 31692 42252 175 Replantation (Scalp Injuries) 74452 111672 148908 176 Rhinoplasty (Secondary) 35315 52968 70632 177 Rhinoplasty Augmentation 38406 57612 76812 178 Rhinoplasty Cosmetic 56911 85368 113820 179 Rhinoplasty Reconstructive 38406 57612 76812 180 Rhinoplasty Reconstructive (Limited) 28814 43224 57624 181 Rhinoplasty Reconstructive(Partial) 19210 28812 38424 182 Scar Revision (simple medium) 10350 15528 20700 183 Scar Revision (simple small) 7246 10872 14496 184 Scar Revision (medium) 22384 33576 44772 185 Scar Revision (small) 14918 22380 29832 186 Skin graft full thickness (half face very large area) 34128 51192 68256 187 Skin graft full thickness (medium) 20687 31032 41376 188 Skin graft full thickness (small) 12779 19164 25560 189 Split thickness skin graft (medium) 19651 29472 39300 190 Split thickness skin graft (small) 11082 16620 22164 191 Suture removal (medium) 2429 3648 4860 192 Suture removal (small) 1477 2220 2952 193 Tissue Expander Insertion-Single 24012 36024 48024 194 Tissue Expander Insufflation (per sitting) 5768 8652 11532 195 Tongue Flap 25241 37860 50484 196 Tongue Tie Release 5768 8652 11532 197 Torticollis Release 35576 53364 71148

Wound (other than burn) cover with split thickness skin graft- 23806 35712 47616 198 medium

13248 19872 26496 199 Wound (other than burn) cover with split thickness skin graft- small 200 Wound Debridement-Large 15870 23808 31740 201 Wound Debridement-Small 11068 16596 22140 204

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202 Wound Debridement-Superficial 6652 9972 13308 203 Y-plasty/Z-plasty 16367 24552 32736 204 Zplasty-small 14918 22380 29832 205 DENTAL IMPLANT (POSTERIOR) 100990 151488 201984

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ONCO SURGERY

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 Nephrectomy Radical ( Oncosurgery ) 41515 51980 69230 2 Sigmoid Colectomy ( Oncosurgery ) 22770 34155 45540 3 Anterior Resection Of Rectum - High ( Oncosurgery ) 37490 46920 62560 4 Anterior Resection Of Rectum - Low / Ultra-Low ( Oncosurgery ) 41515 51980 69230 5 Biopsy Trucut - Deep ( Oncosurgery ) 1610 2415 3220 6 Breast Lump Excision Biopsy - Large ( Oncosurgery ) 9936 12420 16560 7 Breast Lump Excision Biopsy - Small ( Oncosurgery ) 6900 8625 11500 8 Cystectomy Partial ( Oncosurgery ) 70610 88320 117760 9 Double / Triple Bypass For Carcinoma Pancreas ( Oncosurgery ) 29095 36455 48530 10 Fine Needle Aspiration Cytology ( FNAC ) - Oncosurgery 1380 1725 2300 11 Disarticulation - Hip ( Oncosurgery ) 29095 36455 48530 12 Inguinal Lymph Node Dissection - Right Side ( Oncosurgery ) 22540 28175 37490

LaryngoPharyngectomy Total + Gastric Pull Up Procedure ( 70610 88320 117760 13 Oncosurgery ) 14 Lobectomy / Hemithyroidectomy ( Oncosurgery ) 18170 22770 30360 15 Mastectomy - Modified Radical / Radical ( Oncosurgery ) 40825 51060 68080 16 Nephroureterectomy ( Oncosurgery ) 49910 62445 83260 17 Orbital Exenteration ( Oncosurgery ) 29095 36455 48530 18 Orchidectomy Bilateral ( Oncosurgery ) 13915 17480 23230 19 Orchidectomy High ( Oncosurgery ) 15640 19550 25990 20 Pancreatectomy - Distal + Splenectomy ( Oncosurgery ) 45770 57270 76360 21 Parathyroidectomy ( Oncosurgery ) 22540 28175 37490 22 Parotidectomy Superficial ( Oncosurgery ) 22540 28175 37490 23 Amputation Penis - Total ( Oncosurgery ) 20585 25760 34270 24 Pleural Tap / Abdominal Paracentesis ( Oncosurgery ) 6900 8625 11500 25 Pneumonectomy ( Oncosurgery ) 70610 88320 117760 26 Radiofrequency Ablation Tumor ( Oncosurgery ) 66470 83145 110860 27 Retroperitoneal Lymph Node Dissection ( Oncosurgery ) 37490 46920 62560

Right/Left Hemicolectomy / Transverse Colectomy / Sigmoid 22540 28175 37490 28 Colectomy ( Oncosurgery ) 29 Disarticulation - Shoulder Joint ( Oncosurgery ) 22540 28175 37490 30 Thoracotomy ( Oncosurgery ) 29095 36455 48530 31 Thyroidectomy Total ( Oncosurgery ) 29095 36455 48530 32 Laparotomy Exploratory ( Oncosurgery ) 17940 22425 29900 33 Feeding Gastrostomy ( Oncosurgery ) 13915 17480 23230 34 Inguinal Lymph Node Dissection - Bilateral ( Oncosurgery ) 29095 36455 48530 35 Omentectomy ( Oncosurgery ) 30820 38525 51290 36 Maxillectomy Partial ( Oncosurgery ) 22540 28175 37490 37 Pelvic Lymph Node Dissection - Bilateral ( Oncosurgery ) 24150 30245 40250

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38 Pelvic Lymph Node Dissection - Right ( Oncosurgery ) 18170 22770 30360 39 Pelvic Exenteration - Anterior / Posterior ( Oncosurgery ) 70610 88320 117760 40 Pelvic Exenteration - Total ( Oncosurgery ) 70610 88320 117760 41 Debridement - Small ( Oncosurgery ) 6900 8625 11500 42 Debridement - Medium ( Oncosurgery ) 9936 12420 16560 43 Monoclonal Antibody Therapy - Per Day ( Oncosurgery ) 4692 5865 7820 44 Chemotherapy Infusional ( Upto 6 Hrs ) 1380 2070 2760 45 Chemotherapy IntraPleural ( Per Day ) 1380 2070 2760 46 Chemotherapy IntraVesical (Per Day ) 1346 2018 2691 47 Chemotherapy IntraThecal ( Per Day ) 2588 3881 5175 48 Chemotherapy Bolus - Single Drug ( Per Day ) 8625 12938 17250 49 Hemicolectomy Extended - Right / Left ( Oncosurgery ) 36800 46115 61410 50 Chemotherapy Planning 3036 3795 5060 51 Orchidectomy Right ( Oncosurgery ) 12535 15698 20930 52 Liver Abscess Drainage ( Percutaneous ) 6900 8625 11500 53 Supraomohyoid Dissection ( Right ) 22540 28175 37490 54 Suture Removal ( Single Suture ) 414 518 690 Total Abdominal Hysterectomy ( TAH ) + Bilateral Salpingoophorectomy ( BSO ) + Pelvic Lymph Node Dissection + 45770 57270 76360 55 Omentectomy Total Abdominal Hysterectomy ( TAH ) + Bilateral Salpingoophorectomy ( BSO ) + Pelvic Lymph Node Dissection + 58190 72795 97060 Omentectomy + Paraaortic Lymph Node Sampling + Peritoneal 56 Biopsy Total Abdominal Hysterectomy ( TAH ) + Bilateral Salpingoophorectomy ( BSO ) + Pelvic Lymph Node Dissection + 45770 57270 76360 57 Peritoneal Washing 58 Prostate Biopsy ( TRUS Guided ) 4968 6210 8280 59 Axillary Lymph Node Dissection - Right 18170 22770 30360 60 Mediastinoscopy ( Oncosurgery ) 37490 46920 62560 61 Prostate Biopsy ( Transrectal ) 19205 28750 38410 62 EX. LARGE SUPERFICIAL TUMOUR 7705 11558 15410 63 EX. SMALL SUPERFICIAL TUMOUR 5520 8280 11040 64 EXCISION OF UNLATERAL ADRENAL TUMOUR 21620 32430 43240 65 ALCHOHOL ABLATION OF TUMOR MASS 20470 30705 40940 66 INTRAORAL INJECTION FOR SUBMUCOUS FIBROSIS 2300 3450 4600

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INTERVENTIONAL RADIOLOGY & CARDIOLOGY

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 Vertebral Body Hemangioma / Mets Embolization 56523 64239 89930 2 External Carotid Artery Tumor Embolization 56523 64239 89930

Tumor Embolization ( Vertebral Artery And Basilar Artery Supply 83042 94358 132101 3 Zone ) 4 Arterial Embolization ( Empirical ) 103684 117818 164945 5 Gastrointestinal Bleed Embolization 72404 82271 115184 6 Tumors Glue Embolization 124338 141289 197800 7 Pacemaker Lead ( Repositioning ) 23000 34500 46000 8 Pelvic Mass / Tumor Embolization ( Therapeutic ) 51762 58811 82340 9 Portal Vein Embolization 40250 60375 80500 10 Pacemaker Implantation ( Temporary ) 10350 11903 12420 11 Streptokinase Injection Procedure 3105 4658 6210 12 Pericardial Tapping 5750 6613 7605 13 Hemangioma Embolization 71438 81179 113643 14 Pacemaker Explantation 23000 34500 46000 15 Angiography (Venogram) 17250 19838 22814 16 Activated Clotting Time 288 288 288 17 Central Venous Access 9488 11480 12628 18 Embolization For Bleeding ( Radiology ) 40250 60375 80500 19 Check Angiogram ( Radiology ) 4600 6900 9200 20 Intrarterial Vasodilatation ( Radiology ) 23000 34500 46000

Percutaneous Transhepatic Biliary Drainage ( PTBD ) - Single System 11500 17250 23000 21 ( Interventional Rdiology ) 22 HVPG ( Hepatic Venous Pressure Gradient ) (Radiology) 9200 13800 18400 23 Portal Vein Embolization (Radiology) 40250 60375 80500 24 CT Guided Tumor Ablation (Chemical) (Radiology) 17250 23288 25875 25 CT Guided Tumor Ablation ( RFA ) (Radiology) 28750 38813 43125 26 USG Guided Tumor Ablation ( RFA ) (Radiology) 23000 31050 34500 27 Cerebral AVM Embolization ( Besides VB Territory) 36915 55373 73830 28 ICD EXPLANTATION 23000 34500 46000 29 ANGIOEMBOLIZATION 34500 39675 45626

Tumor Embolization ( Benign / Malignant ) - Interventional 62192 70668 98935 30 Radiology 31 Embolization - Preoperative 3174 3634 5037 32 Post Pancreatitis Sequeles / Embolization Of Various Causes 41550 47219 66102 33 Tumor Embolization ( Interventional Radiology ) 41550 47219 66102 34 Intracranial Stenting ( Interventional Radiology ) 36915 55373 73830 35 Spinal AVM / AVF Embolization 145004 164772 230679 36 SPLENIC ARTERY EMBOLIZATION 40250 60375 80500

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ANESTHESIA PROCEDURES

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 Acupuncture ( One Course ) 2300 3450 4600 2 Acupuncture Subsequent Course ( Without Needle ) 1139 1708 2277 3 Chemoport Insertion 9488 11500 12650 4 Sedation ( for Dressing ) 621 932 1242 5 Central Line Insertion 7590 10247 15370 6 Injection Intra Thecal 1610 2415 3220 7 Continuous Positive Airway Pressure ( CPAP ) - Per Day 2300 3105 4658 8 Spinal Ligament Injection ( Diagnostic ) 1150 1725 2300 9 Facet Joint Injection 2875 4313 5750 10 Epidural Injection ( Lumbar ) 2070 3105 4140 11 Epidural Injection ( Thoracic ) 2875 4313 5750 12 Tracheostomy ( Percutaneous ) 3450 5175 6900 13 Spinal Nerve Root Block 4600 6210 6900 14 Acupuncture ( Per Sitting ) 403 604 805 15 Peripheral Nerve Block 920 1380 1840 16 STAND BY ANESTHESIA FOR MRI / CT 460 690 920 17 MARS KIT IMPLEMENTATION CHARGES (DOCTORS) 10925 16388 21850 18 MARS KIT IMPLEMENTATION CHARGES (TECHNICIANS) 1139 1708 2277 19 Joint Injection 1150 1725 2300 20 TRIGGER POINT INJECTION - (P) 920 1380 1840 21 COELIAC PLEXUS BLOCK DIAG/THER (USG) - (P) 2875 4313 5750 22 Sedation for UGI Endoscopy 920 920 920 23 Sedation for Colonoscopy 1840 1840 1840 24 Sedation for ERCP 4025 4025 4025 25 CAUDAL EPIDURAL STEROID INJECTION 1725 2588 3450 26 STELLATE GANGLION BLOCK 1150 1725 2300 27 Hemodialysis Catheter Insertion ( Anesthesia) 5175 5951 6844 28 SEDATION FOR ENDOSCOPY PROCEDURE - MINOR 920 1058 1217 29 SEDATION FOR ENDOSCOPY PROCEDURE - MAJOR 1840 2116 2433 30 Sedation for ERCP 4025 4025 4025 31 SEDATION FOR EUS (DIAGNOSTIC) 3450 3968 4563

4600 5290 6084 32 SEDATION FOR ENDOSCOPY PROCEDURE (THERAPEUTIC/IMAGING) 33 SEDATION FOR ENDOSCOPY PROCEDURE 1215 1350 1800 34 ANESTHESIA CONSUMABLE (ERCP) 1610 1852 2130 35 ANESTHESIA CONSUMABLE (EUS DIAGNOSTIC) 2875 3306 3802 36 ANESTHESIA CONSUMABLE EMERGENCY 3450 3968 4563 37 COCCYGEAL + GANGLION IMPAR NEUROLYSIS 28320 33984 56640 38 CERVICAL DORSAL ROOT GANGLION (DRG) PRFA 29400 44100 58800

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39 LUMBAR DORSAL ROOT GANGLION(DRG)PRFA 29400 44100 58800 40 SPHENOPALATINE GANGLION BLOCK + RFA 34800 52200 69600 41 Transforaminal Decompressive Neuroplasty 23400 35100 46800 42 MEDIAN BRANCH RADIOFREQUENCY RHIZOTOMY(LUMBAR) 34800 52200 69600 43 Peripheral Nerve Block ( Ultrasound Guided ) 10000 10000 10000 44 EPIDURAL NEUROPLASTY - (P) 23400 35100 46800 45 STELLATE GANGLION BLOCK (USG GUIDED) - (P) 20000 20000 20000 46 SEDATION - (P) 3200 4800 6400 47 Intraarticular Injection (Ultrasound Guided) 10000 10000 10000

Peripherally Inserted Central Catheter (PICC) Insertion - USG 10000 10000 10000 48 Guided 49 PAC 1150 1150 1150

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PSYCHOLOGY

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Standard Single Sl / Double Description Dlx Suite No. Dlx Room Room 1 Detailed Evaluation Adult ( Psychology ) 1346 2018 2691 2 Detailed Evaluation Child ( Psychology ) 1242 1863 2484 3 Diagnostic Evaluation ( Psychology ) 1610 2415 3220 4 Cognitive Function tests 828 1242 1656 5 Dyslexia Battery 1610 2415 3220 6 Neuropsychological Battery 1610 2415 3220 7 IQ Test 1495 2243 2990 8 Personality Test / Assessment 828 1242 1656 9 Cognitive Behavioral Therapy 2415 2777 3194 10 Psychotherapy 414 621 828 11 COUNSELLING PSYCHOLOGY ( 30 MIN SESSION ) 1150 1323 1521 12 COUNSELLING PSYCHOLOGY ( 60 MIN SESSION ) 1840 2116 2433 13 STRESSOMETER TEST 230 265 305

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