EXPLANATORY NOTES: FOR BUSINESS RULES/CHARGE LIST FOR SAHARA HOSPITAL - 2019-2020 Date: 18.03.2019 1.0 GENERAL CONDITIONS 1.1 Rate of nursing and surgery are as per the inpatient accommodation. The rates as given under the head "Surgery" are for Semi Private Room. The rates for surgeries will be 90% for General Ward and 150% for Private Room TICU and 175% for Suite Room and the existing rate will be applicable if the patient is required to be shifted to ICU. The investigation rates for outpatients will be as given under the head investigations. 1.2 CREDIT PERIOD: As per agreement of the date of getting the bills paid received from the empanelled corporate/TPA, interest of 2% shall be paid for payments delayed beyond the date as per agreement between Sahara Hospital and Empanelled, Corporate/TPAs. 1.3 DEDUCTION OF BILLS: Panel/TPA should not make any adhoc deductions without discussing with us. Letter/telephones for any queries are welcome, so that our officers can go to company/panel office and sort out the problems. 1.4 In case of any additional rates, revised/new facilities/procedures are started, the rates will be intimated to the empanelled corporate/TPAs and bills will be made as per the rates fixed by Sahara Hospital. 1.5 MODE OF PAYMENT

We accept- 1- Cash (As per RBI new guidelines). 2- Debit / Credit Cards, 3- Demand Drafts 4- No cheques will accepted, expect for TPA/Empanel/Corporate Tie ups. 5- Electronic Clearing System may be used for payment. All NEFT/RTGS details should be informed to Accounts Department by Billing Department. Banking Details for NEFT/RTGS are available with Billing & Cash Department. 6- Multi City Cheques be only accepted, if at least 3 clear banking days are available prior to discharge as endorsed by the Consultant. 7- However, Multicity cheques only be accepted in case of Death, only if Consultant endorses. 1.6 Charges for Monitoring, Oxygen, Disposables, Ventilator, and Infusion Pump will be levied at applicable rates in the Wards/ICU/Emergency room/Day Care/OT.

1.7 Service charges of 20% will be levied on all bed side investigations and procedures as per services at 'HIS'.

1.8 In case any facility is not available with the Hospital, the same will be out sourced and charges will be levied as per actual and additional handling charges, on case to case basis.

Rahul Tewari Dr. (Col) Randhir Puri Dr. H. N. Tripathi Anil Vikram Singh Dr. Mazhar Husain Dy. Sr. Manager Medical Superintendent CMS & Co-ord. Med. Care Sr. Advisor, S.I.P. Director Medical Health Karunesh Kr. Pathak / E. C. 31025 Page 1 of 7 EXPLANATORY NOTES: FOR BUSINESS RULES/CHARGE LIST FOR SAHARA HOSPITAL - 2019-2020 Date: 18.03.2019 2.0 ROOM RENT 2.1 Includes bed, RMO Services and food. 2.2 Dietician Consultation Charges of Rs 300/- once only will be levied for every admission cases. 2.3 For the purpose of billing, a day is calculated from calendar date. When a patient is shifted from one category to another, rental for higher category accommodation occupied, will be charged. 2.4 In case attendants retain the room/accommodation, while patient is admitted in ICU, charges for both will be levied.

2.5 In case a patient is transferred from lower category to higher category after the operation, surgery charges will be as per the higher category.

2.6 Charges are for full day on the day of admission irrespective of time of checking in. 2.7 Room stay for 6 hours and above is counted as one day except in emergency.

2.8 Discharge/Checkout time is 12 noon.

3.0 INVESTIGATIONS 3.1 All Investigations will be charged as per rate available at HIS. 3.2 Donor Screening and Cost of Kit and ACDA will be charged as per MRP of Plasma- aphaeresis. 3.3 All freshly raised diagnostics Services as Emergency /Urgent between 8 PM to 6 AM will be charged 25% extra. 4.0 VISITING CHARGES 4.1 The Consultant’s Post Operative Visit will be charged from next day of Surgery.

4.2 Consultant / Physician will charge maximum one visit per day irrespective of number of visits. In case Consultant visit is required between 10.00 PM to 8.00 AM, visit will be treated as an emergency visit separately and will be charged as per the rates given (as per table on page no. 4). 4.3 Any referral Consultant/Physician can charge one visit per day irrespective of number of visits except during emergencies, when Consultant fee will be charged in addition. 5.0 SURGERY/SURGICAL PROCEDURES 5.1 The rates quoted are for surgery fees only. Anesthesiologist fee, OT charges, Equipments charges, Anaesthesia gas charges will be charged as per the percentage given below. Drugs and disposables will be charged as per actual.

5.2 OT Charges will be charged at 47% of Surgery fee.

5.3 Anesthesiologist fee will be charged at 25% of Surgery fee.

Rahul Tewari Dr. (Col) Randhir Puri Dr. H. N. Tripathi Anil Vikram Singh Dr. Mazhar Husain Dy. Sr. Manager Medical Superintendent CMS & Co-ord. Med. Care Sr. Advisor, S.I.P. Director Medical Health Karunesh Kr. Pathak / E. C. 31025 Page 2 of 7 EXPLANATORY NOTES: FOR BUSINESS RULES/CHARGE LIST FOR SAHARA HOSPITAL - 2019-2020 Date: 18.03.2019 5.4 PAC Charges in IPD is to be charged as IPD Consultant visit charges as per different bed category of the patient. (For eg. Economy Ward Rs. 600/- Semi. Pvt., ICU, HDU, Emergency – Rs. 1000/- and for Suite Room – Rs. 1500/-). 5.5 Anaesthesia gas charges will be charged at 21% of Surgery fee.

5.6 Assistant Surgeon charges will be 25% of Surgery fee.

5.7 Anesthesiologist visit will be free on first post operative day only. 5.8 Oxygen Charges in OT will be charged @ Rs. 260/hour.

5.9 Equipment charges for use at OT. The charges will be charged for all surgical cases as additional, where equipment such as, Laparoscope/C Arm/Microscope/Micro Drill and others are used at 26% of Surgery Fee. 5.10 Where on the insistence of the patient, two Surgeons perform an operation, both the Surgeons can charge their fee separately but the O.T. and Anaesthesia charges will be as per the existing schedule of charges of the procedure only and not based on the total fee of the two Surgeons. 5.11 Where due to complex nature of the Surgery, two Surgeons need to operate; charges will be one and half times that of normal fee, to be divided equally between the two consultants. However, consent from patient is required. 5.12 Where a stand-by Cardiologist or any other specialist is required during the surgery, charges of physician /cardiologist will be Rs. 2000/- and Rs. 2500/- respectively and should be reflected in HIS & OT sheet as a stand-alone Service. 5.13 Second surgery done by the same Surgeon at the same sitting will be 75% of the procedure fee as per bed category. However Anaesthetist fee will be 25% of applicable surgery fee vide para 5.3 as above. 5.14 When two different surgeons operate on two different sites, procedure fee will be 100% for each surgery. Anaesthetist fee will be charged as prevalent i.e. 25% of the surgery charge, however the OT charges will be 15% of 2nd surgery in addition of OT charge, Equipments charges, Gas charges and Anaesthesia drug charge of major surgery. 5.15 Emergency surgeries between 8 PM to 6 AM will be charged 25% extra. Other incidental charges will be charged on pro-rata basis. Case should be of an emergent nature. 5.16 Cases where surgery is not performed due to any medical complication arising on the operation table after giving Anaesthesia, anaesthesia charges and OT charges will be restricted on the actual drugs /consumables used. 5.17 Charges for the remote location Anaesthesia for CT SCAN, MRI, ENDOSCOPY,CATH LAB,PEDIATRICS INTERVENTIONS, ENDOVASCULAR INTERVENTION is to be charged as per Final Charge List 2019-20. 5.18 If paediatric group of patients need anaesthesia/analgesia at remote location such as Cath Lab, CT Scan, MRI, Endoscopy, Dialysis etc then 10% additional enhancement in Anaesthetist charges will be charged. 5.19 Epidural Anaesthesia if given as a primary procedure the repeat charge for pain relief (analgesia) is not admissible.

Rahul Tewari Dr. (Col) Randhir Puri Dr. H. N. Tripathi Anil Vikram Singh Dr. Mazhar Husain Dy. Sr. Manager Medical Superintendent CMS & Co-ord. Med. Care Sr. Advisor, S.I.P. Director Medical Health Karunesh Kr. Pathak / E. C. 31025 Page 3 of 7 EXPLANATORY NOTES: FOR BUSINESS RULES/CHARGE LIST FOR SAHARA HOSPITAL - 2019-2020 Date: 18.03.2019 6.0 AMBULANCE CHARGES: 6.1 Critical Care Ambulance charges as per existing orders with enhancement of 05%. 7.0 EQUIPMENT CHARGES

Particulars Charges

7.1 Ventilator plus oxygen charges (Per day) 10,450/- 7.2 BIPAP Charges plus oxygen charges (Per day) 7,370/-

Above equipments used at change of date at midnight (i.e. 1/2, 1/3), if used for 7.3 less than 6 hrs., then only one day's charge will be charged. 8.0 EMERGENCY SERVICES: 8.1 Emergency admission will be between 4 PM to 9 AM. All services rendered between 8 PM and 6 AM will considered as an Emergency services for New Emergency Admissions in IPD, unless specified for special areas such as Cardiology and Diagnostics Services and few Surgical specialties. 8.2 Emergency primary angioplasty will be charged additional 25% as emergency charges. 8.3 Emergency Surgical Procedures on gazetted holiday’s, Sundays and declared public holidays will be charged 25% extra for NEW admission cases only. 8.4 Charges as surgical fees, should not escalate to higher category of accommodation, if operation done in Emergency. 8.5 No emergency/bed side/Assistant Surgeon/investigations and procedures charges are applicable for TPA/Corporate patients. 9.0 REGISTRATION / CONSULTATION FEE FOR DOCTORS AT SAHARA HOSPITAL EMERGENCY 9.1 SERVICE OPD (8 PM to 6 AM) a REGISTRATION / STATIONARY CHARGES 100 100

b CONSULTATION FEE SPECIALIST OPD 600 1200 c EMO CONSULTATION FEE 300 500 d CONSULTATION FOR DIETICIAN 300 300 e CONSULTATION FOR PHYSIOTHERAPY 300 400 f MLC CASES REGISTRATION FOR IPD 1000/PER CASE

Note:

 Registration charge is valid for one year (365 days).  Consultation fee for specialist is valid for seven days (both days inclusive) for repeat visit.  Check out time for all categories of patients is 12.00 noon.  All taxes / surcharges levied by Government of India / State Government will be charged extra.

Rahul Tewari Dr. (Col) Randhir Puri Dr. H. N. Tripathi Anil Vikram Singh Dr. Mazhar Husain Dy. Sr. Manager Medical Superintendent CMS & Co-ord. Med. Care Sr. Advisor, S.I.P. Director Medical Health Karunesh Kr. Pathak / E. C. 31025 Page 4 of 7 EXPLANATORY NOTES: FOR BUSINESS RULES/CHARGE LIST FOR SAHARA HOSPITAL - 2019-2020 Date: 18.03.2019  Surgery/procedure charges as per the inpatient accommodation category, charges for surgery will be 175% for Suite, 150% for Private & Transplant ICU, 100% for all ICU’s, Emergency, HDU, Semi Private & 90% for Economy ward.  During entire course of stay, surgery/procedure charges will be applicable at the higher category of stay.

 Emergency visit charges will be Rs. 2000/- for Suite Room, Rs. 1500/- for Emergency, HDU, Private Room & all ICU’s & Rs. 800/- for General ward.

 The OPD Charges for Dr. Mazhar Hussain, and Dr. Nakul Sinha is Rs. 1200/- per consultation , whereas Dr. R.K Thukral 's OPD is also Rs 1200/-

 Dr. Mazhar Husain consultation, visit charges for IPD will be Rs. 1000/day for Economy ward, Rs. 1500/day for all ICU’s, Emergency, HDU, Private & Semi Private & Rs. 2000/day for Suite Room.  Investigation & other charges as per actual.

 Unutilized medicine refund before discharge. RATE LIST OF ROOM RENT: SAHARA HOSPITAL

10.0 SERVICE

S.N. PARTICULARS RATES (Rs)

1 REGISTRATION 100 2 ADMISSION CHARGES 500

11.0 BED/ROOM/NURSING/CONSULTATION CHARGES (W.E.F. 01.04.2019)

BED/ROOM NURSING CONSULTATION SN WARD/ROOM CHARGES CHARGES CHARGES 1 TRANSPLANT ICU Rs. 7900/day Rs. 1350/day Rs. 1000/day

2 MEDICAL ICU Rs. 5300/day Rs. 1350/day Rs. 1000/day

3 C.C.U. Rs. 4700/day Rs. 1350/day Rs. 1000/day

4 NEURO MEDICAL ICU Rs. 4700/day Rs. 1350/day Rs. 1000/day

5 NEURO SURGICAL ICU Rs. 4700/day Rs. 1350/day Rs. 1000/day

6 SURGICAL ICU Rs. 4700/day Rs. 1350/day Rs. 1000/day

7 C.T.V.S./C.T. POST OP Rs. 4700/day Rs. 1350/day Rs.1000/day

8 T/H.D.U./ SURGICAL H.D.U. Rs. 3700/day Rs. 1350/day Rs. 1000/day

9 CARDIAC/MEDICAL H.D.U. Rs. 3700/day Rs. 1350/day Rs. 1000/day

Rahul Tewari Dr. (Col) Randhir Puri Dr. H. N. Tripathi Anil Vikram Singh Dr. Mazhar Husain Dy. Sr. Manager Medical Superintendent CMS & Co-ord. Med. Care Sr. Advisor, S.I.P. Director Medical Health Karunesh Kr. Pathak / E. C. 31025 Page 5 of 7 EXPLANATORY NOTES: FOR BUSINESS RULES/CHARGE LIST FOR SAHARA HOSPITAL - 2019-2020 Date: 18.03.2019 10 OBSTETRICS HDU Rs. 3700/day Rs. 1350/day Rs. 1000/day

11 ECONOMY WARD Rs. 1500/day Rs. 950/day Rs. 600/day BED/ROOM/NURSING/CONSULTATION CHARGES (W.E.F. 01.04.2019) SN BED/ROOM NURSING CONSULTATI- WARD/ROOM CHARGES CHARGES ON CHARGES

12 PICU/NICU Rs. 3950/day Rs. 1350/day Rs. 1000/day

13 PICU STEP DOWN Rs. 3400/day Rs. 1350/day Rs. 1000/day

14 EMERGENCY Rs. 3200/day Rs. 1150/day Rs. 1000/day

15 ECONOMY BED (GEN. WARD) Rs. 1500/day Rs. 950/day Rs. 600/day

16 ISOLATION Rs. 1500/day Rs. 950/day Rs. 600/day

17 CATH LAB RECOVERY Rs. 1500/day Rs. 950/day Rs. 600/day

18 DNB Service to be deactivated

19 SUITE ROOM [No change] Rs. 18000/day Rs. 2000/day Rs. 1500/day

20 PRIVATE ROOM Rs. 7400/day Rs. 1350/day Rs. 1000/day

21 SEMI PRIVATE ROOM Rs. 3700/day Rs. 1150/day Rs. 1000/day

AS per package or as per Economy 22 DAY CARE WARD Rs. 2400/day bed beyond 12 hrs of stay

12.0 ALL NURSING PROCEDURES CHARGES (Rs) REMARKS

1 DRESSING SMALL 170

2 DRESSING MEDIUM 360

3 DRESSING LARGE 880

4 DRESSING MAJOR ORTHO/BURN 1210

5 INFUSION PUMP PER PUMP PER DAY 500

6 CUT OPEN (VENOUS) 880

7 LUMBER PUNCTURE IN WARD 2420

8 PARACENTACIS ABDOMINIS 1820

Rahul Tewari Dr. (Col) Randhir Puri Dr. H. N. Tripathi Anil Vikram Singh Dr. Mazhar Husain Dy. Sr. Manager Medical Superintendent CMS & Co-ord. Med. Care Sr. Advisor, S.I.P. Director Medical Health Karunesh Kr. Pathak / E. C. 31025 Page 6 of 7 EXPLANATORY NOTES: FOR BUSINESS RULES/CHARGE LIST FOR SAHARA HOSPITAL - 2019-2020 Date: 18.03.2019 ALL NURSING PROCEDURES CHARGES (Rs) REMARKS

9 ABSCESS DRAINAGE 880

To be charged to patient even if they 10 NEBULIZATION 140 have bought Nebulizer To be charged only if 11 WATER BED / AIR BED 360 provided by the hospital

12 BOWEL / GASTRIC LAVAGE 880

13 CVP LINE 3630

14 CTG 880

15 ARTERIAL LINE 2420

16 ENEMA (OPD) 150

17 FOLEYS CATHETERIZATION (OPD) 400

18 K-90 CATHETERIZATION (OPD) 240

19 LOCAL INFILTRATION 480

20 INTUBATION IN WARD 2640

21 STERNAL PUNCTURE 1540

22 RYLES TUBE INSERTION (OPD) 360

23 CHEST STRAPPING 880

24 PLEURAL ASPIRATION 1540

25 POST OP SUTURE REMOVAL 360

26 INJECTION CHARGES (OPD) 90 To be charged to the 27 BLOOD SUGAR (RANDOM)- GLUCOMETER 90 patient as service charge

28 BLOOD & BLOOD PRODUCTS TRANSFUSION 660 OXYGEN CHARGE FOR NICU/PICU/PICU 29 130 STEP DOWN/HRS

30 OXYGEN CHARGE /HRS 260 31 MORTUARY CHARGE 660 for each 12 hours < allowed 50 kms., 32 HEARSE VAN 26 /KM only

33 VENOUS INFUSION 130 13.0 Note for Corporate Tie-up/TPA:- 13.1 Only 3 categories of LSCS will be applicable as given below for the surgical fee. The additional charges are as per actual on pro-rata basis

a LSCS for Primi- gravida 12,000 b LSCS for subsequent pregnancy 14,000 c LSCS for subsequent and complicated 16,000

Rahul Tewari Dr. (Col) Randhir Puri Dr. H. N. Tripathi Anil Vikram Singh Dr. Mazhar Husain Dy. Sr. Manager Medical Superintendent CMS & Co-ord. Med. Care Sr. Advisor, S.I.P. Director Medical Health Karunesh Kr. Pathak / E. C. 31025 Page 7 of 7 SAHARA HOSPITAL SCHEDULE OF CHARGES W.E.F. 01.04.2019 BED SERVICE NORMAL EMERGENCY DEPARTMENT NAME SUB NAME SERVICE NAME CATEGORY CODE CHARGES CHARGES NAME AMBULANCE AMBULANCE SPECIAL BILLING HEADS ADDITIONAL MILEAGE WITH IN LUCKNOW CITY ABOVE 50 KM (PER KM) BASE PRICE 11875 47 0 AMBULANCE AMBULANCE SPECIAL BILLING HEADS AMBULANCE (PER KM) BASE PRICE 1760 47 0 AMBULANCE AMBULANCE SPECIAL BILLING HEADS AMBULANCE VAN DOCTOR CHARGES WITH IN LUCKNOW CITY BASE PRICE 11896 580 0 AMBULANCE AMBULANCE SPECIAL BILLING HEADS AMBULANCE VAN OUT OF STATION (PER KM) BASE PRICE 11897 23 0 AMBULANCE AMBULANCE SPECIAL BILLING HEADS AMBULANCE VAN WITH IN LUCKNOW CITY (PER KM) BASE PRICE 11895 21 0 AMBULANCE AMBULANCE SPECIAL BILLING HEADS AMBULANCE WITH IN LUCKNOW CITY UPTO 50KM (TO & FRO) BASE PRICE 11874 1160 0 AMBULANCE AMBULANCE SPECIAL BILLING HEADS DOCTOR CHG (IN AMBULANCE 1 TO 100 KM) BASE PRICE 11876 1160 0 AMBULANCE AMBULANCE SPECIAL BILLING HEADS DOCTOR CHG (IN AMBULANCE 101 TO 200 KM) BASE PRICE 11877 1730 0 AMBULANCE AMBULANCE SPECIAL BILLING HEADS DOCTOR CHG (IN AMBULANCE 201 TO 300 KM) BASE PRICE 11878 2310 0 AMBULANCE AMBULANCE SPECIAL BILLING HEADS DOCTOR CHG (IN AMBULANCE 301 TO 400 KM) BASE PRICE 11879 2890 0 AMBULANCE AMBULANCE SPECIAL BILLING HEADS DOCTOR CHG (IN AMBULANCE 401 TO 500 KM) BASE PRICE 11893 3470 0 AMBULANCE AMBULANCE SPECIAL BILLING HEADS DOCTOR CHG (IN AMBULANCE ABOVE 500 KM) BASE PRICE 11880 4040 0 AMBULANCE AMBULANCE SPECIAL BILLING HEADS DOCTOR WITH IN LUCKNOW CITY UPTO 50KM BASE PRICE 11892 580 0 AMBULANCE AMBULANCE SPECIAL BILLING HEADS DRIVER/ATTND CHG (IN AMBULANCE 1 TO 100 KM) BASE PRICE 11881 120 0 AMBULANCE AMBULANCE SPECIAL BILLING HEADS DRIVER/ATTND CHG (IN AMBULANCE 101 TO 200 KM) BASE PRICE 11882 230 0 AMBULANCE AMBULANCE SPECIAL BILLING HEADS DRIVER/ATTND CHG (IN AMBULANCE 201 TO 300 KM) BASE PRICE 11883 290 0 AMBULANCE AMBULANCE SPECIAL BILLING HEADS DRIVER/ATTND CHG (IN AMBULANCE 301 TO 400 KM) BASE PRICE 11884 350 0 AMBULANCE AMBULANCE SPECIAL BILLING HEADS DRIVER/ATTND CHG (IN AMBULANCE 401 TO 500 KM) BASE PRICE 11885 460 0 AMBULANCE AMBULANCE SPECIAL BILLING HEADS DRIVER/ATTND CHG (IN AMBULANCE ABOVE 500 KM) BASE PRICE 11886 690 0 AMBULANCE AMBULANCE SPECIAL BILLING HEADS OXYGEN CHARGE-AMBULANCE PER HOUR BASE PRICE 11650 250 0 AMBULANCE AMBULANCE SPECIAL BILLING HEADS STAFF CHG (IN AMBULANCE 1 TO 100 KM) BASE PRICE 11887 230 0 AMBULANCE AMBULANCE SPECIAL BILLING HEADS STAFF CHG (IN AMBULANCE 101 TO 200 KM) BASE PRICE 11888 350 0 AMBULANCE AMBULANCE SPECIAL BILLING HEADS STAFF CHG (IN AMBULANCE 201 TO 300 KM) BASE PRICE 11889 460 0 AMBULANCE AMBULANCE SPECIAL BILLING HEADS STAFF CHG (IN AMBULANCE 301 TO 400 KM) BASE PRICE 11890 580 0 AMBULANCE AMBULANCE SPECIAL BILLING HEADS STAFF CHG (IN AMBULANCE 401 TO 500 KM) BASE PRICE 11891 690 0 AMBULANCE AMBULANCE SPECIAL BILLING HEADS STAFF CHG (IN AMBULANCE ABOVE 500 KM) BASE PRICE 11894 1160 0 AMBULANCE AMBULANCE SPECIAL BILLING HEADS VENTILATOR CHARGES FOR AMBULANCE BASE PRICE 1773 5780 0 ANAESTHESIA ANAESTHESIA ANAESTHESIA GAS CHARGES(G.A.) IN % OF SURGERY CHARGES BASE PRICE 8367 21% 0 ANAESTHESIA ANAESTHESIA PROCEDURES ACUTE PAIN SERVICE BASE PRICE 11622 1330 0 ANAESTHESIA ANAESTHESIA PROCEDURES CHARGES FOR SEDATION/MONITORED ANESTHESIA CARE PAEDIATRIC-CT SCAN BASE PRICE 12606 1890 0 CHARGES FOR SEDATION/MONITORED ANESTHESIA CARE PAEDIATRIC- ANAESTHESIA ANAESTHESIA PROCEDURES BASE PRICE 12607 1890 ERCP/COLONOSCOPY 0 CHARGES FOR SEDATION/MONITORED ANESTHESIA CARE PAEDIATRIC-GI ANAESTHESIA ANAESTHESIA PROCEDURES BASE PRICE 12608 1890 ENDOSCOPY 0 ANAESTHESIA ANAESTHESIA PROCEDURES CHARGES FOR SEDATION/MONITORED ANESTHESIA CARE PAEDIATRIC-MRI BASE PRICE 12609 2600 0 CHARGES FOR SEDATION/MONITORED ANESTHESIA CARE-CATH ANAESTHESIA ANAESTHESIA PROCEDURES BASE PRICE 11626 3150 LAB/VASCULAR/INTERVENTIONAL RADIOLOGY 0 ANAESTHESIA ANAESTHESIA PROCEDURES CHARGES FOR SEDATION/MONITORED ANESTHESIA CARE-CT SCAN BASE PRICE 11627 1720 0 ANAESTHESIA ANAESTHESIA PROCEDURES CHARGES FOR SEDATION/MONITORED ANESTHESIA CARE-ERCP/COLONOSCOPY BASE PRICE 11625 1720 0

Page 1 of 115 CHARGES FOR SEDATION/MONITORED ANESTHESIA CARE-GI ENDOSCOPY BASE PRICE 11624 1720 ANAESTHESIA ANAESTHESIA PROCEDURES 0 ANAESTHESIA ANAESTHESIA PROCEDURES CHARGES FOR SEDATION/MONITORED ANESTHESIA CARE-MRI BASE PRICE 11628 2370 0 ANAESTHESIA ANAESTHESIA PROCEDURES EPIDURAL CATHETER FOR PAIN RELIF BASE PRICE 12491 4400 0 ANAESTHESIA ANAESTHESIA PROCEDURES INTRA-ARTICULAR INJECTIONS (HIP, KNEE, SHOULDER) BASE PRICE 11496 670 0 ANAESTHESIA ANAESTHESIA PROCEDURES LABOUR ANALGESIA BASE PRICE 11623 4240 0 ANAESTHESIA ANAESTHESIA PROCEDURES MYOFASCIAL TRIGGER POINT INJECTIONS BASE PRICE 11498 670 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP DELUXE SUITE 12258 1500 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP OBG HDU 12258 1000 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP DAY CARE WARD 12258 600 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP NEUROSURGERY DNB12258 600 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP CARDIOLOGY HDU 12258 1000 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP GEN CARDIOLOGY WARD12258 1 600 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP SUITE ROOM 12258 1500 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP WARD 52 12258 600 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP ECONOMY WARD SIXTH12258 FLOOR 600 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP NICU STEP DOWN 12258 1000 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP PICU STEP DOWN 12258 1000 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP TRANSPLANT ICU 12258 1000 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP NMICU 12258 1000 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP SEMI PRIVATE 12258 1000 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP PRIVATE ROOM 12258 1000 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP PICU 12258 1000 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP OT POST OP 12258 1000 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP ONCOLOGY WARD 12258 600 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP OBG SEMI PRIVATE12258 1000 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP OBG PRIVATE 12258 1000 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP OBG ECONOMY ROOM12258 600 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP NICU 12258 1000 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP NEUROSURGERY WARD12258 MALE 600 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP NEUROSURGERY WARD12258 FEMALE 600 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP NEURO SURGICAL ICU12258 1000 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP MICU 12258 1000 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP ISOLATION 12258 600 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP ICCU 12258 1000 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP HIGH DEPENDENCY12258 UNIT 1000 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP ECONOMY WARD FEMALE12258 600 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP ECONOMY WARD 612258 600 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP ECONOMY WARD 512258 600 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP ECONOMY WARD 412258 600 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP ECONOMY WARD 312258 600 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP EMERGENCY 12258 1000 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP SURGICAL ICU 12258 1000 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP CTVS ICU 12258 1000 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP CATH LAB RECOVERY12258 600 0 ANAESTHESIA ANAESTHESIA PROCEDURES PRE ANAESTHESIA CHECKUP BASE PRICE 12258 600 0 ANAESTHESIA ANAESTHESIA PROCEDURES SELECTIVE SUPERFICIAL DIAGNOSTIC NERVE BLOCK BASE PRICE 11497 670 0 ANAESTHESIA ANAESTHESIA SURGICAL PROCEDURES INTRA THECCAL CHEMOTHERAPY INSTILLATION UNDER GA BASE PRICE 12976 2310 25

Page 2 of 115 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY PROCEDURES ABSCESS DRAINAGE BASE PRICE 11947 11030 0 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY PROCEDURES DIAGNOSTIC LYMPH NODE BIOPSY BASE PRICE 11939 9700 0 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY PROCEDURES LIPOMA EXCISION G1 BASE PRICE 11941 6070 0 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY PROCEDURES LIPOMA EXCISION G2 BASE PRICE 11942 9090 0 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY PROCEDURES LIPOMA EXCISION G3 BASE PRICE 11943 12130 0 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY PROCEDURES LOCAL WIDE EXCISION OF BREAST LUMP BASE PRICE 11958 14550 0 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY PROCEDURES MARKER GUIDED LWE OF BREAST LUMP BASE PRICE 11955 19850 0 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY PROCEDURES MARKER GUIDED LWE OF BREAST LUMP + AXILLARY CLEARANCE BASE PRICE 11956 26680 0 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY PROCEDURES NECK DISSECTION (MRND) G1 BASE PRICE 11948 11030 0 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY PROCEDURES NECK DISSECTION (MRND) G2 BASE PRICE 11949 16540 0 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY PROCEDURES NECK DISSECTION (MRND) G3 BASE PRICE 11950 22050 0 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY PROCEDURES SEBACEOUS CYST EXCISION G1 BASE PRICE 11944 6070 0 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY PROCEDURES SEBACEOUS CYST EXCISION G2 BASE PRICE 11945 8490 0 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY PROCEDURES SEBACEOUS CYST EXCISION G3 BASE PRICE 11946 10920 0 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY PROCEDURES SECONDARY SUTURING OF WOUND BASE PRICE 11951 7280 0 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY PROCEDURES SENTINEL LN BIOPSY BASE PRICE 11957 12130 0 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY PROCEDURES SUB MANDIBULAR GLAND EXCISION (BENIGN) BASE PRICE 11940 13790 0 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY PROCEDURES THYROIDECTOMY-TOTAL+RETROSTERNAL EXTENSION G1 BASE PRICE 11952 21830 0 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY PROCEDURES THYROIDECTOMY-TOTAL+RETROSTERNAL EXTENSION G2 BASE PRICE 11953 27900 0 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY PROCEDURES THYROIDECTOMY-TOTAL+RETROSTERNAL EXTENSION G3 BASE PRICE 11954 33960 0 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY PROCEDURES TRUE CUT BIOPSY (OPD) BASE PRICE 12914 2210 0 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY ABDCESS DRAINAGE BASE PRICE 12255 9090 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY ADRENALECTOMY BILATERAL (LAPAROSCOPIC) G1 BASE PRICE 3148 48510 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY ADRENALECTOMY BILATERAL (LAPAROSCOPIC) G2 BASE PRICE 11959 60640 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY ADRENALECTOMY BILATERAL (LAPAROSCOPIC) G3 BASE PRICE 11960 72770 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY ADRENALECTOMY BILATERAL (OPEN) G1 BASE PRICE 3115 42450 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY ADRENALECTOMY BILATERAL (OPEN) G2 BASE PRICE 11961 54580 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY ADRENALECTOMY BILATERAL (OPEN) G3 BASE PRICE 11962 66710 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY ADRENALECTOMY UNILATERAL (LAPAROSCOPIC) G1 BASE PRICE 3111 30320 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY ADRENALECTOMY UNILATERAL (LAPAROSCOPIC) G2 BASE PRICE 11963 40030 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY ADRENALECTOMY UNILATERAL (LAPAROSCOPIC) G3 BASE PRICE 11964 48510 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY ADRENALECTOMY UNILATERAL (OPEN) G1 BASE PRICE 3116 24260 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY ADRENALECTOMY UNILATERAL (OPEN) G2 BASE PRICE 11965 36380 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY ADRENALECTOMY UNILATERAL (OPEN) G3 BASE PRICE 11966 42450 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY AMPUTATIONS (BELOW KNEE) / ABOVE KNEE BASE PRICE 3153 22050 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY AMPUTATIONS G1 BASE PRICE 3154 7720 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY AMPUTATIONS G2 BASE PRICE 11967 9920 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY AMPUTATIONS G3 BASE PRICE 11968 13230 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY AXILLARY DISSECTION BASE PRICE 3119 13790 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY AXILLARY NODE BIOPSY BASE PRICE 3125 7280 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY BREAST CONSERVATIVE SURGERY (QUADRENTECTOMY & AXILLARY CLEARANCE) BASE PRICE 3120 24260 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY BREAST LUMP EXCISION - G1 BASE PRICE 3134 4850 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY BREAST LUMP EXCISION - G1 (B/L) BASE PRICE 11504 8490 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY BREAST LUMP EXCISION - G2 BASE PRICE 3135 7280 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY BREAST LUMP EXCISION - G2 (B/L) BASE PRICE 11503 13350 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY BREAST LUMP EXCISION - G3 BASE PRICE 3136 10920 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY BREAST LUMP EXCISION - G3 (B/L) BASE PRICE 11502 18200 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY CHEMOPORT REMOVAL BASE PRICE 12762 9920 25

Page 3 of 115 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY DEBRIDEMENT OF WOUNDS (DIABETIC) - G1 BASE PRICE 3128 6070 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY DEBRIDEMENT OF WOUNDS (DIABETIC) - G2 BASE PRICE 3151 9090 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY DEBRIDEMENT OF WOUNDS (DIABETIC) - G3 BASE PRICE 3152 14550 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY DIAGNOSTIC LYMPH NODE BIOPSY BASE PRICE 12478 9700 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY DISTAL PANCREATECTOMY BASE PRICE 3108 24260 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY DRAINAGE OF BREAST ABSCESS BASE PRICE 3127 7280 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY ENUCLEATION OF PANCREATIC TUMOR - LAPAROSCOPIC BASE PRICE 3109 36380 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY ENUCLEATION OF PANCREATIC TUMOR - OPEN BASE PRICE 3143 30320 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY EXCISION OF LINGUAL THYROID G1 BASE PRICE 3138 13350 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY EXCISION OF LINGUAL THYROID G2 BASE PRICE 11969 18200 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY EXCISION OF LINGUAL THYROID G3 BASE PRICE 11970 24260 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY EXCISION OF NECROTIC PART AND SSG - G1 BASE PRICE 3149 6070 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY EXCISION OF NECROTIC PART AND SSG - G2 BASE PRICE 3110 15160 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY EXCISION OF NECROTIC PART AND SSG - G3 BASE PRICE 3150 24260 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY EXCISION OF SUPRACLAVICUAR LYMPH NODE MASS BASE PRICE 3124 12130 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY Galactocele BASE PRICE 3139 12130 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY GYNAECOMASTIA EXCISION G1 BASE PRICE 3141 9700 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY GYNAECOMASTIA EXCISION G2 BASE PRICE 11971 12130 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY GYNAECOMASTIA EXCISION G3 BASE PRICE 3142 14550 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY HEMITHYROIDECTOMY WITH RETROSTERNAL EXTENSION BASE PRICE 12763 38590 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY INTRA VASCULAR DEVICE PLACEMENT BASE PRICE 3145 8490 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY LAPAROSCOPIC OOPHORECTOMY BASE PRICE 3112 14550 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY LIPOMA EXCISION G1 BASE PRICE 12487 6070 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY LIPOMA EXCISION G2 BASE PRICE 12488 9090 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY LIPOMA EXCISION G3 BASE PRICE 12370 12130 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY LOCAL WIDE EXCISION OF BREAST LUMP BASE PRICE 12494 14550 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY MARKER GUIDED LWE OF BREAST LUMP BASE PRICE 12497 18200 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY MARKER GUIDED LWE OF BREAST LUMP + AXILLARY CLEARANCE BASE PRICE 12645 26680 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY Micodochotomy & Removal of Papilloma BASE PRICE 3144 13790 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY MICRODOCHOTOMY BASE PRICE 3126 8270 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY MISCELLENOUS PROCEDURES - G1 BASE PRICE 3137 6070 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY MISCELLENOUS PROCEDURES - G2 BASE PRICE 11989 9090 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY MISCELLENOUS PROCEDURES - G3 BASE PRICE 3155 12130 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY MODIFIED RADICAL MASTECTOMY G1 BASE PRICE 3121 24260 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY MODIFIED RADICAL MASTECTOMY G2 BASE PRICE 11972 30320 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY MODIFIED RADICAL MASTECTOMY G3 BASE PRICE 11973 36380 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY MRM WITH LD FLAP WITH SKIN GRAFTING BASE PRICE 3122 30320 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY PARATHYROIDECTOMY (4 GLAND EXPLORATION) G1 BASE PRICE 3107 16980 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY PARATHYROIDECTOMY (4 GLAND EXPLORATION) G2 BASE PRICE 11990 21220 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY PARATHYROIDECTOMY (4 GLAND EXPLORATION) G3 BASE PRICE 11991 24260 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY PARATHYROIDECTOMY (MINIMALLY INVASIVE) BASE PRICE 3106 18200 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY PAROTIDECTOMY G1 BASE PRICE 3101 20950 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY PAROTIDECTOMY G2 BASE PRICE 11974 24260 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY PAROTIDECTOMY G3 BASE PRICE 11975 27560 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY QUADRANECTOMY POLAR BREAST BASE PRICE 12765 24260 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY RADICAL NECK DISSECTION (BLOCK) BASE PRICE 3118 26680 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY SEBACEOUS CYST EXCISION G1 BASE PRICE 12236 6070 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY SEBACEOUS CYST EXCISION G2 BASE PRICE 12175 8490 25

Page 4 of 115 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY SEBACEOUS CYST EXCISION G3 BASE PRICE 12427 12130 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY SECONDARY SUTURING OF WOUND BASE PRICE 12353 7280 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY SIMPLE MASTECTOMY BASE PRICE 3123 16540 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY SISTRUNK'S OPERATION/EXCISION OF THYROGLOSSAL SINUS/CYST/FISTULA BASE PRICE 3105 14550 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY THYMECTOMY (OPEN) BASE PRICE 3114 18200 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY THYROIDECTOMY - COMPLETION G1 BASE PRICE 3129 14550 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY THYROIDECTOMY - COMPLETION G2 BASE PRICE 11976 20620 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY THYROIDECTOMY - COMPLETION G3 BASE PRICE 11977 26680 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY THYROIDECTOMY - HEMI G1 BASE PRICE 3102 13230 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY THYROIDECTOMY - HEMI G2 BASE PRICE 11978 19850 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY THYROIDECTOMY - HEMI G3 BASE PRICE 11979 26460 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY THYROIDECTOMY - TOTAL G1 BASE PRICE 3103 19850 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY THYROIDECTOMY - TOTAL G2 BASE PRICE 11980 26460 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY THYROIDECTOMY - TOTAL G3 BASE PRICE 11981 33080 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY THYROIDECTOMY-TOTAL+RETROSTERNAL EXTENSION G3 BASE PRICE 12373 37260 25 BREAST & ENDOCRINE TOTAL THYROIDECTOMY (TT) + CENTRAL + BILATERAL LYMPHNODE DISSECTION BREAST & ENDOCRINE SURGERY SURGERY SURGERY G1 BASE PRICE 3132 24260 25 BREAST & ENDOCRINE TOTAL THYROIDECTOMY (TT) + CENTRAL + BILATERAL LYMPHNODE DISSECTION BREAST & ENDOCRINE SURGERY SURGERY SURGERY G2 BASE PRICE 11982 36380 25 BREAST & ENDOCRINE TOTAL THYROIDECTOMY (TT) + CENTRAL + BILATERAL LYMPHNODE DISSECTION BREAST & ENDOCRINE SURGERY SURGERY SURGERY G3 BASE PRICE 11983 42450 25 BREAST & ENDOCRINE TOTAL THYROIDECTOMY (TT) + CENTRAL + LATERAL + SUPERIOR MEDIASTINAL BREAST & ENDOCRINE SURGERY SURGERY SURGERY LYMPHNODE DISSECTION G1 BASE PRICE 3133 36380 25 BREAST & ENDOCRINE TOTAL THYROIDECTOMY (TT) + CENTRAL + LATERAL + SUPERIOR MEDIASTINAL BREAST & ENDOCRINE SURGERY SURGERY SURGERY LYMPHNODE DISSECTION G2 BASE PRICE 11984 48510 25 BREAST & ENDOCRINE TOTAL THYROIDECTOMY (TT) + CENTRAL + UNILATERAL LYMPHONODE BREAST & ENDOCRINE SURGERY SURGERY SURGERY DISSECTION G1 BASE PRICE 3131 21830 25 BREAST & ENDOCRINE TOTAL THYROIDECTOMY (TT) + CENTRAL + UNILATERAL LYMPHONODE BREAST & ENDOCRINE SURGERY SURGERY SURGERY DISSECTION G2 BASE PRICE 11985 27900 25 BREAST & ENDOCRINE TOTAL THYROIDECTOMY (TT) + CENTRAL + UNILATERAL LYMPHONODE BREAST & ENDOCRINE SURGERY SURGERY SURGERY DISSECTION G3 BASE PRICE 11986 36380 25 BREAST & ENDOCRINE TOTAL THYROIDECTOMY (TT) + CENTRAL COMPARTMENT LYMPHNODE BREAST & ENDOCRINE SURGERY SURGERY SURGERY DISSECTION G1 BASE PRICE 3130 20620 25 BREAST & ENDOCRINE TOTAL THYROIDECTOMY (TT) + CENTRAL COMPARTMENT LYMPHNODE BREAST & ENDOCRINE SURGERY SURGERY SURGERY DISSECTION G2 BASE PRICE 11987 25470 25 BREAST & ENDOCRINE TOTAL THYROIDECTOMY (TT) + CENTRAL COMPARTMENT LYMPHNODE BREAST & ENDOCRINE SURGERY SURGERY SURGERY DISSECTION G3 BASE PRICE 11988 31530 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY TRUE CUT BIOPSY BASE PRICE 3140 2210 25 BREAST & ENDOCRINE SURGERYBREAST & ENDOCRINE SURGERY SURGERY VATS (VIDEO-ASSISTED THYMIC SURGERY) BASE PRICE 3117 26680 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY A. V. FISTULA FORMATION UNDER LA / BRACHIAL BLOCK (DIFFICULT) BASE PRICE 12510 15160 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY AORTIC DISSECTION SURGERY (AAA) BASE PRICE 12688 70290 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY AORTOCAVAL FISTULA BASE PRICE 12706 44100 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY ARTERIAL EMBOLECTOMY UNDER LA BASE PRICE 8569 22050 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY ARTERIO - ARTERIAL ANASTAMOSIS BASE PRICE 12699 49610 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY ASD/VSD BASE PRICE 12679 49610 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY AV FISTULA SALVAGE BASE PRICE 12716 16540 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY AV GRAFT BASE PRICE 12707 22050 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY B T SHUNT BASE PRICE 12511 48510 25

Page 5 of 115 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY BRANCH LIGATION BASE PRICE 12715 5510 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY CABG + VENTRICLE SEPTAL DEFECT (VSD) BASE PRICE 12504 98540 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY CABG +ATRIAL SEPTAL DEFECT (ASD) BASE PRICE 12684 60640 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY CABG +VENTRICLE SEPTAL DEFECT (VSD) BASE PRICE 12685 70290 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY CABG+VALVE REPLACEMENT BASE PRICE 12680 60640 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY CABG-REDO BASE PRICE 12681 70290 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY CARDIAC RE-EXPLORATION BASE PRICE 12512 12130 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY CARDIOPULMONARY BYPASS FOR EXTENSIVE RENAL OR LIVER TUMOR BASE PRICE 12513 45480 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY CARDIOPULMONARY BYPASS FOR PULMONARY EMBOLECTOMY BASE PRICE 12689 70290 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY CAROTID ARTERY SURGERY BASE PRICE 12702 44100 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY CAROTID ENDARTERECTOMY BASE PRICE 12514 44100 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY CLOSED HEART VALVOTOMY BASE PRICE 12515 42450 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY COARCTATION OF AORTA BASE PRICE 12516 42450 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY CORONARY ARTERY BYPASS GRAFT BASE PRICE 12485 54580 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY DECORTICATION BASE PRICE 12517 42450 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY DIAPHRAGMATIC HERNIA BASE PRICE 12518 42450 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY EMBOLECTOMY BASE PRICE 12719 22050 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY ENDARTERCETOMY BASE PRICE 12714 33080 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY ENDO VENOUS SURGERY (BI- LATERAL) BASE PRICE 12639 36380 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY ENDO VENOUS SURGERY (UNI- LATERAL) BASE PRICE 12638 18200 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY FEM-POP BYPASS WITH GRAFT BASE PRICE 12718 38590 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY FEMORAL/POPLETEAL ARTERY REAPIR BASE PRICE 12701 38590 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY GRAFT THROMBECTOMY BASE PRICE 12712 33080 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY ILLIAC ARTERY REPAIR/ANEURYSM BASE PRICE 12700 38590 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY LIGATION AND STRIPPING OF VARICOSE VEIN BASE PRICE 12519 18200 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY LIGATION OR PLICATION OF VENA CAVA BASE PRICE 12520 29110 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY LOBECTOMY BASE PRICE 12521 30320 25 CARDIO THORACIC & MAJOR VASCULAR RECONSTRUCTIVE PROCEDURE FOR AORTO FEMORAL CTVS SURGERY VASCULAR SURGERY FEMOROPOPLITEAL BYPASS BASE PRICE 12522 42450 25 CARDIO THORACIC & MAJOR VASCULAR RECONSTRUCTIVE PROCEDURE FOR SUBCLAVIAN / AXILLARY CTVS SURGERY VASCULAR SURGERY / BRACHIAL ARTERIAL SUBCLAVION / A BASE PRICE 12523 42450 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY MEDIASTINOTOMY BASE PRICE 12524 24260 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY MINIMALY INVASIVE CORONARY ARTERY SURGERY BASE PRICE 12683 49610 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY MITRAL VALVE / AORTIC VALVE REPAIR / REPLACEMENT BASE PRICE 12486 54580 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY MYXOMA BASE PRICE 12686 49610 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY PACEMAKER IMPLANTATION VIA THORACOTOMY BASE PRICE 12897 49610 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY PATCH PLASTY BASE PRICE 12713 27560 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY PERICARDIAL BIOPSY BASE PRICE 12525 12130 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY PERICARDIECTOMY BASE PRICE 12526 42450 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY PERICARDIOCENTESIS BASE PRICE 12527 12130 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY PERICARDIOSTOMY BASE PRICE 12528 30320 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY PERIPHERAL EMBOLECTOMY BASE PRICE 12529 24260 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY PERMACATH REMOVAL BASE PRICE 12711 4410 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY PERMCATH INSERTION BASE PRICE 12696 7720 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY PLEURECTOMY BASE PRICE 12530 27290 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY PLEURODESIS BASE PRICE 12531 18200 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY PNEUMONECTOMY BASE PRICE 12532 24260 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY RECONSTRUCTION OF TRACHEA BASE PRICE 12533 36380 25

Page 6 of 115 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY REMOVAL OF CHEST WALL TUMOR BASE PRICE 12534 24260 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY REMOVAL OF MEDIASTERNAL MASS BASE PRICE 12535 24260 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY REMOVAL OF STERNAL WIRES BASE PRICE 12536 12130 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY REMOVAL OF VASCULAR TUMOR (LARGE HAEMANGIOMA ) BASE PRICE 12537 24260 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY REPAIR OF PATENT DUTUS BASE PRICE 12538 24260 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY RIGID BRONCHOSCOPY WITH F.B. REMOVAL BASE PRICE 12539 7280 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY RIGID ESHOPHAGOSIOPHY WITH F.B. REMOVAL BASE PRICE 12540 7280 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY RUPTURED AAA BASE PRICE 12697 49610 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY SCLEROTHERAPY BASE PRICE 12709 11030 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY SEGMENTAL RESECTION OF THE LUNG BASE PRICE 12541 24260 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY STAB PHLEBECTOMY/PERFORATOR LIGATION BASE PRICE 12708 8820 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY STERNAL REWIRING WITH PLASTIC SURGICAL PROCEDURE BASE PRICE 12542 24260 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY SUBCLAVIAN ARTERY SURGERY BASE PRICE 12703 38590 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY THORACIC AORTA ANEURYSM REPAIR BASE PRICE 12698 55130 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY THORACIC AORTIC ANEURYSM BASE PRICE 12687 70290 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY THORACIC OUTLET SYNDROME SURGERY BASE PRICE 12544 38590 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY THORACOPLASTY BASE PRICE 12545 24260 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY THORACOSCOPY BASE PRICE 12546 21220 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY THYMECTOMY BASE PRICE 12547 30320 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY TOF /TAPVC /FONTAN /RSOV /SENNING BASE PRICE 12682 60640 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY TOS DECOMPRESSION BASE PRICE 12710 38590 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY TUBE THORACOSTOMY BASE PRICE 12548 3030 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY TUBE THORACOTOMY / RIB RESECTION TUBE THORACOSTOMY BASE PRICE 12549 12130 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY USG GUIDED PSEUDOANERYSM SCLERO BASE PRICE 12717 27560 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY VASCULAR MALFORMATION SURGERY BASE PRICE 12550 30320 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY VEIN BYPASS FEM-DISTAL BASE PRICE 12705 38590 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY VEIN BYPASS FEM-POP BASE PRICE 12704 38590 25 CARDIO THORACIC & VASCULARCTVS SURGERY SURGERY VENOUS THROMBECTOMY BASE PRICE 12551 24260 25 CARDIOLOGY CARDIOLOGY INVESTIGATION AMBULATORY BP MONITORING BASE PRICE 13019 3030 0 CARDIOLOGY CARDIOLOGY INVESTIGATION BNP Assay Kit BASE PRICE 8419 1240 0 CARDIOLOGY CARDIOLOGY INVESTIGATION CARDIAC PANEL (Hs Trop I, CKMB Mass, Myoglobin Assay) BASE PRICE 8418 1320 0 CARDIOLOGY CARDIOLOGY INVESTIGATION Cardio Profiler Panel (Myco, CK MB, Hs Trop I, BNP) BASE PRICE 8420 1760 0 CARDIOLOGY CARDIOLOGY INVESTIGATION D - DIMER BASE PRICE 11598 1020 0 CARDIOLOGY CARDIOLOGY INVESTIGATION DSE BASE PRICE 11854 3660 0 CARDIOLOGY CARDIOLOGY INVESTIGATION ECG BASE PRICE 1 310 0 CARDIOLOGY CARDIOLOGY INVESTIGATION ECHOCARDIOGRAPHY (BED SIDE/SCREENING ) BASE PRICE 13016 970 0 CARDIOLOGY CARDIOLOGY INVESTIGATION ECHOCARDIOGRAPHY COLOR WITH ONE PRINT BASE PRICE 13015 1820 0 CARDIOLOGY CARDIOLOGY INVESTIGATION EXTERNAL LOOP RECORDER (ELR) BASE PRICE 11873 13880 0 CARDIOLOGY CARDIOLOGY INVESTIGATION HOLTER MONITORING/ ANALYSIS BASE PRICE 3 2420 0 CARDIOLOGY CARDIOLOGY INVESTIGATION HS TROP 1 BASE PRICE 11597 1020 0 CARDIOLOGY CARDIOLOGY INVESTIGATION STRESS ECHOCARDIOGRAPHY BASE PRICE 13017 3630 0 CARDIOLOGY CARDIOLOGY INVESTIGATION TMT BASE PRICE 4 1820 0 CARDIOLOGY CARDIOLOGY INVESTIGATION TRANS-OESOPHAGEAL ECHOCARDIOGRAPHY BASE PRICE 13018 3030 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES AICD BASE PRICE 3210 66550 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES AORTIC STENT GRAFT FOR AORTIC ANEURYSM BASE PRICE 3223 99830 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES ASD DEVICE CLOSURE BASE PRICE 3206 66550 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES BALLOON VALVOTOMY/PTMC BASE PRICE 3224 59900 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES BIVENTRICULAR DEVICE IMPLANTATION BASE PRICE 3211 66550 0

Page 7 of 115 CARDIOLOGY CARDIOLOGY IPD PACKAGES CAROTID ANGIOPLASTY BASE PRICE 3231 66550 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES COMBO DEVICE IMPLANTATION BASE PRICE 3234 99830 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES CORONARY ANGIOGRAPHY BASE PRICE 8376 16500 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES CORONARY ANGIOGRAPHY (PRIVATE) BASE PRICE 12598 21180 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES CORONARY ANGIOGRAPHY (SUITE) BASE PRICE 12599 30250 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES CORONARY ANGIOGRAPHY DAY CARE BASE PRICE 3212 16500 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES CORONARY ANGIOPLASTY BASE PRICE 3235 102850 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES CORONARY ANGIOPLASTY ( REDO PACKAGE) BASE PRICE 11851 39930 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES CORONARY ANGIOPLASTY (CTO VESSEL) BASE PRICE 12261 114950 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES CORONARY ANGIOPLASTY (DOUBLE/TRIPLE VESSEL) BASE PRICE 12260 114950 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES CORONARY ANGIOPLASTY (IABP INSERTION) BASE PRICE 12263 102850 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES CORONARY ANGIOPLASTY (LEFT MAIN VESSEL) BASE PRICE 12259 114950 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES CORONARY ANGIOPLASTY (PRIVATE) BASE PRICE 12600 127050 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES CORONARY ANGIOPLASTY (ROTABLATOR USE DURING PROCEDURE) BASE PRICE 12262 108900 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES CORONARY ANGIOPLASTY (SUITE) BASE PRICE 12601 166380 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES ELECTROPHYSIOLOGICAL STUDIES - ABLATION BASE PRICE 3226 39930 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES ELECTROPHYSIOLOGICAL STUDIES - DIAGNOSTIC BASE PRICE 3225 10650 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES EMERGENCY CORONARY ANGIOGRAPHY BASE PRICE 12592 20570 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES EMERGENCY PRIMARY ANGIOPLASTY BASE PRICE 12591 127050 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES FOLLOW-UP CORONARY ANGIOGRAPHY BASE PRICE 3214 7260 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES MITRAL BALLOON DILATATION PROCEDURE BASE PRICE 7373 66550 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES PDA CLOSURE- DEVICE BASE PRICE 3204 33280 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES PDA CLOSURE- FLIPPER COIL BASE PRICE 3203 13310 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES PDA CLOSURE- SIMPLE COIL BASE PRICE 3202 13310 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES PEADIATRIC CATH. & ANGIOGRAPHY BASE PRICE 3201 19360 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES PERICARDIOCENTESIS (CARDIOLOGY) BASE PRICE 12624 13310 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES PERIPHERAL ANGIOGRAPHY BASE PRICE 3217 14520 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES PERIPHERAL VASCULAR INTERVENTION BASE PRICE 3230 33280 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES PERMANENT PACE MAKER (DOUBLE CHAMBER) BASE PRICE 3208 84700 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES PERMANENT PACE MAKER (SINGLE CHAMBER) BASE PRICE 3207 48400 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES PERMANENT PACEMAKER (TRIPLE CHAMBER) BASE PRICE 8386 133100 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES RENAL ANGIOGRAPHY BASE PRICE 3227 14520 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES RENAL ANGIOPLASTY / PHEREPHERAL BASE PRICE 3228 48400 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES VERTEBRAL ARTERY PTA BASE PRICE 3232 33280 0 CARDIOLOGY CARDIOLOGY IPD PACKAGES VSD DEVICE CLOSURE BASE PRICE 3205 93170 0 CARDIOLOGY CARDIOLOGY OTHER BILLING HEADS ANGIO CD BASE PRICE 13020 550 0 CARDIOLOGY CARDIOLOGY PROCEDURES AICD IMPLANTATION BASE PRICE 11804 73210 0 CARDIOLOGY CARDIOLOGY PROCEDURES COLOR DOPPLER ECHO + CAROTID DOPPLER BASE PRICE 11763 2200 0 CARDIOLOGY CARDIOLOGY PROCEDURES EMERGENCY TEMPORARY PACE MAKER BASE PRICE 12593 15970 0 CARDIOLOGY CARDIOLOGY PROCEDURES INR (BEDSIDE) BASE PRICE 11817 450 0 CARDIOLOGY CARDIOLOGY PROCEDURES LEAD REPOSITIONING OF PACEMAKER BASE PRICE 11803 7990 0 CARDIOLOGY CARDIOLOGY PROCEDURES Loop Recorder Implantation BASE PRICE 8503 8790 0 CARDIOLOGY CARDIOLOGY PROCEDURES PERICARDIOCENTESIS (BED SIDE) BASE PRICE 3218 5280 0 CARDIOLOGY CARDIOLOGY PROCEDURES PULMONARY VALVOTOMY BASE PRICE 8541 36610 0 CARDIOLOGY CARDIOLOGY PROCEDURES PULSE GENERATOR CHANGE BASE PRICE 8483 18150 0 CARDIOLOGY CARDIOLOGY PROCEDURES ROTABLATION BASE PRICE 11802 13310 0 CARDIOLOGY CARDIOLOGY PROCEDURES Septal Ablation BASE PRICE 8502 36610 0 CARDIOLOGY CARDIOLOGY PROCEDURES SPECIALISED ECHO-CARDIOGRAPHY- STRESS ECHO BASE PRICE 3216 3630 0

Page 8 of 115 CARDIOLOGY CARDIOLOGY PROCEDURES SPECIALISED ECHO-CARDIOGRAPHY- TRANSOESOPHAGEAL BASE PRICE 3215 3030 0 CARDIOLOGY CARDIOLOGY PROCEDURES TEMPORARY PACE MAKER BASE PRICE 3209 13310 0 CARDIOLOGY CARDIOLOGY PROCEDURES TEST FOR PACEMAKER BASE PRICE 3229 740 0 CLINCAL HAEMATOLOGY CLINICAL HAEMATOLOGY PROCEDURE BONE MARROW HARVESTING PROCEDURE CHARGES BASE PRICE 3310 3330 0 CLINCAL HAEMATOLOGY CLINICAL HAEMATOLOGY PROCEDURE CENTRAL LINE DRESSING BASE PRICE 3306 240 0 CLINCAL HAEMATOLOGY CLINICAL HAEMATOLOGY PROCEDURE CHEMOTHERAPY CHARGES (PRIVATE ROOM) BASE PRICE 3305 2400 0 CLINCAL HAEMATOLOGY CLINICAL HAEMATOLOGY PROCEDURE CHEMOTHERAPY CHARGES (SEMI PRIVATE ROOM) BASE PRICE 3304 2400 0 CLINCAL HAEMATOLOGY CLINICAL HAEMATOLOGY PROCEDURE MULTIPLE DRUGS OR > 6 HOURS IN HOSPITAL BASE PRICE 3302 2400 0 CLINCAL HAEMATOLOGY CLINICAL HAEMATOLOGY PROCEDURE SINGLE DRUG & < 3 HOURS IN HOSPITAL BASE PRICE 3301 800 0 CLINCAL HAEMATOLOGY CLINICAL HAEMATOLOGY SURGERY BONE MARROW ASPIRATION (SURGERY) BASE PRICE 12613 1910 25 CLINCAL HAEMATOLOGY CLINICAL HAEMATOLOGY SURGERY BONE MARROW BIOPSY (SURGERY) BASE PRICE 12614 3180 25 CLINCAL HAEMATOLOGY CLINICAL HAEMATOLOGY SURGERY BONE MARROW HARVESTING (SURGERY) BASE PRICE 8426 11550 25 CLINICAL IMMUNOLOGY ANDCLINICAL RHEUMATOLOGY IMMUNOLOGY AND RHEUMATOLOGY INTRA-ARTICULARPROCEDURES INJECTION (HIP JOINT) BASE PRICE 8468 770 0 CLINICAL IMMUNOLOGY ANDCLINICAL RHEUMATOLOGY IMMUNOLOGY AND RHEUMATOLOGY INTRA-ARTICULARPROCEDURES INJECTION (OTHER THAN HIP JOINT) BASE PRICE 8467 640 0 COMMON PROCEDURAL CHARGESWARD PROCEDURE CHARGES ABSCESS DRAINAGE - CWP BASE PRICE 12557 880 0 COMMON PROCEDURAL CHARGESWARD PROCEDURE CHARGES ARTERIAL LINE - CWP BASE PRICE 12558 2420 0 COMMON PROCEDURAL CHARGESWARD PROCEDURE CHARGES BI PAP SUPPORT - CWP BASE PRICE 12559 7370 0 COMMON PROCEDURAL CHARGESWARD PROCEDURE CHARGES BLOOD SUGAR (RANDOM)- GLUCOMETER - CWP BASE PRICE 12572 90 0 COMMON PROCEDURAL CHARGESWARD PROCEDURE CHARGES BLOOD TRANSFUSION - CWP BASE PRICE 12560 660 0 COMMON PROCEDURAL CHARGESWARD PROCEDURE CHARGES BOWEL / GASTRIC LAVAGE - CWP BASE PRICE 12561 880 0 COMMON PROCEDURAL CHARGESWARD PROCEDURE CHARGES CHEST STRAPPING - CWP BASE PRICE 12562 880 0 COMMON PROCEDURAL CHARGESWARD PROCEDURE CHARGES CTG - CWP BASE PRICE 12584 880 0 COMMON PROCEDURAL CHARGESWARD PROCEDURE CHARGES CUT OPEN (VENOUS) - CWP BASE PRICE 12563 880 0 COMMON PROCEDURAL CHARGESWARD PROCEDURE CHARGES CVP LINE - CWP BASE PRICE 12564 3630 0 COMMON PROCEDURAL CHARGESWARD PROCEDURE CHARGES DRESSING LARGE - CWP BASE PRICE 12565 880 0 COMMON PROCEDURAL CHARGESWARD PROCEDURE CHARGES DRESSING MAJOR ORTHO / BURN - CWP BASE PRICE 12566 1210 0 COMMON PROCEDURAL CHARGESWARD PROCEDURE CHARGES DRESSING MEDIUM - CWP BASE PRICE 12567 360 0 COMMON PROCEDURAL CHARGESWARD PROCEDURE CHARGES DRESSING SMALL - CWP BASE PRICE 12569 170 0 COMMON PROCEDURAL CHARGESWARD PROCEDURE CHARGES DVT PUMP - CWP BASE PRICE 12633 880 0 COMMON PROCEDURAL CHARGESWARD PROCEDURE CHARGES ENEMA - CWP BASE PRICE 12570 150 0 COMMON PROCEDURAL CHARGESWARD PROCEDURE CHARGES FOLEYS CATHETERIZATION - CWP BASE PRICE 12571 400 0 COMMON PROCEDURAL CHARGESWARD PROCEDURE CHARGES INFUSION PUMP - CWP BASE PRICE 12586 500 0 COMMON PROCEDURAL CHARGESWARD PROCEDURE CHARGES INJECTION CHARGES - CWP BASE PRICE 12573 90 0 COMMON PROCEDURAL CHARGESWARD PROCEDURE CHARGES INTUBATION - CWP BASE PRICE 12574 2640 0 COMMON PROCEDURAL CHARGESWARD PROCEDURE CHARGES K-90 CATHETERIZATION - CWP BASE PRICE 12575 240 0 COMMON PROCEDURAL CHARGESWARD PROCEDURE CHARGES LOCAL INFILTRATION - CWP BASE PRICE 12576 480 0 COMMON PROCEDURAL CHARGESWARD PROCEDURE CHARGES LUMBER PUNCTURE - CWP BASE PRICE 12577 2420 0 COMMON PROCEDURAL CHARGESWARD PROCEDURE CHARGES NEBULIZATION - CWP BASE PRICE 12578 140 0 COMMON PROCEDURAL CHARGESWARD PROCEDURE CHARGES OXYGEN PER HOUR - CWP BASE PRICE 12588 260 0 COMMON PROCEDURAL CHARGESWARD PROCEDURE CHARGES PARACENTACIS ABDOMINAL - CWP BASE PRICE 12579 1820 0 COMMON PROCEDURAL CHARGESWARD PROCEDURE CHARGES PLEURAL ASPIRATION - CWP BASE PRICE 12580 1540 0 COMMON PROCEDURAL CHARGESWARD PROCEDURE CHARGES POST OP SUTURE REMOVAL - CWP BASE PRICE 12568 360 0 COMMON PROCEDURAL CHARGESWARD PROCEDURE CHARGES RYLES TUBE INSERTION - CWP BASE PRICE 12581 360 0 COMMON PROCEDURAL CHARGESWARD PROCEDURE CHARGES STERNAL PUNCTURE - CWP BASE PRICE 12582 1540 0 COMMON PROCEDURAL CHARGESWARD PROCEDURE CHARGES VENOUS INFUSION - CWP BASE PRICE 12583 130 0 COMMON PROCEDURAL CHARGESWARD PROCEDURE CHARGES VENTILATOR - CWP BASE PRICE 12587 10450 0 COMMON PROCEDURAL CHARGESWARD PROCEDURE CHARGES WATER BED - CWP BASE PRICE 12585 360 0 CONSULTATION BREAST & ENDOCRINE SURGERY CONSULTATIONBREAST & ENDOCRINE SURGERY FIRST CONSULTATION BASE PRICE 2247 600 0

Page 9 of 115 CONSULTATION BREAST & ENDOCRINE SURGERY CONSULTATIONBREAST & ENDOCRINE SURGERY FIRST CONSULTATION-DR. FARAH ARSHAD BASE PRICE 11765 600 0 CONSULTATION BREAST & ENDOCRINE SURGERY CONSULTATIONBREAST & ENDOCRINE SURGERY FOLLOW-UP CONSULTATION BASE PRICE 2248 600 0 CONSULTATION BREAST & ENDOCRINE SURGERY CONSULTATIONBREAST & ENDOCRINE SURGERY FOLLOW-UP CONSULTATION-Dr. Farah Arsad BASE PRICE 11766 600 0 CONSULTATION CARDIOLOGY CONSULTATION CARDIOLOGY FIRST CONSULTATION BASE PRICE 2251 600 0 CONSULTATION CARDIOLOGY CONSULTATION CARDIOLOGY FIRST CONSULTATION (N.S) BASE PRICE 12589 1200 0 CONSULTATION CARDIOLOGY CONSULTATION CARDIOLOGY FOLLOW-UP CONSULTATION BASE PRICE 2252 600 0 CONSULTATION CARDIOLOGY CONSULTATION CARDIOLOGY FOLLOW-UP CONSULTATION (N.S) BASE PRICE 12590 1200 0 CONSULTATION CLINICAL HEMATOLOGY & HEMATO ONCOLOGYCLINICAL CONSULTATION HEMATOLOGY & HEMATO ONCOLOGY FIRST CONSULTATION BASE PRICE 8427 600 0 CONSULTATION CLINICAL HEMATOLOGY & HEMATO ONCOLOGYCLINICAL CONSULTATION HEMATOLOGY & HEMATO ONCOLOGY FOLLOW-UP CONSULTATION BASE PRICE 8428 600 0 CONSULTATION CTVS CONSULTATION CTVS FIRST CONSULTATION BASE PRICE 2249 600 0 CONSULTATION CTVS CONSULTATION CTVS FOLLOW-UP CONSULTATION BASE PRICE 2250 600 0 CONSULTATION DENTAL & MAXILLOFACIAL SURGERY CONSULTATIONDENTAL & MAXILLOFACIAL SURGERY FIRST CONSULTATION BASE PRICE 2255 600 0 CONSULTATION DENTAL & MAXILLOFACIAL SURGERY CONSULTATIONDENTAL & MAXILLOFACIAL SURGERY FOLLOW-UP CONSULTATION BASE PRICE 2256 600 0 CONSULTATION DERMATOLOGY CONSULTATION DERMATOLOGY FIRST CONSULTATION BASE PRICE 2257 600 0 CONSULTATION DERMATOLOGY CONSULTATION DERMATOLOGY FOLLOW-UP CONSULTATION BASE PRICE 2258 600 0 CONSULTATION EMERGENCY CONSULTATION EMERGENCY FIRST CONSULTATION BASE PRICE 2507 600 0 CONSULTATION EMERGENCY CONSULTATION EMO CONSULTATION FEES BASE PRICE 12382 500 0 CONSULTATION ENDOCRINOLOGY CONSULTATION ENDOCRINOLOGY FIRST CONSULTATION BASE PRICE 2259 600 0 CONSULTATION ENDOCRINOLOGY CONSULTATION ENDOCRINOLOGY FIRST CONSULTATION - 500 BASE PRICE 11513 600 0 CONSULTATION ENDOCRINOLOGY CONSULTATION ENDOCRINOLOGY FOLLOW-UP CONSULTATION BASE PRICE 2260 600 0 CONSULTATION ENDOCRINOLOGY CONSULTATION ENDOCRINOLOGY FOLLOW-UP CONSULTATION - 500 BASE PRICE 11514 600 0 CONSULTATION ENDOCRINOLOGY CONSULTATION ENDOCRINOLOGY FOLLOW-UP CONSULTATION-Dr. Santosh Choubey BASE PRICE 11768 600 0 CONSULTATION ENT CONSULTATION ENT FIRST CONSULTATION BASE PRICE 2261 600 0 CONSULTATION ENT CONSULTATION ENT FOLLOW-UP CONSULTATION BASE PRICE 2262 600 0 CONSULTATION GASTRO SURGERY CONSULTATION GASTRO SURGERY FIRST CONSULTATION BASE PRICE 2263 600 0 CONSULTATION GASTRO SURGERY CONSULTATION GASTRO SURGERY FOLLOW-UP CONSULTATION BASE PRICE 2264 600 0 CONSULTATION GASTROENTEROLOGY CONSULTATION GASTROENTEROLOGY FIRST CONSULTATION BASE PRICE 2265 600 0 CONSULTATION GASTROENTEROLOGY CONSULTATION GASTROENTEROLOGY FIRST CONSULTATION (G.CH.) BASE PRICE 11607 1200 0 CONSULTATION GASTROENTEROLOGY CONSULTATION GASTROENTEROLOGY FIRST CONSULTATION (M.C) BASE PRICE 12471 1200 0 CONSULTATION GASTROENTEROLOGY CONSULTATION GASTROENTEROLOGY FOLLOW-UP CONSULTATION BASE PRICE 2266 600 0 CONSULTATION GASTROENTEROLOGY CONSULTATION GASTROENTEROLOGY FOLLOW-UP CONSULTATION (G.CH.) BASE PRICE 11608 600 0 CONSULTATION GASTROENTEROLOGY CONSULTATION GASTROENTEROLOGY FOLLOW-UP CONSULTATION (G.CH.-SGPGI) BASE PRICE 11609 600 0 CONSULTATION GASTROENTEROLOGY CONSULTATION GASTROENTEROLOGY FOLLOW-UP CONSULTATION (M.C) BASE PRICE 12472 1200 0 CONSULTATION GENERAL SURGERY CONSULTATION GENERAL SURGERY FIRST CONSULTATION BASE PRICE 2245 600 0 CONSULTATION GENERAL SURGERY CONSULTATION GENERAL SURGERY FOLLOW-UP CONSULTATION BASE PRICE 2246 600 0 CONSULTATION IMMUNOLOGY & RHEUMATOLOGY CONSULTATIONIMMUNOLOGY & RHEUMATOLOGY FIRST CONSULTATION BASE PRICE 2293 600 0 CONSULTATION IMMUNOLOGY & RHEUMATOLOGY CONSULTATIONIMMUNOLOGY & RHEUMATOLOGY FOLLOW-UP CONSULTATION BASE PRICE 2294 600 0 CONSULTATION INTERNAL MEDICINE CONSULTATION INTERNAL MEDICINE FIRST CONSULTATION BASE PRICE 2242 600 0 CONSULTATION INTERNAL MEDICINE CONSULTATION INTERNAL MEDICINE FIRST CONSULTATION - DR. DEPALI MOHANTY BASE PRICE 12474 600 0 CONSULTATION INTERNAL MEDICINE CONSULTATION INTERNAL MEDICINE FOLLOW-UP CONSULTATION BASE PRICE 2243 600 0 CONSULTATION INTERNAL MEDICINE CONSULTATION INTERNAL MEDICINE FOLLOW-UP CONSULTATION - DR. DEPALI MOHANTY BASE PRICE 12475 600 0 CONSULTATION IVF CONSULTATION IVF FIRST CONSULTATION BASE PRICE 13227 600 0 CONSULTATION IVF CONSULTATION IVF FOLLOW-UP CONSULTATION BASE PRICE 13228 600 0 CONSULTATION MINIMAL ACCESS & BARIATRIC SURGERY CONSULTATIONMINIMAL ACCESS & BARIATRIC SURGERY FIRST CONSULTATION BASE PRICE 8570 600 0 CONSULTATION MINIMAL ACCESS & BARIATRIC SURGERY CONSULTATIONMINIMAL ACCESS & BARIATRIC SURGERY FOLLOW-UP CONSULTATION BASE PRICE 8571 600 0 CONSULTATION NEPHROLOGY CONSULTATION NEPHROLOGY FIRST CONSULTATION BASE PRICE 2267 600 0 CONSULTATION NEPHROLOGY CONSULTATION NEPHROLOGY FOLLOW-UP CONSULTATION BASE PRICE 2268 600 0 CONSULTATION NEUROLOGY CONSULTATION NEUROLOGY FIRST CONSULTATION BASE PRICE 2269 600 0

Page 10 of 115 CONSULTATION NEUROLOGY CONSULTATION NEUROLOGY FOLLOW-UP CONSULTATION BASE PRICE 2270 600 0 CONSULTATION NEUROSURGERY CONSULTATION NEUROSURGERY FIRST CONSULTATION BASE PRICE 2271 600 0 CONSULTATION NEUROSURGERY CONSULTATION NEUROSURGERY FIRST CONSULTATION (M.HU.) BASE PRICE 2273 1200 0 CONSULTATION NEUROSURGERY CONSULTATION NEUROSURGERY FOLLOW-UP CONSULTATION BASE PRICE 2272 600 0 CONSULTATION NEUROSURGERY CONSULTATION NEUROSURGERY FOLLOW-UP CONSULTATION (M.HU.) BASE PRICE 2274 1200 0 CONSULTATION OBS. & GYANAECOLOGY CONSULTATION GYNAE.&OBS. DR NEELAM VINAY CONSULTATION BASE PRICE 7353 600 0 CONSULTATION OBS. & GYANAECOLOGY CONSULTATION GYNAE.&OBS. DR NEELAM VINAY FOLLOW UP CONSULTATION BASE PRICE 7354 600 0 CONSULTATION OBS. & GYANAECOLOGY CONSULTATION OBSTETRICS & GYANAECOLOGY FIRST CONSULTATION BASE PRICE 2275 600 0 CONSULTATION OBS. & GYANAECOLOGY CONSULTATION OBSTETRICS & GYANAECOLOGY FOLLOW-UP CONSULTATION BASE PRICE 2276 600 0 CONSULTATION ONCO SURGERY CONSULTATION ONCO SURGERY FIRST CONSULTATION BASE PRICE 2277 600 0 CONSULTATION ONCO SURGERY CONSULTATION ONCO SURGERY FOLLOW-UP CONSULTATION BASE PRICE 2278 600 0 CONSULTATION ONCOLOGY CONSULTATION ONCOLOGY FIRST CONSULTATION BASE PRICE 2279 600 0 CONSULTATION ONCOLOGY CONSULTATION ONCOLOGY FOLLOW-UP CONSULTATION BASE PRICE 2280 600 0 CONSULTATION OPHTHALMOLOGY CONSULTATION OPTHALMOLOGY FIRST CONSULTATION BASE PRICE 2283 600 0 CONSULTATION OPHTHALMOLOGY CONSULTATION OPTHALMOLOGY FOLLOW-UP CONSULTATION BASE PRICE 2284 600 0 CONSULTATION ORTHOPEDICS CONSULTATION ORTHOPEDICS DR. AMIT SHARMA FIRST CONSULTATION BASE PRICE 12355 600 0 CONSULTATION ORTHOPEDICS CONSULTATION ORTHOPEDICS DR. AMIT SHARMA FOLLOW-UP CONSULTATION BASE PRICE 12356 600 0 CONSULTATION ORTHOPEDICS CONSULTATION ORTHOPEDICS FIRST CONSULTATION BASE PRICE 2285 600 0 CONSULTATION ORTHOPEDICS CONSULTATION ORTHOPEDICS FOLLOW-UP CONSULTATION BASE PRICE 2286 600 0 CONSULTATION PAEDIATRIC SURGERY CONSULTATION GENERAL & PAEDIATRIC SURGERY FIRST CONSULTATION BASE PRICE 2287 600 0 CONSULTATION PAEDIATRIC SURGERY CONSULTATION GENERAL & PAEDIATRIC SURGERY FOLLOW-UP CONSULTATION BASE PRICE 2288 600 0 CONSULTATION PAEDIATRICS & NEONATOLOGY CONSULTATIONPAEDIATRICS & NEONATOLOGY FIRST CONSULTATION BASE PRICE 2289 600 0 CONSULTATION PAEDIATRICS & NEONATOLOGY CONSULTATIONPAEDIATRICS & NEONATOLOGY FOLLOW-UP CONSULTATION BASE PRICE 2290 600 0 CONSULTATION PAIN MANAGEMENT CONSULTATION PAIN MANAGEMENT FIRST CONSULTATION BASE PRICE 12433 600 0 CONSULTATION PAIN MANAGEMENT CONSULTATION PAIN MANAGEMENT FOLLOWUP CONSULTATION BASE PRICE 12438 600 0 CONSULTATION PANCHKARMA CONSULTATION AYURVED (PANCHKARMA) FIRST CONSULTATION BASE PRICE 2291 300 0 CONSULTATION PANCHKARMA CONSULTATION AYURVED (PANCHKARMA) FOLLOW-UP CONSULTATION BASE PRICE 2292 300 0 CONSULTATION PLASTIC & RECONSTRUCTIVE SURGERY CONSULTATIONPLASTIC & RECONSTRUCTIVE SURGERY FIRST CONSULTATION BASE PRICE 2295 600 0 CONSULTATION PLASTIC & RECONSTRUCTIVE SURGERY CONSULTATIONPLASTIC & RECONSTRUCTIVE SURGERY FOLLOW-UP CONSULTATION BASE PRICE 2296 600 0 CONSULTATION PSYCHIATRY CONSULTATION CONSULTATION-SEXUAL DISORDER BASE PRICE 11810 2500 0 CONSULTATION PSYCHIATRY CONSULTATION PSYCHIATRY FIRST CONSULTATION BASE PRICE 2297 300 0 CONSULTATION PSYCHIATRY CONSULTATION PSYCHIATRY FIRST CONSULTATION (DR. R. K. THUKRAL) BASE PRICE 11809 1200 0 CONSULTATION PSYCHIATRY CONSULTATION PSYCHIATRY FIRST CONSULTATION-300 BASE PRICE 2514 300 0 CONSULTATION PSYCHIATRY CONSULTATION PSYCHIATRY FIRST CONSULTATION-500 BASE PRICE 2299 600 0 CONSULTATION PSYCHIATRY CONSULTATION PSYCHIATRY FOLLOW-UP CONSULTATION BASE PRICE 2298 300 0 CONSULTATION PSYCHIATRY CONSULTATION PSYCHIATRY FOLLOW-UP CONSULTATION (DR. R. K. THUKRAL) BASE PRICE 11811 1200 0 CONSULTATION PSYCHIATRY CONSULTATION PSYCHIATRY FOLLOW-UP CONSULTATION-300 BASE PRICE 2515 300 0 CONSULTATION PSYCHIATRY CONSULTATION PSYCHIATRY FOLLOW-UP CONSULTATION-500 BASE PRICE 2300 600 0 CONSULTATION RESPIRATORY MEDICINE CONSULTATION RESPIRATORY MEDICINE FIRST CONSULTATION BASE PRICE 2301 600 0 CONSULTATION RESPIRATORY MEDICINE CONSULTATION RESPIRATORY MEDICINE FOLLOW-UP CONSULTATION BASE PRICE 2302 600 0 CONSULTATION UROLOGY CONSULTATION UROLOGY FIRST CONSULTATION BASE PRICE 2303 600 0 CONSULTATION UROLOGY CONSULTATION UROLOGY FOLLOW-UP CONSULTATION BASE PRICE 2304 600 0 CONSULTATION VASCULAR & ENDO-VASCULAR SURGERY CONSULTATIONVASCULAR & ENDO-VASCULAR FIRST CONSULTATION BASE PRICE 12634 600 0 CONSULTATION VASCULAR & ENDO-VASCULAR SURGERY CONSULTATIONVASCULAR & ENDO-VASCULAR FOLLOW-UP CONSULTATION BASE PRICE 12635 600 0 CTVS ICU CTVS ICU PACKAGES AORTIC DISSECTION SURGERY BASE PRICE 3378 381150 0 CTVS ICU CTVS ICU PACKAGES ASD / VSD BASE PRICE 3353 317630 0 CTVS ICU CTVS ICU PACKAGES CABG + ATRIAL SEPTAL DEFECT (ASD) BASE PRICE 3363 349390 0 CTVS ICU CTVS ICU PACKAGES CABG + VALVE REPLACEMENT BASE PRICE 3358 349390 0

Page 11 of 115 CTVS ICU CTVS ICU PACKAGES CABG + VENTRICLE SEPTAL DEFECT (VSD) BASE PRICE 3364 381150 0 CTVS ICU CTVS ICU PACKAGES CABG-REDO BASE PRICE 3360 381150 0 CTVS ICU CTVS ICU PACKAGES CARDIAC RE-EXPLORATION BASE PRICE 3356 12710 0 CTVS ICU CTVS ICU PACKAGES CARDIOPULMONARY BYPASS FOR PULMONARY EMBOLECTOMY BASE PRICE 3355 38120 0 CTVS ICU CTVS ICU PACKAGES CORONARY ARTERY BYPASS GRAFT BASE PRICE 3351 317630 0 CTVS ICU CTVS ICU PACKAGES IABP BASE PRICE 3367 63530 0 CTVS ICU CTVS ICU PACKAGES MINIMALY INVASIVE CORONARY ARTERY SURGERY BASE PRICE 3362 317630 0 CTVS ICU CTVS ICU PACKAGES MITRAL VALVE / AORTIC VALVE REPAIR / REPLACEMENT BASE PRICE 3365 317630 0 CTVS ICU CTVS ICU PACKAGES MYXOMA BASE PRICE 3368 317630 0 CTVS ICU CTVS ICU PACKAGES THORACIC AORTIC ANEURYSM BASE PRICE 3377 381150 0 CTVS ICU CTVS ICU PACKAGES TOF / TAPVC / FONTAN / RSOV / SENNING BASE PRICE 3361 349390 0 DAY CARE MINOR OT SURGERIESDAY CARE MINOR OT SURGERIES ARCHBAR REMOVAL (DAY CARE) BASE PRICE 12948 2100 0 DAY CARE MINOR OT SURGERIESDAY CARE MINOR OT SURGERIES CHEMICAL PEEL-DEEP (DAY CARE) BASE PRICE 12953 5250 0 DAY CARE MINOR OT SURGERIESDAY CARE MINOR OT SURGERIES CHEMICAL PEEL-INTERMEDIATE (DAY CARE) BASE PRICE 12954 3150 0 DAY CARE MINOR OT SURGERIESDAY CARE MINOR OT SURGERIES CHEMICAL PEEL-SUPERFICIAL (DAY CARE) BASE PRICE 12952 1050 0 DAY CARE MINOR OT SURGERIESDAY CARE MINOR OT SURGERIES ESTABLISHMENT CHARGES DAY CARE (BED + NURSING) BASE PRICE 12967 3470 0 DAY CARE MINOR OT SURGERIESDAY CARE MINOR OT SURGERIES ESTABLISHMENT CHARGES DAY CARE (NURSING) BASE PRICE 12966 950 0 DAY CARE MINOR OT SURGERIESDAY CARE MINOR OT SURGERIES EXCISION OF CORN OR CALLUS SIMPLE (DAY CARE) BASE PRICE 12961 2100 0 DAY CARE MINOR OT SURGERIESDAY CARE MINOR OT SURGERIES EXCISION OF MOLE LARGE (DAY CARE) BASE PRICE 12945 4200 0 DAY CARE MINOR OT SURGERIESDAY CARE MINOR OT SURGERIES EXCISION OF MOLE SMALL (DAY CARE) BASE PRICE 12944 2100 0 DAY CARE MINOR OT SURGERIESDAY CARE MINOR OT SURGERIES EXCISION OF WARTS SIMPLE (DAY CARE) BASE PRICE 12956 1050 0 DAY CARE MINOR OT SURGERIESDAY CARE MINOR OT SURGERIES FILLERS-MAJOR (DAY CARE) BASE PRICE 12958 8400 0 DAY CARE MINOR OT SURGERIESDAY CARE MINOR OT SURGERIES FILLERS-MINOR (DAY CARE) BASE PRICE 12957 3150 0 DAY CARE MINOR OT SURGERIESDAY CARE MINOR OT SURGERIES INCISION AND DRAINAGE (DAY CARE) BASE PRICE 12955 1050 0 DAY CARE MINOR OT SURGERIESDAY CARE MINOR OT SURGERIES INTRALESIONAL INJECTION-MAJOR (DAY CARE) BASE PRICE 12960 3150 0 DAY CARE MINOR OT SURGERIESDAY CARE MINOR OT SURGERIES INTRALESIONAL INJECTION-MINOR (DAY CARE) BASE PRICE 12959 1050 0 DAY CARE MINOR OT SURGERIESDAY CARE MINOR OT SURGERIES K-WIRE REMOVAL (DAY CARE) BASE PRICE 12949 1050 0 DAY CARE MINOR OT SURGERIESDAY CARE MINOR OT SURGERIES PIERCING OF EAR/NOSE (DAY CARE) BASE PRICE 12946 2100 0 DAY CARE MINOR OT SURGERIESDAY CARE MINOR OT SURGERIES PRP INJECTION MEDIUM (DAY CARE) BASE PRICE 12951 8400 0 DAY CARE MINOR OT SURGERIESDAY CARE MINOR OT SURGERIES PRP INJECTION SMALL (DAY CARE) BASE PRICE 12950 3150 0 DAY CARE MINOR OT SURGERIESDAY CARE MINOR OT SURGERIES REMOVAL OF COMEDONES (DAY CARE) BASE PRICE 12947 1050 0 DAY CARE MINOR OT SURGERIESDAY CARE MINOR OT SURGERIES SPLIT EAR LOBULE REPAIR COMPLEX (DAY CARE) BASE PRICE 12943 8400 0 DAY CARE MINOR OT SURGERIESDAY CARE MINOR OT SURGERIES SPLIT EAR LOBULE REPAIR SIMPLE (DAY CARE) BASE PRICE 12942 3150 0 DAY CARE MINOR OT SURGERIESDAY CARE MINOR OT SURGERIES WOUND MANAGEMENT (DAY CARE) BASE PRICE 12941 1050 0 DAY CARE MINOR OT SURGERIESDAY CARE MINOR OT SURGERIES WOUND REPAIR-MEDIUM (DAY CARE) BASE PRICE 12940 5250 0 DAY CARE MINOR OT SURGERIESDAY CARE MINOR OT SURGERIES WOUND REPAIR-SMALL (DAY CARE) BASE PRICE 12939 2100 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES ARCH WIRE (LOWER) BASE PRICE 3655 3340 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES ARCH WIRE (UPPER & LOWER) BASE PRICE 3654 3340 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES BITE PLATE BASE PRICE 3657 5330 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES BLEACHING MEDIUM BASE PRICE 3618 8670 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES CLEANING AND POLISHING WITH ULTRA SOUND SCALER EXTENSIVE BASE PRICE 3641 1860 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES CLEANING AND POLISHING WITH ULTRASOUND SCALER MEDIUM BASE PRICE 3640 1330 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES COMPLETE TOOTH BUILDUP COMPOSITE BASE PRICE 3617 2270 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES CROWN ACRYLIC BASE PRICE 3620 1600 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES CROWN METAL BASE PRICE 3621 2670 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES CURRETTAGE PER SEGMENT (GRADE I) BASE PRICE 3736 4000 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES CURRETTAGE PER SEGMENT (GRADE II) BASE PRICE 3737 6670 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES DENTAL X-RAY BASE PRICE 3601 140 0

Page 12 of 115 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES DENTURE REPAIR BASE PRICE 3632 810 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES DESENSITIZATION PER TOOTH BASE PRICE 3724 670 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES EXTRACTION EACH MOBILE TOOTH BASE PRICE 3602 400 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES FIBRE SPLINTING PER TOOTH BASE PRICE 3679 2010 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES FILLING COMPOUND SILVER AMALGAN BASE PRICE 3606 670 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES FILLING MIRACLE MIX BASE PRICE 3611 1070 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES FILLING SIMPLE SILVER AMALGAN BASE PRICE 3605 400 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES FIXED ORTHODONTIC BASE PRICE 3646 53360 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES FLAP SURGERY PER SEGMENT (GRADE-I) IF BONE GRAFTING REQUIRED THEN ADDBASE MATERIAL PRICE AT ACTUAL3645 8000 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES FLAP SURGERY PER SEGMENT (GRADE-II) IF BONE GRAFTING REQUIRED THEN ADDBASE MATERIAL PRICE AT ACTUAL3734 9330 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES FLAP SURGERY PER SEGMENT (GRADE-III) IF BONE GRAFTING REQUIRED THEN ADDBASE MATERIAL PRICE AT ACTUAL3735 10670 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES FLEXIBLE DENTURE (UPPER & LOWER) BASE PRICE 3636 33350 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES FLEXIBLE R.P.D.-(PER EXTRA TOOTH) BASE PRICE 11620 1330 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES FLEXIBLE R.P.D.-FIRST TOOTH BASE PRICE 3635 2670 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES FULL DENTURE (UPPER AND LOWER IN ACRYLIC) BASE PRICE 3627 16010 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES GINGIVECTOMY PER SEGMENT EXTENSIVE BASE PRICE 3643 8000 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES GINGIVECTOMY PER SEGMENT MEDIUM BASE PRICE 3642 5330 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES GINGIVECTOMY PER SEGMENT WITH BONE GRAFTING+MATERIAL COST AS ACTUALBASE PRICE 3644 6670 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES GLASS INOMER FILLING BASE PRICE 3612 810 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES GROWTH MODIFICATION GRADE I (BITE CORRECTOR) BASE PRICE 3651 10010 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES GROWTH MODIFICATION GRADE II (ACTIVATOR/BIONATOR) BASE PRICE 3652 16010 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES GROWTH MODIFICATION GRADE III (HEAD GEAR ) BASE PRICE 3653 16010 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES INLAY BASE PRICE 3619 2670 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES LAMINATES PER TOOTH BASE PRICE 3637 8000 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES LIGHT CURE COMPOSITE FILLING (1 SURFACE) BASE PRICE 3607 870 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES LIGHT CURE COMPOSITE FILLING (2 SURFACE) BASE PRICE 3608 1330 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES LIGHT CURE COMPOSITE FILLING (MORE THAN 2 SURFACE) BASE PRICE 3609 2010 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES LINGUAL ORTHODONTICS BASE PRICE 3658 133400 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES METAL CROWN WITH ACRYLIC FACING BASE PRICE 3623 2670 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES METAL CROWN WITH PORCELAIN FACING BASE PRICE 3622 4670 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES OBTURATOR PLATE BASE PRICE 3656 10010 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES ORTHODONTIC TREATMENT WITH REMOVAL APPLIANCES (PER PLATE) BASE PRICE 3647 5330 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES ORTHODONTIC TREATMENT WITH REMOVAL APPLIANCES GRADE I (UPPER & LOWER)BASE PRICE 3648 6670 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES PARTIAL DENTURE EACH TOOTH IN ACRYLIC-FIRST TOOTH BASE PRICE 3629 1330 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES PARTIAL DENTURE IN ACRYLIC (PER EXTRA TOOTH) BASE PRICE 7364 670 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES PORCELAIN CROWN EACH UNIT BASE PRICE 3624 4670 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES POST AND CORE BASE PRICE 3625 2670 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES PROCERA CROWN EACH UNIT BASE PRICE 3639 10670 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES PULP CAPPING BASE PRICE 3615 1010 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES PULPOTOMY BASE PRICE 3614 2010 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES RELINING OF FULL DENTURE BASE PRICE 3630 3340 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES REMOVABLE APPLIANCE GRADE II (SCREW APPLIANCE) BASE PRICE 3649 6670 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES REMOVABLE APPLIANCE GRADE III (SCREW APPLIANCE) BASE PRICE 3650 10010 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES ROOT CANAL TREATMENT WITHOUT CROWN BASE PRICE 3613 3340 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES ROOT PLANNING PER TOOTH BASE PRICE 3729 670 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES ROOT RESECTION / HEMI SECTION (RCT CHARGES EXTRA) BASE PRICE 3728 3340 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES SINGLE TOOTH LAMINATION BASE PRICE 3616 2010 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES SPACE MAINTAINERS - FIXED BASE PRICE 3730 3340 0

Page 13 of 115 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES SPLINT ACRYLIC EACH JAW BASE PRICE 3631 3340 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES SPLINTING PER TOOTH BASE PRICE 3680 670 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES TEMPORARY FILLING BASE PRICE 3610 530 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES TISSUE CONDITIONING BOTH JAW BASE PRICE 3634 3340 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES TISSUE CONDITIONING SINGLE JAW BASE PRICE 3633 2010 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES UPPER OR LOWER , COMPLETE DENTURE IN LUCITRONE BASE PRICE 3628 20010 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES UPPER OR LOWER, COMPLETE DENTURE IN ACRYLIC BASE PRICE 3626 16010 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL PROCEDURES VENEERS PER TOOTH BASE PRICE 3638 10670 0 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY ABSCESS INCISION EXTENSIVE BASE PRICE 3673 1460 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY ABSCESS INCISION SMALL BASE PRICE 3672 610 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY ALL CERAMIC CROWN GRADE I BASE PRICE 12730 13790 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY ALL CERAMIC CROWN GRADE II BASE PRICE 12731 16540 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY ALVEOLOPLASTY (PER SEGMENT) BASE PRICE 3666 1220 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY ALVEOLOPLASTY (PER SEGMENT) GRADE I BASE PRICE 3773 2430 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY ALVEOLOPLASTY (PER SEGMENT) GRADE II BASE PRICE 3774 3640 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY ALVEOLOPLASTY PER SEGMENT (Done in OT) BASE PRICE 8433 1220 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY ANKYLOSIS BILATERAL BASE PRICE 3721 30320 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY ANKYLOSIS UNILATERAL BASE PRICE 3720 18200 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY APICOECTOMY PER TOOTH EXTENSIVE BASE PRICE 3675 2430 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY APICOECTOMY PER TOOTH SMALL BASE PRICE 3674 1820 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY BIOPSY GRADE I BASE PRICE 3722 610 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY BIOPSY GRADE II BASE PRICE 3723 1820 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY BLEACHING EXTENSIVE BASE PRICE 3769 9700 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY CALDWEL LUC SURGERY BASE PRICE 3731 6070 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY CIRCUM MANDIBULAR WIRING BASE PRICE 3717 9700 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY CLOED REDUCTION FRACTURE MAXILLA-MEDIUM BASE PRICE 3697 9700 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY CLOSED REDUCTION FRACTURE MANDIBLE-MAJOR BASE PRICE 3692 14550 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY CLOSED REDUCTION FRACTURE MANDIBLE-MEDIUM BASE PRICE 3691 9700 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY CLOSED REDUCTION FRACTURE MANDIBLE-MINOR BASE PRICE 3690 6070 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY CLOSED REDUCTION FRACTURE MAXILLA BASE PRICE 3696 6070 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY CLOSED REDUCTION FRACTURE MAXILLA-MAJOR BASE PRICE 3698 12130 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY CLOSED REDUCTION ZYGOMATIC COMPLEX-MAJOR BASE PRICE 3704 12130 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY CLOSED REDUCTION ZYGOMATIC COMPLEX-MEDIUM BASE PRICE 3703 8490 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY CLOSED REDUCTION ZYGOMATIC COMPLEX-MINOR BASE PRICE 3702 4850 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY COMBINED FLAP SURGERY BASE PRICE 3761 10920 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY COMPLETE TOOTH BUILDUP COMPOSITE (GRADE II) BASE PRICE 3744 2430 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY COMPLETE TOOTH BUILDUP COMPOSITE (GRADE III) BASE PRICE 3745 3640 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY CORONOPLASTY PER SEGMENT GRADE-I BASE PRICE 3766 970 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY CORONOPLASTY PER SEGMENT GRADE-II BASE PRICE 3767 1220 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY CROWN LENTHENING PER SEGMENT (GRADE I) BASE PRICE 3739 3640 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY CROWN LENTHENING PER SEGMENT (GRADE II) BASE PRICE 3740 6070 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY CROWN LENTHENING PER SEGMENT (GRADE III) BASE PRICE 3741 8490 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY CURRETTAGE PER SEGMENT (GRADE III) BASE PRICE 3738 8490 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY DENTAL IMPLANT BASE PRICE 3659 24260 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY DENTAL IMPLANT Grade II (IF BONE GRAFTING REQUIRED THEN ADD MATERIAL COSTBASE AT PRICE ACTUAL) 3733 30320 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY DENTOALVEOLAR FRACTURE BASE PRICE 3708 6070 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY DENTURE IMPLANT BASED DENTURE (IMPLANT COST EXTRA) TYPE I BASE PRICE 3762 12130 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY DENTURE IMPLANT BASED DENTURE (IMPLANT COST EXTRA) TYPE II BASE PRICE 3763 15770 25

Page 14 of 115 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY DENTURE IMPLANT BASED DENTURE (IMPLANT COST EXTRA) TYPE III BASE PRICE 3764 18200 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY DEPIGMENTATION PER SEGMENT (GRADE I) BASE PRICE 3754 3640 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY DEPIGMENTATION PER SEGMENT (GRADE II) BASE PRICE 3755 6070 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY DEPIGMENTATION PER SEGMENT (GRADEIII) BASE PRICE 3756 8490 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY ENUCLEATION OF CYST-MAJOR BASE PRICE 3686 9700 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY ENUCLEATION OF CYST-MEDIUM BASE PRICE 3685 6070 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY ENUCLEATION OF CYST-MINOR BASE PRICE 3684 3030 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY EXCISION UNDER LA GRADE I BASE PRICE 12720 4410 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY EXCISION UNDER LA GRADE II BASE PRICE 12721 8820 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY EXCISION UNDER LA GRADE III BASE PRICE 12722 13230 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY EXTRACTION EACH TOOTH BASE PRICE 3603 610 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY EYE LET WIRING BASE PRICE 3712 6070 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY FACIAL SPACE INFECTION MAJOR BASE PRICE 3711 18200 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY FACIAL SPACE INFECTION MINOR BASE PRICE 3710 6070 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY FRACTURE JAW CONSERVATIVE MANAGEMENT- WIRING BASE PRICE 3677 6070 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY FRACTURE WIRE REMOVAL BASE PRICE 3668 370 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY FRACTURE WIRE TIGHTENING PER VISIT BASE PRICE 3667 370 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY FRACTURE WIRING IMF BASE PRICE 3714 6070 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY FRACTURE WIRING SINGLE ARCH BASE PRICE 3713 3640 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY FRENECTOMY BASE PRICE 3725 2430 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY FRENECTOMY TYPE I BASE PRICE 3757 3030 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY GBR I BASE PRICE 12734 11030 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY GBR II BASE PRICE 12735 13790 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY GBR II BASE PRICE 12736 16540 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY GENIOPLASTY, SAGITTAL OSTEOTOMY, LEFORT OSTEOTOMY- COSMETIC SURGERYBASE GRADE PRICE I 3663 18200 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY GENIOPLASTY, SAGITTAL OSTEOTOMY, LEFORT OSTEOTOMY- COSMETIC SURGERYBASE GRADE PRICE II 3664 24260 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY GENIOPLASTY, SAGITTAL OSTEOTOMY, LEFORT OSTEOTOMY- COSMETIC SURGERYBASE GRADE PRICE III 3665 30320 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY GINGIVAL RECESSION COVERAGE (GRADE I) BASE PRICE 3746 4850 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY GINGIVAL RECESSION COVERAGE (GRADE II) BASE PRICE 3747 6070 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY GINGIVAL RECESSION COVERAGE (GRADE III) BASE PRICE 3748 9700 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY GTR FLAP SURGERY (MATERIALCOST AT ACTUAL) GRADE I BASE PRICE 3758 7280 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY GTR FLAP SURGERY (MATERIALCOST AT ACTUAL) GRADE II BASE PRICE 3759 8490 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY GTR FLAP SURGERY (MATERIALCOST AT ACTUAL) GRADE III BASE PRICE 3760 9700 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY GUNNING SPLINT FIXATING BASE PRICE 3718 6070 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY IMPACTION EXTENSIVE BASE PRICE 3670 4240 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY IMPACTION SMALL BASE PRICE 3669 3030 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY IMPLANT GRADE I BASE PRICE 12732 38590 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY IMPLANT GRADE II BASE PRICE 12733 44100 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY IMPLANT PROSTHESIS GRADE I BASE PRICE 12740 9700 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY IMPLANT PROSTHESIS GRADE II BASE PRICE 12741 13790 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY IMPLANT PROSTHESIS GRADE III BASE PRICE 12742 16540 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY LOCAL FLAP GRADE I BASE PRICE 12727 3310 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY LOCAL FLAP GRADE II BASE PRICE 12728 6620 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY LOCAL FLAP GRADE II BASE PRICE 12729 9920 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY MARSUPILIZATION OF CYST-MAJOR BASE PRICE 3689 12130 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY MARSUPILIZATION OF CYST-MEDIUM BASE PRICE 3688 8490 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY MARSUPILIZATION OF CYST-MINOR BASE PRICE 3687 4240 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY NERVE REPOSITIONING BASE PRICE 3683 18200 25

Page 15 of 115 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY OPEN REDUCTION FRACTURE MANDIBLE - MAJOR (+PLATING COST AT ACTUAL) BASE PRICE 3695 18200 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY OPEN REDUCTION FRACTURE MANDIBLE – MEDIUM (+PLATING COST AT ACTUAL)BASE PRICE 3694 12130 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY OPEN REDUCTION FRACTURE MANDIBLE – MINOR (+PLATING COST AT ACTUAL) BASE PRICE 3693 8490 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY OPEN REDUCTION FRACTURE MAXILLA-MAJOR (+PLATING COST AT ACTUAL)) BASE PRICE 3701 18200 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY OPEN REDUCTION FRACTURE MAXILLA-MEDIUM (+PLATING COST AT ACTUAL)) BASE PRICE 3700 12130 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY OPEN REDUCTION FRACTURE MAXILLA-MINOR (+PLATING COST AT ACTUAL) BASE PRICE 3699 8490 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY OPEN REDUCTION ZYGOMATIC COMPLEX - MAJOR (+PLATING COST AT ACTUAL)) BASE PRICE 3707 18200 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY OPEN REDUCTION ZYGOMATIC COMPLEX - MEDIUM (+PLATING COST AT ACTUAL))BASE PRICE 3706 12130 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY OPEN REDUCTION ZYGOMATIC COMPLEX – MINOR (+PLATING COST AT ACTUAL))BASE PRICE 3705 8490 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY ORBITAL FRACTURE BASE PRICE 3732 9700 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY ORO- ANTRAL COMMUNICATION CLOSURE BASE PRICE 3715 4850 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY OSMF - RELEASE OF FIBROUS BANDS & GRAFTING BASE PRICE 3726 14550 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY OSMF INJECTION THERAPY GRADE I BASE PRICE 12724 3310 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY OSMF INJECTION THERAPY GRADE II BASE PRICE 12725 6620 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY OSMF INJECTION THERAPY GRADE III BASE PRICE 12726 9920 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY PAPILLA PRESERVATION FLAP (GRADE I) BASE PRICE 3751 6070 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY PAPILLA PRESERVATION FLAP (GRADE II) BASE PRICE 3752 8490 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY PAPILLA PRESERVATION FLAP (GRADE III) BASE PRICE 3753 9700 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY PERI CORONECTOMY BASE PRICE 3671 370 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY PERICORONAL FLAP SURGERY GRADE-I BASE PRICE 3770 3640 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY PERICORONAL FLAP SURGERY GRADE-II BASE PRICE 3771 6070 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY PERICORONAL FLAP SURGERY GRADE-III BASE PRICE 3772 7280 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY POCKET THERAPY (GRADE I) BASE PRICE 3776 3640 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY POCKET THERAPY (GRADE II) BASE PRICE 3777 6070 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY POCKET THERAPY (GRADE III) BASE PRICE 3778 9700 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY POST SURGICAL PLATE BASE PRICE 3765 2430 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY PRE-PROSTHETIC SURGERY - RIDGE AUGMENTATION (BONE GRAFT CHARGES EXTRA)GRADEBASE PRICE I 3781 6070 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY PRE-PROSTHETIC SURGERY - RIDGE AUGMENTATION (BONE GRAFT CHARGES EXTRA)GRADEBASE PRICE II 3775 9700 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY PROSTHESIS FOR IMPLANT BASE PRICE 12739 4410 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY PRP+BONE GRAFT(MATERIAL COST AT ACTUAL) BASE PRICE 3768 3030 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY REIMPLANTATION PER TOOTH EXTENSIVE BASE PRICE 3676 3640 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY RIDGE AUGMENTATION (+ MATERIAL COST AT ACTUAL) BASE PRICE 3682 9700 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY RIDGE SPLIT-I BASE PRICE 12746 11030 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY RIDGE SPLIT-I BASE PRICE 12747 22050 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY SINGLE FRACTURE PLATING BASE PRICE 3716 8490 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY SINGLE SITTING ROOT CANAL TREATMENT BASE PRICE 12723 4410 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY SINGLE TOOTH LAMINATION (GRADE II) BASE PRICE 3742 2430 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY SINGLE TOOTH LAMINATION (GRADE III) BASE PRICE 3743 3640 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY SINUS LIFT PROCEDURE BASE PRICE 3681 9700 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY SUB-EPITHELIAL CONNECTIVE TISSUE GRAFT (GRADE I) BASE PRICE 3749 6070 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY SUB-EPITHELIAL CONNECTIVE TISSUE GRAFT (GRADE II) BASE PRICE 3750 9700 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY SURGICAL EXTRACTION EACH TOOTH BASE PRICE 3604 1220 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY SURGICAL GUIDE-I BASE PRICE 12743 55130 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY SURGICAL GUIDE-II BASE PRICE 12744 66150 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY SURGICAL GUIDE-III BASE PRICE 12745 71660 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY SUSPENSION WIRING BASE PRICE 3719 1220 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY TMJ SURGERY - MEDIUM BASE PRICE 3661 18200 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY TMJ SURGERY – MAJOR BASE PRICE 3662 30320 25

Page 16 of 115 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY TMJ SURGERY – MINOR BASE PRICE 3660 12130 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY TRANSOSSEOUS WIRING BASE PRICE 3709 10920 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY VENEER GRADE I BASE PRICE 12737 12130 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY VENEER GRADE I BASE PRICE 12738 13790 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY VESTIBULAR DEEPENING (GRADE I) BASE PRICE 3779 3640 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY VESTIBULAR DEEPENING (GRADE II) BASE PRICE 3780 6070 25 DENTAL & MAXILLOFACIALDENTAL SURGERY & MAXILLOFACIAL SURGERY WOUND DRESSING PER DRESSING BASE PRICE 3678 190 25 DERMATOLOGY DERMATOLOGY PROCEDURE AUTOLOGOUS SERUM SKIN TEST BASE PRICE 3817 880 0 DERMATOLOGY DERMATOLOGY PROCEDURE CHEMICAL CAUTERY PER SITTING (LARGE) BASE PRICE 3806 1170 0 DERMATOLOGY DERMATOLOGY PROCEDURE CHEMICAL CAUTERY PER SITTING (SMALL) BASE PRICE 3805 740 0 DERMATOLOGY DERMATOLOGY PROCEDURE CHEMICAL PEEL BASE PRICE 3804 2310 0 DERMATOLOGY DERMATOLOGY PROCEDURE COMEDO EXTRACTION PER SITTING (LESS THAN 5) BASE PRICE 3807 1170 0 DERMATOLOGY DERMATOLOGY PROCEDURE COMEDO EXTRACTION PER SITTING (MORE THAN 5) BASE PRICE 3808 1760 0 DERMATOLOGY DERMATOLOGY PROCEDURE CORNS EXCISION (PER CORNS) BASE PRICE 3802 740 0 DERMATOLOGY DERMATOLOGY PROCEDURE CRYOTHERAPY BASE PRICE 3803 1760 0 DERMATOLOGY DERMATOLOGY PROCEDURE INTRA-LESIONAL INJECTION BASE PRICE 3811 1020 0 DERMATOLOGY DERMATOLOGY PROCEDURE MICRODERMABRASION PER SITTING BASE PRICE 3821 1760 0 DERMATOLOGY DERMATOLOGY PROCEDURE MILIA EXTRACTION (LESS THAN 5) BASE PRICE 3820 880 0 DERMATOLOGY DERMATOLOGY PROCEDURE MILIA EXTRACTION PER SITTING (MORE THAN 5) BASE PRICE 3819 1460 0 DERMATOLOGY DERMATOLOGY PROCEDURE MINOR PROCEDURE BASE PRICE 3818 1170 0 DERMATOLOGY DERMATOLOGY PROCEDURE MOLLUSCUM BODY EXPRESSION - A BASE PRICE 3809 1170 0 DERMATOLOGY DERMATOLOGY PROCEDURE MOLLUSCUM BODY EXPRESSION - B BASE PRICE 3810 1760 0 DERMATOLOGY DERMATOLOGY PROCEDURE PARING BASE PRICE 3812 740 0 DERMATOLOGY DERMATOLOGY PROCEDURE PATCH-TEST (ISS) BASE PRICE 3813 1760 0 DERMATOLOGY DERMATOLOGY PROCEDURE PODOPHYLLUM APPLICATION - LARGE BASE PRICE 3815 1170 0 DERMATOLOGY DERMATOLOGY PROCEDURE PODOPHYLLUM APPLICATION - SMALL BASE PRICE 3814 740 0 DERMATOLOGY DERMATOLOGY PROCEDURE RADIOFREQUENCY REMOVAL OF SKIN TAG BASE PRICE 3801 1460 0 DERMATOLOGY DERMATOLOGY PROCEDURE SKIN BIOPSY (SAMPLE COLLECTION) BASE PRICE 3816 1760 0 DERMATOLOGY DERMATOLOGY PROCEDURE WARTS REMOVAL (LARGE) BASE PRICE 3823 4390 0 DERMATOLOGY DERMATOLOGY PROCEDURE WARTS REMOVAL (SMALL) BASE PRICE 3822 2200 0 ENT AUDIOMETERY PROCEDURE AUDIOMETERY BASE PRICE 3851 550 0 ENT AUDIOMETERY PROCEDURE BERA BASE PRICE 3860 2520 0 ENT AUDIOMETERY PROCEDURE CALORIC TESTING BASE PRICE 3865 700 0 ENT AUDIOMETERY PROCEDURE E COG BASE PRICE 3862 1670 0 ENT AUDIOMETERY PROCEDURE FREE FIELD AUDIOMETRY BASE PRICE 3866 550 0 ENT AUDIOMETERY PROCEDURE HEARING AID ASSESSMENT BASE PRICE 3863 850 0 ENT AUDIOMETERY PROCEDURE OAE BASE PRICE 3861 1670 0 ENT AUDIOMETERY PROCEDURE SPECIAL AUDIOMETERY: ABLB BASE PRICE 3854 170 0 ENT AUDIOMETERY PROCEDURE SPECIAL AUDIOMETERY: SISI BASE PRICE 3852 170 0 ENT AUDIOMETERY PROCEDURE SPECIAL AUDIOMETERY: STENGER BASE PRICE 3855 170 0 ENT AUDIOMETERY PROCEDURE SPECIAL AUDIOMETERY: TDT BASE PRICE 3853 170 0 ENT AUDIOMETERY PROCEDURE SPEECH & VOICE THERAPY SESSION OF 30 MINUTES BASE PRICE 3864 360 0 ENT AUDIOMETERY PROCEDURE SPEECH AUDIOMETRY BASE PRICE 3856 550 0 ENT AUDIOMETERY PROCEDURE TYMPANOMETERY BASE PRICE 3857 850 0 ENT AUDIOMETERY PROCEDURE TYMPANOMETERY WITH SPECIAL TEST (EDT DYSFUNCTION) BASE PRICE 3858 850 0 ENT AUDIOMETERY PROCEDURE TYMPANOMETERY WITH SPECIAL TEST (REFLEX DECAY) BASE PRICE 3859 850 0 ENT ENT PROCEDURES ANTRUM PUNCTURE & WASHOUT BASE PRICE 3952 2520 0 ENT ENT PROCEDURES ARTERIAL LIGATION BASE PRICE 3983 25160 0

Page 17 of 115 ENT ENT PROCEDURES AUDIOGRAM BASE PRICE 3980 850 0 ENT ENT PROCEDURES BERA BASE PRICE 3982 2790 0 ENT ENT PROCEDURES DIAGNOSTIC ENDOSCOPY BASE PRICE 3957 2100 0 ENT ENT PROCEDURES DIAGNOSTIC NASAL ENDOSCOPY BASE PRICE 3987 8380 0 ENT ENT PROCEDURES DIRECT LARYNGOSCOPY BASE PRICE 3920 2290 0 ENT ENT PROCEDURES DRAINAGE PERITONSILLAR ABSCESS BASE PRICE 3949 10480 0 ENT ENT PROCEDURES DRAINAGE RETROPHARYNGEAL ABSCESS BASE PRICE 3950 4900 0 ENT ENT PROCEDURES EAR LOBE REPAIR UNILATERAL BASE PRICE 3988 6990 0 ENT ENT PROCEDURES ENG TEST BASE PRICE 3991 3500 0 ENT ENT PROCEDURES EXAMINATION NOSE & NASOPHARYNIX BASE PRICE 3951 2520 0 ENT ENT PROCEDURES FIBRE OPTIC BRONCHOSCOPY BASE PRICE 3915 2100 0 ENT ENT PROCEDURES OESOPHAGOSCOPY BASE PRICE 3914 12570 0 ENT ENT PROCEDURES PAEDATIRC ENDOSCOPY BASE PRICE 3923 20970 0 ENT ENT PROCEDURES PRIMARY SUTURING BASE PRICE 3919 5590 0 ENT ENT PROCEDURES SPEECH ASSESSMENT BASE PRICE 4021 360 0 ENT ENT PROCEDURES SPEECH THERAPY (PER SITTING) BASE PRICE 3984 360 0 ENT ENT PROCEDURES TRACHEOSTOMY BASE PRICE 3944 6990 0 ENT ENT PROCEDURES TYMPANOGRAM BASE PRICE 3981 1670 0 ENT ENT SURGERY ABSCESS DRAINAGE - ENT BASE PRICE 4033 8270 25 ENT ENT SURGERY ADENOIDECTOMY BASE PRICE 12907 11030 25 ENT ENT SURGERY ADENOIDECTOMY & TONSILLECTOMY BASE PRICE 3942 19850 25 ENT ENT SURGERY ANGIOFIBROMA EXCISION BASE PRICE 4030 38590 25 ENT ENT SURGERY ARTERIAL LIGATION (DONE IN OT) BASE PRICE 8553 27560 25 ENT ENT SURGERY BENIGN TUMOR EXCISON BASE PRICE 4062 13230 25 ENT ENT SURGERY BILATERAL DISSECTION CERVICAL NODES BASE PRICE 3917 21830 25 ENT ENT SURGERY BILATERAL ETHMOID POLYPOSIS BASE PRICE 4001 14550 25 ENT ENT SURGERY BIOPSY EAR & NOSE (LOCAL ANAESTHESIA OPD) BASE PRICE 3956 1820 25 ENT ENT SURGERY BIOPSY MOUTH & THROAT BASE PRICE 3955 6620 25 ENT ENT SURGERY CALDWEL-LUC PROCEDURE BASE PRICE 3892 6670 25 ENT ENT SURGERY CAUTERISATION FOR ENT BLEED BASE PRICE 3979 4850 25 ENT ENT SURGERY CHOANAL ATRESIA BASE PRICE 4036 27560 25 ENT ENT SURGERY CLASS VI BASE PRICE 3963 5460 25 ENT ENT SURGERY CLEFT LIP BASE PRICE 3925 21830 25 ENT ENT SURGERY CLEFT PALATE REPAIR BASE PRICE 3924 29110 25 ENT ENT SURGERY COCHLEAR IMPLANT BASE PRICE 3972 44100 25 ENT ENT SURGERY COMMANDO OPERATION BASE PRICE 3965 33080 25 ENT ENT SURGERY CSF RHINORRHOEA BASE PRICE 3975 38590 25 ENT ENT SURGERY CYST EXCISION BASE PRICE 3940 6670 25 ENT ENT SURGERY DECOMPRESSION OF OPTIC NERVE (ENDOSCOPIC) BASE PRICE 3986 18200 25 ENT ENT SURGERY DECOMPRESSION OF ORBIT BASE PRICE 3985 33080 25 ENT ENT SURGERY DENTAL TUMOR/CYST EXCISION BASE PRICE 4029 22050 25 ENT ENT SURGERY DIRECT LARYNGOSCOPY (DONE IN OT) BASE PRICE 11595 11030 25 ENT ENT SURGERY DRAINAGE ABSCESS - ENT BASE PRICE 3953 2180 25 ENT ENT SURGERY EAR LOBE REPAIR BILATERAL BASE PRICE 4055 8270 25 ENT ENT SURGERY ENDOLYMPHATIC SAC DECOMPRESSION BASE PRICE 3973 26680 25 ENT ENT SURGERY ENDOSCOPIC DCR BASE PRICE 4037 22050 25 ENT ENT SURGERY ENDOSCOPIC ETHMOIDECTOMY - BILATERAL BASE PRICE 3922 26460 25 ENT ENT SURGERY ENDOSCOPIC ETHMOIDECTOMY - UNILATERAL BASE PRICE 4070 14550 25

Page 18 of 115 ENT ENT SURGERY ENDOSCOPIC FRONTAL RECESS CLEARANCE BASE PRICE 4038 14550 25 ENT ENT SURGERY ENDOSCOPIC NASAL BIOPSY BASE PRICE 3990 4850 25 ENT ENT SURGERY ENDOSCOPIC ODENOIDECTOMY BASE PRICE 3989 15440 25 ENT ENT SURGERY ENDOSCOPIC SURGERY ANTROSTOMY BASE PRICE 3899 10920 25 ENT ENT SURGERY ENDOSCOPIC SURGERY FRONTAL SINUS BASE PRICE 3900 10920 25 ENT ENT SURGERY ENDOSCOPIC SURGERY INFUNDIBULECTOMY BASE PRICE 3939 10920 25 ENT ENT SURGERY ENDOSCOPIC SURGERY REVISION NASAL BASE PRICE 3901 15160 25 ENT ENT SURGERY ENDOSCOPY THROAT BASE PRICE 3941 1820 25 ENT ENT SURGERY ENDOSCOPY, DECANNULATION & STRAPPING BASE PRICE 4053 7280 25 ENT ENT SURGERY ETHMOIDAL TUMOURS / FUNGAL BASE PRICE 3977 22440 25 ENT ENT SURGERY ETHMOIDECTOMY BASE PRICE 4068 10920 25 ENT ENT SURGERY EXCISION BIOPSY BASE PRICE 4061 11030 25 ENT ENT SURGERY EXCISION BRANCHIAL CYST BASE PRICE 3936 11520 25 ENT ENT SURGERY EXCISION BRANCHIAL SINUS BASE PRICE 3937 11520 25 ENT ENT SURGERY EXCISION CYSTIC HYGROMA EXTENSIVE BASE PRICE 3895 11520 25 ENT ENT SURGERY EXCISION EAR TUMOUR SMALL BASE PRICE 3904 5460 25 ENT ENT SURGERY EXCISION NOSE TUMOUR SMALL BASE PRICE 3893 6670 25 ENT ENT SURGERY EXCISION OF CAROTID BODY TUMOR BASE PRICE 3996 44100 25 ENT ENT SURGERY EXCISION OF CYSTIC HYGROMA BASE PRICE 3992 18200 25 ENT ENT SURGERY EXCISION OF GLOMUS JUGULARE BASE PRICE 3993 44100 25 ENT ENT SURGERY EXCISION OF LARYNGEAL PAPILLOMA BASE PRICE 3994 15160 25 ENT ENT SURGERY EXCISION OF LINGUAL THYROID BASE PRICE 3995 22440 25 ENT ENT SURGERY EXCISION OF PALATAL MASS BASE PRICE 3999 15160 25 ENT ENT SURGERY EXCISION OF PINNA FOR SCC OR BCC BASE PRICE 3997 21830 25 ENT ENT SURGERY EXCISION OF THYROGLOSSAL CYST/FISTULA BASE PRICE 3998 22050 25 ENT ENT SURGERY EXCISION PHARENGEAL HIGROMA AMPUTATION BASE PRICE 3946 10920 25 ENT ENT SURGERY EXCISION PHARYNGEAL DIVRTICULUM BASE PRICE 3943 10920 25 ENT ENT SURGERY EXCISION SINUS TRACT BASE PRICE 3961 22050 25 ENT ENT SURGERY EXCISION THROAT TUMOUR SMALL BASE PRICE 3916 10920 25 ENT ENT SURGERY EXCISON OF CYSTIC HYGROMA - MINOR BASE PRICE 4060 6070 25 ENT ENT SURGERY EXTENDED FESS UNILATERAL BASE PRICE 4057 26460 25 ENT ENT SURGERY FACIAL NERVE DECOMPRESSION BASE PRICE 4000 30320 25 ENT ENT SURGERY FESS FOR ANTROCHOANAL POLYP BASE PRICE 4065 10920 25 ENT ENT SURGERY FESS UNILATERAL BASE PRICE 4056 19850 25 ENT ENT SURGERY FIBRE OPTIC LARYNGOSCOPY BASE PRICE 4002 3030 25 ENT ENT SURGERY FLAP RECONSTRUCTION BASE PRICE 4027 12130 25 ENT ENT SURGERY FOREIGN BODY NOSE REMOVAL BASE PRICE 4004 4240 25 ENT ENT SURGERY FOREIGN BODY REMOVAL (C.A.) OPD EAR BASE PRICE 3954 2180 25 ENT ENT SURGERY FOREIGN BODY REMOVAL EAR BASE PRICE 4003 4240 25 ENT ENT SURGERY FUNCTIONAL ENDOSCOPIC SINUS SURGERY BASE PRICE 3962 16540 25 ENT ENT SURGERY GROMMET INSERTION BASE PRICE 3905 6670 25 ENT ENT SURGERY HEMIGLOSSECTOMY BASE PRICE 3969 21830 25 ENT ENT SURGERY HEMIMANDIBULECTOMY BASE PRICE 3933 21830 25 ENT ENT SURGERY ISTHMECTOMY BASE PRICE 3896 10920 25 ENT ENT SURGERY L. N. BIOPSY BASE PRICE 4005 4240 25 ENT ENT SURGERY LABRYNTHECTOMY BASE PRICE 3930 22440 25 ENT ENT SURGERY LARYNGECTOMY - PARTIAL BASE PRICE 4066 22440 25 ENT ENT SURGERY LARYNGOFISSURE BASE PRICE 4054 14550 25

Page 19 of 115 ENT ENT SURGERY LARYNGOPHARYNGECTOMY BASE PRICE 4006 26680 25 ENT ENT SURGERY LATERAL PHARNGOTOMY BASE PRICE 4041 14550 25 ENT ENT SURGERY LATERAL RHINOTOMY BASE PRICE 4042 14550 25 ENT ENT SURGERY MANDIBULECTOMY BASE PRICE 3929 21830 25 ENT ENT SURGERY MASTOID TYMPANOPLASTY BASE PRICE 3911 28670 25 ENT ENT SURGERY MASTOIDECTOMY BASE PRICE 3907 19850 25 ENT ENT SURGERY MASTOIDECTOMY PLUS OSSICULOPLASTY INCLUDING TORP OR PORP BASE PRICE 4040 33080 25 ENT ENT SURGERY MASTOIDECTOMY WITH CAVITY OBLITERATION BASE PRICE 4058 14550 25 ENT ENT SURGERY MAXILLECTOMY BASE PRICE 3932 26680 25 ENT ENT SURGERY MAXILLECTOMY WITH ORBITAL EXENTERATION BASE PRICE 4059 29110 25 ENT ENT SURGERY MICRO LARYNGEAL SURGERY BASE PRICE 3960 26460 25 ENT ENT SURGERY MODIFIED RADICAL MASTOIDECTOMY BASE PRICE 4007 14550 25 ENT ENT SURGERY MODIFIED RADICAL NECK DISSECTION BASE PRICE 4008 21830 25 ENT ENT SURGERY MYRINGOPLASTY BASE PRICE 3908 14550 25 ENT ENT SURGERY MYRINGOTOMY BASE PRICE 3903 8820 25 ENT ENT SURGERY MYRINGOTOMY & GROMMET BASE PRICE 3912 11030 25 ENT ENT SURGERY NASAL PACKING BASE PRICE 4009 5510 25 ENT ENT SURGERY OPEN REDUCTION MAXILLA BASE PRICE 3934 14550 25 ENT ENT SURGERY OSSICULOPLASTY BASE PRICE 4043 14550 25 ENT ENT SURGERY OSTEOPLASTIC FLAP FRONTAL SINUS BASE PRICE 4039 21830 25 ENT ENT SURGERY PAEDATIRC ENDOSCOPY BASE PRICE 12674 20010 25 ENT ENT SURGERY PALATAL SURGERY BASE PRICE 3948 17590 25 ENT ENT SURGERY PALATO PHARYNGOPLASTY BASE PRICE 4031 21830 25 ENT ENT SURGERY PANAPHARYNGEAL TUMOR REMOVAL BASE PRICE 4028 21830 25 ENT ENT SURGERY PANENDOSCOPY BASE PRICE 4044 2180 25 ENT ENT SURGERY PARAPHARYNGEAL ABSCESS BASE PRICE 4034 11030 25 ENT ENT SURGERY PAROTIDECTOMY BASE PRICE 3966 33080 25 ENT ENT SURGERY PAROTIDECTOMY CONSERVATIVE BASE PRICE 3913 15160 25 ENT ENT SURGERY PAROTIDECTOMY SUPERFICIAL BASE PRICE 3938 21830 25 ENT ENT SURGERY PARTIAL AMPUTATION PINNA BASE PRICE 4010 17590 25 ENT ENT SURGERY PARTIAL GLOSSECTOMY BASE PRICE 4011 14550 25 ENT ENT SURGERY PARTIAL LARYNGECTOMY WITH BLOCK DISSECTION BASE PRICE 4012 29110 25 ENT ENT SURGERY PARTIAL THYROIDECTOMY BASE PRICE 4013 21830 25 ENT ENT SURGERY PHARYNGECTOMY & RECONSTRUCTION BASE PRICE 4045 29110 25 ENT ENT SURGERY PHENGUGOPLASTY BASE PRICE 4046 14550 25 ENT ENT SURGERY PHONO SURGERY BASE PRICE 3968 22050 25 ENT ENT SURGERY POLYP REMOVAL (SEPTAL PDGP) BASE PRICE 4047 7280 25 ENT ENT SURGERY POLYP REMOVAL EAR BASE PRICE 4015 11030 25 ENT ENT SURGERY POLYP REMOVAL UNDER GA BASE PRICE 4067 7280 25 ENT ENT SURGERY POSTERIOR NOSE SURGERY - MAJOR BASE PRICE 3890 10920 25 ENT ENT SURGERY POSTERIOR SINUS NOSE SURGERY - MINOR BASE PRICE 3897 10920 25 ENT ENT SURGERY PRE AURICULAR SINUS REPAIR BASE PRICE 3945 13230 25 ENT ENT SURGERY PREAURICULAR SINUS DISECTION EX. PINNA REPAIR - MINOR BASE PRICE 3906 7890 25 ENT ENT SURGERY PREAURICULAR SINUS DISSECTION EX. PINNA REPAIR - MAJOR BASE PRICE 3902 10920 25 ENT ENT SURGERY PRIMARY SUTURING BASE PRICE 12498 5330 25 ENT ENT SURGERY RADICAL NECK DISSECTION BASE PRICE 3959 21830 25 ENT ENT SURGERY RANULA EXCISION BASE PRICE 4016 16540 25 ENT ENT SURGERY REDUCTION FRACTURE ZYGOMA AND/OR MAXILLA BASE PRICE 3926 10920 25

Page 20 of 115 ENT ENT SURGERY REDUCTION OF FRACTURE NOSE BASE PRICE 4017 16540 25 ENT ENT SURGERY REMOVAL OF FOREIGN BODY FROM NOSE BASE PRICE 4064 720 25 ENT ENT SURGERY REPAIR OF PAROTID DUCT BASE PRICE 4048 14550 25 ENT ENT SURGERY REPAIR ORO-ANTRAL FISTULA BASE PRICE 3927 10920 25 ENT ENT SURGERY REPAIR PHARYNGEAL FISTULA BASE PRICE 4014 14550 25 ENT ENT SURGERY RESECTION ENUCLEATION ADENOMA BASE PRICE 3918 10920 25 ENT ENT SURGERY RESECTION SALIVARY GLAND (SUBMANDIBULAR) BASE PRICE 3921 18200 25 ENT ENT SURGERY RHINOPLASTY BASE PRICE 3898 19850 25 ENT ENT SURGERY SEPTAL ABSCESS DRAINAGE BASE PRICE 4035 8820 25 ENT ENT SURGERY SEPTAL PERFORATION REPAIR BASE PRICE 4018 14550 25 ENT ENT SURGERY SEPTO RHINOPLASTY BASE PRICE 4019 22440 25 ENT ENT SURGERY SEPTOPLASTY BASE PRICE 3958 16540 25 ENT ENT SURGERY SINUS & FISTULA REPAIR BASE PRICE 3928 10920 25 ENT ENT SURGERY SKULL BASE SURGERY BASE PRICE 4020 36380 25 ENT ENT SURGERY SPHENOID SINUS SURGERY BASE PRICE 3976 21830 25 ENT ENT SURGERY SPHENOID SURGERY BASE PRICE 4022 21830 25 ENT ENT SURGERY STAPEDECTOMY BASE PRICE 3909 22050 25 ENT ENT SURGERY STYLOIDECTOMY - BILATERAL BASE PRICE 4071 21830 25 ENT ENT SURGERY STYLOIDECTOMY - UNILATERAL BASE PRICE 4023 16540 25 ENT ENT SURGERY SUB TOTAL RESECTION TEMPORAL BONE BASE PRICE 4024 29110 25 ENT ENT SURGERY SUBMANDIBULAR DUCT LITHOTOMY BASE PRICE 4032 7280 25 ENT ENT SURGERY SUBMANDIBULAR DUCT LITHOTOMY CALCULI BASE PRICE 4049 7280 25 ENT ENT SURGERY SUBMUCUS RESECTION BASE PRICE 3891 9090 25 ENT ENT SURGERY SUBTOTAL THYROIDECTOMY BASE PRICE 4063 33080 25 ENT ENT SURGERY SUBTOTAL THYROIDECTOMY - TOXIC GOITRE BASE PRICE 4069 21830 25 ENT ENT SURGERY SYRINGING (EAR) BASE PRICE 4050 720 25 ENT ENT SURGERY TONGUE TIE BASE PRICE 4051 8820 25 ENT ENT SURGERY TONSILLECTOMY BASE PRICE 12906 22050 25 ENT ENT SURGERY TOTAL AMPUTATION & EXCISION MEATUS BASE PRICE 3935 17590 25 ENT ENT SURGERY TOTAL GLOSSECTOMY BASE PRICE 3964 21830 25 ENT ENT SURGERY TOTAL LARYNGECTOMY BASE PRICE 3931 33080 25 ENT ENT SURGERY TOTAL THYROIDECTOMY WITH ANT. NECK DISC BASE PRICE 3967 36380 25 ENT ENT SURGERY TRACHEAL RECONSTRUCTION BASE PRICE 4025 44100 25 ENT ENT SURGERY TRACHEOSTOMY BASE PRICE 12216 8820 25 ENT ENT SURGERY TUMOR EXTERNAL AUDITORY CANAL BASE PRICE 4026 12130 25 ENT ENT SURGERY TYMPANOPLASTY BASE PRICE 3910 19850 25 ENT ENT SURGERY UPP (FOR SLEEP APNOEA) BASE PRICE 3978 22050 25 ENT ENT SURGERY VERMILONECTOMY BASE PRICE 3970 10920 25 ENT ENT SURGERY VESTIBULAR NEURECTOMY BASE PRICE 3974 32750 25 ENT ENT SURGERY WEDGE-EXCISION BASE PRICE 3947 4370 25 ENT ENT SURGERY WEDGE-EXCISION VERMILIONECTOMY BASE PRICE 3971 10920 25 ENT ENT SURGERY YOUNG'S OPERATION BASE PRICE 4052 7280 25 FRONT OFFICE FO REGISTRATION REGISTRATION BASE PRICE 1395 100 0 GASTRO SURGERY GASTRO SURGERY PACKAGE BARIATRIC SURGERY PACKAGE BASE PRICE 12622 302500 0 GASTRO SURGERY GASTRO SURGERY SURGERY 95% PANCREATECTOMY BASE PRICE 4219 40030 25 GASTRO SURGERY GASTRO SURGERY SURGERY ABDOMINAL DRAINAGE BASE PRICE 4195 8270 25 GASTRO SURGERY GASTRO SURGERY SURGERY ANAL SHINCTER REPAIR AFTER INJURY BASE PRICE 4162 18200 25 GASTRO SURGERY GASTRO SURGERY SURGERY ANORECTAL MANOMETRY BASE PRICE 4165 6070 25

Page 21 of 115 GASTRO SURGERY GASTRO SURGERY SURGERY ANTERIOR RESECTION OF RECTUM BASE PRICE 4166 20670 25 GASTRO SURGERY GASTRO SURGERY SURGERY APPENDECTOMY BASE PRICE 4131 16540 25 GASTRO SURGERY GASTRO SURGERY SURGERY BARIATRIC SURGERY BASE PRICE 12623 109150 25 GASTRO SURGERY GASTRO SURGERY SURGERY BENIGN TUMOURS OF SMALL INTESTINE BASE PRICE 4228 18200 25 GASTRO SURGERY GASTRO SURGERY SURGERY CAECOSTOMY BASE PRICE 4167 18200 25 GASTRO SURGERY GASTRO SURGERY SURGERY CARDIOMYOTOMY BASE PRICE 4101 13940 25 GASTRO SURGERY GASTRO SURGERY SURGERY CBD EXPLORATION BASE PRICE 4106 21500 25 GASTRO SURGERY GASTRO SURGERY SURGERY CHOLECYSTECTOMY WITH CHOLEDOCHODUODENECTOMY BASE PRICE 4107 25800 25 GASTRO SURGERY GASTRO SURGERY SURGERY CHOLEDOCHAL CYST EXCISION BASE PRICE 4108 22930 25 GASTRO SURGERY GASTRO SURGERY SURGERY CLOSURE OF COLOSTOMY BASE PRICE 4168 18200 25 GASTRO SURGERY GASTRO SURGERY SURGERY CLOSURE OF PERFORATION BASE PRICE 4114 18200 25 GASTRO SURGERY GASTRO SURGERY SURGERY COLECTOMY BASE PRICE 4133 24260 25 GASTRO SURGERY GASTRO SURGERY SURGERY COLECTOMY AND COLOSTOMY BASE PRICE 4243 28670 25 GASTRO SURGERY GASTRO SURGERY SURGERY COLONIC POLYPECTOMY BASE PRICE 13176 8820 25 GASTRO SURGERY GASTRO SURGERY SURGERY COLOSTOMY CLOSURE BASE PRICE 4198 14550 25 GASTRO SURGERY GASTRO SURGERY SURGERY CYSTOGASTROSTOMY BASE PRICE 4102 17200 25 GASTRO SURGERY GASTRO SURGERY SURGERY CYSTOJEJUNOSTOMY BASE PRICE 4109 17200 25 GASTRO SURGERY GASTRO SURGERY SURGERY DEVASCULARISATION (ONE PROCEDURE ONLY) BASE PRICE 4211 36380 25 GASTRO SURGERY GASTRO SURGERY SURGERY DGHAL SURGERY BASE PRICE 11785 24260 25 GASTRO SURGERY GASTRO SURGERY SURGERY DIAPHRAGMATIC HERNIA REPAIR BASE PRICE 4129 21500 25 GASTRO SURGERY GASTRO SURGERY SURGERY DIRECT OPERATION ON OESOPHAGUS FOR PORTAL HYPERTENSION BASE PRICE 4169 18200 25 GASTRO SURGERY GASTRO SURGERY SURGERY DISTAL GASTRECTOMY BASE PRICE 4201 18200 25 GASTRO SURGERY GASTRO SURGERY SURGERY DISTAL PANCREATECTOMY (GASTRO) BASE PRICE 4117 28670 25 GASTRO SURGERY GASTRO SURGERY SURGERY DISTAL SPLENORENAL SHUNT BASE PRICE 4214 36380 25 GASTRO SURGERY GASTRO SURGERY SURGERY DOUBLE BARREL COLOSTOMY / ILEOSTOMY BASE PRICE 4203 14550 25 GASTRO SURGERY GASTRO SURGERY SURGERY DRAINAGE OF INTRA-ABDOMINAL ABSCESS BASE PRICE 4118 14550 25 GASTRO SURGERY GASTRO SURGERY SURGERY DRAINAGE OF PERIGASTRIC ABSCESS BASE PRICE 4170 18200 25 GASTRO SURGERY GASTRO SURGERY SURGERY DRAINAGE OF SUBDIAPHRAGMATIC ABSCESS BASE PRICE 4171 21500 25 GASTRO SURGERY GASTRO SURGERY SURGERY DUODENOJEJUNOSTOMY BASE PRICE 4172 24260 25 GASTRO SURGERY GASTRO SURGERY SURGERY ENUCLEATION OF LEIOMYOMA (TRANSTHORACIC) BASE PRICE 4150 24260 25 GASTRO SURGERY GASTRO SURGERY SURGERY EXAMINATION UNDER GA/ANAL DILATATION UNDER GA BASE PRICE 4141 1220 25 GASTRO SURGERY GASTRO SURGERY SURGERY EXCISION HYDATID CYST LIVER - GRADE I BASE PRICE 4119 18200 25 GASTRO SURGERY GASTRO SURGERY SURGERY EXCISION HYDATID CYST LIVER - GRADE II BASE PRICE 4194 26460 25 GASTRO SURGERY GASTRO SURGERY SURGERY EXCISION OF ANAL POLYP BASE PRICE 4140 6620 25 GASTRO SURGERY GASTRO SURGERY SURGERY EXCISION OF ANAL WARTS BASE PRICE 4139 6070 25 GASTRO SURGERY GASTRO SURGERY SURGERY EXCISION OF LARGE/SMALL FIBROADENOMA UNDER U/S GUIDANCE BASE PRICE 4224 9700 25 GASTRO SURGERY GASTRO SURGERY SURGERY EXPLORATION (EMERGENCY) FOR PERFORATION/BILIOMA/OBSTRUCTION BASE PRICE 4122 21500 25 GASTRO SURGERY GASTRO SURGERY SURGERY EXPLORATION LAPAROTOMY + LN BIOPSY BASE PRICE 4120 14550 25 GASTRO SURGERY GASTRO SURGERY SURGERY EXPLORATION OF SINUS UNDER GA/LA BASE PRICE 4121 4850 25 GASTRO SURGERY GASTRO SURGERY SURGERY EXTENDED CHOLECYSTECTOMY BASE PRICE 4207 28670 25 GASTRO SURGERY GASTRO SURGERY SURGERY EXTERNAL DRAINAGE OF PSEUDOPANCREATIC CYST BASE PRICE 4235 12130 25 GASTRO SURGERY GASTRO SURGERY SURGERY FISTULA IN ANO (HIGH LEVEL) BASE PRICE 4248 18200 25 GASTRO SURGERY GASTRO SURGERY SURGERY FISTULECTOMY/SINUS EXPLORATION BASE PRICE 4138 14330 25 GASTRO SURGERY GASTRO SURGERY SURGERY FUNDOPLICATION BASE PRICE 4124 18200 25 GASTRO SURGERY GASTRO SURGERY SURGERY GASTRECTOMY BASE PRICE 4154 21830 25 GASTRO SURGERY GASTRO SURGERY SURGERY GASTRIC & DUODEL BIOPSY (ENDOSCOPIC) BASE PRICE 4173 2430 25 GASTRO SURGERY GASTRO SURGERY SURGERY GASTROJEJUNOSTOMY/LAPAROTOMY GASTROJEJUNOSTOMY BASE PRICE 4125 21500 25 GASTRO SURGERY GASTRO SURGERY SURGERY GASTROSTOMY BASE PRICE 4174 18200 25

Page 22 of 115 GASTRO SURGERY GASTRO SURGERY SURGERY GJ & VAGOTOMY BASE PRICE 4155 18200 25 GASTRO SURGERY GASTRO SURGERY SURGERY HAEMORRHAGE OF SMALL INTESTINES BASE PRICE 4188 24260 25 GASTRO SURGERY GASTRO SURGERY SURGERY HAEMORRHOIDS -LORDS PROCEDURE BASE PRICE 4187 6070 25 GASTRO SURGERY GASTRO SURGERY SURGERY HELLER’S OPERATION BASE PRICE 4175 18200 25 GASTRO SURGERY GASTRO SURGERY SURGERY HEMORRHOIDECTOMY BASE PRICE 4137 11470 25 GASTRO SURGERY GASTRO SURGERY SURGERY HEPATICOJEJUNOSTOMY BASE PRICE 4126 21830 25 GASTRO SURGERY GASTRO SURGERY SURGERY HEPATICOJEJUNOSTOMY FOR STRICTURE BASE PRICE 4222 25800 25 GASTRO SURGERY GASTRO SURGERY SURGERY HIATUS HERNIA OR STRICTURE DUE TO REFLUX BASE PRICE 4164 21830 25 GASTRO SURGERY GASTRO SURGERY SURGERY HIATUS HERNIA REPAIR TRANSTHORACIC BASE PRICE 4177 24260 25 GASTRO SURGERY GASTRO SURGERY SURGERY HIATUS HERNIA REPAIR- ABDOMINAL BASE PRICE 4176 18200 25 GASTRO SURGERY GASTRO SURGERY SURGERY HYDATID CYST (OPEN) BASE PRICE 4221 18200 25 GASTRO SURGERY GASTRO SURGERY SURGERY I & D ABSCESS - LARGE BASE PRICE 4196 6070 25 GASTRO SURGERY GASTRO SURGERY SURGERY I & D ABSCESS - SMALL BASE PRICE 4127 2430 25 GASTRO SURGERY GASTRO SURGERY SURGERY ILEOSTOMY BASE PRICE 4230 21500 25 GASTRO SURGERY GASTRO SURGERY SURGERY ILEOSTOMY CLOSURE BASE PRICE 4199 14550 25 GASTRO SURGERY GASTRO SURGERY SURGERY ILEOTRANSVERSE BYPASS BASE PRICE 4132 18200 25 GASTRO SURGERY GASTRO SURGERY SURGERY ILIEOSIGMOIDOSTOMY BASE PRICE 4178 30320 25 GASTRO SURGERY GASTRO SURGERY SURGERY ILIEOTRANSVERSE COLOSTOMY BASE PRICE 4179 30320 25 GASTRO SURGERY GASTRO SURGERY SURGERY INCISIONAL HERNIA / VENTRAL HERNIA WITHOUT MESH BASE PRICE 4233 15880 25 GASTRO SURGERY GASTRO SURGERY SURGERY INCISIONAL HERNIA REPAIR BASE PRICE 4128 19850 25 GASTRO SURGERY GASTRO SURGERY SURGERY INGUINAL HERNIOPLASTY MESH (UNILATERAL) BASE PRICE 4246 18520 25 GASTRO SURGERY GASTRO SURGERY SURGERY INGUINAL HERNIOPLASTY PROLENE HERNIA SYSTEM BASE PRICE 4247 16980 25 GASTRO SURGERY GASTRO SURGERY SURGERY INGUINAL HERNIORRHAPHY BASE PRICE 4130 15880 25 GASTRO SURGERY GASTRO SURGERY SURGERY INJECTION FOR HAEMORRHOIDS BASE PRICE 4180 6070 25 GASTRO SURGERY GASTRO SURGERY SURGERY INSULINOMA EXCISION BASE PRICE 4220 24260 25 GASTRO SURGERY GASTRO SURGERY SURGERY INTERPOSITION MESCO-CAVAL SHUNT (L.R. SHUNT) BASE PRICE 4215 36380 25 GASTRO SURGERY GASTRO SURGERY SURGERY INTERPOSITION MESOCAVAL SHUNT BASE PRICE 4213 30320 25 GASTRO SURGERY GASTRO SURGERY SURGERY INTESTINAL FISTULA BASE PRICE 4152 30320 25 GASTRO SURGERY GASTRO SURGERY SURGERY INTESTINAL OBSTRUCTION BASE PRICE 4185 19850 25 GASTRO SURGERY GASTRO SURGERY SURGERY INTESTINAL PERFORATION BASE PRICE 4186 19850 25 GASTRO SURGERY GASTRO SURGERY SURGERY INTRA OPERATIVE DOPPLER (CONSUMABLES EXTRA) BASE PRICE 4116 1220 25 GASTRO SURGERY GASTRO SURGERY SURGERY JEJUNOSTOMY BASE PRICE 4181 9700 25 GASTRO SURGERY GASTRO SURGERY SURGERY LEFT HEMICOLECTOMY BASE PRICE 4206 24260 25 GASTRO SURGERY GASTRO SURGERY SURGERY LEFT HEPATECTOMY BASE PRICE 4236 43000 25 GASTRO SURGERY GASTRO SURGERY SURGERY LIVER ABSCESS DRAINAGE (OPEN) BASE PRICE 4146 21500 25 GASTRO SURGERY GASTRO SURGERY SURGERY LIVER RESECTION BASE PRICE 4103 39690 25 GASTRO SURGERY GASTRO SURGERY SURGERY LIVER RESECTION WITH EXCISION OF CBD BASE PRICE 4239 36380 25 GASTRO SURGERY GASTRO SURGERY SURGERY LOOP COLOSTOMY TRANSVERSE SIGMOID BASE PRICE 4182 18200 25 GASTRO SURGERY GASTRO SURGERY SURGERY MAL-ROTATION & VOLVULUS OF THE MIDGUT BASE PRICE 4183 24260 25 GASTRO SURGERY GASTRO SURGERY SURGERY MESENTERICOCAVAL ANASTOMOSIS BASE PRICE 4216 36380 25 GASTRO SURGERY GASTRO SURGERY SURGERY MESENTRIC CYST EXCISION BASE PRICE 4204 18200 25 GASTRO SURGERY GASTRO SURGERY SURGERY MULTIPLE RESECTION AND ANASTOMOSIS BASE PRICE 4161 28670 25 GASTRO SURGERY GASTRO SURGERY SURGERY OPEN CHOLECYSTECTOMY BASE PRICE 4110 17200 25 GASTRO SURGERY GASTRO SURGERY SURGERY OPEN CHOLECYSTECTOMY WITH CBD EXPLORATION BASE PRICE 4111 23810 25 GASTRO SURGERY GASTRO SURGERY SURGERY OPEN DRAINAGE OF PERINEPHERIC ABSCESS BASE PRICE 4184 12130 25 GASTRO SURGERY GASTRO SURGERY SURGERY OPERATION FOR BLEEDING PEPTIC ULCER BASE PRICE 4226 18200 25 GASTRO SURGERY GASTRO SURGERY SURGERY PANCREATIC NECROSECTOMY - GRADE I BASE PRICE 4104 19850 25 GASTRO SURGERY GASTRO SURGERY SURGERY PANCREATIC NECROSECTOMY - GRADE II BASE PRICE 4193 26460 25

Page 23 of 115 GASTRO SURGERY GASTRO SURGERY SURGERY PANCREATICO - JEJUNOSTOMY BASE PRICE 4163 21830 25 GASTRO SURGERY GASTRO SURGERY SURGERY PARAUMBILICAL HERNIA BASE PRICE 4234 12130 25 GASTRO SURGERY GASTRO SURGERY SURGERY PARTIAL GASTRECTOMY BASE PRICE 4200 19850 25 GASTRO SURGERY GASTRO SURGERY SURGERY PARTIAL LIVER RESECTION (LATERAL SEGMENTECTOMY) BASE PRICE 4237 36380 25 GASTRO SURGERY GASTRO SURGERY SURGERY PARTIAL PANCREATECTOMY BASE PRICE 4149 24260 25 GASTRO SURGERY GASTRO SURGERY SURGERY PEG BASE PRICE 12646 15440 25 GASTRO SURGERY GASTRO SURGERY SURGERY PELVIC COLOSTOMY BASE PRICE 4232 18200 25 GASTRO SURGERY GASTRO SURGERY SURGERY PILES SURGERY BY RADIO FREQUENCY BASE PRICE 11786 24260 25 GASTRO SURGERY GASTRO SURGERY SURGERY PORTAVACAL SHUNT WITH/WITHOUT SPLENECTOMY BASE PRICE 4210 36380 25 GASTRO SURGERY GASTRO SURGERY SURGERY PORTO - ENTEROSTOMY BASE PRICE 4105 24260 25 GASTRO SURGERY GASTRO SURGERY SURGERY PYLOROMYOTOMY BASE PRICE 4202 12130 25 GASTRO SURGERY GASTRO SURGERY SURGERY PYLOROPLASTY BASE PRICE 4123 14550 25 GASTRO SURGERY GASTRO SURGERY SURGERY RE-EXPLORATION (ELECTIVE) POSTOPERATIVE ETC. BASE PRICE 4135 12130 25 GASTRO SURGERY GASTRO SURGERY SURGERY RECTOPEXY - MESH BASE PRICE 4197 23810 25 GASTRO SURGERY GASTRO SURGERY SURGERY RECTOPEXY - SUTURE BASE PRICE 4134 19400 25 GASTRO SURGERY GASTRO SURGERY SURGERY RECURRENT INTESTINAL OBSTRUCTION (NOBLE PLICATION & OTHER OPERATIONSBASE FOR PRICEADHESIONS) 4189 30320 25 GASTRO SURGERY GASTRO SURGERY SURGERY REPAIR OF BURST ABDOMEN BASE PRICE 4136 14550 25 GASTRO SURGERY GASTRO SURGERY SURGERY RESECTION OF COMMON HEPATIC DUCT AND REPAIR BASE PRICE 4223 28670 25 GASTRO SURGERY GASTRO SURGERY SURGERY RESTORATIVE PROCTOCOLECTOMY BASE PRICE 4245 24260 25 GASTRO SURGERY GASTRO SURGERY SURGERY RETROPERITONEAL DRAINAGE OF ABSCESS BASE PRICE 4145 13230 25 GASTRO SURGERY GASTRO SURGERY SURGERY RETROPERITONEAL TUMOR EXCISION BASE PRICE 4147 24260 25 GASTRO SURGERY GASTRO SURGERY SURGERY RIGHT HEMICOLECTOMY BASE PRICE 4205 18200 25 GASTRO SURGERY GASTRO SURGERY SURGERY RIGHT HEPATECTOMY BASE PRICE 4241 42450 25 GASTRO SURGERY GASTRO SURGERY SURGERY RIGHT TRISEGMENTECTOMY BASE PRICE 4240 36380 25 GASTRO SURGERY GASTRO SURGERY SURGERY ROUZ-N-Y CYSTOJEJUNOSTOMY BASE PRICE 4151 18200 25 GASTRO SURGERY GASTRO SURGERY SURGERY SHUNT/DEVASCULARIZATION BASE PRICE 4113 36380 25 GASTRO SURGERY GASTRO SURGERY SURGERY SIGMOID & DESCENDING COLECTOMY BASE PRICE 4225 24260 25 GASTRO SURGERY GASTRO SURGERY SURGERY SIGMOID DIVERTICULITIS BASE PRICE 4190 24260 25 GASTRO SURGERY GASTRO SURGERY SURGERY SIGMOID MYOTOMY BASE PRICE 4157 18200 25 GASTRO SURGERY GASTRO SURGERY SURGERY SIGMOIDOSCOPY WITH OR WITHOUT BIOPSY BASE PRICE 4158 6070 25 GASTRO SURGERY GASTRO SURGERY SURGERY SMALL BOWEL RESECTION BASE PRICE 4115 19850 25 GASTRO SURGERY GASTRO SURGERY SURGERY SPLENECTOMY BASE PRICE 4112 14940 25 GASTRO SURGERY GASTRO SURGERY SURGERY SPLENECTOMY - FOR TRAUMA BASE PRICE 4229 19400 25 GASTRO SURGERY GASTRO SURGERY SURGERY SPLENORENAL ANASTOMOSIS BASE PRICE 4217 24260 25 GASTRO SURGERY GASTRO SURGERY SURGERY STAPLER HAEMORRHOIDECTOMY BASE PRICE 4192 14330 25 GASTRO SURGERY GASTRO SURGERY SURGERY SUB TOTAL GASTRECTOMY BASE PRICE 4227 28560 25 GASTRO SURGERY GASTRO SURGERY SURGERY SUB-CARDIAC PORTA-AZYGOS DISCONNECTION & DEVASCULARIZATION (BOTH PROCEDURES)BASE PRICE 4212 36380 25 GASTRO SURGERY GASTRO SURGERY SURGERY SUBTOTAL COLECTOMY BASE PRICE 4209 21830 25 GASTRO SURGERY GASTRO SURGERY SURGERY TERMINAL COLOSTOMY BASE PRICE 4231 18200 25 GASTRO SURGERY GASTRO SURGERY SURGERY TOTAL MESORECTAL EXCISION BASE PRICE 4143 33080 25 GASTRO SURGERY GASTRO SURGERY SURGERY TOTAL PROCTOCOLECTOMY BASE PRICE 4156 24260 25 GASTRO SURGERY GASTRO SURGERY SURGERY TRANSECTION OF OESOPHAGUS AND USE OF EEA STAPLER BASE PRICE 4148 30320 25 GASTRO SURGERY GASTRO SURGERY SURGERY TRANSHIATAL OESOPHAGECTOMY BASE PRICE 4144 30320 25 GASTRO SURGERY GASTRO SURGERY SURGERY TRANSVERSE COLECTOMY BASE PRICE 4208 18200 25 GASTRO SURGERY GASTRO SURGERY SURGERY TRISEGMENTECTOMY BASE PRICE 4242 36380 25 GASTRO SURGERY GASTRO SURGERY SURGERY TUBE CAECOSTOMY BASE PRICE 4159 18200 25 GASTRO SURGERY GASTRO SURGERY SURGERY VOLVULUS OF COLON (RESECTION ANASTOMOSIS) BASE PRICE 4160 26460 25 GASTRO SURGERY GASTRO SURGERY SURGERY VOLVULUS OF LARGE BOWEL BASE PRICE 4191 21830 25

Page 24 of 115 GASTRO SURGERY GASTRO SURGERY SURGERY VOLVULUS OF STOMACH BASE PRICE 4142 24260 25 GASTRO SURGERY GASTRO SURGERY SURGERY WARREN SHUNT BASE PRICE 4218 24260 25 GASTRO SURGERY GASTRO SURGERY SURGERY ZOLLINGER ELLISION SYNDROME TOTAL GASTRECTOMY INTERPOSITION FOR PROBLEMSBASE PRICE 4238 48510 25 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES ACHALASIA DILATATION BASE PRICE 4308 10980 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES APC - MAJOR BASE PRICE 4346 9780 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES APC - SIMPLE BASE PRICE 4315 4900 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES ASCITIC TAP (DIAGNOSTIC) BASE PRICE 11612 1900 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES BLEEDING ULCER INJECTION / BIPOLAR COAGULATION BASE PRICE 4309 8260 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES CAPSULE ENDOSCOPY BASE PRICE 4339 41930 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES CBD stone extraction BASE PRICE 4357 17790 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES CBD stricture dilatation BASE PRICE 4358 17790 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES COLONIC METAL STENTING BASE PRICE 4322 17790 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES COLONIC POLYPECTOMY BASE PRICE 4320 9240 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES Colonic stricture dilatation BASE PRICE 4363 11550 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES COLONOSCOPY LEFT LIMITED BASE PRICE 4317 3180 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES COLONOSCOPY - II BASE PRICE 4367 5590 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES COLONOSCOPY AND BLEED MANAGEMENT BASE PRICE 4321 6990 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES COLONOSCOPY FULL LENGTH BASE PRICE 4316 5900 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES DIAGNOSTIC UGI ENDOSCOPY BASE PRICE 4301 3470 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES DIS-IMPACTION BASE PRICE 11610 700 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES Duodel stricture dilation BASE PRICE 4364 9780 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES EMERGENCY MANAGEMENT OF GI BLEED BASE PRICE 4307 15020 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES EMR BASE PRICE 4347 6990 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES ENDOSCOPIC BIOPSY CHARGES BASE PRICE 4330 890 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES ENDOSCOPIC PROCEDURE - COMPLEX BASE PRICE 4337 6990 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES ENDOSCOPIC PROCEDURE - MAJOR BASE PRICE 4336 5590 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES ENDOSCOPIC PROCEDURE - SIMPLE BASE PRICE 4335 2790 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES ENDOSCOPY BRUSH CHARGE BASE PRICE 4342 890 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES Enteral stenting BASE PRICE 4362 16780 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES ENTEROSCOPY BASE PRICE 4348 6990 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES ERCP - EPT BASE PRICE 4353 13340 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES ERCP Balloon dilatation of papilla BASE PRICE 4355 13980 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES ERCP Biliary stenting BASE PRICE 4356 16520 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES ERCP DIAGNOSTIC BASE PRICE 4326 10160 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES ERCP THERAPEUTIC BASE PRICE 4327 16750 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES ESOPHAGEAL / GASTRIC / DUODENAL POLYPECTOMY BASE PRICE 4310 12070 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES ESOPHAGEAL STENTING BASE PRICE 4311 13980 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES ESOPHAGEAL STRICTURE DILATATION BASE PRICE 4306 8900 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES EST - MAJOR BASE PRICE 4354 8900 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES EST - SIMPLE BASE PRICE 4369 7830 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES EST / EVL FOR ACTIVE BLEED BASE PRICE 4304 9150 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES EVL - MAJOR BASE PRICE 4370 7830 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES EVL - SIMPLE BASE PRICE 4303 4190 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES FNAB BASE PRICE 4333 5590 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES FNAC BASE PRICE 4332 3500 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES FOREIGN BODY REMOVAL BASE PRICE 4314 11440 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES FUNDAL VARICEAL GLUE INJECTION BASE PRICE 4305 9240 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES GASTRIC VARICEAL BANDING BASE PRICE 4344 6990 0

Page 25 of 115 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES Gastroscopy BASE PRICE 4366 2540 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES HOT BIOPSY FORCEPS PROCEDURE BASE PRICE 4349 6990 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES LIGATOR BAND (PANTAGUN) BASE PRICE 4345 2100 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES MECHANICAL LITHOTRIPSY BASE PRICE 4350 34940 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES METAL BILIARY STENTING BASE PRICE 4328 20970 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES NASAL JEJUNUM FEEDING TUBE PLACEMENT BASE PRICE 4343 8670 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES Oesophageal stricture dilatation BASE PRICE 4365 7940 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES Oesophagoscopy BASE PRICE 4371 1670 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES PANCREATIC PSEUDOCYST DRAINAGE / CYSTO-GASTRIC STENTING BASE PRICE 4329 16900 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES Pancreatic sphincterotomy BASE PRICE 4359 13980 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES Pancreatic stone extraction BASE PRICE 4360 19570 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES Pancreatic stricture dilatation BASE PRICE 4361 18040 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES PCD / LIVER ABSCESS DRAINAGE BASE PRICE 4324 6990 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES PEG BASE PRICE 4313 16170 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES PEJ BASE PRICE 4338 9090 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES PERCUTANEOUS LIVER BIOPSY BASE PRICE 4331 5590 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES PH MONITORING BASE PRICE 4351 4190 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES PILES BANDING BASE PRICE 4318 8670 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES PLACEMENT OF SB TUBE BASE PRICE 4302 5080 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES PTBD / STENTING BASE PRICE 4323 15250 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES PYLORIC / DUODENAL STRICTURE DILATATION BASE PRICE 4312 5590 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES RAPID UREASE TEST (RUT) BASE PRICE 4340 420 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES RT PLACEMENT (UGI) BASE PRICE 4341 6360 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES SIDE VIEWING ENDOSCOPY BASE PRICE 4325 4140 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES SIGMOIDOSCOPY BASE PRICE 4319 2860 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES THERAPEUTIC PARACENTESIS BASE PRICE 11611 3700 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES TRANSJUGULAR LIVER BIOPSY BASE PRICE 4334 11180 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES Upper G.I.Endoscopy - II BASE PRICE 4368 6360 0 GASTROENTEROLOGY GASTROENTEROLOGY PROCEDURES UPPER GI ENDOSCOPY WITH BIOPSY BASE PRICE 4352 3470 0 GASTROENTEROLOGY SURGICAL PROCEDURE ENDOSCOPY DONE IN OT BASE PRICE 13221 6990 25 GASTROENTEROLOGY DONE IN OT GASTROENTEROLOGY SURGICAL PROCEDURE ERCP DONE IN OT BASE PRICE 13220 16750 25 GASTROENTEROLOGY DONE IN OT GENERAL SURGERY GENERAL SURGERY SURGERY 95% PANCREATECTOMY BASE PRICE 4957 41930 25 GENERAL SURGERY GENERAL SURGERY SURGERY ABDOMINO PERINEAL EXCISION BASE PRICE 4867 37420 25 GENERAL SURGERY GENERAL SURGERY SURGERY ADHESIONOLYSIS OR DIVISION OF BANDS (ABDOMEN) BASE PRICE 4929 22180 25 GENERAL SURGERY GENERAL SURGERY SURGERY ANTERIOR RESECTION BASE PRICE 4931 31880 25 GENERAL SURGERY GENERAL SURGERY SURGERY APENDICULAR ABCESS DRAINAGE BASE PRICE 4908 19400 25 GENERAL SURGERY GENERAL SURGERY SURGERY APPENDECTOMY BASE PRICE 4837 19400 25 GENERAL SURGERY GENERAL SURGERY SURGERY ASPIRATION OF LIVER ABSCESS BASE PRICE 4924 6360 25 GENERAL SURGERY GENERAL SURGERY SURGERY AUXILLARY / INGUINAL BIOPSY BASE PRICE 4803 5540 25 GENERAL SURGERY GENERAL SURGERY SURGERY BENIGN TUMOURS OF SMALL INTESTINE BASE PRICE 4966 20970 25 GENERAL SURGERY GENERAL SURGERY SURGERY BILATERAL INGUINAL HERNIA / TISSUE BASE PRICE 4921 26690 25 GENERAL SURGERY GENERAL SURGERY SURGERY BREAST LUMP EXCISION LARGE BASE PRICE 4812 10160 25 GENERAL SURGERY GENERAL SURGERY SURGERY BREAST LUMP EXCISION SMALL BASE PRICE 4811 6360 25 GENERAL SURGERY GENERAL SURGERY SURGERY CERVICAL LYMPH NODE BIOPSY BASE PRICE 4802 6930 25 GENERAL SURGERY GENERAL SURGERY SURGERY CHOLECYSTECTOMY & EXPLORATION OF CBD BASE PRICE 4826 24950 25 GENERAL SURGERY GENERAL SURGERY SURGERY CHOLECYSTECTOMY (OPEN) BASE PRICE 4827 18020 25

Page 26 of 115 GENERAL SURGERY GENERAL SURGERY SURGERY CHOLECYSTOSTOMY BASE PRICE 4825 15250 25 GENERAL SURGERY GENERAL SURGERY SURGERY CHOLEDOCHODUODENOSTOMY BASE PRICE 4828 29110 25 GENERAL SURGERY GENERAL SURGERY SURGERY CIRCUMCISSION BASE PRICE 4914 6930 25 GENERAL SURGERY GENERAL SURGERY SURGERY COLOSTOMY / ILEOSTOMY / TERMINAL COLOSTOMY BASE PRICE 4836 24950 25 GENERAL SURGERY GENERAL SURGERY SURGERY CONGENITAL DIAPH-HERNIA BASE PRICE 4842 24950 25 GENERAL SURGERY GENERAL SURGERY SURGERY CVP LINE BASE PRICE 12256 3180 25 GENERAL SURGERY GENERAL SURGERY SURGERY DELAYED PRIMARY SUTURE BASE PRICE 4926 3180 25 GENERAL SURGERY GENERAL SURGERY SURGERY DEVASCULARISATION (ONE PROCEDURE ONLY) BASE PRICE 4949 45740 25 GENERAL SURGERY GENERAL SURGERY SURGERY DIABETIC FOOT / CARBUNCLE BASE PRICE 4902 6360 25 GENERAL SURGERY GENERAL SURGERY SURGERY DISTAL SPLENORENAL SHUNT BASE PRICE 4952 38120 25 GENERAL SURGERY GENERAL SURGERY SURGERY DRAINAGE ABSCESS - LARGE BASE PRICE 4877 4160 25 GENERAL SURGERY GENERAL SURGERY SURGERY DRAINAGE ABSCESS - SMALL BASE PRICE 4876 1900 25 GENERAL SURGERY GENERAL SURGERY SURGERY DRAINAGE BREAST ABSCESS - LARGE BASE PRICE 4875 4440 25 GENERAL SURGERY GENERAL SURGERY SURGERY DRAINAGE BREAST ABSCESS - SMALL BASE PRICE 4874 2540 25 GENERAL SURGERY GENERAL SURGERY SURGERY DRAINAGE OF PELVIC ABSCESS BASE PRICE 4933 22870 25 GENERAL SURGERY GENERAL SURGERY SURGERY DRAINAGE OF PEROTID ABSCESS BASE PRICE 4934 6360 25 GENERAL SURGERY GENERAL SURGERY SURGERY DRAINAGE OF PSOAS ABSCES BASE PRICE 4892 10520 25 GENERAL SURGERY GENERAL SURGERY SURGERY DRAINAGE OF RETROPHARYNGEAL ABSCESS BASE PRICE 4935 6360 25 GENERAL SURGERY GENERAL SURGERY SURGERY DRAINAGE PLURAL CAVITY BASE PRICE 4864 2290 25 GENERAL SURGERY GENERAL SURGERY SURGERY DRAINAGE WITH RETROPERITONEAL ABCESS BASE PRICE 4913 16630 25 GENERAL SURGERY GENERAL SURGERY SURGERY DRESSING OT UNDER GA LARGE BASE PRICE 4975 7620 25 GENERAL SURGERY GENERAL SURGERY SURGERY DRESSING OT UNDER GA MEDIUM BASE PRICE 4974 5080 25 GENERAL SURGERY GENERAL SURGERY SURGERY DRESSING OT UNDER GA SMALL BASE PRICE 4863 2540 25 GENERAL SURGERY GENERAL SURGERY SURGERY EPIGASTRIC HERNIA - PROLENE HERNIA SYSTEM BASE PRICE 4845 16630 25 GENERAL SURGERY GENERAL SURGERY SURGERY EPIGASTRIC HERNIA - TISSUE REPAIR BASE PRICE 4844 16630 25 GENERAL SURGERY GENERAL SURGERY SURGERY EXCISION BRANCHIAL SINUS BASE PRICE 4807 10160 25 GENERAL SURGERY GENERAL SURGERY SURGERY EXCISION OF BURSA LARGE BASE PRICE 4976 9530 25 GENERAL SURGERY GENERAL SURGERY SURGERY EXCISION OF BURSA SMALL BASE PRICE 4868 6360 25 GENERAL SURGERY GENERAL SURGERY SURGERY EXCISION OF DERMOID CYST BASE PRICE 4927 3180 25 GENERAL SURGERY GENERAL SURGERY SURGERY EXCISION OF DERMOID CYST NECK BASE PRICE 4878 12710 25 GENERAL SURGERY GENERAL SURGERY SURGERY EXCISION OF LARGE/SMALL FIBROADENOMA UNDER U/S GUIDANCE BASE PRICE 4962 10160 25 GENERAL SURGERY GENERAL SURGERY SURGERY EXCISION OF SEBACEOUS CYSTS - LARGE BASE PRICE 4873 4160 25 GENERAL SURGERY GENERAL SURGERY SURGERY EXCISION OF SEBACEOUS CYSTS - MEDIUM BASE PRICE 4872 2770 25 GENERAL SURGERY GENERAL SURGERY SURGERY EXCISION OF SEBACEOUS CYSTS - SMALL BASE PRICE 4871 2080 25 GENERAL SURGERY GENERAL SURGERY SURGERY EXCISION OF SIGMOID VOLVULUS BASE PRICE 4881 24150 25 GENERAL SURGERY GENERAL SURGERY SURGERY EXCISION OF SUBMANDICULAR GLAND BASE PRICE 4879 12710 25 GENERAL SURGERY GENERAL SURGERY SURGERY EXCISION OF SUPERFICIAL LIPOMA - LARGE BASE PRICE 4938 12470 25 GENERAL SURGERY GENERAL SURGERY SURGERY EXCISION OF SUPERFICIAL LIPOMA - MEDIUM BASE PRICE 4937 6930 25 GENERAL SURGERY GENERAL SURGERY SURGERY EXCISION OF SUPERFICIAL LIPOMA - SMALL BASE PRICE 4936 2770 25 GENERAL SURGERY GENERAL SURGERY SURGERY EXCISION OF SUPRAACLAVICULAR LYMPH NODE MASS BASE PRICE 4813 15250 25 GENERAL SURGERY GENERAL SURGERY SURGERY EXCISION PILONDALSINUS BASE PRICE 4854 16630 25 GENERAL SURGERY GENERAL SURGERY SURGERY EXCISION RANULA BASE PRICE 4801 7620 25 GENERAL SURGERY GENERAL SURGERY SURGERY EXCISION RECTAL POLYP BASE PRICE 4860 6360 25 GENERAL SURGERY GENERAL SURGERY SURGERY EXCISION SCAR / MOLE / CYST BASE PRICE 4805 6360 25 GENERAL SURGERY GENERAL SURGERY SURGERY EXCISION SUPERFICIAL LUMPS BASE PRICE 4804 6930 25 GENERAL SURGERY GENERAL SURGERY SURGERY EXCISION WITH MULTIPLE SEBACEOUS CYST OF SCROTAL SKIN BASE PRICE 4920 10160 25 GENERAL SURGERY GENERAL SURGERY SURGERY EXPLORATORY LAPARATOMY BASE PRICE 4817 19400 25 GENERAL SURGERY GENERAL SURGERY SURGERY FEMORAL HERNIA BASE PRICE 4839 22870 25

Page 27 of 115 GENERAL SURGERY GENERAL SURGERY SURGERY FISSURE - ANO DILATATION BASE PRICE 4866 3610 25 GENERAL SURGERY GENERAL SURGERY SURGERY FISSURECTOMY BASE PRICE 4857 12010 25 GENERAL SURGERY GENERAL SURGERY SURGERY GASTROSTOMY BASE PRICE 4815 15250 25 GENERAL SURGERY GENERAL SURGERY SURGERY GJ & VAGOTOMY BASE PRICE 4928 22870 25 GENERAL SURGERY GENERAL SURGERY SURGERY GUN SHOT INJURY (LEVEL 1) BASE PRICE 4899 19400 25 GENERAL SURGERY GENERAL SURGERY SURGERY GUN SHOT INJURY (LEVEL 2) BASE PRICE 4900 29110 25 GENERAL SURGERY GENERAL SURGERY SURGERY GUN SHOT INJURY (LEVEL 3) BASE PRICE 4901 38810 25 GENERAL SURGERY GENERAL SURGERY SURGERY GYNAECOMSTIA EXCISION LARGE BASE PRICE 4810 15250 25 GENERAL SURGERY GENERAL SURGERY SURGERY GYNAECOMSTIA EXCISION SMALL BASE PRICE 4809 10160 25 GENERAL SURGERY GENERAL SURGERY SURGERY HAEMANGIOMA EXCISION & REPAIR - LARGE BASE PRICE 4897 15250 25 GENERAL SURGERY GENERAL SURGERY SURGERY HAEMANGIOMA EXCISION & REPAIR - SMALL BASE PRICE 4896 5720 25 GENERAL SURGERY GENERAL SURGERY SURGERY HEAMORROIDE EXCISION BASE PRICE 4855 11090 25 GENERAL SURGERY GENERAL SURGERY SURGERY HEPATICOJEJUNOSTOMY FOR STRICTURE BASE PRICE 4960 29110 25 GENERAL SURGERY GENERAL SURGERY SURGERY HIDRAADENITIS AXILLA EXCISION & REPAIR BASE PRICE 4891 5080 25 GENERAL SURGERY GENERAL SURGERY SURGERY HIG. SELTV. VAGOTOMY BASE PRICE 4833 26690 25 GENERAL SURGERY GENERAL SURGERY SURGERY HIGH FISTULECTOMY BASE PRICE 4858 22870 25 GENERAL SURGERY GENERAL SURGERY SURGERY HYDADIT CYST LIVER BASE PRICE 4824 24950 25 GENERAL SURGERY GENERAL SURGERY SURGERY HYDATID CYST (OPEN) BASE PRICE 4959 22870 25 GENERAL SURGERY GENERAL SURGERY SURGERY HYDROCELE BILATERAL BASE PRICE 4850 16630 25 GENERAL SURGERY GENERAL SURGERY SURGERY HYDROCELE UNILATERAL BASE PRICE 4849 8320 25 GENERAL SURGERY GENERAL SURGERY SURGERY ILEOSTOMY BASE PRICE 4969 24950 25 GENERAL SURGERY GENERAL SURGERY SURGERY INCISION BIOPSY GR/ULCER BASE PRICE 4870 2290 25 GENERAL SURGERY GENERAL SURGERY SURGERY INCISIONAL HERNIA / VENTRAL HERNIA WITHOUT MESH BASE PRICE 4972 19400 25 GENERAL SURGERY GENERAL SURGERY SURGERY INGUINAL HERNIOPLASTY MESH (BILATERAL) BASE PRICE 4911 30490 25 GENERAL SURGERY GENERAL SURGERY SURGERY INGUINAL HERNIOPLASTY MESH (UNILATERAL) BASE PRICE 4840 19400 25 GENERAL SURGERY GENERAL SURGERY SURGERY INGUINAL HERNIOPLASTY PHS (BILATERAL) BASE PRICE 4912 33260 25 GENERAL SURGERY GENERAL SURGERY SURGERY INGUINAL HERNIORRAPHY BASE PRICE 4838 17330 25 GENERAL SURGERY GENERAL SURGERY SURGERY INGUINAL HERNIORRHAPHY TISSUE REPAIR BASE PRICE 4841 17790 25 GENERAL SURGERY GENERAL SURGERY SURGERY INJECTION FOR VARICOSE VEINS BASE PRICE 4939 6360 25 GENERAL SURGERY GENERAL SURGERY SURGERY INJURY TONGUE REPAIR - LARGE BASE PRICE 4888 8900 25 GENERAL SURGERY GENERAL SURGERY SURGERY INJURY TONGUE REPAIR - SMALL BASE PRICE 4887 6360 25 GENERAL SURGERY GENERAL SURGERY SURGERY INSULINOMA EXCISION BASE PRICE 4958 30490 25 GENERAL SURGERY GENERAL SURGERY SURGERY INTERNAL HAEMARRHOIDECTOMY BASE PRICE 4865 11090 25 GENERAL SURGERY GENERAL SURGERY SURGERY INTERPOSITION MESCO-CAVAL SHUNT (L.R. SHUNT) BASE PRICE 4953 38120 25 GENERAL SURGERY GENERAL SURGERY SURGERY INTERPOSITION MESOCAVAL SHUNT BASE PRICE 4951 31770 25 GENERAL SURGERY GENERAL SURGERY SURGERY INTESSUCEPTION SECTION BASE PRICE 4822 22870 25 GENERAL SURGERY GENERAL SURGERY SURGERY INTESTINAL / GASTRIC PERFORATION BASE PRICE 4820 24950 25 GENERAL SURGERY GENERAL SURGERY SURGERY INTESTINAL OBSTRUCTION BASE PRICE 4818 24950 25 GENERAL SURGERY GENERAL SURGERY SURGERY INTRA ORAL REMOVAL OF SUBMANDIBULAR DUCT CALCULUS BASE PRICE 4910 7620 25 GENERAL SURGERY GENERAL SURGERY SURGERY ISHEORECTAL ABCESS DRAINAGE BASE PRICE 4918 9010 25 GENERAL SURGERY GENERAL SURGERY SURGERY LAPAROTOMY & PROCEED BASE PRICE 4816 15250 25 GENERAL SURGERY GENERAL SURGERY SURGERY LOW FISTULECTOMY BASE PRICE 4859 12710 25 GENERAL SURGERY GENERAL SURGERY SURGERY LT COLECTOMY / SIGMOID BASE PRICE 4906 30490 25 GENERAL SURGERY GENERAL SURGERY SURGERY LUMPECTOMY BASE PRICE 4932 6360 25 GENERAL SURGERY GENERAL SURGERY SURGERY MEAKEL'S DIVERTICULAM BASE PRICE 4821 24150 25 GENERAL SURGERY GENERAL SURGERY SURGERY MESENTERIC CYST EXCISION - LARGE BASE PRICE 4894 25410 25 GENERAL SURGERY GENERAL SURGERY SURGERY MESENTERIC CYST EXCISION - SMALL BASE PRICE 4893 19690 25 GENERAL SURGERY GENERAL SURGERY SURGERY MESENTERICOCAVAL ANASTOMOSIS BASE PRICE 4954 38120 25

Page 28 of 115 GENERAL SURGERY GENERAL SURGERY SURGERY MICRODOCHOTOMY BASE PRICE 4806 6360 25 GENERAL SURGERY GENERAL SURGERY SURGERY OMENTAL CYST EXCISION BASE PRICE 4895 17790 25 GENERAL SURGERY GENERAL SURGERY SURGERY OMENTECTOMY BASE PRICE 4923 17790 25 GENERAL SURGERY GENERAL SURGERY SURGERY OPEN DRAINAGE IN LIVER BASE PRICE 4909 21020 25 GENERAL SURGERY GENERAL SURGERY SURGERY OPERATION FOR BLEEDING PEPTIC ULCER BASE PRICE 4964 24950 25 GENERAL SURGERY GENERAL SURGERY SURGERY PAEDIATRIC EXCISION BRANCHEAL SINUS BASE PRICE 4808 12710 25 GENERAL SURGERY GENERAL SURGERY SURGERY PAEDIATRIC ING. HERNIOTOMY BASE PRICE 4848 12710 25 GENERAL SURGERY GENERAL SURGERY SURGERY PANCREODEUODONECTOMY BASE PRICE 4830 38120 25 GENERAL SURGERY GENERAL SURGERY SURGERY PARAUMBILICAL HERNIA BASE PRICE 4973 16630 25 GENERAL SURGERY GENERAL SURGERY SURGERY PELVIC COLOSTOMY BASE PRICE 4971 22870 25 GENERAL SURGERY GENERAL SURGERY SURGERY PERFORATED PEPTIC ULCER BASE PRICE 4940 22870 25 GENERAL SURGERY GENERAL SURGERY SURGERY PERIANAL ABCESS BASE PRICE 4907 6360 25 GENERAL SURGERY GENERAL SURGERY SURGERY PORTAVACAL SHUNT WITH/WITHOUT SPLENECTOMY BASE PRICE 4948 38120 25 GENERAL SURGERY GENERAL SURGERY SURGERY PROLAPS RECTUM ABDOMINAL RECTOPEXY BASE PRICE 4862 20330 25 GENERAL SURGERY GENERAL SURGERY SURGERY PROLAPS RECTUM THIRSCH'S WIRING BASE PRICE 4861 10160 25 GENERAL SURGERY GENERAL SURGERY SURGERY PROLAPSE RECTUM - GRAHAMS OPERATION BASE PRICE 4941 8900 25 GENERAL SURGERY GENERAL SURGERY SURGERY RAMSTEDS OPERATION BASE PRICE 4977 11440 25 GENERAL SURGERY GENERAL SURGERY SURGERY RARE HERNIA (OBTURATOR, SPIGELION, POTTS, INTESTITIAL) BASE PRICE 4847 27030 25 GENERAL SURGERY GENERAL SURGERY SURGERY RECURRENT HERNIA REPAIR (HERNIORRHAPHY) BASE PRICE 4903 20970 25 GENERAL SURGERY GENERAL SURGERY SURGERY RECURRENT HERNIOPLASTY BASE PRICE 4904 22870 25 GENERAL SURGERY GENERAL SURGERY SURGERY RECURRENT HERNIOPLASTY (PHS) BASE PRICE 4905 21600 25 GENERAL SURGERY GENERAL SURGERY SURGERY RECURRENT INCISIONAL HERNIA WITH MESH BASE PRICE 4916 26330 25 GENERAL SURGERY GENERAL SURGERY SURGERY REMOVAL OF BENIGN TUMOR (SUPERFICIAL) BASE PRICE 4942 2540 25 GENERAL SURGERY GENERAL SURGERY SURGERY REPAIR OF CBD BASE PRICE 4943 24950 25 GENERAL SURGERY GENERAL SURGERY SURGERY RESECTION & ANASTAMOSIS INTESTINE BASE PRICE 4819 24950 25 GENERAL SURGERY GENERAL SURGERY SURGERY RESECTION OF COMMON HEPATIC DUCT AND REPAIR BASE PRICE 4961 33260 25 GENERAL SURGERY GENERAL SURGERY SURGERY RIGHT HEMICOLECTOMY BASE PRICE 4835 24020 25 GENERAL SURGERY GENERAL SURGERY SURGERY SECONDARY SUTURE ABDOMEN BASE PRICE 4869 11090 25 GENERAL SURGERY GENERAL SURGERY SURGERY SECONDARY SUTURE OF WOUNDS BASE PRICE 4944 6930 25 GENERAL SURGERY GENERAL SURGERY SURGERY SELECTIVE VAGOTOMY & DRAINAGE BASE PRICE 4945 20970 25 GENERAL SURGERY GENERAL SURGERY SURGERY SETON REMOVAL BASE PRICE 4915 3180 25 GENERAL SURGERY GENERAL SURGERY SURGERY SIGMOID & DESCENDING COLECTOMY BASE PRICE 4963 30490 25 GENERAL SURGERY GENERAL SURGERY SURGERY SIMPLE MASTECTOMY BASE PRICE 4814 13980 25 GENERAL SURGERY GENERAL SURGERY SURGERY SINUS EXPLORATION BASE PRICE 4856 7620 25 GENERAL SURGERY GENERAL SURGERY SURGERY SPLELECTOMY / HYPERPLESIA (OPEN) BASE PRICE 4829 24020 25 GENERAL SURGERY GENERAL SURGERY SURGERY SPLENECTOMY (OPEN) & SHUNT PROCEDURE BASE PRICE 4930 20330 25 GENERAL SURGERY GENERAL SURGERY SURGERY SPLENECTOMY - FOR TRAUMA BASE PRICE 4967 24150 25 GENERAL SURGERY GENERAL SURGERY SURGERY SPLENORENAL ANASTOMOSIS BASE PRICE 4955 30490 25 GENERAL SURGERY GENERAL SURGERY SURGERY SPLIT EAR LOBULE REPAIR - BOTH SIDES BASE PRICE 4890 2790 25 GENERAL SURGERY GENERAL SURGERY SURGERY SPLIT EAR LOBULE REPAIR - ONE SIDE BASE PRICE 4889 1400 25 GENERAL SURGERY GENERAL SURGERY SURGERY STRINGULATED VENTRAL OR INCISIONAL HERNIA BASE PRICE 4917 33260 25 GENERAL SURGERY GENERAL SURGERY SURGERY SUB TOTAL GASTRECTOMY BASE PRICE 4965 30490 25 GENERAL SURGERY GENERAL SURGERY SURGERY SUB-CARDIAC PORTA-AZYGOS DISCONNECTION & DEVASCULARIZATION (BOTH PROCEDURES)BASE PRICE 4950 45740 25 GENERAL SURGERY GENERAL SURGERY SURGERY SUPERFICIAL PAROTIDECTOMY BASE PRICE 4880 15250 25 GENERAL SURGERY GENERAL SURGERY SURGERY SUPERFICIAL VERISCOSITY (INJECTION) BASE PRICE 4946 1280 25 GENERAL SURGERY GENERAL SURGERY SURGERY SURRPUBIC DRAINAGE - CYSTOSTOMY BASE PRICE 4853 11440 25 GENERAL SURGERY GENERAL SURGERY SURGERY SUTURE OF LARGE LACERATION BASE PRICE 4922 8320 25 GENERAL SURGERY GENERAL SURGERY SURGERY SUTURING OF SMALL WOUNDS BASE PRICE 4947 2540 25

Page 29 of 115 GENERAL SURGERY GENERAL SURGERY SURGERY SYMPATHECTOMY CERVICAL BASE PRICE 4832 22870 25 GENERAL SURGERY GENERAL SURGERY SURGERY SYMPATHECTOMY LUMBAR BASE PRICE 4834 19060 25 GENERAL SURGERY GENERAL SURGERY SURGERY TERMINAL COLOSTOMY BASE PRICE 4970 22870 25 GENERAL SURGERY GENERAL SURGERY SURGERY TESTICULAR BIOPSY BASE PRICE 4852 5080 25 GENERAL SURGERY GENERAL SURGERY SURGERY TRANSVERS COLOSTOMY BASE PRICE 4968 22870 25 GENERAL SURGERY GENERAL SURGERY SURGERY UMBILECTOMY WITHOUT ENTERING ABDOMEN BASE PRICE 4919 11090 25 GENERAL SURGERY GENERAL SURGERY SURGERY UMBILECTOMY, ENTERING ABDOMINAL CAVITY BASE PRICE 4831 19400 25 GENERAL SURGERY GENERAL SURGERY SURGERY UMBILICAL HERNIA BASE PRICE 4846 16630 25 GENERAL SURGERY GENERAL SURGERY SURGERY VAGOTOMY PYLEROPLASTY / GASTROJEJUNOSTOMY BASE PRICE 4823 22870 25 GENERAL SURGERY GENERAL SURGERY SURGERY VARICOCELE LIGATION BASE PRICE 4851 7620 25 GENERAL SURGERY GENERAL SURGERY SURGERY VARICOSE VEIN - TRENDELENBERGH OPEN WITH MULTIPLE LIGATION BASE PRICE 4883 13980 25 GENERAL SURGERY GENERAL SURGERY SURGERY VARICOSE VEIN - TRENDELENBERGH OPEN WITH STRIPPING BASE PRICE 4882 16520 25 GENERAL SURGERY GENERAL SURGERY SURGERY VENTRAL & RARE HERNIA WITH MESH BASE PRICE 4843 22180 25 GENERAL SURGERY GENERAL SURGERY SURGERY WARREN SHUNT BASE PRICE 4956 30490 25 GENERAL SURGERY GENERAL SURGERY SURGERY WEDGE BIOPSY BASE PRICE 4898 2540 25 GENERAL SURGERY GENERAL SURGERY SURGERY WOUND DEBRIDEMENT BASE PRICE 4925 6930 25 GENERAL SURGERY GENERAL SURGERY SURGERY WOUND DEBRIDEMENT & EXCISION - LARGE BASE PRICE 4886 9700 25 GENERAL SURGERY GENERAL SURGERY SURGERY WOUND DEBRIDEMENT & EXCISION - MEDIUM BASE PRICE 4885 6240 25 GENERAL SURGERY GENERAL SURGERY SURGERY WOUND DEBRIDEMENT & EXCISION - SMALL BASE PRICE 4884 3050 25 IPD ADMISSION IPD ADMISSION ADMISSION CHARGES BASE PRICE 8369 500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT PRESIDENTIAL SUITE7367 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT DELUXE SUITE 7367 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SURGICAL HDU 7367 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT MEDICAL HDU 7367 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT NEUROLOGY ECNOMY7367 WARD 6 600 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT OBG HDU 7367 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT NEUROSURGERY DNB7367 600 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT CARDIOLOGY HDU 7367 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT GEN CARDIOLOGY WARD7367 2 250 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT GEN CARDIOLOGY WARD7367 1 600 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SUITE ROOM CRIB 7367 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SUITE ROOM 7367 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT OBG SEMI PRIVATE CRIB7367 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT OBG GEN CRIB 7367 600 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT OBG PRIVATE (CRIB)7367 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT NICU STEP DOWN 7367 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT PICU STEP DOWN 7367 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT TRANSPLANT ICU 7367 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT NMICU 7367 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SEMI PRIVATE 7367 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT PRIVATE ROOM 7367 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT PICU 7367 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT ONCOLOGY WARD 7367 600 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT OBG SEMI PRIVATE 7367 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT OBG PRIVATE 7367 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT OBG ECONOMY ROOM7367 600 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT NICU 7367 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT NEUROSURGERY WARD7367 MALE 600 0

Page 30 of 115 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT NEUROSURGERY WARD7367 FEMALE 600 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT NEURO SURGICAL ICU7367 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT MICU 7367 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT ISOLATION 7367 600 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT ICCU 7367 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT HIGH DEPENDENCY UNIT7367 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT ECONOMY WARD FEMALE7367 600 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT ECONOMY WARD 6 7367 600 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT ECONOMY WARD 5 7367 600 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT ECONOMY WARD 4 7367 600 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT ECONOMY WARD 3 7367 600 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT ENDOSCOPY 7367 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT EMERGENCY 7367 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SURGICAL ICU 7367 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT CTVS ICU 7367 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT BASE PRICE 7367 600 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) NEUROSURGERY DNB11613 1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) GEN CARDIOLOGY WARD11613 2 250 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) GEN CARDIOLOGY WARD11613 1 500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) SUITE ROOM CRIB 11613 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) SUITE ROOM 11613 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) OBG SEMI PRIVATE11613 CRIB 1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) OBG GEN CRIB 11613 1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) OBG PRIVATE (CRIB)11613 1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) WARD 52 11613 1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) ECONOMY WARD SIXTH11613 FLOOR 1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) NICU STEP DOWN 11613 1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) PICU STEP DOWN 11613 1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) TRANSPLANT ICU 11613 1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) NMICU 11613 1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) SEMI PRIVATE 11613 1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) PRIVATE ROOM 11613 1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) PICU 11613 1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) OT PRE OP 11613 1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) OT POST OP 11613 1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) ONCOLOGY WARD 11613 1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) OBG SEMI PRIVATE11613 1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) OBG PRIVATE 11613 1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) OBG ECONOMY ROOM11613 1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) NICU 11613 1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) NEUROSURGERY WARD11613 MALE 1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) NEUROSURGERY WARD11613 FEMALE1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) NEURO SURGICAL ICU11613 1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) MICU 11613 1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) ISOLATION 11613 1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) ICCU 11613 1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) HIGH DEPENDENCY11613 UNIT 1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) ECONOMY WARD FEMALE11613 600 0

Page 31 of 115 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) ECONOMY WARD 611613 600 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) ECONOMY WARD 511613 600 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) ECONOMY WARD 411613 600 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) ECONOMY WARD 311613 600 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) ENDOSCOPY 11613 1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) EMERGENCY 11613 1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) DIALYSIS CHAIR 11613 1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) DIALYSIS 11613 1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) SURGICAL ICU 11613 1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) CTVS ICU 11613 1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) CATH LAB RECOVERY11613 1200 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT (G) BASE PRICE 11613 600 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT EMERGENCY BASE PRICE 8409 600 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SECOND SURGICAL HDU 7368 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SECOND NEUROSURGERY DNB7368 500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SECOND SUITE ROOM 7368 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SECOND NICU STEP DOWN 7368 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SECOND PICU STEP DOWN 7368 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SECOND TRANSPLANT ICU 7368 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SECOND NMICU 7368 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SECOND SEMI PRIVATE 7368 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SECOND PRIVATE ROOM 7368 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SECOND PICU 7368 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SECOND ONCOLOGY WARD 7368 500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SECOND OBG SEMI PRIVATE 7368 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SECOND OBG PRIVATE 7368 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SECOND OBG ECONOMY ROOM7368 500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SECOND NICU 7368 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SECOND NEUROSURGERY WARD7368 MALE 500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SECOND NEUROSURGERY WARD7368 FEMALE 500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SECOND NEURO SURGICAL ICU7368 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SECOND MICU 7368 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SECOND ISOLATION 7368 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SECOND ICCU 7368 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SECOND HIGH DEPENDENCY UNIT7368 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SECOND ECONOMY WARD FEMALE7368 500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SECOND ECONOMY WARD 6 7368 500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SECOND ECONOMY WARD 5 7368 500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SECOND ECONOMY WARD 4 7368 500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SECOND ECONOMY WARD 3 7368 500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SECOND EMERGENCY 7368 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SECOND SURGICAL ICU 7368 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SECOND CTVS ICU 7368 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SECOND BASE PRICE 7368 500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL SURGICAL HDU 7369 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL MEDICAL HDU 7369 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL OBG HDU 7369 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL CARDIOLOGY HDU 7369 1500 0

Page 32 of 115 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL GEN CARDIOLOGY WARD7369 1 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL SUITE ROOM 7369 2000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL NICU STEP DOWN 7369 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL PICU STEP DOWN 7369 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL TRANSPLANT ICU 7369 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL NMICU 7369 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL SEMI PRIVATE 7369 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL PRIVATE ROOM 7369 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL PICU 7369 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL ONCOLOGY WARD 7369 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL OBG SEMI PRIVATE 7369 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL OBG PRIVATE 7369 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL OBG ECONOMY ROOM7369 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL NICU 7369 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL NEUROSURGERY WARD7369 MALE 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL NEUROSURGERY WARD7369 FEMALE1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL NEURO SURGICAL ICU7369 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL MICU 7369 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL ISOLATION 7369 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL ICCU 7369 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL HIGH DEPENDENCY UNIT7369 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL ECONOMY WARD FEMALE7369 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL ECONOMY WARD 6 7369 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL ECONOMY WARD 5 7369 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL ECONOMY WARD 4 7369 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL ECONOMY WARD 3 7369 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY 7369 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL SURGICAL ICU 7369 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL CTVS ICU 7369 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL BASE PRICE 7369 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY GEN CARDIOLOGY WARD8385 1 800 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY SUITE ROOM CRIB 8385 2000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY SUITE ROOM 8385 2000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY OBG SEMI PRIVATE CRIB8385 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY OBG GEN CRIB 8385 800 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY OBG PRIVATE (CRIB)8385 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY WARD 52 8385 800 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY ECONOMY WARD SIXTH8385 FLOOR 800 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY NICU STEP DOWN 8385 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY PICU STEP DOWN 8385 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY TRANSPLANT ICU 8385 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY NMICU 8385 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY SEMI PRIVATE 8385 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY PRIVATE ROOM 8385 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY PICU 8385 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY OT PRE OP 8385 800 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY OT POST OP 8385 800 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY ONCOLOGY WARD 8385 800 0

Page 33 of 115 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY OBG SEMI PRIVATE 8385 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY OBG PRIVATE 8385 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY OBG ECONOMY ROOM8385 800 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY NICU 8385 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY NEUROSURGERY WARD8385 MALE 800 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY NEUROSURGERY WARD8385 FEMALE 800 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY NEURO SURGICAL ICU8385 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY MICU 8385 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY ISOLATION 8385 800 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY ICCU 8385 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY HIGH DEPENDENCY UNIT8385 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY ECONOMY WARD FEMALE8385 800 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY ECONOMY WARD 6 8385 800 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY ECONOMY WARD 5 8385 800 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY ECONOMY WARD 4 8385 800 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY ECONOMY WARD 3 8385 800 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY ENDOSCOPY 8385 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY EMERGENCY 8385 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY SURGICAL ICU 8385 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY CTVS ICU 8385 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL EMERGENCY BASE PRICE 8385 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL SECOND SUITE ROOM 7370 2000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL SECOND NICU STEP DOWN 7370 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL SECOND PICU STEP DOWN 7370 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL SECOND TRANSPLANT ICU 7370 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL SECOND NMICU 7370 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL SECOND SEMI PRIVATE 7370 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL SECOND PRIVATE ROOM 7370 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL SECOND PICU 7370 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL SECOND ONCOLOGY WARD 7370 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL SECOND OBG SEMI PRIVATE 7370 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL SECOND OBG PRIVATE 7370 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL SECOND OBG ECONOMY ROOM7370 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL SECOND NICU 7370 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL SECOND NEUROSURGERY WARD7370 MALE 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL SECOND NEUROSURGERY WARD7370 FEMALE1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL SECOND NEURO SURGICAL ICU7370 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL SECOND MICU 7370 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL SECOND ISOLATION 7370 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL SECOND ICCU 7370 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL SECOND HIGH DEPENDENCY UNIT7370 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL SECOND ECONOMY WARD FEMALE7370 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL SECOND ECONOMY WARD 6 7370 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL SECOND ECONOMY WARD 5 7370 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL SECOND ECONOMY WARD 4 7370 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL SECOND ECONOMY WARD 3 7370 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL SECOND EMERGENCY 7370 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL SECOND SURGICAL ICU 7370 1500 0

Page 34 of 115 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL SECOND CTVS ICU 7370 1500 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES IPD DOCTOR VISIT SPECIAL SECOND BASE PRICE 7370 1000 0 IPD DOCTOR VISIT IPD DOCTOR VISIT CHARGES NIGHT VISIT BASE PRICE 8411 1000 0 IPD PACKAGE IPD PACKAGES ESWL Big Stone (>1.5 cm) BASE PRICE 8407 19970 0 IPD PACKAGE IPD PACKAGES ESWL Small Stone (<1.5 cm) BASE PRICE 8408 15970 0 IVF IVF OPD PACKAGES Blastocyst Culture BASE PRICE 13234 15000 0 IVF IVF OPD PACKAGES Diagnostic - Testicular Epididymal Sperm Aspiration BASE PRICE 13237 5000 0 IVF IVF OPD PACKAGES DNA Fragmentation Index BASE PRICE 13240 7500 0 IVF IVF OPD PACKAGES Embryo Donation IVF BASE PRICE 13230 120000 0 IVF IVF OPD PACKAGES Embryo Freezing (One Time) BASE PRICE 13235 15000 0 IVF IVF OPD PACKAGES Embryo Maintenance (Per Year) BASE PRICE 13236 15000 0 IVF IVF OPD PACKAGES Follicle Monitoring -IVF BASE PRICE 13244 1500 0 IVF IVF OPD PACKAGES Frozen Embryo Transfer -Professional fees BASE PRICE 13231 45000 0 IVF IVF OPD PACKAGES Intra Uterine Insemination - Charges for Donor Bank Semen BASE PRICE 13233 5500 0 IVF IVF OPD PACKAGES Intra Uterine Insemination - charges for Husband semen BASE PRICE 13232 4000 0 IVF IVF OPD PACKAGES Oocyte Donation - IVF BASE PRICE 13229 140000 0 IVF IVF OPD PACKAGES Physiological Intra-Cytoplasmic Sperm Injection (PICSI) BASE PRICE 13242 15000 0 IVF IVF OPD PACKAGES Semen Analysis - IVF BASE PRICE 13241 500 0 IVF IVF OPD PACKAGES Semen Freezing BASE PRICE 13243 2500 0 IVF IVF OPD PACKAGES Testicular Epididymal Sperm Aspiration Freezing BASE PRICE 13238 5000 0 IVF IVF OPD PACKAGES Testicular Epididymal Sperm Aspiration Intra-Cytoplasmic Sperm Injection (ICSI) BASE PRICE 13239 15000 0 IVF IVF PROCEDURE IVF Professional Fees BASE PRICE 13245 50000 0 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY ANTERIOR RESECTION BASE PRICE 5178 300 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY BANDING FOR OBERITY BASE PRICE 5082 300 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY BILATERAL OVARIAN CYSTECTOMY BASE PRICE 5130 19850 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY BURSCH SUSPENSION BASE PRICE 5201 18200 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY CARDIOMYOTOMY + FUNDOPLICATION BASE PRICE 5171 32750 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY CHOLECYSTECTOMY + CHOLEDOCHODUODENECTOMY BASE PRICE 5196 31750 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY CHOLEDOCHAL CYST BASE PRICE 5195 29110 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY CONGENITAL HYDROCELE BASE PRICE 5106 7280 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY CONGENITAL HYDROCELE WITH HERNIA BASE PRICE 5111 11520 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY CYSTECTOMY BASE PRICE 5174 31530 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY CYSTOJEJUNOSTOMY BASE PRICE 5197 32750 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY CYSTOSCOPY BASE PRICE 5108 3970 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY DIAGNOSTIC LAPAROSCOPIC FOLLOWING GASTIC BANDING /GASTIC BYPASS BASE PRICE 5070 6070 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY DIAGNOSTIC LAPAROSCOPY + HYSTEROSCOPY BASE PRICE 5148 8490 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY DIAGNOSTIC LAPAROSCOPY WITH BIOPSY BASE PRICE 5043 12130 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY DIAGNOSTIC LAPAROSCOPY WITH DRAINAGE BASE PRICE 5041 15440 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY DIAGNOSTIC LAPAROSCOPY WITHOUT BIOPSY BASE PRICE 5044 9700 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY DIAGNOSTIC LAPROSCOPY BASE PRICE 5001 9700 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY DIAGNOSTIC RETROPERITONEOSCOPY AND BIOPSY BASE PRICE 5058 8490 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY DIAGNOSTIC THORACOSCOPY WITH BIOPSY BASE PRICE 5030 7280 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY DISTAL PANCREATECTOMY BASE PRICE 5175 40030 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY DOUBLE INCISION LAPAROSCOPIC SURGERY BASE PRICE 5188 7940 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY ENGIASTRIC HERNIA BASE PRICE 5096 15880 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY ENTEROENTEROSTOMY BASE PRICE 5198 32750 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY EVACUATION OF CLOTTED HEMOTHORAX BASE PRICE 5083 14550 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY EXCISION EMPYEMA / THORACOSCOPIC DECORTICATION BASE PRICE 5045 26680 25

Page 35 of 115 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY EXCISION OF EXTERNAL PILES BASE PRICE 5113 6620 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY FEEDING GASTROSTOMY BASE PRICE 5119 18200 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY FEEDING JEJUNASTOMY BASE PRICE 5118 15880 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY FEMORAL HERNIA BASE PRICE 5191 26680 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY GYNAECOMASTIA BASE PRICE 5193 12130 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY HAEMORROIDECTOMY WITH HARMONIC BASE PRICE 12802 19850 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY HALS BASE PRICE 5137 31750 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY HEPATICO JEJUNOSTOMY BASE PRICE 5176 33080 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY HERNIOTOMY - BILETERAL BASE PRICE 5079 15880 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY HERNIOTOMY - UNILATERAL BASE PRICE 5080 13230 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY HIATAL SURGERY BASE PRICE 5202 31750 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY HILL'S PROCEDURE BASE PRICE 5170 29110 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY HYSTEROSCOPY BASE PRICE 5150 3640 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY HYSTEROSCOPY WITH BIOPSY BASE PRICE 5151 6070 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY ICD BASE PRICE 5107 5410 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY INCISIONAL HERNIA BASE PRICE 5097 29110 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY INFRA RED COAGULATION IN HEAMORRHOIDS BASE PRICE 5022 21830 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY INGUINAL HERNIOPLASTY (BILATERAL) BASE PRICE 5072 35720 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY INGUINAL HERNIOPLASTY UNILATERAL BASE PRICE 5067 26460 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY INTRA OP CHOLANGIOGRAM BASE PRICE 5124 2430 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAP ASSISTED NEPHRECTOMY BASE PRICE 5192 24260 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAP ASSISTED VAGINAL HYSTERECTOMY BASE PRICE 5146 18200 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAP CHOLECYSTECTOMY WITH HAR MONIC BASE PRICE 12804 27560 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAP CHOLECYSTETOMY WITH ADHESIOLYSIS BASE PRICE 12800 27560 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAP CHOLECYSTO DUODENAL FISTILA REPAIR BASE PRICE 12795 38590 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAP RETROPERITO NEAL LYMPH NODE BIOPSY BASE PRICE 12796 33080 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAP SUBTOTAC CHOLECYSTECTOMY BASE PRICE 12803 33080 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC CHOLECYSTECTOMY + CBD EXPLORATION BASE PRICE 5099 39690 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC CHOLECYSTECTOMY EXTENDED BASE PRICE 5024 31750 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC ECTOPIC WITH RUPTURE PREGNANCY BASE PRICE 5158 18200 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC PROCTOCOLECTOMY BASE PRICE 5062 43660 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC VACULT SUSPENSION BASE PRICE 5159 24260 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC ABDOMINO PERINEAL RESECTION BASE PRICE 5103 40130 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC ADHESIOLYSIS- GRADE I BASE PRICE 5049 13230 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC ADHESIOLYSIS- GRADE II BASE PRICE 5050 19850 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING BASE PRICE 5028 40030 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC ADRENALECTOMY BASE PRICE 5029 32750 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC ANTERIOR RESECTION BASE PRICE 5048 35720 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC ASISTED ABDOMINOPERINEAL RESECTION OF RECTUM BASE PRICE 5085 32750 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC ASSISTED AP PULL THROUGH BASE PRICE 5141 19400 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC ASSISTED HEMICOLECTOMY BASE PRICE 5086 29110 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC ASSISTED TOTAL COLECTOMY BASE PRICE 5095 32750 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC ASSISTED VASCULAR SURGERY BASE PRICE 5046 32750 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC ASSOSTED HERMICOLECTOMY BASE PRICE 5073 14550 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC AXILLARY L. NODE SAMPLING BASE PRICE 5059 12130 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC BILIOPANCREATIC DIVERSION BASE PRICE 5066 53360 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC BULLECTOMY BASE PRICE 5031 30320 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC CARDIOMYOTOMY BASE PRICE 5075 26680 25

Page 36 of 115 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC CBD EXPLORATION - TRANS CHOLEDOCHAL BASE PRICE 5133 31750 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC CBD EXPLORATION - TRANSCYSTIC BASE PRICE 5132 26460 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC CHOLECYSTECTOMY WITH CHOLEDCOHODENOSTOMY BASE PRICE 5084 31750 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC CHOLECYSTECTOMY WITH LAP CBD EXPLORATION BASE PRICE 5068 31750 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC CHOLEDOCHAL CYST BASE PRICE 5052 35720 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC CORRECTIONOF MALROTATION BASE PRICE 5140 21830 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC DERMOID CYSTECTOMY BASE PRICE 5156 19400 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC DISTAL PANCREATECTOMY BASE PRICE 5055 39690 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC DRAINED BILIOMA BASE PRICE 5145 15440 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC ENDOMETRIOSIS (G I & G II) BASE PRICE 5153 12130 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC ENDOMETRIOSIS (G III & G IV) BASE PRICE 5154 18200 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC ERR …………. BASE PRICE 5144 18200 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC FIMBRIOPLASTY BASE PRICE 5152 12130 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC FUNDOPLICATION BASE PRICE 5032 29110 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC GASTRECTOMY BASE PRICE 5063 32750 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC HELLER'S BASE PRICE 5134 30430 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC HEPATICOJEJUNOSTOMY BASE PRICE 5053 35720 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC HERNIOTOMY BASE PRICE 5139 14330 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC LEFT Hemicolectomy BASE PRICE 5091 39690 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC LEFT HEPATECTOMY BASE PRICE 5027 40030 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC LIGATION BASE PRICE 5163 3090 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC LIVER RESECTION BASE PRICE 5065 48510 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC LOBECTOMY BASE PRICE 5061 36380 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC LOW ANTERIOR RESECTION BASE PRICE 5102 46860 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC LUNG NODULE EXCISION BASE PRICE 5069 12130 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC LYMPH NODE BIOPSY BASE PRICE 5114 11910 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC MANAGEMENT OF APPNDICULAR LUMP BASE PRICE 5121 30320 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC MECHAL'S DIVERTICULUM BASE PRICE 5127 27560 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC MECKELS DIVERTICULECTOMY BASE PRICE 5051 21830 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC MYOMA ABLATION BASE PRICE 5125 3640 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC MYOTOMY - LARGE BASE PRICE 5162 27560 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC MYOTOMY - MEDIUM BASE PRICE 5161 18200 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC MYOTOMY - SMALL BASE PRICE 5160 12130 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC NEPHRECTOMY BASE PRICE 5172 31530 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC ORCHIDOPEXY BASE PRICE 5142 18200 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC OVARIAN CYSTECTOMY (SIMPLE) BASE PRICE 5155 14550 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC OVARIAN CYSTECTOMY WITH RECONSTRUCTION BASE PRICE 5135 30430 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC OVARIAN DRILLING BASE PRICE 5110 6070 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC PARATHYROIDECTOMY BASE PRICE 5047 30320 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC PEUSTOWS BASE PRICE 5054 35720 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC PNEUMONECTOMY BASE PRICE 5076 36380 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC PULL THROUGH BASE PRICE 5138 21830 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC PULL THROUGH IN ADULT BASE PRICE 5179 44980 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC PYELOLITHOTOMY BASE PRICE 5060 20010 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC RADICAL CHOLECYSTECTOMY BASE PRICE 5064 40130 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC REPAIR OF DIAPHRAGMATIC HERNIA BASE PRICE 5036 43000 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC RIGHT Hemicolectomy BASE PRICE 5090 31750 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC ROUX-EN-YGASTRIC BYPASS BASE PRICE 5042 59540 25

Page 37 of 115 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC SACROCALPOPEXY BASE PRICE 5164 26680 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC SALPINGAOPHERECTOMY BASE PRICE 5157 13350 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC SALPINGECTOMY BASE PRICE 5136 18200 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC SLEEVE GASTRECTOMY BASE PRICE 5057 54580 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC SPLENECTOMY BASE PRICE 5037 40130 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC TOTAL COLECTOMY BASE PRICE 5056 41230 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC TOTAL MESORECTAL EXCISION BASE PRICE 5023 43000 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC TRANSHIATAL OESOPHAGECTOMY BASE PRICE 5025 54580 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC TUBOTITAL ANASTOM….. BASE PRICE 5149 30320 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC URETERIC REMOVAL BASE PRICE 5190 24260 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC VASECTOMY BASE PRICE 5109 9700 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC WERTHIM'S BASE PRICE 5165 36380 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPIC WHIPPLES PROCEDURE BASE PRICE 5026 53360 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPY FOR INTESTINAL OBSTRUCTION BASE PRICE 5087 19850 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPAROSCOPY FOR INTESTINAL PERFORATION BASE PRICE 5093 23810 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPRASCOPIC HERNIA REPAIR BASE PRICE 5004 30100 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPROSCOPIC HIATUS HERNIA REPAIR BASE PRICE 5088 32970 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPROSCOPIC URETEROLITHOTOMY BASE PRICE 5089 25470 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPROSCOPY ADHSIOLYSIS - STAGE I BASE PRICE 5098 19850 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPROSCOPY ADHSIOLYSIS - STAGE II BASE PRICE 5006 26460 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPROSCOPY APPENDISECTOMY SURGERY BASE PRICE 5003 25800 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPROSCOPY ASSISTED BOWEL RESECTION BASE PRICE 5011 29110 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPROSCOPY ASSISTED ORCHIDOPEXY BASE PRICE 5005 25470 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPROSCOPY CHOLECYSTECTOMY BASE PRICE 5002 24370 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPROSCOPY CLOSURE OF PERFORATED PEPTIC ULCER BASE PRICE 5014 19400 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPROSCOPY CYSTOGASTROSTOMY BASE PRICE 5010 31530 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPROSCOPY DONOR NEPHRECTOMY BASE PRICE 5020 26460 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPROSCOPY DRAINAGE OF PSEDOPANCREATIC CYST BASE PRICE 5092 19400 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPROSCOPY GASTROSTOMY BASE PRICE 5013 19400 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPROSCOPY HYDATID OF LIVER SURGERY BASE PRICE 5016 33080 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPROSCOPY OP. VARICOCELE BASE PRICE 5007 21830 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPROSCOPY RECTOPEXY - MESH BASE PRICE 5094 31750 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPROSCOPY RECTOPEXY - SUTURE BASE PRICE 5017 26680 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPROSCOPY RESCTOSCOPY PYLOROMYOTOMY BASE PRICE 5012 19400 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPROSCOPY SPLENECTOMY BASE PRICE 5019 28940 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPROSCOPY THYROIDECTOMY BASE PRICE 5018 27900 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPROSCOPY UMBILICAL HERNIA REPAIR BASE PRICE 5008 29110 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPROSCOPY VAGOTOMY PYLEROPLASTY / GASTRO JEJUNOSTOMY BASE PRICE 5015 34450 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAPROSCOPY VENTRAL HERNIA REPAIR BASE PRICE 5009 30320 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LAR BASE PRICE 12794 44100 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LATERAL INTERNAL SPHINECTRECTOMY BASE PRICE 12801 13230 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LATERAL PANCREATICOJEJUNOSTOMY BASE PRICE 5185 37040 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LIVER CYST (OTHERS) BASE PRICE 5038 28940 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LIVER CYST (SIMPLE) BASE PRICE 5039 12130 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LOWER ABDOMINAL HERNIA BASE PRICE 5199 25470 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY LYMPATHECTOMY BASE PRICE 5177 21830 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY MEDIASTINAL L. NODE BIOPSY BASE PRICE 5071 12130 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY MEDIASTINOSCOPY BASE PRICE 5115 12130 25

Page 38 of 115 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY NISSEN FUNDOPLICATION BASE PRICE 5105 35840 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY OESOPHAGEAL MOBILISATION BASE PRICE 5189 18200 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY PARTIAL CYSTECTOMY BASE PRICE 5173 30320 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY PARTIAL FUNDOPLICATION BASE PRICE 5101 23810 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY PELVIC FLOOR REPAIR - MESH BASE PRICE 5186 36380 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY PERICARDIAL WINDOW BASE PRICE 5074 12130 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY PERICARDIOTOMY BASE PRICE 5104 18200 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY PERINEPHRIC ABSCESS BASE PRICE 5203 21830 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY POST CABG HERNIA BASE PRICE 5200 25800 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY PSEUDOPANCREATIC CYST BASE PRICE 5040 24810 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY PYELOPLASTY BASE PRICE 5180 30320 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY RARE HERNIA / SPIGELIAN, OBTURATOR / LUMBER BASE PRICE 5077 33960 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY RETRO PERITONEOSCOPY BASE PRICE 5021 30320 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY RETROPENTRONEALSCOPY BASE PRICE 5126 13230 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY SEPS BASE PRICE 5131 19850 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY SINGLE INCISION LAPAROSCOPIC SURGERY BASE PRICE 5187 7280 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY SINGLE PORT CHOLECYSTECTOMY BASE PRICE 12793 38590 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY STAGING LAPAROSCOPY BASE PRICE 5120 14550 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY STAPLED HEMORRLADECTOMY BASE PRICE 5128 16540 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY STOPAS INTRAHEPATIC FIXATION BASE PRICE 12798 77180 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY STUMP CHOLECYSTECTOMY BASE PRICE 5123 31530 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY SUBTOTAL / PARTIAL CHOLEPLASTY BASE PRICE 5122 28670 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY SYMPATHECTOMY BASE PRICE 5081 18200 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY THORACOSCOPIC DISECTION BASE PRICE 5100 18200 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY THORACOSCOPY BASE PRICE 5112 20010 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY THORACOSCOPY FOR EMPYOMA THORACIS BASE PRICE 5143 23650 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY THORASCOPIC MEDIASTINAL TUMOR GRADE I BASE PRICE 5033 12130 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY THORASCOPIC MEDIASTINAL TUMOR GRADE II BASE PRICE 5034 18200 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY THORASCOPIC MEDIASTINAL TUMOR GRADE III BASE PRICE 5035 30320 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY TLH + BILATERAL BALPINGOOPHERECTOMY BASE PRICE 5181 30320 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY TOTAL LAPAROSCOPIC HYSTERECTOMY BASE PRICE 5147 28670 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY TRANSTIATAL OESOPHAGECTOMY BASE PRICE 5183 38700 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY TRUNKAL VAGOTOMY + GASTROJEJUNOSTOMY BASE PRICE 5194 26680 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY TWO PORT CHOLECYSTECTOMY BASE PRICE 12797 33080 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY VARICOCELE - LARGE BASE PRICE 5117 11470 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY VARICOCELE - SMALL BASE PRICE 5116 6070 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY VATS BASE PRICE 5129 15770 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY VATS - THYMUS BASE PRICE 5182 30320 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY VENTRAL HERNIA WITH ABDOMINAPLASTY BASE PRICE 12799 38590 25 MINIMAL ACCESS & BARIATRICMINIMAL SURGERY ACCESS & BARIATRIC SURGERY VERICOCELECTOMY UNILATERAL BASE PRICE 5078 12130 25 MISCELLANEOUS RECEIPTSDUPLICATE/MEDICAL CERTIFICATE CASE SHEET/HOSPITAL DOCUMENT BASE PRICE 11797 120 0 MISCELLANEOUS RECEIPTSDUPLICATE/MEDICAL CERTIFICATE DUPLICATE BILL BASE PRICE 11794 120 0 MISCELLANEOUS RECEIPTSDUPLICATE/MEDICAL CERTIFICATE DUPLICATE DEATH CERTIFICATE BASE PRICE 11799 120 0 MISCELLANEOUS RECEIPTSDUPLICATE/MEDICAL CERTIFICATE DUPLICATE DISCHARGE/DEATH SUMMARY BASE PRICE 11795 120 0 MISCELLANEOUS RECEIPTSDUPLICATE/MEDICAL CERTIFICATE DUPLICATE PASS BASE PRICE 11793 120 0 MISCELLANEOUS RECEIPTSDUPLICATE/MEDICAL CERTIFICATE DUPLICATE REPORTS BASE PRICE 11796 120 0 MISCELLANEOUS RECEIPTSDUPLICATE/MEDICAL CERTIFICATE EMERGENCY CERTIFICATE BASE PRICE 11798 120 0 MISCELLANEOUS RECEIPTSDUPLICATE/MEDICAL CERTIFICATE SICKNESS CERTIFICATE BASE PRICE 11800 240 0

Page 39 of 115 MORTUARY MORTUARY SPECIAL BILLING HEADS BED SHEET - MORTUARY BASE PRICE 8410 120 0 MORTUARY MORTUARY SPECIAL BILLING HEADS HEARSE VAN (PER KM) BASE PRICE 1835 26 0 MORTUARY MORTUARY SPECIAL BILLING HEADS MORTUARY CHARGE (ONE DAY) BASE PRICE 1834 660 0 MORTUARY MORTUARY SPECIAL BILLING HEADS MORTUARY CHARGES FOR OUTSIDERS (FOR 24 HRS) BASE PRICE 12376 1320 0 MORTUARY MORTUARY SPECIAL BILLING HEADS PATIENT DRESS - MORTUARY BASE PRICE 8431 610 0 NEUROLOGY NEUROLOGY PROCEDURES BOTOX INJECTION FOR SPASTICITY / MOVEMENT DISORDERS BASE PRICE 5457 13980 0 NEUROLOGY NEUROLOGY PROCEDURES ELECTROENCEPHALOGRAPHY (EEG) BASE PRICE 5451 1400 0 NEUROLOGY NEUROLOGY PROCEDURES ELECTROENCEPHALOGRAPHY (EEG) - BED SIDE BASE PRICE 5462 2520 0 NEUROLOGY NEUROLOGY PROCEDURES ELECTROENCEPHALOGRAPHY (EEG) - VIDEO MONITORING BASE PRICE 5461 3500 0 NEUROLOGY NEUROLOGY PROCEDURES ELECTROMYOGRAPHY (EMG) BASE PRICE 5453 1400 0 NEUROLOGY NEUROLOGY PROCEDURES EVOKED POTENTIAL STUDY BASE PRICE 5455 1400 0 NEUROLOGY NEUROLOGY PROCEDURES LUMBAR PUNCTURE BASE PRICE 5460 1400 0 NEUROLOGY NEUROLOGY PROCEDURES MUSCLE BIOPSY BASE PRICE 5459 5040 0 NEUROLOGY NEUROLOGY PROCEDURES NERVE CONDUCTION STUDY (NCS) BASE PRICE 5452 2100 0 NEUROLOGY NEUROLOGY PROCEDURES NERVE CONDUCTION STUDY (NCS) & ELECTROMYOGRAPHY (EMG) BASE PRICE 5454 3500 0 NEUROLOGY NEUROLOGY PROCEDURES REPETITIVE NERVE STIMULATION (RNS) BASE PRICE 5456 2100 0 NEUROLOGY NEUROLOGY PROCEDURES S S E P STUDY BASE PRICE 5464 1400 0 NEUROLOGY NEUROLOGY PROCEDURES THROMBOLYSIS BASE PRICE 5458 20970 0 NEUROLOGY NEUROLOGY PROCEDURES VISUAL EVOKED POTENTIAL STUDY BASE PRICE 5463 1400 0 NEUROSURGERY NEUROSURGERY PROCEDURES A V M EMBOLIZATION BASE PRICE 12621 27950 0 NEUROSURGERY NEUROSURGERY PROCEDURES COMPLEX INTRACRANIAL ANEURYSM COILING BASE PRICE 12617 27950 0 NEUROSURGERY NEUROSURGERY PROCEDURES DSA CEREBRAL BASE PRICE 12619 20970 0 NEUROSURGERY NEUROSURGERY PROCEDURES SIMPLE INTRACRANIAL ANEURYSM COILING BASE PRICE 12616 27950 0 NEUROSURGERY NEUROSURGERY PROCEDURES SPINAL ANGIOGRAPHY BASE PRICE 12620 19060 0 NEUROSURGERY NEUROSURGERY PROCEDURES TWO ANEURYSM IN SAME SESSION BASE PRICE 12618 27950 0 NEUROSURGERY NEUROSURGERY SURGERY ANEURYSM COILING BASE PRICE 5403 43660 25 NEUROSURGERY NEUROSURGERY SURGERY ASPIRATION OF ABSCESS IN SPINAL TB BASE PRICE 5361 1700 25 NEUROSURGERY NEUROSURGERY SURGERY AVULSION SUTURING BASE PRICE 5303 6070 25 NEUROSURGERY NEUROSURGERY SURGERY BONE FLAP REMOVAL CERVICAL CORPECTOMY - SINGLE SEGMENT & FUSION BASE PRICE 5327 29110 25 NEUROSURGERY NEUROSURGERY SURGERY BRACHIAL PLEXUS SURGERY BASE PRICE 5345 43660 25 NEUROSURGERY NEUROSURGERY SURGERY BRAIN ABSCESS (CRANIOTOMY & EXCISION) BASE PRICE 5360 29110 25 NEUROSURGERY NEUROSURGERY SURGERY BRAIN ABSCESS TAPPING BASE PRICE 5359 19400 25 NEUROSURGERY NEUROSURGERY SURGERY BRAIN BIOPSY BASE PRICE 5413 19400 25 NEUROSURGERY NEUROSURGERY SURGERY BRAIN MAPPING BASE PRICE 5377 14550 25 NEUROSURGERY NEUROSURGERY SURGERY C. V. JUNCTION ANOMALY SURGERY COMBINED ANTERIOR & POSTERIOR BASE PRICE 5347 63060 25 NEUROSURGERY NEUROSURGERY SURGERY CAROTID ENDARTECTOMY BASE PRICE 5333 38810 25 NEUROSURGERY NEUROSURGERY SURGERY CARPEL TUNNEL RELEASE (ENDOSCOPIC) BASE PRICE 5325 19400 25 NEUROSURGERY NEUROSURGERY SURGERY CARPEL TUNNEL RELEASE (OPEN) BASE PRICE 5312 14550 25 NEUROSURGERY NEUROSURGERY SURGERY CERVICAL / LUMBER LAMINECTOMY BASE PRICE 5319 29110 25 NEUROSURGERY NEUROSURGERY SURGERY CERVICAL CORPECTOMY & FUSION MULTILEVEL BASE PRICE 5338 48510 25 NEUROSURGERY NEUROSURGERY SURGERY CERVICAL DISSECTOMY BASE PRICE 5388 29110 25 NEUROSURGERY NEUROSURGERY SURGERY CHRONIC SUBDURAL HEMATOMA SURGERY - DOUBLE BURR HOLE EVACUATION BASE PRICE 5358 29110 25 NEUROSURGERY NEUROSURGERY SURGERY CHRONIC SUBDURAL HEMATOMA SURGERY - SINGLE BURR HOLE EVACUATION BASE PRICE 5357 19400 25 NEUROSURGERY NEUROSURGERY SURGERY CISTERNAL PUNCTURE BASE PRICE 5355 4370 25 NEUROSURGERY NEUROSURGERY SURGERY CISTERNAL PUNCTURE /EVD BASE PRICE 11902 6070 25 NEUROSURGERY NEUROSURGERY SURGERY CLIPPING OF INTRACRANIAL ANEURYSM WITH USE OF STENT BASE PRICE 5404 48510 25 NEUROSURGERY NEUROSURGERY SURGERY CRANIAL / SPINAL DSA BASE PRICE 5315 19400 25 NEUROSURGERY NEUROSURGERY SURGERY CRANIAL / SPINAL DYSRAPHISM BASE PRICE 5314 16980 25

Page 40 of 115 NEUROSURGERY NEUROSURGERY SURGERY CRANIAL DSA BASE PRICE 5364 19400 25 NEUROSURGERY NEUROSURGERY SURGERY CRANIAL ENDOSCOPIC THERAPEUTIC PROCEDURES BASE PRICE 5329 38810 25 NEUROSURGERY NEUROSURGERY SURGERY CRANIAL NERVE ANASTOMOSIS BASE PRICE 5397 43660 25 NEUROSURGERY NEUROSURGERY SURGERY CRANIO SYNOSTOSIS MULTIPLE SUTURE BASE PRICE 5351 38810 25 NEUROSURGERY NEUROSURGERY SURGERY CRANIO SYNOSTOSIS SINGLE SUTURE BASE PRICE 5350 29110 25 NEUROSURGERY NEUROSURGERY SURGERY CRANIOPLASTY BASE PRICE 5328 33960 25 NEUROSURGERY NEUROSURGERY SURGERY CRANIOTOMY BASE PRICE 5352 14550 25 NEUROSURGERY NEUROSURGERY SURGERY CRANIOTOMY & EVACUATION OF HAEMATOMA -EXTRADURAL BASE PRICE 5384 33080 25 NEUROSURGERY NEUROSURGERY SURGERY CRANIOTOMY & EVACUATION OF HAEMATOMA -SUBDURAL BASE PRICE 5385 33080 25 NEUROSURGERY NEUROSURGERY SURGERY CRANIOTOMY - REDOFOR PROCEDURES DONE OUTSIDE BASE PRICE 5343 33080 25 NEUROSURGERY NEUROSURGERY SURGERY CRANIOTOMY FOR EMERGENCY HI BASE PRICE 5320 33080 25 NEUROSURGERY NEUROSURGERY SURGERY CRANIOTOMY FOR ICH BASE PRICE 12753 36380 25 NEUROSURGERY NEUROSURGERY SURGERY CRANIOTOMY FOR MICRO VASCULAR DECOMPRESSION BASE PRICE 5336 48510 25 NEUROSURGERY NEUROSURGERY SURGERY CRANIOTOMY FOR OTHER TUMORS / ELECTIVE CRANIOTOMIES BASE PRICE 5337 48510 25 NEUROSURGERY NEUROSURGERY SURGERY CRANIOTOMY FOR ST MALIGNANT GLIOMA BASE PRICE 5334 29110 25 NEUROSURGERY NEUROSURGERY SURGERY CRANIOTOMY FOR VASCULAR MALFORMATIONS / ANEURYSM BASE PRICE 5342 48510 25 NEUROSURGERY NEUROSURGERY SURGERY CSF DIVERSION PROCEDURES BASE PRICE 5311 19400 25 NEUROSURGERY NEUROSURGERY SURGERY CSF DIVERSION PROCEDURES - LUMBO PERITONEAL SHUNT BASE PRICE 5380 19400 25 NEUROSURGERY NEUROSURGERY SURGERY CSF DIVERSION PROCEDURES - PROGRAMMABLE SHUNTS BASE PRICE 5392 19400 25 NEUROSURGERY NEUROSURGERY SURGERY CSF DIVERSION PROCEDURES - VENTRICULO-ATRIAL SHUNT BASE PRICE 5379 19400 25 NEUROSURGERY NEUROSURGERY SURGERY CSF DIVERSION PROCEDURES - VENTRICULOPERITONEAL SHUNT BASE PRICE 5378 19400 25 NEUROSURGERY NEUROSURGERY SURGERY CSF RHIRRORHEA BASE PRICE 5367 36380 25 NEUROSURGERY NEUROSURGERY SURGERY DECOMPRESSION & POSTERIOR FUSION - SPINE BASE PRICE 5339 48510 25 NEUROSURGERY NEUROSURGERY SURGERY DECOMPRESSION ANT. & POST. FUSION FIXATION BASE PRICE 5348 63060 25 NEUROSURGERY NEUROSURGERY SURGERY DECOMPRESSION ANTERIOR OR ANTERO - LATERAL - SPINE BASE PRICE 5349 58210 25 NEUROSURGERY NEUROSURGERY SURGERY DECOMRESSION ENTRAPMENT BASE PRICE 5362 19400 25 NEUROSURGERY NEUROSURGERY SURGERY DEPRESSED FRACTURE BASE PRICE 5386 29110 25 NEUROSURGERY NEUROSURGERY SURGERY DIAGNOSTIC NEUROENDOSCOPIC PROCEDURES / ETV BASE PRICE 5318 29110 25 NEUROSURGERY NEUROSURGERY SURGERY DISC REPLACEMENT (CERVICAL / LUMBAR) BASE PRICE 5346 58210 25 NEUROSURGERY NEUROSURGERY SURGERY DISCECTOMY - ENDOSCOPIC (CERVICAL / LUMBAR) BASE PRICE 5332 33960 25 NEUROSURGERY NEUROSURGERY SURGERY ENDOSCOPIC ADUEDUCTOPLASTY BASE PRICE 5410 38810 25 NEUROSURGERY NEUROSURGERY SURGERY ENDOSCOPIC ASPIRATION OF INTRACEREBELLAR HAEMATOMA BASE PRICE 5411 38810 25 NEUROSURGERY NEUROSURGERY SURGERY ENDOSCOPIC CRANIAL SURGERY/BIOPSY/ASPIRATION BASE PRICE 5412 38810 25 NEUROSURGERY NEUROSURGERY SURGERY EXCISION OF BRAIN TUMOURS -INFRATENTORIAL BASE PRICE 5395 29110 25 NEUROSURGERY NEUROSURGERY SURGERY EXCISION OF BRAIN TUMOURS -INFRATENTORIAL (CPL,Tumor,MVD) BASE PRICE 11903 48510 25 NEUROSURGERY NEUROSURGERY SURGERY EXCISION OF BRAIN TUMOURS -SUPRATENTOTIAL BASE PRICE 5396 36380 25 NEUROSURGERY NEUROSURGERY SURGERY EXCISION OF EXTRACALVAREAL CYST BASE PRICE 12748 13230 25 NEUROSURGERY NEUROSURGERY SURGERY EXCISION OF LOBE (FRONTAL, TEMPORAL, CEREBELIUM ETC.) BASE PRICE 5387 38810 25 NEUROSURGERY NEUROSURGERY SURGERY FORAMEN MAGNUM DECOMPRESSION WITH SYRINGOSUBARACHNOID SHUNT BASE PRICE 5409 48510 25 NEUROSURGERY NEUROSURGERY SURGERY IC EC BYPASS PROCEDURES BASE PRICE 5405 48510 25 NEUROSURGERY NEUROSURGERY SURGERY KYPHOPLASTY BASE PRICE 5323 29110 25 NEUROSURGERY NEUROSURGERY SURGERY LACERATION SUTURING MAJOR BASE PRICE 12752 5510 25 NEUROSURGERY NEUROSURGERY SURGERY LACERATION SUTURING MINOR BASE PRICE 12751 2760 25 NEUROSURGERY NEUROSURGERY SURGERY LAMINOPLASTY BASE PRICE 5322 29110 25 NEUROSURGERY NEUROSURGERY SURGERY LARGE LACERATION SUTURING BASE PRICE 5301 6070 25 NEUROSURGERY NEUROSURGERY SURGERY LATERAL MASS C1-C2 SCREW FIXATION BASE PRICE 5401 48510 25 NEUROSURGERY NEUROSURGERY SURGERY LUMBAR DISC ARTHROPLASTY BASE PRICE 5393 48510 25 NEUROSURGERY NEUROSURGERY SURGERY LUMBER DISKECTOMY BASE PRICE 5356 29110 25

Page 41 of 115 NEUROSURGERY NEUROSURGERY SURGERY LUMBER PRESSURE MONITORING BASE PRICE 5391 6070 25 NEUROSURGERY NEUROSURGERY SURGERY MANIPULATION / SKULL TRACTION BASE PRICE 5306 4850 25 NEUROSURGERY NEUROSURGERY SURGERY MENINGO ENCEPHALOCOEL BASE PRICE 5381 29110 25 NEUROSURGERY NEUROSURGERY SURGERY MENINGOCOELE EXCISION BASE PRICE 5382 29110 25 NEUROSURGERY NEUROSURGERY SURGERY MENINGOMYELOCOEL BASE PRICE 5383 29110 25 NEUROSURGERY NEUROSURGERY SURGERY MICROSURGICAL EXCISION OF ACOUSTIC TOMOUR / CP ANGLE TUMOURS BASE PRICE 5399 48510 25 NEUROSURGERY NEUROSURGERY SURGERY MICROSURGICAL EXCISION OF MENINGOMAS BASE PRICE 5400 48510 25 NEUROSURGERY NEUROSURGERY SURGERY MICROVASCULAR DECOMPRESSION FOR TRIGEMINAL NEURALGIA / HEMIFACIAL SPASMBASE PRICE 5398 48510 25 NEUROSURGERY NEUROSURGERY SURGERY MULTI LEVEL SPINAL DECOMPRESSION WITH INSTRUMENTATION BASE PRICE 5370 48510 25 NEUROSURGERY NEUROSURGERY SURGERY MUSCLE BIOPSY BASE PRICE 5375 6070 25 NEUROSURGERY NEUROSURGERY SURGERY NERUOLYSIS/ANTERIOR TRANS POSITION BASE PRICE 5363 19400 25 NEUROSURGERY NEUROSURGERY SURGERY NERVE / MUSCLE BIOPSY BASE PRICE 5304 6070 25 NEUROSURGERY NEUROSURGERY SURGERY NERVE BIOPSY BASE PRICE 5376 6070 25 NEUROSURGERY NEUROSURGERY SURGERY OPEN CERVICAL / LUMBER DISC MULTIPLE LEVEL BASE PRICE 5353 33960 25 NEUROSURGERY NEUROSURGERY SURGERY OPEN DISCECTOMY - SINGLE LEVEL (ERVICAL / LUMBAR / DORSAL) BASE PRICE 5321 29110 25 NEUROSURGERY NEUROSURGERY SURGERY PEOSTERIOR FUSION FOR CV JUNCTION BASE PRICE 5330 48510 25 NEUROSURGERY NEUROSURGERY SURGERY PERIPHERAL NERVE RELEASE BASE PRICE 5326 19400 25 NEUROSURGERY NEUROSURGERY SURGERY PINEL REGION TUMOURS BASE PRICE 5368 46080 25 NEUROSURGERY NEUROSURGERY SURGERY POST FOSSA SURGERY BASE PRICE 5369 46080 25 NEUROSURGERY NEUROSURGERY SURGERY POSTERIOR CERVICAL DISSECTOMY BASE PRICE 5394 23050 25 NEUROSURGERY NEUROSURGERY SURGERY PRGR BASE PRICE 5317 16980 25 NEUROSURGERY NEUROSURGERY SURGERY REEXPLORATION MAJOR BASE PRICE 12750 16540 25 NEUROSURGERY NEUROSURGERY SURGERY REEXPLORATION MINOR BASE PRICE 12749 5510 25 NEUROSURGERY NEUROSURGERY SURGERY REVISION OF LUMBAR / CERVICAL DISC SURGERY (DONE OUTSIDE) BASE PRICE 5340 46080 25 NEUROSURGERY NEUROSURGERY SURGERY SCALP SURGERY FOR VASCULAR MALFORMATION BASE PRICE 5316 16980 25 NEUROSURGERY NEUROSURGERY SURGERY SCOLIOSIS SURGERY INSTRUMENTA-TION, FUSION (ANTERIOR/POSTERIOR) / VERTEBRECTOMYBASE PRICE 5374 58210 25 NEUROSURGERY NEUROSURGERY SURGERY SHUNT REMOVAL BASE PRICE 5307 5460 25 NEUROSURGERY NEUROSURGERY SURGERY SINGLE BURR HOLE / ASPIRATION OF ABCESS / BRAIN BIOPSY BASE PRICE 5308 16980 25 NEUROSURGERY NEUROSURGERY SURGERY SPINA BIFIDA SURGERY BASE PRICE 5390 23050 25 NEUROSURGERY NEUROSURGERY SURGERY SPINAL DECOMPRESSION AND FUSION WITH INSTRUMENTATION (ANTERIOR/POSTERIOR)BASE PRICE 5371 46080 25 NEUROSURGERY NEUROSURGERY SURGERY SPINAL DECOMPRESSION WITHOUT INSTRUMENTATION BASE PRICE 5372 46080 25 NEUROSURGERY NEUROSURGERY SURGERY SPINAL DSA BASE PRICE 5365 16980 25 NEUROSURGERY NEUROSURGERY SURGERY SPINAL FUSION PROCEDURE BASE PRICE 5402 46080 25 NEUROSURGERY NEUROSURGERY SURGERY SURGERY FOR BRAIN STEM TUMOURS BASE PRICE 5408 46080 25 NEUROSURGERY NEUROSURGERY SURGERY SURGERY FOR INTRACRANIAL ARTERIOVENOUS MALFORMARIONS(AVM) BASE PRICE 5406 46080 25 NEUROSURGERY NEUROSURGERY SURGERY SURGERY OF CORD TUMOURS BASE PRICE 5389 46080 25 NEUROSURGERY NEUROSURGERY SURGERY SYRINGOMYELA-SHUNT SURGERY BASE PRICE 5373 46080 25 NEUROSURGERY NEUROSURGERY SURGERY THERAPEUTIC SPINAL INJECTIONS FOR PAIN / BLOCKS BASE PRICE 5305 5460 25 NEUROSURGERY NEUROSURGERY SURGERY TRANS ORAL DECOMPRESSION FOR CV JUNCTION ANOMALY BASE PRICE 5335 33960 25 NEUROSURGERY NEUROSURGERY SURGERY TRANSPHENOIDAL PROCEDURES FOR PITUITARY BASE PRICE 5366 35180 25 NEUROSURGERY NEUROSURGERY SURGERY TRANSPHENOIDAL PROCEDURES FOR PITUITARY / CSF RHIRRORHEA BASE PRICE 5331 35180 25 NEUROSURGERY NEUROSURGERY SURGERY TUMOR SPINAL EXTRADURAL BASE PRICE 5324 23050 25 NEUROSURGERY NEUROSURGERY SURGERY TUMORS EMBOLIZATION OF EXTRA CRANICAL LESIONS BASE PRICE 5313 16980 25 NEUROSURGERY NEUROSURGERY SURGERY TUMORS FORAMEN MAGNUM / SPINAL INTRA - MEDULLARY BASE PRICE 5344 46080 25 NEUROSURGERY NEUROSURGERY SURGERY TUMORS SPINAL INTRA - DURAL BASE PRICE 5341 46080 25 NEUROSURGERY NEUROSURGERY SURGERY TWIST DRILL PROCEDURE / ICP MONITORING BASE PRICE 5302 5460 25 NEUROSURGERY NEUROSURGERY SURGERY VASCULAR MALFORMATIONS BASE PRICE 5407 46080 25 NEUROSURGERY NEUROSURGERY SURGERY VERTEBRAL BIOPSY PERCUTANEOUS BASE PRICE 5309 16980 25

Page 42 of 115 NEUROSURGERY NEUROSURGERY SURGERY VERTEBROPLASTY BASE PRICE 5310 16980 25 NURSING NURSING CHAREGS NURSING CHARGES PRESIDENTIAL SUITE7366 2000 0 NURSING NURSING CHAREGS NURSING CHARGES DELUXE SUITE 7366 2000 0 NURSING NURSING CHAREGS NURSING CHARGES SURGICAL HDU 7366 1350 0 NURSING NURSING CHAREGS NURSING CHARGES MEDICAL HDU 7366 1350 0 NURSING NURSING CHAREGS NURSING CHARGES NEUROLOGY ECNOMY7366 WARD 6 950 0 NURSING NURSING CHAREGS NURSING CHARGES OBG HDU 7366 1350 0 NURSING NURSING CHAREGS NURSING CHARGES NEUROSURGERY DNB7366 950 0 NURSING NURSING CHAREGS NURSING CHARGES CARDIOLOGY HDU 7366 1350 0 NURSING NURSING CHAREGS NURSING CHARGES LABOUR BED 7366 950 0 NURSING NURSING CHAREGS NURSING CHARGES GEN CARDIOLOGY WARD7366 2 300 0 NURSING NURSING CHAREGS NURSING CHARGES GEN CARDIOLOGY WARD7366 1 950 0 NURSING NURSING CHAREGS NURSING CHARGES SUITE ROOM CRIB 7366 2000 0 NURSING NURSING CHAREGS NURSING CHARGES SUITE ROOM 7366 2000 0 NURSING NURSING CHAREGS NURSING CHARGES OBG SEMI PRIVATE CRIB7366 1150 0 NURSING NURSING CHAREGS NURSING CHARGES OBG GEN CRIB 7366 950 0 NURSING NURSING CHAREGS NURSING CHARGES OBG PRIVATE (CRIB)7366 1350 0 NURSING NURSING CHAREGS NURSING CHARGES ECONOMY WARD SIXTH7366 FLOOR 950 0 NURSING NURSING CHAREGS NURSING CHARGES NICU STEP DOWN 7366 1350 0 NURSING NURSING CHAREGS NURSING CHARGES PICU STEP DOWN 7366 1350 0 NURSING NURSING CHAREGS NURSING CHARGES TRANSPLANT ICU 7366 1350 0 NURSING NURSING CHAREGS NURSING CHARGES NMICU 7366 1350 0 NURSING NURSING CHAREGS NURSING CHARGES SEMI PRIVATE 7366 1150 0 NURSING NURSING CHAREGS NURSING CHARGES PRIVATE ROOM 7366 1350 0 NURSING NURSING CHAREGS NURSING CHARGES PICU 7366 1350 0 NURSING NURSING CHAREGS NURSING CHARGES ONCOLOGY WARD 7366 950 0 NURSING NURSING CHAREGS NURSING CHARGES OBG SEMI PRIVATE 7366 1150 0 NURSING NURSING CHAREGS NURSING CHARGES OBG PRIVATE 7366 1350 0 NURSING NURSING CHAREGS NURSING CHARGES OBG ECONOMY ROOM7366 950 0 NURSING NURSING CHAREGS NURSING CHARGES NICU 7366 1350 0 NURSING NURSING CHAREGS NURSING CHARGES NEUROSURGERY WARD7366 MALE 950 0 NURSING NURSING CHAREGS NURSING CHARGES NEUROSURGERY WARD7366 FEMALE 950 0 NURSING NURSING CHAREGS NURSING CHARGES NEURO SURGICAL ICU7366 1350 0 NURSING NURSING CHAREGS NURSING CHARGES MICU 7366 1350 0 NURSING NURSING CHAREGS NURSING CHARGES ISOLATION 7366 950 0 NURSING NURSING CHAREGS NURSING CHARGES ICCU 7366 1350 0 NURSING NURSING CHAREGS NURSING CHARGES HIGH DEPENDENCY UNIT7366 1350 0 NURSING NURSING CHAREGS NURSING CHARGES ECONOMY WARD FEMALE7366 950 0 NURSING NURSING CHAREGS NURSING CHARGES ECONOMY WARD 6 7366 950 0 NURSING NURSING CHAREGS NURSING CHARGES ECONOMY WARD 5 7366 950 0 NURSING NURSING CHAREGS NURSING CHARGES ECONOMY WARD 4 7366 950 0 NURSING NURSING CHAREGS NURSING CHARGES ECONOMY WARD 3 7366 950 0 NURSING NURSING CHAREGS NURSING CHARGES EMERGENCY 7366 1150 0 NURSING NURSING CHAREGS NURSING CHARGES SURGICAL ICU 7366 1350 0 NURSING NURSING CHAREGS NURSING CHARGES CTVS ICU 7366 1350 0 NURSING NURSING CHAREGS NURSING CHARGES CATH LAB RECOVERY7366 950 0 NURSING NURSING CHAREGS NURSING CHARGES BASE PRICE 7366 950 0 NUTRITION & KITCHEN NUTRITION COUNSELLING DIET COUNSELLING BASE PRICE 1669 300 0

Page 43 of 115 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY ABDOMINAL ANTERIOR CERVICOPEXY BASE PRICE 11992 9700 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY ABDOMINAL METROPLASTY BASE PRICE 5545 14550 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY ABDOMINAL MYOMECTOMY,myoma<5cm BASE PRICE 5544 12130 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY ABDOMINAL MYOMECTOMY,myoma>5cm BASE PRICE 11922 18200 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY ABDOMINAL OOPHORECTOMY BASE PRICE 5546 9700 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY ABDOMINAL OVARIAN CYSTECTOMY BASE PRICE 5547 9700 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY ABDOMINAL SACRAL COLPOPEXY FOR VAULT SUSPENSION BASE PRICE 5553 21830 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY ABDOMINAL SALPINGECTOMY (U/L OR B/L) BASE PRICE 5548 9700 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY ABDOMINAL SALPINGO - OOPHORECTOMY (U/L OR B/L) BASE PRICE 5549 10310 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY ABDOMINAL TUBOPLASTY / RECANALIZATION BASE PRICE 5562 21830 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY ABDOMINAL VENTRISUSPENSION OF UTERUS BASE PRICE 5552 10310 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY ANTERIOR COLPORRHAPHY BASE PRICE 5555 4850 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY ASSISTED BREECH DELIVERY BASE PRICE 5468 10920 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY BURST ABDOMINAL REPAIR BASE PRICE 5484 6070 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY CERVICAL BIOPSY BASE PRICE 5506 1820 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY CERVICAL COLD KNIFE CONIZATION BASE PRICE 5518 6070 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY CHEMICAL CAUTERIZATION BASE PRICE 5519 720 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY COLPOPERINEORRHAPHI BASE PRICE 5557 4850 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY COLPOSCOPY BASE PRICE 5502 1460 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY COLPOTOMY BASE PRICE 5513 4240 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY COMPLETE PERINEAL TEAR REPAIR (OUTSIDE DELIVERY) BASE PRICE 5481 14550 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY CRYOTHERAPY BASE PRICE 5517 1820 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY D & C (HISTOPATHOLOGY CHARGE EXTRA) BASE PRICE 5503 2430 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY ENDOMETRIAL ASPIRATION BASE PRICE 5499 720 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY EUA BASE PRICE 5501 1220 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY EVACUATION FOR INCOMPLETE ABORTION BASE PRICE 5491 3030 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY EVACUATION FOR MOLAR PREGNANCY BASE PRICE 5492 3640 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY EXCISION OF BARTHOLINS CYST BASE PRICE 5510 2430 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY EXCISION OF URETHRAL CARUNCLE BASE PRICE 5509 3030 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY EXCISION OF VAGINAL CYST BASE PRICE 5511 2430 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY EXCISION OF VAGINAL SEPTUM BASE PRICE 5512 3640 25 EXPLORATARY LAPAROTOMY FOR PERFORATION OF UTERUS AFTER OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY BASE PRICE 5493 14550 25 EVACUATION / MTP EXPLORATARY LAPAROTOMY FOR RUPTURE UTERUS - REPAIR & TUBAL OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY BASE PRICE 5478 14550 25 LIGATION OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY EXPLORATARY LAPAROTOMY OF ABDOMINAL HEMATOMA BASE PRICE 5477 14550 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY EXPLORATION FOR PERINEAL HEAMTOMA BASE PRICE 11927 6070 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY EXPLORATION FOR PERINEAL HEMATOMA & EPISIOTOMY RESUTURING BASE PRICE 5480 3030 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY EXPLORATION FOR PPH & CERVICAL / VAGINAL TEAR REPAIR BASE PRICE 5479 3030 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY EXPLORATORY LAPAROTOMY BASE PRICE 5563 16540 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY FEMALE URETHRAL DILATATION BASE PRICE 5508 1220 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY FORCEPS DELIVERY BASE PRICE 5469 10920 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY FRACTIONAL CURETTAGE (HISTOPATHOLOGY CHARGE EXTRA) BASE PRICE 5504 1820 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY GAPING ABDOMINAL WOUND - SECONDARY RESUTURING BASE PRICE 5482 3030 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY GAPING PERINEAL WOUND - SECONDARY RESUTURING BASE PRICE 5483 1460 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY HYMENECTOMY BASE PRICE 5541 7280 25 OBSTETRICS & HYSTERECTOMY - TOTAL ABDOMINAL HYSTERECTOMY + / - BILATERAL OBS. & GYANAECOLOGY SURGERY BASE PRICE 5528 16540 25 GYANAECOLOGY SALPINGO - OOPHORECTOMY (TAHBSO)

Page 44 of 115 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY HYSTERECTOMY - CAESAREAN HYSTERECTOMY (CsH) BASE PRICE 5526 14550 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY HYSTERECTOMY - EXTRAFASCIAL HYSTERECTOMY BASE PRICE 5537 24260 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY HYSTERECTOMY - LAPAROSCOPIC ASSISTED VAGINAL HYSTERECTOMY (LAVH) BASE PRICE 5530 21830 25 OBSTETRICS & HYSTERECTOMY - LAPAROSCOPIC ASSISTED VAGINAL HYSTERECTOMY (LAVH) - OBS. & GYANAECOLOGY SURGERY BASE PRICE 5602 29110 25 GYANAECOLOGY DIFFICULT OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY HYSTERECTOMY - LAPAROSCOPIC SUPRA CERVICAL HYSTERECTOMY (LASCH) BASE PRICE 5529 21830 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY HYSTERECTOMY - NON DESCENT VAGINAL HYSTERECTOMY (NDVH) BASE PRICE 5532 26680 25 OBSTETRICS & HYSTERECTOMY - NON DESCENT VAGINAL HYSTERECTOMY WITH BILATERAL OBS. & GYANAECOLOGY SURGERY BASE PRICE 5533 29110 25 GYANAECOLOGY SALPINGO - OOPHORECTOMY (NDVHBSO) OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY HYSTERECTOMY - 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Page 45 of 115 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY LAPAROSCOPY - OOPHORECTOMY BASE PRICE 5580 12130 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY LAPAROSCOPY - OVARIAN BIOPSY BASE PRICE 5585 8490 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY LAPAROSCOPY - OVARIAN CYSTECTOMY BASE PRICE 5581 16540 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY LAPAROSCOPY - OVARIAN DRILLING BASE PRICE 5586 9700 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY LAPAROSCOPY - PRESACRAL NEURECTOMY BASE PRICE 5596 12130 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY LAPAROSCOPY - RADICAL LYMPHADENECTOMY BASE PRICE 5600 29110 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY LAPAROSCOPY - SACRAL COLPOPEXY (VAULT SUSPENSION) BASE PRICE 5597 29110 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY LAPAROSCOPY - SALPINGECTOMY FOR ECTOPIC PREGENCY BASE PRICE 5584 15440 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY LAPAROSCOPY - SALPINGO - 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Page 46 of 115 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY VAGINAL DELIVERY WITH COMPLICATION BASE PRICE 5471 17640 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY VAGINOPLASTY BASE PRICE 5561 14550 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY VENTOUSE DELIVERY BASE PRICE 5470 10310 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY VULVAL BIOPSY BASE PRICE 5507 1820 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY VULVAL INJURY (MAJOR) BASE PRICE 5522 12130 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY VULVAL INJURY (MINOR) BASE PRICE 5521 6070 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY VULVECTOMY - RADICAL BASE PRICE 5543 21830 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY VULVECTOMY - SIMPLE BASE PRICE 5542 10310 25 OBSTETRICS & GYANAECOLOGYOBS. & GYANAECOLOGY SURGERY VVF REPAIR BASE PRICE 5559 14550 25 ONCO SURGERY ONCO SURGERY PROCEDURES ANTERIOR RESECTION OF RECTUM BASE PRICE 11918 24260 0 ONCO SURGERY ONCO SURGERY PROCEDURES COMPLETION THYROIDECTOMY BASE PRICE 11915 18200 0 ONCO SURGERY ONCO SURGERY PROCEDURES HEMI-THYROIDECTOMY BASE PRICE 11916 14550 0 ONCO SURGERY ONCO SURGERY PROCEDURES ORAL CANCER DOUBLE FLAP RECONSTRUCTION BASE PRICE 11907 36380 0 ONCO SURGERY ONCO SURGERY PROCEDURES ORAL CANCER FREE FLAP RECONSTRUCTION BASE PRICE 11908 48510 0 ONCO SURGERY ONCO SURGERY PROCEDURES ORAL CANCER LOCAL FLAP RECONSTRUCTION BASE PRICE 11912 18200 0 ONCO SURGERY ONCO SURGERY PROCEDURES ORAL CANCER SINGLE FLAP RECONSTRUCTION BASE PRICE 11906 30320 0 ONCO SURGERY ONCO SURGERY PROCEDURES PARTITAL MAXILLECTOMY BASE PRICE 11913 18200 0 ONCO SURGERY ONCO SURGERY PROCEDURES RADICAL VULVECTOMY BASE PRICE 11921 24260 0 ONCO SURGERY ONCO SURGERY PROCEDURES SKIN GRAFTING-ORAL CANCER RECONSTRUCTION BASE PRICE 11911 12130 0 ONCO SURGERY ONCO SURGERY PROCEDURES TOTAL ABDOMINAL HYSTERECTOMY+BSO+OMENTECTOMY (OVARIAN CANCER) BASE PRICE 11919 21830 0 ONCO SURGERY ONCO SURGERY PROCEDURES TOTAL AMPUTATION WITH SCROTECTOMY BASE PRICE 11904 21830 0 ONCO SURGERY ONCO SURGERY PROCEDURES TOTAL GLOSSECTOMY BASE PRICE 11910 27560 0 ONCO SURGERY ONCO SURGERY PROCEDURES TOTAL LARYNGECTOMY BASE PRICE 11909 27560 0 ONCO SURGERY ONCO SURGERY PROCEDURES TOTAL MAXILLECTOMY BASE PRICE 11914 27560 0 ONCO SURGERY ONCO SURGERY PROCEDURES TOTAL THYROIDECTOMY BASE PRICE 11917 21830 0 ONCO SURGERY ONCO SURGERY PROCEDURES WERTHEIMS HYSTERETOMY BASE PRICE 11920 30320 0 ONCO SURGERY ONCO SURGERY PROCEDURES WIDE EXCISION OF ORAL CANCER BASE PRICE 11905 12130 0 ONCO SURGERY ONCO SURGERY SURGERY ABDOMINAL PERINEAL RESECTION BASE PRICE 5635 30320 25 ONCO SURGERY ONCO SURGERY SURGERY AXILLARY DISSECTION BASE PRICE 5616 12130 25 ONCO SURGERY ONCO SURGERY SURGERY BREAST CONSERVATIVE SURGERY (QUADRANTECTOMY & AXILLARY CLEARANCE) BASE PRICE 5617 20620 25 ONCO SURGERY ONCO SURGERY SURGERY BREAST LUMP EXCISION - LARGE BASE PRICE 5653 12130 25 ONCO SURGERY ONCO SURGERY SURGERY BREAST LUMP EXCISION - MEDIUM BASE PRICE 5652 8490 25 ONCO SURGERY ONCO SURGERY SURGERY BREAST LUMP EXCISION - SMALL BASE PRICE 5651 6070 25 ONCO SURGERY ONCO SURGERY SURGERY CERVICAL ESOPHAGOSTOMY BASE PRICE 5618 18200 25 ONCO SURGERY ONCO SURGERY SURGERY CLOSURE OF ILEOSTOMY/COLOSTOMY BASE PRICE 5634 12130 25 ONCO SURGERY ONCO SURGERY SURGERY COMMANDO OPERATION BASE PRICE 5614 44100 25 ONCO SURGERY ONCO SURGERY SURGERY COMMANDO PLUS PMMFC + MNO BASE PRICE 12755 66150 25 ONCO SURGERY ONCO SURGERY SURGERY CYTOREDUCTIVE SURGERY FOR GYNAECOLOGICAL & GI MALIGNANCY BASE PRICE 12761 55130 25 ONCO SURGERY ONCO SURGERY SURGERY ESOPHAGECTOMY/ESOPHAGEAL BYPASS BASE PRICE 5619 36380 25 ONCO SURGERY ONCO SURGERY SURGERY EXCISION OF RETROPERITONEAL TUMOR BASE PRICE 5636 30320 25 ONCO SURGERY ONCO SURGERY SURGERY EXCISION OF SUPRACLAVICULAR LYMPH NODE MAS BASE PRICE 5643 12130 25 ONCO SURGERY ONCO SURGERY SURGERY EXTENDED HEPATECTOMY BASE PRICE 12760 55130 25 ONCO SURGERY ONCO SURGERY SURGERY FEEDING GASTROSTOMY/JEJUNOSTOMY BASE PRICE 5626 12130 25 ONCO SURGERY ONCO SURGERY SURGERY GASTRECTOMY - PARTIAL BASE PRICE 5658 24260 25 ONCO SURGERY ONCO SURGERY SURGERY GASTRECTOMY - SUBTOTAL BASE PRICE 5657 30320 25 ONCO SURGERY ONCO SURGERY SURGERY GASTRECTOMY - TOTAL BASE PRICE 5625 36380 25 ONCO SURGERY ONCO SURGERY SURGERY GLOSSECTOMY PARTIAL BASE PRICE 5611 12130 25 ONCO SURGERY ONCO SURGERY SURGERY HEMIGLOSSECTOMY BASE PRICE 5612 18200 25

Page 47 of 115 ONCO SURGERY ONCO SURGERY SURGERY INGUINAL BLOCK DISSECTION - UNILATERAL BASE PRICE 5654 12130 25 ONCO SURGERY ONCO SURGERY SURGERY LAPAROTOMY/COLOSTOMY/ILEOSTOMY BASE PRICE 5631 12130 25 ONCO SURGERY ONCO SURGERY SURGERY LATERAL PANCREATICOJEJUNOSTOMY/TRIPLE BYPASS BASE PRICE 5630 30320 25 ONCO SURGERY ONCO SURGERY SURGERY MANDIBULECTOMY BASE PRICE 5610 23150 25 ONCO SURGERY ONCO SURGERY SURGERY MODIFIED RADICAL MASTECTOMY BASE PRICE 5621 24260 25 ONCO SURGERY ONCO SURGERY SURGERY MODIFIED RADICAL MASTECTOMY WITH LD FLAP WITH SKIN GRAFTING BASE PRICE 5622 36380 25 ONCO SURGERY ONCO SURGERY SURGERY NEOPLASM OF ADRENAL GLAND BASE PRICE 5644 24260 25 ONCO SURGERY ONCO SURGERY SURGERY OESOPHAGO MYCRO EXCISION BASE PRICE 5620 30320 25 ONCO SURGERY ONCO SURGERY SURGERY ORAL CANCER FREE FLAP RECONSTRUCTION BASE PRICE 12179 48510 25 ONCO SURGERY ONCO SURGERY SURGERY ORAL CANCER SINGLE FLAP RECONSTRUCTION BASE PRICE 12641 30320 25 ONCO SURGERY ONCO SURGERY SURGERY PANCREATICO-DUODENECTOMY (WHIPPLE'S PROCEDURE) BASE PRICE 5629 42450 25 ONCO SURGERY ONCO SURGERY SURGERY PAROTIDECTOMY SUPERFICIAL BASE PRICE 5650 21830 25 ONCO SURGERY ONCO SURGERY SURGERY PAROTIDECTOMY TOTAL BASE PRICE 5655 30320 25 ONCO SURGERY ONCO SURGERY SURGERY PARTIAL AMPUTATION PENIS BASE PRICE 5642 12130 25 ONCO SURGERY ONCO SURGERY SURGERY PARTIAL CYSTECTOMY BASE PRICE 5638 18200 25 ONCO SURGERY ONCO SURGERY SURGERY PELVIC EXERTERNATION TOTAL/ANTERIOR/POSTERIOR BASE PRICE 12758 55130 25 ONCO SURGERY ONCO SURGERY SURGERY R/L HEMICOLECTOMY BASE PRICE 5637 24260 25 ONCO SURGERY ONCO SURGERY SURGERY RADICAL CHOLECYSTECTOMY BASE PRICE 5628 30320 25 ONCO SURGERY ONCO SURGERY SURGERY RADICAL CHOLECYSTECTOMY + CBD EXCISION +HEPATICOJEJUNOSTOMY BASE PRICE 5627 36380 25 ONCO SURGERY ONCO SURGERY SURGERY RADICAL NECK DISSECTION BASE PRICE 5615 27560 25 ONCO SURGERY ONCO SURGERY SURGERY RESECTION & ANASTAMOSIS INTESTINE BASE PRICE 5632 18200 25 ONCO SURGERY ONCO SURGERY SURGERY SIMPLE MASTECTOMY BASE PRICE 5623 14550 25 ONCO SURGERY ONCO SURGERY SURGERY SKIN GRAFTING-ORAL CANCER RECONSTRUCTION BASE PRICE 12174 12130 25 ONCO SURGERY ONCO SURGERY SURGERY SOFT TISSUE TUMOUR - WIDE EXCISION BASE PRICE 5649 18200 25 ONCO SURGERY ONCO SURGERY SURGERY SUBMANDIBULAR SALIVARY GLAND EXCISION BASE PRICE 5613 12130 25 ONCO SURGERY ONCO SURGERY SURGERY SUPERFICIAL TUMOUR - LARGE BASE PRICE 5648 18200 25 ONCO SURGERY ONCO SURGERY SURGERY SUPERFICIAL TUMOUR - MEDIUM BASE PRICE 5647 12130 25 ONCO SURGERY ONCO SURGERY SURGERY SUPERFICIAL TUMOUR - SMALL BASE PRICE 5646 6070 25 ONCO SURGERY ONCO SURGERY SURGERY SUPRAOMOHYOID NECK DISSECTION BASE PRICE 5656 22050 25 ONCO SURGERY ONCO SURGERY SURGERY TERMINAL COLOSTOMY BASE PRICE 5633 12130 25 ONCO SURGERY ONCO SURGERY SURGERY THORACOTOMY BASE PRICE 5624 18200 25 ONCO SURGERY ONCO SURGERY SURGERY TOTAL AMPUTATION OF PENIS WITH BLOCK DISSECTION - BILATERAL BASE PRICE 5645 30320 25 ONCO SURGERY ONCO SURGERY SURGERY TOTAL AMPUTATION OF PENIS WITH BLOCK DISSECTION - UNILATERAL BASE PRICE 5659 21830 25 ONCO SURGERY ONCO SURGERY SURGERY TOTAL AMPUTATION PENIS BASE PRICE 5641 18200 25 ONCO SURGERY ONCO SURGERY SURGERY TOTAL CYSTECTOMY BASE PRICE 5639 30320 25 ONCO SURGERY ONCO SURGERY SURGERY TOTAL PROCTOCOLECTOMY BASE PRICE 5640 36380 25 ONCO SURGERY ONCO SURGERY SURGERY WERTHEIMS HYSTERETOMY BASE PRICE 12476 30320 25 ONCO SURGERY ONCO SURGERY SURGERY WHIPPLE & ADDITIONAL ORGAN RESECTION BASE PRICE 12759 55130 25 ONCO SURGERY ONCO SURGERY SURGERY WIDE EXCISION OF ORAL CANCER BASE PRICE 12178 12130 25 WIDE EXICISION TONGUE AND / OR BUCCAL MUCOSA + MODIFIED NECK ONCO SURGERY ONCO SURGERY SURGERY BASE PRICE 12756 33080 25 DISSECTION ONCO SURGERY ONCO SURGERY SURGERY WIDE EXICISION TONGUE AND BASE OF TONGUE BASE PRICE 12757 22050 25 ONCOLOGY ONCOLOGY PROCEDURE 24 HOURS CHEMO INFUSION BASE PRICE 5212 2540 0 ONCOLOGY ONCOLOGY PROCEDURE CHEMOTHERAPY CHARGES (PRIVATE ROOM) BASE PRICE 5214 1900 0 ONCOLOGY ONCOLOGY PROCEDURE CHEMOTHERAPY CHARGES (SEMI PRIVATE ROOM) BASE PRICE 5213 1280 0 ONCOLOGY ONCOLOGY PROCEDURE CHEMOTHERAPY GENERAL WARD BASE PRICE 8383 910 0 ONCOLOGY ONCOLOGY PROCEDURE MULTIPLE DRUGS/ 3 OR MORE HOURS IN HOSPITAL BASE PRICE 5211 1900 0 OPERATION THEATRE O.T. O.T. IN % OF SURGERY CHARGES BASE PRICE 8368 47% 0

Page 48 of 115 OPERATION THEATRE OPERATION THEATRE PROCEDURE DONE IN OT ARTERIAL CANNULATION IN OT BASE PRICE 13223 3630 0 OPERATION THEATRE OPERATION THEATRE PROCEDURE DONE IN OT CVP LINE INSERTION IN OT BASE PRICE 13224 3630 0 OPERATION THEATRE OPERATION THEATRE PROCEDURE DONE IN OT LUMBER PUNCTURE IN OT BASE PRICE 13222 2420 0 OPERATION THEATRE OPERATION THEATRE SPECIAL BILLING HEADS OXYGEN CHARGES-OT PER HOUR BASE PRICE 12105 240 0 OPERATION THEATRE OPERATION THEATRE SPECIAL BILLING HEADS OXYGEN CHARGES-POST OP PER HOUR BASE PRICE 12106 240 0 OPHTHALMOLOGY OPHTHALMOLOGY INVESTIGATION ANGIOGRAPHY (EYE) BASE PRICE 894 2040 0 OPHTHALMOLOGY OPHTHALMOLOGY INVESTIGATION DIGITAL IMAGING BASE PRICE 895 510 0 OPHTHALMOLOGY OPHTHALMOLOGY INVESTIGATION EYE CHECK-UP BASE PRICE 2230 390 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) DAY CARE WARD 5793 26380 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) SUITE ROOM 5793 46200 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) WARD 52 5793 26380 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) ECONOMY WARD SIXTH5793 FLOOR26380 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) NICU STEP DOWN 5793 28140 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) PICU STEP DOWN 5793 28140 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) TRANSPLANT ICU 5793 28140 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) NMICU 5793 28140 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) SEMI PRIVATE 5793 28140 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) PRIVATE ROOM 5793 36960 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) PICU 5793 28140 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) OT PRE OP 5793 28140 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) OT POST OP 5793 28140 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) ONCOLOGY WARD 5793 26380 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) OBG SEMI PRIVATE 5793 28140 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) OBG PRIVATE 5793 36960 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) OBG ECONOMY ROOM5793 26380 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) NICU 5793 28140 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) NEUROSURGERY WARD5793 MALE 26380 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) NEUROSURGERY WARD5793 FEMALE26380 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) NEURO SURGICAL ICU5793 28140 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) MICU 5793 28140 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) ISOLATION 5793 26380 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) ICCU 5793 28140 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) HIGH DEPENDENCY UNIT5793 28140 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) ECONOMY WARD FEMALE5793 26380 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) ECONOMY WARD 6 5793 26380 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) ECONOMY WARD 5 5793 26380 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) ECONOMY WARD 4 5793 26380 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) ECONOMY WARD 3 5793 26380 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) ENDOSCOPY 5793 28140 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) EMERGENCY 5793 28140 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) DIALYSIS CHAIR 5793 28140 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) DIALYSIS 5793 28140 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) SURGICAL ICU 5793 28140 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) CTVS ICU 5793 28140 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) CATH LAB RECOVERY5793 28140 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF IQ (TECHNIS/B & I) BASE PRICE 5793 28140 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE SUITE ROOM 5794 46200 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE WARD 52 5794 26410 0

Page 49 of 115 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE ECONOMY WARD SIXTH5794 FLOOR26410 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE NICU STEP DOWN 5794 28180 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE PICU STEP DOWN 5794 28180 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE TRANSPLANT ICU 5794 28180 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE NMICU 5794 28180 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE SEMI PRIVATE 5794 28180 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE PRIVATE ROOM 5794 37080 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE PICU 5794 28180 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE OT PRE OP 5794 28180 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE OT POST OP 5794 28180 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE ONCOLOGY WARD 5794 26410 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE OBG SEMI PRIVATE 5794 28180 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE OBG PRIVATE 5794 37080 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE OBG ECONOMY ROOM5794 26410 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE NICU 5794 28180 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE NEUROSURGERY WARD5794 MALE 26410 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE NEUROSURGERY WARD5794 FEMALE26410 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE NEURO SURGICAL ICU5794 28180 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE MICU 5794 28180 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE ISOLATION 5794 26410 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE ICCU 5794 28180 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE HIGH DEPENDENCY UNIT5794 28180 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE ECONOMY WARD FEMALE5794 26410 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE ECONOMY WARD 6 5794 26410 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE ECONOMY WARD 5 5794 26410 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE ECONOMY WARD 4 5794 26410 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE ECONOMY WARD 3 5794 26410 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE ENDOSCOPY 5794 28180 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE EMERGENCY 5794 28180 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE DIALYSIS CHAIR 5794 28180 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE DIALYSIS 5794 28180 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE SURGICAL ICU 5794 28180 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE CTVS ICU 5794 28180 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE CATH LAB RECOVERY5794 28180 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH ACRYOF SP/A-ONE BASE PRICE 5794 28180 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE SUITE ROOM 5796 36960 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE WARD 52 5796 19750 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE ECONOMY WARD SIXTH5796 FLOOR19750 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE NICU STEP DOWN 5796 21370 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE PICU STEP DOWN 5796 21370 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE TRANSPLANT ICU 5796 21370 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE NMICU 5796 21370 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE SEMI PRIVATE 5796 21370 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE PRIVATE ROOM 5796 29450 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE PICU 5796 21370 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE OT PRE OP 5796 21370 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE OT POST OP 5796 21370 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE ONCOLOGY WARD 5796 19750 0

Page 50 of 115 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE OBG SEMI PRIVATE 5796 21370 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE OBG PRIVATE 5796 29450 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE OBG ECONOMY ROOM5796 19750 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE NICU 5796 21370 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE NEUROSURGERY WARD5796 MALE 19750 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE NEUROSURGERY WARD5796 FEMALE19750 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE NEURO SURGICAL ICU5796 21370 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE MICU 5796 21370 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE ISOLATION 5796 19750 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE ICCU 5796 21370 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE HIGH DEPENDENCY UNIT5796 21370 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE ECONOMY WARD FEMALE5796 19750 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE ECONOMY WARD 6 5796 19750 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE ECONOMY WARD 5 5796 19750 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE ECONOMY WARD 4 5796 19750 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE ECONOMY WARD 3 5796 19750 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE ENDOSCOPY 5796 21370 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE EMERGENCY 5796 21370 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE DIALYSIS CHAIR 5796 21370 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE DIALYSIS 5796 21370 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE SURGICAL ICU 5796 21370 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE CTVS ICU 5796 21370 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE CATH LAB RECOVERY5796 21370 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH INDIAN FOLDABLE BASE PRICE 5796 21370 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER SUITE ROOM 5795 40430 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER WARD 52 5795 22640 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER ECONOMY WARD SIXTH5795 FLOOR22640 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER NICU STEP DOWN 5795 24260 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER PICU STEP DOWN 5795 24260 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER TRANSPLANT ICU 5795 24260 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER NMICU 5795 24260 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER SEMI PRIVATE 5795 24260 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER PRIVATE ROOM 5795 32340 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER PICU 5795 24260 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER OT PRE OP 5795 24260 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER OT POST OP 5795 24260 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER ONCOLOGY WARD 5795 22640 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER OBG SEMI PRIVATE 5795 24260 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER OBG PRIVATE 5795 32340 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER OBG ECONOMY ROOM5795 22640 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER NICU 5795 24260 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER NEUROSURGERY WARD5795 MALE 22640 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER NEUROSURGERY WARD5795 FEMALE22640 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER NEURO SURGICAL ICU5795 24260 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER MICU 5795 24260 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER ISOLATION 5795 22640 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER ICCU 5795 24260 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER HIGH DEPENDENCY UNIT5795 24260 0

Page 51 of 115 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER ECONOMY WARD FEMALE5795 22640 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER ECONOMY WARD 6 5795 22640 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER ECONOMY WARD 5 5795 22640 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER ECONOMY WARD 4 5795 22640 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER ECONOMY WARD 3 5795 22640 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER ENDOSCOPY 5795 24260 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER EMERGENCY 5795 24260 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER DIALYSIS CHAIR 5795 24260 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER DIALYSIS 5795 24260 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER SURGICAL ICU 5795 24260 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER CTVS ICU 5795 24260 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER CATH LAB RECOVERY5795 24260 0 OPHTHALMOLOGY OPHTHALMOLOGY PACKAGES PHACO WITH RAYNER BASE PRICE 5795 24260 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES A SCAN BIOMETRY (IOL POWER CALCULATION) BASE PRICE 5701 180 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES Botulinum injection for blepharospasm or squint BASE PRICE 5812 11550 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES Cauterisation of ulcer/subconjuctival injection BASE PRICE 5813 1160 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES COLOUR FUNDS PHOTOGRAPHY (DIGITAL) BASE PRICE 5706 460 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES CONTACT LENS FITTING (PER EYE) BASE PRICE 5702 920 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES CONTACT LENS FITTING (RGP) BASE PRICE 897 920 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES CONTACT LENS FITTING (SOFT/TORIC) BASE PRICE 898 690 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES CONTACT LENS POLISHING BASE PRICE 5703 460 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES Corneal pachymetry BASE PRICE 5814 580 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES CORNEAL TOPOGRAPHY (BOTH EYE) BASE PRICE 5770 580 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES CORNEAL TOPOGRAPHY (ONE EYE) BASE PRICE 5769 290 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES DIURNAL VARITATION (GLAUCOMA) BASE PRICE 5729 350 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES F B REMOVAL BASE PRICE 899 230 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES FIELD TEST, AUTOMATED PERIMETRY BASE PRICE 5710 1160 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES FOCAL LASER (PER EYE) BASE PRICE 5738 1730 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES FUNDUS EXAMINATION BASE PRICE 11805 350 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES FUNDUS FLUORESCEIN ANGIOGRAPHY (FFA) - DIGITAL BASE PRICE 5709 1850 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES G.P CONTACT LENS BASE PRICE 5704 1850 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES GLUE+BCL BASE PRICE 900 1730 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES GLUOCOMA WORK UP (GONIOSCOPOY, VFA, COLOUR DIGITAL PHOTO, TN CHECKBASE UP) PRICE 5737 1390 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES LASER (PDT) BASE PRICE 5726 138600 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES LASER FOR LATTICE BASE PRICE 5725 2310 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES LASER LESIK BASE PRICE 5727 25410 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES Laser Photocoagulation - R. O. P. BASE PRICE 5818 5780 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES LOW VISUAL AIDS BASE PRICE 5744 200 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES ORTHOPTIC EVALUATION BASE PRICE 5746 120 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES ORTHOPTIC EXERCISE BASE PRICE 5747 33 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES POSTERIOR SUBTENON (PST) - Both Eyes BASE PRICE 5820 1160 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES POSTERIOR SUBTENON (PST) - One Eye BASE PRICE 5821 580 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES PRP LASER PHOTOCOAGULATION PER EYE PER SITTING BASE PRICE 5724 1390 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES PST/AST BASE PRICE 905 580 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES PTK BASE PRICE 5728 11550 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES ROP SREENING BASE PRICE 5757 580 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES SCHIMMERS TEST BASE PRICE 5822 580 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES SUTURE REMOVAL (PER SUTURE) BASE PRICE 5760 70 0

Page 52 of 115 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES SYRINGING BASE PRICE 5723 230 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES ULTASONOGRAPHY (B SCAN) BASE PRICE 5708 920 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES VISUAL FIELD ANALYSIS BASE PRICE 8506 1390 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES YAG CAPSULOTOMY BASE PRICE 5761 1730 0 OPHTHALMOLOGY OPHTHALMOLOGY PROCEDURES YAG PI BASE PRICE 5762 2310 0 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY ACRYSOF LQ -TECHNIS/B & I (PHACO WITH) BASE PRICE 11629 13230 0 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY ACRYSOF SP/A-ONE (PHACO WITH) BASE PRICE 11630 13350 0 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY AMG BASE PRICE 5766 12130 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY AMNIOTIC MEMBARE TRANSPLANT FOR O.S DISORDER BASE PRICE 5775 6070 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY Arcuate keratotomy for astigmatism BASE PRICE 5811 6070 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY BLOW OUT FRACTURE REPAIR BASE PRICE 5773 9700 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY BSK REMOVAL ( EDTA) BAND SAVE KERATOPATHY BASE PRICE 5771 6070 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY BUCKLE BASE PRICE 5792 19400 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY Buckle Removal BASE PRICE 5809 6070 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY CHALAZION BASE PRICE 5705 970 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY CONJ. FLAPPING BASE PRICE 5707 2430 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY CORNEAL FOREIGN BODY REMOVAL SUPERFICIAL/ DEEP (UNDER GA) BASE PRICE 5711 1220 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY CORNEAL FOREIGN BODY REMOVAL SUPERFICIAL/ DEEP (UNDER LA) BASE PRICE 5712 240 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY CORNEAL TATTOOING BASE PRICE 5767 6070 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY CORNEAL TRANSPLANT BASE PRICE 5765 18200 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY CRYO FOR LATTICE (PER EYE) BASE PRICE 5714 3030 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY CTR BASE PRICE 5825 1220 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY CYCLOCRYOPEXY/ ARC (PER EYE) BASE PRICE 5713 3030 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY DACRYOCISTORHINOSTOMY/ CYCTECTOMY BASE PRICE 5715 12130 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY DECOMPRESSION OF ORBIT BASE PRICE 5772 9700 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY DERMOID CYST BASE PRICE 5779 3640 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY DRAINAGE OF LACRAIMAL ABSCESS BASE PRICE 5730 1220 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY DRAINAGE OF LID ABSCESS BASE PRICE 5731 1460 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY ECTROPIAN BASE PRICE 5732 3030 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY Electrolysis BASE PRICE 5815 1820 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY ENTROPION BASE PRICE 5733 3030 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY ENUCLEATION BASE PRICE 5717 6070 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY EPICANTHUS BASE PRICE 5734 4850 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY EVISERATION BASE PRICE 5718 6070 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY Examination under GA BASE PRICE 5803 1820 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY EXENTERATION BASE PRICE 5735 10920 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY EYLEA INTRAVITREAL INJECTION BASE PRICE 12979 8400 0 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY FGE+ EL+SOI/GAS BASE PRICE 5790 8490 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY FUNDUS EXAMINATION UNDER GA BASE PRICE 5736 1220 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY GLUE AND BCL APLLICATION BASE PRICE 5768 6070 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY GLUOCOMA NEEDLING BASE PRICE 5740 7280 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY IMPORTED NON-FOLDABLI/HSM (M. PHACO) BASE PRICE 11633 8490 0 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY INDIAN FOLDABLE (PHACO WITH) BASE PRICE 11632 12130 0 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY INDIAN NON-FOLDABLE (M. PHACO) BASE PRICE 11634 6070 0 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY INTRAOCULAR FOEIGN BODY REMOVAL BASE PRICE 5739 10920 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY Intravitreal injections- of avastin BASE PRICE 5816 9700 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY Intravitreal injections- of lucentis BASE PRICE 5817 60640 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY INTRAVITRIAL INJECTION IN OT BASE PRICE 5741 1460 25

Page 53 of 115 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY KERATECTOMY PARTIAL BASE PRICE 5764 3030 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY KERATOPLASTY LAMELLAR BASE PRICE 5763 8490 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY LASER TRABECULOPLASTY BASE PRICE 5810 6070 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY LATERAL ORBITOTOMY BASE PRICE 5774 9700 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY LENS REMOVAL (ECCE) BASE PRICE 11635 6070 0 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY LENS+VITRECTOMY,DROP NUC+AC/PC IOL BASE PRICE 5789 24260 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY LENSECTOMY BASE PRICE 5742 7280 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY LID RE- CONSTRUTION MAJOR BASE PRICE 5755 12130 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY LID RE- CONSTRUTION MINOR BASE PRICE 5756 7280 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY LID TUMAR EXCISION & REPAIR BASE PRICE 5743 6310 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY MAJOR CYST REMOVAL BASE PRICE 5780 12130 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY MINOR CYST REMOVAL BASE PRICE 5781 6070 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY MOLE/ NERVOUS EXSICION BASE PRICE 5778 3640 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY OCCULOPLASTIC SURGERY BASE PRICE 5719 6070 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY OPTICAL IRIDECTOMY BASE PRICE 5721 4850 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY ORBITAL BIOPSY BASE PRICE 5722 610 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY ORBITOTOMY BASE PRICE 5745 9700 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY PACKAGE FOR PHACO WITH FOLDABLE LENS (RESTOR) MULTIFOCAL BASE PRICE 5782 54580 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY PAED. CATARACT SURGERY (BOTH EYE) BASE PRICE 5785 30320 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY PAED. CATARACT SURGERY (ONE EYE) BASE PRICE 5786 24260 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY PERFORATING INJURIES OF CORNEA BASE PRICE 5748 7280 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY PHAKIC IOL (EACH EYE NON TORIC) BASE PRICE 5783 46080 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY PHAKIC IOL (EACH EYE TORIC) BASE PRICE 5784 58210 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY Pneumatic Retinopexy BASE PRICE 5806 12130 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY PROBING UNDER G.A BASE PRICE 5749 2430 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY PROSTHESIS BASE PRICE 5802 12130 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY PTERIGIUM WITH GRAFTING BASE PRICE 5750 9700 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY PTERYGIUM- BARE SELERA BASE PRICE 5777 6070 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY PTOSIS BASE PRICE 5720 12130 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY Punctal plugs for dry eyes (excluding implant cost) BASE PRICE 5819 1820 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY RAYNER (PHACO WITH) BASE PRICE 11631 12130 0 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY Reinjection of Silicone Oil BASE PRICE 5808 12130 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY REPAIR OF COLOBOMA BASE PRICE 5752 6070 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY REPAIR OF LID CANALICULI BASE PRICE 5751 6070 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY REPAIR OF LID INJURIES (MAJOR) BASE PRICE 5753 12130 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY REPAIR OF LID INJURIES (MINOR) BASE PRICE 5754 7280 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY Scleral Fixated IOL BASE PRICE 5824 18200 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY Scleral graft for scleral melting or perforation BASE PRICE 5823 9700 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY Silicone Oil Removal BASE PRICE 5807 9700 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY SKIN GRAFTING IN COSMATIC SURGERIES BASE PRICE 5776 6070 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY SLING BASE PRICE 5826 1820 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY SQUINT HORIZONTAL MUSCLES PER EYE BASE PRICE 5758 9700 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY SQUINT VERTICAL MUSCLE PER EYE BASE PRICE 5759 12130 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY Symblephron Release BASE PRICE 5804 1220 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY Symblephron Release with Grafting BASE PRICE 5805 6070 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY TARSORRAPHY BASE PRICE 5716 1220 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY TRABECULECTOMY (TRAB) BASE PRICE 5787 12130 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY VITRECTOMY (END) BASE PRICE 5791 18200 25

Page 54 of 115 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY VITRECTOMY (R.D/DIABETIC/ERM) BASE PRICE 5788 24260 25 OPHTHALMOLOGY OPHTHALMOLOGY SURGERY VITRO RETINAL SURGERIES BASE PRICE 8507 24260 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES ABOVE ELBOW FULL PLASTER BASE PRICE 5855 1530 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES ABOVE ELBOW SLAB BASE PRICE 5854 1530 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES ABOVE KNEE FULL PLASTER BASE PRICE 5860 2540 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES ABOVE KNEE FULL SLAB BASE PRICE 6175 1530 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES ABOVE KNEE POST - SLAB BASE PRICE 5856 1530 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES APPLICATION OF FUNCTIOL CAST BRACE BASE PRICE 6201 1280 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES APPLICATION OF P.O.P CASTS FOR UPPER & LOWER LIMBS BASE PRICE 6174 2540 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES APPLICATION OF SKELETAL TRACTIONS BASE PRICE 6205 3180 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES APPLICATION OF SKIN TRACTION BASE PRICE 6189 390 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES BALL BANDAGE BASE PRICE 5880 640 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES BANDAGE & STRAPPINGS FOR FRACTURES BASE PRICE 6198 640 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES BELOW KNEE FULL PLASTER BASE PRICE 5857 1280 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES BELOW KNEE POST - SLAB BASE PRICE 5858 1280 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES COLAR AND CULF SLING BASE PRICE 5879 170 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES COLLES FRACTURE - BELOW ELBOW PLASTER BASE PRICE 5852 1280 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES COLLES FRACTURE - FULL PLASTER BASE PRICE 5853 1280 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES CTEV CAST BASE PRICE 5867 1010 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES DOUBLE HIP SPICA BASE PRICE 5866 4440 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES DRESSING IN OT BASE PRICE 5943 960 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES FIGURE OF 8 BANDAGE BASE PRICE 5878 640 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES FINGERS (POST, SLAB) BASE PRICE 5850 640 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES FINGERS FULL PLASTER BASE PRICE 5851 640 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES I & D ABSCESS BASE PRICE 5954 3180 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES JOINTS ASPIRATION BASE PRICE 6180 3180 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES MINERVA JACKET BASE PRICE 5861 5080 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES NASAL BONE FRACTURE BASE PRICE 5877 450 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES PLASTER JACKET BASE PRICE 5862 4440 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES PODIATRIC EXAMINATION BASE PRICE 2234 250 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES POP REMOVAL BASE PRICE 5868 250 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES REMOVAL OF SUBCUTANEOUS SCREW BASE PRICE 5955 3180 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES SHOULDER SPICA BASE PRICE 5863 3180 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES SINGLE HIP SPICA - ADULT BASE PRICE 5864 3180 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES SINGLE HIP SPICA - CHILD BASE PRICE 5865 2540 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES SKELETAL TRACTION UNDER LA IN OT BASE PRICE 5952 3180 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES STRAPPING BASE PRICE 6197 250 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES STRAPPING OF ANKLE BASE PRICE 5874 390 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES STRAPPING OF CHEST BASE PRICE 5875 390 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES STRAPPING OF ELBOW BASE PRICE 5872 250 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES STRAPPING OF FINGER BASE PRICE 5869 250 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES STRAPPING OF KNEE BASE PRICE 5873 390 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES STRAPPING OF SHOULDER BASE PRICE 5876 450 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES STRAPPING OF TOES BASE PRICE 5870 250 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES STRAPPING OF WRIST BASE PRICE 5871 250 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES TUBE PLASTER (OR PLASTER CYLINDER) BASE PRICE 5859 1900 0 ORTHOPEDICS ORTHOPEDICS PROCEDURES WOUND DEBRIDEMENT BASE PRICE 5953 3180 0 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHROSCOPIC LOOSE BODY REMOVAL BASE PRICE 6118 15440 25

Page 55 of 115 ORTHOPEDICS ORTHOPEDICS SURGERY BELL TWASES PROCEDURE BASE PRICE 12896 39690 25 ORTHOPEDICS ORTHOPEDICS SURGERY TROCHLEOPLASTY BASE PRICE 12859 52920 25 ORTHOPEDICS ORTHOPEDICS SURGERY A.O. FIXATION/NAILING WITH BONE GRAFTING LONG BONES BASE PRICE 6165 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY ABOVE ELBOW AMPUTATION BASE PRICE 6002 15440 25 ORTHOPEDICS ORTHOPEDICS SURGERY ACI BASE PRICE 12857 44100 25 ORTHOPEDICS ORTHOPEDICS SURGERY ACROMIOCLAVICULAR JOINT SURGERY BASE PRICE 5995 15440 25 ORTHOPEDICS ORTHOPEDICS SURGERY ADDUCTION CONTRACTURE RELEASE & FLAP BASE PRICE 6062 15440 25 ORTHOPEDICS ORTHOPEDICS SURGERY ADDUCTOR TENOTOMY BASE PRICE 6107 13890 25 ORTHOPEDICS ORTHOPEDICS SURGERY ADOLOCENT FEMUR NAILING BASE PRICE 12843 35280 25 ORTHOPEDICS ORTHOPEDICS SURGERY ALL INSIDE ACL BASE PRICE 12849 39690 25 ORTHOPEDICS ORTHOPEDICS SURGERY ALL INSIDE PC BASE PRICE 12850 52920 25 ORTHOPEDICS ORTHOPEDICS SURGERY ALL INSIDE TRICLANLE ACL BASE PRICE 12851 44100 25 ORTHOPEDICS ORTHOPEDICS SURGERY AMPUTATION: FOOT, HAND, RAY EXCISION BASE PRICE 6162 15440 25 ORTHOPEDICS ORTHOPEDICS SURGERY AMPUTATION: FORE QUARTER/HIND QUARTER BASE PRICE 6170 30870 25 ORTHOPEDICS ORTHOPEDICS SURGERY AMPUTATIONS UPPER LIMB & LOWER LIMB BASE PRICE 5918 30870 25 ORTHOPEDICS ORTHOPEDICS SURGERY AMPUTATIONS - ABOVE ELBOW BASE PRICE 6176 30870 25 ORTHOPEDICS ORTHOPEDICS SURGERY AMPUTATIONS - ABOVE KNEE BASE PRICE 6177 30870 25 ORTHOPEDICS ORTHOPEDICS SURGERY AMPUTATIONS - BELOW ELBOW BASE PRICE 6178 30870 25 ORTHOPEDICS ORTHOPEDICS SURGERY AMPUTATIONS - BELOW KNEE BASE PRICE 6179 30870 25 ORTHOPEDICS ORTHOPEDICS SURGERY ANCLE LIGAMENT RECONTRCTION BASE PRICE 12895 39690 25 ORTHOPEDICS ORTHOPEDICS SURGERY ANKLE DEFORMITY CORRECTION BASE PRICE 6131 15440 25 ORTHOPEDICS ORTHOPEDICS SURGERY ANTEREOLATERAL DECOMPRESSION AND SPINAL FUSION BASE PRICE 6192 24260 25 ORTHOPEDICS ORTHOPEDICS SURGERY ANTERIOR FIXATION AUTABULUSS BASE PRICE 12827 52920 25 ORTHOPEDICS ORTHOPEDICS SURGERY ANTERIOR TRANSPOSITION BASE PRICE 6021 15440 25 ORTHOPEDICS ORTHOPEDICS SURGERY ANTERIOR TRANSPOSITION OF ULNAR NERVE BASE PRICE 5963 24260 25 ORTHOPEDICS ORTHOPEDICS SURGERY ANTEROLATERAL CLEARANCE FOR TUBERCULOSIS BASE PRICE 6193 24260 25 ORTHOPEDICS ORTHOPEDICS SURGERY ANTIBIOTIC SPACER IN ARTHROPLASTY BASE PRICE 12836 39690 25 ORTHOPEDICS ORTHOPEDICS SURGERY AO PROCEDURE BASE PRICE 5928 10670 25 ORTHOPEDICS ORTHOPEDICS SURGERY APPLICATION OF P.O.P SPICES & JACKETS BASE PRICE 6204 10700 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTH CAPSULAR RELEASE BASE PRICE 5984 15440 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTH ROTATOR CUFF REPAIR BASE PRICE 5979 34730 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHRODESIS MAJOR JOINTS BASE PRICE 5910 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHRODESIS MINOR JOINTS BASE PRICE 5926 19300 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHRODESIS MINOR JOINTS BASE PRICE 5972 19300 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHRODESIS MINOR JOINTS GRICE GREEN BASE PRICE 6151 19300 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHROGRAPHY BASE PRICE 6208 12130 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHROLYSIS BASE PRICE 6013 19300 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHROPLASTY: THR, TKR, SHOULDER, ELBOW, ANKLE BASE PRICE 6171 40250 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHROSCOPIC ACL BASE PRICE 6111 24260 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHROSCOPIC ANKLE FUSION BASE PRICE 6132 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHROSCOPIC ANKLE SYNOVECTOMY BASE PRICE 6138 15440 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHROSCOPIC ARTHROLYSIS BASE PRICE 6121 15440 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHROSCOPIC ARTHROLYSIS BASE PRICE 6008 15440 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHROSCOPIC ASSISTED FIXATION BASE PRICE 12821 39690 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHROSCOPIC ASSISTED RADIUS FRACTURE FIXATION BASE PRICE 6027 30870 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHROSCOPIC BANKART'S REPAIR BASE PRICE 5978 30870 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHROSCOPIC CLAVICLE RESECTION BASE PRICE 5996 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHROSCOPIC GANGLION EXCISION BASE PRICE 6043 23150 25

Page 56 of 115 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHROSCOPIC IMPINGEMENT RELEASE BASE PRICE 6139 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHROSCOPIC KNEE SYNOVECTOMY BASE PRICE 6117 19300 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHROSCOPIC LATERAL RELEASE BASE PRICE 6120 19300 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHROSCOPIC LOOSE BODY REMOVAL BASE PRICE 6140 15440 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHROSCOPIC LOOSE BODY REMOVAL BASE PRICE 6000 15440 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHROSCOPIC MENESECTOMY BASE PRICE 6119 15440 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHROSCOPIC PCL BASE PRICE 6108 34730 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHROSCOPIC SL LIGAMENT SHRINKAGE BASE PRICE 6044 15440 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHROSCOPIC SLAP REPAIR BASE PRICE 5980 34730 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHROSCOPIC STYLOIDECTOMY BASE PRICE 6045 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHROSCOPIC SUBACROMIAL DECOMPRESSION BASE PRICE 5997 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHROSCOPIC SYNOVECTOMY BASE PRICE 5999 19300 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHROSCOPIC TFCC REPAIR BASE PRICE 6038 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHROSCOPIC WAFER PROCEDURE BASE PRICE 6037 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHROSCOPIC WRIST SYNOVECTOMY BASE PRICE 6042 19300 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHROTOMY - DIFFICULT BASE PRICE 5967 19300 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHROTOMY - MAJOR BASE PRICE 5998 15440 25 ORTHOPEDICS ORTHOPEDICS SURGERY ARTHROTOMY - SIMPLE BASE PRICE 6047 11580 25 ORTHOPEDICS ORTHOPEDICS SURGERY ASIF PROCEDURES BASE PRICE 5905 21350 25 ORTHOPEDICS ORTHOPEDICS SURGERY ASTHROSCOPIC ANKLE FESION BASE PRICE 12880 35280 25 ORTHOPEDICS ORTHOPEDICS SURGERY BARREL PLATE FXIATION # NECK FEMUR BASE PRICE 5925 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY BELOW KNEE AMPUTATION BASE PRICE 6133 12350 25 ORTHOPEDICS ORTHOPEDICS SURGERY BICEPS TENODESIS BASE PRICE 12863 35280 25 ORTHOPEDICS ORTHOPEDICS SURGERY BIPOLAR HIP REPLACEMENT BASE PRICE 5892 25470 25 ORTHOPEDICS ORTHOPEDICS SURGERY BONE GRAFTING BASE PRICE 5971 15440 25 ORTHOPEDICS ORTHOPEDICS SURGERY BONE OPEN BIOPSY BASE PRICE 5949 7720 25 ORTHOPEDICS ORTHOPEDICS SURGERY BOYES/BRAND/JONES TRANSFER BASE PRICE 6022 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY BRANCHIAL PLESUS RECONSTRUCTION SURGERY BASE PRICE 12815 35280 25 ORTHOPEDICS ORTHOPEDICS SURGERY BURSION SURGERY BASE PRICE 12881 26460 25 ORTHOPEDICS ORTHOPEDICS SURGERY CABLE & NAILING IN SUB-TROCHANTRC FRACTURE BASE PRICE 12845 39690 25 ORTHOPEDICS ORTHOPEDICS SURGERY CARAEOCLANICULAR LIGAMENT RECONSTRUCTION) BASE PRICE 12810 30870 25 ORTHOPEDICS ORTHOPEDICS SURGERY CARPAL TUNNEL RELEASE BASE PRICE 12819 17640 25 ORTHOPEDICS ORTHOPEDICS SURGERY CARPAL DISLOCATION SURGERY BASE PRICE 6024 34730 25 ORTHOPEDICS ORTHOPEDICS SURGERY CENTRALIZATION SURGERY BASE PRICE 6055 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY CERAMIC THR (TOTAL) BASE PRICE 8491 53360 25 ORTHOPEDICS ORTHOPEDICS SURGERY CEREBRAL PALSY SURGERIES BASE PRICE 5920 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY CHARCOT FOOT STABILIZATION BASE PRICE 12894 35280 25 ORTHOPEDICS ORTHOPEDICS SURGERY CLAVICLE FIXATION BASE PRICE 5989 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY CLOSE REDUCTION OF FRACTURES OF LIMB & P.O.P BASE PRICE 6181 9920 25 ORTHOPEDICS ORTHOPEDICS SURGERY CLOSED REDUCTION FRACTURES & DISLOCATIONS BASE PRICE 5946 7720 25 ORTHOPEDICS ORTHOPEDICS SURGERY CLOSED REDUCTION FRACTURES & DISLOCATIONS - SMALL BONES BASE PRICE 6157 7720 25 ORTHOPEDICS ORTHOPEDICS SURGERY CLOSED REDUCTION: SECONDARY CLOSURE OF WOUNDS BASE PRICE 6155 11580 25 ORTHOPEDICS ORTHOPEDICS SURGERY CLUB FOOT SOFT TISSUE SURGERIES BASE PRICE 6149 15440 25 ORTHOPEDICS ORTHOPEDICS SURGERY CMC ARTHROPLASTY BASE PRICE 12823 35280 25 ORTHOPEDICS ORTHOPEDICS SURGERY CMC JOINT ARTHROSCOPY BASE PRICE 6060 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY CMC JOINT SUSPENSION ARTHROPLASTY BASE PRICE 6067 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY CONGENITAL SYNOSTOSIS SURGERY BASE PRICE 6018 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY CORE DECOMPRESSION IN AVN BASE PRICE 6101 23150 25

Page 57 of 115 ORTHOPEDICS ORTHOPEDICS SURGERY CORRECTIVE OSTEOTOMIES LOWER LIMB BASE PRICE 5907 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY CORRECTIVE OSTEOTOMIES UPPER LIMB BASE PRICE 5921 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY CORRECTIVE OSTEOTOMY PROXIMAL HUMERUS BASE PRICE 5988 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY CORTICOTEMY BASE PRICE 6163 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY COSTO TRANSVERSECTOMY BASE PRICE 6194 24010 25 ORTHOPEDICS ORTHOPEDICS SURGERY COXA VARA SURGERY BASE PRICE 6093 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY CP SURGERY BASE PRICE 6124 3640 25 ORTHOPEDICS ORTHOPEDICS SURGERY CUBITUS VARUS/VALGUS SURGERY BASE PRICE 6016 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY CUBOID/NATUCULAR SURGERY BASE PRICE 12877 30870 25 ORTHOPEDICS ORTHOPEDICS SURGERY DARRACH'S PROCEDURE BASE PRICE 5960 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY DCP FIXATION OF DIAPHYSEAL FRACTURES BASE PRICE 5922 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY DDH SURGERIES BASE PRICE 6092 46310 25 ORTHOPEDICS ORTHOPEDICS SURGERY DE-QUERVAINS RELEASE BASE PRICE 6053 19300 25 ORTHOPEDICS ORTHOPEDICS SURGERY DEBRIDEMENT COMPOUND FRACTURES BASE PRICE 5969 11580 25 ORTHOPEDICS ORTHOPEDICS SURGERY DEBRIDEMENT, CLOSURE AND CLOSED REDUCTION BASE PRICE 6156 11580 25 ORTHOPEDICS ORTHOPEDICS SURGERY DEGA'S OSTIOTOMY BASE PRICE 12838 44100 25 ORTHOPEDICS ORTHOPEDICS SURGERY DELTOID TRANFER BASE PRICE 6017 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY DFN BASE PRICE 5902 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY DIAGNOSTIC WRIST ARTHROSCOPY BASE PRICE 6041 19300 25 ORTHOPEDICS ORTHOPEDICS SURGERY DIP FIXATION BASE PRICE 12824 35280 25 ORTHOPEDICS ORTHOPEDICS SURGERY DISARTICULATION MAJOR JOINTS BASE PRICE 5881 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY DISLOCATION: OPEN REDUCTION DISLOCATION HIP, KNEE, SHOULDER, ELBOW BASE PRICE 6166 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY DOUBLE BUNDLE ACL BASE PRICE 12852 44100 25 ORTHOPEDICS ORTHOPEDICS SURGERY DRESSING IN OT BASE PRICE 12484 910 25 ORTHOPEDICS ORTHOPEDICS SURGERY DRUJ RECONSTRUCTION BASE PRICE 12890 39690 25 ORTHOPEDICS ORTHOPEDICS SURGERY DUAL MOBILITY IN THR BASE PRICE 12837 44100 25 ORTHOPEDICS ORTHOPEDICS SURGERY DUPYUTRENS CONTRACTURE RELEASE BASE PRICE 6068 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY DYNAMIC HIP SCREW FIXATION[DHS] BASE PRICE 5890 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY ECRL TRANSFER IN VIC BASE PRICE 6058 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY ELBOW ARTHROSCOPY BASE PRICE 12818 30870 25 ORTHOPEDICS ORTHOPEDICS SURGERY ELBOW EHDS SURGERY BASE PRICE 6011 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY ELBOW FLEXUROPLASTY BASE PRICE 6005 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY ENDOSCOPIC /OPEN CARPAL TUNNEL RELEASE BASE PRICE 6031 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY ENDOSCOPIC CUBITAL TUNNEL RELEASE BASE PRICE 6020 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY EPL TRANSFER BASE PRICE 6054 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY EXCISION ARTHROPLASTY - ELBOW, KNEE, HIP BASE PRICE 5924 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY EXCISION HEAD RADIUS BASE PRICE 5959 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY EXCISION,CURETTAGE&BONE GRAFTING BASE PRICE 6112 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY EXT - FIXATION HAND INJURIES BASE PRICE 5965 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY EXT - FIXATION SIMPLE FRACTURES BASE PRICE 5956 13350 25 ORTHOPEDICS ORTHOPEDICS SURGERY EXTERNAL FIXATION COMPOUND FRACTURE BASE PRICE 5908 19400 25 ORTHOPEDICS ORTHOPEDICS SURGERY EXTERNAL FIXATION: PELVIS, FEMUR, LEG AND FOREARM, HUMERUS BASE PRICE 6161 19400 25 ORTHOPEDICS ORTHOPEDICS SURGERY FASCIOTOMY BASE PRICE 6057 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY FEMER HEAD FIXATION BASE PRICE 12830 52920 25 ORTHOPEDICS ORTHOPEDICS SURGERY FHL AUGMENTATION IN TA BASE PRICE 12872 39690 25 ORTHOPEDICS ORTHOPEDICS SURGERY FINGER AMPUTATION BASE PRICE 6082 15440 25 ORTHOPEDICS ORTHOPEDICS SURGERY FINGER DEFORMITY CORRECTION BASE PRICE 6081 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY FINGER FLAPS BASE PRICE 6075 23150 25

Page 58 of 115 ORTHOPEDICS ORTHOPEDICS SURGERY FINGER JOINT FUSION BASE PRICE 6084 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY FIXATION OF CONDYLAR FRACTURES BASE PRICE 5966 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY FIXATION OF DIAPHYSEAL & EPIPHYSEAL FRACTURES BASE PRICE 6158 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY FIXED BEARING BASE PRICE 5931 24260 25 ORTHOPEDICS ORTHOPEDICS SURGERY FIXED COMPONENT REMOVAL IN ARTHROPLASTY BASE PRICE 12835 39690 25 ORTHOPEDICS ORTHOPEDICS SURGERY FLAT FOOT SURGERY BASE PRICE 12874 35280 25 ORTHOPEDICS ORTHOPEDICS SURGERY FOOT AMPUTATIONS BASE PRICE 6150 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY FOOT FEESION BASE PRICE 12878 30870 25 ORTHOPEDICS ORTHOPEDICS SURGERY FRAGMENT SPECIFIC FRACTURE RADIUS BASE PRICE 12820 39690 25 ORTHOPEDICS ORTHOPEDICS SURGERY FREE FLAP COVERAGE BASE PRICE 6128 46310 25 ORTHOPEDICS ORTHOPEDICS SURGERY FREE GRACILIS TRANSFER BASE PRICE 6029 46310 25 ORTHOPEDICS ORTHOPEDICS SURGERY FULKERSONS OSTEOTOMY BASE PRICE 12858 44100 25 ORTHOPEDICS ORTHOPEDICS SURGERY GANGLION EXCISION BASE PRICE 5945 19300 25 ORTHOPEDICS ORTHOPEDICS SURGERY GENU VALGUM CORRECTION BASE PRICE 6115 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY GIRDLESTONE ARTHROPLASTY BASE PRICE 6105 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY GOULDS PROCEDURE BASE PRICE 6141 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY HAEGHNDS DEFORMITY BASE PRICE 12873 35280 25 ORTHOPEDICS ORTHOPEDICS SURGERY HALLEX VALYES SURGERY BASE PRICE 12875 35280 25 ORTHOPEDICS ORTHOPEDICS SURGERY HALLUX VALGUS CORRECTION BASE PRICE 6145 3640 25 ORTHOPEDICS ORTHOPEDICS SURGERY HALLUX VALGUS DEFORMITY BASE PRICE 5964 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY HAMMER TOE CORRECTION BASE PRICE 6146 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY HAND FOREIGN BODY REMOVAL BASE PRICE 6085 15440 25 ORTHOPEDICS ORTHOPEDICS SURGERY HANUSTRING/QUADRICEPS REPAIR BASE PRICE 12864 39690 25 ORTHOPEDICS ORTHOPEDICS SURGERY HEMI HAMATE ARTHROPLASTY BASE PRICE 12825 39690 25 ORTHOPEDICS ORTHOPEDICS SURGERY HEMIEPIPHYSEODESIS BASE PRICE 12867 30870 25 ORTHOPEDICS ORTHOPEDICS SURGERY HEMIREPLACEMENT IN HUMERUS FRACTURES BASE PRICE 5983 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY HIGH TIBIAL OSTEOTOMY BASE PRICE 5888 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY HINDFOOT FESION BASE PRICE 12879 35280 25 ORTHOPEDICS ORTHOPEDICS SURGERY HIP ARTHROCOPY BASE PRICE 12842 35280 25 ORTHOPEDICS ORTHOPEDICS SURGERY HIP BIOPSY BASE PRICE 6104 19300 25 ORTHOPEDICS ORTHOPEDICS SURGERY HIP DISARTICULATION BASE PRICE 6096 34730 25 ORTHOPEDICS ORTHOPEDICS SURGERY HRA BASE PRICE 5916 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY I & D ABSCESS BASE PRICE 12181 3030 25 ORTHOPEDICS ORTHOPEDICS SURGERY IIIIZAROV TECHNIQUE BASE PRICE 5884 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY ILIOSACRAL SEREWS BASE PRICE 12831 52920 25 ORTHOPEDICS ORTHOPEDICS SURGERY ILLIZAROVS EQUINUS CORRECTION BASE PRICE 6130 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY IMPLANT REMOVAL: LOCAL INTRA-ARTICULAR INJECTION BASE PRICE 6168 10010 25 ORTHOPEDICS ORTHOPEDICS SURGERY IMPLANT REMOVAL: REMOVAL OF FIXATORS, TENSION BAND WIRE BASE PRICE 6169 11030 25 ORTHOPEDICS ORTHOPEDICS SURGERY IMPLANT REMOVAL: SKELETAL TRACTION APPLICATION BASE PRICE 6159 9090 25 ORTHOPEDICS ORTHOPEDICS SURGERY INTERLOCKING NAILING (IMPORTED) BASE PRICE 5885 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY INTERLOCKING NAILING (INDIAN) BASE PRICE 5912 19400 25 ORTHOPEDICS ORTHOPEDICS SURGERY INTERPOSITIONAL ARTHROPLASTY BASE PRICE 6065 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY INTRAPELVIC FIXATION BASE PRICE 12826 61740 25 ORTHOPEDICS ORTHOPEDICS SURGERY JESS BASE PRICE 5901 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY K - WIRE FIXATION CONDYLAR FRACTURES BASE PRICE 5962 13350 25 ORTHOPEDICS ORTHOPEDICS SURGERY K - WIRE FIXATION FINGER /TOES BASE PRICE 5947 7280 25 ORTHOPEDICS ORTHOPEDICS SURGERY KAPLANS PROCEDURE BASE PRICE 6072 15440 25 ORTHOPEDICS ORTHOPEDICS SURGERY KNEE FUSION BASE PRICE 6114 6070 25

Page 59 of 115 ORTHOPEDICS ORTHOPEDICS SURGERY KNEE SURGERY: DIAGNOSTIC ARTHROSCOPY BASE PRICE 6153 15440 25 ORTHOPEDICS ORTHOPEDICS SURGERY KNEE SURGERY: OPEN SYNOVECTOMY - KNEE, HIP, WRIST, ELBOW, ANKLE ETC. BASE PRICE 6154 19300 25 ORTHOPEDICS ORTHOPEDICS SURGERY LATARJET'S PROCEDURE BASE PRICE 12812 39690 25 ORTHOPEDICS ORTHOPEDICS SURGERY LATERAL WALL EXOSECTOMY BASE PRICE 6142 19300 25 ORTHOPEDICS ORTHOPEDICS SURGERY LC - DCP FIXATION OF DIAPHYSEAL FRACTURES BASE PRICE 5913 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY LCP FIXATION OF DIAPHYSEAL FRACTURE. BASE PRICE 5883 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY LD TRANSFORM ROTATION CUFF TEARS BASE PRICE 12891 52920 25 ORTHOPEDICS ORTHOPEDICS SURGERY LEPROSY SURGERY BASE PRICE 6088 5510 25 ORTHOPEDICS ORTHOPEDICS SURGERY LIGAMENT REPAIR BASE PRICE 6086 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY LIMB SALVAGE IN ELBOW TUMORS BASE PRICE 6003 30870 25 ORTHOPEDICS ORTHOPEDICS SURGERY LIMB SALVAGE IN HIP TUMORS BASE PRICE 6090 46310 25 ORTHOPEDICS ORTHOPEDICS SURGERY LIMB SALVAGE IN KNEE TUMORS BASE PRICE 6109 46310 25 ORTHOPEDICS ORTHOPEDICS SURGERY LIMB SALVAGE IN SHOULDER TUMORS BASE PRICE 5981 46310 25 ORTHOPEDICS ORTHOPEDICS SURGERY LIMB SALVAGE IN WRIST TUMORS BASE PRICE 6026 30870 25 ORTHOPEDICS ORTHOPEDICS SURGERY LIS FRAME SURGERY BASE PRICE 12876 35280 25 ORTHOPEDICS ORTHOPEDICS SURGERY LOCAL FLAP COVERAGE BASE PRICE 6147 3640 25 ORTHOPEDICS ORTHOPEDICS SURGERY LONG BONES - BI/TRIMALLEOLAR ANKLE BASE PRICE 6167 21830 25 ORTHOPEDICS ORTHOPEDICS SURGERY MAEDLUNG DEFORMITY CORRECTION BASE PRICE 6036 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY MALLET FINGER SURGERY BASE PRICE 6087 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY MASQUELET TECHNIQUE BASE PRICE 12847 39690 25 ORTHOPEDICS ORTHOPEDICS SURGERY MAXPAGE RELEASE BASE PRICE 6056 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY MCL/PLC RECONSTRUCTION BASE PRICE 12854 44100 25 ORTHOPEDICS ORTHOPEDICS SURGERY MCL/PLC REPAIR BASE PRICE 12853 35280 25 ORTHOPEDICS ORTHOPEDICS SURGERY MENISCAL REPAIR BASE PRICE 12865 30870 25 ORTHOPEDICS ORTHOPEDICS SURGERY MENISCAL ROOT REPAIR BASE PRICE 12866 35280 25 ORTHOPEDICS ORTHOPEDICS SURGERY MENISCOPLASTY BASE PRICE 12886 35280 25 ORTHOPEDICS ORTHOPEDICS SURGERY METASTATIC LESION MANAGEMENT BASE PRICE 12889 35280 25 ORTHOPEDICS ORTHOPEDICS SURGERY MIDCARPAL FUSION BASE PRICE 6052 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY MINI ROTATOR CUFF REPAIR BASE PRICE 5986 30870 25 ORTHOPEDICS ORTHOPEDICS SURGERY MIPPO DISTAL FEMER BASE PRICE 12860 39690 25 ORTHOPEDICS ORTHOPEDICS SURGERY MIPPO TIBIA BASE PRICE 12861 39690 25 ORTHOPEDICS ORTHOPEDICS SURGERY MISCELLANEOUS / UNCLASSIFIED PROCEDURE - MAJOR BASE PRICE 5904 34730 25 ORTHOPEDICS ORTHOPEDICS SURGERY MISCELLANEOUS / UNCLASSIFIED PROCEDURE - SIMPLE BASE PRICE 5915 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY MOBILE BEARING/HIGH FLEXION KNEE BASE PRICE 5932 40030 25 ORTHOPEDICS ORTHOPEDICS SURGERY MOSAIC PLASTY BASE PRICE 6129 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY MULTIPLE DRILL HOLES BASE PRICE 5968 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY MULTIPLE PINNING FRACTURE NECK FEMUR BASE PRICE 6202 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY MUSCLE PEDICLE GRAFT AND INTERNAL FIXATION BASE PRICE 5882 34730 25 ORTHOPEDICS ORTHOPEDICS SURGERY MYOCUTANEOUS AND FASCIOCUTANEOUS FLAP PROCEDURES FOR LIMBS BASE PRICE 6206 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY NAILBED REPAIR BASE PRICE 6083 19300 25 ORTHOPEDICS ORTHOPEDICS SURGERY NERVE REPAIR WITH GRAFTING BASE PRICE 6187 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY NERVE/TENDON REPAIR BASE PRICE 6028 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY NEUROVASCULAR ISLAND FLAP BASE PRICE 6063 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY OCD TALUS BASE PRICE 12883 35280 25 ORTHOPEDICS ORTHOPEDICS SURGERY OLECRONON FRACTURE / DISLOCATION BASE PRICE 12892 39690 25 ORTHOPEDICS ORTHOPEDICS SURGERY OPEN BANKART'S REPAIR BASE PRICE 5985 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY OPEN REDUCTION OF DISLOCATIONS - DEEP BASE PRICE 6182 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY OPEN REDUCTION OF DISLOCATIONS - SUPERFICIAL BASE PRICE 6183 21830 25

Page 60 of 115 ORTHOPEDICS ORTHOPEDICS SURGERY OPEN REDUCTION OF FRACTURE DISLOCATION & INTERNAL FIXATION BASE PRICE 6184 21830 25 ORTHOPEDICS ORTHOPEDICS SURGERY OPEN REDUCTION OF FRACTURE OF LONG BONES OF UPPER / LOWER LIMB -AO PROCEDURESBASE PRICE 6185 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY OPEN REDUCTION OFFRACTURE OF LONG BONES OF UPPER / LOWER LIMB -NAILINGBASE & PRICEEXTERNAL FIXATION6186 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY OPEN SYNDESMOTIC REPAIR BASE PRICE 12869 35280 25 ORTHOPEDICS ORTHOPEDICS SURGERY ORBEY'S FIXATION OF RADIUS BASE PRICE 12822 39690 25 ORTHOPEDICS ORTHOPEDICS SURGERY OSTEO SYNTHESIS OF NON UNION FRACTURES BASE PRICE 5887 30870 25 ORTHOPEDICS ORTHOPEDICS SURGERY OSTEOMYELITIS: FIBULA, RADIUS, ULNA, CLAVICLE BASE PRICE 6172 19300 25 ORTHOPEDICS ORTHOPEDICS SURGERY OSTEOMYELITIS: WRIST, ANKLE, HAND, FOOT BASE PRICE 6173 19300 25 ORTHOPEDICS ORTHOPEDICS SURGERY OSTEOSYNTHESIS ACETABULAR FRACTURE BASE PRICE 5900 46310 25 ORTHOPEDICS ORTHOPEDICS SURGERY OSTEOSYNTHESIS COMPLEX FRACTURES AROUND WRIST. BASE PRICE 5911 30870 25 ORTHOPEDICS ORTHOPEDICS SURGERY OSTEOSYNTHESIS DISTAL FEMORAL FARACTURES BASE PRICE 5898 34730 25 ORTHOPEDICS ORTHOPEDICS SURGERY OSTEOSYNTHESIS FRACTURE DISLOCATIONS BASE PRICE 5899 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY OSTEOSYNTHESIS LOWER HUMERUS BASE PRICE 5894 34730 25 ORTHOPEDICS ORTHOPEDICS SURGERY OSTEOSYNTHESIS LOWER TIBIA BASE PRICE 5897 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY OSTEOSYNTHESIS LOWER UPPER TIBIA BASE PRICE 5895 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY OSTEOSYNTHESIS UPPER HUMERUS BASE PRICE 5896 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY OSTEOTOMIES AROUND HIP - MAJOR BASE PRICE 5886 34730 25 ORTHOPEDICS ORTHOPEDICS SURGERY OSTEOTOMIES AROUND HIP - SIMPLE BASE PRICE 5906 19400 25 ORTHOPEDICS ORTHOPEDICS SURGERY PARREL PLATING AND TRAP IN DISTAL HUMERUS FRACTURE BASE PRICE 12816 39690 25 ORTHOPEDICS ORTHOPEDICS SURGERY PARTIAL JOINT REPLACEMENT BASE PRICE 5891 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY PATELLA REALIGNMENT SURGERY BASE PRICE 6122 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY PATELLAR RESURFACING BASE PRICE 8487 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY PATELLECOMY BASE PRICE 5958 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY PCL AVULSION BASE PRICE 12856 30870 25 ORTHOPEDICS ORTHOPEDICS SURGERY PEDICLE LAT DORSII FLAP BASE PRICE 5994 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY PELVIC RESECTIONS BASE PRICE 6089 46310 25 ORTHOPEDICS ORTHOPEDICS SURGERY PERCUTANEOUS ELBOW K-WIRE FIXATION BASE PRICE 6019 19300 25 ORTHOPEDICS ORTHOPEDICS SURGERY PERCUTANEOUS SCAPHOID FIXATION BASE PRICE 6046 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY PES PLANUS SURGERY BASE PRICE 6148 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY PFN BASE PRICE 5903 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY PHALANGES FIXATION BASE PRICE 6071 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY PILON FIXATION BASE PRICE 12868 39690 25 ORTHOPEDICS ORTHOPEDICS SURGERY PIP/MCP CONTRACTURE RELEASE BASE PRICE 6070 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY PLANTAR FASCIA SURGERY BASE PRICE 12882 35280 25 PLASTER CASTS: MANIPULATION UNDER GA FOR CLUB FOOT & CONGENITAL ORTHOPEDICS ORTHOPEDICS SURGERY BASE PRICE 6152 7720 DISLOCATION HIP, STIFF SHOULDER, STIFF KNEE 25 ORTHOPEDICS ORTHOPEDICS SURGERY PLC RECONSTRUCTION BASE PRICE 6116 3640 25 ORTHOPEDICS ORTHOPEDICS SURGERY POLIO SOFT TISSUE SURGERIES - MAJOR BASE PRICE 6098 15440 25 ORTHOPEDICS ORTHOPEDICS SURGERY POLIO SOFT TISSUE SURGERIES - SIMPLE BASE PRICE 6137 3640 25 ORTHOPEDICS ORTHOPEDICS SURGERY POLIO SOFT TISSUE SURGERY - COMPLEX BASE PRICE 6123 3640 25 ORTHOPEDICS ORTHOPEDICS SURGERY POLIO SURGERIES BASE PRICE 5919 16980 25 ORTHOPEDICS ORTHOPEDICS SURGERY POLIO SURGERY: LIMB LENGTHENING/SHORTENING BASE PRICE 6164 26460 25 ORTHOPEDICS ORTHOPEDICS SURGERY POLLICISATION BASE PRICE 6066 34730 25 ORTHOPEDICS ORTHOPEDICS SURGERY POLYDACTYLY EXCISION BASE PRICE 6080 15440 25 ORTHOPEDICS ORTHOPEDICS SURGERY POSTERIOR FIXATION AUTABULUSS BASE PRICE 12828 52920 25 ORTHOPEDICS ORTHOPEDICS SURGERY PRESSURE SORE FLAP SURGERIES BASE PRICE 6103 26460 25 ORTHOPEDICS ORTHOPEDICS SURGERY RA SOFT TISSUE SURGERIES BASE PRICE 6144 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY RA SOFT TISSUE SURGERIES BASE PRICE 6074 23150 25

Page 61 of 115 ORTHOPEDICS ORTHOPEDICS SURGERY RADIAL HEAD FIXATION,CORONOID FIXATION & LIGAMENT REPAIR BASE PRICE 6006 34730 25 ORTHOPEDICS ORTHOPEDICS SURGERY RADIAL HEAD SPACER BASE PRICE 6004 26460 25 ORTHOPEDICS ORTHOPEDICS SURGERY RADIAL SHORTENING IN KIENBOCK BASE PRICE 6051 26460 25 ORTHOPEDICS ORTHOPEDICS SURGERY RADIAL/CAPITELLUM/CORONOID BASE PRICE 6009 26460 25 ORTHOPEDICS ORTHOPEDICS SURGERY RADIAL/ULNAR COLLATERAL LIGAMENT RECONSTRUCTION BASE PRICE 6007 26460 25 ORTHOPEDICS ORTHOPEDICS SURGERY RADIAL/ULNAR/MEDIAN NERVE REPAIR BASE PRICE 6010 26460 25 ORTHOPEDICS ORTHOPEDICS SURGERY REMOVAL EXTERNAL FIXATION BASE PRICE 5950 8820 25 ORTHOPEDICS ORTHOPEDICS SURGERY REMOVAL FB DEEP BASE PRICE 5951 7720 25 ORTHOPEDICS ORTHOPEDICS SURGERY REMOVAL INTERLOCKING NAIL BASE PRICE 5976 10010 25 ORTHOPEDICS ORTHOPEDICS SURGERY REMOVAL K - WIRES BASE PRICE 5944 4800 25 ORTHOPEDICS ORTHOPEDICS SURGERY REMOVAL OF NAILS, WIRES & SCREW BASE PRICE 6188 10010 25 ORTHOPEDICS ORTHOPEDICS SURGERY REMOVAL OF SUBCUTANEOUS SCREW BASE PRICE 12630 6170 25 ORTHOPEDICS ORTHOPEDICS SURGERY REMOVAL PLATE & SCRIEWS BASE PRICE 5973 7720 25 ORTHOPEDICS ORTHOPEDICS SURGERY REMOVAL SCRIEWS BASE PRICE 5974 10010 25 ORTHOPEDICS ORTHOPEDICS SURGERY REPAIR RECURRENT DISLOCATION SHOULDER BASE PRICE 5889 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY RERRIBLE TRIAD ELBOW BASE PRICE 12893 52920 25 ORTHOPEDICS ORTHOPEDICS SURGERY RESECTION CURETTAGE & BONE GRAFTING BASE PRICE 5993 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY REVERSE SHOULDER REPLACEMENT BASE PRICE 12811 39690 25 ORTHOPEDICS ORTHOPEDICS SURGERY REVISION ACL BASE PRICE 12855 57330 25 ORTHOPEDICS ORTHOPEDICS SURGERY REVISION KNEE SURGERY BASE PRICE 8488 53360 25 ORTHOPEDICS ORTHOPEDICS SURGERY REVISION SHOULDER REPLACEMENT BASE PRICE 12813 57330 25 ORTHOPEDICS ORTHOPEDICS SURGERY RICHARDS SCREW FIXATION IN HIP FRACTURES BASE PRICE 5914 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY ROTATING HINGE ARTHROPLASTY BASE PRICE 12885 57330 25 ORTHOPEDICS ORTHOPEDICS SURGERY S-L LIGAMENT RECONSTRUCTION BASE PRICE 6040 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY S.P.NAILING FOR FRACTURE NECK FEMUR BASE PRICE 6203 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY SCAPHOID FIXATION BASE PRICE 6039 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY SCAPHOID VASCULAR BONE GRAFTING BASE PRICE 6023 34730 25 ORTHOPEDICS ORTHOPEDICS SURGERY SCAPULA FIXATION BASE PRICE 5991 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY SCFE PERCUTANEOUS FIXATION BASE PRICE 6102 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY SCHANZ PROCEDURE BASE PRICE 6106 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY SEMIEXTENDED TIBIAL NAILING BASE PRICE 12848 39690 25 ORTHOPEDICS ORTHOPEDICS SURGERY SEQUESTRECTOMY BASE PRICE 6100 15440 25 ORTHOPEDICS ORTHOPEDICS SURGERY SEQUESTRECTOMY & SAUCERISATION - SUPERFICIAL BASE PRICE 6195 16980 25 ORTHOPEDICS ORTHOPEDICS SURGERY SEQUESTRECTOMY & SAUCERIZATIONS -ARTHROTOMY BASE PRICE 6196 16980 25 ORTHOPEDICS ORTHOPEDICS SURGERY SHELF PROCEDURE BASE PRICE 12887 44100 25 ORTHOPEDICS ORTHOPEDICS SURGERY SHOULDER DISARTICULATION BASE PRICE 5992 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY SHOULDER FUSION BASE PRICE 5990 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY SHOULDER REPLACEMENT (HEMIARTHROPLASTY) BASE PRICE 5940 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY SIVER TARSIL CALCALNEAL FIXATION BASE PRICE 12870 39690 25 ORTHOPEDICS ORTHOPEDICS SURGERY SMALL BONE AMPUTATIONS BASE PRICE 5970 9090 25 ORTHOPEDICS ORTHOPEDICS SURGERY SMALL JOINT REPLACEMENT BASE PRICE 5942 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY SPINAL SURGERIES BASE PRICE 5893 24260 25 ORTHOPEDICS ORTHOPEDICS SURGERY SQ & SN (SQUESTRECTOMY & SAUCERIZATION) DEEP BASE PRICE 5917 16980 25 ORTHOPEDICS ORTHOPEDICS SURGERY SQ & SN SUPERFICIAL BASE PRICE 5975 9090 25 ORTHOPEDICS ORTHOPEDICS SURGERY ST. JOINTS/SYMPHYSES PUBIC FIXATION BASE PRICE 12832 52920 25 ORTHOPEDICS ORTHOPEDICS SURGERY SUAVI-KAPANDJI PROCEDURE BASE PRICE 6033 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY SUBTALAR FUSION BASE PRICE 6143 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY SURGICAL DISLOCATION OF HIP BASE PRICE 6094 30870 25

Page 62 of 115 ORTHOPEDICS ORTHOPEDICS SURGERY SYNDACTYLY RELEASE BASE PRICE 6077 7720 25 ORTHOPEDICS ORTHOPEDICS SURGERY SYNOVECTOMY & RADIAL HEAD RESECTION BASE PRICE 6015 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY SYNOVIAL BIOPSY BASE PRICE 5948 11580 25 ORTHOPEDICS ORTHOPEDICS SURGERY TA LENGTHENING BASE PRICE 6134 3640 25 ORTHOPEDICS ORTHOPEDICS SURGERY TA REPAIR BASE PRICE 6135 3640 25 ORTHOPEDICS ORTHOPEDICS SURGERY TALUS FIXATION BASE PRICE 12871 35280 25 ORTHOPEDICS ORTHOPEDICS SURGERY TARPO IN DISTAL FEMUR BASE PRICE 12846 39690 25 ORTHOPEDICS ORTHOPEDICS SURGERY TENDON GRAFTING BASE PRICE 6073 3640 25 ORTHOPEDICS ORTHOPEDICS SURGERY TENDON LENGTHENING/TENDON REPAIR BASE PRICE 6207 16980 25 ORTHOPEDICS ORTHOPEDICS SURGERY TENDON LENGTHENING/TENDON SUTURES BASE PRICE 6199 16980 25 ORTHOPEDICS ORTHOPEDICS SURGERY TENDON REPAIR BASE PRICE 5961 13350 25 ORTHOPEDICS ORTHOPEDICS SURGERY TENDON TRANSFER BASE PRICE 5923 16980 25 ORTHOPEDICS ORTHOPEDICS SURGERY TENDON TRANSFERS IN MEDIAN/ULNAR PALSY BASE PRICE 6032 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY TENDON WITH TRANSPLANT OR GRAFT BASE PRICE 6200 16980 25 ORTHOPEDICS ORTHOPEDICS SURGERY TENDON/NERVE REPAIR BASE PRICE 6061 6070 25 ORTHOPEDICS ORTHOPEDICS SURGERY TENNIS ELBOW SURGERY BASE PRICE 6012 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY TENSION BAND WIRINGS BASE PRICE 5957 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY TFCC RECONSTRUCTION BASE PRICE 6035 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY THR WITH AUTOVULAR DEFECT BASE PRICE 12834 52920 25 ORTHOPEDICS ORTHOPEDICS SURGERY THR IN PELVIC DISCONTINUITY BASE PRICE 12833 61740 25 ORTHOPEDICS ORTHOPEDICS SURGERY THR WITH CUP-CAGE TREBECLAR METAL BASE PRICE 12839 44100 25 ORTHOPEDICS ORTHOPEDICS SURGERY THUMB RECONSTRUCTION BASE PRICE 6064 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY TKR USING PATIENT SPECIFIC INSTRUMENT BASE PRICE 8489 55130 25 ORTHOPEDICS ORTHOPEDICS SURGERY TKR WITH TIBIO DEFECT BASE PRICE 12884 44100 25 ORTHOPEDICS ORTHOPEDICS SURGERY TORTISOCLLIN SURGERY BASE PRICE 12814 17640 25 ORTHOPEDICS ORTHOPEDICS SURGERY TOTAL ANKLE JOINT REPLACEMENT BASE PRICE 6190 34730 25 ORTHOPEDICS ORTHOPEDICS SURGERY TOTAL ELBOW REPLACEMENT BASE PRICE 5941 34730 25 ORTHOPEDICS ORTHOPEDICS SURGERY TOTAL HIP REPLACEMENT (CEMENTED) BASE PRICE 5933 30870 25 ORTHOPEDICS ORTHOPEDICS SURGERY TOTAL HIP REPLACEMENT (MODULAR BIPOLAR) BASE PRICE 5934 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY TOTAL HIP REPLACEMENT (NON CEMENTED) BASE PRICE 5935 38590 25 ORTHOPEDICS ORTHOPEDICS SURGERY TOTAL HIP REPLACEMENT (RESURFACING) BASE PRICE 5936 42450 25 ORTHOPEDICS ORTHOPEDICS SURGERY TOTAL HIP REPLACEMENT (REVISION) BASE PRICE 5938 55130 25 ORTHOPEDICS ORTHOPEDICS SURGERY TOTAL HIP REPLACEMENT (UNIPOLAR) BASE PRICE 5937 53360 25 ORTHOPEDICS ORTHOPEDICS SURGERY TOTAL KNEE REPLACEMENT BASE PRICE 5930 34730 25 ORTHOPEDICS ORTHOPEDICS SURGERY TOTAL SHOULDER REPLACEMENT BASE PRICE 5939 34730 25 ORTHOPEDICS ORTHOPEDICS SURGERY TOTAL WRIST JOINT REPLACEMENT BASE PRICE 6191 34730 25 ORTHOPEDICS ORTHOPEDICS SURGERY TRAPEZIUS TRANSFER SURGERY BASE PRICE 5987 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY TRICEPS/BICEPS/PECTORALIS REPAIR BASE PRICE 12862 35280 25 ORTHOPEDICS ORTHOPEDICS SURGERY TRIGGER DIGIT RELEASE BASE PRICE 6078 21610 25 ORTHOPEDICS ORTHOPEDICS SURGERY TROCHANTERIC FEMUR NAILING BASE PRICE 12844 35280 25 ORTHOPEDICS ORTHOPEDICS SURGERY TROCHRTERIC FLOP OSTEOTOMY BASE PRICE 12829 52920 25 ORTHOPEDICS ORTHOPEDICS SURGERY TUMOR EXCISION BASE PRICE 6076 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY TUMOR EXCISION WITH BONE GRAFTING BASE PRICE 6095 6070 25 ORTHOPEDICS ORTHOPEDICS SURGERY UNICONDYLAR KNEE REPLACEMENT BASE PRICE 6110 34730 25 ORTHOPEDICS ORTHOPEDICS SURGERY VALGUS OSTEOTOMY BASE PRICE 12888 39690 25 ORTHOPEDICS ORTHOPEDICS SURGERY VARUS DEROTATION OSTEOTOMY BASE PRICE 12841 44100 25 ORTHOPEDICS ORTHOPEDICS SURGERY VASCULAR BONE GRAFTING IN KEINBOCK DISEASE BASE PRICE 6025 34730 25 ORTHOPEDICS ORTHOPEDICS SURGERY VASCULARISED FIBULAR GRAFTING IN AVN BASE PRICE 6091 34730 25

Page 63 of 115 ORTHOPEDICS ORTHOPEDICS SURGERY VASCULARISED TOE / JOINT TRANSFER BASE PRICE 6059 34730 25 ORTHOPEDICS ORTHOPEDICS SURGERY VASCULARIZED FIBULA / PEDICLED RIB GRAFTING IN HUMERUS NON UNIONS BASE PRICE 5982 34730 25 ORTHOPEDICS ORTHOPEDICS SURGERY VASCULARIZED FIBULA IN PSEUDOARTHROSIS BASE PRICE 6127 34730 25 ORTHOPEDICS ORTHOPEDICS SURGERY VOLAR PLATE ARTHROPLASTY BASE PRICE 6069 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY WOUND DEBRIDEMENT BASE PRICE 12496 3030 25 ORTHOPEDICS ORTHOPEDICS SURGERY WRIST CONTRACTURE RELEASE BASE PRICE 6050 27020 25 ORTHOPEDICS ORTHOPEDICS SURGERY WRIST DENERVATION PROCEDURE BASE PRICE 6049 23150 25 ORTHOPEDICS ORTHOPEDICS SURGERY WRIST DISARTICULATION BASE PRICE 6048 3640 25 ORTHOPEDICS ORTHOPEDICS SURGERY WRIST FUSION BASE PRICE 6034 6070 25 ORTHOPEDICS ORTHOPEDICS SURGERY WRIST PEDICLED FLAP BASE PRICE 6030 6070 25 OT EQUIPMENT CHARGES OT EQUIPMENT EQUIPMENT CHARGES IN % OF SURGERY CHARGES BASE PRICE 12375 26% 0 OT EQUIPMENT CHARGES OT EQUIPMENT EQUIPMENT CHARGES EYE IN % OF SURGERY CHARGES BASE PRICE 11649 21% 0 OT EQUIPMENT CHARGES OT EQUIPMENT Fentanyl Injection BASE PRICE 8485 63 0 OT EQUIPMENT CHARGES OT EQUIPMENT SECOND SURGERY OT CHARGES IN % BASE PRICE 12808 21% 0 OT EQUIPMENT CHARGES OT EQUIPMENT CHARGES F CARE - EVRF MACHINE BASE PRICE 12640 7500 0 OT EQUIPMENT CHARGES OT EQUIPMENT CHARGES HARMONIC SCALPEL BASE PRICE 8559 2310 0 OTHERS OTHER CHARGES BED SHEET BASE PRICE 12233 120 0 OTHERS OTHER CHARGES MLC CHARGES BASE PRICE 12631 1210 0 OTHERS OTHER CHARGES PATIENT DRESS BASE PRICE 8582 610 0 PAEDIATRIC SURGERY PAEDIATRIC SURGERY ABDOMINAL DRAINAGE - BABIES BASE PRICE 6452 5330 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY ABSCESS DEEP - I & D BASE PRICE 6355 4000 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY ABSCESS DRAINAGE BASE PRICE 6267 2670 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY ADRENALECTOMY - UNILATERAL BASE PRICE 6418 18680 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY ADRENALECTOMY BILATERAL BASE PRICE 6314 37350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY AMBIGIOUS GENITALIA - CLITOROPLASTY BASE PRICE 6448 20010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY AMBIGIOUS GENITALIA - GONADIAL BIOPSY BASE PRICE 6447 4000 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY APPENDICECTOMY BASE PRICE 6291 8000 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY ASARP BASE PRICE 6432 16010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY ATRESIA OF THE EXTRAHEPATIC BILIARY DUCTS - KASAI OPERATION BASE PRICE 6302 33350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY ATYPICAL DIAPHRAGMATIC HERNIA BASE PRICE 6438 20010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY AXILLARY LYMPH NODE BIOPSY BASE PRICE 6270 4000 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY BLADDER DIVERTICULECTOMY BASE PRICE 6397 10670 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY BLEOMYCIN INJECTION BASE PRICE 6451 5330 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY CERVICAL LYMPH NODE BIOPSY BASE PRICE 6268 4000 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY CHOLEDOCHAL CYST - CYSTO JEJUNOSTOMY BASE PRICE 6416 16010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY CHOLEDOCHAL CYST - DRAINAGE BASE PRICE 6417 10670 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY CHOLEDOCHO DUODENOSTOMY BASE PRICE 6303 20010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY CIRCUMCISION BASE PRICE 6265 4000 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY CLEFT LIP BASE PRICE 6287 16010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY CLEFT PALATE REPAIR SEVER DEGREE BASE PRICE 6288 16010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY COLON REPLACEMENT OF OESOPHAGUS BASE PRICE 6301 33350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY COLOSTOMY CLOSURE BASE PRICE 6297 10670 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY CONGENITAL ATRESIA & STENOSIS OF SMALL INTESTINE BASE PRICE 6293 18680 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY CONGENITAL HYDROCELE BASE PRICE 6425 8000 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY CONGENITAL PYLORIC STENOSIS - RAMSTED'S OPERATION BASE PRICE 6260 12000 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY CONGENITAL SHORT COLON - COLOPLASTY BASE PRICE 6420 20010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY CONGENITAL SHORT COLON - COLOPLASTY WITH ABDOMINO PSARP BASE PRICE 6421 26680 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY CONGENITAL SHORT COLON - WINDOW COLOSTOMY BASE PRICE 6419 12000 25

Page 64 of 115 PAEDIATRIC SURGERY PAEDIATRIC SURGERY CYSTIC HYGROMA - BLEOMYCIN INJ. (PROCEDURE) BASE PRICE 6413 5330 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY CYSTIC HYGROMA - EXCISION BASE PRICE 6410 16010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY CYSTOSCOPY AND FULGRATION OF VALVES BASE PRICE 6338 13350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY DEBRIDEMENT - LARGE BASE PRICE 6441 8000 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY DEBRIDEMENT - SMALL BASE PRICE 6442 2670 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY DECORTICATION BASE PRICE 6339 26680 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY DIAG. LAPAROSCOPY WITH LYMPH NODE BIOPSY BASE PRICE 6336 13350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY DIAGNOSTIC LAPAROSCOPY BASE PRICE 6335 10670 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY DIAPHRAGMATIC HERNIA REPAIR (THORACIC OR ABDOMINAL APPROACH) BASE PRICE 6275 20010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY DUODENAL-ATRESIA OPERATION BASE PRICE 6278 18680 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY DUPLICATION - THORACOTOMY OESOPHAGEAL / NEURENTERIC CYST BASE PRICE 6370 26680 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY DUPLICATION GASTRIC BASE PRICE 6423 24010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY DUPLICATION OF THE INTESTINES - JEJUNAL / ILEAL BASE PRICE 6415 16010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY DUPLICATION RECTAL BASE PRICE 6422 24010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY DUPLICATIONS COLONIC BASE PRICE 6424 20010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY DYE -UROGRAFFIN ENEMA BASE PRICE 6450 5330 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY ECTOPIA OF SINGLE URETER BASE PRICE 6316 20010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY ENCEPHALOCOELE BASE PRICE 6445 26680 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY EPISPADIS REPAIR BASE PRICE 6290 24010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY ESOPHAGOSTOMY / GASTROSTOMY BASE PRICE 6392 20010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY EXCISION CYST (NECK) BASE PRICE 6264 10670 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY EXCISION CYST (THROAT) BASE PRICE 6272 6010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY EXCISION OF BRANCHIAL SINUS / CYST BASE PRICE 6261 13350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY EXCISION OF CYST (THROAT) BASE PRICE 6269 10670 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY EXCISION OF CYST / TUMOR - LARGE BASE PRICE 6394 10670 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY EXCISION OF CYST / TUMOR - SMALL BASE PRICE 6393 6670 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY EXCISION OF MECKEL'S DIVERTICULUM BASE PRICE 6294 10670 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY EXCISION OF THYROGLOSSAL DUCT / CYST BASE PRICE 6273 13350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY EXOMPHALOS MAJOR BASE PRICE 6340 26680 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY EXOMPHALOS MINOR BASE PRICE 6341 20010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY EXPLORATORY LAPAROTOMY BASE PRICE 6298 13350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY EXSTROPHY BLADDER SINGLE STAGE REPAIR BASE PRICE 6343 64030 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY EXSTROPHY BLADDER TURN IN BASE PRICE 6344 26680 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY EXTENDED RPLND WITH WILM'S TUMOR EXCISION BASE PRICE 6389 26680 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY GASTRIC OUTLET OBSTRUCTION - DOUBLE DIAPHGRAM BASE PRICE 6405 20010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY GASTRIC OUTLET OBSTRUCTION - DUODENAL DIAPHGRAM BASE PRICE 6406 20010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY GASTRIC OUTLET OBSTRUCTION - PRE PYLORIC DIAPHGRAM BASE PRICE 6407 20010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY GASTRIC TERATOMA BASE PRICE 6428 16010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY GASTRIC VOLVULUS BASE PRICE 6412 20010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY GASTROGRAFFIN ENEMA BASE PRICE 6453 6670 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY GASTROSCHISIS BASE PRICE 6342 33350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY GASTROSTOMY BASE PRICE 6252 12000 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY HAEMANGIOMA - LARGE BASE PRICE 6262 10670 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY HEMANGIOMA - SMALL BASE PRICE 6429 6670 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY HEMI NEPHRECTOMY BASE PRICE 6346 40030 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY HEMI-COLECTOMY BASE PRICE 6296 20010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY HEPATIC RESECTIONS BASE PRICE 6312 33350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY HIGH ORCHIETOMY TESTICULAR TERATOMA BASE PRICE 12470 21830 25

Page 65 of 115 PAEDIATRIC SURGERY PAEDIATRIC SURGERY HIRSCHSPRUNGS (COLOSTOMY WITH BIOPSY) BASE PRICE 6337 13350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY HIRSCHSPRUNGS DISEASE - SOAVES OP BASE PRICE 6380 18680 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY HIRSCHSPRUNGS DISEASE - SWENSONS OP BASE PRICE 6382 18680 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY HIRSCHSPRUNGS DISEASE - TRANSANAL PULL THROUGH BASE PRICE 6381 20010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY HIRSCHSPRUNGS DISEASE - DUHAMELS OP BASE PRICE 6379 16010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY HYDROCELE OF CORD BASE PRICE 6251 8000 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY HYDRONEPHROSIS - PYELOPLASTY BASE PRICE 6285 16010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY HYPOSPADIAS - ASOPAS ONLAY URETHROPLASTY BASE PRICE 6349 16010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY HYPOSPADIAS - ASOPAS TUBED URETHROPLASTY BASE PRICE 6350 18680 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY HYPOSPADIAS - BRACA'S - FIRST STAGE BASE PRICE 6351 16010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY HYPOSPADIAS - BRACA'S - SECOND STAGE BASE PRICE 6352 16010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY HYPOSPADIAS - SNODGRASS INCISED PLATE URETHROPLASTY BASE PRICE 6353 16010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY HYPOSPADIAS CRIPPLE BASE PRICE 6354 21350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY HYPOSPADIAS MAGPI BASE PRICE 6396 8000 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY HYPOSPADIAS SANS HYPOSPADIAS BASE PRICE 6446 21350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY HYPOSPADIAS WITH FISTULA - LARGE/MULTIPLE BASE PRICE 6348 10670 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY HYPOSPADIAS WITH FISTULA - SMALL BASE PRICE 6395 6670 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY ILEOSTOMY - BISHOP KOOP BASE PRICE 6403 13350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY ILEOSTOMY - DOUBLE BARREL BASE PRICE 6402 10670 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY ILEOSTOMY - SANTULLI BASE PRICE 6404 13350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY IMP. ANUS LOW ANOMALY - PERINEAL ANOPLASTY BASE PRICE 6254 13350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY IMPERFORATE ANUS HIGH ANOMALY - TRANSVERSE COLOSTOMY BASE PRICE 6255 10670 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY IMPERFORATE ANUS LOW ANOMALY - CUT BACK OPERATION BASE PRICE 6253 13350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY INCISION & DRAINAGE ABSCESS - LARGE / DEEP BASE PRICE 6444 4000 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY INCISION & DRAINAGE ABSCESS - SMALL BASE PRICE 6443 2010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY INGUINAL HERNIA BILATERAL BASE PRICE 6437 10010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY INGUINAL HERNIOTOMY BASE PRICE 6250 8000 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY INGUINAL HERNIOTOMY BILATERAL BASE PRICE 6356 13350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY INTERCOSTAL DRAINAGE OF EMPYEMA BASE PRICE 6258 4670 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY INTUSSUSCEPTION - OPERATION BASE PRICE 6283 20010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY LAP ADHESIOLYSIS BASE PRICE 6357 20010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY LAP APPENDICECTOMY BASE PRICE 6327 13350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY LAP ASSISTED ABDOMINO PERINAL PULL THROUGH BASE PRICE 6333 20010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY LAP ASSISTED SMALL BOWEL RESECTION BASE PRICE 6330 20010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY LAP CORRECTION OF DIAPHRAGMATIC HERNIA BASE PRICE 6332 20010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY LAP CORRECTION OF MALROTATION BASE PRICE 6331 20010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY LAP HERNIOTOMY BASE PRICE 6328 13350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY LAP ORCHIOPEXY BASE PRICE 6325 16010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY LAP PULLTHROUGH BASE PRICE 6329 26680 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY LAP THORACOSCOPIC EXCISION OF INTRA THORACIC MASS BASE PRICE 6334 32010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY LIPOMYELOMENINGO COELE BASE PRICE 6368 26680 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY MALROTATION OF INTESTINES BASE PRICE 6281 16010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY MALROTATION WITH MIDGUT VOLVULUS BASE PRICE 6384 21350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY MEATAL DILATION BASE PRICE 6433 2010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY MEATOPLASTY BASE PRICE 6398 5330 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY MEATOTOMY BASE PRICE 6266 4000 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY MECONIUM ILEUS OPERATION BASE PRICE 6280 16010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY MECONIUM PLUG SYNDROME - UROGRAFIN ENEMA (PROCEDURE) BASE PRICE 6411 6670 25

Page 66 of 115 PAEDIATRIC SURGERY PAEDIATRIC SURGERY MENINGOMYLOCELE BASE PRICE 6308 24010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY MESENTERICOCAVAL ANASTOMOSIS BASE PRICE 6323 29350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY MINILAP CHOLECYSTECTOMY BASE PRICE 6435 17350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY MULTIPLE RESECTION & ANASTOMOSIS BASE PRICE 6358 24010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY MUSCLE BIOPSY BASE PRICE 6271 1600 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY NECROTIZING ENTEROCOLITIS - ABD DRAINAGE (PROCEDURE) BASE PRICE 6414 5330 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY NECROTIZING ENTEROCOLITIS - NEC (EXPLORATORY LAPAROTOMY) BASE PRICE 6409 16010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY NEONATAL INTESTINAL OBSTRUCTION BASE PRICE 6436 17350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY NEPHRECTOMY FOR - HYDRONEPHROSIS BASE PRICE 6439 20010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY NEPHRECTOMY FOR PYONEPHROSIS BASE PRICE 6284 13350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY NEPHRO / PYELOLITHOTOMY BASE PRICE 6399 16010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY NEPHROURETERECTOMY BASE PRICE 6347 20010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY NEUROBLASTOMA (NON ADRENAL) BASE PRICE 6440 20010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY NEUROBLASTOMA DEBULKING BASE PRICE 6385 20010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY NEUROBLASTOMA TOTAL EXCISION BASE PRICE 6386 26680 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY OMPHALO MESENTERIC CYST EXCISION BASE PRICE 6274 13350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY OPERATION FOR HAEMORRAGE OF THE SMALL INTESTINE BASE PRICE 6295 20010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY OPERATION FOR OESOPHAGEAL REPLACEMENT BASE PRICE 6310 33350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY OPERATION FOR PORTAL HYPERTENSION BASE PRICE 6311 24010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY OPERATION OF CHOLEDOCHAL CYST - RESECTION BASE PRICE 6304 20010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY OPERATIONS FOR EXTROPHY BLADDER BASE PRICE 6309 33350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY OPERATIONS FOR HYPOSPADIAS CHORDEE CORRECTION BASE PRICE 6256 10670 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY OPERATIONS FOR URETER DOUBLE URETERS BASE PRICE 6315 17350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY OPERATIONS FOR VESIOCOURETERIC REFLUX BASE PRICE 6317 18680 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY ORCHIDOPEXY BILATERAL BASE PRICE 6400 18680 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY ORCHIPEXY - SINGLE STAGE BASE PRICE 6427 10670 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY ORCHIPEXY - STEPHENS FOWLER STAGE I BASE PRICE 6276 10670 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY ORCHIPEXY - STEPHENS FOWLER STAGE II BASE PRICE 6426 10670 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY PANCREATIC RING OPERATION BASE PRICE 6279 18680 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY PARASITIC TWIN - EXCISION BASE PRICE 6430 33350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY PATENT VID BASE PRICE 6387 16010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY PELVIC COLOSTOMY BASE PRICE 6434 10670 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY PHIMOSIS - DORSAL SLIT BASE PRICE 6449 2670 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY PORTOCAVAL ANASTOMOSIS BASE PRICE 6322 32010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY PREAURICULAR TAGS EXCISION BASE PRICE 6360 6670 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY PREPUTIOPLASTY BASE PRICE 6377 10670 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY PSARP - COMPLETE BASE PRICE 6362 16010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY PSARP - LIMITED BASE PRICE 6361 13350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY RANULA EXCISION BASE PRICE 6299 8000 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY RECTAL BIOPSY BASE PRICE 6390 8000 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY RECTAL POLYP EXCISION BASE PRICE 6359 8000 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY RECURRENT INGUINAL HERNIA BILATERAL BASE PRICE 6363 16010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY RECURRENT INGUINAL HERNIA UNILATERAL BASE PRICE 6364 10670 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY REIMPLANTATION OF URETERS (ANTI REFLUX PROCEDURE) BASE PRICE 6345 24010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY RELEASE OF TONGUE TIE BASE PRICE 6365 2010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY RELEASE OF TORTICOLLIS BASE PRICE 6366 10670 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY RESECTION & ANASTOMOSIS BASE PRICE 6367 20010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY RHABDOMYOSARCOMA WIDE EXCISION BASE PRICE 6307 24010 25

Page 67 of 115 PAEDIATRIC SURGERY PAEDIATRIC SURGERY SACROABDOMINO PERINEAL PULL THROUGH BASE PRICE 6282 20010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY SACROCOCCYGEAL TERATOMA EXCISION BASE PRICE 6318 24010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY SECOND STAGE OR ONE STAGE REPAIR BASE PRICE 6289 17350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY SMALL LEFT COLON SYNDROME - UROGRAFIN ENEMA (PROCEDURE) BASE PRICE 6408 5330 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY SPLENECTOMY FOR HYPERSPLENISM BASE PRICE 6320 18680 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY SPLENECTOMY FOR TRAUMA BASE PRICE 6319 13350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY SPLENORENAL ANASTOMOSIS BASE PRICE 6321 32010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY SUPRAPUBIC DRAINAGE (CYSTOSTOMY) BASE PRICE 6257 8000 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY SUPRAPUBLIC CYSTOLITHOTOMY BASE PRICE 6369 10670 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY T. O. FISTULA PRIMARY SURGERY BASE PRICE 6391 20010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY TESTICULAR IMPLANTS BASE PRICE 12424 21830 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY THEIRSCH WIRING BASE PRICE 6263 4000 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY THORACOSCOPIC EMPYEMA THORACIS - VATS BASE PRICE 6326 20010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY THORACTOMY LOBECTOMY BASE PRICE 6371 20010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY THORACTOMY PNEUMONECTOMY BASE PRICE 6372 16010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY THYROGLOSSAL CYST / DUCT - SISTRUNKS BASE PRICE 6383 18680 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY TORSION TESTIS - OPERATION BASE PRICE 6277 13350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY TOTAL COLECTOMY BASE PRICE 6313 26680 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY TOTAL EXCISION OF THE WILM'S TUMOR BASE PRICE 6306 26680 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY TRACHEO OESOPHAGEAL FISTULA (CORRECTION SURGERY) BASE PRICE 6300 26680 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY ULTRA SHORT HIRSCHSPRUNGS - RECTAL MYOMECTOMY BASE PRICE 6401 13350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY UMBILICAL HERNIA REPAIR BASE PRICE 6259 10670 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY UNILATERAL URETER REIMPLANT BASE PRICE 6373 12000 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY URETEROSTOMY - REVERSAL BASE PRICE 6431 16010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY URETEROSTOMY CUTANEOUS BASE PRICE 6292 14680 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY URETHRAL DILATION BASE PRICE 6374 2670 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY VAGINOPLASTY BASE PRICE 6375 26680 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY VENESECTION BASE PRICE 6378 2010 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY VENTRAL HERNIA AFTER GROBS TECHNIQUE BASE PRICE 6388 13350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY VENTRICULOATRIAL SHUNT/VENTRICULOPERITONEAL BASE PRICE 6286 17350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY VESICOSTOMY BASE PRICE 6376 10670 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY WARREN SHUNT BASE PRICE 6324 29350 25 PAEDIATRIC SURGERY PAEDIATRIC SURGERY WILM'S TUMOR BASE PRICE 6305 20010 25 PAEDIATRICS & NEONATOLOGYPAEDIATRICS & NEONATOLOGY PROCEDURES ASCITIC TAP BASE PRICE 12691 580 0 PAEDIATRICS & NEONATOLOGYPAEDIATRICS & NEONATOLOGY PROCEDURES BILIRUBINOMETER MONITORING (PER TEST0 BASE PRICE 5226 120 0 PAEDIATRICS & NEONATOLOGYPAEDIATRICS & NEONATOLOGY PROCEDURES EXCHANGE TRANSFUSION BASE PRICE 5230 3470 0 PAEDIATRICS & NEONATOLOGYPAEDIATRICS & NEONATOLOGY PROCEDURES INTERCOASTAL DRAINAGE BASE PRICE 12695 4050 0 PAEDIATRICS & NEONATOLOGYPAEDIATRICS & NEONATOLOGY PROCEDURES NEONATAL TRANSPORT (WITH VENTILATOR) BASE PRICE 5234 3470 0 PAEDIATRICS & NEONATOLOGYPAEDIATRICS & NEONATOLOGY PROCEDURES NEONATAL TRANSPORT (WITHOUT VENTILATOR) BASE PRICE 5235 2310 0 PAEDIATRICS & NEONATOLOGYPAEDIATRICS & NEONATOLOGY PROCEDURES ORAL POLIO DROPS BASE PRICE 8432 70 0 PAEDIATRICS & NEONATOLOGYPAEDIATRICS & NEONATOLOGY PROCEDURES OXYGEN THERAPY BASE PRICE 5242 130 0 PAEDIATRICS & NEONATOLOGYPAEDIATRICS & NEONATOLOGY PROCEDURES PAEDIATRICS CANULATION BASE PRICE 5232 120 0 PAEDIATRICS & NEONATOLOGYPAEDIATRICS & NEONATOLOGY PROCEDURES PARENTRAL NUTRTION BASE PRICE 5233 230 0 PAEDIATRICS & NEONATOLOGYPAEDIATRICS & NEONATOLOGY PROCEDURES PERITONIAL TAP BASE PRICE 12694 580 0 PAEDIATRICS & NEONATOLOGYPAEDIATRICS & NEONATOLOGY PROCEDURES PHOTOTHERAPY - DOUBLE SURFACE BASE PRICE 5223 1390 0 PAEDIATRICS & NEONATOLOGYPAEDIATRICS & NEONATOLOGY PROCEDURES PHOTOTHERAPY - DOUBLE SURFACE (PRIVATE WARD) BASE PRICE 5249 1390 0 PAEDIATRICS & NEONATOLOGYPAEDIATRICS & NEONATOLOGY PROCEDURES PHOTOTHERAPY - DOUBLE SURFACE (SEMI PRIVATE WARD) BASE PRICE 5250 1390 0 PAEDIATRICS & NEONATOLOGYPAEDIATRICS & NEONATOLOGY PROCEDURES PHOTOTHERAPY - SINGLE SURFACE BASE PRICE 5222 690 0

Page 68 of 115 PAEDIATRICS & NEONATOLOGYPAEDIATRICS & NEONATOLOGY PROCEDURES PHOTOTHERAPY - SINGLE SURFACE (PRIVATE WARD) BASE PRICE 5251 690 0 PAEDIATRICS & NEONATOLOGYPAEDIATRICS & NEONATOLOGY PROCEDURES PHOTOTHERAPY - SINGLE SURFACE (SEMI PRIVATE WARD) BASE PRICE 5252 690 0 PAEDIATRICS & NEONATOLOGYPAEDIATRICS & NEONATOLOGY PROCEDURES RESUSCITATION CHARGES - SEMI PRIVATE (CAESARIAN SECTION) BASE PRICE 5243 1160 0 PAEDIATRICS & NEONATOLOGYPAEDIATRICS & NEONATOLOGY PROCEDURES RESUSCITATION CHARGES - SEMI PRIVATE (NORMAL DELIVERY) BASE PRICE 5237 1160 0 PAEDIATRICS & NEONATOLOGYPAEDIATRICS & NEONATOLOGY PROCEDURES RESUSCITATION CHARGES ONLY BASE PRICE 5246 1160 0 PAEDIATRICS & NEONATOLOGYPAEDIATRICS & NEONATOLOGY PROCEDURES STEP DOWN NURSERY BASE PRICE 5236 920 0 PAEDIATRICS & NEONATOLOGYPAEDIATRICS & NEONATOLOGY PROCEDURES SUPRAPUBIC TAP BASE PRICE 5231 580 0 PAEDIATRICS & NEONATOLOGYPAEDIATRICS & NEONATOLOGY PROCEDURES SURFACTANT THERAPY BASE PRICE 5238 2310 0 PAEDIATRICS & NEONATOLOGYPAEDIATRICS & NEONATOLOGY PROCEDURES UMBLICAL ARTERY CATHETERIZATION BASE PRICE 5228 1740 0 PAEDIATRICS & NEONATOLOGYPAEDIATRICS & NEONATOLOGY PROCEDURES UMBLICAL VEIN CATHETERIZATION BASE PRICE 5229 1740 0 PAIN MANAGEMENT PAIN MANAGEMENT PROCEDURE INTRA-ARTICULAR JOINT INJECTIONS BASE PRICE 12429 1900 0 PAIN MANAGEMENT PAIN MANAGEMENT PROCEDURE MYOFACIAL TRIGGER POINT INJ BASE PRICE 12430 1900 0 PAIN MANAGEMENT PAIN MANAGEMENT SURGICAL PROCEDURE ALL NEUROLYTIC PROCEDURES BASE PRICE 12464 14550 25 PAIN MANAGEMENT PAIN MANAGEMENT SURGICAL PROCEDURE BICULLOPLASTY/ANNULOPLASTY BASE PRICE 12443 18200 25 PAIN MANAGEMENT PAIN MANAGEMENT SURGICAL PROCEDURE CAUDAL EPIDURAL BASE PRICE 12445 9700 25 PAIN MANAGEMENT PAIN MANAGEMENT SURGICAL PROCEDURE CAUDAL NEUROPLASTY/ADHESIOLYSIS BASE PRICE 12446 12130 25 PAIN MANAGEMENT PAIN MANAGEMENT SURGICAL PROCEDURE CERVICAL FACET JOINT BLOCK BASE PRICE 12467 12130 25 PAIN MANAGEMENT PAIN MANAGEMENT SURGICAL PROCEDURE CERVICAL INTERLAMINAR EPIDURAL BASE PRICE 12466 9700 25 PAIN MANAGEMENT PAIN MANAGEMENT SURGICAL PROCEDURE CERVICAL MEDIAL BRANCH (DIAGNOSTIC) BASE PRICE 12436 12130 25 PAIN MANAGEMENT PAIN MANAGEMENT SURGICAL PROCEDURE CERVICAL MEDIAN BRANCH RF ABLATION BASE PRICE 12454 18200 25 PAIN MANAGEMENT PAIN MANAGEMENT SURGICAL PROCEDURE DORSAL ROOT GANGLIA PULSE-RF ABLATION BASE PRICE 12458 18200 25 PAIN MANAGEMENT PAIN MANAGEMENT SURGICAL PROCEDURE GANGLION IMPAR BLOCK BASE PRICE 12449 9700 25 PAIN MANAGEMENT PAIN MANAGEMENT SURGICAL PROCEDURE GANGLION IMPAR RF BASE PRICE 12462 12130 25 PAIN MANAGEMENT PAIN MANAGEMENT SURGICAL PROCEDURE GASSERIAN GANGLIA RF ABLATION BASE PRICE 12455 18200 25 PAIN MANAGEMENT PAIN MANAGEMENT SURGICAL PROCEDURE GASSERIAN GANGLION (DIAGNOSTIC) BASE PRICE 12434 12130 25 PAIN MANAGEMENT PAIN MANAGEMENT SURGICAL PROCEDURE GENICULAR (KNEE JOINT) RF ABLATION BASE PRICE 12461 18200 25 PAIN MANAGEMENT PAIN MANAGEMENT SURGICAL PROCEDURE GREATER/LESSER OCCIPITAL (DIAGNOSTIC) BASE PRICE 12437 7280 25 PAIN MANAGEMENT PAIN MANAGEMENT SURGICAL PROCEDURE INTRA-THECAL PUMP IMPLANTATION BASE PRICE 12453 24260 25 PAIN MANAGEMENT PAIN MANAGEMENT SURGICAL PROCEDURE LUMBAR MEDIAL BRANCH RF ABLATION BASE PRICE 12459 18200 25 PAIN MANAGEMENT PAIN MANAGEMENT SURGICAL PROCEDURE LUMBAR SYMPATHETIC BLOCK BASE PRICE 12447 12130 25 PAIN MANAGEMENT PAIN MANAGEMENT SURGICAL PROCEDURE LUMBAR SYMPATHETIC RF ABLATION BASE PRICE 12460 18200 25 PAIN MANAGEMENT PAIN MANAGEMENT SURGICAL PROCEDURE LUMBAR TRANSFORAMINAL (SINGLE LEVEL) BASE PRICE 12440 7280 25 PAIN MANAGEMENT PAIN MANAGEMENT SURGICAL PROCEDURE PERCUTANEOUS DISC DECOMPRESSION/NUCLEOPLASTY BASE PRICE 12444 18200 25 PAIN MANAGEMENT PAIN MANAGEMENT SURGICAL PROCEDURE PERCUTANEOUS KYPHOPLASTY BASE PRICE 12451 18200 25 PAIN MANAGEMENT PAIN MANAGEMENT SURGICAL PROCEDURE PERCUTANEOUS VERTEBROPLASTY BASE PRICE 12450 14550 25 PAIN MANAGEMENT PAIN MANAGEMENT SURGICAL PROCEDURE PHERIPHERAL NERVE PULSE RF BASE PRICE 12463 12130 25 PAIN MANAGEMENT PAIN MANAGEMENT SURGICAL PROCEDURE PROVOCATIVE DISCOGRAPHY BASE PRICE 12442 12130 25 PAIN MANAGEMENT PAIN MANAGEMENT SURGICAL PROCEDURE SACRO-ILIAC JOINT BLOCK BASE PRICE 12441 7280 25 PAIN MANAGEMENT PAIN MANAGEMENT SURGICAL PROCEDURE SPHENOPALATINE GANGLIA RF ABLATION BASE PRICE 12457 18200 25 PAIN MANAGEMENT PAIN MANAGEMENT SURGICAL PROCEDURE SPHENOPALATINE GANGLION (DIAGNOSTIC) BASE PRICE 12435 12130 25 PAIN MANAGEMENT PAIN MANAGEMENT SURGICAL PROCEDURE SPINAL CORD STIMULATOR PERMANENT LEAD PLACEMENT BASE PRICE 12465 24260 25 PAIN MANAGEMENT PAIN MANAGEMENT SURGICAL PROCEDURE SPINAL CORD STIMULATOR TEST LEAD PLACEMENT BASE PRICE 12452 18200 25 PAIN MANAGEMENT PAIN MANAGEMENT SURGICAL PROCEDURE STELLATE GANGLION (DIAGNOSTIC) BASE PRICE 12439 12130 25 PAIN MANAGEMENT PAIN MANAGEMENT SURGICAL PROCEDURE STELLATE GANGLION RF ABLATION BASE PRICE 12456 18200 25 PAIN MANAGEMENT PAIN MANAGEMENT SURGICAL PROCEDURE SUPERIOR HYPOGASTRIC PLEXUS BLOCK BASE PRICE 12448 12130 25 PATHOLOGY BIOCHEMISTRY ABG (Arterial blood gas) BASE PRICE 1933 760 950 PATHOLOGY BIOCHEMISTRY Abnormal Haemoglobin Studies (By HPLC)* BASE PRICE 1918 1910 2390 PATHOLOGY BIOCHEMISTRY Acid Phosphatase* BASE PRICE 1849 560 700

Page 69 of 115 PATHOLOGY BIOCHEMISTRY Adenosine Deaminase (ADA) (Body Fluid)* BASE PRICE 1852 1100 1380 PATHOLOGY BIOCHEMISTRY Adenosine Deaminase (ADA) (CSF)* BASE PRICE 1851 1100 1380 PATHOLOGY BIOCHEMISTRY Adenosine Deaminase (ADA) (Serum)* BASE PRICE 1853 1100 1380 PATHOLOGY BIOCHEMISTRY Albumin (Serum) BASE PRICE 1855 160 200 PATHOLOGY BIOCHEMISTRY Alcohol Quantative* BASE PRICE 1836 1320 1650 PATHOLOGY BIOCHEMISTRY Aldolase* BASE PRICE 1857 1270 1590 PATHOLOGY BIOCHEMISTRY Alkaline Phosphatase BASE PRICE 1858 160 200 PATHOLOGY BIOCHEMISTRY ALPHA-1-ANTITRYPSIN QUANTITATION* BASE PRICE 11871 2130 2660 PATHOLOGY BIOCHEMISTRY Amikacin* BASE PRICE 1837 1520 1900 PATHOLOGY BIOCHEMISTRY Ammonia* BASE PRICE 1859 1000 1250 PATHOLOGY BIOCHEMISTRY Amylase (Serum) BASE PRICE 1860 560 700 PATHOLOGY BIOCHEMISTRY Angiotensin Converting Enzyme (ACE)* BASE PRICE 1862 1320 1650 PATHOLOGY BIOCHEMISTRY Apolipoprotein A1 BASE PRICE 1863 390 490 PATHOLOGY BIOCHEMISTRY Apolipoprotein B BASE PRICE 1864 390 490 PATHOLOGY BIOCHEMISTRY APOLIPOPROTEINS A1 & B BASE PRICE 2432 760 950 PATHOLOGY BIOCHEMISTRY ARSENIC , BLOOD BASE PRICE 13047 3620 4530 PATHOLOGY BIOCHEMISTRY Ascitic Fluid -ADA* BASE PRICE 2319 1100 1380 PATHOLOGY BIOCHEMISTRY Ascitic fluid amylase BASE PRICE 1861 560 700 PATHOLOGY BIOCHEMISTRY ASCITIC FLUID LDH BASE PRICE 11831 440 550 PATHOLOGY BIOCHEMISTRY ASO - Anti Streptolysin O (Quantitative)* BASE PRICE 1919 880 1100 PATHOLOGY BIOCHEMISTRY BETA HYDROXYBUTYRATE BASE PRICE 12904 8420 10530 PATHOLOGY BIOCHEMISTRY BILIRUBIN - TOTAL & DIRECT BASE PRICE 1865 190 240 PATHOLOGY BIOCHEMISTRY BODY FLUID ALBUMIN BASE PRICE 1856 160 200 PATHOLOGY BIOCHEMISTRY BODY FLUID AMYLASE BASE PRICE 11832 560 700 PATHOLOGY BIOCHEMISTRY BODY FLUID CREATININE* BASE PRICE 8563 140 180 PATHOLOGY BIOCHEMISTRY BODY FLUID LDH BASE PRICE 11830 440 550 PATHOLOGY BIOCHEMISTRY BODY FLUID LIPASE BASE PRICE 12180 780 980 PATHOLOGY BIOCHEMISTRY BODY FLUID PROTEIN* BASE PRICE 8564 190 240 PATHOLOGY BIOCHEMISTRY BODY FLUID SUGAR* BASE PRICE 8561 110 140 PATHOLOGY BIOCHEMISTRY BODY FLUID TRIGLYCERIDES BASE PRICE 12899 340 430 PATHOLOGY BIOCHEMISTRY BODY FLUID UREA* BASE PRICE 8562 140 180 PATHOLOGY BIOCHEMISTRY BUN - Blood Urea Nitrogen BASE PRICE 1866 140 180 PATHOLOGY BIOCHEMISTRY C1 ESTERASE FUNCTIONAL BASE PRICE 12229 5580 6980 PATHOLOGY BIOCHEMISTRY C3 & C4 COMPLEMENT PANEL BASE PRICE 2433 1770 2210 PATHOLOGY BIOCHEMISTRY C3 (Complement Component 3) BASE PRICE 1867 890 1110 PATHOLOGY BIOCHEMISTRY C4 (Complement Component 4) BASE PRICE 1868 890 1110 PATHOLOGY BIOCHEMISTRY Calcium - Ionised BASE PRICE 1869 250 310 PATHOLOGY BIOCHEMISTRY Calcium - Total BASE PRICE 1870 190 240 PATHOLOGY BIOCHEMISTRY CALPROTECTIN BASE PRICE 12980 2630 3290 PATHOLOGY BIOCHEMISTRY Carbamazepine* BASE PRICE 1838 1910 2390 PATHOLOGY BIOCHEMISTRY Ceruloplasmin BASE PRICE 1871 1520 1900 PATHOLOGY BIOCHEMISTRY Chloride BASE PRICE 1872 140 180 PATHOLOGY BIOCHEMISTRY Cholesterol - Total BASE PRICE 1873 160 200 PATHOLOGY BIOCHEMISTRY CK-MB BASE PRICE 1935 560 700 PATHOLOGY BIOCHEMISTRY CPK BASE PRICE 1934 390 490 PATHOLOGY BIOCHEMISTRY Creatinine BASE PRICE 1874 140 180 PATHOLOGY BIOCHEMISTRY Creatinine Clearance test* BASE PRICE 1875 250 310 PATHOLOGY BIOCHEMISTRY CRP- C Reactive Protein BASE PRICE 1920 660 830

Page 70 of 115 PATHOLOGY BIOCHEMISTRY CRP- C Reactive Protein - High Sensitivity (HS-CRP) BASE PRICE 1921 660 830 PATHOLOGY BIOCHEMISTRY CSF-Lactate* BASE PRICE 1887 760 950 PATHOLOGY BIOCHEMISTRY Cyclosporine* BASE PRICE 1839 3490 4360 PATHOLOGY BIOCHEMISTRY D-Dimer Quantitative)* BASE PRICE 1915 1270 1590 PATHOLOGY BIOCHEMISTRY Digoxin Level* BASE PRICE 1936 1100 1380 PATHOLOGY BIOCHEMISTRY DOPAMINE BASE PRICE 12921 4680 5850 PATHOLOGY BIOCHEMISTRY DRUGS OF ABUSE : 6 DRUGS BASE PRICE 12167 3310 4140 PATHOLOGY BIOCHEMISTRY DRUGS OF ABUSE : METHAMPHETAMINE BASE PRICE 12257 1260 1580 PATHOLOGY BIOCHEMISTRY DRUGS OF ABUSE :9 DRUGS BASE PRICE 12253 4800 6000 PATHOLOGY BIOCHEMISTRY ELECTROLYTES, 24 HR URINE* BASE PRICE 2435 390 490 PATHOLOGY BIOCHEMISTRY ELECTROLYTES, RANDOM URINE* BASE PRICE 2436 250 310 PATHOLOGY BIOCHEMISTRY EXTENDED LIPID PROFILE BASE PRICE 2244 1770 2210 PATHOLOGY BIOCHEMISTRY FDP (Quantitative)* BASE PRICE 1916 1270 1590 PATHOLOGY BIOCHEMISTRY FRUCTOSAMINE BASE PRICE 12308 1440 1800 PATHOLOGY BIOCHEMISTRY G6PD (Quantitative* BASE PRICE 1917 1270 1590 PATHOLOGY BIOCHEMISTRY Gamma Glutamyl Transferase (GGT) BASE PRICE 1876 250 310 PATHOLOGY BIOCHEMISTRY Gentamicin* BASE PRICE 1840 15210 19010 PATHOLOGY BIOCHEMISTRY GFR (GLOMERULAR FILTRATION RATE, ESTIMATED) BASE PRICE 11828 250 310 PATHOLOGY BIOCHEMISTRY Glucose - Fasting BASE PRICE 1880 110 140 PATHOLOGY BIOCHEMISTRY Glucose - Post Prandial (PP) BASE PRICE 1881 110 140 PATHOLOGY BIOCHEMISTRY glucose challenge test BASE PRICE 1932 110 140 PATHOLOGY BIOCHEMISTRY Glucose Random BASE PRICE 1878 110 140 PATHOLOGY BIOCHEMISTRY Glucose Tolerance Test (2 sample) BASE PRICE 1879 190 240 PATHOLOGY BIOCHEMISTRY Glucose Tolerance Test (3 Samples) BASE PRICE 11829 190 240 PATHOLOGY BIOCHEMISTRY Glucose Tolerance Test (4 Samples) BASE PRICE 1877 390 490 PATHOLOGY BIOCHEMISTRY Glycosylated Haemoglobin (HbA1C) BASE PRICE 1882 660 830 PATHOLOGY BIOCHEMISTRY Haptoglobin* BASE PRICE 1883 2540 3180 PATHOLOGY BIOCHEMISTRY HDL - Cholesterol BASE PRICE 1884 250 310 PATHOLOGY BIOCHEMISTRY HOMA* BASE PRICE 12366 1100 1380 PATHOLOGY BIOCHEMISTRY Homocysteine* BASE PRICE 1847 1980 2480 PATHOLOGY BIOCHEMISTRY IgG4 BASE PRICE 11788 7610 9510 PATHOLOGY BIOCHEMISTRY Immunoglobulins (IgA) Serum BASE PRICE 1925 890 1110 PATHOLOGY BIOCHEMISTRY Immunoglobulins (IgG) Serum BASE PRICE 1923 890 1110 PATHOLOGY BIOCHEMISTRY Immunoglobulins (IgG, IgM, IgA) Serum BASE PRICE 1922 2670 3340 PATHOLOGY BIOCHEMISTRY Immunoglobulins (IgM) Serum BASE PRICE 1924 890 1110 PATHOLOGY BIOCHEMISTRY Iron And TIBC BASE PRICE 1885 660 830 PATHOLOGY BIOCHEMISTRY KAPPA & LAMBDA FREE LIGHT CHAIN SERUM* BASE PRICE 11822 5580 6980 PATHOLOGY BIOCHEMISTRY KAPPA & LAMBDA FREE LIGHT CHAIN, URINE * BASE PRICE 11827 5580 6980 PATHOLOGY BIOCHEMISTRY KAPPA FREE LIGHT CHAIN SERUM * BASE PRICE 11823 2790 3490 PATHOLOGY BIOCHEMISTRY KAPPA FREE LIGHT CHAIN, URINE * BASE PRICE 11825 2790 3490 PATHOLOGY BIOCHEMISTRY KFT-KIDNEY FUNCTION TEST BASE PRICE 2313 250 310 PATHOLOGY BIOCHEMISTRY Lactate - Plasma BASE PRICE 1886 760 950 PATHOLOGY BIOCHEMISTRY LAMBDA FREE LIGHT CHAIN SERUM * BASE PRICE 11824 2790 3490 PATHOLOGY BIOCHEMISTRY LAMBDA FREE LIGHT CHAIN, URINE * BASE PRICE 11826 2790 3490 PATHOLOGY BIOCHEMISTRY LAMOTRIGINE BASE PRICE 12503 6620 8280 PATHOLOGY BIOCHEMISTRY LDH - Lactate Dehydrogenase BASE PRICE 1888 440 550 PATHOLOGY BIOCHEMISTRY LDL - Cholesterol BASE PRICE 1889 250 310 PATHOLOGY BIOCHEMISTRY LEAD, BLOOD* BASE PRICE 8449 2210 2760

Page 71 of 115 PATHOLOGY BIOCHEMISTRY LFT- Liver Function Test BASE PRICE 1890 780 980 PATHOLOGY BIOCHEMISTRY Lipase BASE PRICE 1891 780 980 PATHOLOGY BIOCHEMISTRY Lipid Profile BASE PRICE 1892 1100 1380 PATHOLOGY BIOCHEMISTRY Lipoprotein (a) Lp(a)* BASE PRICE 1893 760 950 PATHOLOGY BIOCHEMISTRY Lithium Level* BASE PRICE 1841 1100 1380 PATHOLOGY BIOCHEMISTRY Magnesium BASE PRICE 1894 390 490 PATHOLOGY BIOCHEMISTRY MERCURY SERUM ICPMS BASE PRICE 13046 4620 5780 PATHOLOGY BIOCHEMISTRY MERCURY, SERUM BASE PRICE 11790 4190 5240 PATHOLOGY BIOCHEMISTRY METAL SCREEN 2 WHOLE BLOOD BASE PRICE 13045 11550 14440 PATHOLOGY BIOCHEMISTRY NEONATAL SCREENING PANEL (ALL 42 PARAMETERS) BASE PRICE 12371 5320 6650 PATHOLOGY BIOCHEMISTRY Osmolality - Urine* BASE PRICE 1896 640 800 PATHOLOGY BIOCHEMISTRY Osmolality-Serum* BASE PRICE 1895 640 800 PATHOLOGY BIOCHEMISTRY Pericardial Fluid - ADA* BASE PRICE 2321 1100 1380 PATHOLOGY BIOCHEMISTRY PERICARDIAL FLUID AMYLASE BASE PRICE 11834 560 700 PATHOLOGY BIOCHEMISTRY Pericardial Fluid LDH* BASE PRICE 2316 440 550 PATHOLOGY BIOCHEMISTRY PET (PERITONIAL EQUILIBRIUM TEST) 0 HR BASE PRICE 8585 390 490 PATHOLOGY BIOCHEMISTRY PET (PERITONIAL EQUILIBRIUM TEST) 2 HR BASE PRICE 8586 390 490 PATHOLOGY BIOCHEMISTRY PET (PERITONIAL EQUILIBRIUM TEST) 4 HR BASE PRICE 8587 390 490 PATHOLOGY BIOCHEMISTRY Phenobarbitone (Gardinal)* BASE PRICE 1842 1010 1260 PATHOLOGY BIOCHEMISTRY Phenytoin (Eptoin)* BASE PRICE 1843 1270 1590 PATHOLOGY BIOCHEMISTRY Phosphorous BASE PRICE 1897 190 240 PATHOLOGY BIOCHEMISTRY PLEURAL FLUID -ADA* BASE PRICE 2318 1100 1380 PATHOLOGY BIOCHEMISTRY PLEURAL FLUID AMYLASE BASE PRICE 11833 560 700 PATHOLOGY BIOCHEMISTRY Pleural Fluid LDH* BASE PRICE 2315 440 550 PATHOLOGY BIOCHEMISTRY POST DIALYSIS PANEL BASE PRICE 7377 500 630 PATHOLOGY BIOCHEMISTRY Potassium -Serum BASE PRICE 1898 140 180 PATHOLOGY BIOCHEMISTRY PRE DIALYSIS PANEL BASE PRICE 7376 830 1040 PATHOLOGY BIOCHEMISTRY Protein & Albumin (TP,ALB,GLOB,A/G) BASE PRICE 2440 320 400 PATHOLOGY BIOCHEMISTRY Proteins Total BASE PRICE 1899 190 240 PATHOLOGY BIOCHEMISTRY QUANTITATIVE ALBUMIN/SUGAR* BASE PRICE 8595 190 240 PATHOLOGY BIOCHEMISTRY RF - Rheumatoid Factor BASE PRICE 1926 660 830 PATHOLOGY BIOCHEMISTRY SAAG (Serum Ascitic Albumin Gradient)* BASE PRICE 1900 390 490 PATHOLOGY BIOCHEMISTRY SELENIUM , BLOOD BASE PRICE 13042 3730 4660 PATHOLOGY BIOCHEMISTRY SERUM ACETONE BASE PRICE 12615 780 980 PATHOLOGY BIOCHEMISTRY SERUM BICARBONATE* BASE PRICE 12177 320 400 PATHOLOGY BIOCHEMISTRY Serum Copper* BASE PRICE 2322 1100 1380 PATHOLOGY BIOCHEMISTRY Serum Electrolytes (Sodium & Potassium) BASE PRICE 2240 250 310 PATHOLOGY BIOCHEMISTRY SERUM PARACETAMOL BASE PRICE 13177 1260 1580 PATHOLOGY BIOCHEMISTRY SGOT (AST) BASE PRICE 1901 160 200 PATHOLOGY BIOCHEMISTRY SGPT (ALT) BASE PRICE 1902 160 200 PATHOLOGY BIOCHEMISTRY Sodium Serum BASE PRICE 1903 140 180 PATHOLOGY BIOCHEMISTRY Soluble Transferrin Receptors* BASE PRICE 1848 760 950 PATHOLOGY BIOCHEMISTRY Spot Urine Calcium* BASE PRICE 1927 160 200 PATHOLOGY BIOCHEMISTRY SPOT URINE CHLORIDE BASE PRICE 12477 220 280 PATHOLOGY BIOCHEMISTRY Spot Urine Creatinine* BASE PRICE 1928 140 180 PATHOLOGY BIOCHEMISTRY SPOT URINE PHOSPHORUS BASE PRICE 12900 340 430 PATHOLOGY BIOCHEMISTRY Spot Urine Potassium* BASE PRICE 1929 140 180 PATHOLOGY BIOCHEMISTRY Spot Urine Protein* BASE PRICE 1930 190 240

Page 72 of 115 PATHOLOGY BIOCHEMISTRY Spot Urine Protein/Creatinine Ratio* BASE PRICE 1854 390 490 PATHOLOGY BIOCHEMISTRY Spot Urine Sodium* BASE PRICE 1931 140 180 PATHOLOGY BIOCHEMISTRY SPOT URINE UREA* BASE PRICE 8588 140 180 PATHOLOGY BIOCHEMISTRY SPOT URINE URIC ACID* BASE PRICE 8590 190 240 PATHOLOGY BIOCHEMISTRY Stone (Calculus) Analysis - Kidney/Gallbladder* BASE PRICE 1904 440 550 PATHOLOGY BIOCHEMISTRY Synovial Fluid (Uric Acid)* BASE PRICE 2317 190 240 PATHOLOGY BIOCHEMISTRY Synovial Fluid - ADA* BASE PRICE 2320 1020 1280 PATHOLOGY BIOCHEMISTRY TOTAL BILE ACIDS BASE PRICE 12922 2320 2900 PATHOLOGY BIOCHEMISTRY Triglycerides BASE PRICE 1905 190 240 PATHOLOGY BIOCHEMISTRY UREA BASE PRICE 1906 140 180 PATHOLOGY BIOCHEMISTRY Uric Acid BASE PRICE 1907 190 240 PATHOLOGY BIOCHEMISTRY URINARY CHLORIDE (24 HOURS)* BASE PRICE 12176 250 310 PATHOLOGY BIOCHEMISTRY Urine Calcium (24 Hrs)* BASE PRICE 1908 190 240 PATHOLOGY BIOCHEMISTRY Urine Copper (24 Hrs)* BASE PRICE 1909 1100 1380 PATHOLOGY BIOCHEMISTRY Urine Creatinine (24 Hrs)* BASE PRICE 1910 190 240 PATHOLOGY BIOCHEMISTRY Urine Microalbumin* BASE PRICE 1911 500 630 PATHOLOGY BIOCHEMISTRY URINE PHOSPHORUS (24 HRS) BASE PRICE 12901 440 550 PATHOLOGY BIOCHEMISTRY Urine Potassium (24 Hrs)* BASE PRICE 1912 190 240 PATHOLOGY BIOCHEMISTRY Urine Protein (24 Hrs)* BASE PRICE 1913 250 310 PATHOLOGY BIOCHEMISTRY Urine Sodium (24 Hrs)* BASE PRICE 1914 190 240 PATHOLOGY BIOCHEMISTRY URINE UREA (24 HRS)* BASE PRICE 8589 190 240 PATHOLOGY BIOCHEMISTRY URINE URIC ACID (24 HRS)* BASE PRICE 8591 250 310 PATHOLOGY BIOCHEMISTRY Valporic Acid* BASE PRICE 1844 1270 1590 PATHOLOGY BIOCHEMISTRY Vancomycin* BASE PRICE 1845 6660 8330 PATHOLOGY BIOCHEMISTRY Zinc Level* BASE PRICE 1846 2160 2700 PATHOLOGY CLINICAL PATHOLOGY ASCITIC FLUID (ROUTINE EXAMINATION) BASE PRICE 1989 660 830 PATHOLOGY CLINICAL PATHOLOGY CSF (ROUTINE EXAMINATION) BASE PRICE 1991 660 830 PATHOLOGY CLINICAL PATHOLOGY FLUID - ROUTINE EXAMINATION BASE PRICE 2442 660 830 PATHOLOGY CLINICAL PATHOLOGY PERICARDIAL FLUID (ROUTINE EXAMINATION) BASE PRICE 1992 660 830 PATHOLOGY CLINICAL PATHOLOGY Peritonial Dialysis Fluid BASE PRICE 7363 560 700 PATHOLOGY CLINICAL PATHOLOGY PLEURAL FLUID (ROUTINE EXAMINATION) BASE PRICE 1993 660 830 PATHOLOGY CLINICAL PATHOLOGY SEMEN,( ROUTINE EXAMINATION) BASE PRICE 1995 880 1100 PATHOLOGY CLINICAL PATHOLOGY SYNOVIAL FLUID (ROUTINE EXAMINATION) BASE PRICE 1996 640 800 PATHOLOGY CLINICAL PATHOLOGY URINE (ROUTINE AND MICROSCOPIC EXAMINATION) BASE PRICE 1999 140 180 PATHOLOGY CLINICAL PATHOLOGY URINE - PH BASE PRICE 1998 140 180 PATHOLOGY CLINICAL PATHOLOGY URINE ALBUMIN (SEMIQUANTITATIVE) BASE PRICE 2000 140 180 PATHOLOGY CLINICAL PATHOLOGY URINE BENCE JONES PROTEIN BASE PRICE 2389 250 310 PATHOLOGY CLINICAL PATHOLOGY URINE BILE SALTS AND BILE PIGMENTS (SEMIQUANTITATIVE) BASE PRICE 2001 140 180 PATHOLOGY CLINICAL PATHOLOGY URINE COTININE BASE PRICE 8579 1270 1590 PATHOLOGY CLINICAL PATHOLOGY URINE FOR HEMOGLOBIN (QUALITATIVE ) BASE PRICE 2002 190 240 PATHOLOGY CLINICAL PATHOLOGY URINE FOR CHYLE (QUALITATIVE) BASE PRICE 2003 250 310 PATHOLOGY CLINICAL PATHOLOGY URINE KETONES (SEMIQUANTITATIVE) BASE PRICE 2004 140 180 PATHOLOGY CLINICAL PATHOLOGY URINE PORPHOBILINOGEN (SCREENING) BASE PRICE 2005 1270 1590 PATHOLOGY CLINICAL PATHOLOGY Urine Pregnancy Card Test BASE PRICE 1994 190 240 PATHOLOGY CLINICAL PATHOLOGY URINE SPECIFIC GRAVITY BASE PRICE 2006 140 180 PATHOLOGY CLINICAL PATHOLOGY URINE SUGAR (SEMIQUANTITATIVE) BASE PRICE 2007 140 180 PATHOLOGY CLINICAL PATHOLOGY URINE UROBILINOGEN (SEMIQUANTITATIVE) BASE PRICE 2008 140 180 PATHOLOGY CYTOLOGY BRCA 1&2 GENETIC TEST-BREAST CANCER BASE PRICE 12357 22050 27560

Page 73 of 115 PATHOLOGY CYTOLOGY CYTOGENETICS: CHROMOSOME ANALYSIS BY KARYOTYPING BASE PRICE 8476 3170 3960 PATHOLOGY CYTOLOGY Cytogenetics:Chromosome Analysis by FISH BASE PRICE 8375 3170 3960 PATHOLOGY CYTOLOGY CYTOGENETICS:PRODUCT OF CONECEPTION(POC) BASE PRICE 8492 6220 7780 PATHOLOGY CYTOLOGY CYTOGENTICS: FANCONI ANEMIA BASE PRICE 12242 7930 9910 PATHOLOGY CYTOLOGY CYTOLOGY (FLUID / IMPRINT/ SQUASH)* BASE PRICE 2198 760 950 PATHOLOGY CYTOLOGY CYTOLOGY SLIDE FOR REVIEW BASE PRICE 2199 660 830 PATHOLOGY CYTOLOGY FNAC - PROCEDURE & EXAMINATION* BASE PRICE 8592 1320 1650 HISTOPATHOLOGY,KIDNEY BIOPSY PANEL 1 - HISTOPATHOLOGY,SPECIAL STAINS PATHOLOGY CYTOLOGY BASE PRICE 12360 4320 5400 ,DIF FOR LGG,IGA,IGM,C3 & C1Q HLA DNA TYPING FOR KIDNEY TRANSPLANT, PCR-*A,B & DR LOW RESOLUTION PATHOLOGY CYTOLOGY BASE PRICE 12358 18130 22660 TYPING PATHOLOGY CYTOLOGY HLA DSA (donor specific IgG Antibodies, Class I & II BASE PRICE 12359 12680 15850 PATHOLOGY CYTOLOGY HLA T & B CELL LYMPHOCYTE CROSS MATCH BASE PRICE 12364 4190 5240 PATHOLOGY CYTOLOGY HLA-DR (CLASS II) TYPING BASE PRICE 12365 6980 8730 PATHOLOGY CYTOLOGY HLA-PANEL REACTIVE IGG ANTIBODIES (PRA), SCREEN CLASS I & CLASS II BASE PRICE 12361 6980 8730 PATHOLOGY CYTOLOGY HLA-PANEL REACTIVE IGG ANTIBODIES (PRA), SCREEN CLASS I QUANTAVIE BASE PRICE 12362 12560 15700 PATHOLOGY CYTOLOGY HLA-PANEL REACTIVE IGG ANTIBODIES (PRA), SCREEN CLASS II QUANTAVIE BASE PRICE 12363 12560 15700 PATHOLOGY CYTOLOGY LIQUID BASED CYTOLOGY BASE PRICE 13172 950 1190 PATHOLOGY CYTOLOGY NEONATAL KARYPTYPING (NEWBORN TO ONE MONTH OLD CHILD) BASE PRICE 11646 3360 4200 PATHOLOGY CYTOLOGY PAP DUO-LIQUIPREP BASE PRICE 12368 2920 3650 PATHOLOGY CYTOLOGY PAP SMEAR* BASE PRICE 2228 640 800 PATHOLOGY CYTOLOGY SYNOVIAL FLUID-CRYSTALS BASE PRICE 8597 320 400 PATHOLOGY HAEMATOLOGY ABSOLUTE EOSINOPHILS COUNT (AEC) BASE PRICE 1942 250 310 PATHOLOGY HAEMATOLOGY AML ETO t(8:21) GENE REARRANGEMENT QUANTITATIVE, MRD MONITOR BASE PRICE 13178 5460 6830 ANAEMIA TYPING/COMPLETE HEMOGRAM( CBC+ GBP+INDICES+RETICULOCYTE PATHOLOGY HAEMATOLOGY BASE PRICE 1951 780 980 COUNT)) PATHOLOGY HAEMATOLOGY ANTI THROMBIN III* BASE PRICE 1958 4440 5550 PATHOLOGY HAEMATOLOGY APTT - (ACTIVATED PARTIAL THROMBOPLASTIN TIME) BASE PRICE 1937 390 490 PATHOLOGY HAEMATOLOGY BCR-ABL QUANTIFICATION BY REAL-TIME PCR BASE PRICE 1976 7420 9280 PATHOLOGY HAEMATOLOGY BLEEDING & CLOTTING TIME* BASE PRICE 1938 140 180 PATHOLOGY HAEMATOLOGY BONE MARROW ASPIRATION* BASE PRICE 11614 1660 2080 PATHOLOGY HAEMATOLOGY BONE MARROW BIOPSY* BASE PRICE 11615 2760 3450 PATHOLOGY HAEMATOLOGY BONE MARROW SLIDES FOR REVIEW* BASE PRICE 1972 640 800 PATHOLOGY HAEMATOLOGY CBC & MP (TOGETHER) BASE PRICE 2451 890 1110 PATHOLOGY HAEMATOLOGY CBC + GBP BASE PRICE 11511 560 700 PATHOLOGY HAEMATOLOGY CD4 Count BASE PRICE 8473 830 1040 PATHOLOGY HAEMATOLOGY COMPLETE BLOOD COUNT(CBC includes Hb + TLC +DLC +PLATELET COUNT)) BASE PRICE 1943 390 490 PATHOLOGY HAEMATOLOGY COMPLETE BLOOD COUNTS (OPD)includes Hb, TLC, DLC, Platelet count and ESR BASE PRICE 12469 440 550 PATHOLOGY HAEMATOLOGY CRYOGLOBULIN QUALITATIVE BASE PRICE 8475 1120 1400 PATHOLOGY HAEMATOLOGY CYTOGENETICS: CHROMOSOME ANALYSIS IN HEMATOLOGICAL DISORDERS BASE PRICE 8481 4050 5060 PATHOLOGY HAEMATOLOGY DIC SCREENING (INR,APTT, FIBRINOGEN, FDP) BASE PRICE 1956 1910 2390 PATHOLOGY HAEMATOLOGY DLC-DIFFERENTIAL LEUCOCYTE COUNT BASE PRICE 2333 250 310 PATHOLOGY HAEMATOLOGY ESR BASE PRICE 1944 160 200 PATHOLOGY HAEMATOLOGY EUGLOBIN CLOT LYSIS TIME BASE PRICE 1959 500 630 PATHOLOGY HAEMATOLOGY FACTOR II ASSAY* BASE PRICE 1960 3170 3960 PATHOLOGY HAEMATOLOGY FACTOR IX ASSAY* BASE PRICE 1963 2540 3180 PATHOLOGY HAEMATOLOGY FACTOR VII ASSAY* BASE PRICE 1964 2540 3180 PATHOLOGY HAEMATOLOGY FACTOR VIII ASSAY* BASE PRICE 1965 2540 3180

Page 74 of 115 PATHOLOGY HAEMATOLOGY FACTOR X ASSAY* BASE PRICE 1961 3170 3960 PATHOLOGY HAEMATOLOGY FACTOR XIII (QUALITATIVE)* BASE PRICE 1962 1910 2390 PATHOLOGY HAEMATOLOGY FDP (LATEX AGGLUTINATION TEST)* BASE PRICE 1939 1270 1590 PATHOLOGY HAEMATOLOGY FIBRINOGEN BASE PRICE 1940 640 800 PATHOLOGY HAEMATOLOGY FISH-BCR/ABL BASE PRICE 12965 4520 5650 PATHOLOGY HAEMATOLOGY FLOW CYTOMETRY - ADD-ON MARKERS BASE PRICE 8484 2600 3250 PATHOLOGY HAEMATOLOGY HAEMATOCRIT (PCV) BASE PRICE 1946 160 200 PATHOLOGY HAEMATOLOGY HAEMOGLOBIN, BLOOD BASE PRICE 1945 160 200 PATHOLOGY HAEMATOLOGY HEINZ BODIES BASE PRICE 1947 140 180 PATHOLOGY HAEMATOLOGY HLA DNA TYPING FOR BMT (6 ANTIGEN) BASE PRICE 12671 16320 20400 PATHOLOGY HAEMATOLOGY HLA-B27 by Flow Cytometry* BASE PRICE 1979 2420 3030 PATHOLOGY HAEMATOLOGY IMMUNOFIXATION ELECTROPHORESIS, QUANTITATIVE ANALYSIS BASE PRICE 11791 7720 9650 PATHOLOGY HAEMATOLOGY IMMUNOFIXATION ELECTROPHORESIS, SERUM* BASE PRICE 11639 7290 9110 PATHOLOGY HAEMATOLOGY IMMUNOFIXATION ELECTROPHORESIS, URINE* BASE PRICE 11640 8560 10700 PATHOLOGY HAEMATOLOGY IMMUNOPHENOTYPING(MRD) BASE PRICE 12210 5070 6340 PATHOLOGY HAEMATOLOGY IMMUNOPHENOTYPING-CHRONIC LYMPHOPROLIFERATIVE DISORDER PANEL BASE PRICE 1984 12360 15450 PATHOLOGY HAEMATOLOGY IMMUNOPHENOTYPING: - CD4/CD8 COUNT BASE PRICE 1980 2350 2940 IMMUNOPHENOTYPING:- ACUTE MYELOID LEUKEMIA (AML) PATHOLOGY HAEMATOLOGY BASE PRICE 1983 11290 14110 CHARACTERIZATION PANEL PATHOLOGY HAEMATOLOGY IMMUNOPHENOTYPING:-ACUTE LEUKEMIA: PANEL BASE PRICE 1981 8870 11090 PATHOLOGY HAEMATOLOGY IMMUNOPHENOTYPING:-ACUTE LYMPHOPLASTIC LEUKEMIA (ALL) PANEL BASE PRICE 1982 11290 14110 PATHOLOGY HAEMATOLOGY INR - PROTHROMBIN TIME BASE PRICE 1941 390 490 PATHOLOGY HAEMATOLOGY LEUCOCYTE COUNT -TOTAL AND DIFFERENTIAL BASE PRICE 1948 250 310 PATHOLOGY HAEMATOLOGY LEUKEMIA DIAGNOSTIC COMPREHENSIVE PROFILE BASE PRICE 13225 15750 19690 PATHOLOGY HAEMATOLOGY LEUKEMIA TRANSLOCATION PANEL 1 BASE PRICE 11642 7930 9910 PATHOLOGY HAEMATOLOGY LEUKEMIA TRANSLOCATION PANEL 2 BASE PRICE 11596 5710 7140 PATHOLOGY HAEMATOLOGY LEUKEMIA TRANSLOCATION PANEL 3 BASE PRICE 11641 8620 10780 PATHOLOGY HAEMATOLOGY LEUKEMIA TRANSLOCATION PANEL 5 BASE PRICE 11643 5320 6650 PATHOLOGY HAEMATOLOGY LEUKEMIA TRANSLOCATION PANEL 6 BASE PRICE 11644 6850 8560 PATHOLOGY HAEMATOLOGY LUPUS ANTICOAGULANT MIXING STUDIES BASE PRICE 8594 3170 3960 PATHOLOGY HAEMATOLOGY LUPUS ANTICOAGULANT SCREENING (DRVVT/KCT)* BASE PRICE 1966 1270 1590 PATHOLOGY HAEMATOLOGY LYMPHOCYTE SURFACE MARKERS BASE PRICE 8604 2350 2940 PATHOLOGY HAEMATOLOGY MEAN CORPUSCULAR HEMOGLOBIN BASE PRICE 2308 190 240 PATHOLOGY HAEMATOLOGY MEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION BASE PRICE 2309 190 240 PATHOLOGY HAEMATOLOGY MEAN CORPUSCULAR VOLUME BASE PRICE 2307 190 240 PATHOLOGY HAEMATOLOGY MF MICROFILARIA PARASITE( BY MICROSCOPY) BASE PRICE 1949 190 240 PATHOLOGY HAEMATOLOGY MP-MALARIAL PARASITE ( SMEAR+ANTIGEN) BASE PRICE 1950 500 630 PATHOLOGY HAEMATOLOGY MYELOMA BONE MARROW PROCEDURE & EXAMINATION BASE PRICE 12920 5290 6610 PATHOLOGY HAEMATOLOGY MYOGLOBIN* BASE PRICE 8544 2210 2760 PATHOLOGY HAEMATOLOGY OLIGOCLONAL BANDS, CSF BASE PRICE 11771 4440 5550 PATHOLOGY HAEMATOLOGY OSMOTIC FRAGILITY TEST BASE PRICE 1973 1270 1590 PATHOLOGY HAEMATOLOGY PERIPHERAL SMEAR FOR SCHISTOCYTES BASE PRICE 1957 250 310 PATHOLOGY HAEMATOLOGY PLATELET COUNT BASE PRICE 1952 250 310 PATHOLOGY HAEMATOLOGY PNH CONFIRMATORY TEST (FLAER) BASE PRICE 11658 8240 10300 PATHOLOGY HAEMATOLOGY PNH SCREENING TEST (FLOW CYTOMETRY) BASE PRICE 1969 2210 2760 PATHOLOGY HAEMATOLOGY PROTEIN C ASSAY BASE PRICE 1967 4440 5550 PATHOLOGY HAEMATOLOGY PROTEIN S ASSAY BASE PRICE 1968 4130 5160 PATHOLOGY HAEMATOLOGY PT & APTT MIXING STUDIES BASE PRICE 8593 3170 3960

Page 75 of 115 PATHOLOGY HAEMATOLOGY RBC INDICES BASE PRICE 1953 250 310 PATHOLOGY HAEMATOLOGY RETICULOCYTE COUNT BASE PRICE 1954 250 310 PATHOLOGY HAEMATOLOGY SICKLING TEST BASE PRICE 1975 250 310 PATHOLOGY HAEMATOLOGY THROMBIN TIME BASE PRICE 1974 1020 1280 PATHOLOGY HAEMATOLOGY THROMBOCHECK TOTAL BASE PRICE 12611 23710 29640 PATHOLOGY HAEMATOLOGY TLC- TOTAL LEUCOCYTE COUNT BASE PRICE 1955 160 200 PATHOLOGY HISTOPATHOLOGY ALK-1 IMMUNOHISTOCHEMISTRY BASE PRICE 13037 5040 6300 PATHOLOGY HISTOPATHOLOGY BLOCK FOR ISSUE - (COST PER BLOCK) BASE PRICE 2193 1270 1590 PATHOLOGY HISTOPATHOLOGY COLORECTAL CANCER PANEL BASE PRICE 13218 12080 15100 PATHOLOGY HISTOPATHOLOGY CUSTOM IHC PANEL BASE PRICE 12231 5510 6890 PATHOLOGY HISTOPATHOLOGY DR ANITA BORGES SLIDE/BLOCK REVIEW BASE PRICE 13219 9240 11550 PATHOLOGY HISTOPATHOLOGY EGFR IMMUNOHISTOCHEMISTRY BASE PRICE 13039 2840 3550 PATHOLOGY HISTOPATHOLOGY EGFR MUTATION BY PYROSEQUENCING BASE PRICE 13044 8400 10500 PATHOLOGY HISTOPATHOLOGY EXTERNAL HISTOPATHOLOGY SMALL BIOPSY* BASE PRICE 12632 780 980 PATHOLOGY HISTOPATHOLOGY HER-2/NEU ONCOPROTEIN (C-ERB B2) BASE PRICE 11745 2030 2540 PATHOLOGY HISTOPATHOLOGY HER2/NEU (BY FISH) BASE PRICE 11636 13310 16640 PATHOLOGY HISTOPATHOLOGY HISTOPATHOLOGY FROZEN SECTION )* BASE PRICE 2191 2210 2760 HISTOPATHOLOGY MEDIUM BIOPSY* TURP,TURBT,NEUROSURGERY, PATHOLOGY HISTOPATHOLOGY BASE PRICE 2188 1660 2080 LYMPHNODES, THYROID NODULE, BONY LESIONS) PATHOLOGY HISTOPATHOLOGY HISTOPATHOLOGY RENAL BIOPSY WITH IMMUNOFLUORESCENCE* BASE PRICE 2190 3860 4830 PATHOLOGY HISTOPATHOLOGY HISTOPATHOLOGY RESECTED SPECIMEN* BASE PRICE 2189 2210 2760 PATHOLOGY HISTOPATHOLOGY HISTOPATHOLOGY SLIDE FOR REVIEW BASE PRICE 2194 1320 1650 PATHOLOGY HISTOPATHOLOGY HISTOPATHOLOGY SMALL BIOPSY* BASE PRICE 2187 1100 1380 PATHOLOGY HISTOPATHOLOGY IMMUNOHISTOCHEMISTRY - BREAST - ER & PR & Her2neu* BASE PRICE 2197 3800 4750 PATHOLOGY HISTOPATHOLOGY IMMUNOHISTOCHEMISTRY - BREAST - ER & PR* BASE PRICE 2196 2280 2850 PATHOLOGY HISTOPATHOLOGY IMMUNOHISTOCHEMISTRY* BASE PRICE 2195 3170 3960 PATHOLOGY HISTOPATHOLOGY K-RAS MUTATION DETECTION BASE PRICE 11695 7930 9910 PATHOLOGY HISTOPATHOLOGY MSI STUDY FOR COLORECTAL CANCER BASE PRICE 12916 7170 8960 PATHOLOGY HISTOPATHOLOGY ONCO SURGERY SPECIMEN (MULTIPLE CONTAINERS) BASE PRICE 12975 6300 7880 PATHOLOGY HISTOPATHOLOGY ROS-1 IMMUNOHISTOCHEMISTRY BASE PRICE 13038 3680 4600 PATHOLOGY HISTOPATHOLOGY SLIDE TO BE ISSUED –(COST PER SLIDE) BASE PRICE 2192 140 180 PATHOLOGY HISTOPATHOLOGY SPECIAL STAIN BASE PRICE 12217 140 180 PATHOLOGY HISTOPATHOLOGY TRUS GUIDED PROSTATE BIOPSY HISTOPATHOLOGY BASE PRICE 12809 4410 5510 PATHOLOGY HORMONES 17 HYDROXY-PROGESTERONE* BASE PRICE 2134 1820 2280 PATHOLOGY HORMONES 5-HYDROXY 3-INDOLE ACETIC ACID (5-HIAA)* BASE PRICE 2135 3860 4830 PATHOLOGY HORMONES ACTH-ADRENOCORTICOTROPIC HORMONE BASE PRICE 2136 2040 2550 PATHOLOGY HORMONES Adrenaline (Plasma) BASE PRICE 11499 3970 4960 PATHOLOGY HORMONES AFP-ALPHA FETO PROTEIN-SERUM/BODYFLUID BASE PRICE 2137 780 980 PATHOLOGY HORMONES ALDOSTERONE* BASE PRICE 8412 2920 3650 PATHOLOGY HORMONES ANDROSTENEDIONE* BASE PRICE 2138 2540 3180 PATHOLOGY HORMONES ANTI DIURETIC HOROMONE BASE PRICE 12419 5730 7160 PATHOLOGY HORMONES BETA 2 MICROGLOBULIN BASE PRICE 2374 2040 2550 PATHOLOGY HORMONES BETA 2 MICROGLOBULIN (URINE) BASE PRICE 2383 1910 2390 PATHOLOGY HORMONES BETA HUMAN CHORIONIC GONADOTROPIN BASE PRICE 2139 780 980 PATHOLOGY HORMONES C PEPTIDE BASE PRICE 8546 1380 1730 PATHOLOGY HORMONES CA-125 (OVARIAN MARKER) BASE PRICE 2140 1270 1590 PATHOLOGY HORMONES CA-15.3 (BREAST MARKER) BASE PRICE 2141 1660 2080 PATHOLOGY HORMONES CA-19.9 (PANCREATIC / COLORECTAL MARKER) BASE PRICE 2142 1540 1930

Page 76 of 115 PATHOLOGY HORMONES CALCITONIN BASE PRICE 2143 2870 3590 PATHOLOGY HORMONES CATECHOLAMINES (URINE) BASE PRICE 11616 4760 5950 PATHOLOGY HORMONES CATECHOLAMINES, PLASMA BASE PRICE 11773 8620 10780 PATHOLOGY HORMONES CEA -CARCINO EMBRYONIC ANTIGEN BASE PRICE 2144 930 1160 PATHOLOGY HORMONES CHROMOGRANIN A BASE PRICE 11770 8160 10200 PATHOLOGY HORMONES CORTISOL (OVERNIGHT DEXAMETHASONE SUPPRESSION TEST) BASE PRICE 2393 660 830 PATHOLOGY HORMONES CORTISOL (RANDOM) BASE PRICE 2392 660 830 PATHOLOGY HORMONES CORTISOL AFTER ACTH STIMULATION (2 SAMPLES) BASE PRICE 2145 1320 1650 PATHOLOGY HORMONES CORTISOL AFTER ACTH STIMULATION (3 SAMPLES) BASE PRICE 2387 1930 2410 PATHOLOGY HORMONES CORTISOL, SERUM BASE PRICE 2146 660 830 DEXAMETHASONE SUPPRESSION TEST FOR CORTISOL: CONFIRMATORY : THREE PATHOLOGY HORMONES BASE PRICE 2147 1980 2480 SAMPLES (LOW DOSE & HIGH DOSE) DEXAMETHASONE SUPPRESSION TEST FOR CORTISOL: SCREENING : TWO PATHOLOGY HORMONES BASE PRICE 2148 1320 1650 SAMPLES (OVERNIGHT SUPPRESSION) PATHOLOGY HORMONES DHEAS-DEHYDROEPIANDROSTERONE SULPHATE BASE PRICE 2149 1110 1390 PATHOLOGY HORMONES DIHYDROTESTOSTERONE (DHT) BASE PRICE 12489 2590 3240 DOUBLE MARKER TEST(First trimester risk assessment 8-14 wks)-PAPA-P & FREE PATHOLOGY HORMONES BASE PRICE 2186 2650 3310 B-HCG PATHOLOGY HORMONES E2-ESTRADIOL BASE PRICE 2150 660 830 PATHOLOGY HORMONES E3-UNCONJUGATED ESTRIOL BASE PRICE 2151 1330 1660 PATHOLOGY HORMONES ERYTHROPOIETIN BASE PRICE 2152 2260 2830 PATHOLOGY HORMONES FERRITIN BASE PRICE 2153 640 800 PATHOLOGY HORMONES FOLATE & VITAMIN B12, SERUM BASE PRICE 2452 2540 3180 PATHOLOGY HORMONES FOLATE, RBC AND SERUM BASE PRICE 2453 3170 3960 PATHOLOGY HORMONES FOLIC ACID, RBC BASE PRICE 2154 2030 2540 PATHOLOGY HORMONES FOLIC ACID, SERUM BASE PRICE 2155 1270 1590 PATHOLOGY HORMONES FREE PSA-PROSTATE SPECIFIC ANTIGEN-FREE BASE PRICE 2166 760 950 PATHOLOGY HORMONES FREE T3 & FREE T4 BASE PRICE 2457 500 630 PATHOLOGY HORMONES FREE T3 - TRI-IODOTHYRONINE-FREE BASE PRICE 2169 320 400 PATHOLOGY HORMONES FREE T4 & THYROID STIMULATING HORMONE BASE PRICE 2458 500 630 PATHOLOGY HORMONES FREE T4 - THYROXINE-FREE BASE PRICE 2171 320 400 PATHOLOGY HORMONES FREE THYROID PROFILE (FT3,FT4,TSH) BASE PRICE 2460 660 830 PATHOLOGY HORMONES FSH & LH BASE PRICE 2454 1020 1280 PATHOLOGY HORMONES FSH-FOLLICLE STIMULATING HORMONE BASE PRICE 2156 500 630 PATHOLOGY HORMONES GASTRIN BASE PRICE 2377 1980 2480 PATHOLOGY HORMONES GNRH STIMULATION TEST FOR FSH & LH BASE PRICE 2157 1270 1590 PATHOLOGY HORMONES GROWTH HORMONE BASE PRICE 2158 890 1110 PATHOLOGY HORMONES h-tTG/DGP BASE PRICE 12482 1270 1590 PATHOLOGY HORMONES HCG STIMULATION TEST FOR TESTOSTERONE BASE PRICE 2159 640 800 PATHOLOGY HORMONES HE4 (HUMAN EPIDIDYMIS PROTEIN-4)* BASE PRICE 11808 3200 4000 PATHOLOGY HORMONES HoLo TC BASE PRICE 12483 1820 2280 PATHOLOGY HORMONES HUMAN GROWTH HORMONE (2 SAMPLE) BASE PRICE 2379 1760 2200 PATHOLOGY HORMONES HUMAN GROWTH HORMONE(3 SAMPLE) BASE PRICE 2378 2650 3310 PATHOLOGY HORMONES INSULIN BASE PRICE 2160 930 1160 PATHOLOGY HORMONES INSULIN LIKE GROWTH FACTOR-1 (IGF-1) BASE PRICE 11659 4490 5610 PATHOLOGY HORMONES LH-LEUTINISHING HORMONE BASE PRICE 2161 500 630 PATHOLOGY HORMONES MACROPROLACTIN, SERUM BASE PRICE 12303 13060 16330 PATHOLOGY HORMONES METANEPHRINE-FREE PLASMA (EDTA PLASMA, ELISA) BASE PRICE 12479 6070 7590

Page 77 of 115 PATHOLOGY HORMONES METANEPHRINES, 24-HOUR URINE(Fractionated) BASE PRICE 12480 10090 12610 PATHOLOGY HORMONES Nor Adrenaline (Plasma) BASE PRICE 11500 3970 4960 PATHOLOGY HORMONES NT-PRO-BNP BASE PRICE 2376 4410 5510 PATHOLOGY HORMONES OSTEOPOROSIS MONITORING (TOTAL P1NP) BASE PRICE 11764 2210 2760 PATHOLOGY HORMONES PAPP A - PREGNANCY ASSOCIATED PLASMA PROTEIN A BASE PRICE 2162 1750 2190 PATHOLOGY HORMONES PARANEOPLASTIC DISORDER PROFILE (YO AND HU ABS) BASE PRICE 12372 6620 8280 PATHOLOGY HORMONES PLASMA RENIN BASE PRICE 8413 5950 7440 PATHOLOGY HORMONES PRESAGE ST2 BASE PRICE 12237 2040 2550 PATHOLOGY HORMONES PROINSULIN BASE PRICE 13009 12240 15300 PATHOLOGY HORMONES PSA -PROSTATE SPECIFIC ANTIGEN-TOTAL BASE PRICE 2165 760 950 PATHOLOGY HORMONES PSA PROFILE BASE PRICE 2444 1520 1900 PATHOLOGY HORMONES PTH-PARATHYROID HORMONE BASE PRICE 2167 1910 2390 QUADRUPLE MARKER TEST/ 2nd Trimester Risk assessment, 14-22 Weeks.( AFP, PATHOLOGY HORMONES BASE PRICE 2184 3970 4960 HCG,E3UN & DIA) PATHOLOGY HORMONES SEROTONIN, SERUM BASE PRICE 12426 4970 6210 PATHOLOGY HORMONES SERUM PROGESTERONE BASE PRICE 2163 830 1040 PATHOLOGY HORMONES SERUM PROLACTIN BASE PRICE 2164 580 730 PATHOLOGY HORMONES SEX HORMONE BINDING GLOBULIN BASE PRICE 12264 2590 3240 PATHOLOGY HORMONES T3-TRI-IODOTHYRONINE-TOTAL BASE PRICE 2170 250 310 PATHOLOGY HORMONES T4-THYROXINE-TOTAL BASE PRICE 2172 250 310 PATHOLOGY HORMONES TACROLIMUS BASE PRICE 11938 2480 3100 PATHOLOGY HORMONES TBG (THYROXINE BINDING GLOBULIN) BASE PRICE 12493 6620 8280 PATHOLOGY HORMONES TESTOSTERONE PANEL, TOTAL & FREE BASE PRICE 2459 2040 2550 PATHOLOGY HORMONES TESTOSTERONE-FREE BASE PRICE 2173 1710 2140 PATHOLOGY HORMONES TESTOSTERONE-TOTAL BASE PRICE 2174 640 800 PATHOLOGY HORMONES THYROGLOBULIN BASE PRICE 2175 2040 2550 PATHOLOGY HORMONES THYROID PROFILE 1 (TSH+T3+T4) BASE PRICE 2344 660 830 PATHOLOGY HORMONES THYROID PROFILE 3 (TSH + FT4) BASE PRICE 2346 440 550 PATHOLOGY HORMONES THYROXINE BINDING GLOBULIN (TBG) BASE PRICE 12610 4970 6210 PATHOLOGY HORMONES TRIPLE TEST / 2nd Trimester Risk assessment,14-22 Weeks. (AFP, HCG &E3UN) BASE PRICE 2185 3260 4080 PATHOLOGY HORMONES TROPONIN I BASE PRICE 2348 1660 2080 PATHOLOGY HORMONES TROPONIN T BASE PRICE 2349 1660 2080 PATHOLOGY HORMONES TSH-THYROID STIMULATING HORMONE BASE PRICE 2176 250 310 PATHOLOGY HORMONES URINE 17 KETOSTEROIDS (24 HRS) BASE PRICE 2177 6670 8340 PATHOLOGY HORMONES URINE CORTISOL (24 HRS.) BASE PRICE 2178 1100 1380 PATHOLOGY HORMONES URINE METANEPHRINE LEVEL (QUANTITATIVE) BASE PRICE 2179 2370 2960 PATHOLOGY HORMONES URINE VMA -VANILLYL MANDELIC ACID (24 HRS) BASE PRICE 2180 4020 5030 PATHOLOGY HORMONES VITAMIN A BASE PRICE 13041 4830 6040 PATHOLOGY HORMONES VITAMIN B1 BASE PRICE 12367 4190 5240 PATHOLOGY HORMONES VITAMIN B12 BASE PRICE 2181 1520 1900 PATHOLOGY HORMONES VITAMIN B6 BASE PRICE 2373 3860 4830 PATHOLOGY HORMONES VITAMIN D (1,25 HYDROXY) BASE PRICE 2183 3970 4960 PATHOLOGY HORMONES VITAMIN D3 (25 HYDROXY) BASE PRICE 2182 2040 2550 PATHOLOGY HORMONES VITAMIN E BASE PRICE 11617 3970 4960 PATHOLOGY HORMONES VITAMIN K1 SERUM BASE PRICE 13040 4410 5510 PATHOLOGY IMMUNOLOGY ABPA PANEL BASE PRICE 13179 3100 3880 PATHOLOGY IMMUNOLOGY ACETYL CHOLINE RECEPTOR ANTIBODIES BASE PRICE 2200 5240 6550 PATHOLOGY IMMUNOLOGY ALDEHYDE CHOPRA TEST FOR KALA AZAR* BASE PRICE 2071 220 280

Page 78 of 115 PATHOLOGY IMMUNOLOGY ALLERGEN - CASEIN BASE PRICE 8567 1270 1590 ALLERGEN - DUST PANEL (HouseduST-Greer, Cockroach, D. Farinae, D. PATHOLOGY IMMUNOLOGY BASE PRICE 8429 2920 3650 Pteronyssinus PATHOLOGY IMMUNOLOGY ALLERGEN - ECZEMA/GIT (Non-veg & Veg) PANEL BASE PRICE 11594 6670 8340 PATHOLOGY IMMUNOLOGY ALLERGEN - FOOD ALLERGY SCREENING PANEL VEG BASE PRICE 12428 3310 4140 ALLERGEN PANEL-COMPHRENSIVE ALLERGY PANEL-INFANCY (PHADIA TOP PATHOLOGY IMMUNOLOGY BASE PRICE 12215 7500 9380 INFANT) PATHOLOGY IMMUNOLOGY ALLERGEN PANEL-COMPREHENSIVE- ADULT BASE PRICE 7356 10800 13500 PATHOLOGY IMMUNOLOGY ALLERGEN-MILK BASE PRICE 12669 1660 2080 PATHOLOGY IMMUNOLOGY ALLERGEN-SOYBEAN BASE PRICE 12670 1540 1930 PATHOLOGY IMMUNOLOGY ALLERGIC PANEL-PAEDIATRIC BASE PRICE 12234 3310 4140 PATHOLOGY IMMUNOLOGY ALLERGY PANEL RHINITIS ASTHMA BASE PRICE 2201 5410 6760 PATHOLOGY IMMUNOLOGY AMOEBIASIS ANTIBODIES IgG BASE PRICE 2072 1930 2410 PATHOLOGY IMMUNOLOGY ANA (ANTI NUCLEAR ANTIBODY)* BASE PRICE 2202 1270 1590 PATHOLOGY IMMUNOLOGY ANCA* BASE PRICE 2203 2040 2550 PATHOLOGY IMMUNOLOGY ANTI CARDIOLIPIN ANTIBODIES PANEL* BASE PRICE 2445 1660 2080 PATHOLOGY IMMUNOLOGY ANTI dsDNA ANTIBODIES* BASE PRICE 2204 1270 1590 PATHOLOGY IMMUNOLOGY ANTI ENDOMYSIAL ANTIBODIES BASE PRICE 2205 3090 3860 PATHOLOGY IMMUNOLOGY ANTI GBM ANTIBODIES* BASE PRICE 2206 2000 2500 PATHOLOGY IMMUNOLOGY ANTI GLIADIN IgA ANTIBODIES BASE PRICE 8543 3640 4550 PATHOLOGY IMMUNOLOGY ANTI HBc- IgM BASE PRICE 2073 1220 1530 PATHOLOGY IMMUNOLOGY ANTI HBc- TOTAL BASE PRICE 2074 1320 1650 PATHOLOGY IMMUNOLOGY ANTI HBe BASE PRICE 2075 1100 1380 PATHOLOGY IMMUNOLOGY ANTI HBs ANTIBODIES BASE PRICE 2076 1100 1380 PATHOLOGY IMMUNOLOGY ANTI LKM ANTIBODIES* BASE PRICE 2207 2040 2550 PATHOLOGY IMMUNOLOGY ANTI MITOCHONDRIAL ANTIBODIES* BASE PRICE 2208 2030 2540 PATHOLOGY IMMUNOLOGY ANTI MPO ANTIBODIES* BASE PRICE 2209 1840 2300 PATHOLOGY IMMUNOLOGY ANTI MUELLERIAN HORMONE BASE PRICE 2210 2320 2900 PATHOLOGY IMMUNOLOGY ANTI MUSK ANTIBODIES BASE PRICE 12636 11030 13790 PATHOLOGY IMMUNOLOGY ANTI NMDA RECEPTOR ENCEPHALITIS IGG ANTIBODIES BASE PRICE 11759 9530 11910 PATHOLOGY IMMUNOLOGY ANTI OVARIAN ANTIBODIES BASE PRICE 2211 3640 4550 PATHOLOGY IMMUNOLOGY ANTI PARIETAL CELL ANTIBODIES BASE PRICE 2212 2540 3180 PATHOLOGY IMMUNOLOGY ANTI PHOSPHOLIPID (IGG+IGM) ANTIBODIES* BASE PRICE 2368 1660 2080 PATHOLOGY IMMUNOLOGY ANTI PHOSPHOLIPID IgG ANTIBODIES* BASE PRICE 2446 880 1100 PATHOLOGY IMMUNOLOGY ANTI PHOSPHOLIPID IgM ANTIBODIES* BASE PRICE 2447 880 1100 PATHOLOGY IMMUNOLOGY ANTI PR3 ANTIBODIES* BASE PRICE 2372 1760 2200 PATHOLOGY IMMUNOLOGY ANTI SACCHAROMYCES CEREVISIAE ANTIBODIES BASE PRICE 2214 3090 3860 PATHOLOGY IMMUNOLOGY ANTI SMOOTH MUSCLE ANTIBODIES* BASE PRICE 2215 2030 2540 PATHOLOGY IMMUNOLOGY ANTI SPERM ANTIBODIES BASE PRICE 2216 1600 2000 PATHOLOGY IMMUNOLOGY ANTI TG ANTIBODIES* BASE PRICE 2217 1710 2140 PATHOLOGY IMMUNOLOGY ANTI TPO ANTIBODIES* BASE PRICE 2218 1220 1530 PATHOLOGY IMMUNOLOGY ANTI TTG IgA* BASE PRICE 2219 1320 1650 PATHOLOGY IMMUNOLOGY ANTI-CARDIOLIPIN ANTIBODDIES-IgM* BASE PRICE 2221 880 1100 PATHOLOGY IMMUNOLOGY ANTI-CARDIOLIPIN ANTIBODIES-IGG* BASE PRICE 2222 880 1100 PATHOLOGY IMMUNOLOGY ANTI-CCP (CYCLIC CENTRILUNETED PEPTIDE) ANTIBODIES* BASE PRICE 2223 1520 1900 PATHOLOGY IMMUNOLOGY ANTI-HCV (ANTIBODIES TO HEPATITIS C VIRUS)* BASE PRICE 2095 1020 1280 PATHOLOGY IMMUNOLOGY ANTITHYROID ANTIBODY PANEL* BASE PRICE 2448 2540 3180 PATHOLOGY IMMUNOLOGY APLA TOTAL BASE PRICE 12898 5340 6680

Page 79 of 115 PATHOLOGY IMMUNOLOGY ASPERGILLUS ANTIBODIES* BASE PRICE 2077 2040 2550 PATHOLOGY IMMUNOLOGY ASPERGILLUS FUMIGATUS IgE BASE PRICE 12218 1220 1530 PATHOLOGY IMMUNOLOGY AUTOIMMUNE ENCEPHALITIS PANEL BASE PRICE 13011 21000 26250 PATHOLOGY IMMUNOLOGY BCR-ABL IS BASE PRICE 12230 10020 12530 PATHOLOGY IMMUNOLOGY BETA 2 GLYCOPROTEIN IgG BASE PRICE 12902 880 1100 PATHOLOGY IMMUNOLOGY BOH PANEL (ANTIPHOSHOLIPID EVALUATION, TORCH IgC & IgM, ANA, TSH) BASE PRICE 11772 5730 7160 PATHOLOGY IMMUNOLOGY BRUCELLA ANTIBODIES* BASE PRICE 2078 2700 3380 PATHOLOGY IMMUNOLOGY BRUCELLA IgG ANTIBODIES BASE PRICE 13248 2550 3190 PATHOLOGY IMMUNOLOGY CHIKUNGUNYA IgM BASE PRICE 2079 830 1040 PATHOLOGY IMMUNOLOGY CHLAMYDIA PNEUMONIAE IgM BASE PRICE 2080 2430 3040 PATHOLOGY IMMUNOLOGY CHLAMYDIA TRACHOMATIS IGG BASE PRICE 11638 2320 2900 PATHOLOGY IMMUNOLOGY CHLAMYDIA TRACHOMATIS IGM BASE PRICE 11637 2320 2900 PATHOLOGY IMMUNOLOGY CLOSTRIDIUM DIFFICILE TOXIN A & B DETECTION* BASE PRICE 2081 2320 2900 PATHOLOGY IMMUNOLOGY CMV IgG BASE PRICE 2082 1000 1250 PATHOLOGY IMMUNOLOGY CMV IgM BASE PRICE 2083 1000 1250 PATHOLOGY IMMUNOLOGY COXASACKIE IgG BASE PRICE 8495 4440 5550 PATHOLOGY IMMUNOLOGY COXASACKIE IgM BASE PRICE 8496 4440 5550 PATHOLOGY IMMUNOLOGY CSF,MEASELS (RUBEOLA), IGG ANTIBODIES BASE PRICE 12625 4580 5730 PATHOLOGY IMMUNOLOGY CYTOMEGALOVIRUS ANTIBODIES BASE PRICE 2449 1710 2140 PATHOLOGY IMMUNOLOGY DENGUE IgG aNTIBODIES* BASE PRICE 2084 1140 1430 PATHOLOGY IMMUNOLOGY DENGUE IgM ANTIBODIES* BASE PRICE 2085 1140 1430 PATHOLOGY IMMUNOLOGY DENGUE NS1 ANTIGEN* BASE PRICE 2086 1140 1430 PATHOLOGY IMMUNOLOGY DENGUE NS1 ANTIGEN, IgG & IgM ANTIBODIES* BASE PRICE 2087 2280 2850 PATHOLOGY IMMUNOLOGY DENGUE RNA PCR BASE PRICE 12642 3580 4480 PATHOLOGY IMMUNOLOGY DRUG ALLERGY PANEL BASE PRICE 12903 5510 6890 PATHOLOGY IMMUNOLOGY EBV VCA IgG BASE PRICE 2088 2040 2550 PATHOLOGY IMMUNOLOGY EBV VCA IgM BASE PRICE 2089 2040 2550 PATHOLOGY IMMUNOLOGY ECHINOCOCCUS IgG BASE PRICE 2090 2370 2960 PATHOLOGY IMMUNOLOGY ENA PROFILE* BASE PRICE 2224 5510 6890 PATHOLOGY IMMUNOLOGY FOOD ALLERGY SCREENING PANEL (VEG & NON VEG) BASE PRICE 12926 4460 5580 PATHOLOGY IMMUNOLOGY FOOD ALLERGY SCREENING PANEL (VEG & NON VEG) BASE PRICE 13250 4460 5580 PATHOLOGY IMMUNOLOGY FOOD DETECT BASE PRICE 13012 5250 6560 PATHOLOGY IMMUNOLOGY FOOD INTOLERANCE TEST BASE PRICE 12927 18900 23630 PATHOLOGY IMMUNOLOGY GALACTOMANNAN BASE PRICE 12938 5780 7230 PATHOLOGY IMMUNOLOGY GLUTAMIC ACID DECARBOXYLASE (GAD) IgG ANTIBODIES BASE PRICE 11761 7500 9380 PATHOLOGY IMMUNOLOGY H.PYLORIA ANTIGEN DETECTION BASE PRICE 12102 1270 1590 PATHOLOGY IMMUNOLOGY HAV TOTAL ANTIBODIES BASE PRICE 2091 1440 1800 PATHOLOGY IMMUNOLOGY HAV-IgM** BASE PRICE 2092 1320 1650 PATHOLOGY IMMUNOLOGY HBeAg BASE PRICE 2093 1710 2140 PATHOLOGY IMMUNOLOGY HBsAG (HEPATITIS B SURFACE ANTIGEN)* BASE PRICE 2094 440 550 PATHOLOGY IMMUNOLOGY HDV ANTIBODIES BASE PRICE 2096 2760 3450 PATHOLOGY IMMUNOLOGY HELICOBACTER PYLORI IGA ANTIBODIES BASE PRICE 11777 2980 3730 PATHOLOGY IMMUNOLOGY HELICOBACTER PYLORI IgG ANTIBODIES BASE PRICE 11775 2980 3730 PATHOLOGY IMMUNOLOGY HELICOBACTER PYLORI IgM ANTIBODIES BASE PRICE 11776 2980 3730 PATHOLOGY IMMUNOLOGY HEV IgM* BASE PRICE 2097 1710 2140 PATHOLOGY IMMUNOLOGY HIV DUO ANTIGEN & ANTIBODIES SCREEN* BASE PRICE 2098 500 630 PATHOLOGY IMMUNOLOGY HSV (Herpes Simplex Virus) 1 & 2 IgG & IgM BASE PRICE 8504 2320 2900 PATHOLOGY IMMUNOLOGY HSV 1 IgG BASE PRICE 2099 1000 1250

Page 80 of 115 PATHOLOGY IMMUNOLOGY HSV 1 IgM BASE PRICE 2100 1020 1280 PATHOLOGY IMMUNOLOGY HSV 2 IgG BASE PRICE 2101 1000 1250 PATHOLOGY IMMUNOLOGY HSV 2 IgM BASE PRICE 2102 1020 1280 PATHOLOGY IMMUNOLOGY HSV IgM BASE PRICE 2104 1260 1580 PATHOLOGY IMMUNOLOGY IgE TOTAL* BASE PRICE 2225 1000 1250 PATHOLOGY IMMUNOLOGY INFECTIOUS MONONUCLEOSIS ANTIBODY TEST BASE PRICE 2105 1160 1450 PATHOLOGY IMMUNOLOGY INSULIN ANTIBODIES BASE PRICE 12673 1850 2310 PATHOLOGY IMMUNOLOGY INTRINSIC FACTOR IgG BASE PRICE 2226 2760 3450 PATHOLOGY IMMUNOLOGY ISLET CELL ANTIBODY BASE PRICE 12672 1630 2040 PATHOLOGY IMMUNOLOGY JAPANESE ENCEPHALITIS VIRUS IGM BASE PRICE 2365 1440 1800 PATHOLOGY IMMUNOLOGY LEGIONELLA ANTIGEN BASE PRICE 8556 660 830 PATHOLOGY IMMUNOLOGY LEGIONELLA PNEUMOPHILA IGM (SERUM,EIA) BASE PRICE 12627 5070 6340 PATHOLOGY IMMUNOLOGY LEPTOSPIRA ANTIBODIES (IgG + IgM) BASE PRICE 2106 3030 3790 PATHOLOGY IMMUNOLOGY LEPTOSPIRA IgG BASE PRICE 2107 1540 1930 PATHOLOGY IMMUNOLOGY LEPTOSPIRA IgM BASE PRICE 2108 1540 1930 PATHOLOGY IMMUNOLOGY LYME DISEASE IgG BASE PRICE 12912 2040 2550 PATHOLOGY IMMUNOLOGY LYME DISEASE IgM BASE PRICE 12913 1980 2480 PATHOLOGY IMMUNOLOGY MEASLES IgG BASE PRICE 2109 1930 2410 PATHOLOGY IMMUNOLOGY MEASLES IgM BASE PRICE 2110 1930 2410 PATHOLOGY IMMUNOLOGY MUMPS IgG BASE PRICE 2112 2430 3040 PATHOLOGY IMMUNOLOGY MUMPS IgM BASE PRICE 2113 2430 3040 PATHOLOGY IMMUNOLOGY MYCOPLASAMA-IgM BASE PRICE 2369 2650 3310 PATHOLOGY IMMUNOLOGY MYCOPLASMA PNEUMONIAE IgG BASE PRICE 7378 2650 3310 PATHOLOGY IMMUNOLOGY NEUROCYSTICERCOSIS (NCC) ANTIBODIES BASE PRICE 2114 1980 2480 PATHOLOGY IMMUNOLOGY NMDA PLUS BASE PRICE 12919 16540 20680 PATHOLOGY IMMUNOLOGY NMO Antibodies (Anti Neuromyelitis Optica) BASE PRICE 8505 10140 12680 PATHOLOGY IMMUNOLOGY Parathyroid Hormone Related Peptide (PTHrP) BASE PRICE 8581 25360 31700 PATHOLOGY IMMUNOLOGY Parvovirus B19 IgG Antibodies BASE PRICE 2371 3580 4480 PATHOLOGY IMMUNOLOGY Parvovirus B19 IgM Antibodies BASE PRICE 2370 3580 4480 PATHOLOGY IMMUNOLOGY PCT - PROCALCITONIN* BASE PRICE 2115 2540 3180 PATHOLOGY IMMUNOLOGY PHADIATOP ADULT (ALLERGY SCREENING TEST) BASE PRICE 12909 530 660 PATHOLOGY IMMUNOLOGY PHADIATOP INFANT (ALLERGY SCREENING TEST) BASE PRICE 12908 530 660 PATHOLOGY IMMUNOLOGY QUANTIFERRON TB GOLD (TB Ferron, IGRA)* BASE PRICE 2116 3300 4130 PATHOLOGY IMMUNOLOGY RAPID FILARIA ANTIGEN DETECTION* BASE PRICE 11774 1050 1310 PATHOLOGY IMMUNOLOGY RHINITIS/ASTHMA PANEL-CHILD BASE PRICE 12929 11030 13790 PATHOLOGY IMMUNOLOGY rK 16 / 39 ANTIBODIES (RECOMBINANT)* BASE PRICE 2117 1220 1530 PATHOLOGY IMMUNOLOGY RSV-RESPIRATORY SYNCYTIAL VIRUS IgG BASE PRICE 12935 4200 5250 PATHOLOGY IMMUNOLOGY RSV-RESPIRATORY SYNCYTIAL VIRUS IgM BASE PRICE 12936 3780 4730 PATHOLOGY IMMUNOLOGY RUBELLA IgG BASE PRICE 2118 910 1140 PATHOLOGY IMMUNOLOGY RUBELLA IGG AVIDITY BASE PRICE 12917 1820 2280 PATHOLOGY IMMUNOLOGY RUBELLA IgM BASE PRICE 2119 910 1140 PATHOLOGY IMMUNOLOGY SCRUB TYPHUS ANTIBODY BASE PRICE 12103 1000 1250 PATHOLOGY IMMUNOLOGY TORCH SEROLOGY IgG BASE PRICE 2123 1760 2200 PATHOLOGY IMMUNOLOGY TORCH SEROLOGY IgG + IgM (9 PARAMETERS) BASE PRICE 2124 3090 3860 PATHOLOGY IMMUNOLOGY TORCH SEROLOGY IgM BASE PRICE 2125 1660 2080 PATHOLOGY IMMUNOLOGY TOXOPLASMA IgG BASE PRICE 2126 1000 1250 PATHOLOGY IMMUNOLOGY TOXOPLASMA IgM BASE PRICE 2127 1000 1250 PATHOLOGY IMMUNOLOGY TPHA BASE PRICE 2128 830 1040

Page 81 of 115 PATHOLOGY IMMUNOLOGY TSH RECEPTOR ANTIBODIES BASE PRICE 11807 4130 5160 PATHOLOGY IMMUNOLOGY TYPHOID IgM + IgG* BASE PRICE 2130 580 730 PATHOLOGY IMMUNOLOGY TYPHOID IgM* BASE PRICE 2129 390 490 PATHOLOGY IMMUNOLOGY VARICELLA ZOSTER ANTIBODIES IGG BASE PRICE 8471 2100 2630 PATHOLOGY IMMUNOLOGY VARICELLA ZOSTER ANTIBODIES IgM BASE PRICE 2131 2100 2630 PATHOLOGY IMMUNOLOGY VDRL / RPR* BASE PRICE 2132 190 240 PATHOLOGY IMMUNOLOGY VGKC VOLTAGE GATED POTASSIUM CHANNEL BASE PRICE 11760 14270 17840 PATHOLOGY IMMUNOLOGY VIRAL MARKERS (HEPATITIS B & C)* BASE PRICE 7365 1270 1590 PATHOLOGY IMMUNOLOGY VIRAL MARKERS* BASE PRICE 7359 1770 2210 PATHOLOGY IMMUNOLOGY WESTERN BLOT: HIV -1 ANTIBODIES INDICATES HIV -2 BASE PRICE 8560 3750 4690 PATHOLOGY IMMUNOLOGY WIDAL TEST* BASE PRICE 2133 250 310 PATHOLOGY MICROBIOLOGY AFB CULTURE* BASE PRICE 2039 1660 2080 PATHOLOGY MICROBIOLOGY AFB SMEAR* BASE PRICE 2041 170 210 PATHOLOGY MICROBIOLOGY AIR CULTURE BASE PRICE 2009 270 340 PATHOLOGY MICROBIOLOGY ALBERT'S STAIN FOR DIPHTHERIA* BASE PRICE 2010 270 340 PATHOLOGY MICROBIOLOGY ANAEROBIC BACTERIAL CULTURE* BASE PRICE 2011 660 830 PATHOLOGY MICROBIOLOGY BACTERIAL VAGINOSIS STAINING* BASE PRICE 2012 170 210 PATHOLOGY MICROBIOLOGY BIOLOGICAL INDICATOR (EQAS) BASE PRICE 12972 260 0 PATHOLOGY MICROBIOLOGY BLOOD COMPONENT CULTURE* BASE PRICE 2028 560 700 PATHOLOGY MICROBIOLOGY BLOOD CULTURE SENSITIVITY BACTEC (1 SET)* BASE PRICE 2013 1710 2140 PATHOLOGY MICROBIOLOGY CRYPTOCOCCUS ANTIGEN* BASE PRICE 2029 1930 2410 PATHOLOGY MICROBIOLOGY CULTURE & SENSITIVITY BODY FLUID, BACTEC* BASE PRICE 2014 890 1110 PATHOLOGY MICROBIOLOGY CULTURE & SENSITIVITY, AUTOMATED* BASE PRICE 2015 690 860 PATHOLOGY MICROBIOLOGY CULTURE & SENSITIVITY, PUS* BASE PRICE 2016 1020 1280 PATHOLOGY MICROBIOLOGY ENVIRONMENTAL SAMPLING OT/ICU (24 SWABS, 2 AIR SAMPLES)* BASE PRICE 2049 5510 6890 PATHOLOGY MICROBIOLOGY ENVIRONMENTAL SAMPLING PROCEDURE ROOM 1 (16 SWABS & 1 AIR SAMPLE)*BASE PRICE 2050 3310 4140 PATHOLOGY MICROBIOLOGY ENVIRONMENTAL SAMPLING PROCEDURE ROOM 2 (8 SWABS & 1 AIR SAMPLE)* BASE PRICE 2051 1820 2280 PATHOLOGY MICROBIOLOGY ENVIRONMENTAL SURFACE SWAB* BASE PRICE 2017 220 280 PATHOLOGY MICROBIOLOGY FUNGAL CULTURE* BASE PRICE 2030 660 830 PATHOLOGY MICROBIOLOGY FUNGAL ELEMENTS / SMEAR* BASE PRICE 2031 220 280 PATHOLOGY MICROBIOLOGY GONOCOCCUS CULTURE* BASE PRICE 2018 1020 1280 PATHOLOGY MICROBIOLOGY GONOCOCCUS SMEAR* BASE PRICE 2019 140 180 PATHOLOGY MICROBIOLOGY GRAM'S STAINING* BASE PRICE 2020 170 210 PATHOLOGY MICROBIOLOGY HANGING DROP FOR VIBRIO CHOLERAE* BASE PRICE 2021 140 180 PATHOLOGY MICROBIOLOGY MANTOUX TEST (TUBERCULIN TEST)* BASE PRICE 2043 170 210 PATHOLOGY MICROBIOLOGY MANUAL BLOOD CULTURE* BASE PRICE 2022 560 700 PATHOLOGY MICROBIOLOGY MANUAL CULTURE & SENSITIVITY AEROBIC (OPD)* BASE PRICE 2023 440 550 PATHOLOGY MICROBIOLOGY MIC TESTING FOR RAPIDLY GROWING MYCOBACTERIA BASE PRICE 12172 9510 11890 PATHOLOGY MICROBIOLOGY Modified ZN staining for Nocardia* BASE PRICE 8584 190 240 PATHOLOGY MICROBIOLOGY MRSA SCREEN* BASE PRICE 2024 190 240 PATHOLOGY MICROBIOLOGY MYCOBACTERIA SPECIATION BASE PRICE 12173 2790 3490 PATHOLOGY MICROBIOLOGY NIS : NOSOCOMIAL INFECTION SCREEN* BASE PRICE 2025 320 400 PATHOLOGY MICROBIOLOGY PANCREATIC ELASTASE TEST BASE PRICE 11787 10780 13480 PATHOLOGY MICROBIOLOGY PARASITE IDENTIFICATION* BASE PRICE 8568 250 310 PATHOLOGY MICROBIOLOGY PNEUMOCYSTIS GMS STAINING* BASE PRICE 2033 390 490 PATHOLOGY MICROBIOLOGY ROTA VIRUS ANTIGEN DETECTION, STOOL BASE PRICE 11850 1520 1900 PATHOLOGY MICROBIOLOGY SINGLE BLOOD CULTURE, BACTEC* BASE PRICE 11516 930 1160 PATHOLOGY MICROBIOLOGY STOOL EXAMINATION EXTENDED* BASE PRICE 2034 390 490

Page 82 of 115 PATHOLOGY MICROBIOLOGY STOOL EXAMINATION ROUTINE* BASE PRICE 2035 250 310 PATHOLOGY MICROBIOLOGY STOOL FAT* BASE PRICE 2036 70 90 PATHOLOGY MICROBIOLOGY STOOL OCCULT BLOOD (SINGLE SAMPLE)* BASE PRICE 2038 150 190 PATHOLOGY MICROBIOLOGY TUBERCULOSIS SUSCEPTIBILITY - SIRE* BASE PRICE 2044 5390 6740 PATHOLOGY MICROBIOLOGY TUBERCULOSIS SUSCEPTIBILITY - SIREP BASE PRICE 2045 5830 7290 PATHOLOGY MICROBIOLOGY TUBERCULOSIS SUSCEPTIBILITY -10 DRUGS BASE PRICE 2046 10020 12530 PATHOLOGY MICROBIOLOGY TUBERCULOSIS SUSCEPTIBILITY -15 DRUGS BASE PRICE 8499 19220 24030 PATHOLOGY MICROBIOLOGY TUBERCULOSIS SUSCEPTIBILITY -5 DRUGS BASE PRICE 2047 6470 8090 PATHOLOGY MICROBIOLOGY TUBERCULOSIS SUSCEPTIBILITY -SINGLE DRUG BASE PRICE 2048 2790 3490 PATHOLOGY MICROBIOLOGY TYPHOID VACCINATION BASE PRICE 12170 80 100 PATHOLOGY MICROBIOLOGY TZANCK SMEAR* BASE PRICE 8573 140 180 PATHOLOGY MICROBIOLOGY WATER : PRESUMPTIVE COLIFORM COUNT* BASE PRICE 2027 390 490 PATHOLOGY MICROBIOLOGY YEAST SUSCEPTIBILITY* BASE PRICE 2032 4690 5860 PATHOLOGY MOLECULAR PATHOLOGY ADENO VIRUS PCR* BASE PRICE 11645 4130 5160 PATHOLOGY MOLECULAR PATHOLOGY AML ETO t(8;21) , PCR(QUALITATIVE) BASE PRICE 13014 4410 5510 PATHOLOGY MOLECULAR PATHOLOGY BCR-ABL 1 KINASE DOMAIN MUTATION ANALYSIS BASE PRICE 8545 10780 13480 PATHOLOGY MOLECULAR PATHOLOGY BCR/abl QUALITATIVE BASE PRICE 2065 7540 9430 PATHOLOGY MOLECULAR PATHOLOGY BK VIRUS, PCR, QUALITATIVE BASE PRICE 13048 4100 5130 PATHOLOGY MOLECULAR PATHOLOGY C-KIT MUTATION BASE PRICE 12499 4410 5510 PATHOLOGY MOLECULAR PATHOLOGY C. DIPTHERIA TOXIN A&B BY PCR BASE PRICE 12662 4970 6210 PATHOLOGY MOLECULAR PATHOLOGY CHROMOSOME INTERPHASE PROFILING, PRODUCT OF CONCEPTION BASE PRICE 12676 13230 16540 PATHOLOGY MOLECULAR PATHOLOGY CLL PANEL BY FISH BASE PRICE 12678 7610 9510 PATHOLOGY MOLECULAR PATHOLOGY CLOSTRIDIUM DIFFICILE-RTPCR BASE PRICE 12807 3310 4140 PATHOLOGY MOLECULAR PATHOLOGY CYSTIC FIBROSIS DELTA F508 GENE MUTATION BASE PRICE 11872 15210 19010 PATHOLOGY MOLECULAR PATHOLOGY CYTOMEGALOVIRUS DNA PCR (QUALITATIVE) BASE PRICE 2052 4380 5480 PATHOLOGY MOLECULAR PATHOLOGY CYTOMEGALOVIRUS DNA RQ - PCR (QUANTITATIVE) BASE PRICE 2053 6660 8330 PATHOLOGY MOLECULAR PATHOLOGY DENGUE RNA PCR BASE PRICE 12637 3580 4480 PATHOLOGY MOLECULAR PATHOLOGY EBV DNA PCR BASE PRICE 2067 3430 4290 PATHOLOGY MOLECULAR PATHOLOGY EGFR GENE AMPLIFICATION BY FISH BASE PRICE 12915 8050 10060 PATHOLOGY MOLECULAR PATHOLOGY ETV6-NTRK3 (COE) BY RT-PCR BASE PRICE 12934 5990 7490 PATHOLOGY MOLECULAR PATHOLOGY FACTOR V MUTATION DETECTION* BASE PRICE 8482 6050 7560 PATHOLOGY MOLECULAR PATHOLOGY FIP1L1-PDGFRA GENE REARRANGEMENT BASE PRICE 11762 6780 8480 PATHOLOGY MOLECULAR PATHOLOGY FISH-FOLLICULAR LYMPHOMA (IGH/BCL2) t(14:18) BASE PRICE 12693 7170 8960 PATHOLOGY MOLECULAR PATHOLOGY FISH-t(11:14) OR LSI IGH/CCNDI BASE PRICE 12692 4850 6060 PATHOLOGY MOLECULAR PATHOLOGY FLT3 MUTATION DETECTION BASE PRICE 8497 4820 6030 PATHOLOGY MOLECULAR PATHOLOGY FLU REAL TIME PCR (H1N1) BASE PRICE 2070 6660 8330 PATHOLOGY MOLECULAR PATHOLOGY FOOD ALLERGY SCREENING PANEL (VEG & NON VEG) BASE PRICE 12925 4460 5580 PATHOLOGY MOLECULAR PATHOLOGY FOOD INTOLERANCE TEST BASE PRICE 12924 19850 24810 PATHOLOGY MOLECULAR PATHOLOGY GENE XPERT BASE PRICE 11510 2430 3040 PATHOLOGY MOLECULAR PATHOLOGY GENEXPERT PLUS BASE PRICE 12490 2760 3450 PATHOLOGY MOLECULAR PATHOLOGY HBV DRUG RESISTANCE BASE PRICE 11621 7350 9190 PATHOLOGY MOLECULAR PATHOLOGY HBV GENOTYPING BASE PRICE 2054 7300 9130 PATHOLOGY MOLECULAR PATHOLOGY HBV-DNA (VIRAL LOAD) BY RQ-PCR BASE PRICE 2056 8810 11010 PATHOLOGY MOLECULAR PATHOLOGY HBV-DNA DETECTION (QUALITATIVE) BASE PRICE 2055 4880 6100 PATHOLOGY MOLECULAR PATHOLOGY HCV (VIRAL LOAD) QUANTITATIVE - REAL TIME PCR BASE PRICE 2057 9510 11890 PATHOLOGY MOLECULAR PATHOLOGY HCV ALPHA (HCV RNA QUANTITATIVE AND HCV GENOTYPING) BASE PRICE 12492 16540 20680 PATHOLOGY MOLECULAR PATHOLOGY HCV GENOTYPING BASE PRICE 2058 15090 18860 PATHOLOGY MOLECULAR PATHOLOGY HCV-RNA DETECTION (QUALITATIVE) BASE PRICE 2059 4880 6100

Page 83 of 115 PATHOLOGY MOLECULAR PATHOLOGY HFE GENE MUTATIONS BASE PRICE 12383 7720 9650 PATHOLOGY MOLECULAR PATHOLOGY HIV-1 DNA PCR BASE PRICE 2060 3490 4360 PATHOLOGY MOLECULAR PATHOLOGY HIV-1 RNA DETECTION, QUANTITATIVE BASE PRICE 2061 6090 7610 PATHOLOGY MOLECULAR PATHOLOGY HLA B27 BY PCR BASE PRICE 8365 3490 4360 PATHOLOGY MOLECULAR PATHOLOGY HLA DNA TYPING HIGH RESOLUTION BY NGS BASE PRICE 12923 14330 17910 PATHOLOGY MOLECULAR PATHOLOGY HPV DUO BASE PRICE 2069 2670 3340 PATHOLOGY MOLECULAR PATHOLOGY HPV E6/E7 mRNA TEST BASE PRICE 12228 3740 4680 PATHOLOGY MOLECULAR PATHOLOGY HPV TYPING BY SEQUENCING BASE PRICE 8451 2160 2700 PATHOLOGY MOLECULAR PATHOLOGY HSV 1 AND 2 BY PCR BASE PRICE 2062 4130 5160 PATHOLOGY MOLECULAR PATHOLOGY IMMUNOHISTOCHEMISTRY FOR SINGLE MARKER BASE PRICE 12677 3310 4140 PATHOLOGY MOLECULAR PATHOLOGY INTERPHASE CHROMOSOME PROFILING ,POC (ICP-POC) BASE PRICE 12628 11030 13790 PATHOLOGY MOLECULAR PATHOLOGY JAK2 EXON 12 MUTATION BASE PRICE 2066 6910 8640 PATHOLOGY MOLECULAR PATHOLOGY JAK2 V617F MUTATION DETECTION BASE PRICE 8470 6980 8730 PATHOLOGY MOLECULAR PATHOLOGY JAPANESE ENCEPHALITIS VIRUS RNA DETECTION (CSF) BASE PRICE 12232 5390 6740 PATHOLOGY MOLECULAR PATHOLOGY LEUKAEMIA TRANSLOCATION PANEL 4 BASE PRICE 8661 6850 8560 PATHOLOGY MOLECULAR PATHOLOGY MATERNAL BLOOD FOR FETAL DNA BASE PRICE 12626 27560 34450 PATHOLOGY MOLECULAR PATHOLOGY MDS Panel by FISH BASE PRICE 11515 10460 13080 PATHOLOGY MOLECULAR PATHOLOGY MPN REFLEX PANEL BASE PRICE 12643 17090 21360 PATHOLOGY MOLECULAR PATHOLOGY MULTIPLE MYELOMA PANEL (BY FISH) BASE PRICE 12937 14180 17730 PATHOLOGY MOLECULAR PATHOLOGY MYCOBACTERIUM LEPRAE POLYMERASE CHAIN REACTION BASE PRICE 12302 3990 4990 PATHOLOGY MOLECULAR PATHOLOGY NPM1 MUTATION DETECTION BASE PRICE 8498 3490 4360 PATHOLOGY MOLECULAR PATHOLOGY O6-METHYLGUANINE METHYLTRANSFERASE (MGMT) PROMOTER BASE PRICE 12675 7170 8960 PATHOLOGY MOLECULAR PATHOLOGY PAN-NEUROTROPIC VIRUS PANEL BASE PRICE 12243 5580 6980 PATHOLOGY MOLECULAR PATHOLOGY PEDIATRIC SCREENING PANEL (ALL 42 PARAMETERS) BASE PRICE 12911 5410 6760 PATHOLOGY MOLECULAR PATHOLOGY Phiadelphia Chromosome (BCR - abl t(9:22)) BASE PRICE 8472 5960 7450 PATHOLOGY MOLECULAR PATHOLOGY PML Ra Ra Gene Rearrangement,Qualitative BASE PRICE 2068 5580 6980 PATHOLOGY MOLECULAR PATHOLOGY PML RA RA T (15:17), QUANTITATIVE BASE PRICE 7375 5900 7380 PATHOLOGY MOLECULAR PATHOLOGY PML RA RAT(15:17) BY FISH BASE PRICE 12806 6620 8280 PATHOLOGY MOLECULAR PATHOLOGY PV JAK2 REFLEX PANEL BASE PRICE 12644 7720 9650 PATHOLOGY MOLECULAR PATHOLOGY RESPIRATORY COMPREHENSIVE PANEL BASE PRICE 12663 16540 20680 PATHOLOGY MOLECULAR PATHOLOGY SEPSI SCREEN BASE PRICE 12374 17330 21660 PATHOLOGY MOLECULAR PATHOLOGY SPINAL MUSCULAR ATROPHY MICRODELETION PCR BASE PRICE 11744 2420 3030 PATHOLOGY MOLECULAR PATHOLOGY TB RAPID GENOTYPIC TEST (HAINS MDR TB) BASE PRICE 11769 2320 2900 PATHOLOGY MOLECULAR PATHOLOGY TB SECOND LINE DRUG, GENOTYPIC ASSAY (HAINS MDR TB) BASE PRICE 11778 7610 9510 PATHOLOGY MOLECULAR PATHOLOGY TORCH PCR BASE PRICE 8486 6340 7930 PATHOLOGY MOLECULAR PATHOLOGY TUBERCULOSIS (MYCOBACTERIUM TUBERCULOSIS) BY PCR BASE PRICE 2063 2670 3340 PHYSIOTHERAPY PHYSIOTHERAPY ANTENATAL EXERCISE PER SITTING BASE PRICE 6565 360 0 PHYSIOTHERAPY PHYSIOTHERAPY BREATHING EXERCISES & POSTURAL DRAINAGE BASE PRICE 6578 360 0 PHYSIOTHERAPY PHYSIOTHERAPY CERVICAL TRACTION BASE PRICE 6553 240 0 PHYSIOTHERAPY PHYSIOTHERAPY CHEST PHYSIOTHERAPY BASE PRICE 6566 310 0 PHYSIOTHERAPY PHYSIOTHERAPY COLD PACK / CRYOTHERAPY (SINGLE) BASE PRICE 6582 240 0 PHYSIOTHERAPY PHYSIOTHERAPY COMBINED LUMBAR & CERVICAL TRACTION BASE PRICE 6579 480 0 PHYSIOTHERAPY PHYSIOTHERAPY ELECTRIC VIBRATOR BASE PRICE 6567 240 0 PHYSIOTHERAPY PHYSIOTHERAPY ELECTRICAL MUSCLE TESTING (MULTIPLE) BASE PRICE 6580 360 0 PHYSIOTHERAPY PHYSIOTHERAPY ELECTRICAL MUSCLE TESTING (SINGLE) BASE PRICE 6575 240 0 PHYSIOTHERAPY PHYSIOTHERAPY EXERCISE THERAPY: GENERAL BASE PRICE 6550 190 0 PHYSIOTHERAPY PHYSIOTHERAPY EXERCISE THERAPY: SPECIFIC BASE PRICE 6551 240 0 PHYSIOTHERAPY PHYSIOTHERAPY EXTENSIVE EXERCISE (STRENGTHENING) / LIMB PHYSIOTHERAPY BASE PRICE 6576 360 0

Page 84 of 115 PHYSIOTHERAPY PHYSIOTHERAPY GAIT TRAINING BASE PRICE 6568 360 0 PHYSIOTHERAPY PHYSIOTHERAPY HANDS-ON' MANUAL THERAPY / NEURO DEVELOPMENTAL TECH. BASE PRICE 6552 430 0 PHYSIOTHERAPY PHYSIOTHERAPY HOT-PACK / THERMOTHERAPY (SINGLE) BASE PRICE 6562 240 0 PHYSIOTHERAPY PHYSIOTHERAPY INFRARED THERAPY BASE PRICE 6557 240 0 PHYSIOTHERAPY PHYSIOTHERAPY LUMBAR TRACTION BASE PRICE 6554 240 0 PHYSIOTHERAPY PHYSIOTHERAPY M.M.T (SINGLE) BASE PRICE 11818 360 0 PHYSIOTHERAPY PHYSIOTHERAPY MANUAL MUSCLE TESTING (SINGLE) BASE PRICE 6571 240 0 PHYSIOTHERAPY PHYSIOTHERAPY MOBILIZATION EXERCISE BASE PRICE 6569 360 0 PHYSIOTHERAPY PHYSIOTHERAPY MUSCLE TESTING & DIAGNOSTIC BASE PRICE 6570 360 0 PHYSIOTHERAPY PHYSIOTHERAPY NEURO-MUSCULAR STIMULATION BASE PRICE 6581 430 0 PHYSIOTHERAPY PHYSIOTHERAPY OBSITY EXERCISE BASE PRICE 6577 360 0 PHYSIOTHERAPY PHYSIOTHERAPY PHYSIOTHERAPY - PER SITTING BASE PRICE 6563 430 0 PHYSIOTHERAPY PHYSIOTHERAPY PHYSIOTHERAPY CONSULTATION FEE BASE PRICE 6564 360 0 PHYSIOTHERAPY PHYSIOTHERAPY PHYSIOTHERAPY CONSULTATION FEE EMERGENCY BASE PRICE 12629 400 0 PHYSIOTHERAPY PHYSIOTHERAPY PHYSIOTHERAPY PROCEDURE CHARGE (SUITE ROOM) BASE PRICE 11819 610 0 PHYSIOTHERAPY PHYSIOTHERAPY PHYSIOTHERAPY procedure CHARGES (CRITICAL CARE/PVT. WD.) BASE PRICE 8493 430 0 PHYSIOTHERAPY PHYSIOTHERAPY PHYSIOTHERAPY PROCEDURE CHARGES (GEN) BASE PRICE 8494 240 0 PHYSIOTHERAPY PHYSIOTHERAPY POST OP CHEST PHYSIOTHERAPY BASE PRICE 6574 360 0 PHYSIOTHERAPY PHYSIOTHERAPY POST-POLIO EXERCISE BASE PRICE 6572 360 0 PHYSIOTHERAPY PHYSIOTHERAPY POSTNATAL EXERCISE (SINGLE) BASE PRICE 6573 360 0 PHYSIOTHERAPY PHYSIOTHERAPY POSTURAL DRAINAGE TECHNIQUES BASE PRICE 6560 240 0 PHYSIOTHERAPY PHYSIOTHERAPY SHORT WAVE DIATHERMY BASE PRICE 6558 240 0 PHYSIOTHERAPY PHYSIOTHERAPY STIMULATION OF NERVES & MUSCLES (THERAPEUTIC-T.E.N.S. / STIMULATOR / I.F.T.)BASE PRICE 6556 360 0 PHYSIOTHERAPY PHYSIOTHERAPY TILT TABLE EXERCISE TRAINING BASE PRICE 6559 240 0 PHYSIOTHERAPY PHYSIOTHERAPY ULTRA SONIC THERAPY BASE PRICE 6561 240 0 PHYSIOTHERAPY PHYSIOTHERAPY WAX (PARAFFIN) THERAPY BASE PRICE 6555 240 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PACKAGESHAIR REMOVAL - ARM - EACH COMPLETE BASE PRICE 11589 12710 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PACKAGESHAIR REMOVAL - ARM - EACH PARTIAL BASE PRICE 11590 19060 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PACKAGESHAIR REMOVAL - FACE FULL BASE PRICE 11588 31770 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PACKAGESHAIR REMOVAL - FACE LARGE BASE PRICE 11587 19060 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PACKAGESHAIR REMOVAL - FACE MEDIUM BASE PRICE 11586 12710 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PACKAGESHAIR REMOVAL - LEGS (EACH) LARGE BASE PRICE 11591 76230 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PACKAGESHAIR REMOVAL - LEGS (EACH) MEDIUM BASE PRICE 11592 44470 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PACKAGESHAIR REMOVAL - LEGS (EACH) SMALL BASE PRICE 11593 19060 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PACKAGESHAIR RESTORATION: MILD BALDNESS (GRADE I) BASE PRICE 8477 53360 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PACKAGESHAIR RESTORATION: MODERATE BALDNESS (GRADE II) BASE PRICE 8478 106720 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PACKAGESHAIR RESTORATION: SEVER BALDNESS (GRADE III) BASE PRICE 8479 158820 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PACKAGESHAIR TRANSPLANT MAJOR BASE PRICE 12420 203280 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PACKAGESHAIR TRANSPLANT MINOR BASE PRICE 12421 127050 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PACKAGESSKIN REJUVENATION - FACE LARGE BASE PRICE 11567 25410 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PACKAGESSKIN REJUVENATION - FACE MEDIUM BASE PRICE 11568 19060 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PACKAGESSKIN REJUVENATION - FACE SMALL BASE PRICE 11569 12710 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PACKAGESSKIN REJUVENATION - FACE VERY LARGE BASE PRICE 11565 38120 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PACKAGESTATTOO REMOVAL - EXTENSIVE BASE PRICE 11573 44470 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PACKAGESTATTOO REMOVAL - LARGE BASE PRICE 11572 31770 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PACKAGESTATTOO REMOVAL - MEDIUM BASE PRICE 11571 19060 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PACKAGESTATTOO REMOVAL - SMALL BASE PRICE 11570 12710 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESDRESSING – SERVICE CHARGES (LARGE) BASE PRICE 6602 810 0

Page 85 of 115 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESDRESSING – SERVICE CHARGES (MEDIUM) BASE PRICE 6601 350 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESDRESSING – SERVICE CHARGES (SMALL) BASE PRICE 6600 170 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESEXTENSIVE SCAR BASE PRICE 11530 31770 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESFACE & NECK COMBINATION BASE PRICE 11526 127050 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESFACIAL RESURFACING - LARGE BASE PRICE 11519 63530 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESFACIAL RESURFACING - MEDIUM BASE PRICE 11518 38120 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESFACIAL RESURFACING - SMALL BASE PRICE 11517 12710 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESFACIAL WRINKLES - MINIMUM BASE PRICE 11520 19060 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESFACIAL WRINKLES - MODERATE BASE PRICE 11521 31770 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESFACIAL WRINKLES - SEVERE BASE PRICE 11522 76230 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESHAIR REMOVAL - ABDOMEN COMPLETE BASE PRICE 11557 19060 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESHAIR REMOVAL - ABDOMEN PARTIAL BASE PRICE 11556 6360 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESHAIR REMOVAL - ARM COMPLETE BASE PRICE 11553 10160 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESHAIR REMOVAL - ARM PARTIAL BASE PRICE 11552 5080 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESHAIR REMOVAL - ARM PIT BASE PRICE 11551 6360 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESHAIR REMOVAL - BACK COMPLETE BASE PRICE 11555 19060 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESHAIR REMOVAL - BACK PARTIAL BASE PRICE 11554 6360 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESHAIR REMOVAL - FACE SMALL BASE PRICE 11538 9530 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESHAIR REMOVAL - FULL FACE BASE PRICE 11550 5080 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESHAIR REMOVAL - LARGE AREA BASE PRICE 11549 3820 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESHAIR REMOVAL - LEG LARGE BASE PRICE 11558 12710 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESHAIR REMOVAL - LEG MEDIUM BASE PRICE 11559 8900 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESHAIR REMOVAL - LEG SMALL BASE PRICE 11560 3820 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESHAIR REMOVAL - MEDIUM AREA BASE PRICE 11548 2540 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESHAIR REMOVAL - PER SHOT BASE PRICE 11537 640 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESHAIR REMOVAL - SMALL AREA BASE PRICE 11547 1280 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESMAJOR DRESSING > 50 % BASE PRICE 6605 2540 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESMINOR DRESSING (15% TO 30%) BASE PRICE 6603 640 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESMODERATE DRESSING (30% TO 50%) BASE PRICE 6604 1900 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESNECK WRINKLES - MINIMUM BASE PRICE 11523 6360 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESNECK WRINKLES - MODERATE BASE PRICE 11524 19060 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESNECK WRINKLES - SEVERE BASE PRICE 11525 38120 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESPIGMENTED LESION - LARGE BASE PRICE 11584 8900 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESPIGMENTED LESION - MEDIUM BASE PRICE 11583 5080 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESPIGMENTED LESION - SMALL BASE PRICE 11582 2540 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESPIGMENTED LESION - VERY LARGE BASE PRICE 11585 12710 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESQ - SWITCH PER SHOT BASE PRICE 11561 510 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESRHINOPHYEMA BASE PRICE 11531 25410 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESSCAR - LARGE BASE PRICE 11529 19060 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESSCAR - MEDIUM BASE PRICE 11528 6360 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESSCAR - SMALL BASE PRICE 11527 1280 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESSINGLE SHOT - CO2 BASE PRICE 11532 1280 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESSKIN REJUVENATION - FACE LARGE BASE PRICE 11564 5080 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESSKIN REJUVENATION - FACE MEDIUM BASE PRICE 11563 3820 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESSKIN REJUVENATION - FACE SMALL BASE PRICE 11562 2540 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESSKIN REJUVENATION - FACE VERY LARGE BASE PRICE 11566 6360 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESTATTOO REMOVAL - EXTENSIVE BASE PRICE 11577 12710 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESTATTOO REMOVAL - LARGE BASE PRICE 11576 6360 0

Page 86 of 115 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESTATTOO REMOVAL - MEDIUM BASE PRICE 11575 3820 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESTATTOO REMOVAL - SMALL BASE PRICE 11574 2540 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESTUMOR EXCISION - EXTENSIVE BASE PRICE 11536 31770 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESTUMOR EXCISION - LARGE BASE PRICE 11535 12710 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESTUMOR EXCISION - MEDIUM BASE PRICE 11534 6360 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESTUMOR EXCISION - SMALL BASE PRICE 11533 2540 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESVASCULAR MALFORMATION - LARGE BASE PRICE 11580 8900 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESVASCULAR MALFORMATION - MEDIUM BASE PRICE 11579 5080 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESVASCULAR MALFORMATION - SMALL BASE PRICE 11578 2540 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY PROCEDURESVASCULAR MALFORMATION - VERY LARGE BASE PRICE 11581 12710 0 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYA.V.FISTULA BASE PRICE 6722 12130 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYABDOMINAL FLAP BASE PRICE 6823 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYABDOMINAL FLAP : 1ST STAGE BASE PRICE 6765 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYABDOMINAL FLAP : 2ND STAGE BASE PRICE 6664 8490 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYABDOMINAL FLAP : 3RD STAGE BASE PRICE 6665 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYABDOMINAL LIPECTOMY BASE PRICE 6891 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYABDOMINOPLASTY (MINI) BASE PRICE 7036 24260 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYABDOMINOPLASTY + HERNIOPLASTY BASE PRICE 6949 30320 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYABDOMINOPLASTY + LIPOSUCTION (MAJOR) BASE PRICE 6971 60640 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYADVANCEMENT FLAPS BASE PRICE 6771 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYALAE CORRECTION- MAJOR BASE PRICE 6783 14550 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYALAE CORRECTION- MINOR BASE PRICE 6681 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYALEOLAR BONE GRAFTING BASE PRICE 7007 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYAMPUTATION (EACH FINGER) - SUTURING BASE PRICE 6624 3640 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYAMPUTATION (EACH FINGER)-S.S.G. BASE PRICE 6650 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYAMPUTATION(EACH FINGER)-FLAP COVER (V-Y) BASE PRICE 6648 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYAMPUTATION(EACH FINGER)-REVISION BASE PRICE 6649 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYAMUPUTATION(EACH FINGER)-FLAP COVER(CFF) BASE PRICE 6647 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYAMUTATION(EACH FINGER)-FLAP COVER(DISTANT) BASE PRICE 6746 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYARTHRODESIS (EACH FINGER JOINT) BASE PRICE 6713 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYAUGMENTATION & MAMOPLASTY B/L BASE PRICE 6973 60640 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYAUGMENTATION CHIN BASE PRICE 6862 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYAUGMENTATION MALAR EMINAMCE BASE PRICE 6863 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYAUGMENTATION RHINOPLASTY W BONE/CARTILAGE GRAFT- MAJOR BASE PRICE 6849 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYAUGMENTATION RHINOPLASY- SILASTIC BASE PRICE 6848 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYAUGMENTATION RHINPOPLASTY W BONE/CARTILAGE GRAFT- MINOR BASE PRICE 6799 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYAVULSED SCALP REPLANTATION BASE PRICE 6955 36380 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYBED SORE (MYOCUTANEOUS FLAP) BASE PRICE 6835 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYBIFID THUMB (SIMPLE) BASE PRICE 6983 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYBLEPHAROPLASTY BASE PRICE 6847 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYBLOW OUT FRACTURE ORBIT BASE PRICE 6858 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYBONE GRAFTING FOR JAW BASE PRICE 6808 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYBRACHIAL PLEXUS EXPLORATION & REPAIR BASE PRICE 6961 36380 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYBRACHIAL PLEXUS SURGERY ( MAJOR) BASE PRICE 6962 48510 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYBRACHIAL PLEXUS SURGERY MAJOR RS 75000/- BASE PRICE 12778 82690 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYBROW LIFT BASE PRICE 6864 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYBUTTOCK AUGMENTATION BASE PRICE 6976 72770 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCALVARIAL DRILLING/CHIESELING BASE PRICE 6673 9090 25

Page 87 of 115 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCALVARIAL GRAFTING BASE PRICE 6674 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCAMPODACTYLY CORRECTION BASE PRICE 6747 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCAMSULATOMY(EACH) BASE PRICE 6698 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCANCER SKIN/FACE-RESECTION(EXTENSIVE GRAFTING) BASE PRICE 6888 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCANTHOPLASTY BASE PRICE 6632 3640 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCAP SPLINTING BASE PRICE 6714 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCARPAL BONE STABILISATION-MAJOR BASE PRICE 6815 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCARPAL BONE STABILISATION-MINOR BASE PRICE 6748 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCARPAL TUNNEL SYNDOME BASE PRICE 6699 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCARTILAGE GRAFTING BASE PRICE 6731 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCARTILAGE RECONSTRUCTION BASE PRICE 6677 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCLEFT LIP REPAIR – UNILATERAL- COMPLETE BASE PRICE 6773 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCLEFT LIP REPAIR BILATERAL – COMPLETE BASE PRICE 6772 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCLEFT LIP REPAIR BILATERAL – INCOMPLETE BASE PRICE 6734 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCLEFT LIP REPAIR UNILATERAL – INCOMPLETE BASE PRICE 6735 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCLEFT PALATE COMPLETE REPAIR BASE PRICE 6774 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCLEFT PALATE INCOMPLETE REPAIR BASE PRICE 6775 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCLINDACTYLY CORRECTION BASE PRICE 6749 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCLOSURE OF PALATAL FISTULA BASE PRICE 6736 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCLOSURE OF PALATAL FISTULA WITH TONGUE/CHEEK FLAP EACH STAGE BASE PRICE 6688 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCLOSURE OF URETHRAL FISTULA BASE PRICE 6697 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCOLUMELLA LENGTHENING BASE PRICE 6680 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCOMPOSITE GRAFTING BASE PRICE 6757 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCONG.FLEXION DEFORMITY-MAJOR BASE PRICE 6750 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCONG.FLEXION DEFORMITY-MINOR BASE PRICE 6651 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCONG.SINUSES/FIST./CYSTS/EXC. RECONSTRUCTION-MAJOR BASE PRICE 6816 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCONG.SINUSES/FIST./CYSTS/EXC.RECONSTRUCTION-MINOR BASE PRICE 6652 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCONGENITAL CLEF FACE – RECONSTRUCTION – MAJOR BASE PRICE 6912 24260 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCONGENITAL CLEF FACE – RECONSTRUCTION – MINOR BASE PRICE 6742 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCONSTRACTURE RELEASE NECK-FLAP COVER(FREE) BASE PRICE 6942 30320 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCONSTRACTURES RELEASE&GRAFTING-LARGE AREA BASE PRICE 6827 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCONSTRCTURE RELEASE LARGE AREA COVER-LARGE BASE PRICE 6884 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCONSTRCTURE RELEASE LARGE AREA FLAP COVER-EXTENSIVE BASE PRICE 6826 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCONSTRCTURE RELEASE LARGE AREA FLAP COVER-SMALL BASE PRICE 6758 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCONTOURING NECK SKIN BASE PRICE 6865 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCONTRACTURE OF NECK RELEASE&S.S.G. BASE PRICE 6825 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCONTRACTURE RELEASE - MULTIPLE FINGERS/EXTENSIVE BASE PRICE 7023 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCONTRACTURE RELEASE LARGE AREA FLAP COVER-LARGE BASE PRICE 6883 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCONTRACTURE RELEASE NECK-FLAP COVER(LOCAL) BASE PRICE 6885 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCONTRACTURE RELEASE&SKIN GRAFTING(EACH) BASE PRICE 6653 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCONTRACTURES - ONE FINGER/ TOE/ MINOR BASE PRICE 7024 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCONTRACTURES RELEASE&GRAFTING-SMALL AREA BASE PRICE 6759 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCORECTION MALLET FINGER-CONSERVATIVE BASE PRICE 6612 2430 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCORRECTION LYMPHOEDEMA - MINOR BASE PRICE 6836 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCORRECTION LYMPHOEDEMA – MAJOR BASE PRICE 6943 30320 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCORRECTION MALLET FINGER-SURGICAL BASE PRICE 6700 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCORRECTION WITH LOCAL FLAP BASE PRICE 6672 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCORRECTION WITH MICROVASCULAR FLAP BASE PRICE 6925 30320 25

Page 88 of 115 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCORRECTION WITH TISSUE EXPANDER – I STAGE BASE PRICE 6797 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCORRECTION WITH TISSUE EXPANDER – II STAGE BASE PRICE 6846 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCORRECTIVE OSTEOTOMIE EACH FINGER BASE PRICE 6715 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCORRECTIVE SEPTO RHINOPLASTY BASE PRICE 6850 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCORRECTIVE SEPTOPLASTY BASE PRICE 6782 14550 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCRANIOFACIAL RESECTION BASE PRICE 6930 30320 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCRANIOPLASTY BASE PRICE 6956 36380 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCROSS LEG / CROSS ARM BASE PRICE 6882 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCROSS- FINGER FLAP/OTHER FLAP BASE PRICE 6817 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCURETTAGE & SAUCERISATION BASE PRICE 6666 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYCYST & BENIGN TUMOUR OF PALATE BASE PRICE 7022 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYD&S BADLY MULTILATED HAND-EACH STAGE BASE PRICE 6751 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYD&S FINGER INJURIES WITH FRACTURE(EACH) BASE PRICE 6654 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYDEBRIDEMENT – MEDIUM BASE PRICE 7040 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYDEBRIDEMENT – MINOR BASE PRICE 6607 2430 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYDEBRIDEMNT – MAJOR UNDER G.A. BASE PRICE 6634 3640 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYDEBRIDMENT LARGE BASE PRICE 6999 14550 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYDEEPENING CONTRACTED SOCKET BASE PRICE 6636 3640 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYDELAYED PRIMARY SUTURING BASE PRICE 7028 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYDENTAL CYST EXCISION BASE PRICE 6998 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYDENTAL CYST EXCISION & BONE GRAFTING BASE PRICE 7039 24260 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYDENTAL CYST EXCISION AND RECONSTRUCTION OF JAW WITH FIBULA BASE PRICE 7026 48510 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYDERMABRASION – MAJOR BASE PRICE 6866 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYDERMABRASION FULL FACE BASE PRICE 6986 36380 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYDERMABRASION- MINOR BASE PRICE 6809 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYDERMAFAT/MUSCLE GRAFT BASE PRICE 6810 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYDERMOFAT GRAFT (LARGE) BASE PRICE 6996 36380 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYDERMOFAT GRAFT (SMALL) BASE PRICE 6997 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYDIABETIC FOOT DEBRIDMENT - LARGE BASE PRICE 7010 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYDIABETIC FOOT DEBRIDMENT - MEDIUM BASE PRICE 7009 3640 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYDIABETIC FOOT DEBRIDMENT - SMALL BASE PRICE 7008 2430 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYDIVISION OF SKIN FLAP BASE PRICE 6630 3640 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYDRAINAGE OF ABSCESS BASE PRICE 6694 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYDUPUTYREN'S CONSTRAXTURE-MINOR BASE PRICE 6818 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYDUPUYTERN'CONSTRACTURE-MAJOR BASE PRICE 6875 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEAR INJURY – MAJOR SUTURING BASE PRICE 6801 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEAR INJURY – MINOR SUTURING BASE PRICE 6610 2430 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEAR INJURY – MODERATE SUTURING BASE PRICE 6682 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEAR KELOID EXCISION/RECONSTRUCTION- MINOR BASE PRICE 6686 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEAR KELOID EXCISON/ RECONSTRUCTION- MAJOR BASE PRICE 6733 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEAR RECONSTRUCTION - STAGE I BASE PRICE 7017 14550 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEAR RECONSTRUCTION - STAGE II BASE PRICE 7018 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEAR RECONSTRUCTION - STAGE III BASE PRICE 7019 21830 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEAR RECONSTRUCTION RS 75000/- BASE PRICE 12780 82690 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYECTROPION / ENTROPION BASE PRICE 7021 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYECTROPION RELEASE & SKIN GRAFTING (EACH EYE LID) BASE PRICE 6637 3640 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYENDOSCOPIC BROW LIFT BASE PRICE 6994 30320 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYENDOSCOPIC FACE LIFT BASE PRICE 6993 60640 25

Page 89 of 115 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEPISPADIAS WITH GENITELIA RECONSTRUCTION BASE PRICE 6995 48510 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYESCHARECTOMY – MAJOR UNDER G.A. BASE PRICE 6633 3640 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYESCHARECTOMY – MINOR BASE PRICE 6606 2430 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEXCISION / CAUTERIZATION OF BENIGN GROWTH – SMALL BASE PRICE 6615 2430 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEXCISION / CAUTERIZATION OF BENIGN GROWTH–LARGE BASE PRICE 6614 2430 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEXCISION /CAUTERIZATION OF BENIGN GROWTHS-EXTENSIVE BASE PRICE 6628 3640 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEXCISION BENIGN GROWTH/RECONSTRUCTION-EXTENSIVE BASE PRICE 6760 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEXCISION BENIGN GROWTH/RECONSTRUCTION-LARGE AREA BASE PRICE 6705 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEXCISION BENIGN GROWTH/RECONSTRUCTION-SMALL AREA BASE PRICE 6659 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEXCISION OF CYST - MEDIUM BASE PRICE 7020 14550 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEXCISION OF EXTENSIVE LESSION SKIN BASE PRICE 6830 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEXCISION OF LUMP BASE PRICE 6744 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEXCISION OF MAMMARY FISTULA BASE PRICE 6813 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEXCISION OF SKIN TOMOURS & RECONSTRUCTION – EXTENSIVE BASE PRICE 6892 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEXCISION OF SKIN TUMOURS & RECONSTRUCTION – LARGE BASE PRICE 6837 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEXCISION OF SKIN TUMOURS & RECONSTRUCTION – SMALL BASE PRICE 6716 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEXCISION OF TUMOUR & CLOSURE BASE PRICE 6638 3640 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEXCISION OF VERY EXTENSIVE SKIN TUMOURS BASE PRICE 6944 30320 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEXCISION OF VERY EXTENSIVE SKIN TUMOURS & RECON – MINOR BASE PRICE 6893 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEXCISION TUMOURS&RECONSTRACTION FACE-EXTENSIVE BASE PRICE 6886 21830 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEXCISION TUMOURS&RECONSTRUCTION FACE-SMALL BASE PRICE 6706 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEXCISION TUMOURS&RECONSTRUCTIONFACE-LARGE BASE PRICE 6828 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEXCISION&RECONSTRUCTION-LARGE TUMOUR FACE BASE PRICE 6829 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEXICISION OF MULTIPLE MOLES BASE PRICE 6725 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEXICISION OF SMALL SCARS, MOLES, SMALL CYST BASE PRICE 6635 3640 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEXICISION OF VENOUS ULCER & SKIN GRAFTS BASE PRICE 6897 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEXISION OF MULTIPLE WARTS BASE PRICE 6726 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEXPANDER REMOVAL AND MULTIPLE CONTOURING BASE PRICE 6989 36380 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEXTENSIVE WOUND HOMOGRAFTING(DONOR) BASE PRICE 6707 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEXTERNAL AUDITORY CANAL RECONSTRUCTION BASE PRICE 6687 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEXTERNAL FIXATION FINGERS(EACH) BASE PRICE 6655 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYEXTERNAL FIXATION FOR MAJOR LIMBS BASE PRICE 6766 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYFACE LIFTS BASE PRICE 6959 36380 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYFACE LIFTS MINIMAL BASE PRICE 12784 33080 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYFACE TRANSPLANTATION BASE PRICE 6974 60640 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYFACIAL LIFT MAJOR RS 60000/- BASE PRICE 12777 66150 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYFACIAL NERVE DECOMPRESSION BASE PRICE 6903 24260 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYFACIAL NERVE GRAFTING BASE PRICE 6934 30320 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYFACIAL NERVE REPAIR (MICRO) BASE PRICE 6935 30320 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYFACIAL REJUVENATION RS 60000/- BASE PRICE 12775 66150 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYFACIAL RESURFACING - LARGE BASE PRICE 12506 60640 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYFACIAL SURGERY MAJOR RS 50000/- BASE PRICE 12772 55130 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYFACIAL SURGERY MINOR BASE PRICE 12766 33080 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYFINGER JOINT REPLACEMENT EACH BASE PRICE 6838 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYFIXATION OF FRACTURE WITH SINGLE PLATE(EACH) BASE PRICE 6752 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYFLAP DETACHMENT BASE PRICE 7015 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYFORE HEAD LIFT BASE PRICE 6923 24260 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYFRACTURE FIXATION FACE- WITH EXTERNAL FIXATOR BASE PRICE 6803 18200 25

Page 90 of 115 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYFRACTURE FIXATION FACE- WITH LAG SCREW BASE PRICE 6804 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYFRACTURE MANDIBLE MULTIPLE PLATE BASE PRICE 6859 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYFRACTURE MANDIBLE SINGLE PLATE BASE PRICE 6807 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYFREE FLAP TRANSFER (MICROVASCULAR) – MAJOR BASE PRICE 6945 30320 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYFREE FLAP TRANSFER (MICROVASCULAR) – MINOR BASE PRICE 6919 24260 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYFULL THICKNESS SKIN GRAFT- MAJOR BASE PRICE 6867 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYFULL THICKNESS SKIN GRAFT- MINOR BASE PRICE 6740 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYFULL VAGINAL REJUVENATION BASE PRICE 6975 72770 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYGANGLION BASE PRICE 6724 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYGINGIVOPLERISOTEOPLASTY BASE PRICE 6737 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYGORNET INSERTION BASE PRICE 6732 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYGYNAECOMASIA B/L BASE PRICE 6794 14550 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYHAEMANGIOMA (MEDIUM) BASE PRICE 6796 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYHAIR TRANSPLANT MAJOR BASE PRICE 12422 109150 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYHAIR TRANSPLANT MINOR BASE PRICE 12423 60640 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYHAND COMPLEX SYNDACTYLY BASE PRICE 6984 30320 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYHAND POLYDACTYLY (COMPLEX) BASE PRICE 6982 24260 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYHAND SURGERY MODERATE RS 50000/- BASE PRICE 12771 55130 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYHAND SURGERY SMALL BASE PRICE 12764 33080 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYHOODECTOMY BASE PRICE 6899 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYHYPOSPADIAS-SINGLE STAGE-RECONSTRUCTION OF URETHRA BASE PRICE 6872 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYIM FIXATION BASE PRICE 6717 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYIMPLANTATION MAJOR RS 75000/- BASE PRICE 12781 82690 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYINGROWING TOE NAIL BASE PRICE 7013 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYINJECTION HAEMANGIOMA BASE PRICE 7030 1220 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYINTERNAL FIXATION OF FRACTURE(METACARPAL EACH) BASE PRICE 6656 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYINTEROSSEOUS WIRE REMOVAL – MAJOR BASE PRICE 6667 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYINTEROSSEOUS WIRE RIMOVAL – MINOR BASE PRICE 6616 2430 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYINTEROSSEOUS WIRING/ARCH BARS BASE PRICE 6805 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYINTRA LESIONAL INJECTION BASE PRICE 7002 1220 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYKELOIDS BASE PRICE 6727 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYLARGE BED SORE (BILATERAL) BASE PRICE 6988 36380 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYLEFAT III OSTEOTOMY BASE PRICE 6911 24260 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYLEFORT I + MANDIBULAR OSTEOTOMY BASE PRICE 6928 30320 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYLEFORT II OSTEOTOMY BASE PRICE 6910 24260 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYLEFORT-I OSTEOTOMY BASE PRICE 6909 24260 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYLEFORTE I FRACTURE MAXILLA BASE PRICE 6904 24260 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYLEFORTE II & III FRACTURE MAXILLA BASE PRICE 6905 24260 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYLIGATION OF ANKLE PERFORATORS BASE PRICE 6896 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYLIMB SURGERY MINOR BASE PRICE 12767 33080 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYLIMB SURGERY RS 60000/- BASE PRICE 12776 66150 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYLIP REDUCTION BASE PRICE 7003 24260 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYLIPOINJECTION - MAJOR BASE PRICE 7027 36380 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYLIPOSUCTION (MAJOR) BASE PRICE 6952 30320 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYLIPOSUCTION (MINOR) BASE PRICE 6845 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYLIPOSUCTION OF ONE AREA BASE PRICE 6924 24260 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYLIPOSUCTION SMALL BASE PRICE 12783 33080 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYLOBULE RECONSTRUCTION BASE PRICE 6683 9090 25

Page 91 of 115 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYLOCAL FLAP(EG.V-Y) BASE PRICE 6657 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYLOCAL FLAPS FACE – COMPLEX BASE PRICE 6629 3640 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYLOCAL FLAPS FACE – LARGE BASE PRICE 6763 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYLOCAL FLAPS FACE – SMALL BASE PRICE 6709 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYLOP EAR CORRECTION BASE PRICE 6684 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYMAIN ARTERIES OF THE LIMBS BASE PRICE 6950 30320 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYMAJOR BURN DRESSING UNDER G.A. BASE PRICE 6618 3640 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYMAJOR HAND SURGERY BASE PRICE 7000 48510 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYMAJOR LIMB AMPUTATION BASE PRICE 6839 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYMAJOR RECONSTRUCTION OF EAR EACH STAGE BASE PRICE 6793 14550 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYMAMOPLASTY BASE PRICE 6938 30320 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYMEATAL STENOSIS BASE PRICE 7016 14550 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYMEGA LIPOSUCTION RS 60000/- BASE PRICE 12773 66150 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYMEGALIPOSCUTION BASE PRICE 6981 48510 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYMICRO NEURAL SURGERY (MAJOR) BASE PRICE 6964 48510 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYMICRO VASCULAR AUGMENTATION USING OWN TISSUES ONE SIDE BASE PRICE 6936 30320 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYMICRO VASCULAR NERVE GRAFTING BASE PRICE 6914 24260 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYMICRO VASCULAR NERVE REPAIR-EACH BASE PRICE 6876 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYMICROLYMPHATIC SURGERY – MAJOR BASE PRICE 6946 30320 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYMICROLYMPHATIC SURGERY – MINOR BASE PRICE 6894 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYMICROVASCULAR FREE FASCIAL TRANSFER BASE PRICE 6947 30320 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYMICROVASCULAR REANIMATION OF FACE FOR PLASTY- FULL BASE PRICE 6931 30320 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYMICROVASCULAR REANIMATION OF FACE FOR PLASTY- PART BASE PRICE 6932 30320 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYMICROVASCULAR RECONSTRUCTION OF PENIS(EACH STAGE) BASE PRICE 6939 30320 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYMICROVASCULAR SOFT TISSUE TRANSFER FACE BASE PRICE 6933 30320 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYMICROVASCULAR SURGERY (MAJOR) BASE PRICE 6963 48510 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYMICROVASCULAR TM JOINT RECONSTRUCTION BASE PRICE 6929 30320 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYMINIMAL HAIR TRANSPLANT BASE PRICE 6795 14550 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYMINOR BREAST SURGERY BASE PRICE 6695 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYMINOR HAND SURGERY BASE PRICE 7001 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYMINOR RECONSTRACTION GENITILIA BASE PRICE 6745 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYMINOR RECONSTRUCTION OF EAR BASE PRICE 6623 3640 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYMINOR REPAIR OF NOSE BASE PRICE 6622 3640 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYMULTIPLE FINGER REPLANTATION BASE PRICE 6990 48510 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYMYOCUTANEOUS / MUSCLE FLAP BASE PRICE 6840 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYNAEVUS EXCISION SCAR/NAEVUS – EXTENSIVE AREA BASE PRICE 6811 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYNAEVUS EXCISION SCAR/NAEVUS- LARGE AREA BASE PRICE 6785 14550 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYNAEVUS EXCISION SCAR/NAEVUS- SMALL AREA BASE PRICE 6643 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYNAEVUS EXCISION WITH LOCAL FLAP- EXTENSIVE AREA BASE PRICE 6868 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYNAEVUS EXCISION WITH LOCAL FLAP- LARGE AREA BASE PRICE 6692 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYNAEVUS EXCISION WITH LOCAL FLAP- SMALL AREA BASE PRICE 6644 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYNAIL BED REPAIR - MULTIPLE BASE PRICE 7012 9700 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYNAIL BED REPAIR - SINGLE BASE PRICE 7011 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYNASAL – TIP CORRECTION BASE PRICE 6678 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYNERVE BIOPSY BASE PRICE 6723 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYNERVE REPAIR BASE PRICE 6701 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYNERVE SURGERY MINOR BASE PRICE 12768 33080 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYNIPPLE RECONSTRUCTION (BOTH) BASE PRICE 7037 24260 25

Page 92 of 115 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYNONVASCULARIZED TM JOINT RECONSTRUCTION BASE PRICE 6861 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYNOSE SURGERY MINOR BASE PRICE 12770 33080 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYNRURO SENSORY FLAP BASE PRICE 6787 14550 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYON BOUTENIERE DEFORMITY BASE PRICE 6753 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYON SWAN NECK DEFORMITY BASE PRICE 6788 14550 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYON TRIGGER FINGER BASE PRICE 6754 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYONLAY BONE GRAFT BASE PRICE 6869 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYOPEN REDUCTION OF FRACTURE ZYGOMA BASE PRICE 6806 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYOPERATION FOR MICROGNAPTHIA BASE PRICE 6906 24260 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYOPERATION FOR PROGNANTHISM BASE PRICE 6907 24260 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYOPPONENS PLASTY BASE PRICE 6789 14550 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYOSTEOTOMY WITH BONE GRAFT BASE PRICE 6908 24260 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYPALATO PHARYNGOPLASTY BASE PRICE 6855 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYPAN FACIAL FRACTURE - MAJOR BASE PRICE 6966 48510 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYPAN FACIAL FRACTURE - SIMPLE BASE PRICE 6958 36380 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYPAN FACIAL FRACTURE MINOR BASE PRICE 6927 30320 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYPAROTID DUCT REPAIR / SECTION BASE PRICE 6767 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYPARTIAL CLITORIDECTOMY BASE PRICE 6900 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYPARTIAL HAIR TRANSPLANT BASE PRICE 6922 24260 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYPENILE FAT FILLING BASE PRICE 6954 30320 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYPENILE LENGTHENING BASE PRICE 6953 30320 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYPENILE RECONSTRUCTION RS 75000/- BASE PRICE 12779 82690 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYPERFORATOR FREE FLAP BASE PRICE 7025 48510 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYPERIPHERAL NERVE SURGERY - MAJOR BASE PRICE 6951 30320 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYPERIPHERAL NERVE SURGERY - MINOR BASE PRICE 6843 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYPHALANGISATION BASE PRICE 6755 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYPHARYNGOPLASTY SPHINCTER BASE PRICE 6776 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYPHARYNGOPLASTY WITH REPAIR OF PALATE BASE PRICE 6854 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYPLAMER REPAIR OF TENDON(EACH)DUPEUTRYN'S CONTRA. BASE PRICE 6877 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYPLATE / NAIL / SCREW REMOVAL – MAJOR BASE PRICE 6718 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYPLATE / NAIL / SCREW REMOVAL – MINOR BASE PRICE 6631 3640 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYPOLLICIZATION BASE PRICE 6878 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYPOLYDACTYLY EXCISION BASE PRICE 6756 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYPOLYDACTYLY EXCISION-MINOR BASE PRICE 6658 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYPRIMARY BONE GRAFTING OF CLEFT LIP-PALATE BASE PRICE 6779 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYPRIMARY REPAIR OF TENDON(EACH) BASE PRICE 6702 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYPRIMARY SUTURE OF WOUNDS MILD BASE PRICE 6609 2430 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYPRIMERY SUTURE OF WOUNDS MODERATE BASE PRICE 6619 3640 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYPRIMERY SUTURE OF WOUNDS SEVERE BASE PRICE 6671 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYPROTRUDING EAR CORRECTION BASE PRICE 6685 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYPROXIMAL HYPOSPADIAS BASE PRICE 6985 24260 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYPTOSIS CORRECTION BASE PRICE 6798 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYPULLEY FORMATION (EACH) BASE PRICE 6703 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYRADIAL FOREARM FLAPS / SIMILAR FLAPS BASE PRICE 6889 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYRADICAL CLUB HAND-CENTRALISATION BASE PRICE 6819 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYREANIMATION FACE FOR PLASTY BASE PRICE 6870 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYRECONSTRUCTION OF EYE LID- MINOR DEFECTS BASE PRICE 6675 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYRECONSTRUCTION WITH TEMPORALIS FACIAL FLAP BASE PRICE 6853 18200 25

Page 93 of 115 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYRECONSTRUCTION MAMMOPLASTY BASE PRICE 7029 30320 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYRECONSTRUCTION OF EYE BROW (EACH) BASE PRICE 6639 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYRECONSTRUCTION OF EYE LID – MAJOR DEFECT BASE PRICE 6780 14550 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYRECONSTRUCTION OF EYE LID- MODERATE DEFECTS BASE PRICE 6676 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYRECONSTRUCTION OF LIP – BY ABBE FLAP EACH STAGE BASE PRICE 6689 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYRECONSTRUCTION OF LIP – BY LOCAL FLAP BASE PRICE 6784 14550 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYRECONSTRUCTION OF NIPPLE EACH BASE PRICE 6696 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYRECONSTRUCTION OF PARTIAL LOSS- MAJOR BASE PRICE 6729 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYRECONSTRUCTION OF PARTIAL LOSS- MINOR BASE PRICE 6641 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYRECONSTRUCTION OF PENIS(EACH STAGE) BASE PRICE 6786 14550 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYRECONSTRUCTION OF TOTAL LOSS- EACH STAGE BASE PRICE 6730 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYRECONSTRUCTION ORAL CA WITH SINGLE FLAP BASE PRICE 6831 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYRECONSTRUCTION POST BURNS- DEFORMITY OF HAND BASE PRICE 6704 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYRECONSTRUCTION POST BURNS-MAJOR DEFORMITY OF HAND BASE PRICE 6915 24260 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYRECONSTRUCTION POST BURNS-MODERATE DEFORMITY OF HAND BASE PRICE 6820 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYRECONSTRUCTION WITH DAUBLE FLAP BASE PRICE 6890 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYRECONSTRUCTION WITH FASCIOCUTANEOUS FLAP BASE PRICE 6832 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYREDUCTION & SPLINITING OF FRACTURES (EACH) BASE PRICE 6719 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYREDUCTION OF FRACTURE OF – NASAL BONES BASE PRICE 6642 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYREDUCTION OF FRACTURE OF – ZYGOMA (GILLIES) BASE PRICE 6691 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYREDUCTION RHINOPLASTY MAJOR BASE PRICE 6851 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYRELEASE OF SYNDACTYLY(FOR EACH FINGER RELEASE) BASE PRICE 6821 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYRELEASE SYNCHLAE & SSG – EACH EYE BASE PRICE 6670 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYREPAIR AFTER INJURY BASE PRICE 6620 3640 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYREPAIR MULTIPLE TENDONS –EACH HAND BASE PRICE 6879 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYREPAIR OF BILATERAL CLEFT LIP & ANTERIOR PALATE BASE PRICE 6857 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYREPAIR OF EPISPADIAS BASE PRICE 6873 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYREPAIR OF INJURY-SKIN ONLY BASE PRICE 6625 3640 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYREPAIR OF MACROSTOMIA BASE PRICE 6802 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYREPAIR OF MULTIPLE TENDONS/NERV REPAIR BASE PRICE 6940 30320 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYREPAIR OF TORN EAR LOBULE – EACH BASE PRICE 6611 2430 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYREPAIR OF UNILATERAL CLEFT LIP & ANTERIOR PALATE BASE PRICE 6777 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYREPLANTATION / REVASCULARISATION OF EXTRIMITIES BASE PRICE 6991 60640 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYREVASCULARIZATION FINGER /HAND/FOREARM-MAJOR BASE PRICE 6916 24260 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYREVASCULARIZATION FINGER/HAND/FOREARM-MINOR BASE PRICE 6880 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYREVISION & SKIN GRAFTING – EXTENSIVE AREA BASE PRICE 6792 14550 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYREVISION & SKIN GRAFTING – LARGE AREA BASE PRICE 6710 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYREVISION & SKIN GRAFTING – SMALL AREA BASE PRICE 6661 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYREVISION AMPUTATION-EACH FINGER BASE PRICE 6626 3640 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYREVISION OF SCARS – EXTENSIVE AREA BASE PRICE 6833 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYREVISION OF SCARS – LARGE AREA BASE PRICE 6764 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYREVISION OF SCARS – SMALL AREA BASE PRICE 6662 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYREVISION OF SCARS WITH Z- PLASTICS (EACH) BASE PRICE 6711 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYREVISION SCAR WITH FLAP COVER – EXTENSIVE AREA BASE PRICE 6834 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYREVISION SCAR WITH FLAP COVER – LARGE AREA BASE PRICE 6712 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYREVISION SCARE WITH FLAP COVER – SMALL AREA BASE PRICE 6663 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYRHINOPLASTY MAJOR BASE PRICE 6987 36380 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYRHINOPLASTY WITH FORE HEAD FLAP BASE PRICE 7038 36380 25

Page 94 of 115 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYROTATION FLAPS BASE PRICE 6770 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSECONDARY CORRECTION OF CLEFT LIP- MAJOR BASE PRICE 6778 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSECONDARY CORRECTION OF CLEFT LIP- MINOR BASE PRICE 6690 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSECONDARY CORRECTION OF CLEFT LIP/NOSE – MAJOR BASE PRICE 6852 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSECONDARY CORRECTION OF CLEFT LIP/NOSE – MINOR BASE PRICE 6800 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSECONDARY SUTURING BASE PRICE 7004 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSEGMENTAL EXCISION OF MANDIBLE BASE PRICE 6738 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSERIAL EXCISION SCAR/NAEVUS (EACH STAGE) – MAJOR BASE PRICE 6693 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSERIAL EXCISION SCAR/NAEVUS (EACH STAGE) – MINOR BASE PRICE 6645 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSINGLE STAGE CLIFT LIP AND PALATE REPAIR BASE PRICE 6856 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSINGLE STAGE RECONSTRUCTION (MAJOR) BASE PRICE 6965 48510 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSINGLE STAGE RECONSTRUCTION (OTOPLASTY) BASE PRICE 6926 30320 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSINGLE STAGE RECONSTRUCTION / FLAP RECONSTRUCTIVE SURGERY BASE PRICE 6902 24260 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSINGLE STAGE RECONSTRUCTION MINOR BASE PRICE 12769 33080 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSKIN FLAP FOR BED SORE (EACH) BASE PRICE 6768 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSKIN GRAFTING MAJOR BASE PRICE 6992 36380 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSKIN GRAFTING-EXTENSIVE AREA BASE PRICE 6887 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSKIN GRAFTING-LARGE AREA BASE PRICE 6790 14550 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSKIN GRAFTING-SMALL AREA BASE PRICE 6660 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSKULL BASE SURGERY BASE PRICE 6957 36380 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSOFT TISSUE CORRECTION TRISMUS – BILATERAL BASE PRICE 6895 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSOFT TISSUE CORRECTION TRISMUS – COMPLEX BASE PRICE 6948 30320 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSOFT TISSUE CORRECTION TRISMUS – UNILATERAL BASE PRICE 6769 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSTAGED EAR RECONSTRUCTION (CARTILAGE IMPLANTATION) BASE PRICE 7006 36380 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSTENOSIS NOSTRAL CORRECTION BASE PRICE 6679 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSTRIPPING OF SAPHENOUS VAIN BASE PRICE 6898 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSUBCUTANEOUS PEDICLE FLAP BASE PRICE 6761 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSUBCUTANEOUS PEDICLE FLAP DELAY BASE PRICE 6627 3640 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSUBCUTANEOUS PEDICLE FLAP TRANSFER BASE PRICE 6708 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSUBCUTANEOUS PEDICLE PLAT RASING BASE PRICE 6762 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSUBSEQUENT STAGE BASE PRICE 6668 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSUPER MICRO SURGERY RS 60000/- BASE PRICE 12774 66150 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSURGICAL PREMAXILLARY SET BACK BASE PRICE 6841 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSUTURE OF MINOR WOUNDS(EACH) BASE PRICE 6613 2430 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSUTURE OF MULTIPLE LACERETED WOUNDS BASE PRICE 6918 24260 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYSUTURE REMOVAL POST CLEFT LIP REPAIR UNDER GA BASE PRICE 6617 2430 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYTANGENITAL – EXCISION & GRAFTING (EACH 4%BSA) BASE PRICE 6720 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYTARSORRHAPY (EACH EYE) BASE PRICE 6608 2430 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYTELECANTHUS RECONSSTRUCITON- MODERATE DEFORMITIES BASE PRICE 6640 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYTELECANTHUS RECONSTRUCTION –MAJOR DEFORMITIES BASE PRICE 6781 14550 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYTELECANTHUS RECONSTRUCTION- MINOR DEFORMITIES BASE PRICE 6621 3640 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYTENDON TRANSFER (EACH) BASE PRICE 6791 14550 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYTHIGH (EACH) BASE PRICE 6844 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYTHORACIC FLAP BASE PRICE 6824 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYTHUMB POLYDACTYLY BASE PRICE 7014 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYTHUMB RECONSTRUCTION BY LOCAL FLAP&BONE GRAFT BASE PRICE 6881 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYTHUMB RECONSTRUCTION BY MICROVASCULAR REPAIR BASE PRICE 6941 30320 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYTHUMB RECONSTRUCTION BYBONE GRAFT&FLAP-EACH STAGE BASE PRICE 6822 18200 25

Page 95 of 115 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYTISSUE – EXPANSION (EACH STAGE) BASE PRICE 6842 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYTM JOINT EXCISION – BILATERAL BASE PRICE 6739 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYTM JOINT EXCISION – UNILATERAL BASE PRICE 6860 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYTORTICOLLIS BASE PRICE 7005 24260 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYTOTAL BODY LIFT BASE PRICE 6970 60640 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYTOTAL BODY RECONSTRUCTION BASE PRICE 6969 60640 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYTOTAL FACE LIFT BASE PRICE 6967 48510 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYTOTAL FACE LIFT RS 75000/- BASE PRICE 12782 82690 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYTOTAL LIMB REPLACEMENT (MAJOR) BASE PRICE 6972 60640 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYTOTAL REPLATATION HAND-MICROVASCULAR BASE PRICE 6960 36380 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYTOTAL REPLATATION-EACH FINGER(MICROVASCULAR) BASE PRICE 6917 24260 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYTRANSFER OF SKIN AS TUBES OF PEDICLES – 1ST STAGE BASE PRICE 6721 9090 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYTRANSFER OF SKIN AS TUBES OF PEDICLES – SUB- STAGE BASE PRICE 6669 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYTUMMY TUCK BASE PRICE 6968 48510 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYTUMOUR EXCISION WITH RESCONSTRUCTION BASE PRICE 6728 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYUNDER DEVELOPED BREAST BASE PRICE 6937 30320 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYURETHROPLASTY EACH STAGE BASE PRICE 6814 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYVACCUM ASSISTED CLOSURE (REPEAT) - MAJOR BASE PRICE 7035 2430 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYVACCUM ASSISTED CLOSURE (REPEAT) - MINOR BASE PRICE 7033 1220 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYVACCUM ASSISTED CLOSURE (REPEAT) - MODERATE BASE PRICE 7034 1820 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYVACCUM ASSISTED CLOSURE - MAJOR BASE PRICE 7032 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYVACCUM ASSISTED CLOSURE - MINOR BASE PRICE 6980 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYVACCUM ASSISTED CLOSURE - MODERATE BASE PRICE 7031 12130 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYVAGINOPLASTY WITH FLAPS BASE PRICE 6913 24260 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYVAGINOPLASTY-SSG BASE PRICE 6874 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYVASCULAR MALFORMATION BASE PRICE 6921 24260 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYVASCULAR MALFORMATION - MAJOR BASE PRICE 6871 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYVASCULAR MALFORMATION – MINOR BASE PRICE 6743 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYVENOUS THROMBECTOMY BASE PRICE 6920 24260 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYVENUS THROMBECTOMY BASE PRICE 6901 18200 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYVITILIGO EXCISION – OVER GRAFTING (MINOR) BASE PRICE 6741 10920 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYVITILIGO EXCISION – PRIMARY CLOSURE BASE PRICE 6646 6070 25 PLASTIC & RECONSTRUCTIVEPLASTIC SURGERY & RECONSTRUCTIVE SURGERY SURGERYVITILIGO EXCISION- OVER GRAFTING (MAJOR) BASE PRICE 6812 18200 25 PSYCHIATRY DEPARTMENTPSYCHIATRY PROCEDURE ADL CHART BASE PRICE 7053 370 0 PSYCHIATRY DEPARTMENTPSYCHIATRY PROCEDURE ANGER MANAGEMENT THERAPY BASE PRICE 7065 610 0 PSYCHIATRY DEPARTMENTPSYCHIATRY PROCEDURE BEHAVIOUR ASSESSMENT BASE PRICE 7055 370 0 PSYCHIATRY DEPARTMENTPSYCHIATRY PROCEDURE BEHAVIOUR THERAPY BASE PRICE 7057 610 0 PSYCHIATRY DEPARTMENTPSYCHIATRY PROCEDURE BIO FEEDBACK THERAPY BASE PRICE 7070 720 0 PSYCHIATRY DEPARTMENTPSYCHIATRY PROCEDURE COGNITIVE BEHAVIOUR THERAPY BASE PRICE 7061 610 0 PSYCHIATRY DEPARTMENTPSYCHIATRY PROCEDURE COUNSELLING BASE PRICE 7054 370 0 PSYCHIATRY DEPARTMENTPSYCHIATRY PROCEDURE COUPLE THERAPY BASE PRICE 7059 610 0 PSYCHIATRY DEPARTMENTPSYCHIATRY PROCEDURE DE-ADDICTION THERAPY BASE PRICE 7068 1220 0 PSYCHIATRY DEPARTMENTPSYCHIATRY PROCEDURE FAMILY THERAPY BASE PRICE 7058 850 0 PSYCHIATRY DEPARTMENTPSYCHIATRY PROCEDURE GROUP THERAPY BASE PRICE 7072 370 0 PSYCHIATRY DEPARTMENTPSYCHIATRY PROCEDURE HABIT MODIFICATION THERAPY BASE PRICE 7069 1220 0 PSYCHIATRY DEPARTMENTPSYCHIATRY PROCEDURE INTERACTIVE PLAY THERAPY BASE PRICE 7071 480 0 PSYCHIATRY DEPARTMENTPSYCHIATRY PROCEDURE IQ ASSESSMENT BASE PRICE 7050 480 0 PSYCHIATRY DEPARTMENTPSYCHIATRY PROCEDURE KNOW YOUR CHILD BASE PRICE 7371 370 0

Page 96 of 115 PSYCHIATRY DEPARTMENTPSYCHIATRY PROCEDURE LIFE SKILLS TRAINING THERAPY BASE PRICE 7062 1220 0 PSYCHIATRY DEPARTMENTPSYCHIATRY PROCEDURE MOTIVATION THERAPY BASE PRICE 7064 610 0 PSYCHIATRY DEPARTMENTPSYCHIATRY PROCEDURE PARANTING SKILLS TRAINING THERAPY BASE PRICE 7063 1220 0 PSYCHIATRY DEPARTMENTPSYCHIATRY PROCEDURE PERSONALITY ASSESSMENT BASE PRICE 7051 610 0 PSYCHIATRY DEPARTMENTPSYCHIATRY PROCEDURE PRANIC PSYCHOTHERAPY BASE PRICE 7052 370 0 PSYCHIATRY DEPARTMENTPSYCHIATRY PROCEDURE PROGRESSIVE RELAXATION THERAPY BASE PRICE 7056 610 0 PSYCHIATRY DEPARTMENTPSYCHIATRY PROCEDURE PSYCHO DIAGNOSTICS CATEGORY-A BASE PRICE 11814 1220 0 PSYCHIATRY DEPARTMENTPSYCHIATRY PROCEDURE PSYCHO DIAGNOSTICS CATEGORY-B BASE PRICE 11815 3030 0 PSYCHIATRY DEPARTMENTPSYCHIATRY PROCEDURE PSYCHO THERAPY BASE PRICE 7060 610 0 PSYCHIATRY DEPARTMENTPSYCHIATRY PROCEDURE STRESS MANAGEMENT THERAPY BASE PRICE 7066 610 0 PSYCHIATRY DEPARTMENTPSYCHIATRY PROCEDURE THERAPY CATEGORY-A BASE PRICE 11812 1220 0 PSYCHIATRY DEPARTMENTPSYCHIATRY PROCEDURE THERAPY CATEGORY-B BASE PRICE 11813 3030 0 PSYCHIATRY DEPARTMENTPSYCHIATRY PROCEDURE TIME MANAGEMENT THERAPY BASE PRICE 7067 610 0 PSYCHIATRY DEPARTMENTPSYCHIATRY SPECIAL BILLING HEADS IN PATIENT SUPERVISION CHARGES (TEAM MANAGEMENT) SUITE ROOM 11816 1660 0 PSYCHIATRY DEPARTMENTPSYCHIATRY SPECIAL BILLING HEADS IN PATIENT SUPERVISION CHARGES (TEAM MANAGEMENT) WARD 52 11816 560 0 PSYCHIATRY DEPARTMENTPSYCHIATRY SPECIAL BILLING HEADS IN PATIENT SUPERVISION CHARGES (TEAM MANAGEMENT) ECONOMY WARD SIXTH11816 FLOOR 560 0 PSYCHIATRY DEPARTMENTPSYCHIATRY SPECIAL BILLING HEADS IN PATIENT SUPERVISION CHARGES (TEAM MANAGEMENT) NICU STEP DOWN 11816 1100 0 PSYCHIATRY DEPARTMENTPSYCHIATRY SPECIAL BILLING HEADS IN PATIENT SUPERVISION CHARGES (TEAM MANAGEMENT) PICU STEP DOWN 11816 1100 0 PSYCHIATRY DEPARTMENTPSYCHIATRY SPECIAL BILLING HEADS IN PATIENT SUPERVISION CHARGES (TEAM MANAGEMENT) TRANSPLANT ICU 11816 1100 0 PSYCHIATRY DEPARTMENTPSYCHIATRY SPECIAL BILLING HEADS IN PATIENT SUPERVISION CHARGES (TEAM MANAGEMENT) NMICU 11816 1100 0 PSYCHIATRY DEPARTMENTPSYCHIATRY SPECIAL BILLING HEADS IN PATIENT SUPERVISION CHARGES (TEAM MANAGEMENT) SEMI PRIVATE 11816 1100 0 PSYCHIATRY DEPARTMENTPSYCHIATRY SPECIAL BILLING HEADS IN PATIENT SUPERVISION CHARGES (TEAM MANAGEMENT) PRIVATE ROOM 11816 1100 0 PSYCHIATRY DEPARTMENTPSYCHIATRY SPECIAL BILLING HEADS IN PATIENT SUPERVISION CHARGES (TEAM MANAGEMENT) PICU 11816 1100 0 PSYCHIATRY DEPARTMENTPSYCHIATRY SPECIAL BILLING HEADS IN PATIENT SUPERVISION CHARGES (TEAM MANAGEMENT) ONCOLOGY WARD 11816 560 0 PSYCHIATRY DEPARTMENTPSYCHIATRY SPECIAL BILLING HEADS IN PATIENT SUPERVISION CHARGES (TEAM MANAGEMENT) OBG SEMI PRIVATE11816 1100 0 PSYCHIATRY DEPARTMENTPSYCHIATRY SPECIAL BILLING HEADS IN PATIENT SUPERVISION CHARGES (TEAM MANAGEMENT) OBG PRIVATE 11816 1100 0 PSYCHIATRY DEPARTMENTPSYCHIATRY SPECIAL BILLING HEADS IN PATIENT SUPERVISION CHARGES (TEAM MANAGEMENT) OBG ECONOMY ROOM11816 560 0 PSYCHIATRY DEPARTMENTPSYCHIATRY SPECIAL BILLING HEADS IN PATIENT SUPERVISION CHARGES (TEAM MANAGEMENT) NICU 11816 1100 0 PSYCHIATRY DEPARTMENTPSYCHIATRY SPECIAL BILLING HEADS IN PATIENT SUPERVISION CHARGES (TEAM MANAGEMENT) NEUROSURGERY WARD11816 MALE 560 0 PSYCHIATRY DEPARTMENTPSYCHIATRY SPECIAL BILLING HEADS IN PATIENT SUPERVISION CHARGES (TEAM MANAGEMENT) NEUROSURGERY WARD11816 FEMALE 560 0 PSYCHIATRY DEPARTMENTPSYCHIATRY SPECIAL BILLING HEADS IN PATIENT SUPERVISION CHARGES (TEAM MANAGEMENT) NEURO SURGICAL ICU11816 1100 0 PSYCHIATRY DEPARTMENTPSYCHIATRY SPECIAL BILLING HEADS IN PATIENT SUPERVISION CHARGES (TEAM MANAGEMENT) MICU 11816 1100 0 PSYCHIATRY DEPARTMENTPSYCHIATRY SPECIAL BILLING HEADS IN PATIENT SUPERVISION CHARGES (TEAM MANAGEMENT) ISOLATION 11816 560 0 PSYCHIATRY DEPARTMENTPSYCHIATRY SPECIAL BILLING HEADS IN PATIENT SUPERVISION CHARGES (TEAM MANAGEMENT) ICCU 11816 1100 0 PSYCHIATRY DEPARTMENTPSYCHIATRY SPECIAL BILLING HEADS IN PATIENT SUPERVISION CHARGES (TEAM MANAGEMENT) HIGH DEPENDENCY11816 UNIT 1100 0 PSYCHIATRY DEPARTMENTPSYCHIATRY SPECIAL BILLING HEADS IN PATIENT SUPERVISION CHARGES (TEAM MANAGEMENT) ECONOMY WARD FEMALE11816 560 0 PSYCHIATRY DEPARTMENTPSYCHIATRY SPECIAL BILLING HEADS IN PATIENT SUPERVISION CHARGES (TEAM MANAGEMENT) ECONOMY WARD 611816 560 0 PSYCHIATRY DEPARTMENTPSYCHIATRY SPECIAL BILLING HEADS IN PATIENT SUPERVISION CHARGES (TEAM MANAGEMENT) ECONOMY WARD 511816 560 0 PSYCHIATRY DEPARTMENTPSYCHIATRY SPECIAL BILLING HEADS IN PATIENT SUPERVISION CHARGES (TEAM MANAGEMENT) ECONOMY WARD 411816 560 0 PSYCHIATRY DEPARTMENTPSYCHIATRY SPECIAL BILLING HEADS IN PATIENT SUPERVISION CHARGES (TEAM MANAGEMENT) ECONOMY WARD 311816 560 0 PSYCHIATRY DEPARTMENTPSYCHIATRY SPECIAL BILLING HEADS IN PATIENT SUPERVISION CHARGES (TEAM MANAGEMENT) EMERGENCY 11816 1100 0 PSYCHIATRY DEPARTMENTPSYCHIATRY SPECIAL BILLING HEADS IN PATIENT SUPERVISION CHARGES (TEAM MANAGEMENT) SURGICAL ICU 11816 1100 0 PSYCHIATRY DEPARTMENTPSYCHIATRY SPECIAL BILLING HEADS IN PATIENT SUPERVISION CHARGES (TEAM MANAGEMENT) CTVS ICU 11816 1100 0 PSYCHIATRY DEPARTMENTPSYCHIATRY SPECIAL BILLING HEADS IN PATIENT SUPERVISION CHARGES (TEAM MANAGEMENT) BASE PRICE 11816 30320 0 PULMONARY MEDICINE RESPIRATORY MEDICINE CLINICAL PROCEDURESPOLYSOMNOGRAPHY WITH RESPIRATORY + NEURO PARAMETER BASE PRICE 8600 16010 0 PULMONARY MEDICINE RESPIRATORY MEDICINE CLINICAL PROCEDURESPOLYSOMNOGRAPHY WITH RESPIRATORY + NEURO PARAMETER WITH TITRATIONBASE PRICE 8601 18680 0 PULMONARY MEDICINE RESPIRATORY MEDICINE CLINICAL PROCEDURESPOLYSOMNOGRAPHY WITH RESPIRATORY PARAMETER BASE PRICE 8598 8000 0 PULMONARY MEDICINE RESPIRATORY MEDICINE CLINICAL PROCEDURESPOLYSOMNOGRAPHY WITH RESPIRATORY PARAMETER WITH TITRATION BASE PRICE 8599 10670 0

Page 97 of 115 PULMONARY MEDICINE RESPIRATORY MEDICINE PROCEDURES BRONCHOALVEOLAR LAVAGE (BAL) BASE PRICE 7080 670 0 PULMONARY MEDICINE RESPIRATORY MEDICINE PROCEDURES BRONCHOSCOPY FOR REMOVAL OF F.B. BASE PRICE 7088 11030 0 PULMONARY MEDICINE RESPIRATORY MEDICINE PROCEDURES DIFFUSION BASE PRICE 13226 3200 0 PULMONARY MEDICINE RESPIRATORY MEDICINE PROCEDURES ENDOBRONCHIAL BIOPSY BASE PRICE 7077 2210 0 PULMONARY MEDICINE RESPIRATORY MEDICINE PROCEDURES F.N.A.C. OF LUNG: CT GUIDED BASE PRICE 7085 4410 0 PULMONARY MEDICINE RESPIRATORY MEDICINE PROCEDURES F.N.A.C. OF LUNG: U.S.G. GUIDED BASE PRICE 7084 1330 0 PULMONARY MEDICINE RESPIRATORY MEDICINE PROCEDURES PLEURAL ASPIRATION DIAGNOSTIC BASE PRICE 7081 2210 0 PULMONARY MEDICINE RESPIRATORY MEDICINE PROCEDURES PLEURAL ASPIRATION THERAPEUTIC BASE PRICE 7082 3310 0 PULMONARY MEDICINE RESPIRATORY MEDICINE PROCEDURES PLEURAL BIOPSY VIA BIOPSY NEEDLE BASE PRICE 7083 2210 0 PULMONARY MEDICINE RESPIRATORY MEDICINE PROCEDURES ROUTINE BRONCHOSCOPY (ADULT) BASE PRICE 7075 8820 0 PULMONARY MEDICINE RESPIRATORY MEDICINE PROCEDURES ROUTINE BRONCHOSCOPY (PAEDIATRIC) BASE PRICE 7076 8820 0 PULMONARY MEDICINE RESPIRATORY MEDICINE PROCEDURES SPIROMETERY/PFT BASE PRICE 13247 1700 0 PULMONARY MEDICINE RESPIRATORY MEDICINE PROCEDURES THORACOSCOPY BASE PRICE 7089 6670 0 PULMONARY MEDICINE RESPIRATORY MEDICINE PROCEDURES THORACOSCOPY - PLEUORODESIS BASE PRICE 7090 9380 0 PULMONARY MEDICINE RESPIRATORY MEDICINE PROCEDURES TRANS BRONCHIAL LUNG BIOPSY (TBLB) BASE PRICE 7079 4410 0 PULMONARY MEDICINE RESPIRATORY MEDICINE PROCEDURES TRANS BRONCHIAL NEEDLE ASPIRATION (TBNA) BASE PRICE 7078 4410 0 PULMONARY MEDICINE RESPIRATORY MEDICINE PROCEDURES TUBE THORACOSTOMY / KD UNDER WATER SEAL BASE PRICE 7087 15440 0 PULMONARY MEDICINE RESPIRATORY MEDICINE SURGERY ROUTINE BRONCHOSCOPY (ADULT) (DONE IN OT) BASE PRICE 8466 8820 25 PULMONARY MEDICINE RESPIRATORY MEDICINE SURGERY TUBE THORACOSTOMY / KD UNDER WATER SEAL (DONE IN OT) BASE PRICE 12505 13350 25 RADIOLOGY BMD BMD WHOLE BODY BASE PRICE 12973 2100 2630 RADIOLOGY CT SCAN INVESTIGATION 3D CT ANKLE JOINT BASE PRICE 553 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT ATLANTO-AXIAL JOINT (CV JUNCTION) BASE PRICE 554 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT CERVICAL SPINE BASE PRICE 555 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT CERVICO DORSAL SPINE BASE PRICE 556 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT CLAVICLE BASE PRICE 583 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT DORSAL SPINE BASE PRICE 557 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT DORSO-LUMBAR SPINE BASE PRICE 558 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT ELBOW JOINTS (SINGLE JOINT) BASE PRICE 549 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT FACE BASE PRICE 546 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT FEMUR (THIGH) BASE PRICE 570 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT FIBULA (LEG) BASE PRICE 572 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT HIP JOINTS BASE PRICE 551 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT HUMERUS (ARM) BASE PRICE 566 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT KNEE JOINT BASE PRICE 552 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT LUMBAR SPINE BASE PRICE 559 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT LUMBO-SACRAL SPINE BASE PRICE 560 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT MANDIBLE BASE PRICE 575 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT MANDIBLE + MAXILLA BASE PRICE 577 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT MAXILLA BASE PRICE 576 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT ORBITS BASE PRICE 578 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT PATELLA (KNEE) BASE PRICE 574 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT PELVIS BASE PRICE 564 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT PELVIS + HIP JOINTS BASE PRICE 565 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT RADIUS (FOREARM) BASE PRICE 567 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT RADIUS + ULNA (FOREARM) BASE PRICE 569 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT RIBS (THORAX) BASE PRICE 584 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT RIBS + STERMUM (THORAX) BASE PRICE 586 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT SACRO-COCCYGEAL SEGMENTS (PELVIS) BASE PRICE 562 6670 8340

Page 98 of 115 RADIOLOGY CT SCAN INVESTIGATION 3D CT SACRUM (PELVIS) BASE PRICE 561 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT SCAPULA BASE PRICE 581 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT SHOULDER JOINT + SCAPULA BASE PRICE 582 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT SHOULDER JOINTS BASE PRICE 548 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT SKULL BASE PRICE 547 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT TEMPORAL BONES BASE PRICE 580 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT TEMPORO-MANDIBULAR JOINTS BASE PRICE 579 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT TIBIA (LEG) BASE PRICE 571 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT TIBIA + FIBULA (LEG) BASE PRICE 573 6670 8340 RADIOLOGY CT SCAN INVESTIGATION 3D CT WRIST JOINT BASE PRICE 550 6670 8340 RADIOLOGY CT SCAN INVESTIGATION C.T CNS ANGIOGRAPHY BASE PRICE 13010 12600 15750 RADIOLOGY CT SCAN INVESTIGATION CONTRAST CHARGE ONLY (CT) BASE PRICE 720 670 840 RADIOLOGY CT SCAN INVESTIGATION CT - CECT LIVER (TRIPHASIC STUDY) BASE PRICE 429 12000 15000 RADIOLOGY CT SCAN INVESTIGATION CT - HRCT THORAX PLAIN STUDY BASE PRICE 8512 5330 6660 RADIOLOGY CT SCAN INVESTIGATION CT ANGIOGRAPHY & VENOGRAPHY OF ABDOMEN BASE PRICE 430 13470 16840 RADIOLOGY CT SCAN INVESTIGATION CT ANGIOGRAPHY (CONTRAST) BASE PRICE 418 10800 13500 RADIOLOGY CT SCAN INVESTIGATION CT ANGIOGRAPHY - ABDOMEN BASE PRICE 592 10800 13500 RADIOLOGY CT SCAN INVESTIGATION CT ANGIOGRAPHY - ABDOMINAL AORTA BASE PRICE 431 10800 13500 RADIOLOGY CT SCAN INVESTIGATION CT ANGIOGRAPHY - COELIAC AXIS ABDOMEN BASE PRICE 432 10800 13500 RADIOLOGY CT SCAN INVESTIGATION CT ANGIOGRAPHY - CORONARY ARTERIES BASE PRICE 423 13470 16840 RADIOLOGY CT SCAN INVESTIGATION CT ANGIOGRAPHY - LOWER LIMBS (SINGLE) BASE PRICE 478 10800 13500 RADIOLOGY CT SCAN INVESTIGATION CT ANGIOGRAPHY - NECK BASE PRICE 414 8140 10180 RADIOLOGY CT SCAN INVESTIGATION CT ANGIOGRAPHY - PELVIS BASE PRICE 451 6800 8500 RADIOLOGY CT SCAN INVESTIGATION CT ANGIOGRAPHY - PULMONARY BASE PRICE 420 10800 13500 RADIOLOGY CT SCAN INVESTIGATION CT ANGIOGRAPHY - RENAL ARTERIES BASE PRICE 434 10800 13500 RADIOLOGY CT SCAN INVESTIGATION CT ANGIOGRAPHY - SUPERIOR MESENTERIC ARTERY (ABDOMEN) BASE PRICE 433 10800 13500 RADIOLOGY CT SCAN INVESTIGATION CT ANGIOGRAPHY - THORACIC AORTA BASE PRICE 419 10800 13500 RADIOLOGY CT SCAN INVESTIGATION CT ANGIOGRAPHY - UPPER LIMB (SINGLE) BASE PRICE 475 10800 13500 RADIOLOGY CT SCAN INVESTIGATION CT ANGIOGRAPHY ORBITS BASE PRICE 382 8140 10180 RADIOLOGY CT SCAN INVESTIGATION CT ANKLE JOINT (PLAIN) BASE PRICE 533 5330 6660 RADIOLOGY CT SCAN INVESTIGATION CT ANKLE JOINT (WITH ARTHROGRAPHY) BASE PRICE 535 6010 7510 RADIOLOGY CT SCAN INVESTIGATION CT ANKLE JOINT (WITH I.V CONTRAST) BASE PRICE 534 6010 7510 RADIOLOGY CT SCAN INVESTIGATION CT BASE OF SKULL (WITH CONTRAST) BASE PRICE 373 4670 5840 RADIOLOGY CT SCAN INVESTIGATION CT BASE OF SKULL PLAIN BASE PRICE 372 4000 5000 RADIOLOGY CT SCAN INVESTIGATION CT BRAIN + ANGIOGRAPHY BASE PRICE 365 8140 10180 RADIOLOGY CT SCAN INVESTIGATION CT BRAIN + ANGIOGRAPHY + VENOGRAPHY BASE PRICE 367 10800 13500 RADIOLOGY CT SCAN INVESTIGATION CT BRAIN + CT ORBITS (CONTRAST) BASE PRICE 379 5330 6660 RADIOLOGY CT SCAN INVESTIGATION CT BRAIN + CT ORBITS (PLAIN) BASE PRICE 378 4670 5840 RADIOLOGY CT SCAN INVESTIGATION CT BRAIN + CT TEMPORAL BONES (CONTRAST) BASE PRICE 377 6010 7510 RADIOLOGY CT SCAN INVESTIGATION CT BRAIN + CT TEMPORAL BONES (PLAIN) BASE PRICE 376 5330 6660 RADIOLOGY CT SCAN INVESTIGATION CT BRAIN + VENOGRAPHY BASE PRICE 366 8000 10000 RADIOLOGY CT SCAN INVESTIGATION CT BRAIN PLAIN BASE PRICE 361 2670 3340 RADIOLOGY CT SCAN INVESTIGATION CT BRAIN PLAIN + CONTRAST BASE PRICE 362 3340 4180 RADIOLOGY CT SCAN INVESTIGATION CT BRAIN PLAIN + CONTRAST + PERFUSION BASE PRICE 363 10670 13340 RADIOLOGY CT SCAN INVESTIGATION CT BRONCHOSCOPY (NA) BASE PRICE 591 8000 10000 RADIOLOGY CT SCAN INVESTIGATION CT CALCIUM SCORING SCAN BASE PRICE 7360 4000 5000 RADIOLOGY CT SCAN INVESTIGATION CT CALCULATION PACKAGE BASE PRICE 425 14680 18350 RADIOLOGY CT SCAN INVESTIGATION CT CERVICAL SPINE (FLEXION/EXTENSION STUDY) CONTRAST BASE PRICE 487 7340 9180

Page 99 of 115 RADIOLOGY CT SCAN INVESTIGATION CT CERVICAL SPINE (FLEXION/EXTENSION STUDY) PLAIN BASE PRICE 488 6670 8340 RADIOLOGY CT SCAN INVESTIGATION CT CERVICAL SPINE CONTRAST BASE PRICE 486 6010 7510 RADIOLOGY CT SCAN INVESTIGATION CT CERVICAL SPINE PLAIN BASE PRICE 485 5330 6660 RADIOLOGY CT SCAN INVESTIGATION CT CISTERNOGRAPHY BASE PRICE 8514 8000 10000 RADIOLOGY CT SCAN INVESTIGATION CT CONTRAST 100 ML BASE PRICE 8516 1330 1660 RADIOLOGY CT SCAN INVESTIGATION CT CONTRAST 50 ML BASE PRICE 8515 670 840 RADIOLOGY CT SCAN INVESTIGATION CT DORSAL SPINE CONTRAST BASE PRICE 490 6010 7510 RADIOLOGY CT SCAN INVESTIGATION CT DORSAL SPINE PLAIN BASE PRICE 489 5330 6660 RADIOLOGY CT SCAN INVESTIGATION CT ELBOW JOINT (PLAIN) BASE PRICE 513 5330 6660 RADIOLOGY CT SCAN INVESTIGATION CT ELBOW JOINT (WITH ARTHROGRAPHY) BASE PRICE 515 6010 7510 RADIOLOGY CT SCAN INVESTIGATION CT ELBOW JOINT (WITH I.V. CONTRAST) BASE PRICE 514 6010 7510 RADIOLOGY CT SCAN INVESTIGATION CT ENTEROCLYSIS (NA) BASE PRICE 594 8000 10000 RADIOLOGY CT SCAN INVESTIGATION CT FACE AND NECK (CONTRAST) BASE PRICE 413 6670 8340 RADIOLOGY CT SCAN INVESTIGATION CT FACE AND NECK PLAIN BASE PRICE 412 6010 7510 RADIOLOGY CT SCAN INVESTIGATION CT FOOT (SINGLE) CONTRAST STUDY BASE PRICE 466 6010 7510 RADIOLOGY CT SCAN INVESTIGATION CT FOOT (SINGLE) PLAIN STUDY BASE PRICE 465 5330 6660 RADIOLOGY CT SCAN INVESTIGATION CT HAND CONTRAST STUDY BASE PRICE 460 6010 7510 RADIOLOGY CT SCAN INVESTIGATION CT HAND PLAIN BASE PRICE 459 5330 6660 RADIOLOGY CT SCAN INVESTIGATION CT HEPATO-BILLARY SYSTEM / UPPER ABDOMEN CONTRAST BASE PRICE 428 6670 8340 RADIOLOGY CT SCAN INVESTIGATION CT HEPATO-BILLARY SYSTEM / UPPER ABDOMEN PLAIN BASE PRICE 427 5330 6660 RADIOLOGY CT SCAN INVESTIGATION CT HIP JOINTS (WITH ARTHROGRAPHY) BASE PRICE 529 6010 7510 RADIOLOGY CT SCAN INVESTIGATION CT HIP JOINTS (WITH I.V. CONTRAST) BASE PRICE 528 6010 7510 RADIOLOGY CT SCAN INVESTIGATION CT HIP JOINTS PLAIN BASE PRICE 527 5330 6660 RADIOLOGY CT SCAN INVESTIGATION CT KNEE JOINT (WITH ARTHROGRAPHY) BASE PRICE 532 6010 7510 RADIOLOGY CT SCAN INVESTIGATION CT KNEE JOINT (WITH I.V. CONTRAST) BASE PRICE 531 6010 7510 RADIOLOGY CT SCAN INVESTIGATION CT KNEE JOINT PLAIN BASE PRICE 530 5330 6660 RADIOLOGY CT SCAN INVESTIGATION CT LOWER ABDOMEN / KUB (CONTRAST) BASE PRICE 453 6670 8340 RADIOLOGY CT SCAN INVESTIGATION CT LOWER ABDOMEN / KUB PLAIN BASE PRICE 446 6010 7510 RADIOLOGY CT SCAN INVESTIGATION CT LUMBER SPINE (CONTRAST) BASE PRICE 494 6010 7510 RADIOLOGY CT SCAN INVESTIGATION CT LUMBER SPINE PLAIN BASE PRICE 493 5330 6660 RADIOLOGY CT SCAN INVESTIGATION CT LUMBOSACRAL SPINE CONTRAST BASE PRICE 500 6010 7510 RADIOLOGY CT SCAN INVESTIGATION CT LUMBOSACRAL SPINE PLAIN BASE PRICE 499 5330 6660 RADIOLOGY CT SCAN INVESTIGATION CT MYELOGRAPHY BASE PRICE 11846 8000 10000 RADIOLOGY CT SCAN INVESTIGATION CT MYELOGRAPHY CERVICAL BASE PRICE 504 8000 10000 RADIOLOGY CT SCAN INVESTIGATION CT MYELOGRAPHY CERVICO-DORSAL BASE PRICE 505 9330 11660 RADIOLOGY CT SCAN INVESTIGATION CT MYELOGRAPHY DORSAL BASE PRICE 506 8000 10000 RADIOLOGY CT SCAN INVESTIGATION CT MYELOGRAPHY DORSO-LUMBAR BASE PRICE 507 9330 11660 RADIOLOGY CT SCAN INVESTIGATION CT MYELOGRAPHY LUMBAR BASE PRICE 508 8000 10000 RADIOLOGY CT SCAN INVESTIGATION CT MYELOGRAPHY LUMBO-SACRAL BASE PRICE 509 9330 11660 RADIOLOGY CT SCAN INVESTIGATION CT NECK CONTRAST STUDY BASE PRICE 391 4670 5840 RADIOLOGY CT SCAN INVESTIGATION CT NECK PLAIN STUDY BASE PRICE 390 4000 5000 RADIOLOGY CT SCAN INVESTIGATION CT ORBITS CONTRAST BASE PRICE 381 4670 5840 RADIOLOGY CT SCAN INVESTIGATION CT ORBITS PLAIN BASE PRICE 380 4000 5000 RADIOLOGY CT SCAN INVESTIGATION CT PARANASAL SINUSES (PNS) CONTRAST BASE PRICE 387 4670 5840 RADIOLOGY CT SCAN INVESTIGATION CT PARANASAL SINUSES (PNS) PLAIN BASE PRICE 389 4000 5000 RADIOLOGY CT SCAN INVESTIGATION CT PERIPHERAL VENOGRAPHY (UPPER OR LOWER LIMB) SINGLE BASE PRICE 470 10670 13340 RADIOLOGY CT SCAN INVESTIGATION CT PULMONARY ANGIOGRAPHY BASE PRICE 422 10800 13500 RADIOLOGY CT SCAN INVESTIGATION CT SCAN SELLA (PITUITARY) PLAIN BASE PRICE 374 5330 6660

Page 100 of 115 RADIOLOGY CT SCAN INVESTIGATION CT SCAN SELLA (PITUITARY) WITH CONTRAST BASE PRICE 375 6010 7510 RADIOLOGY CT SCAN INVESTIGATION CT SCAN SINGLE LOWER LIMB (CONTRAST) BASE PRICE 464 6670 8340 RADIOLOGY CT SCAN INVESTIGATION CT SCAN SINGLE LOWER LIMB (PLAIN) BASE PRICE 463 6010 7510 RADIOLOGY CT SCAN INVESTIGATION CT SCAN SINGLE UPPER LIMB (CONTRAST) BASE PRICE 462 6670 8340 RADIOLOGY CT SCAN INVESTIGATION CT SCAN SINGLE UPPER LIMB (PLAIN) BASE PRICE 461 6010 7510 RADIOLOGY CT SCAN INVESTIGATION CT SCAN TEMPORAL BONES (CONTRAST) BASE PRICE 370 5330 6660 RADIOLOGY CT SCAN INVESTIGATION CT SCAN TEMPORAL BONES PLAIN BASE PRICE 369 4670 5840 RADIOLOGY CT SCAN INVESTIGATION CT SCAN THORAX (CONTRAST)/CECT THORAX BASE PRICE 2484 5330 6660 RADIOLOGY CT SCAN INVESTIGATION CT SCAN THORAX (PLAIN) BASE PRICE 2485 4670 5840 RADIOLOGY CT SCAN INVESTIGATION CT SCAN WHOLE ABDOMEN (WITH CONTRAST) BASE PRICE 2490 8000 10000 RADIOLOGY CT SCAN INVESTIGATION CT SHOULDER JOINT SINGLE (WITH ARTHROGRAPHY) BASE PRICE 512 6010 7510 RADIOLOGY CT SCAN INVESTIGATION CT SHOULDER JOINT SINGLE (WITH I.V. CONTRAST) BASE PRICE 511 6010 7510 RADIOLOGY CT SCAN INVESTIGATION CT SHOULDER JOINT SINGLE PLAIN BASE PRICE 510 5330 6660 RADIOLOGY CT SCAN INVESTIGATION CT SKULL BASE + NECK (CONTRAST) BASE PRICE 403 6670 8340 RADIOLOGY CT SCAN INVESTIGATION CT SKULL BASE + NECK PLAIN BASE PRICE 402 6010 7510 RADIOLOGY CT SCAN INVESTIGATION CT THORAX CONTRAST BASE PRICE 417 5330 6660 RADIOLOGY CT SCAN INVESTIGATION CT THORAX PLAIN BASE PRICE 416 4670 5840 RADIOLOGY CT SCAN INVESTIGATION CT TOMOGRAM LIMB BASE PRICE 8518 670 840 RADIOLOGY CT SCAN INVESTIGATION CT VENOGRAPHY ABDOMEN BASE PRICE 368 10670 13340 RADIOLOGY CT SCAN INVESTIGATION CT VENOGRAPHY ORBITS BASE PRICE 383 8000 10000 RADIOLOGY CT SCAN INVESTIGATION CT WHOLE ABDOMEN (CONTRAST) BASE PRICE 454 8000 10000 RADIOLOGY CT SCAN INVESTIGATION CT WHOLE ABDOMEN PLAIN BASE PRICE 426 7340 9180 RADIOLOGY CT SCAN INVESTIGATION CT WHOLE SPINE (CONTRAST) BASE PRICE 2491 19350 24190 RADIOLOGY CT SCAN INVESTIGATION CT WHOLE SPINE (PLAIN) BASE PRICE 2492 17350 21690 RADIOLOGY CT SCAN INVESTIGATION CT WRIST JOINT (PLAIN) BASE PRICE 516 5330 6660 RADIOLOGY CT SCAN INVESTIGATION CT WRIST JOINT (WITH ARTHROGRAPHY) BASE PRICE 518 6010 7510 RADIOLOGY CT SCAN INVESTIGATION CT WRIST JOINT (WITH I.V. CONTRAST) BASE PRICE 517 6010 7510 RADIOLOGY CT SCAN INVESTIGATION DENTAL CT BASE PRICE 587 2670 3340 RADIOLOGY CT SCAN INVESTIGATION DENTAL CT MANDIBLE BASE PRICE 589 2670 3340 RADIOLOGY CT SCAN INVESTIGATION DENTAL CT MAXILLA BASE PRICE 588 2670 3340 RADIOLOGY CT SCAN INVESTIGATION DUPLICATE FILM CHARGES CT PER FILM BASE PRICE 745 210 260 RADIOLOGY CT SCAN INVESTIGATION HRCT THORAX PLAIN BASE PRICE 11843 5330 6660 RADIOLOGY CT SCAN INVESTIGATION LIMB TOMOGRAM BY CT BASE PRICE 11848 670 840 RADIOLOGY CT SCAN INVESTIGATION PORTABLE CT SCAN (BED SIDE) BASE PRICE 8425 4810 6010 RADIOLOGY CT SCAN INVESTIGATION PORTABLE CT SCAN (OT) BASE PRICE 8424 6670 8340 RADIOLOGY CT SCAN INVESTIGATION REVIEW/COMPARE WITH OUTSIDE CT (PER STUDY) BASE PRICE 8519 670 840 RADIOLOGY MRI INVESTIGATION CONTRAST CHARGE ONLY (MRI) BASE PRICE 721 2800 3500 RADIOLOGY MRI INVESTIGATION DUPLICATE FILM CHARGES MRI PER FILM BASE PRICE 746 210 260 RADIOLOGY MRI INVESTIGATION FUNCTONAL MRI BRAIN BASE PRICE 160 8140 10180 RADIOLOGY MRI INVESTIGATION GADOLINIUM (CONTRAST) INJ. EXTRA BASE PRICE 741 2670 3340 RADIOLOGY MRI INVESTIGATION MR ENTEROCLYSIS (CONTRAST) BASE PRICE 255 8000 10000 RADIOLOGY MRI INVESTIGATION MR ENTEROCLYSIS (NON CONTRAST) BASE PRICE 254 5330 6660 RADIOLOGY MRI INVESTIGATION MRA BASE PRICE 12997 2310 2890 RADIOLOGY MRI INVESTIGATION MRI + CT OF TEMPORAL BONES FOR COCHLEAR IMPLANT BASE PRICE 163 13470 16840 RADIOLOGY MRI INVESTIGATION MRI - MRCP BASE PRICE 253 8140 10180 RADIOLOGY MRI INVESTIGATION MRI ANGIOGRAPHY LOWER ABDOMEN / PELVIS BASE PRICE 277 13470 16840 RADIOLOGY MRI INVESTIGATION MRI ANGIOGRAPHY PERIPHERAL (UPPER OR LOWER LIMB) SINGLE BASE PRICE 298 13470 16840 RADIOLOGY MRI INVESTIGATION MRI ANGIOGRAPHY RENAL ARTERIES BASE PRICE 259 13470 16840

Page 101 of 115 RADIOLOGY MRI INVESTIGATION MRI ANGIOGRAPHY THORACIC AORTA BASE PRICE 235 13470 16840 RADIOLOGY MRI INVESTIGATION MRI ANGIOGRAPHY UPPER ABDOMEN BASE PRICE 278 13470 16840 RADIOLOGY MRI INVESTIGATION MRI ANGOIGRAM OR VENOGRAM BRAIN (PLAIN STUDY) BASE PRICE 8511 2800 3500 RADIOLOGY MRI INVESTIGATION MRI ANKLE JOINT (WITH ARTHROGRAPHY) BASE PRICE 350 9470 11840 RADIOLOGY MRI INVESTIGATION MRI ANKLE JOINT (WITH I.V. CONTRAST) BASE PRICE 349 9470 11840 RADIOLOGY MRI INVESTIGATION MRI ANKLE JOINT PLAIN STUDY BASE PRICE 348 6800 8500 RADIOLOGY MRI INVESTIGATION MRI ARM/HUMERUS (SINGLE LIMB) CONTRAST BASE PRICE 285 10800 13500 RADIOLOGY MRI INVESTIGATION MRI ARM/HUMERUS (SINGLE LIMB) PLAIN BASE PRICE 286 8140 10180 RADIOLOGY MRI INVESTIGATION MRI BASE OF SKULL (CONTRAST STUDY) BASE PRICE 202 10800 13500 RADIOLOGY MRI INVESTIGATION MRI BASE OF SKULL (PLAIN STUDY) BASE PRICE 203 8140 10180 RADIOLOGY MRI INVESTIGATION MRI BRACHIAL PLEXUS (CONTRAST STUDY) BASE PRICE 212 11480 14350 RADIOLOGY MRI INVESTIGATION MRI BRACHIAL PLEXUS (PLAIN STUDY) BASE PRICE 213 8810 11010 RADIOLOGY MRI INVESTIGATION MRI BRAIN + ANGIO (TOF) CONTRAST BASE PRICE 154 10140 12680 RADIOLOGY MRI INVESTIGATION MRI BRAIN + ANGIO (TOF) PLAIN BASE PRICE 734 7480 9350 RADIOLOGY MRI INVESTIGATION MRI BRAIN + ANGIO + VENOGRAM (CONTRAST) BASE PRICE 157 10800 13500 RADIOLOGY MRI INVESTIGATION MRI BRAIN + ANGIO + VENOGRAM PLAIN BASE PRICE 158 8140 10180 RADIOLOGY MRI INVESTIGATION MRI BRAIN + CONTRAST + PERFUSION + SPECTROSCOPY BASE PRICE 150 13470 16840 RADIOLOGY MRI INVESTIGATION MRI BRAIN + FIESTA BASE PRICE 12996 6350 7940 RADIOLOGY MRI INVESTIGATION MRI BRAIN + MRI OF TEMPORAL BONES (CONTRAST) BASE PRICE 169 12140 15180 RADIOLOGY MRI INVESTIGATION MRI BRAIN + MRI OF TEMPORAL BONES (NON CONTRAST) BASE PRICE 168 9470 11840 RADIOLOGY MRI INVESTIGATION MRI BRAIN + MRI ORBITS (CONTRAST) BASE PRICE 171 12140 15180 RADIOLOGY MRI INVESTIGATION MRI BRAIN + MRI ORBITS (NON CONTRAST) BASE PRICE 170 9470 11840 RADIOLOGY MRI INVESTIGATION MRI BRAIN + SCREENING OF CERVICAL SPINE (CONTRAST) BASE PRICE 173 12140 15180 RADIOLOGY MRI INVESTIGATION MRI BRAIN + SCREENING OF CERVICAL SPINE (NON CONTRAST) BASE PRICE 172 9470 11840 RADIOLOGY MRI INVESTIGATION MRI BRAIN + SCREENING OF ONE PART SPINE BASE PRICE 12983 9470 11840 RADIOLOGY MRI INVESTIGATION MRI BRAIN + SCREENING OF WHOLE OF SPINE (CONTRAST) BASE PRICE 175 14810 18510 RADIOLOGY MRI INVESTIGATION MRI BRAIN + SCREENING OF WHOLE OF SPINE (NON CONTRAST) BASE PRICE 174 12140 15180 RADIOLOGY MRI INVESTIGATION MRI BRAIN + TIM(TOTAL IMAGING MATRIX) BASE PRICE 12982 9470 11840 RADIOLOGY MRI INVESTIGATION MRI BRAIN + VENOGRAPHY (CONTRAST) BASE PRICE 156 10140 12680 RADIOLOGY MRI INVESTIGATION MRI BRAIN + VENOGRAPHY (NON CONTRAST) BASE PRICE 155 7480 9350 RADIOLOGY MRI INVESTIGATION MRI BRAIN PLAIN BASE PRICE 146 6140 7680 RADIOLOGY MRI INVESTIGATION MRI BRAIN PLAIN + CONTRAST BASE PRICE 147 8810 11010 RADIOLOGY MRI INVESTIGATION MRI BRAIN PLAIN + CONTRAST + PERFUSION BASE PRICE 148 12140 15180 RADIOLOGY MRI INVESTIGATION MRI BRAIN PLAIN + CONTRAST + SPECTROSCOPY BASE PRICE 149 12140 15180 RADIOLOGY MRI INVESTIGATION MRI BRAIN SPECTROSCOPY BASE PRICE 151 6800 8500 RADIOLOGY MRI INVESTIGATION MRI BRAIN WITH EPILEPSY PROTOCOLS BASE PRICE 12993 6350 7940 RADIOLOGY MRI INVESTIGATION MRI BREAST (WITH CONTRAST) BASE PRICE 8417 8140 10180 RADIOLOGY MRI INVESTIGATION MRI CARDIAC CALCULATION PACKAGE BASE PRICE 245 13470 16840 RADIOLOGY MRI INVESTIGATION MRI CERVICAL SPINE (CONTRAST) BASE PRICE 313 9470 11840 RADIOLOGY MRI INVESTIGATION MRI CERVICAL SPINE (PLAIN) BASE PRICE 311 6800 8500 RADIOLOGY MRI INVESTIGATION MRI CERVICAL SPINE + SCREENING OF BRAIN BASE PRICE 12986 9470 11840 RADIOLOGY MRI INVESTIGATION MRI CERVICAL SPINE + SCREENING OF ONE PART OF SPINE BASE PRICE 12984 9470 11840 RADIOLOGY MRI INVESTIGATION MRI CERVICO-DORSAL SPINE (CONTRAST) BASE PRICE 312 10800 13500 RADIOLOGY MRI INVESTIGATION MRI CERVICO-DORSAL SPINE (PLAIN) BASE PRICE 310 8140 10180 RADIOLOGY MRI INVESTIGATION MRI DORSAL SPINE (CONTRAST) BASE PRICE 317 9470 11840 RADIOLOGY MRI INVESTIGATION MRI DORSAL SPINE (PLAIN) BASE PRICE 315 6800 8500 RADIOLOGY MRI INVESTIGATION MRI DORSAL SPINE + SCREENING OF BRAIN BASE PRICE 12985 9470 11840 RADIOLOGY MRI INVESTIGATION MRI DORSO LUMBAR SPINE PLAIN WITH SCREENING OF BRAIN BASE PRICE 12992 9470 11840

Page 102 of 115 RADIOLOGY MRI INVESTIGATION MRI DORSO-LUMBAR SPINE WITH SCREENING OF S.I. JOINT BASE PRICE 12981 9470 11840 RADIOLOGY MRI INVESTIGATION MRI DORSOLUMBAR SPINE (CONTRAST) BASE PRICE 316 10800 13500 RADIOLOGY MRI INVESTIGATION MRI DORSOLUMBAR SPINE (PLAIN) BASE PRICE 314 8140 10180 RADIOLOGY MRI INVESTIGATION MRI ELBOW JOINT (CONTRAST STUDY) SINGLE BASE PRICE 330 9470 11840 RADIOLOGY MRI INVESTIGATION MRI ELBOW JOINT (PLAIN STUDY) SINGLE BASE PRICE 329 6800 8500 RADIOLOGY MRI INVESTIGATION MRI ELBOW JOINT (WITH ARTHROGRAPHY) BASE PRICE 336 9470 11840 RADIOLOGY MRI INVESTIGATION MRI FACE (CONTRAST STUDY) BASE PRICE 217 10800 13500 RADIOLOGY MRI INVESTIGATION MRI FACE (PLAIN STUDY) BASE PRICE 216 8140 10180 RADIOLOGY MRI INVESTIGATION MRI FISTULOGRAM BASE PRICE 256 9470 11840 RADIOLOGY MRI INVESTIGATION MRI FISTULOGRAM PLAIN BASE PRICE 11849 8000 10000 RADIOLOGY MRI INVESTIGATION MRI FISTULOGRAM WITH CONTRAST BASE PRICE 11842 10670 13340 RADIOLOGY MRI INVESTIGATION MRI FOOT (CONTRAST) BASE PRICE 294 9470 11840 RADIOLOGY MRI INVESTIGATION MRI FOOT (PLAIN STUDY) BASE PRICE 293 6800 8500 RADIOLOGY MRI INVESTIGATION MRI FOR CRANIAL NERVES (CONTRAST STUDY) BASE PRICE 204 10800 13500 RADIOLOGY MRI INVESTIGATION MRI FOR CRANIAL NERVES (PLAIN STUDY) BASE PRICE 205 8140 10180 RADIOLOGY MRI INVESTIGATION MRI FOR SELLA/CAVERNOUS SINUS (CONTRAST STUDY) BASE PRICE 218 10800 13500 RADIOLOGY MRI INVESTIGATION MRI FOR SELLA/CAVERNOUS SINUS (PLAIN STUDY) BASE PRICE 219 8140 10180 RADIOLOGY MRI INVESTIGATION MRI FOR TEMPORAL REGION (CONTRAST STUDY) BASE PRICE 198 10800 13500 RADIOLOGY MRI INVESTIGATION MRI FOR TEMPORAL REGION (PLAIN STUDY) BASE PRICE 199 8140 10180 RADIOLOGY MRI INVESTIGATION MRI FOREARM (SINGLE LIMB) CONTRAST BASE PRICE 283 10800 13500 RADIOLOGY MRI INVESTIGATION MRI FOREARM (SINGLE LIMB) PLAIN BASE PRICE 284 8140 10180 RADIOLOGY MRI INVESTIGATION MRI HAND (CONTRAST) BASE PRICE 288 9470 11840 RADIOLOGY MRI INVESTIGATION MRI HAND (PLAIN STUDY) BASE PRICE 287 6800 8500 RADIOLOGY MRI INVESTIGATION MRI HEPATO-BILIARY SYSTEM (MRCP) BASE PRICE 246 8140 10180 RADIOLOGY MRI INVESTIGATION MRI HIP JOINT (PLAIN STUDY) BASE PRICE 342 6800 8500 RADIOLOGY MRI INVESTIGATION MRI HIP JOINT (WITH ARTHROGRAPHY) BASE PRICE 344 9470 11840 RADIOLOGY MRI INVESTIGATION MRI HIP JOINT (WITH I.V. CONTRAST) BASE PRICE 343 9470 11840 RADIOLOGY MRI INVESTIGATION MRI HIP JOINT + SCREENING OF S.I. JOINT BASE PRICE 12994 9470 11840 RADIOLOGY MRI INVESTIGATION MRI KNEE JOINT (PLAIN STUDY) SINGLE BASE PRICE 345 6800 8500 RADIOLOGY MRI INVESTIGATION MRI KNEE JOINT (WITH ARTHROGRAPHY) SINGLE BASE PRICE 347 9470 11840 RADIOLOGY MRI INVESTIGATION MRI KNEE JOINT (WITH I.V. CONTRAST) SINGLE BASE PRICE 346 9470 11840 RADIOLOGY MRI INVESTIGATION MRI KUB PLAIN BASE PRICE 12989 8140 10180 RADIOLOGY MRI INVESTIGATION MRI LEG/TIBIA (SINGLE LIMB) CONTRAST BASE PRICE 289 10800 13500 RADIOLOGY MRI INVESTIGATION MRI LEG/TIBIA (SINGLE LIMB) PLAIN BASE PRICE 290 8140 10180 RADIOLOGY MRI INVESTIGATION MRI LIVER - DYNAMIC CONTRAST STUDY BASE PRICE 249 13470 16840 RADIOLOGY MRI INVESTIGATION MRI LIVER / UPPER ABDOMEN PLAIN BASE PRICE 247 8140 10180 RADIOLOGY MRI INVESTIGATION MRI LOWER ABDOMEN CONTRAST BASE PRICE 234 10800 13500 RADIOLOGY MRI INVESTIGATION MRI LOWER ABDOMEN PLAIN BASE PRICE 252 8140 10180 RADIOLOGY MRI INVESTIGATION MRI LS SPINE + SCREENING OF SI JOINTS BASE PRICE 8542 8140 10180 RADIOLOGY MRI INVESTIGATION MRI LUMBAR SPINE (CONTRAST) BASE PRICE 323 9470 11840 RADIOLOGY MRI INVESTIGATION MRI LUMBAR SPINE / LS SPINE (PLAIN) BASE PRICE 321 6800 8500 RADIOLOGY MRI INVESTIGATION MRI LUMBER SPINE WITH SCREENING OF SPINE BASE PRICE 12987 9470 11840 RADIOLOGY MRI INVESTIGATION MRI LUMBOSACRAL SPINE (CONTRAST) BASE PRICE 322 10800 13500 RADIOLOGY MRI INVESTIGATION MRI MISCELLANEOUS SINGLE PART BASE PRICE 8509 6800 8500 RADIOLOGY MRI INVESTIGATION MRI MISCELLANEOUS SINGLE PART WITH CONTRAST BASE PRICE 8510 9470 11840 RADIOLOGY MRI INVESTIGATION MRI NECK (CONTRAST STUDY) BASE PRICE 195 9470 11840 RADIOLOGY MRI INVESTIGATION MRI NECK (PLAIN STUDY) BASE PRICE 194 6800 8500 RADIOLOGY MRI INVESTIGATION MRI NECK ANGIOGRAPHY (CONTRAST STUDY) BASE PRICE 231 8140 10180

Page 103 of 115 RADIOLOGY MRI INVESTIGATION MRI NECK ANGIOGRAPHY (PLAIN STUDY) BASE PRICE 230 5470 6840 RADIOLOGY MRI INVESTIGATION MRI NECK VENOGRAPHY (CONTRAST) BASE PRICE 232 8140 10180 RADIOLOGY MRI INVESTIGATION MRI OF PITUITARY (CONTRAST) BASE PRICE 167 10800 13500 RADIOLOGY MRI INVESTIGATION MRI OF PITUITARY (NON CONTRAST) BASE PRICE 166 8140 10180 RADIOLOGY MRI INVESTIGATION MRI OF TEMPORAL BONES (CONTRAST) BASE PRICE 162 10800 13500 RADIOLOGY MRI INVESTIGATION MRI OF TEMPORAL BONES (NON CONTRAST) BASE PRICE 161 8140 10180 RADIOLOGY MRI INVESTIGATION MRI ORBIT PLAIN BASE PRICE 12990 6800 8500 RADIOLOGY MRI INVESTIGATION MRI ORBITS CONTRAST STUDY BASE PRICE 177 9470 11840 RADIOLOGY MRI INVESTIGATION MRI ORBITS PLAIN STUDY BASE PRICE 176 6800 8500 RADIOLOGY MRI INVESTIGATION MRI PARANASAL SINUSES (CONTRAST) BASE PRICE 185 10140 12680 RADIOLOGY MRI INVESTIGATION MRI PARANASAL SINUSES (PLAIN STUDY) BASE PRICE 184 7480 9350 RADIOLOGY MRI INVESTIGATION MRI PELVIS CONTRAST BASE PRICE 152 10800 13500 RADIOLOGY MRI INVESTIGATION MRI PELVIS PLAIN BASE PRICE 153 8140 10180 RADIOLOGY MRI INVESTIGATION MRI PELVIS WITH SCREENING OF HIP JOINT BASE PRICE 12995 9470 11840 RADIOLOGY MRI INVESTIGATION MRI PULMONARY ANGIOGRAPHY BASE PRICE 236 13470 16840 RADIOLOGY MRI INVESTIGATION MRI SACROILIAC JOINT PLAIN BASE PRICE 12991 6800 8500 RADIOLOGY MRI INVESTIGATION MRI SCROTUM (PLAIN) BASE PRICE 272 6800 8500 RADIOLOGY MRI INVESTIGATION MRI SHOULDER JOINT (PLAIN STUDY) SINGLE BASE PRICE 326 6800 8500 RADIOLOGY MRI INVESTIGATION MRI SHOULDER JOINT (WITH ARTHROGRAPHY) SINGLE BASE PRICE 328 9470 11840 RADIOLOGY MRI INVESTIGATION MRI SHOULDER JOINT (WITH I.V. CONTRAST) SINGLE BASE PRICE 327 9470 11840 RADIOLOGY MRI INVESTIGATION MRI SPINE - CERVICAL (CONTRAST) BASE PRICE 309 9470 11840 RADIOLOGY MRI INVESTIGATION MRI SPINE - CERVICAL (NON CONTRAST) BASE PRICE 308 6800 8500 RADIOLOGY MRI INVESTIGATION MRI THIGH/FEMUR (SINGLE) CONTRAST BASE PRICE 291 10800 13500 RADIOLOGY MRI INVESTIGATION MRI THIGH/FEMUR (SINGLE) PLAIN BASE PRICE 292 8140 10180 RADIOLOGY MRI INVESTIGATION MRI UPPER ABDOMEN CONTRAST BASE PRICE 281 10800 13500 RADIOLOGY MRI INVESTIGATION MRI UPPER ABDOMEN PLAIN BASE PRICE 282 8140 10180 RADIOLOGY MRI INVESTIGATION MRI VENOGRAPHY ABDOMEN (UPPER OR LOWER) BASE PRICE 159 13470 16840 RADIOLOGY MRI INVESTIGATION MRI VENOGRAPHY PERIPHERAL (UPPER OR LOWER LIMB) SINGLE BASE PRICE 304 13470 16840 RADIOLOGY MRI INVESTIGATION MRI WHOLE ABDOMEN PLAIN BASE PRICE 12988 16280 20350 RADIOLOGY MRI INVESTIGATION MRI WRIST (PLAIN STUDY) SINGLE BASE PRICE 331 6800 8500 RADIOLOGY MRI INVESTIGATION MRI WRIST (WITH ARTHROGRAPHY) SINGLE BASE PRICE 333 9470 11840 RADIOLOGY MRI INVESTIGATION MRI WRIST (WITH I.V. CONTRAST) SINGLE BASE PRICE 332 9470 11840 RADIOLOGY MRI INVESTIGATION MRS BASE PRICE 12999 2310 2890 RADIOLOGY MRI INVESTIGATION MRU (MRI - UROGRAPHY / MR PELOGRAPHY) BASE PRICE 8508 8140 10180 RADIOLOGY MRI INVESTIGATION MRV BASE PRICE 12998 2310 2890 RADIOLOGY MRI INVESTIGATION REVIEW/COMPARE WITH OUTSIDE MRI (PER STUDY) BASE PRICE 8520 670 840 RADIOLOGY MRI INVESTIGATION TO ADD MR ANGIOGRAM OR MR VENOGRAM WITHOUT CONTRAST BASE PRICE 11841 2670 3340 RADIOLOGY MRI INVESTIGATION WHOLE BODY LOW DOSE CT SCANNING BASE PRICE 13173 12600 15750 RADIOLOGY RADIOLOGY PROCEDURES CT GUIDED BIOPSY BASE PRICE 13180 10670 13340 RADIOLOGY RADIOLOGY PROCEDURES CT GUIDED FNAC BASE PRICE 13181 5330 6660 RADIOLOGY RADIOLOGY PROCEDURES CT GUIDED LIVER ABSCESS ASPIRATION BASE PRICE 13182 10670 13340 RADIOLOGY RADIOLOGY PROCEDURES CT GUIDED LIVER ABSCESS PCD BASE PRICE 13183 10670 13340 RADIOLOGY RADIOLOGY PROCEDURES DSA - CRANIAL DIAGNOSTIC BASE PRICE 13184 20010 25010 RADIOLOGY RADIOLOGY PROCEDURES DSA - CRANIAL THERAPEUTIC (PROCEDURE CHARGE) BASE PRICE 13185 26680 33350 RADIOLOGY RADIOLOGY PROCEDURES DSA - GA THERAPEUTIC (PROCEDURE CHARGE) BASE PRICE 13186 26680 33350 RADIOLOGY RADIOLOGY PROCEDURES DSA - GI DIAGNOSTIC BASE PRICE 13187 20010 25010 RADIOLOGY RADIOLOGY PROCEDURES DSA - HEPATIC VEIN STENTING (PROCEDURE CHARGE) BASE PRICE 13188 26680 33350 RADIOLOGY RADIOLOGY PROCEDURES DSA - PERIPHERAL ANGIOGRAM DIAGNOSTIC BASE PRICE 13189 20010 25010

Page 104 of 115 RADIOLOGY RADIOLOGY PROCEDURES DSA - PERIPHERAL ANGIOGRAM THERAPEUTIC (PROCEDURE CHARGE) BASE PRICE 13190 26680 33350 RADIOLOGY RADIOLOGY PROCEDURES DSA - RENAL DIAGNOSTIC BASE PRICE 13191 20010 25010 RADIOLOGY RADIOLOGY PROCEDURES DSA - RENAL THERAPEUTIC (PROCEDURE CHARGE) BASE PRICE 13192 26680 33350 RADIOLOGY RADIOLOGY PROCEDURES DSA - TRANS ARTERIAL CHEMO EMBOLISATION (PROCEDURE CHARGE) BASE PRICE 13193 26680 33350 RADIOLOGY RADIOLOGY PROCEDURES DSA - UTERINE ARTERY EMBOLISATION (PROCEDURE CHARGE) BASE PRICE 13194 26680 33350 RADIOLOGY RADIOLOGY PROCEDURES DSA - VENOGRAPHY DIAGNOSTIC BASE PRICE 13195 20010 25010 RADIOLOGY RADIOLOGY PROCEDURES INTERVENTION - BILLARY STENTING (PROCEDURE CHARGE) BASE PRICE 13196 14550 18190 RADIOLOGY RADIOLOGY PROCEDURES INTERVENTION - PCD (PROCEDURE CHARGE) BASE PRICE 13197 2910 3640 RADIOLOGY RADIOLOGY PROCEDURES INTERVENTION - PCN (PROCEDURE CHARGE) BASE PRICE 13198 2910 3640 RADIOLOGY RADIOLOGY PROCEDURES INTERVENTION - PTBD (PROCEDURE CHARGE) BASE PRICE 13199 6670 8340 RADIOLOGY RADIOLOGY PROCEDURES INTERVENTION - SCLEROTHERAPY BASE PRICE 13200 7280 9100 RADIOLOGY RADIOLOGY PROCEDURES INTERVENTION - USG GUIDED ASCITIS TAP (DIAGNOSTIC) BASE PRICE 13201 1460 1830 RADIOLOGY RADIOLOGY PROCEDURES INTERVENTION - USG GUIDED DRAINAGE BASE PRICE 13202 2910 3640 RADIOLOGY RADIOLOGY PROCEDURES INTERVENTION - USG GUIDED FNAC BASE PRICE 13203 1460 1830 RADIOLOGY RADIOLOGY PROCEDURES INTERVENTION - USG GUIDED IJV CATHETERIZATION BASE PRICE 13204 1460 1830 RADIOLOGY RADIOLOGY PROCEDURES INTERVENTION - USG GUIDED PLEURAL TAP (DIAGNOSTIC) BASE PRICE 13205 1460 1830 RADIOLOGY RADIOLOGY PROCEDURES INTERVENTION - USG GUIDED RENAL/LIVER/MASS BIOPSY BASE PRICE 13206 2910 3640 RADIOLOGY RADIOLOGY PROCEDURES INTERVENTION - VERTEBRO PLASTY BASE PRICE 13207 21830 27290 RADIOLOGY RADIOLOGY PROCEDURES INTERVENTION-ANTEGRADE URETERIC STENTING (PROCEDURE CHARGE) BASE PRICE 13208 7280 9100 RADIOLOGY RADIOLOGY PROCEDURES PARACOLIC GUTTER COLLECTION PERCUTANEOUS DRINAGE(CT GUIDED) BASE PRICE 13209 10670 13340 RADIOLOGY RADIOLOGY PROCEDURES PERCUTANEOUS CHOLECYSTOSTOMY(CT GUIDED) BASE PRICE 13210 21230 26540 RADIOLOGY RADIOLOGY PROCEDURES PERCUTANEOUS NEPHROSTOMY(CT GUIDED) BASE PRICE 13211 10670 13340 RADIOLOGY RADIOLOGY PROCEDURES PERCUTANEOUS PERIHEPATIC COLLECTION PERCUTANEOUS DRAINAGE(CT GUIDED)BASE PRICE 13212 10670 13340 RADIOLOGY RADIOLOGY PROCEDURES PERCUTANEOUS TRANSHEPATIC BILIARY DRAINAGE(CT GUIDED) BASE PRICE 13213 21230 26540 RADIOLOGY RADIOLOGY PROCEDURES PSOAS ABSCESS PERCUTANEOUS DRINAGE(CT GUIDED) BASE PRICE 13214 10670 13340 RADIOLOGY RADIOLOGY PROCEDURES TRANS-GASTRIC PERCUTANEOUS CYSTO-GASTROSTOMY(CT GUIDED) BASE PRICE 13215 21230 26540 RADIOLOGY RADIOLOGY PROCEDURES TRANS-GASTRIC PSUDOCYST ASPIRATION(CT GUIDED) BASE PRICE 13216 10670 13340 RADIOLOGY RADIOLOGY PROCEDURES TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT(CT GUIDED) BASE PRICE 13217 21230 26540 RADIOLOGY ULTRASOUND INVESTIGATION BILATERAL ILIAC ARTERIAL AND VENOUS DOPPLER BASE PRICE 12468 3640 4550 RADIOLOGY ULTRASOUND INVESTIGATION COLOR DOPPLER CAROTIDS BASE PRICE 136 2040 2550 RADIOLOGY ULTRASOUND INVESTIGATION COLOR DOPPLER FETAL BASE PRICE 712 1460 1830 RADIOLOGY ULTRASOUND INVESTIGATION COLOR DOPPLER FOR AV FISTULA BASE PRICE 732 1170 1460 RADIOLOGY ULTRASOUND INVESTIGATION COLOR DOPPLER FOR SPLENO-PORTAL AXIS BASE PRICE 733 2330 2910 RADIOLOGY ULTRASOUND INVESTIGATION COLOR DOPPLER IVC/HEPATIC/PORTAL BASE PRICE 137 2330 2910 RADIOLOGY ULTRASOUND INVESTIGATION COLOR DOPPLER RENAL BASE PRICE 139 2910 3640 RADIOLOGY ULTRASOUND INVESTIGATION COLOR DOPPLER SINGLE UPPER LIMB (ARTERIAL AND VENOUS) BASE PRICE 718 4650 5810 RADIOLOGY ULTRASOUND INVESTIGATION COLOR DOPPLER SINGLE UPPER LIMB (ARTERIAL OR VENOUS) BASE PRICE 717 2330 2910 RADIOLOGY ULTRASOUND INVESTIGATION COLOUR DOPPLER BOTH LOWER LIMBS ARTERIAL BASE PRICE 2493 4650 5810 RADIOLOGY ULTRASOUND INVESTIGATION COLOUR DOPPLER BOTH LOWER LIMBS VENOUS BASE PRICE 2494 4650 5810 RADIOLOGY ULTRASOUND INVESTIGATION COLOUR DOPPLER BOTH UPPER LIMBS ARTERIAL BASE PRICE 665 4650 5810 RADIOLOGY ULTRASOUND INVESTIGATION COLOUR DOPPLER BOTH UPPER LIMBS VENOUS BASE PRICE 666 4650 5810 RADIOLOGY ULTRASOUND INVESTIGATION COLOUR DOPPLER FOR TESTIS (SCROTUM) BASE PRICE 669 1090 1360 RADIOLOGY ULTRASOUND INVESTIGATION COLOUR DOPPLER OBSTETRICS (PREGNANCY) BASE PRICE 668 1460 1830 RADIOLOGY ULTRASOUND INVESTIGATION COLOUR DOPPLER SINGLE LOWER LIMB (ARTERIAL AND VENOUS) BASE PRICE 667 4650 5810 RADIOLOGY ULTRASOUND INVESTIGATION COLOUR DOPPLER SINGLE LOWER LIMB (ARTERIAL OR VENOUS) BASE PRICE 719 2330 2910 RADIOLOGY ULTRASOUND INVESTIGATION COLOUR DOPPLER ULTRASOUND THYROID OR BREAST BASE PRICE 2495 1170 1460 RADIOLOGY ULTRASOUND INVESTIGATION EXTRA CD CHARGES BASE PRICE 743 150 190 RADIOLOGY ULTRASOUND INVESTIGATION INTERVENTION - VARICOSE VEIN TREATMENT (FOAM SCLEROTHERAPY) BASE PRICE 8527 2910 3640

Page 105 of 115 RADIOLOGY ULTRASOUND INVESTIGATION INTERVENTION - VARICOSE VEIN TREATMENT (RFA - PROCEDURE CHARGE) BASE PRICE 8528 14550 18190 RADIOLOGY ULTRASOUND INVESTIGATION ULTRASOUND OPHTHALMIC BASE PRICE 605 720 900 RADIOLOGY ULTRASOUND INVESTIGATION ULTRASOUND THYROID BASE PRICE 610 720 900 RADIOLOGY ULTRASOUND INVESTIGATION USG - BOTH BREAST (SONOMAMMOGRAPHY) BASE PRICE 713 1820 2280 RADIOLOGY ULTRASOUND INVESTIGATION USG - CHEST/THORAX FOR PLEURAL FLUID BASE PRICE 671 1460 1830 RADIOLOGY ULTRASOUND INVESTIGATION USG - FACE/CHEEK (WITH COLOR DOPPLER) BASE PRICE 655 1460 1830 RADIOLOGY ULTRASOUND INVESTIGATION USG - FOLLICULAR STUDY BASE PRICE 602 1460 1830 RADIOLOGY ULTRASOUND INVESTIGATION USG - KUB REGION BASE PRICE 604 720 900 RADIOLOGY ULTRASOUND INVESTIGATION USG - LOWER ABDOMEN/PELVIS BASE PRICE 657 720 900 RADIOLOGY ULTRASOUND INVESTIGATION USG - PREGNANCY + BIOPHYSICAL PROFILE (SINGLE FETUS) BASE PRICE 672 1460 1830 RADIOLOGY ULTRASOUND INVESTIGATION USG - PREGNANCY + BIOPHYSICAL PROFILE + COLOUR DOPPLER BASE PRICE 673 2910 3640 RADIOLOGY ULTRASOUND INVESTIGATION USG - PREGNANCY BIOPHYSICAL SCORE (SINGLE) BASE PRICE 722 1460 1830 RADIOLOGY ULTRASOUND INVESTIGATION USG - PREGNANCY DOPPLER (SINGLE) BASE PRICE 723 1460 1830 RADIOLOGY ULTRASOUND INVESTIGATION USG - PREGNANCY DOPPLER (TWINS) BASE PRICE 724 2180 2730 RADIOLOGY ULTRASOUND INVESTIGATION USG - PREGNANCY FOLLOWUP (SCREENING ONLY) BASE PRICE 714 440 550 RADIOLOGY ULTRASOUND INVESTIGATION USG - PREGNANCY ROUTINE (FIRST TRIMESTER) BASE PRICE 662 720 900 RADIOLOGY ULTRASOUND INVESTIGATION USG - PREGNANCY ROUTINE (SECOND & THIRD TRIMESTER) BASE PRICE 661 970 1210 RADIOLOGY ULTRASOUND INVESTIGATION USG - SCROTUM BASE PRICE 682 720 900 RADIOLOGY ULTRASOUND INVESTIGATION USG - SCROTUM (WITH COLOR DOPPLER) BASE PRICE 607 870 1090 RADIOLOGY ULTRASOUND INVESTIGATION USG - SINGLE BREAST BASE PRICE 600 970 1210 RADIOLOGY ULTRASOUND INVESTIGATION USG - SOFT TISSUE (THYROID/NECK/PAROTID/FACE) BASE PRICE 670 1170 1460 RADIOLOGY ULTRASOUND INVESTIGATION USG - TIFFA (SINGLE FETUS) BASE PRICE 728 2430 3040 RADIOLOGY ULTRASOUND INVESTIGATION USG - TIFFA (TWINS FETUS) BASE PRICE 729 2910 3640 RADIOLOGY ULTRASOUND INVESTIGATION USG - TRANSCRANIAL BASE PRICE 730 1170 1460 RADIOLOGY ULTRASOUND INVESTIGATION USG - TRANSRECTAL BASE PRICE 611 970 1210 RADIOLOGY ULTRASOUND INVESTIGATION USG - TRANSVAGINAL (TVS) BASE PRICE 731 970 1210 RADIOLOGY ULTRASOUND INVESTIGATION USG - UPPER ABDOMEN / HEPATO-BILIARY BASE PRICE 603 720 900 RADIOLOGY ULTRASOUND INVESTIGATION USG - WHOLE ABDOMEN BASE PRICE 613 1020 1280 RADIOLOGY ULTRASOUND INVESTIGATION USG ABDOMEN (BED-SIDE) BASE PRICE 674 1740 2180 RADIOLOGY ULTRASOUND INVESTIGATION USG JOINT BASE PRICE 12380 970 1210 RADIOLOGY ULTRASOUND INVESTIGATION USG PELVIS + KUB BASE PRICE 12378 970 1210 RADIOLOGY ULTRASOUND INVESTIGATION USG PREGNANCY (NT & NB SCAN 12 WEEKS) BASE PRICE 12377 1460 1830 RADIOLOGY ULTRASOUND INVESTIGATION USG PREGNANCY ROUTINE FOR TWINS BASE PRICE 12381 1220 1530 RADIOLOGY ULTRASOUND INVESTIGATION USG SCREEN FOLLOW-UP BASE PRICE 12379 610 760 RADIOLOGY X-RAY INVESTIGATION DUPLICATE FILM CHARGES X-RAY PER FILM BASE PRICE 744 210 260 RADIOLOGY X-RAY INVESTIGATION OPG - OrthoPentoGram BASE PRICE 7361 700 880 RADIOLOGY X-RAY INVESTIGATION X RAY (SINGLE VIEW) ANY PART BASE PRICE 114 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY - ABDOMEN KUB & LATERAL (2 VIEWS) BASE PRICE 616 570 710 RADIOLOGY X-RAY INVESTIGATION X RAY - ABDOMEN LATERAL (SINGLE VIEW) BASE PRICE 617 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY - ANKLE AP VIEW (SINGLE VIEW) BASE PRICE 687 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY - ANKLE JOINT AP & LATERAL (2 VIEWS) BASE PRICE 654 570 710 RADIOLOGY X-RAY INVESTIGATION X RAY - ANKLE LATERAL (SINGLE VIEW) BASE PRICE 688 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY - BARIUM ENEMA DOUBLE CONTRAST BASE PRICE 735 2100 2630 RADIOLOGY X-RAY INVESTIGATION X RAY - BARIUM ENEMA SINGLE CONTRAST BASE PRICE 736 1680 2100 RADIOLOGY X-RAY INVESTIGATION X RAY - BARIUM MEAL (UGI) BASE PRICE 737 1400 1750 RADIOLOGY X-RAY INVESTIGATION X RAY - BARIUM MEAL FOLLOW THROUGH (BMFT) BASE PRICE 691 2100 2630 RADIOLOGY X-RAY INVESTIGATION X RAY - BARIUM SWALLOW OF ESOPHAGUS BASE PRICE 738 1110 1390 RADIOLOGY X-RAY INVESTIGATION X RAY - BOTH HANDS (AP & LATERAL) (4 VIEWS) BASE PRICE 635 1110 1390

Page 106 of 115 RADIOLOGY X-RAY INVESTIGATION X RAY - BOTH KNEE (AP & LATERAL) (4 VIEWS) BASE PRICE 659 1110 1390 RADIOLOGY X-RAY INVESTIGATION X RAY - CERVICAL SPINE AP & LATERAL (2 VIEWS) BASE PRICE 620 570 710 RADIOLOGY X-RAY INVESTIGATION X RAY - CERVICAL SPINE BOTH OBLIQUES (2 VIEWS) BASE PRICE 621 570 710 RADIOLOGY X-RAY INVESTIGATION X RAY - CERVICAL SPINE LATERAL (SINGLE VIEW) BASE PRICE 623 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY - CERVICAL SPINE SINGLE VIEW (AP OR LATERAL OR OBLIQUE) BASE PRICE 117 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY - CERVICAL SPINE TRANSLATERAL (SINGLE VIEW) BASE PRICE 624 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY - CEVICAL SPINE LATERAL FLEXION & EXTENSION (2 VIEWS) BASE PRICE 622 570 710 RADIOLOGY X-RAY INVESTIGATION X RAY - CHEST (SINGLE VIEW) BASE PRICE 625 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY - CHEST AP (SINGLE VIEW) BASE PRICE 626 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY - CHEST AP PENETRATED BASE PRICE 118 270 340 RADIOLOGY X-RAY INVESTIGATION X RAY - CHEST BED SIDE (SINGLE VIEW) BASE PRICE 119 670 840 RADIOLOGY X-RAY INVESTIGATION X RAY - CHEST LATERAL (SINGLE VIEW) BASE PRICE 628 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY - CHEST LATERAL DECUBITUS (SINGLE VIEW) BASE PRICE 629 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY - CHEST PA & LATERAL (2 VIEWS) BASE PRICE 631 570 710 RADIOLOGY X-RAY INVESTIGATION X RAY - CHEST PA (SINGLE VIEW) BASE PRICE 630 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY - DORSAL SPINE AP & LATERAL (2 VIEWS) BASE PRICE 633 570 710 RADIOLOGY X-RAY INVESTIGATION X RAY - DORSAL SPINE AP (SINGLE VIEW) BASE PRICE 632 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY - DORSAL SPINE LATERAL (SINGLE VIEW) BASE PRICE 634 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY - ELBOW JOINT AP & LATERAL (2 VIEWS) BASE PRICE 656 570 710 RADIOLOGY X-RAY INVESTIGATION X RAY - ERECT ABDOMEN (SINGLE VIEW) BASE PRICE 710 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY - FOOT AP & LATERAL (2 VIEWS) BASE PRICE 652 570 710 RADIOLOGY X-RAY INVESTIGATION X RAY - FOOT AP VIEW (SINGLE VIEW) BASE PRICE 689 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY - FOOT LATERAL (SINGLE VIEW) BASE PRICE 690 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY - HAND AP (SINGLE VIEW) BASE PRICE 698 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY - HAND LATERAL (SINGLE VIEW) BASE PRICE 699 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY - HIP JOINT AP & LATERAL (2 VIEWS) BASE PRICE 708 570 710 RADIOLOGY X-RAY INVESTIGATION X RAY - HIP JOINT AP (SINGLE VIEW) BASE PRICE 706 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY - HIP JOINT LATERAL (SINGLE VIEW) BASE PRICE 707 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY - KNEE AP & LATERAL (2 VIEWS) BASE PRICE 660 570 710 RADIOLOGY X-RAY INVESTIGATION X RAY - KNEE SKYLINE (SINGLE VIEW) BASE PRICE 697 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY - LEG AP & LATERAL (2 VIEWS) BASE PRICE 694 570 710 RADIOLOGY X-RAY INVESTIGATION X RAY - LUMBAR SPINE AP & LATERAL (2 VIEWS) BASE PRICE 658 570 710 RADIOLOGY X-RAY INVESTIGATION X RAY - LUMBAR SPINE BOTH OBLIQUES (2 VIEWS) BASE PRICE 637 570 710 RADIOLOGY X-RAY INVESTIGATION X RAY - PELVIS AP (SINGLE VIEW) BASE PRICE 122 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY - PELVIS PA (SINGLE VIEW) BASE PRICE 123 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY - SI JOINTS (SINGLE VIEW) BASE PRICE 124 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY - STENTOGRAM BASE PRICE 596 1110 1390 RADIOLOGY X-RAY INVESTIGATION X RAY - T-TUBE CHOLANGIOGRAPHY BASE PRICE 597 1110 1390 RADIOLOGY X-RAY INVESTIGATION X RAY - THIGH AP & LATERAL VIEW (SINGLE VIEW) BASE PRICE 692 700 880 RADIOLOGY X-RAY INVESTIGATION X RAY - THIGH AP OR LATERAL (SINGLE VIEW) BASE PRICE 727 430 540 RADIOLOGY X-RAY INVESTIGATION X RAY - WRIST AP & LATERAL (2 VIEWS) BASE PRICE 704 570 710 RADIOLOGY X-RAY INVESTIGATION X RAY - WRIST AP (SINGLE VIEW) BASE PRICE 702 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY ABDOMEN DECUBITUS BASE PRICE 115 270 340 RADIOLOGY X-RAY INVESTIGATION X RAY ABDOMEN KUB BASE PRICE 116 270 340 RADIOLOGY X-RAY INVESTIGATION X RAY DIGITAL MAMMOGRAPHY B/L (BOTH BREAST) (4 VIEWS) BASE PRICE 642 1400 1750 RADIOLOGY X-RAY INVESTIGATION X RAY DIGITAL MAMMOGRAPHY SINGLE BREAST (2 VIEWS) BASE PRICE 693 700 880 RADIOLOGY X-RAY INVESTIGATION X RAY FISTULOGRAPHY/SINOGRAPHY BASE PRICE 141 840 1050 RADIOLOGY X-RAY INVESTIGATION X RAY HSG/GENITOGRAM BASE PRICE 142 1400 1750

Page 107 of 115 RADIOLOGY X-RAY INVESTIGATION X RAY IVP/UROGRAPHY BASE PRICE 143 1680 2100 RADIOLOGY X-RAY INVESTIGATION X RAY LOOPOGRAPHY BASE PRICE 144 1400 1750 RADIOLOGY X-RAY INVESTIGATION X RAY LUMBAR SPINE - SINGLE VIEW (AP OR LATERAL) BASE PRICE 127 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY MAMMOGRAPHY (EXTRA VIEW PER FILM) BASE PRICE 643 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY MCU OR RGU BASE PRICE 145 1110 1390 RADIOLOGY X-RAY INVESTIGATION X RAY PNS AP & LATERAL (2 VIEWS) BASE PRICE 686 570 710 RADIOLOGY X-RAY INVESTIGATION X RAY PNS LATERAL BASE PRICE 685 270 340 RADIOLOGY X-RAY INVESTIGATION X RAY PNS WATERS VIEW (SINGLE VIEW) BASE PRICE 684 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY SHOULDER JOINT AP & LATERAL (VIEWS) BASE PRICE 653 570 710 RADIOLOGY X-RAY INVESTIGATION X RAY SHOULDER JOINT AP (SINGLE VIEW) BASE PRICE 663 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY SHOULDER JOINT LATERAL (SINGLE VIEW) BASE PRICE 664 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY SINGLE HAND AP & LATERAL (2 VIEWS) BASE PRICE 700 570 710 RADIOLOGY X-RAY INVESTIGATION X RAY SINGLE WRIST AP & LATERAL (2 VIEWS) BASE PRICE 705 570 710 RADIOLOGY X-RAY INVESTIGATION X RAY SINGLE WRIST LATERAL VIEW (SINGLE VIEW) BASE PRICE 703 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY SKULL - SINGLE VIEW (AP OR LATERAL) BASE PRICE 125 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY SKULL AP & LATERAL (2 VIEWS) BASE PRICE 647 570 710 RADIOLOGY X-RAY INVESTIGATION X RAY SKULL AP (SINGLE VIEW) BASE PRICE 646 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY SKULL BOTH MASTOIDS LATERAL OBLIQUE (2 VIEWS) BASE PRICE 648 570 710 RADIOLOGY X-RAY INVESTIGATION X RAY SKULL BOTH OPTIC FORAMINA (2 VIEWS) BASE PRICE 649 570 710 RADIOLOGY X-RAY INVESTIGATION X RAY SKULL LATERAL (SINGLE VIEW) BASE PRICE 650 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY SKULL OM (SINGLE VIEW) BASE PRICE 695 360 450 RADIOLOGY X-RAY INVESTIGATION X RAY STANDING ABDOMEN SINGLE VIEW (AP OR LATERAL) BASE PRICE 126 360 450 RADIOLOGY X-RAY INVESTIGATION X-RAY ANY PART BESIDE AP/LAT BASE PRICE 11937 1110 1390 RADIOLOGY X-RAY INVESTIGATION X-RAY ARM AP/LAT BASE PRICE 11930 570 710 RADIOLOGY X-RAY INVESTIGATION X-RAY BOTH S.I.JOINT OBLIQUE VIEW BASE PRICE 11935 570 710 RADIOLOGY X-RAY INVESTIGATION X-RAY CERVICAL SPINE FLEXION/EXTENSION BASE PRICE 11931 570 710 RADIOLOGY X-RAY INVESTIGATION X-RAY CHEST PA VIEW (WITHOUT FILM) BASE PRICE 11993 360 450 RADIOLOGY X-RAY INVESTIGATION X-RAY FOREARN AP/LAT BASE PRICE 11929 570 710 RADIOLOGY X-RAY INVESTIGATION X-RAY LUMBO-SACRAL SPINE FLEXION/EXTENSION BASE PRICE 11932 570 710 RADIOLOGY X-RAY INVESTIGATION X-RAY NECK AP/LAT BASE PRICE 11933 570 710 RADIOLOGY X-RAY INVESTIGATION X-RAY NECK FOR ADENOIDS BASE PRICE 11934 360 450 RADIOLOGY X-RAY INVESTIGATION X-RAY SINGLE VIEW BED SIDE BASE PRICE 11936 570 710 SAHARA HOSPITAL-DCDC NEPHROLOGY INVESTIGATION KIDNEY DONOR WORK UP CHARGES BASE PRICE 12213 10000 0 SAHARA HOSPITAL-DCDC NEPHROLOGY INVESTIGATION KIDNEY RECIPIENT WORK UP CHARGES BASE PRICE 12214 10000 0 SAHARA HOSPITAL-DCDC NEPHROLOGY IPD PACKAGES RENAL TRANSPLANT PACKAGE (DONOR) BASE PRICE 12385 120000 0 SAHARA HOSPITAL-DCDC NEPHROLOGY IPD PACKAGES RENAL TRANSPLANT PACKAGE (RECIPIENT) BASE PRICE 12384 280000 0 SAHARA HOSPITAL-DCDC NEPHROLOGY PROCEDURES ACUTE PERITONEAL DIALYSIS BASE PRICE 5271 3000 0 SAHARA HOSPITAL-DCDC NEPHROLOGY PROCEDURES AMBULATORY PERITONEAL DIALYSIS TRAINING BASE PRICE 5286 9000 0 SAHARA HOSPITAL-DCDC NEPHROLOGY PROCEDURES ARTERIOVENOUS FISTULA (AVF) SURGERY BASE PRICE 5266 7500 0 SAHARA HOSPITAL-DCDC NEPHROLOGY PROCEDURES ARTERIOVENOUS SHUNT (AVS) SURGERY BASE PRICE 5267 5500 0 SAHARA HOSPITAL-DCDC NEPHROLOGY PROCEDURES AV SHUNT REMOVAL SURGERY BASE PRICE 5268 1100 0 SAHARA HOSPITAL-DCDC NEPHROLOGY PROCEDURES BEDSIDE HEMODIALYSIS BASE PRICE 5285 3000 0 SAHARA HOSPITAL-DCDC NEPHROLOGY PROCEDURES CAPD CATHETER INSERTION BASE PRICE 5269 5500 0 SAHARA HOSPITAL-DCDC NEPHROLOGY PROCEDURES CAPD CATHETER REMOVAL BASE PRICE 5270 2200 0 SAHARA HOSPITAL-DCDC NEPHROLOGY PROCEDURES CENTRAL LINE BASE PRICE 5275 2750 0 SAHARA HOSPITAL-DCDC NEPHROLOGY PROCEDURES CENTRAL LINE INSERTION UNDER ULTRASOUND BASE PRICE 5276 3000 0 SAHARA HOSPITAL-DCDC NEPHROLOGY PROCEDURES CONTINUOUS RENAL REPLACEMENT THERAPY (CRRT) FOR 24 HOURS BASE PRICE 5278 6000 0 SAHARA HOSPITAL-DCDC NEPHROLOGY PROCEDURES CONTINUOUS RENAL REPLACEMENT THERAPY (CRRT) FOR NEXT 24 HOURS BASE PRICE 5279 3000 0

Page 108 of 115 SAHARA HOSPITAL-DCDC NEPHROLOGY PROCEDURES CUFFED HEMODIALYSIS CATHETER INSERTION BASE PRICE 5284 5500 0 SAHARA HOSPITAL-DCDC NEPHROLOGY PROCEDURES CYCLER PERITONEAL DIALYSIS PER DAY BASE PRICE 5277 2750 0 SAHARA HOSPITAL-DCDC NEPHROLOGY PROCEDURES DIALYSIS FEMORAL CATHETERIZATION - BILATERAL BASE PRICE 5287 7700 0 SAHARA HOSPITAL-DCDC NEPHROLOGY PROCEDURES DOUBLE LUMEN FEMORAL CATHETERIZATION (PACKAGE) BASE PRICE 5280 4000 0 SAHARA HOSPITAL-DCDC NEPHROLOGY PROCEDURES DOUBLE LUMEN JUGULAR CATHETERIZATION (PACKAGE) BASE PRICE 5281 5000 0 SAHARA HOSPITAL-DCDC NEPHROLOGY PROCEDURES EMERGENCY ACUTE PERITONEAL DIALYSIS BASE PRICE 5272 3000 0 SAHARA HOSPITAL-DCDC NEPHROLOGY PROCEDURES EMERGENCY HEMODIALYSIS (WITH REUSE DIALYZER) BASE PRICE 5262 3000 0 SAHARA HOSPITAL-DCDC NEPHROLOGY PROCEDURES EMERGENCY SLOW LOW EFFICIENCY DIALYSIS (SLED) BASE PRICE 5264 2000 0 SAHARA HOSPITAL-DCDC NEPHROLOGY PROCEDURES HEMODIALYSIS CONSUMABLES ONLY PACKAGE BASE PRICE 12266 1540 0 SAHARA HOSPITAL-DCDC NEPHROLOGY PROCEDURES HEMODIALYSIS FOR HEPATITIS B,C BASE PRICE 12267 3200 0 SAHARA HOSPITAL-DCDC NEPHROLOGY PROCEDURES HEMODIALYSIS WITH AVF WITH NEW DIALYZER (PACKAGE) BASE PRICE 5283 3500 0 SAHARA HOSPITAL-DCDC NEPHROLOGY PROCEDURES HEMODIALYSIS WITH AVF WITH REUSE DIALYZER (PACKAGE) BASE PRICE 5282 1850 0 SAHARA HOSPITAL-DCDC NEPHROLOGY PROCEDURES HEMODIALYSIS WITH AVF WITH REUSE DIALYZER AND NEW TUBING BASE PRICE 12270 1950 0 SAHARA HOSPITAL-DCDC NEPHROLOGY PROCEDURES INTERNAL JUGLAR CATHETERIZATION FOR DIALYSIS BASE PRICE 5274 1000 0 SAHARA HOSPITAL-DCDC NEPHROLOGY PROCEDURES KIDNEY BIOPSY BASE PRICE 5273 6000 0 SAHARA HOSPITAL-DCDC NEPHROLOGY PROCEDURES NEPHROLOGIST PATIENT MANAGEMENT FEES (RENAL TRANSPLANT) BASE PRICE 12389 40000 0 SAHARA HOSPITAL-DCDC NEPHROLOGY PROCEDURES SLOW LOW EFFICIENCY DIALYSIS (SLED) BASE PRICE 5263 3000 0 SAHARA HOSPITAL-DCDC NEPHROLOGY PROCEDURES SURGICAL REMOVAL OF PERMACATH BASE PRICE 12265 1100 0 SAHARA HOSPITAL-DCDC NEPHROLOGY PROCEDURES TRANSPLANT BIOPSY BASE PRICE 5288 5000 0 SAHARA HOSPITAL-DCDC NEPHROLOGY PROCEDURES TRIPLE LUMEN FEMORAL, INSERTION BASE PRICE 12268 4500 0 SAHARA HOSPITAL-DCDC NEPHROLOGY PROCEDURES TRIPLE LUMEN JUGLAR, INSERTION BASE PRICE 12269 5000 0 TRANSFUSION MEDICINE &BLOOD BLOOD BANK BANK INVESTIGATION ANTI-D TITRE BASE PRICE 3018 750 0 TRANSFUSION MEDICINE &BLOOD BLOOD BANK BANK INVESTIGATION ANTIBODY IDENTIFICATION BASE PRICE 13032 600 0 TRANSFUSION MEDICINE &BLOOD BLOOD BANK BANK INVESTIGATION ANTIBODY SCREENING BASE PRICE 13024 300 0 TRANSFUSION MEDICINE &BLOOD BLOOD BANK BANK INVESTIGATION BLOOD GROUP ABO & RH (D) BASE PRICE 3023 300 0 TRANSFUSION MEDICINE &BLOOD BLOOD BANK BANK INVESTIGATION COLD AGGLUTININ WITH TITRE BASE PRICE 3019 1250 0 TRANSFUSION MEDICINE &BLOOD BLOOD BANK BANK INVESTIGATION COOMBS TEST -DIRECT BASE PRICE 13022 300 0 TRANSFUSION MEDICINE &BLOOD BLOOD BANK BANK INVESTIGATION COOMBS TEST -INDIRECT BASE PRICE 13023 300 0 TRANSFUSION MEDICINE &BLOOD BLOOD BANK BANK INVESTIGATION EXTENDED PHENOTYPING (COMPLETE) BASE PRICE 13031 3000 0 TRANSFUSION MEDICINE &BLOOD BLOOD BANK BANK INVESTIGATION EXTENDED PHENOTYPING (RH & KELL) BASE PRICE 13025 250 0 TRANSFUSION MEDICINE &BLOOD BLOOD BANK BANK INVESTIGATION NEONATE TYPE & SCREEN (PHENOTYPING RH (EXTENDED) & KELL) BASE PRICE 13043 850 0 TRANSFUSION MEDICINE &BLOOD BLOOD BANK BANK INVESTIGATION NEW BORN GROUPING WITH DCT BASE PRICE 3024 600 0 TRANSFUSION MEDICINE &BLOOD BLOOD BANK BANK INVESTIGATION PATIENT TYPE & SCREEN (PHENOTYPING RH (EXTENDED) & KELL) BASE PRICE 13027 850 0 TRANSFUSION MEDICINE &BLOOD BLOOD BANK BANK INVESTIGATION SALIVA GROUPING BASE PRICE 3025 1250 0 TRANSFUSION MEDICINE &TRANSFUSION BLOOD BANK MEDICINE & BLOOD BANK OTHERBASIC BILLING PROCESSING CHARGES - PLATELET CONCENTRATE BASE PRICE 12650 400 0 TRANSFUSION MEDICINE &TRANSFUSION BLOOD BANK MEDICINE & BLOOD BANK OTHERBASIC BILLING PROCESSING CHARGES - PRBC BASE PRICE 12647 1450 0 TRANSFUSION MEDICINE &TRANSFUSION BLOOD BANK MEDICINE & BLOOD BANK OTHERBASIC BILLING PROCESSING CHARGES FRESH FROZEN PLASMA (FFP) BASE PRICE 12652 400 0 TRANSFUSION MEDICINE &TRANSFUSION BLOOD BANK MEDICINE & BLOOD BANK OTHERBASIC BILLING PROCESSING CHARGES WHOLE BLOOD BASE PRICE 12654 1450 0 TRANSFUSION MEDICINE &TRANSFUSION BLOOD BANK MEDICINE & BLOOD BANK OTHERCROSS BILLING MATCHING (AUTOMATED) BASE PRICE 13033 280 0 TRANSFUSION MEDICINE &TRANSFUSION BLOOD BANK MEDICINE & BLOOD BANK OTHERCRYO BILLING POOR PLASMA (CPP) BASE PRICE 3005 900 0 TRANSFUSION MEDICINE &TRANSFUSION BLOOD BANK MEDICINE & BLOOD BANK OTHERCRYO BILLING PRECIPETATE (CPPT) BASE PRICE 3004 250 0 TRANSFUSION MEDICINE &TRANSFUSION BLOOD BANK MEDICINE & BLOOD BANK OTHERFFP BILLING NAT BASE PRICE 13035 425 0 FFP- ADDITIONAL PROCESSING CHARGES (CHEM-166,AB SCREEN (DONOR)- TRANSFUSION MEDICINE &TRANSFUSION BLOOD BANK MEDICINE & BLOOD BANK OTHER50,QUAD BILLING BAGS-100,NAT-425) BASE PRICE 12653 741 0 TRANSFUSION MEDICINE &TRANSFUSION BLOOD BANK MEDICINE & BLOOD BANK OTHERHES BILLING BASE PRICE 11605 397 0 PC-ADDITIONAL PROCESSING CHARGES(CHEM-166,Ab SCR-50,BACTERIAL DETC- TRANSFUSION MEDICINE &TRANSFUSION BLOOD BANK MEDICINE & BLOOD BANK OTHER400,QUAD BILLING BAGS-150),NAT-175) BASE PRICE 12651 941 0 TRANSFUSION MEDICINE &TRANSFUSION BLOOD BANK MEDICINE & BLOOD BANK OTHERPC-NAT BILLING BASE PRICE 13036 175 0

Page 109 of 115 TRANSFUSION MEDICINE &TRANSFUSION BLOOD BANK MEDICINE & BLOOD BANK OTHERPLATELET BILLING APHERESIS PROCESSING CHARGES BASE PRICE 12657 11000 0 PRBC-ADDI.PROCES.CHARGES(CHEM-166,ABSCR.-200,LEUCOFLT-REDCELL- TRANSFUSION MEDICINE &TRANSFUSION BLOOD BANK MEDICINE & BLOOD BANK OTHER1000,QUAD BILLING BAGS-150),PHENO-250,NAT-600) BASE PRICE 12648 2366 0 TRANSFUSION MEDICINE &TRANSFUSION BLOOD BANK MEDICINE & BLOOD BANK OTHERPRBC-NAT BILLING BASE PRICE 13034 600 0

PRELI SCREEN(CBC)-440,SCREEN (INFECT MARKER,ANTIBODY,GROUPING,X- TRANSFUSION MEDICINE &TRANSFUSION BLOOD BANK MEDICINE & BLOOD BANK OTHERMATCH)-920,Ab BILLING SCREEN (RECIPIENT)-300 BASE PRICE 12661 1660 0 TRANSFUSION MEDICINE &TRANSFUSION BLOOD BANK MEDICINE & BLOOD BANK OTHERPRELIMINARY BILLING SCREENING (CBC) BASE PRICE 12658 440 0 TRANSFUSION MEDICINE &TRANSFUSION BLOOD BANK MEDICINE & BLOOD BANK OTHERSCREENING BILLING (INFECTIOUS MARKER, ANTIBODY,GROUPING,CROSS MATCHING) BASE PRICE 12659 920 0 TRANSFUSION MEDICINE &TRANSFUSION BLOOD BANK MEDICINE & BLOOD BANK OTHERSTERILE BILLING CONNECTION BASE PRICE 3030 150 0 TRANSFUSION MEDICINE &TRANSFUSION BLOOD BANK MEDICINE & BLOOD BANK OTHERTRANSFER BILLING BAG BASE PRICE 3013 130 0 TRANSFUSION MEDICINE &TRANSFUSION BLOOD BANK MEDICINE & BLOOD BANK OTHERTRANSPORTATION BILLING BOXES BASE PRICE 11606 150 0 WB-ADDITIONAL PROCESSING CHARGES (CHEM-500,AB SCREEN (DONOR)-300 TRANSFUSION MEDICINE &TRANSFUSION BLOOD BANK MEDICINE & BLOOD BANK OTHER,PHENOTYPING BILLING (DONOR)-250,NAT-1200) BASE PRICE 12655 2250 0 TRANSFUSION MEDICINE &TRANSFUSION BLOOD BANK MEDICINE & BLOOD BANK PROCEDURESGRANULOCYTE HARVESTING BASE PRICE 11604 15000 0 TRANSFUSION MEDICINE &TRANSFUSION BLOOD BANK MEDICINE & BLOOD BANK PROCEDURESLEUCAPHERESIS BASE PRICE 3031 15000 0 TRANSFUSION MEDICINE &TRANSFUSION BLOOD BANK MEDICINE & BLOOD BANK PROCEDURESPLASMA EXCHANGE BASE PRICE 3021 16000 0 TRANSFUSION MEDICINE &TRANSFUSION BLOOD BANK MEDICINE & BLOOD BANK PROCEDURESRED CELL EXCHANGE BASE PRICE 12473 15000 0 TRANSFUSION MEDICINE &TRANSFUSION BLOOD BANK MEDICINE & BLOOD BANK PROCEDURESSTEM CELL PROCESSING CHARGES BASE PRICE 3029 15000 0 TRANSFUSION MEDICINE &TRANSFUSION BLOOD BANK MEDICINE & BLOOD BANK PROCEDURESTHERAPEUTIC PHELEBOTOMY BASE PRICE 3012 400 0 UROLOGY UROLOGY INVESTIGATION URODYNAMIC STUDY BASE PRICE 1186 4440 0 UROLOGY UROLOGY PROCEDURES BCG INSTILLATION BASE PRICE 7115 980 0 UROLOGY UROLOGY PROCEDURES CALIBRATION BASE PRICE 7128 980 0 UROLOGY UROLOGY PROCEDURES CATHETERISATION BASE PRICE 7130 850 0 UROLOGY UROLOGY PROCEDURES CIC (CLEAN INTERMITTENT CATHETERISATION) BASE PRICE 7129 980 0 UROLOGY UROLOGY PROCEDURES CYSTOSCOPY (CPE) BASE PRICE 7121 8380 0 UROLOGY UROLOGY PROCEDURES D J STENT REMOVAL (DJR) BASE PRICE 7135 5590 0 UROLOGY UROLOGY PROCEDURES EPS BASE PRICE 7143 1060 0 UROLOGY UROLOGY PROCEDURES FLEXIBLE CYSTOSCOPY BASE PRICE 12788 9240 0 UROLOGY UROLOGY PROCEDURES INTRACAVERNOSAL INJECTION BASE PRICE 7151 1060 0 UROLOGY UROLOGY PROCEDURES INTRAOPERATIVE BLADDER INJURY REPAIR BASE PRICE 12790 23100 0 UROLOGY UROLOGY PROCEDURES MCU (MICTURATING CYSTOURETHROGRAM) BASE PRICE 7276 1400 0 UROLOGY UROLOGY PROCEDURES MEATOTOMY BASE PRICE 7277 6990 0 UROLOGY UROLOGY PROCEDURES MICROSURGICAL VARICOCELECTOMY BASE PRICE 12787 23100 0 UROLOGY UROLOGY PROCEDURES NO SCALPEL VASECTOMY BASE PRICE 12791 17330 0 UROLOGY UROLOGY PROCEDURES PAN ANTERIOR URETHRAL STRICTURE (SINGLE STAGE) BASE PRICE 12785 46200 0 UROLOGY UROLOGY PROCEDURES PANANTERIOR URETHRAL STRICTURE (FIRST STAGE) BASE PRICE 12786 28880 0 UROLOGY UROLOGY PROCEDURES PARAPHIMOSIS BASE PRICE 7189 6990 0 UROLOGY UROLOGY PROCEDURES PELVIC LYMPH NODE DISSECTION BASE PRICE 12792 23100 0 UROLOGY UROLOGY PROCEDURES RGU (RETROGRADE URETHROGRAM) BASE PRICE 7286 700 0 UROLOGY UROLOGY PROCEDURES RGU (RETROGRADE URETHROGRAM)+ MCU BASE PRICE 7287 2790 0 UROLOGY UROLOGY PROCEDURES TEFLON URETHRAL DILATATION & CYSTOSCOPY BASE PRICE 12789 13860 0 UROLOGY UROLOGY PROCEDURES TRUCUT PROSTATE BIOPSY BASE PRICE 7306 2790 0 UROLOGY UROLOGY PROCEDURES URETHRAL DILATATION (OPD) BASE PRICE 7249 6990 0 UROLOGY UROLOGY PROCEDURES URETHROSCOPY BASE PRICE 7329 2790 0 UROLOGY UROLOGY PROCEDURES UROFLOWMETRY BASE PRICE 7254 420 0 UROLOGY UROLOGY SURGERY A V FISTULA - COMPLEX BASE PRICE 7105 15160 25 UROLOGY UROLOGY SURGERY A V FISTULA - SIMPLE BASE PRICE 7104 12130 25

Page 110 of 115 UROLOGY UROLOGY SURGERY AMBIGOUS GENITALIA REPAIR BASE PRICE 7102 36380 25 UROLOGY UROLOGY SURGERY ANTEGRADE STENTING BASE PRICE 7106 8490 25 UROLOGY UROLOGY SURGERY AORTO-RENAL BYPASS (SURGERY FOR RENOVASCULAR HTN) BASE PRICE 7100 54580 25 UROLOGY UROLOGY SURGERY ARTEFICIAL SPHINCTOR IMPLANTATION BASE PRICE 7103 45480 25 UROLOGY UROLOGY SURGERY AUGMENTATION CYSTOPLASTY BASE PRICE 7101 38810 25 UROLOGY UROLOGY SURGERY BALLON DILATATION OF URETER BASE PRICE 7266 8490 25 UROLOGY UROLOGY SURGERY BIOPSY OF BLADDER (CYSTOSCOPIC) BASE PRICE 7325 9700 25 UROLOGY UROLOGY SURGERY BLADDER DIVERTICULECTOMY BASE PRICE 7108 21830 25 UROLOGY UROLOGY SURGERY BLADDER EXTROPHY REPAIR BASE PRICE 7111 42450 25 UROLOGY UROLOGY SURGERY BLADDER NECK RECONSTRUCTION BASE PRICE 7109 43660 25 UROLOGY UROLOGY SURGERY BLADDER REPAIR OPEN BASE PRICE 7112 19400 25 UROLOGY UROLOGY SURGERY BLADDER WASH WITH CLOT EVACUATION BASE PRICE 7110 12130 25 UROLOGY UROLOGY SURGERY BNI (TUIP) BASE PRICE 7114 13350 25 UROLOGY UROLOGY SURGERY BORIE`S FLAP BASE PRICE 7107 27290 25 UROLOGY UROLOGY SURGERY BOTOX INJECTION BASE PRICE 7113 14330 25 UROLOGY UROLOGY SURGERY CAPD INSERTION BASE PRICE 7127 12130 25 UROLOGY UROLOGY SURGERY CAPD REMOVAL BASE PRICE 7126 10920 25 UROLOGY UROLOGY SURGERY CHECK CYSTOSCOPY (CPE) BASE PRICE 7120 6070 25 UROLOGY UROLOGY SURGERY CIRCUMCISION BASE PRICE 7124 7280 25 UROLOGY UROLOGY SURGERY CLOSURE OF URETHRAL FISTULA BASE PRICE 7309 10920 25 UROLOGY UROLOGY SURGERY CUTANEOUS URETEROSTOMY B/L BASE PRICE 7117 19400 25 UROLOGY UROLOGY SURGERY CUTANEOUS URETEROSTOMY U/L BASE PRICE 7116 13350 25 UROLOGY UROLOGY SURGERY CYSTOCEL REPAIR WITH MESH BASE PRICE 7125 21830 25 UROLOGY UROLOGY SURGERY CYSTOLITHOLAPAXY BASE PRICE 7119 16540 25 UROLOGY UROLOGY SURGERY CYSTOLITHOTOMY BASE PRICE 7118 12130 25 UROLOGY UROLOGY SURGERY CYSTOSCOPY (CPE) BASE PRICE 12354 7280 25 UROLOGY UROLOGY SURGERY CYSTOSTOMY OPEN BASE PRICE 7122 9700 25 UROLOGY UROLOGY SURGERY D J STENT REMOVAL (DJR) (DONE IN OT) BASE PRICE 8455 4850 25 UROLOGY UROLOGY SURGERY D J STENT REMOVAL (DJR) - BILATERAL BASE PRICE 7313 7280 25 UROLOGY UROLOGY SURGERY DEFLUX INJECTION BASE PRICE 7136 11030 25 UROLOGY UROLOGY SURGERY DEFLUX INJECTION B/L BASE PRICE 7307 16540 25 UROLOGY UROLOGY SURGERY DILATATION OF STRICTURE URETHRA UNDER GA BASE PRICE 7305 6070 25 UROLOGY UROLOGY SURGERY DIVERTICULAR EXCISION BASE PRICE 7131 21830 25 UROLOGY UROLOGY SURGERY DJ STENTING B/L BASE PRICE 7134 13230 25 UROLOGY UROLOGY SURGERY DJ STENTING U/L BASE PRICE 7133 7720 25 UROLOGY UROLOGY SURGERY DONOR NEPHRECTOMY BASE PRICE 7132 36380 25 UROLOGY UROLOGY SURGERY DVIU (OPTICAL URETHROTOMY, OIU) BASE PRICE 7137 11030 25 UROLOGY UROLOGY SURGERY ENDOPYELOTOMY AANTEGRADE BASE PRICE 7140 18200 25 UROLOGY UROLOGY SURGERY ENDOPYELOTOMY RETROGRADE BASE PRICE 7268 18200 25 UROLOGY UROLOGY SURGERY EPIDIDYMECTOMY BASE PRICE 7141 13350 25 UROLOGY UROLOGY SURGERY EPISPADIAS -CRIPPLED EPISPAEDIAS BASE PRICE 7330 31530 25 UROLOGY UROLOGY SURGERY EPISPADIAS -EXTROPHY REPAIR BASE PRICE 7142 27290 25 UROLOGY UROLOGY SURGERY EXTENDED PYELOLITHOTOMY BASE PRICE 7314 27900 25 UROLOGY UROLOGY SURGERY EXTROPHY MULTSTAGE REPAIR BASE PRICE 7269 30320 25 UROLOGY UROLOGY SURGERY FILARIAL SCROTUM (EXCISION AND GRAFTING) BASE PRICE 7144 27290 25 UROLOGY UROLOGY SURGERY FRENULOPLASTY BASE PRICE 7145 3640 25 UROLOGY UROLOGY SURGERY HOLEP (HOLMIUM LASER PROSTATECTOMY) / OIU BASE PRICE 7270 42450 25 UROLOGY UROLOGY SURGERY HYDROCELE B/L BASE PRICE 7148 13230 25

Page 111 of 115 UROLOGY UROLOGY SURGERY HYDROCELE UNILATERAL BASE PRICE 7147 11030 25 UROLOGY UROLOGY SURGERY HYDRODISTENTION OF BLADDER BASE PRICE 7146 8490 25 UROLOGY UROLOGY SURGERY HYPOSPADIAS REPAIR BASE PRICE 7149 19400 25 UROLOGY UROLOGY SURGERY HYPSPADIAS - SECOND STAGE REPAIR BASE PRICE 7271 19400 25 UROLOGY UROLOGY SURGERY HYPSPADIAS CRIPPLED BASE PRICE 7272 20620 25 UROLOGY UROLOGY SURGERY ILEAL CONDUIT BASE PRICE 7152 38810 25 UROLOGY UROLOGY SURGERY ILEAL REPLACEMENT OF URETER BASE PRICE 7150 44100 25 UROLOGY UROLOGY SURGERY ILEO CAECO CYSTOPLASTY BASE PRICE 7340 38810 25 UROLOGY UROLOGY SURGERY INTERL URETHROTOMY -CORE THROUGH URETHROPLASTY BASE PRICE 7328 12130 25 UROLOGY UROLOGY SURGERY LAPARASCOPIC BOARIE`S FLAP BASE PRICE 7154 33080 25 UROLOGY UROLOGY SURGERY LAPARASCOPIC VAULT PROLAPSE REPAIR WITH MESH BASE PRICE 7163 45480 25 UROLOGY UROLOGY SURGERY LAPARASCOPIC VERICOCELECTOMY B/L BASE PRICE 7274 26680 25 UROLOGY UROLOGY SURGERY LAPAROSCOPIC BLADDER DIVERTICULECTOMY BASE PRICE 7153 36380 25 UROLOGY UROLOGY SURGERY LAPAROSCOPIC LYMPHOCELE DRAINAGE BASE PRICE 7159 25470 25 UROLOGY UROLOGY SURGERY LAPAROSCOPIC NEPHROURETERECTOMY BASE PRICE 7273 44100 25 UROLOGY UROLOGY SURGERY LAPAROSCOPIC ORCHIECTOMY BASE PRICE 7162 26680 25 UROLOGY UROLOGY SURGERY LAPAROSCOPIC ORCHIOPEXY B/L BASE PRICE 7161 36380 25 UROLOGY UROLOGY SURGERY LAPAROSCOPIC ORCHIOPEXY U/L BASE PRICE 7160 27900 25 UROLOGY UROLOGY SURGERY LAPAROSCOPIC PARTIAL CYSTECOMTY BASE PRICE 7165 46080 25 UROLOGY UROLOGY SURGERY LAPAROSCOPIC PYELOLITHOTOMY BASE PRICE 7164 37600 25 UROLOGY UROLOGY SURGERY LAPAROSCOPIC PYELOPLASTY BASE PRICE 7166 38810 25 UROLOGY UROLOGY SURGERY LAPAROSCOPIC RADICAL CYSTECTOMY BASE PRICE 7170 72770 25 UROLOGY UROLOGY SURGERY LAPAROSCOPIC RADICAL NEPHRECOMY BASE PRICE 7169 40030 25 UROLOGY UROLOGY SURGERY LAPAROSCOPIC RADICAL PROSTATECTOMY BASE PRICE 7171 49610 25 UROLOGY UROLOGY SURGERY LAPAROSCOPIC RENAL BIOPSY BASE PRICE 7155 24260 25 UROLOGY UROLOGY SURGERY LAPAROSCOPIC SIMPLE NEPHRECTOMY BASE PRICE 7172 36380 25 UROLOGY UROLOGY SURGERY LAPAROSCOPIC URETERIC REIMPLANTATION B/L BASE PRICE 7175 45480 25 UROLOGY UROLOGY SURGERY LAPAROSCOPIC URETERIC REIMPLANTATION U/L BASE PRICE 7174 36380 25 UROLOGY UROLOGY SURGERY LAPAROSCOPIC URETEROLITHOTOMY BASE PRICE 7173 27900 25 UROLOGY UROLOGY SURGERY LAPAROSCOPIC URETEROLYSIS (RPF) BASE PRICE 7176 27290 25 UROLOGY UROLOGY SURGERY LAPAROSCOPIC V V F REPAIR BASE PRICE 7178 44100 25 UROLOGY UROLOGY SURGERY LAPAROSCOPIC VERICOCELECTOMY - BILATERAL BASE PRICE 7334 26680 25 UROLOGY UROLOGY SURGERY LAPAROSCOPIC VERICOCELECTOMY U/L BASE PRICE 7177 21830 25 UROLOGY UROLOGY SURGERY LAPAROSCOPY DIAGNOSTIC BASE PRICE 7158 24260 25 UROLOGY UROLOGY SURGERY LAPROSCOPIC CYST DECORTICATION BASE PRICE 7156 27900 25 UROLOGY UROLOGY SURGERY LAPROSCOPIC DONOR NEPHRECTOMY BASE PRICE 7157 54580 25 UROLOGY UROLOGY SURGERY LAPROSCOPIC NEPHROLITHOMY BASE PRICE 7333 36380 25 UROLOGY UROLOGY SURGERY LAPROSCOPIC PARTIAL NEPHRECTOMY BASE PRICE 7167 49610 25 UROLOGY UROLOGY SURGERY LAPROSCOPIC PYELOLYMPHATIC DISCONNECTION BASE PRICE 7168 36380 25 UROLOGY UROLOGY SURGERY LAY OPEN AND PERINEAL URETHROSTOMY BASE PRICE 7179 24260 25 UROLOGY UROLOGY SURGERY LITHOLAPEXY BASE PRICE 7318 14550 25 UROLOGY UROLOGY SURGERY LYMPHOCELE POST TRANSPLANT BASE PRICE 7275 18200 25 UROLOGY UROLOGY SURGERY MEATOPLASTY BASE PRICE 7182 9700 25 UROLOGY UROLOGY SURGERY MODIFIED INGUINAL LYMPH NODE DISSECTION B/L BASE PRICE 7181 36380 25 UROLOGY UROLOGY SURGERY MODIFIED INGUINAL LYMPH NODE DISSECTION U/L BASE PRICE 7180 27290 25 UROLOGY UROLOGY SURGERY NEPHRECTOMY SIMPLE OPEN BASE PRICE 7183 24260 25 UROLOGY UROLOGY SURGERY NEPHROLITHOMY OPEN BASE PRICE 7322 27900 25 UROLOGY UROLOGY SURGERY NEPHROSTOMY OPEN BASE PRICE 7184 18200 25

Page 112 of 115 UROLOGY UROLOGY SURGERY NEPHROURETERECTOMY B/L (NATIVE) BASE PRICE 7279 26680 25 UROLOGY UROLOGY SURGERY NEPHROURETERECTOMY OPEN BASE PRICE 7278 33080 25 UROLOGY UROLOGY SURGERY OPEN PROSTATECTOMY BASE PRICE 7324 18200 25 UROLOGY UROLOGY SURGERY OPERATIONS FOR EPISPADIAS BASE PRICE 7321 24260 25 UROLOGY UROLOGY SURGERY OPERATIONS FOR EXTROPHY OF THE BLADDER- SIMPLE CYSTECTOMY WITH URINARYBASE DIVERSION PRICE 7331 33960 25 UROLOGY UROLOGY SURGERY OPERATIONS FOR HYPOSPADIAS + CHORDEE CORRECTION BASE PRICE 7332 19400 25 UROLOGY UROLOGY SURGERY OPERATIONS FOR INCONTINENCE OF URINE - FEMALE-BULKING AGENT BASE PRICE 7337 12130 25 UROLOGY UROLOGY SURGERY OPERATIONS FOR INCONTINENCE OF URINE - MALE-BULKING AGENT BASE PRICE 7338 12130 25 UROLOGY UROLOGY SURGERY OPERATIONS FOR VESICO- URETERIC REFLUX BASE PRICE 7326 27900 25 UROLOGY UROLOGY SURGERY OPTICAL URETHROTOMY BASE PRICE 7320 8490 25 UROLOGY UROLOGY SURGERY ORCHIECTOMY INGUINAL B/L BASE PRICE 7188 18200 25 UROLOGY UROLOGY SURGERY ORCHIECTOMY SIMPLE B/L BASE PRICE 7187 16540 25 UROLOGY UROLOGY SURGERY ORCHIECTOMY U/L BASE PRICE 7280 11030 25 UROLOGY UROLOGY SURGERY ORCHIOPEXY OPEN B/L BASE PRICE 7186 24260 25 UROLOGY UROLOGY SURGERY ORCHIOPEXY OPEN U/L BASE PRICE 7185 19850 25 UROLOGY UROLOGY SURGERY PARTIAL CYSTECTOMY OPEN BASE PRICE 7201 27290 25 UROLOGY UROLOGY SURGERY PARTIAL NEPHRECTOMY OPEN BASE PRICE 7195 38590 25 UROLOGY UROLOGY SURGERY PARTIAL PENECTOMY BASE PRICE 7202 19400 25 UROLOGY UROLOGY SURGERY PCNL B/L BASE PRICE 7281 26680 25 UROLOGY UROLOGY SURGERY PCNL LARGE STONE / STAGHORN BASE PRICE 7193 26680 25 UROLOGY UROLOGY SURGERY PCNL MEDIUM STONE BASE PRICE 7192 22050 25 UROLOGY UROLOGY SURGERY PCNL SMALL STONE BASE PRICE 7191 16540 25 UROLOGY UROLOGY SURGERY PENILE CURVATURE SURGERY BASE PRICE 7205 27290 25 UROLOGY UROLOGY SURGERY PENILE FRACTURE REPAIR BASE PRICE 7203 19850 25 UROLOGY UROLOGY SURGERY PENILE IMPLANT BASE PRICE 7204 36380 25 UROLOGY UROLOGY SURGERY PERCUTANEOUS CYSTOLITHOTRIPSY (PCLT) BASE PRICE 7200 16540 25 UROLOGY UROLOGY SURGERY PERCUTANEOUS NEPHROSTOMY (PCN) BASE PRICE 7197 6070 25 UROLOGY UROLOGY SURGERY PERINEAL URETHROSTOMY BASE PRICE 7319 18200 25 UROLOGY UROLOGY SURGERY PERINEPHRIC AND RENAL ABSCESS DRAINAGE (OPEN) BASE PRICE 7198 19400 25 UROLOGY UROLOGY SURGERY PERINEPHRIC AND RENAL ABSCESS DRAINAGE (PERCUTANEOUS) BASE PRICE 7199 9090 25 UROLOGY UROLOGY SURGERY POSTERIOR URETHRAL VALVE FULGRATION BASE PRICE 7282 13230 25 UROLOGY UROLOGY SURGERY PYELOLITHOTOMY OPEN BASE PRICE 7190 25470 25 UROLOGY UROLOGY SURGERY PYELOLYMPHATIC DISCONNECTION BASE PRICE 7196 25470 25 UROLOGY UROLOGY SURGERY PYELOPLASTY OPEN BASE PRICE 7194 26680 25 UROLOGY UROLOGY SURGERY RADICAL CYSTECTOMY WITH ILEAL CONDUIT BASE PRICE 7212 49610 25 UROLOGY UROLOGY SURGERY RADICAL CYSTECTOMY WITH ORTHOTOPIC BLADDER BASE PRICE 7211 54580 25 UROLOGY UROLOGY SURGERY RADICAL ILIO-INGUINAL LYMPH NODE DISSECTION B/L BASE PRICE 7215 54580 25 UROLOGY UROLOGY SURGERY RADICAL ILIO-INGUINAL LYMPH NODE DISSECTION U/L BASE PRICE 7214 36380 25 UROLOGY UROLOGY SURGERY RADICAL NEPHRECTOMY + IV THROMBUS BASE PRICE 7283 42450 25 UROLOGY UROLOGY SURGERY RADICAL NEPHRECTOMY OPEN BASE PRICE 7206 30320 25 UROLOGY UROLOGY SURGERY RADICAL NEPHRECTOMY PLUS IV THROMBUS PLUS CARDIAC BYPASS BASE PRICE 7284 60640 25 UROLOGY UROLOGY SURGERY RADICAL PROSTATECTOMY OPEN BASE PRICE 7216 38590 25 UROLOGY UROLOGY SURGERY RENAL BIOPSY BASE PRICE 7210 7280 25 UROLOGY UROLOGY SURGERY RENAL CYST DECORTICATION - OPEN BASE PRICE 7335 24260 25 UROLOGY UROLOGY SURGERY RENAL CYST EXCISION BASE PRICE 7208 24260 25 UROLOGY UROLOGY SURGERY RENAL TRANSPLANT RECIPIENT BASE PRICE 7209 72770 25 UROLOGY UROLOGY SURGERY REPAIR OF URETEROCOEL -OPEN BASE PRICE 7339 21830 25 UROLOGY UROLOGY SURGERY RETROPERITONEAL LYMPH NODE DISSECTION BASE PRICE 7213 54580 25

Page 113 of 115 UROLOGY UROLOGY SURGERY RETROPERITONEOSCOPY NEPHROLITHOTOMY BASE PRICE 7323 36380 25 UROLOGY UROLOGY SURGERY RETROPERITONEOSCOPY NEPHRECTOMY BASE PRICE 7289 30320 25 UROLOGY UROLOGY SURGERY RETROPERITONEOSCOPY NEPHROURETERECTOMY BASE PRICE 7295 36380 25 UROLOGY UROLOGY SURGERY RETROPERITONEOSCOPY PARTIAL NEPHRECTOMY BASE PRICE 7290 38810 25 UROLOGY UROLOGY SURGERY RETROPERITONEOSCOPY PYELOLITHOTOMY BASE PRICE 7291 27900 25 UROLOGY UROLOGY SURGERY RETROPERITONEOSCOPY PYELOPLASTY BASE PRICE 7292 30320 25 UROLOGY UROLOGY SURGERY RETROPERITONEOSCOPY RENAL CYST DECORTICATION BASE PRICE 7293 27900 25 UROLOGY UROLOGY SURGERY RETROPERITONEOSCOPY URETEROLITHOTOMY BASE PRICE 7294 26680 25 UROLOGY UROLOGY SURGERY RETROPUBIC PROSTATATECOMY OPEN BASE PRICE 7288 18200 25 UROLOGY UROLOGY SURGERY RGP BASE PRICE 7207 7280 25 UROLOGY UROLOGY SURGERY RGP B/L BASE PRICE 7285 9700 25 UROLOGY UROLOGY SURGERY SALVAGE CYSTECTOMY BASE PRICE 7217 36380 25 UROLOGY UROLOGY SURGERY SCROTAL EXPLORATION BASE PRICE 7218 9090 25 UROLOGY UROLOGY SURGERY SECONDARY SUTURING UNDER GA BASE PRICE 7222 7280 25 UROLOGY UROLOGY SURGERY SECONDARY SUTURING UNDER LOCAL BASE PRICE 7223 3640 25 UROLOGY UROLOGY SURGERY SIGMOID VAGINOPLASTY BASE PRICE 7221 36380 25 UROLOGY UROLOGY SURGERY SIMPLE CYSTECTOMY BASE PRICE 7336 21830 25 UROLOGY UROLOGY SURGERY SLING FOR STRESS URINARY INCONTINENCE (FEMALE) BASE PRICE 7220 22050 25 UROLOGY UROLOGY SURGERY SLING SURGERY (MALE) BASE PRICE 7219 25360 25 UROLOGY UROLOGY SURGERY SUPRAPUBIC PROSTATECTOMY OPEN BASE PRICE 7296 14550 25 UROLOGY UROLOGY SURGERY SVG BASE PRICE 7308 6070 25 UROLOGY UROLOGY SURGERY TESTICULAR BIOPSY BASE PRICE 7230 7280 25 UROLOGY UROLOGY SURGERY TESTICULAR PROSTHESIS IMPLANT BASE PRICE 7231 10920 25 UROLOGY UROLOGY SURGERY TORSION TESTIS B/L BASE PRICE 7229 21830 25 UROLOGY UROLOGY SURGERY TORSION TESTIS U/L BASE PRICE 7228 14550 25 UROLOGY UROLOGY SURGERY TOTAL PELVIC FLOOR REPAIR WITH MESH BASE PRICE 7237 36380 25 UROLOGY UROLOGY SURGERY TOTAL PENECTOMY BASE PRICE 7232 36380 25 UROLOGY UROLOGY SURGERY TRANSPLANT NEPHRECTOMY BASE PRICE 7299 30320 25 UROLOGY UROLOGY SURGERY TROCAR CYSTOSTOMY BASE PRICE 7224 9700 25 UROLOGY UROLOGY SURGERY TRUCUT PROSTATE BIOPSY BASE PRICE 12507 2670 25 UROLOGY UROLOGY SURGERY TRUS GUIDED PROSTATE BIOPSY BASE PRICE 7233 9700 25 UROLOGY UROLOGY SURGERY TURBT LARGE BASE PRICE 7227 24260 25 UROLOGY UROLOGY SURGERY TURBT MEDIUM BASE PRICE 7226 19850 25 UROLOGY UROLOGY SURGERY TURBT SMALL BASE PRICE 7225 14550 25 UROLOGY UROLOGY SURGERY TURP AND TURBT BASE PRICE 7298 25470 25 UROLOGY UROLOGY SURGERY TURP LARGE BASE PRICE 7236 27560 25 UROLOGY UROLOGY SURGERY TURP MEDIUM BASE PRICE 7235 22050 25 UROLOGY UROLOGY SURGERY TURP SMALL BASE PRICE 7234 16540 25 UROLOGY UROLOGY SURGERY TURP WITH CYSTOLITHOTRIPSY BASE PRICE 7297 25470 25 UROLOGY UROLOGY SURGERY URETEONEOCYSTOSTOMY WITH URETERIC TAILORING BASE PRICE 7245 27290 25 UROLOGY UROLOGY SURGERY URETERIC BASKETING BASE PRICE 7311 6070 25 UROLOGY UROLOGY SURGERY URETERIC CATHTERISATION (B/L) BASE PRICE 7310 9700 25 UROLOGY UROLOGY SURGERY URETERIC CATHTERISATION (U/L) BASE PRICE 7302 6070 25 UROLOGY UROLOGY SURGERY URETERIC REIMPLANTATION B/L BASE PRICE 7243 27290 25 UROLOGY UROLOGY SURGERY URETERIC REIMPLANTATION U/L BASE PRICE 7242 18200 25 UROLOGY UROLOGY SURGERY URETEROCALYCOSTOMY OPEN BASE PRICE 7300 24260 25 UROLOGY UROLOGY SURGERY URETEROCELE INCISION B/L BASE PRICE 7248 16540 25 UROLOGY UROLOGY SURGERY URETEROCELE INCISION U/L BASE PRICE 7247 11030 25

Page 114 of 115 UROLOGY UROLOGY SURGERY URETEROCELE REPAIR OPEN BASE PRICE 7301 19400 25 UROLOGY UROLOGY SURGERY URETEROLITHOTOMY OPEN BASE PRICE 7240 18200 25 UROLOGY UROLOGY SURGERY URETEROLYSIS (RPF) UNILATERAL BASE PRICE 7244 27290 25 UROLOGY UROLOGY SURGERY URETEROLYSIS - BILATERAL BASE PRICE 7315 30320 25 UROLOGY UROLOGY SURGERY URETEROSCOPY DIAGNOSTIC (URS) BASE PRICE 7238 10920 25 UROLOGY UROLOGY SURGERY URETEROSCOPY THERAPEUTIC (URSL) BASE PRICE 7239 19850 25 UROLOGY UROLOGY SURGERY URETEROSIGMOID ANASTOMOSIS BASE PRICE 7246 36380 25 UROLOGY UROLOGY SURGERY URETEROURETEROSTOMY BASE PRICE 7241 19400 25 UROLOGY UROLOGY SURGERY URETHRAL DILATATION BASE PRICE 12386 6670 25 UROLOGY UROLOGY SURGERY URETHRAL RECONSTRUCTION BASE PRICE 7327 18200 25 UROLOGY UROLOGY SURGERY URETHROPLASTY BASE PRICE 7250 19400 25 UROLOGY UROLOGY SURGERY URETHROPLASTY - 1ST STAGE BASE PRICE 7316 18200 25 UROLOGY UROLOGY SURGERY URETHROPLASTY - BUCCAL MUCOSA BASE PRICE 7253 30320 25 UROLOGY UROLOGY SURGERY URETHROPLASTY - CIRCUMPENILE FLAP BASE PRICE 7252 30320 25 UROLOGY UROLOGY SURGERY URETHROPLASTY - END TO END BASE PRICE 7251 24260 25 UROLOGY UROLOGY SURGERY URETHROPLASTY SECOND STAGE BASE PRICE 7303 18200 25 UROLOGY UROLOGY SURGERY URETROCOLIC ANASTOMOSIS BASE PRICE 7341 21830 25 UROLOGY UROLOGY SURGERY URODYNAMICS - CMG BASE PRICE 7123 4240 25 UROLOGY UROLOGY SURGERY URODYNAMICS - EMG BASE PRICE 7255 4850 25 UROLOGY UROLOGY SURGERY URODYNAMICS - UPP BASE PRICE 7312 3640 25 UROLOGY UROLOGY SURGERY V V F REPAIR BASE PRICE 7257 27290 25 UROLOGY UROLOGY SURGERY VASCULAR PROSTHETIC GRAFT BASE PRICE 7304 7280 25 UROLOGY UROLOGY SURGERY VASECTOMY BASE PRICE 7258 3640 25 UROLOGY UROLOGY SURGERY VASECTOMY REVERSAL - B/L BASE PRICE 7317 12130 25 UROLOGY UROLOGY SURGERY VASECTOMY REVERSAL - U/L BASE PRICE 7267 9700 25 UROLOGY UROLOGY SURGERY VASOVSOSTOMY MICRO BASE PRICE 7259 36380 25 UROLOGY UROLOGY SURGERY VAULT PROLAPSE REPAIR WITH MESH OPEN BASE PRICE 7264 36380 25 UROLOGY UROLOGY SURGERY VERICOCELE OPEN B/L BASE PRICE 7263 18200 25 UROLOGY UROLOGY SURGERY VERICOCELE OPEN UNILATERAL BASE PRICE 7262 14550 25 UROLOGY UROLOGY SURGERY VESICOSTOMY BASE PRICE 7256 18200 25 UROLOGY UROLOGY SURGERY VESOEPIDIDIMOSTOMY B/L MICRO BASE PRICE 7261 54580 25 UROLOGY UROLOGY SURGERY VESOEPIDIMOSTOMY U/L MICRO BASE PRICE 7260 36380 25 UROLOGY UROLOGY SURGERY WOUND EXPLORATION BASE PRICE 7265 3640 25

NOTE: 1. ADDITION AND UPGRADATION OF SERVICES WILL BE APPLICABLE FROM TIME TO TIME AND INFORMED ACCORDINGLY. 2. EXPLANATORY NOTES (OTHER BILLING RULES/ BUSINESS RULES 2019-2020) IS INTEGRAL PART OF THIS SCHEDULE OF CHARGES. 3. PLEASE CHECK AND VERIFY THE SERVICES OF RESPECTIVE DAPARTMENT AS CHARGED IN THE BILL. 4. MANY IPD PACKAGES COST MAY VERY DEPENDING UPON THE PATIENT CONDITION, HOSPITAL STAY, MEDICINE CONSUMED ETC. 5. THIS SCHEDULE OF CHARGES IS VALID UPTO 31.03.2020

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