Schedule of Charges Effective from 01.04.2019

SCHEDULE OF CHARGES EFFECTIVE FROM 01.04.2019

S.NO INDEX PAGE NO 1 INTRODUCTION 1 MANAGEMENT 2 FACILITY AVAILABLE 3 2 ROOM TARRIF /DAY 10 3 REGISTRATION, CONSULTATION & COUNSELINGS 11 REGISTRATION OPD CONSULTATION IPD CONSULTATION SPECIAL COUNSELINGS 4 AMBULANCE CHARGES 14 5 BLOOD TRANSFUSION SERVICES 15 6 EMERGENCY CHARGES 16 7 EQUIPMENT CHARGES 17 8 HEALTH CHECKUP PACKAGES 20 9 LABORATORY SERVICES 21 i) BIO-CHEMISTRY ii) CLINICAL PATHOLOGY iii) HAEMATOLOGY iv) HISTOPATHOLOGY v) MICROBIOLOGY vi) SEROLOGY vii) SPECIAL LAB INVESTIGATIONS 10 OPERATION THEATER CHARGES 42 11 RADIOGRAPHY 43 i) X-RAY ii) BONE DENSITOMETRY iii) ULTRASOUND iv) MRI v) CT SCAN vi) SPECIAL RADIOLOGICAL INVESTIGATIONS 12 REHABILITATION CHARGES 95 - 118 i) PHYSIOTHERAPY ii) REHAB HOME CARE iii) OCCUPATIONAL THERAPY iv) ASSISTIVE TECHNOLOGY v) PSYCHOLOGY PROCEDURES vi) VOCATIONAL THERAPY vii) GERIATRIC CLINIC (ATTENTION & MEMORY) viii) GERIATRIC CLINIC (FALL PREVENTION) ix) GERIATRIC CLINIC (HEART & LUNG) x) GERIATRIC CLINIC (JOINT REPLACEMENT) xi) SHOULDER CLINIC PROCEDURES xii) TELE REHABILITATION

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xiii) GERIATRIC REHAB xiv) ADVANCE REHAB MANAGEMENT xv) TRADITIONAL MEDICINE PROCEDURES PROCEDURES CHARGES 13 ANAESTHESIA PROCEDURE CHARGES 119 14 BEDSIDE PROCEDURES(OPD & IPD) 121 CARDIOLOGY PROCEDURES (WITH INTERVENTIONAL CARDIO 15 128 PACKAGES) 16 DENTAL PROCEDURES 132 i) CONSERVATIVE/RESTORATIVE ii) DENTAL ORAL PROCEDURE iii) ORTHODONTICS 17 DERMATOLOGY PROCEDURES 138 18 DIABETIC FOOT CARE PROCEDURES 139 19 ENT PROCEDURES 140 20 GASTROENTROLOGY PROCEDURES 142 21 INTERNAL MEDICINE PROCEDURES 145 23 GENERAL PROCEDURES 146 22 NEPHROLOGY/DIALYSIS PROCEDURES 147 24 NEUROLOGY PROCEDURES 149 25 OPHTHALMOLOGY PROCEDURES 151 26 PAEDIATRIC PROCEDURES 153 27 PAIN MANAGEMENT PROCEDURES 155 28 RESPIRATORY MED. PROCEDURES 156 29 UROLOGY PROCEDURES 158 SURGERY CHARGES 30 DENTAL SURGERY 160 31 ENT SURGERY 163 32 GENERAL SURGERY 167 33 GYANECOLOGY SURGERY 181 34 NEURO SURGERY 184 35 ORTHOPAEDIC SURGERY 187 36 PAIN MANAGEMENT SURGERY 204 37 PLASTIC SURGERY 208 38 RESPIRATORY SURGERY 214 39 SPINE SURGERY 215 40 UROLOGY SURGERY 222

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INTRODUCTION ISIC Mission Statement and Philosophy-

To become a center of excellence and an apex referral center in Asia.

To set up collaborations with other leading Institutes from around the world and participate in global research in the field of spinal injuries.

To serve the needs of humanity as a whole and deliver the highest quality care to the poorest of the poor.

Indian Spinal Injuries Centre the brainchild of Major HPS Ahluwalia was conceived in the early 1980s and was finally materialized in the year of 1997. A Major in the army, he found himself spinally injured in the Indo-Pak war of September 1965, after his successful climb to Mt. Everest earlier that year in May. Despite the tragedy that confined him to a wheelchair for the rest of his life, hope and courage did not falter as he was shunted from one hospital to other due to the scarcity of spinal injury services in India. He went to the Stoke Mandeville Hospital in the United Kingdom for rehabilitation determined to rebuild his life. A dream that began to realize in the 1990s soon found its motivation to serve its countrymen by catering to spinal injured patients making it a one of a kind institution in the country. A 185 bedded hospital in New Delhi, in collaboration with the Government of Italy through San Raffaele Hospital, Milan is nestled in a vast beautifully landscaped campus that stretches across fifteen acres of land with its own fruit orchards with over 150 trees and 15 varieties of fruit. All the wards are large and airy with a beautiful view of the citrus gardens.The ISIC model is economically sustainable, equitable and replicable in any developing country and has become a popular brand name in rehabilitation program both at global and national level.

ISIC is the most advanced Spine, Orthopedic and Neuromuscular Surgical centre in India with the latest state of the art diagnostics and surgical equipment and a highly qualified team of specialists recognized internationally who have been trained in leading institutes of India and abroad. ISIC is much more than a hospital, it is also considered a training institute and teaching hospital affiliated with the National Board of Examination, internationally recognized leading Board of the country. Among the coveted courses are Fellowship in spine surgery, DNB Courses in anaesthesia and Orthopedic as well as Masters of Physiotherapy, Occupational therapy, Prosthetics and Orthotics among many with the provision of on the job training thus, attracting students from all over the nation.

At ISIC, we seek to provide a comprehensive health care plan for our patients pertaining to all possible needs and requirements that can arise during a patient’s stay with us. We not only provide Neurology, Urology, Joint replacement and Joint disease services to our patients but also provide them with Ophthalmology, Dental, ENT, Plastic surgery, Psychiatry and AYUSH (Ayurveda, Yoga, Unani, Siddha and Homoeopathy) specialists thus nurturing the mind, body and spirit within the walls of one institute.

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MANAGEMENT

Major H.P.S. Ahluwalia Chairman, ISIC, Ex-Chairman, Rehabilitation Council of India President, Indian Mountaineering Foundation.

Dr. A.K. Mukherjee Director General-ISIC, Former Dir. Gen- Health Services, Govt of India and Advisor to WHO

Dr. H.S. Chhabra Medical Director & Chief of Spine Services

Mr. K.V. Uthaman Chief Administrative Officer

Dr. H.P. Singh Chief of Medical Administration

Dr. K. Preetham Addl. Chief of Medical Administration

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FACILITIES AVAILABLE at INDIAN SPINAL INJURIES CENTRE

1. EMERGENCY (24X7)

2. SPINAL DISORDERS & SURGERY  BACK PAIN  DEGENERATIVE SPINE  DEFORMITY  INFECTIONS  MINIMALLY INVASIVE SPINE SURGERY  OSTEOPOROSIS  SPINAL TUMOR  SPINAL TRAUMA  SPINAL ROBOTIC SURGERY

3. ORTHOPEDICS & JOINT REPLACEMENT  JOINT REPLACEMENT & ARTHROSCOPY  KNEE CLINIC  HIP CLINIC  SPORTS MEDICINE  SHOULDER & HAND  PEDIATRIC ORTHOPEDIC  ORTHOPEDIC ONCOLOGY  ORTHOPEDIC TRAUMA

4. ANAESTHESIA

5. CARDIOLOGY  ECG  ECHO INCLUDING STRESS ECHO, TEE  TMT  HOLTER  DOPPLER STUDY  TILT TEST  ANGIOGRAPHY  ANGIOPLASTY (PTCA)  ELECTRO PHYSIOLOGY (EPS)  SINGLE / DOUBLE CHAMBER PACEMAKER  PERIPHERAL EMBOLECTOMY

6. CHEST & RESPIRATORY MEDICINE  BRONCHOSCOPY  CHEST TUBE

7. DENTAL 8. DERMATOLOGY 9. ENT (EAR/NOSE/THROAT) 10. EXECUTIVE HEALTH CHECKUP 11. FOOT CARE CLINIC (PODIATRY)

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12. GASTROENTEROLOGY  BRONCHOSCOPY  CHEST TUBE

13. GYNAECOLOGY 14. INTERNAL MEDICINE 15. RHEUMATOLOGY (JOINT DISEASE SERVICES) 16. NEUROLOGY  EEG  EMG  NCV  STROKE  SLEEP LAB

17. NEUROSURGERY  TRUAMA  TUMOURS (BRAIN & SPINAL)  SPINAL DYSRAPHISM  CEREBROVASCULAR SURGERY

18. NEPHROLOGY & DIALYSIS 19. OPHTHALMOLOGY 20. OBESITY & WEIGHT MANAGEMENT PROGRAMME 21. PAEDIATRICS (OPD) 22. PAIN CLINIC 23. PLASTIC SURGERY 24. PSYCHIATRY 25. PSYCHOLOGY & STRESS MANAGEMENT 26. PHARMACY (24 HOURS) 27. REHABILITATION  PHYSIOTHERAPY  ADVANCE REHAB MANAGEMENT  REHAB HOME CARE MANAGEMENT  OCCUPATIONAL THERAPY  HYDROTHERAPY  ASSISTIVE TECHNOLOGY  SOCIAL WORK  ORTHOTICS & PROSTHETICS  PEER COUNSELING  VOCATIONAL COUNSELING  GERIATRIC REHAB  ISIC-MULTI MEDICINE CENTRE (TRADITIONAL MEDICINE)

28. RADIOLOGY & IMAGING SERVICES  CT  DEXA SCAN  DOPPLER STUDIES  MRI 1.5 TESLA  ULTRASOUND  X-RAY

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29. SURGERY  BARIATRIC SURGERY  GENERAL SURGERY  GASTRO INTESTINAL SURGERY  MINIMALLY INVASIVE SURGERY (LAPROSCOPIC & THORASCOPIC)

30. SPEECH THERAPY

31. ALTERNATIVE MEDICINE  AROMA THERAPY  ACUPRESSURE  HOMOEOPATHY  MEDITATION  NATUROPATHY  REFLEXOLOGY  YOGA

32. UROLOGY  GENERAL UROLOGY  NEURO UROLOGY  PROSTRATE SURGERY  HOLMIUM LASER

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SCHEDULE OF CHARGES – 2019-20 BILLING GUIDELINES

 Registration Charges Registration fees Rs.200 (One Time) Admission Charges Rs.500/- Medical Documentation Charges – Rs.600/- TPA Evaluation – Rs.300/-

 OPD Consultation charges 1600/- to 600/- per consultation 2400/- to 1300/- per consultation (Joint Disease Service)

All revisits shall be registered for the follow up payment at the OPD Billing Counter irrespective of the purpose, however the revisit for reports review within 3 days of the first visit shall not be charged.

However all IPD visits in emergency hrs / holidays / off duty hours, shall be charged as double the charges of normal visits charges.

POLICY GUIDELINES Billing cycle is 24 hours, however on the day of discharge if the patient vacates the room within 3 hours no room charges shall be levied for that day. In case patient vacates the room between 3 to 8 hours, half day room rent shall be levied & beyond 8 hours full day charge will be levied.

ICU charges include – Room Rent, Patient’s diet, Resident Doctor fee, nursing charges.

ICU charges do not include – Consultant fees/Critical Care Team Visits, Cardiac Monitoring Ventilator (Initiation/maintenance charges), DVT pump, Patient Warming System, Infusion/Syringe pump, Pulse Oxymeter, Oxygen, Air Mattress, Nebulisation, Alpha Bed, Investigations, Procedures, Consumables, and Medicines.

Where a patient is to be admitted and the desired category of bed is not available, the patient may opt for next available higher category bed & would be charged as per the category of admission. In case of transfer to ICU, the bed/room will have to be vacated.

When a patient is admitted directly to an ICU bed and is not willing to make a choice of bed category, the charges for procedure/ surgery shall be according to Single Room category. However, if the patient opts for occupancy higher than the single room category at the time of transfer from ICU, the procedure/surgery shall be charged according to the higher category.

Change of Category of Bed – At the time of transfer from ICU, if the patient opts for a bed category lower than the Single room, the cost of procedure/ surgery already done shall be charged as per single room category. Thereafter all charges will be applicable as per the lower category levied from the date and time when the request for change of category is executed.

In case of up-gradation of room to the higher category, all the charges (Including Procedure charges, Surgery Charges, Anaesthesia, OT Charges, etc.) will be applicable as per the opted higher category room from day one of admission except for room rent, doctor visit charges and investigations (lab & radiology).

In case the patient opts for lower category the charges for the lower category will be levied from the date and time when the request for change of category is executed and subject to clearing the dues till that time.

In case of packages if up gradation is done the package would be charged as per higher bed category.

Ambulance Charges

Advanced Life Support (ACLS) Minimum Rs.1300/- up to 5 Km and above 5 Km Rs. 50/-Per Km; waiting charges shall be Rs. 200/- per hour

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Personnel Within NCR(Rs.) Paramedic/Nurse 650/- EMO/Senior Resident 2200/- Consultant 4500/- Wardboys (per wardboy) 300/-

PTA (Patient Transport Ambulance) Minimum Rs.1100/- up to 5 Km and above 5 Km Rs. 30/-Per Km; waiting charges shall be Rs. 200/- per hour Drugs and Consumables shall be charged extra as per actual.

Advance Policy: Minimum Advance to be collected as per Room Category  ICU - Rs.50000/-  Suite - Rs.60000/-  Deluxe Room - Rs.60000/-  Single room - Rs.50000/-  Sharing room - Rs.30000/-  General Ward - Rs.20000/-  Day Care - Rs.10000/-

In case the patient has to undergo surgery / procedure, the clearance will be provided subject to the deposit of the full amount for the package/surgery specified in the IPD Estimate and Counselling by 08:00pm, the day before the surgery is scheduled.

For payment only Cash, Demand Draft, NEFT, RTGS, Pay Order, Credit / Debit Cards (All major credit/debit cards-except diners cards) are accepted. Cheques are accepted only at the time of admission. Permanent Account Number (PAN) is mandatory if cash amount exceeding one lakh rupees. Cash payments are accepted less than rupees two lakhs.

As per new sections 269 ST & 271DA to the Income Tax Act. It has been provided that no person (other than those specified therein) shall receive an amount of two lakh rupees or more.

(a) in aggregate from a person in a total bill;

(b) in respect of a single transaction; or

otherwise than by an account payee cheque or account payee bank draft or use of electronic clearing system through a bank account.

Demand Draft shall be made in favour of “Indian Spinal Injuries Centre”, New Delhi.

For International patients, foreign currency will be accepted.

Refunds up to Rs.10,000/- will be made in cash. Refunds above Rs.10,000/- will be made in the form of Bank Transfer OR cheque in the patient’s name only. In case the cheque has to be made in some other name the same can be done after a declaration has been given. All refund cheque will take a minimum of three working days to be made available.

Hospital Equipment usage charges: Use of equipment will be charged as per the details on - Page No. 17 Special Equipment Charges: Use of Special equipment will be as per the details on - Page No. 19

CASH PATIENTS Medical /Conservative Management 80% of the Total estimate given to the patient is to be deposited at the time of Admission. Minimum Advance Deposit as per Room Category

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Surgical Management 100% of the estimated expenses to be taken as an advance. Cases where package rates are applicable, entire package cost to be taken as Advance.

TPA PATIENTS

Medical /Conservative Management In cases where TPA full approval has been received- minimum Rs.10000/- is to be taken against the non payable items. In cases where approval received is lesser than the estimate provided- differential amount to be collected at the time of Admission (80% of the total estimate or the Minimum advance against Room category). In cases where approval is not received then it will be treated as Cash patient till approval is received and minimum advance is deposited as per Room Category highlighted above.

Surgical Management In cases where TPA full approval has been received- minimum Rs.10000/- is to be taken against the non payable items.

In cases where approval received is lesser than the estimate provided- differential amount to be collected at the time of Admission (100% of the total estimate).

In cases where approval is not received then it will be treated as Cash patient till approval is received and 100% of the estimated expenses to be taken as an advance. Cases where package rates are applicable, entire package cost is to be taken as Advance.

Upto two visits per day per Treating Unit/Consultant will be charged. Each Referral Unit/Consultant will charge one visit per day unless the patient is transferred to the side of the referred consultant/Unit.

Surgery/Procedure Charges Surgery/Procedure will be charged as per opted bed category Any procedure carried out in the OPD will be charged as per the schedule in addition to the consultation charges.

Multiple Surgeries If the same surgeon performs more than one procedure in the same sitting, on the same area of body, then the surgery costing the higher shall be billed as 100% followed by the Surgeries costing lesser at 50% each.

However, if more than one surgery is carried out on different body parts by the same or different surgeons then all these surgeries/procedures will be charged independently as full procedures/surgeries as per the schedule.(i.e. 100%+100%)

In case a surgeon requires the presence of another surgeon of the different speciality (This does not mean an assistant surgeon), then the charges for the same surgery/procedure shall be 100% additional of the surgical fee for that procedure. (i.e. 100% +100%). However, prior consent of patient/attendants and Medical Administration shall be required. In the event as the OT and Anaesthesia charges shall be as per the primary surgeon fee only and not on combined surgical fees.

In case a surgeon requires the presence of another surgeon of the same speciality (This does not mean an assistant surgeon), then the charges for the same surgery/procedure shall be 30% additional of the surgical fee for that procedure.

However, prior consent of patient/attendants and Medical Administration shall be required. In the event as the OT and Anaesthesia charges shall be as per the primary surgeon fee only and not on combined surgical fees.

Assistant Surgeon If the surgery is assisted by an assistant surgeon, then the charges for the surgery shall be additional 25% of the surgical fee for that procedure.

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However, prior consent of patient/attendants and Medical Administration shall be required.

Re-exploratory Surgery (For the same procedure) Within 48 hrs of surgery – No Surgeons fee 48 to 96 hrs of surgery – 50% of the Surgeons fee Beyond 96 hrs of first surgery – 100% of the Surgeons fee However, OT charges, Anaesthesia fee as per surgeon fee, consumables & pharmacy will be charged as per actuals.  Standby charges during surgery for all Consultants such as Anaesthetist, Cardiologist, Physician, etc are 20% of the Surgeon’s Fee.  Incase of surgeries performed in emergency/holidays, additional 20% of surgeon fee would be charged extra.

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ROOM RENT / BED CHARGES

S.No. Bed Categories Charges / Day 1 General Ward 2850 2 Sharing Room 7100 3 Single Room 11500 4 Deluxe (NDW) 15000 5 Special Deluxe (NDW) 17500 6 Suite (HW) 17500 7 Super Dlx. Suite (Nanda Devi) 24500 9 HDU(Non-Ventilator Patient) 6000 10 ICU (GW) 9500 11 ICU (Shared) 11800 12 ICU (Single) 15000 13 ICU (suite-HW) 19250 14 ICU (Super Dlx. Single) 15950 15 ICU (Super Dlx. Spl.) 19305 16 ICU (Super Dlx. Suite) 26400 17 Heart Command ICU 14960 Admission Charges (for all admissions) 500 Medical Documentation Charges (for all admissions) 600 TPA Evalaution Charges 300 50% of the opted Day Care (upto first 8 hours) category

Note :- Total of 3 hrs relaxation would be applicable during the entire stay.

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OPD CONSULTATION CHARGES

Super Speciality Speciality Follow-up Follow-up First Consultation First Consultation Consultation Consultation 1 Sr. Consultants (Cat-A) 1600 1550 - - 2 Sr. Consultants (Cat-B) 1500 1450 1400 1350 3 Consultants/Associate Consultants 1350 1300 1300 1250 4 Jr. Consultants/Asstt. Consultants 1200 1150 1100 1000 Super-specialities Specialities

a. Spine a. Internal Medicine

b. Neurology b. Orthopaedics

c. Neurosurgery c. Gastroenterology

d. Respiratory Medicine d. Rheumatology

e. Cardiology e. General Surgery

f. Urology f. Gynaecology

g. Plastic Surgery g. ENT / Ophthalmology

h. Others….. First Consultation Follow-up Consulttion 5 Dentists 600 600 6 Psychologist 1100 1100 7 Sr. Resident 650 650 8 Diet Counselling 550 550 9 Physiotherapy Consultation 600 600 10 Emergency OPDs 2200 2200 OPD Registration Charges (on first visit) 200

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IN-PATIENT VISITS / CONSULTATIONS

S.No. Category Super Speciality Speciality Consultants / Consultants / Sr. Asstt. Consultants / Asstt. Consultants / Associate Sr. Consultants Associate Consultants Jr. Consultants Jr. Consultants Consultants Consultants 1 General Ward 770 700 600 770 700 600 2 HDU 1300 1200 1150 1250 1150 1050

3 Semi Pvt. (Everest / Heritage Ward 1375 1300 1150 1300 1200 1100

4 Single Room (Everest / Heritage Ward ) 1650 1375 1250 1600 1300 1250 5 ICU / ICCU 1800 1600 1425 1750 1425 1300 6 Deluxe (Nanda Devi Ward) 1950 1750 1600 1850 1650 1500 Super Dlx. Spl / Suite (Nand Devi / 7 2400 2100 1800 2350 1950 1750 Heritage Ward) 8 Super Dlx. Suite (Nanda Devi Ward) 2950 2400 2200 2650 2350 2200

Maximum of 2 Visit / day are permitted for same speciality. All visits paid on Holidays / off duty hours shall be charged as double. Super-specialities Specialities

a. Spine a. Internal Medicine

b. Neurology b. Orthopaedics

c. Neurosurgery c. Gastroenterology

d. Respiratory Medicine d. Rheumatology

e. Cardiology e. General Surgery

f. Urology f. Gynaecology

g. Plastic Surgery g. ENT / Ophthalmology

h. Others…..

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2 SPECIAL CONSULTATIONS/COUNSELLINGS Peer / Social S.No. Category Dental Consultation Diet Counselling Psychology Counselling Counselling 1 General Ward 600 330 440 440 2 HDU 750 440 600 600 3 Semi Pvt. (Everest / Heritage Ward 750 440 600 600 5 Single Room (Everest / Heritage Ward ) 825 600 650 650 4 ICU / ICCU 1100 550 600 600 5 Deluxe (Nanda Devi Ward) 1300 650 700 700 Super Dlx. Spl / Suite (Nand Devi / Heritage 6 1375 700 750 750 Ward) 7 Super Dlx. Suite (Nanda Devi Ward) 1600 750 850 900

One Diet Conselling / Consultation on the day of Admission is mandatory.

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AMBULANCE CHARGES

1 PTA Ambulance - Rs.1000/- first 5 km, after that Rs. 25/- per km

2 ACLS ambulance - Rs.1200/- first 5 km, after that Rs.45/- per km

3 Rs.2200/ extra for doctor

4 Rs.650/- for Nurse (1 no.)

5 Rs.300/- for Ward Boy (1 no.)

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BLOOD BANK

S.No. NEW CODE OLD CODE Service Name Charge/OPD 1 BLD-01 BLD-1 FRESH FROZEN PLASMA IP 400 2 BLD-02 BLD-2 PLATELET CONCENTRATE IP 400 3 BLD-03 BLD-3 PRBC 3700 4 BLD-04 BLD-4 BLOOD NAT TESTING 1200 5 BLD-05 BLD-7 BLOOD ADMINISTRATIVE CHARGES (NON-REFUNDABLE) 500 6 BLD-06 BLD-8 BLOOD BANK SECURITY DEPOSIT (REFUNDABLE) 5020 7 BLD-07 BLD-5 CROSS MATCHING OF BLOOD 620 8 BLD-08 BLD-6 BLOOD GROUPING +ANTIBODY SCREENING 512

Note:- Charges Of item no. 1 to 6, are fixed for all categories

Charges basis on item no. 7 & 8 are applicable as under - Charges Basis OPD/GW 100% HDU + ICU (all categories) 125% Shared 125% Single 135% Dlx 150% Spr. Dlx 150% Suite 150% Spr. Dlx Suite 150%

Note :- Above Charge basis would also be applicable on all newly added services

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EMERGENCY / CASUALTY CHARGES

S.No. Services Charges

2 EMO Consultation 650 3 14922 MINOR OT CHARGES 1500 + Procedure charges 4 ER-1 OBSERVATION CHARGES PER HOUR. 300 5 14921 SOB PROFILE 3000

Medicines & Other Charges At actuals

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MEDICAL EQUIPMENT CHARGES

S.No. MEDICAL EQUIPMENT Charges Billing Base 1 AIR PEN DRIVE SYSTEM -H 3542 per application 2 ALPHABED -H 264 per application 3 ANAESTHESIA MACHINE 2123 per application 4 ARTHOSCOPE PUMP -H 11781 per day 5 B-1 CUTTER -H 3212 per application 6 BATTERY OPERATED DRILL -H 451 per application 7 BIPAP -H 2387 per application 8 BLANKET WARMER (ELECTRIC) -H 627 per application 9 BLANKET WARMER(OT) -H 880 per application 10 BRONCHOSCOPE -H 8855 per application 11 COLPOSCOPE -R 6050 per application 12 COMPACT DRILL -H 2398 per application 13 COUGH ASSIST MACHINE -H 451 per day 14 DEFIBRILLATOR -H 1518 per application 15 DIODE LASER (BARE FIBRE) -R 22960 per application 16 DVT PUMP -H 2123 per day 17 EASYNAV BRAIN NAVIGATOR-R 32200 per application 18 FLEXIBLE URETEROSCOPE -R 21780 per application 19 HYSTROSCOPE -R 12500 per application 20 HYSTROSCOPE((HYSTROSCOPIC IUCD REMOVAL INCLUDES FORCEPS, CUTTING LOOP) -R 12500 per application 21 HYSTROSCOPE(BIPOLAR SALINE CAUTERY MACHINE) -R 18750 per application 22 HYSTROSCOPE(HARMONIC WITH HAND INSTRUMENTS) -R 28125 per application 23 HYSTROSCOPE(HARMONIC WITHOUT HAND INSTRUMENTS) -R 18750 per application 24 HYSTROSCOPE(HYSTROSCOPIC +LAPRO+PETENCY-T) -R 12500 per application 25 HYSTROSCOPE(HYSTROSCOPIC BIOPSY INCLUDES FORCEPS, CUTTING LOOP) -R 12500 per application 26 HYSTROSCOPE(HYSTROSCOPIC CANULATION INCLUDES CANNULATION SET) -R 12500 per application 27 HYSTROSCOPE(HYSTROSCOPIC CARUAL BLOCKING-BUCK BEE) -R 12500 per application 28 HYSTROSCOPE(HYSTROSCOPIC MYOMECTOMY INCLUDES CUTTING LOOP. KOLLEY KNIFE) -R 12500 per application 29 HYSTROSCOPE(HYSTROSCOPIC POLYPECTOMY INCLUDES CUTTING LOOP, BOLAR BALL) -R 12500 per application

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30 HYSTROSCOPE(HYSTROSCOPIC SEPTUM REMOVAL INCLUDES CUTTING LOOP. KOLLEY KNIFE) -R 12500 per application 31 HYSTROSCOPE(HYSTROSCOPIC TCRE INCLUDES CUTTING LOOP, BOLAR BALL) -R 12500 per application Rs.880/- upto 1 hr. Rs.2123/- 32 IMAGE INTENSIFIER -H 2123 upto 4 hrs. then Rs.4443/- Flat per day 33 LAPROSCOPE-H 14641 per application 34 LAPROSCOPE+ HYSTROSCOPE SET-R 10000 per application 35 LASER FIBRE -R 8790 per application 36 MIDAS BURR (SINGLE USE) -H 17545 per application 37 MIDAS DIAMOND BURR -H 7799 per application 38 MIDAS DRILL -H 11869 per day 39 MONITOR-H 1067 per day 40 Navigation System (TKR) Bilateral -R 19130 per application 41 Navigation System (TKR) Unilateral -R 11250 per application 42 NIM (NERVE INTEGRITY MONITOR) SYSTEM -H 32208 per connection 43 NITROUS GAS 1331 per hour 44 OPERATING MICROSCOPE -H 2123 per application 45 OPERATING MICROSCOPE(NEURO SURGICAL) -H 8855 per application Rs.451/- upto 4 hrs. then Rs.60 46 OXYGEN 451 per hour 47 POWER SAW & DRILL (STRYKER) - H 4257 per application 48 PULSE OXEMETRES 528 per application 49 RECON POWER SYSTEM -H 1771 per application 50 RF GENERATOR -R 10300 per application 51 SCD EXPRESS(VENAFLOW) MACHINE -H 2123 per day 52 SOURCE LIGHT 209 per application 53 SPINAL ROBOT USAGE CHARGES - H 50000 per application 54 STEREO TACTIC FRAME (INMITO) - R 45000 per application 55 SURGICAL DIATHERMY(AESCULAP) 715 per application 56 SYRINGE INFUSION PUMP 319 per application Rs.209/- upto 1 hr. then 57 SYRINGE PUMP 209 Rs.440/- per day Flat

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58 TOURNIQUET 451 per application 59 ULTRASONIC ASPIRATOR SYSTEM-R 23000 per application 60 VENTILATOR 5313 Per Day 61 VIDEO LARYNGOSCOPY INTUBATION-H 3223 per application 62 VOLUMETRIC INFUSION PUMP -H 264 per day Special OT Equipments 63 Thoracoscope-R 25% of Surgeon Fee 64 Arthroscope-H 25% of Surgeon Fee 65 Cystoscope - H 25% of Surgeon Fee 66 Harmonic Scalpal-R 25% of Surgeon Fee 67 ENT Instrument Charges -R 25% of Surgeon Fee 68 Rhinoplasty Set (ENT)-R 25% of Surgeon Fee 69 Urethroscope-H 25% of Surgeon Fee 70 Urethroscopic Equipment-H 25% of Surgeon Fee

Note:- Charges are fixed for all bed categories Cosumables would be charged extra Rented Equipment would be charged at actuals as per the invoice raised.

Any new service/tariff may be changed/added/deleted without prior notice. 19 Schedule of Charges 2019-20 ISIC

HEALTH CHECK-UP PACKAGES

Code Health Check-UP Charges

HCU-01 PRE-EMPLOYMENT HEALTH CHECK-UP - MALE 4100 HCU-02 PRE-EMPLOYMENT HEALTH CHECK-UP - FEMALE 4100 HCU-03 Exec. Health Chk-Up UNDER 35 yrs (ISIC) MALE 7400 HCU-04 Exec. Health Chk-Up UNDER 35 yrs (ISIC) FEMALE 9000 HCU-05 Exec. Health Chk-Up ABOVE 35 yrs (ISIC) MALE 9000 HCU-06 Exec. Health Chk-Up ABOVE 35 yrs (ISIC) FEMALE 9570 HCU-07 Exec. Health & Cardiac Chk-Up ABOVE 45 yrs (ISIC) MALE 11000 HCU-08 Exec. Health & Cardiac Chk-Up ABOVE 45 yrs (ISIC) FEMALE 12000

Any new service/tariff may be changed/added/deleted without prior notice. 20 Schedule of Charges 2019-20 ISIC

LABORATORY SERVICES

Dlx/ Shared Super NEW OLD Single Super S.No. Investigation/Procedure OPD/GW Room/ Dlx. CODE CODE Room Dlx / ICU/ HDU Suite Suite BIO-CHEMISTRY 1 BIOC-1 15758 24 HRS URINE-MAGNESIUM* (COLORIMETRY-CHLOROPHOSPHONAZO-III) 730 913 986 1095 1095 2 BIOC-2 BIOC-4 ABG (ISE)* 1320 1650 1782 1980 1980 3 BIOC-3 BIOC-5 ALBUMIN & GLOBULIN-SERUM 480 600 648 720 720 4 BIOC-4 BIOC-6 ALBUMIN (End point Colorimetry-BCG) 240 300 324 360 360 5 BIOC-5 BIOC-7 ALKALINE PHOSPHATASE( Enzymatic Colorimetry -IFCC) 290 363 392 435 435 6 BIOC-6 BIOC-8 AMYLASE (ENZYMATIC COLORIMETRY - IFCC) 650 813 878 975 975 7 BIOC-7 BIOC-9 ASCITIC FLUID (AMYLASE)-ENZYMATIC COLORIMETRY - IFCC 650 813 878 975 975 ASCITIC FLUID FOR BIOCHEMICAL ANALYSIS(ABSORBANCE 8 BIOC-8 BIOC-10 650 813 878 975 975 PHOTOMETRY) 9 BIOC-9 BIOC-11 BILIRUBIN TOTAL & CONJUGATED(DIAZO) 450 563 608 675 675 10 BIOC-10 BIOC-12 BILIRUBIN TOTAL(DIAZO) 240 300 324 360 360 11 BIOC-11 BIOC-13 BLOOD SUGAR-POST 75 G. GLUCOSE HEXOKINASE (UV TEST) 120 150 162 180 180 12 BIOC-12 BIOC-15 BLOOD SUGAR -FASTING HEXOKINASE (UV TEST) 120 150 162 180 180 13 BIOC-13 BIOC-16 BLOOD SUGAR -POST PRANDIAL HEXOKINASE (UV TEST) 120 150 162 180 180 14 BIOC-14 BIOC-14 BLOOD SUGAR -RANDOM HEXOKINASE (UV TEST) 120 150 162 180 180 15 BIOC-15 BIOC-17 BLOOD UREA NITROGEN (Kinetic- Urease& glutamate dehydrogenase) 240 300 324 360 360 16 BIOC-16 BIOC-18 BODY FLUID BIO-CHEMISTRY 650 813 878 975 975 17 BIOC-17 BIOC-19 BODY FLUID LDH (UV ASSAY-IFCC) 550 688 743 825 825 18 BIOC-18 BIOC-20 CALCIUM (5-nitro-5 methyl-BAPTA) 260 325 351 390 390 19 BIOC-19 BIOC-21 CHLORIDE (DIRECT ISE) 260 325 351 390 390 20 BIOC-20 BIOC-22 CHOLESTEROL (Enzymatic Colorimetry) 240 300 324 360 360 21 BIOC-21 BIOC-68 CK INDEX* 1300 1625 1755 1950 1950 22 BIOC-22 BIOC-23 CK-MB (ECLIA)* 740 925 999 1110 1110 23 BIOC-23 BIOC-24 CK-TOTAL (UV-IFCC) 570 713 770 855 855 24 BIOC-24 BIOC-25 CREATININE (Kinetic Jaffe ) 210 263 284 315 315 25 BIOC-25 BIOC-26 CREATININE CLEARENCE TEST (Kinetic Jaffe )* 730 913 986 1095 1095 26 BIOC-26 BIOC-71 CRP-QUANTITATIVE(PARTICLE ENHANCED TURBIDIMETRY) 650 813 878 975 975

Any new service/tariff may be changed/added/deleted without prior notice. 21 Schedule of Charges 2019-20 ISIC

27 BIOC-27 BIOC-27 CSF - BIO-CHEMICAL ANALYSIS 650 813 878 975 975 28 BIOC-28 BIOC-28 DIALYSIS FLUID ELECTROLYTES 730 913 986 1095 1095 29 BIOC-29 BIOC-29 DIRECT BILIRUBIN (Diazo) 240 300 324 360 360 30 BIOC-30 BIOC-99 e - GFR* 260 325 351 390 390 31 BIOC-31 BIOC-30 ELECTROLYTES (ISE-DIRECT) 730 913 986 1095 1095 32 BIOC-32 BIOC-31 GAMMA GT (Enzymatic Colorimetric-IFCC) 390 488 527 585 585 33 BIOC-33 16089 GCT (50 GM GLUCOSE) - HEXOKINASE (UV TEST) 120 150 162 180 180 34 BIOC-34 BIOC-32 GCT (WITH 75 GM GLUCOSE) -HEXOKINASE (UV TEST) 120 150 162 180 180 35 BIOC-35 BIOC-33 GLUCOSE TOLERANCE TEST (GTT)-100GM GLUCOSE 860 1075 1161 1290 1290 36 BIOC-36 14501 GLUCOSE TOLERANCE TEST (GTT)-75 GM (EXTENDED) 1270 1588 1715 1905 1905 37 BIOC-37 BIOC-34 GLUCOSE TOLERANCE TEST (GTT)-75 GM GLUCOSE 860 1075 1161 1290 1290 38 BIOC-38 BIOC-35 GLYCOSYLATED HAEMOGLOBIN (HBA1C)- Acc. to IFCC, DCCT/ NGSP* 730 913 986 1095 1095 39 BIOC-39 BIOC-36 HDL - CHOLESTEROL(Enzymatic colorimetry-Direct) 450 563 608 675 675 40 BIOC-40 BIOC-37 HS-CRP (Particle enhanced Immuno turbidimetry)* 650 813 878 975 975 41 BIOC-41 BIOC-38 KIDNEY FUNCTION TEST 1210 1513 1634 1815 1815 42 BIOC-42 BIOC-39 LDH (UV ASSAY-IFCC) 550 688 743 825 825 43 BIOC-43 BIOC-40 LFT (LIVER FUNCTION TEST) 1100 1375 1485 1650 1650 44 BIOC-44 BIOC-41 LIPID PROFILE TEST 1280 1600 1728 1920 1920 45 BIOC-45 BIOC-42 MAGNESIUM (Colorimetry-Chlorophosphonazo III)) 660 825 891 990 990 46 BIOC-46 BIOC-43 OSMOLALITY - SERUM* 950 1188 1283 1425 1425 47 BIOC-47 BIOC-45 PHOSPHORUS-(End point Amm.molybdate) 260 325 351 390 390 48 BIOC-48 BIOC-46 POTASSIUM-(DIRECT ISE) 260 325 351 390 390 49 BIOC-49 BIOC-48 RHEUMATOID FACTOR- QUANTITATIVE(TURBIDIMETRY)* 730 913 986 1095 1095 50 BIOC-50 BIOC-49 SGOT(AST)(IFCC WITHOUT PYRIDOXAL PHOSPHATE) 260 325 351 390 390 51 BIOC-51 BIOC-50 SGPT(ALT)(IFCC WITHOUT PYRIDOXAL PHOSPHATE) 260 325 351 390 390 52 BIOC-52 BIOC-51 SODIUM-(DIRECT ISE) 260 325 351 390 390 53 BIOC-53 BIOC-47 TOTAL PROTEIN (Colorimetry- Biuret) 240 300 324 360 360 54 BIOC-54 BIOC-52 TRIGLYCERIDES (Colorotimetry-Enzymatic) 450 563 608 675 675 55 BIOC-55 BIOC-53 TROP - I (IMMUNOCHROMATOGRAPHY)* 1820 2275 2457 2730 2730 56 BIOC-56 BIOC-54 TROP - T (IMMUNOCHROMATOGRAPHY)* 2180 2725 2943 3270 3270 57 BIOC-57 BIOC-55 URIC ACID(Enzymatic colorimetry-Uricase) 260 325 351 390 390 58 BIOC-58 BIOC-1 URINE URIC ACID*24 HOURS (Enzymatic colorimetry-Uricase) 370 463 500 555 555

Any new service/tariff may be changed/added/deleted without prior notice. 22 Schedule of Charges 2019-20 ISIC

59 BIOC-59 BIOC-56 URINE ALBUMIN CREATININE RATIO.* (CLINITEK-SEMIQUANTITATIVE) 670 838 905 1005 1005 60 BIOC-60 BIOC-59 URINE CALCIUM (5-nitro-5 methyl-BAPTA) 370 463 500 555 555 61 BIOC-61 BIOC-70 URINE CALCIUM 24 Hrs -(5-NITRO-5 METHYL-BAPTA) 370 463 500 555 555 62 BIOC-62 15006 URINE CALCIUM CREATININE RATIO 740 925 999 1110 1110 63 BIOC-63 BIOC-57 URINE CREATININE(Kinetic Jaffe's) 370 463 500 555 555 64 BIOC-64 15759 URINE MAGNESIUM(CALORYMETRY-CHLOROPHONAZO-III) 730 913 986 1095 1095 65 BIOC-65 BIOC-58 URINE RANDOM -ELECTROLYTES (ISE)* 800 1000 1080 1200 1200 66 BIOC-66 BIOC-66 URINE URIC ACID* (Enzymatic colorimetry-Uricase) 370 463 500 555 555 67 BIOC-67 BIOC-3 URINE CREATININE 24 Hrs(Kinetic Jeffe) 370 463 500 555 555 68 BIOC-68 BIOC-61 URINE MICROALBUMIN -SEMI AUTOMATED URINE ANALYZER* 670 838 905 1005 1005 69 BIOC-69 BIOC-44 URINE OSMOLALITY* 950 1188 1283 1425 1425 70 BIOC-70 BIOC-60 URINE PHOSPHORUS-24 Hrs * (End point Amm.molybdate) 370 463 500 555 555 71 BIOC-71 BIOC-62 URINE PROTEIN CREATININE RATIO 740 925 999 1110 1110 72 BIOC-72 BIOC-2 URINE PROTEIN-24 HOURS (Colorimetry- Biuret) 370 463 500 555 555 73 BIOC-73 15713 URINE SODIUM CREATININE RATIO 740 925 999 1110 1110 74 BIOC-74 14776 URINE SPOT CHLORIDE* 370 463 500 555 555 75 BIOC-75 BIOC-63 URINE SPOT POTASSIUM* 370 463 500 555 555 76 BIOC-76 BIOC-64 URINE SPOT SODIUM* 370 463 500 555 555 77 BIOC-77 BIOC-65 URINE UREA* 370 463 500 555 555 78 BIOC-78 BIOC-67 VBG* 1320 1650 1782 1980 1980 CLINICAL PATHOLOGY 79 CPA-1 CPA-1 ASCITIC FLUID CELLS & BIOCHEMISTRY 1120 1400 1512 1680 1680 80 CPA-2 CPA-6 CSF - CELLS & BIOCHEMISTRY 1120 1400 1512 1680 1680 81 CPA-3 CPA-7 FAT GLOBULES* 290 363 392 435 435 82 CPA-4 CPA-25 KOH WET MOUNT 180 225 243 270 270 83 CPA-5 CPA-8 OCCULT BLOOD (STD GUAIAC METHOD) 210 263 284 315 315 84 CPA-6 15804 PERICARDIAL FLUID 1120 1400 1512 1680 1680 85 CPA-7 CPA-9 PERITONEAL FLUID CELLS & BIOCHEMISTRY 1120 1400 1512 1680 1680 86 CPA-8 CPA-10 PLEURAL FLUID CELLS & BIO-CHEMISTRY 1120 1400 1512 1680 1680 87 CPA-9 CPA-11 SEMEN ANALYSIS* 650 813 878 975 975 88 CPA-10 15774 SPUTUM FOR EOSINOPHILS* 180 225 243 270 270 89 CPA-11 CPA-13 STOOL - REDUCING SUBSTANCES( Benedict's Test)* 240 300 324 360 360

Any new service/tariff may be changed/added/deleted without prior notice. 23 Schedule of Charges 2019-20 ISIC

90 CPA-12 CPA-12 STOOL HANGING DROP (MICROSCOPY) 240 300 324 360 360 91 CPA-13 CPA-14 STOOL ROUTINE (MANUAL) 180 225 243 270 270 92 CPA-14 16199 SURGICAL SITE FLUID EXAMINATION 1120 1400 1512 1680 1680 93 CPA-15 CPA-15 SYNOVIAL FLUID - TLC (MICROSCOPY) 240 300 324 360 360 94 CPA-16 CPA-16 SYNOVIAL FLUID, TLC, DLC, RBC. 650 813 878 975 975 95 CPA-17 CPA-18 URINE KETONE ( Strip & Manual) 130 163 176 195 195 96 CPA-18 CPA-3 URINE BILE PIGMENT(Dipstick/Fouchet's) 130 163 176 195 195 URINE BILE SALTS & BILE PIGMENT* ( DIPSTICK/SULPHUR 97 CPA-19 CPA-17 150 188 203 225 225 POWDER,FOUCHET`S)* 98 CPA-20 CPA-4 URINE BILE SALTS( Suphur powdersinking) 130 163 176 195 195 99 CPA-21 CPA-2 URINE BENCE JONES PROTEIN* 730 913 986 1095 1095 100 CPA-22 14301 URINE EOSINOPHILS (U065) 180 225 243 270 270 101 CPA-23 CPA-24 URINE FOR RBC MORPHOLOGY (MICROSCOPY)* 430 538 581 645 645 102 CPA-24 CPA-23 URINE GLUCOSE ( Strip & Manual) 130 163 176 195 195 103 CPA-25 CPA-19 URINE OCCULT BLOOD* 210 263 284 315 315 104 CPA-26 CPA-21 URINE PROTEIN(Turbidimetry) 370 463 500 555 555 105 CPA-27 CPA-22 URINE ROUTINE(Manual, Strip) 150 188 203 225 225 HAEMATOLOGY 106 HMA-1 HMA-1 ABSOLUTE EOSINOPHIL COUNT(Flowcytometry/microscopy) 240 300 324 360 360 107 HMA-2 HMA-2 ABSOLUTE LYMPHOCYTE COUNT(Flowcytometry/microscopy) 240 300 324 360 360 108 HMA-3 HMA-3 ABSOLUTE NEUTROPHIL COUNT(Flowcytometry/microscopy) 240 300 324 360 360 109 HMA-4 HMA-4 BLOOD GROUPING & RH TYPING* 240 300 324 360 360 110 HMA-5 HMA-5 CBC ( AUTOMATED HEMATOLOGY CELL COUNTER)-WITH ESR 650 813 878 975 975 111 HMA-6 HMA-6 CBC -WITHOUT ESR 570 713 770 855 855 112 HMA-7 HMA-7 Coagulation Profile 1210 1513 1634 1815 1815 113 HMA-8 HMA-32 COAGULATION PROFILE WITH PLATELET COUNT 1450 1813 1958 2175 2175 114 HMA-9 HMA-11 DLC (Flowcytometry/microscopy) 240 300 324 360 360 115 HMA-10 HMA-12 ESR -(WESTERGREN) 200 250 270 300 300 116 HMA-11 HMA-13 HAEMATOCRIT (PCV)-CALCULATED PARAMETER 180 225 243 270 270 117 HMA-12 HMA-14 HAEMOGLOBIN(Photometry-Cyanide free ) 180 225 243 270 270 118 HMA-13 HMA-15 HAEMOGRAM 650 813 878 975 975 119 HMA-14 HMA-16 HB TLC DLC PLATELET COUNT(AUTOMATED CELL COUNTER) ESR 570 713 770 855 855 120 HMA-15 HMA-17 HB TLC DLC(AUTOMATED HEMATOLOGY CELL COUNTER) ESR 480 600 648 720 720

Any new service/tariff may be changed/added/deleted without prior notice. 24 Schedule of Charges 2019-20 ISIC

121 HMA-16 HMA-18 MALARIA PARASITE-MICROSCOPY (THICK & THIN SMEAR) 200 250 270 300 300 122 HMA-17 HMA-19 MCH( Calculated Parameter) 180 225 243 270 270 123 HMA-18 HMA-20 MCHC( Calculated Parameter) 180 225 243 270 270 124 HMA-19 HMA-21 MCV (Calculated parameter) 180 225 243 270 270 125 HMA-20 HMA-22 MICROFILARIA (MICROSCOPY) 290 363 392 435 435 126 HMA-21 HMA-24 PARTIAL THROMBO PLASTIN TIME (APTT)(Electro magnetic Clot detection) 730 913 986 1095 1095 127 HMA-22 HMA-25 PERIPHERAL SMEAR (BLOOD)-MICROSCOPY 320 400 432 480 480 128 HMA-23 HMA-26 PLATELET COUNT (Impedence) 50 63 68 75 75 129 HMA-24 HMA-27 PROTHROMBIN TIME(Electro magnetic Clot detection) 570 713 770 855 855 130 HMA-25 HMA-28 RBC COUNT (Impedence) 180 225 243 270 270 131 HMA-26 HMA-29 RETICULOCYTE COUNT (SUPRAVITAL STAINING) 520 650 702 780 780 132 HMA-27 HMA-30 TLC & DLC(Flow cytometry/microscopy) 410 513 554 615 615 133 HMA-28 HMA-31 TLC (Flow cytometry) 240 300 324 360 360 HISTOPATHOLOGY 134 HIS-1 HIS-1 BIOPSY SECOND OPINION* 600 750 810 900 900 135 HIS-2 HIS-2 BODY FLUID FOR MALIGNANT CELLS/CYTOLOGY* 790 988 1067 1185 1185 136 HIS-3 HIS-3 BONE MARROW ASPIRATION CYTOLOGY* 990 1238 1337 1485 1485 137 HIS-4 14560 BONE MARROW ASPIRATION+BIOPSY. 1600 2000 2160 2400 2400 138 HIS-5 HIS-21 BONE MARROW PANEL II (Z499). 2090 2613 2822 3135 3135 139 HIS-6 HIS-4 CYTOLOGICAL EXAMINATION* 790 988 1067 1185 1185 140 HIS-7 HIS-5 F N A C / F N A B* 1210 1513 1634 1815 1815 141 HIS-8 15011 HISTO PATHOLOGY SECOND OPINION (J007). 800 1000 1080 1200 1200 142 HIS-9 HIS-7 HISTOPATHOLOGY - SKIN(J117) 890 1113 1202 1335 1335 143 HIS-10 HIS-8 HISTOPATHOLOGY BONE(J118) 1210 1513 1634 1815 1815 144 HIS-11 14557 HISTOPATHOLOGY LARGE (ONCQUEST). 1650 2063 2228 2475 2475 145 HIS-12 HIS-19 HISTOPATHOLOGY LARGE COMPLEX.(J116) 3870 4838 5225 5805 5805 146 HIS-13 14558 HISTOPATHOLOGY MEDIUM (ONCQUEST). 1000 1250 1350 1500 1500 147 HIS-14 14556 HISTOPATHOLOGY SMALL (ONCQUEST)H 650 813 878 975 975 148 HIS-15 14589 MULTIPLE MYELOMA PANEL II. 8800 11000 11880 13200 13200 149 HIS-16 HIS-11 PAP SMEAR-(MICROSCOPY)* 790 988 1067 1185 1185 150 HIS-17 14559 REQUEST FOR SLIDE AND BLOCK (ONCQUEST). 340 425 459 510 510 151 HIS-18 HIS-12 REQUEST FOR SLIDES AND BLOCKS(J119) 280 350 378 420 420

Any new service/tariff may be changed/added/deleted without prior notice. 25 Schedule of Charges 2019-20 ISIC

152 HIS-19 HIS-13 SPUTUM FOR MALIGNANT CELLS* (MICROSCOPY) 790 988 1067 1185 1185 153 HIS-20 HIS-18 USG GUIDED FNAC* 1650 2063 2228 2475 2475 LAB PANEL 154 LABP-1 LABP-1 ANTE NATAL PANEL 3000 3750 4050 4500 4500 155 LABP-2 LABP-2 ARTHRITIS PANEL 4770 5963 6440 7155 7155 156 LABP-3 LABP-3 CARDIAC ENZYME PANEL I 3630 4538 4901 5445 5445 157 LABP-4 LABP-4 CARDIAC ENZYME PANEL II 3990 4988 5387 5985 5985 158 LABP-5 LABP-5 DIABETES PANEL I 2410 3013 3254 3615 3615 159 LABP-6 LABP-6 DIABETES PANEL II 3830 4788 5171 5745 5745 160 LABP-7 LABP-7 FEVER SCREENING PANEL 2490 3113 3362 3735 3735 161 LABP-8 LABP-8 HEALTHY HEART PANEL 3630 4538 4901 5445 5445 162 LABP-9 LABP-9 OSTEOSCREEN PANEL-Z612 5200 6500 7020 7800 7800 LABP- 163 LABP-10 SENIOR CITIZENS PANEL (FEMALES) 3070 3838 4145 4605 4605 10 LABP- 164 LABP-11 SENIOR CITIZENS PANEL (MALES) 4100 5125 5535 6150 6150 11 MICROBIOLOGY 165 MIC-1 MIC-13 AEROBIC CULTURE & SENSITIVITY - CSF (Automated/manual) MIC-13 1450 1813 1958 2175 2175 AEROBIC CULTURE & SENSITIVITY - SPUTUM (Aerobic automated/manual) 166 MIC-2 MIC-11 980 1225 1323 1470 1470 MIC-11 167 MIC-3 MIC-7 AEROBIC CULTURE & SENSITIVITY - STOOL (Automated/manual) MIC-7 980 1225 1323 1470 1470 168 MIC-4 MIC-9 AEROBIC CULTURE & SENSITIVITY- EYE SWAB (Automated/manual) MIC-9 980 1225 1323 1470 1470 169 MIC-5 MIC-10 AEROBIC CULTURE & SENSITIVITY- PUS (Automated/manual) MIC-10 980 1225 1323 1470 1470 AEROBIC CULTURE & SENSITIVITY -THROAT SWAB (Automated/manual) 170 MIC-6 MIC-12 980 1225 1323 1470 1470 MIC-12 171 MIC-7 MIC-22 AFB SMEAR (MANUAL) MIC-22 450 563 608 675 675 172 MIC-8 MIC-1 AFB STAIN - ZN STAIN(MICROSCOPY) MIC-1 450 563 608 675 675 173 MIC-9 MIC-2 ALBERTS STAIN(FOR C.DIPTHERIAE)-MICROSCOPY MIC-2 450 563 608 675 675 174 MIC-10 MIC-3 AUTOMATED ORGANISM IDENTIFICATION & SENSITIVITY MIC-3 1450 1813 1958 2175 2175 175 MIC-11 MIC-6 BLOOD & BODY FLUID CULTURE (BACTALERT) MIC-6 1450 1813 1958 2175 2175 176 MIC-12 MIC-5 CSF FOR GRAMSTAIN (MICROSCOPY) MIC-5 450 563 608 675 675 177 MIC-13 MIC-14 CULTURE & SENSITIVITY- (OTHERS) Aerobic automated/manual MIC-14 980 1225 1323 1470 1470 178 MIC-14 MIC-8 CULTURE & SENSITIVITY-(URINE) MIC-8 980 1225 1323 1470 1470 179 MIC-15 MIC-15 E. HISTOLYTICA MIC-15 150 188 203 225 225

Any new service/tariff may be changed/added/deleted without prior notice. 26 Schedule of Charges 2019-20 ISIC

180 MIC-16 MIC-17 FUNGAL SMEAR MIC-17 450 563 608 675 675 181 MIC-17 MIC-16 FUNGUS IDENTIFICATION & SUSCEPTIBILITY* MIC-16 1390 1738 1877 2085 2085 182 MIC-18 MIC-18 GRAM STAIN (MICROSCOPY) MIC-18 450 563 608 675 675 183 MIC-19 MIC-19 INDIA INK (MICROSCOPY) MIC-19 350 438 473 525 525 184 MIC-20 MIC-20 MRSA SCREENING (MANUAL)* MIC-20 730 913 986 1095 1095 185 MIC-21 MIC-23 STAIN FOR FUNGI MIC-23 450 563 608 675 675 186 MIC-22 MIC-24 STERILITY CHECKING MIC-24 880 1100 1188 1320 1320 187 MIC-23 MIC-25 URINE FOR AFB SMEAR (MANUAL) MIC-25 450 563 608 675 675 188 MIC-24 MIC-26 WET MOUNT FOR FUNGUS (MICROSCOPY)* MIC-26 320 400 432 480 480 189 MIC-25 MIC-27 Z.N. STAIN - NOCARDIA (MICROSCOPY)* MIC-27 450 563 608 675 675 SEROLOGY ANTI HCV ANTIBODY-RAPID SCREENING TEST (Solid phase 190 SER-1 SER-1 1000 1250 1350 1500 1500 immunochromatography) 191 SER-2 SER-2 ASO TITRE (LATEX AGGLUTINATION) 800 1000 1080 1200 1200 192 SER-3 SER-3 CHIKUNGUNYA RAPID TEST-IgM (IMMUNOCHROMATOGRAPHY)* 600 750 810 900 900 DENGUE NS-1 ANTIGEN (SOLID PHASE 193 SER-4 SER-6 600 750 810 900 900 IMMUNOCHROMATOGRAPHY)RAPID TEST 194 SER-5 SER-7 DENGUE SEROLOGY IgG(IMMUNOCHROMATOGRAPHY)RAPID TEST 600 750 810 900 900 195 SER-6 SER-5 DENGUE SEROLOGY IgM -IMMUNOCHROMATOGRAPHY(RAPID) 600 750 810 900 900 196 SER-7 SER-18 HBS AG SCREENING (ECLIA) 800 1000 1080 1200 1200 197 SER-8 SER-10 HIV COMBI (P24 AG; AB I & II) ECLIA 950 1188 1283 1425 1425 198 SER-9 SER-11 MALARIA ANTIGEN RAPID TEST(IMMUNOCHROMATOGRAPHY) 1100 1375 1485 1650 1650 199 SER-10 SER-12 MANTOUX TEST (IMMUNE RESPONSE)* 320 400 432 480 480 200 SER-11 SER-14 PROCALCITONIN (ECLIA)* 3330 4163 4496 4995 4995 201 SER-12 SER-15 RPR (SLIDE FLOCCULATION) 320 400 432 480 480 202 SER-13 SER-16 TYPHI DOT(SALMONELLA IGM -IMMUNOCHROMATOGRAPHY) 800 1000 1080 1200 1200 203 SER-14 SER-13 URINE PREGNANCY TEST (IMMUNOCHROMATOGRAPHY)* 290 363 392 435 435 204 SER-15 SER-17 WIDAL TEST (SLIDE AGGLUTINATION) 410 513 554 615 615 SPECIAL LAB INVESTIGATIONS 205 SLI-1 SLI-1 ADA (ADENOSINE DEAMINASE)* 1050 1313 1418 1575 1575 206 SLI-2 SLI-2 ANTI C.C.P. ANTIBODIES (ECLIA)* 2060 2575 2781 3090 3090 207 SLI-3 SLI-3 ANTI NUCLEAR Ab(ANA)-IFA, TRANSFECTED HEP-2* 1910 2388 2579 2865 2865 208 SLI-4 SLI-4 ANTI NUCLEAR ANTIBODY(ANA) WITH TITRE-IFA, TRANSFECTED HEP-2* 3620 4525 4887 5430 5430

Any new service/tariff may be changed/added/deleted without prior notice. 27 Schedule of Charges 2019-20 ISIC

209 SLI-5 SLI-5 D.DIMER ( SEMI QUANTITATIVE)* 1830 2288 2471 2745 2745 210 SLI-6 SLI-6 ENA PROFILE (EXTRACTABLE NUCLEAR ANTIGEN)-LIA* 5590 6988 7547 8385 8385 211 SLI-7 SLI-7 FDP(FIFRINOGEN DEGRADATION PRODUCT)* 1870 2338 2525 2805 2805 212 SLI-8 SLI-301 FERRITIN, SERUM (ECLIA)* 920 1150 1242 1380 1380 213 SLI-9 SLI-8 FREE T3 (FT3) (ECLIA) 500 625 675 750 750 214 SLI-10 SLI-375 FREE T4 (FT4) -ECLIA 500 625 675 750 750 215 SLI-11 SLI-10 FT3,FT4,TSH ( ECLIA) (THYROID FUNCTION PANEL 2) 1330 1663 1796 1995 1995 216 SLI-12 SLI-11 FT4/TSH(ECLIA) 950 1188 1283 1425 1425 217 SLI-13 SLI-181 HLA B-27 PCR, QUALITATIVE* (REAL TIME PCR) 3510 4388 4739 5265 5265 218 SLI-14 SLI-13 IRON PROFILE* (FERROZINE METHOD) 650 813 878 975 975 219 SLI-15 SLI-14 LE CELL* 520 650 702 780 780 220 SLI-16 SLI-233 NT-PRO BNP(B185) 3450 4313 4658 5175 5175 221 SLI-17 SLI-15 PARA THYROID HORMONE(PTH)-ECLIA 2200 2750 2970 3300 3300 222 SLI-18 SLI-16 PROTEIN ELECTRO PHORESIS (SERUM)* 1450 1813 1958 2175 2175 223 SLI-19 SLI-17 PSA TOTAL(ECLIA) 1120 1400 1512 1680 1680 224 SLI-20 SLI-18 SICKLING TEST 350 438 473 525 525 225 SLI-21 SLI-19 SYNOVIAL FLUID CRYSTALS*(POLARIZING MICROSCOPY) 480 600 648 720 720 226 SLI-22 SLI-20 T3,T4,TSH (ECLIA) 1020 1275 1377 1530 1530 227 SLI-23 SLI-21 T3-TOTAL (ECLIA) 370 463 500 555 555 228 SLI-24 SLI-22 T4-TOTAL (ECLIA) 370 463 500 555 555 229 SLI-25 SLI-23 TSH (THYROID STIMULATING HORMONE)-ECLIA 500 625 675 750 750 230 SLI-26 SLI-24 VITAMIN - D -TOTAL(25 HYDROXY ) (ECLIA) 2130 2663 2876 3195 3195 231 SLI-27 SLI-25 VITAMIN B12 (ECLIA) 1330 1663 1796 1995 1995 OUTSOURCED SPL. LAB INVESTIGATIONS 232 SLI-28 SLI-28 17- HYDROXYPROGESTRONE.(R053) 1300 1625 1755 1950 1950 233 SLI-29 14703 5-HYDROXY INDOLE ACETIC ACID (5-HIAA). U-034 2650 3313 3578 3975 3975 234 SLI-30 SLI-30 ACE(ANGIOTENISIN CONVERTING ENZYME)(B063) 1000 1250 1350 1500 1500 235 SLI-31 SLI-31 ACETYLCHOLINE RECEPTOR BINDING ANTIBODIES(S220) 2170 2713 2930 3255 3255 236 SLI-32 SLI-33 ACID PHOSPHATASE - PROST. FRACTION(B054) 330 413 446 495 495 237 SLI-33 SLI-34 ACID PHOSPHATASE TOTAL (ACP)(B053) 170 213 230 255 255 238 SLI-34 SLI-35 ACT HORMONE(ACTH)(R040) 1480 1850 1998 2220 2220 239 SLI-35 SLI-36 ACTIVATED PROTEIN C RESISTANCE (APC-R)(E016) 3900 4875 5265 5850 5850

Any new service/tariff may be changed/added/deleted without prior notice. 28 Schedule of Charges 2019-20 ISIC

240 SLI-36 SLI-37 ACUTE HEPATITIS VIRUS CONFIRMATION(Z372) 6600 8250 8910 9900 9900 241 SLI-37 SLI-38 ACUTE HEPATITIS VIRUS SCREEN(Z371) 5180 6475 6993 7770 7770 242 SLI-38 14314 ACUTE LEUKAMIA DIAGNOSTIC PANEL.(Z-268) 9000 11250 12150 13500 13500 243 SLI-39 SLI-43 AFB CULTURE RAPID(M050) 1000 1250 1350 1500 1500 244 SLI-40 SLI-40 AFB DRUG SENSITIVITY - 11 DRUGS(M123) 11000 13750 14850 16500 16500 245 SLI-41 SLI-341 AFB DRUG SENSITIVITY 15 DRUGS.(M176) 16000 20000 21600 24000 24000 246 SLI-42 14686 AFB DRUG SENSITIVITY KANAMYCIN 2700 3375 3645 4050 4050 247 SLI-43 SLI-41 AFB DRUG SENSITIVITY SINGLE DRUG 2700 3375 3645 4050 4050 248 SLI-44 SLI-42 AFB DRUG SENSTIVITY- 12 DRUGS(M124) 12000 15000 16200 18000 18000 249 SLI-45 14690 AFB DRUG SENSTIVITY CYCLOSERIN 2700 3375 3645 4050 4050 250 SLI-46 14689 AFB DRUG SENSTIVITY ETHIONAMIDE 2700 3375 3645 4050 4050 251 SLI-47 14688 AFB DRUG SENSTIVITY LEVOFROXACIN 2700 3375 3645 4050 4050 252 SLI-48 14687 AFB DRUG SENSTIVITY MOXI FLOXACIN 3700 4625 4995 5550 5550 253 SLI-49 SLI-44 AFB SUSCEPTIBILITY : 10 DRUG PANEL(M107) 10500 13125 14175 15750 15750 254 SLI-50 SLI-378 AFB-SUCEPTIBILITY : 5 DRUG PANEL(M106) 6000 7500 8100 9000 9000 255 SLI-51 SLI-24 AFP (ALPHA FETO PROTEIN)(LIVER CANCER MONITOR)(F001) 800 1000 1080 1200 1200 256 SLI-52 SLI-379 ALDOLASE(B052) 690 863 932 1035 1035 257 SLI-53 SLI-47 ALDOSTERONE-SERUM(R049) 1600 2000 2160 2400 2400 258 SLI-54 SLI-48 ALLERGY - WHEAT(A018) 1100 1375 1485 1650 1650 259 SLI-55 SLI-301 ALLERGY COMPREHENSIVE PROFILE(Z089) 10000 12500 13500 15000 15000 260 SLI-56 14709 ALLERGY VEGETABLE COMPREHENSIVE PANEL (Z531.) 6500 8125 8775 9750 9750 261 SLI-57 14520 ALLERGY-FRUIT COMPREHENSIVE PANEL (Z524) 7000 8750 9450 10500 10500 262 SLI-58 SLI-51 ALPHA-1 ANTI TRYPSIN (B096) 2000 2500 2700 3000 3000 263 SLI-59 SLI-52 AMH(ANTI MULLERIAN HORMONE)(B171) 1850 2313 2498 2775 2775 264 SLI-60 16421 AMINO ACIDS QUANTITATIVE-10(G-165). 3900 4875 5265 5850 5850 265 SLI-61 SLI-54 AMOEBIC SEROLOGY(S014) 1350 1688 1823 2025 2025 266 SLI-62 SLI-55 AMYLOID STAIN(J052) 600 750 810 900 900 ANCA (ANTI NEUTROPHIL CYTOPLASM ANTI-BODY WITH DILUTION) - 267 SLI-63 SLI-57 3500 4375 4725 5250 5250 IFA(S172) 268 SLI-64 SLI-58 ANCA (ANTI NEUTROPHIL CYTOPLASMIC ANTIBODIES) - IFA(S171) 1700 2125 2295 2550 2550 269 SLI-65 SLI-59 ANCA-MPO(S048) 1800 2250 2430 2700 2700 270 SLI-66 SLI-60 ANCA-PR3(S047) 1800 2250 2430 2700 2700 271 SLI-67 SLI-342 ANDROSTENEDIONE(R060) 1820 2275 2457 2730 2730

Any new service/tariff may be changed/added/deleted without prior notice. 29 Schedule of Charges 2019-20 ISIC

272 SLI-68 14287 ANTENATAL PANAL II 2300 2875 3105 3450 3450 273 SLI-69 14283 ANTI - NMO (S238) 4500 5625 6075 6750 6750 274 SLI-70 SLI-61 ANTI CARDIO LIPIN ANTIBODIES(ACLA)-PANEL(Z102) 2400 3000 3240 3600 3600 275 SLI-71 SLI-62 ANTI ds DNA ANTIBODIES WITH TITRE((S119) 3250 4063 4388 4875 4875 276 SLI-72 SLI-302 ANTI ds DNA CRITHIDIA -IFA(S096) 1700 2125 2295 2550 2550 277 SLI-73 SLI-63 ANTI GBM - Ab (S098) 1450 1813 1958 2175 2175 278 SLI-74 SLI-64 ANTI GLIADIN ANTIBODIES IGG IGA(Z204) 3000 3750 4050 4500 4500 279 SLI-75 SLI-65 ANTI MITOCHONDRIAL ANTIBODIES(AMA)(S046) 1700 2125 2295 2550 2550 280 SLI-76 16241 ANTI NMO PROFILE - (S266) 6500 8125 8775 9750 9750 281 SLI-77 SLI-66 ANTI PHOSPHO LIPID ANTIBODIES (IGG & IGM)(Z287) 1400 1750 1890 2100 2100 282 SLI-78 SLI-343 ANTI PHOSPHO LIPID IGG(S191) 800 1000 1080 1200 1200 283 SLI-79 SLI-344 ANTI PHOSPHO LIPID IGM(S192) 800 1000 1080 1200 1200 284 SLI-80 SLI-67 ANTI SMOOTH MUSCLE ANTI BODY (ASMA) IFA(S045) 1700 2125 2295 2550 2550 285 SLI-81 SLI-68 ANTI SPERM ANTIBODIES(S012) 800 1000 1080 1200 1200 286 SLI-82 SLI-72 ANTI THROMBIN-ACTIVITY FUNCTIONAL(H101) 2850 3563 3848 4275 4275 287 SLI-83 SLI-69 ANTI THYROID ANTIBODIES (PANEL)(Z201) 2500 3125 3375 3750 3750 288 SLI-84 SLI-370 ANTI TPO( THYROID PEROXIDASE ANTIBODIES)(S094) 1300 1625 1755 1950 1950 289 SLI-85 16152 ANTI-DNase- B (B075) 1200 1500 1620 1800 1800 290 SLI-86 SLI-71 ANTI-DNASE B(B075) 1200 1500 1620 1800 1800 291 SLI-87 SLI-303 ANTI-ssDNA ANTIBODY(S097) 2450 3063 3308 3675 3675 292 SLI-88 SLI-73 APOLIPO PROTEINS A1&B(Z212) 680 850 918 1020 1020 293 SLI-89 14817 ARSENIC (C-006). 2750 3438 3713 4125 4125 294 SLI-90 SLI-74 ASPERGILLUS IgG(S102) 1700 2125 2295 2550 2550 295 SLI-91 SLI-371 ASPERGILLUS IgM(S155) 1700 2125 2295 2550 2550 296 SLI-92 15790 AUTO IMMUNE ENCEPHALITIS PANEL-S253. 18000 22500 24300 27000 27000 297 SLI-93 MIC-30 BACTERIAL MENINGITIS-PANEL (S103) 2700 3375 3645 4050 4050 298 SLI-94 16104 BCR ABL (GENX). 6000 7500 8100 9000 9000 299 SLI-95 SLI-305 BCR- ABL QUANTITIVE(N037) 3100 3875 4185 4650 4650 300 SLI-96 14284 BECCKER MUSKULAR DYSTROPHY GENE MUTATION(N116) 7500 9375 10125 11250 11250 301 SLI-97 SLI-78 BETA-2 GLYCOPROTEIN PANEL(Z547) 2600 3250 3510 3900 3900 302 SLI-98 SLI-79 BETA-2 MICRO GLOBULIN-SERUM(R061) 1300 1625 1755 1950 1950 303 SLI-99 SLI-81 BETA-HCG WITH TITRE 650 813 878 975 975

Any new service/tariff may be changed/added/deleted without prior notice. 30 Schedule of Charges 2019-20 ISIC

304 SLI-100 SLI-80 BETA-HCG(R021) 650 813 878 975 975 305 SLI-101 16256 BILE ACID TOTAL (B197). 1500 1875 2025 2250 2250 306 SLI-102 SLI-83 BONE SPECIFIC ALKALINE PO4(R121) 4500 5625 6075 6750 6750 307 SLI-103 SLI-84 BORRELIA ANTIBODY IgG-IgM (LYME DISEASE Ab)(S092) 3300 4125 4455 4950 4950 308 SLI-104 SLI-345 BREAST CANCER PANEL-3(Z293) 3800 4750 5130 5700 5700 309 SLI-105 SLI-306 BREAST CANCER PANEL-1 ERPR(Z240) 2400 3000 3240 3600 3600 310 SLI-106 SLI-85 BREAST MONITOR-I(CA-15.3,CEA)(Z388) 2000 2500 2700 3000 3000 311 SLI-107 SLI-86 BRUCELLA ANTIBODIES (IgG,IgM Ab PANEL)(Z676) 1850 2313 2498 2775 2775 312 SLI-108 SLI-15806 BRUCELLA IgM ANTIBODIES(S222) 1150 1438 1553 1725 1725 313 SLI-109 SLI-373 C- PEPTIDE SERUM (R055) 1050 1313 1418 1575 1575 314 SLI-110 SLI-104 C. DIFFICILE TOXIN(T006) 2450 3063 3308 3675 3675 315 SLI-111 SLI-374 CA 15.3-BREAST CANCER MARKER(F010) 1350 1688 1823 2025 2025 316 SLI-112 SLI-89 CA 19.9-PANCREATIC CANCER MARKER(F008) 1350 1688 1823 2025 2025 317 SLI-113 SLI-376 CA-125(OVARIAN CANCER MONITOR) 1200 1500 1620 1800 1800 318 SLI-114 SLI-91 CALCITONIN(R062) 2150 2688 2903 3225 3225 319 SLI-115 SLI-202 CALCIUM IONIZED (B055) 580 725 783 870 870 320 SLI-116 SLI-94 CARBAMAZEPINE(D051) 800 1000 1080 1200 1200 321 SLI-117 14493 CD-19 (H-147). 2050 2563 2768 3075 3075 322 SLI-118 SLI-95 CD-20(IHC)((J062) 1570 1963 2120 2355 2355 323 SLI-119 SLI-96 CD3 & CD4(Z219) 1600 2000 2160 2400 2400 324 SLI-120 SLI-97 CD3(IHC)(J066) 1570 1963 2120 2355 2355 325 SLI-121 SLI-98 CD3,CD4 & CD8 COUNT(Z147) 2230 2788 3011 3345 3345 326 SLI-122 SLI-26 CEA ( CARCINO-EMBRYONIC ANTIGEN)(F003). 670 838 905 1005 1005 327 SLI-123 SLI-99 CEA (CARCINO EMBRIONIC ANTIGEN)(F003) 670 838 905 1005 1005 328 SLI-124 SLI-100 CERULOPLASMIN(B087) 1100 1375 1485 1650 1650 329 SLI-125 14592 CHIKUNGUNYA DETECTION-PCR (N-131) 1500 1875 2025 2250 2250 330 SLI-126 16100 CHIKUNGUNYA PCR (GENX) 1500 1875 2025 2250 2250 331 SLI-127 SLI-101 CHLAMYDIA IgG PANEL. (EIA)(S156) 1400 1750 1890 2100 2100 332 SLI-128 SLI-102 CHOLINESTERASE(B065) 490 613 662 735 735 333 SLI-129 OUT-1001 CHROMASOME ANALYSIS FOR HEMATOLOGIC MALIGNANCY (Q-005). 3200 4000 4320 4800 4800 334 SLI-130 SLI-377 CHROMOGRANIN A(R098) 6900 8625 9315 10350 10350 335 SLI-131 15737 CHROMOSOME (PHILA DELPHIA) (Q016) 2900 3625 3915 4350 4350

Any new service/tariff may be changed/added/deleted without prior notice. 31 Schedule of Charges 2019-20 ISIC

336 SLI-132 SLI-307 CHROMOSOME ANALYSIS (KARYOTYPING) BLOOD(Q008) 2850 3563 3848 4275 4275 337 SLI-133 SLI-308 CMV DNA PCR(N031) 8600 10750 11610 12900 12900 338 SLI-134 SLI-339 COLLAGEN CROSS-LINKED N-TELOPEPTIDE (URINE)(B161) 7500 9375 10125 11250 11250 339 SLI-135 SLI-106 COMPLEMENT -C3(H105) 650 813 878 975 975 340 SLI-136 SLI-107 COMPLEMENT C4(H106) 650 813 878 975 975 341 SLI-137 SLI-309 COMPREHENSIVE LIPID PROFILE(Z279) 4200 5250 5670 6300 6300 342 SLI-138 HMA-8 COOMBS TEST (DIRECT)(H028) 470 588 635 705 705 343 SLI-139 HMA-9 COOMBS TEST INDIRECT(H027) 480 600 648 720 720 344 SLI-140 SLI-109 COPPER(C019) 1300 1625 1755 1950 1950 345 SLI-141 SLI-110 CORTISOL 550 688 743 825 825 346 SLI-142 SLI-111 CRYOGLOBULIN PANEL(H117) 5750 7188 7763 8625 8625 347 SLI-143 SLI-112 CRYOGLOBULINS SCREENING 950 1188 1283 1425 1425 348 SLI-144 MIC-28 CRYPTOSPORIDIUM / ISOSPORA(T011) 330 413 446 495 495 349 SLI-145 SLI-116 CSF & SERUM OLIGOCLONAL BANDS(E018) 4200 5250 5670 6300 6300 350 SLI-146 SLI-114 CSF FOR CRYPTOCOCCUS ANTIGEN(S111) 2000 2500 2700 3000 3000 351 SLI-147 SLI-118 CSF/PLASMA HSV DNA PCRTYPE 1 & 2(Z303) 6100 7625 8235 9150 9150 352 SLI-148 SLI-56 CULTURE ANAEROBIC, BODY FLUIDS(M134) 1200 1500 1620 1800 1800 353 SLI-149 SLI-119 CULTURE BLOOD & BODY FLUID ANAEROBIC 1200 1500 1620 1800 1800 354 SLI-150 MIC-29 CULTURE CHOLERA(M076) 750 938 1013 1125 1125 355 SLI-151 SLI-524 CULTURED MOLD ANTIFUNGAL DRUG SENSITIVITY (AST) TEST (M 223) 10000 12500 13500 15000 15000 356 SLI-152 SLI-356 CULTURE-GONOCOCCUS 1000 1250 1350 1500 1500 357 SLI-153 SLI-122 CYCLOSPORINE (COC2) 2400 3000 3240 3600 3600 358 SLI-154 SLI-123 CYSTICERCOSIS IgG ANTIBODY(S033) 1300 1625 1755 1950 1950 359 SLI-155 SLI-105 CYTOMEGALO VIRUS - PCR -QUALITATIVE(N017) 3900 4875 5265 5850 5850 360 SLI-156 SLI-124 CYTOMEGALO VIRUS-IgG AVIDITY(B156) 580 725 783 870 870 361 SLI-157 SLI-125 CYTOMEGALO VIRUS-IgM(S022) 580 725 783 870 870 362 SLI-158 14227 DENGUE FEVER NS1 AG (ELISA) 600 750 810 900 900 363 SLI-159 14228 DENGUE IgG (ELISA)(S217) 600 750 810 900 900 364 SLI-160 14229 DENGUE IgM (ELISA)(S216) 600 750 810 900 900 365 SLI-161 16101 DENGUE PCR (GENX). 1500 1875 2025 2250 2250 366 SLI-162 SLI-368 DHEA SULPHATE(R044) 1000 1250 1350 1500 1500 367 SLI-163 SLI-126 DHEA(DEHYDROEPIANDROSTERONE) 2230 2788 3011 3345 3345

Any new service/tariff may be changed/added/deleted without prior notice. 32 Schedule of Charges 2019-20 ISIC

368 SLI-164 SLI-127 DIGOXIN(D008) 900 1125 1215 1350 1350 369 SLI-165 14772 DMD/BMD GENE MUTATION-N-116 7500 9375 10125 11250 11250 370 SLI-166 SLI-128 DOUBLE MARKER (DUEL TEST)-Z397 2150 2688 2903 3225 3225 371 SLI-167 SLI-349 ECHINOCOCCUS (HYDATID SEROLOGY) IGG-SERUM-S036. 1200 1500 1620 1800 1800 372 SLI-168 SLI-129 EH ANTIBODIES (ENTAMOEBA HISTOLYTICA)-S014 1350 1688 1823 2025 2025 373 SLI-169 SLI-1254 ENA (QUANTITATIVE) 7000 8750 9450 10500 10500 374 SLI-170 SLI-130 ENDOMYSIAL AB-IgA(S078) 1700 2125 2295 2550 2550 375 SLI-171 OUT-1959 EPSTEIN BARR VIRUS IgM(S070) 1600 2000 2160 2400 2400 376 SLI-172 SLI-132 EPSTEIN BARRS VIRUS IgG & IgM(Z172) 3000 3750 4050 4500 4500 377 SLI-173 SLI-133 ERYTHROPOIETIN(R018) 2000 2500 2700 3000 3000 378 SLI-174 SLI-134 ESTRADIOL(E-2)-R019) 590 738 797 885 885 379 SLI-175 SLI-135 ESTRIOL (UNCONJUGATED)(R101) 1230 1538 1661 1845 1845 380 SLI-176 SLI-313 EXTENDED LIPID PROFILE(Z060) 2600 3250 3510 3900 3900 381 SLI-177 SLI-136 FACTOR II FUNCTIONAL(H173) 7200 9000 9720 10800 10800 382 SLI-178 SLI-314 FACTOR IX FUNCTIONAL(H175) 1750 2188 2363 2625 2625 383 SLI-179 SLI-351 FACTOR VII FUNCTIONAL(H178) 2900 3625 3915 4350 4350 384 SLI-180 SLI-315 FACTOR VIII FUNCTIONAL(H240) 1400 1750 1890 2100 2100 385 SLI-181 SLI-137 FACTOR X FUNCTIONAL(H176) 4700 5875 6345 7050 7050 386 SLI-182 SLI-316 FACTOR XIII CLOT SOLUBILITY(H041) 350 438 473 525 525 387 SLI-183 SLI-138 FACTOR-V LEIDEN MUTATION(H209) 5500 6875 7425 8250 8250 388 SLI-184 14282 FAECAL CALPROTECTIN (S231.) 3680 4600 4968 5520 5520 389 SLI-185 SLI-140 FIBRINOGEN CLOT ACTIVITY(B088) 690 863 932 1035 1035 390 SLI-186 SLI-352 FILARIA ANTIGEN(S170) 790 988 1067 1185 1185 391 SLI-187 SLI-353 FISH (1P & 19Q) CODELATION(XX013) 9000 11250 12150 13500 13500 392 SLI-188 SLI-561 FISH MULTIPLE MYELOMA (XX027). 12200 15250 16470 18300 18300 393 SLI-189 SLI-141 FOLIC ACID(R046) 1150 1438 1553 1725 1725 394 SLI-190 16205 FRIEDREICH ATAXIA MUTATION PANEL- 6600 8250 8910 9900 9900 395 SLI-191 SLI-142 FSH (FOLLICLE STIMULATING HORMONE)-(ECLIA)R080 530 663 716 795 795 396 SLI-192 SLI-143 FUNGAL CULTURE* 1100 1375 1485 1650 1650 397 SLI-193 SLI-144 G6 PD -QUANTITATIVE(H018) 830 1038 1121 1245 1245 398 SLI-194 SLI-145 GAD 65 ANTI BODY.(B150) 6200 7750 8370 9300 9300 399 SLI-195 SLI-146 GALACTOMANNAN (S242) 5100 6375 6885 7650 7650

Any new service/tariff may be changed/added/deleted without prior notice. 33 Schedule of Charges 2019-20 ISIC

400 SLI-196 16202 GANGLIOSIDE ANTIBODY PROFILE IGG (S-233) 4000 5000 5400 6000 6000 401 SLI-197 16201 GANGLIOSIDE ANTIBODY PROFILE IGM (S-234) 4000 5000 5400 6000 6000 402 SLI-198 SLI-147 GASTRIN(R020) 1200 1500 1620 1800 1800 403 SLI-199 SLI-148 GENE - XPERT((N061) 2000 2500 2700 3000 3000 404 SLI-200 SLI-354 GM2 GANGLIOSIDOSIS QUANTITATIVE(G124) 2400 3000 3240 3600 3600 405 SLI-201 SLI-149 GROWTH HORMONE(R031) 750 938 1013 1125 1125 406 SLI-202 16102 H1N1 RT PCR (GENX). 4000 5000 5400 6000 6000 407 SLI-203 SLI-150 H1-N1 RTPCR(N034) 4500 5625 6075 6750 6750 408 SLI-204 SLI-151 HAPTOGLOBIN(B100) 1900 2375 2565 2850 2850 409 SLI-205 SLI-152 HB -ELECTRO PHORESIS(E002) 950 1188 1283 1425 1425 410 SLI-206 16096 HBV DNA QUALITATIVE (GENX). 4000 5000 5400 6000 6000 411 SLI-207 16095 HBV DNA QUANTITATIVE (GENX). 7000 8750 9450 10500 10500 412 SLI-208 SLI-153 HCV COMBO-QUANTITATIVE RT PCR+GENOTYPE(Z511) 8200 10250 11070 12300 12300 413 SLI-209 16099 HCV GENOTYPING (GENX). 5000 6250 6750 7500 7500 414 SLI-210 16085 HCV RNA GENOTYPE(N032). 4500 5625 6075 6750 6750 415 SLI-211 16098 HCV RNA QUALITATIVE (GENX). 4000 5000 5400 6000 6000 416 SLI-212 16097 HCV RNA QUANTITATIVE (GENX). 8000 10000 10800 12000 12000 417 SLI-213 SLI-318 HEMOPHILIA A CARRIER DETECTION(H241) 10400 13000 14040 15600 15600 418 SLI-214 SLI-319 HEMOPHILIA PANEL(Z374) 2800 3500 3780 4200 4200 419 SLI-215 SLI-355 HEP B SURFACE Ag (QTY) 1390 1738 1877 2085 2085 420 SLI-216 SLI-154 HEPATITIS ACUTE PANEL (VIRUS CONFIRMATION) 6600 8250 8910 9900 9900 421 SLI-217 SLI-156 HEPATITIS B CORE IGM AB(S058) 1100 1375 1485 1650 1650 422 SLI-218 SLI-155 HEPATITIS B SURFACE ANTIBODY((S057) 720 900 972 1080 1080 423 SLI-219 SLI-157 HEPATITIS Be ANTIBODY(S060) 800 1000 1080 1200 1200 424 SLI-220 SLI-158 HEPATITIS Be VIRUS ANTIGEN(S059) 900 1125 1215 1350 1350 425 SLI-221 SLI-159 HEPATITIS C VIRUS Ab(S062) 1450 1813 1958 2175 2175 426 SLI-222 SLI-160 HEPATITIS C VIRUS RNA DETECTOR (QUALITATIVE) 4300 5375 5805 6450 6450 427 SLI-223 SLI-161 HEPATITIS C VIRUS RNA PCR (QUALITATIVE)(N004) 4300 5375 5805 6450 6450 428 SLI-224 SLI-162 HEPATITIS C VIRUS RNA QUANTITATIVE(N028) 4500 5625 6075 6750 6750 429 SLI-225 SLI-320 HEPATITIS E IgG(S202) 1600 2000 2160 2400 2400 430 SLI-226 SLI-163 HEPATITIS E IgM AB (S051) 1600 2000 2160 2400 2400 431 SLI-227 14145 HEPATITIS-A VIRUS IgG ANTIBODIES(S090) 1190 1488 1607 1785 1785

Any new service/tariff may be changed/added/deleted without prior notice. 34 Schedule of Charges 2019-20 ISIC

432 SLI-228 SLI-164 HEPATITIS-A VIRUS IgM ANTIBODIES(S061) 1190 1488 1607 1785 1785 433 SLI-229 SLI-165 HEPATITIS-B SURFACE Ag-(CONFIRMATION)(S116) 650 813 878 975 975 434 SLI-230 SLI-166 HEPATITIS-B VIRUS DNA QUALITATIVE(N011) 4400 5500 5940 6600 6600 435 SLI-231 SLI-167 HEP-B DNA QUANTITATIVE(N027) 7500 9375 10125 11250 11250 436 SLI-232 SLI-168 HEP-B-CORE TOTAL Ab(S115) 1100 1375 1485 1650 1650 437 SLI-233 SLI-169 HERPES SIMPLEX VIRUS - IgM TYPE I Abs(S213) 700 875 945 1050 1050 438 SLI-234 SLI-170 HERPES SIMPLEX VIRUS IgG TYPE I Abs(S211) 700 875 945 1050 1050 439 SLI-235 SLI-171 HERPES SIMPLEX VIRUS -IgG TYPE II Abs(S212) 700 875 945 1050 1050 440 SLI-236 SLI-172 HERPES SIMPLEX VIRUS IGM TYPE-II ANTIBODIES 700 875 945 1050 1050 441 SLI-237 SLI-173 HERPES SIMPLEX VIRUS TYPE I & TYPE II IgG & IgM Abs(Z205) 1140 1425 1539 1710 1710 442 SLI-238 SLI-175 HISTO PLASMA ANTIBODIES SCREEN 3600 4500 4860 5400 5400 443 SLI-239 SLI-321 HISTONE ANTIBODIES(S019) 1350 1688 1823 2025 2025 444 SLI-240 SLI-208 HISTOPATHOLOGY KIDNEY BIOPSY PANEL-1(Z353) 3600 4500 4860 5400 5400 445 SLI-241 SLI-209 HISTOPATHOLOGY KIDNEY BIOPSY PANEL-2(Z355) 1700 2125 2295 2550 2550 446 SLI-242 SLI-176 HIV ANTIBODIES WESTERN BLOT((S063) 3350 4188 4523 5025 5025 447 SLI-243 SLI-356 HIV I RNA QUANTITATIVE PCR(N029) 5000 6250 6750 7500 7500 448 SLI-244 14726 HIV I RNA QUANTITATIVE WITH CD3/CD4/CD8(H216) 7000 8750 9450 10500 10500 449 SLI-245 SLI-178 HIV MONITOR( CD4 CD8) VIRAL LOAD PANEL-2 7000 8750 9450 10500 10500 450 SLI-246 16103 HIV RT PCR (GENX). 4000 5000 5400 6000 6000 451 SLI-247 SLI-179 HIV-I RNA QTY. PCR WITH CD3 / CD4 6180 7725 8343 9270 9270 452 SLI-248 16235 HLA (DR- DQ2- DQ8). 5700 7125 7695 8550 8550 453 SLI-249 15991 HLA-B5(B*51/52) 4300 5375 5805 6450 6450 454 SLI-250 15757 HLA-PANEL REACTIVE IgG ABs (PRA) SCREEN-L003 5790 7238 7817 8685 8685 455 SLI-251 SLI-182 HOMOCYSTEINE-SERUM(R143) 900 1125 1215 1350 1350 456 SLI-252 SLI-230 HPV DETECTION & QUALITATIVE PCR(N040) 1100 1375 1485 1650 1650 457 SLI-253 SLI-183 H-PYLORI-IGG & IGA(Z121) 3100 3875 4185 4650 4650 458 SLI-254 SLI-184 HSV PCR(TYPE 1-TYPE 2 CSF)-Z303. 6100 7625 8235 9150 9150 459 SLI-255 SLI-185 HTLV I & II ANTIBODIES(RW096) 13740 17175 18549 20610 20610 460 SLI-256 SPL-101 HU ANTIBODY (METRO). 5000 6250 6750 7500 7500 461 SLI-257 14588 HUNTINGTON-DISEASE MUTATION DETECTION (N118). 3000 3750 4050 4500 4500 462 SLI-258 14151 IHC - CD -20(J062) 1570 1963 2120 2355 2355 463 SLI-259 SLI-188 IHC - EMA(J030) 1570 1963 2120 2355 2355

Any new service/tariff may be changed/added/deleted without prior notice. 35 Schedule of Charges 2019-20 ISIC

464 SLI-260 SLI-189 IHC - S-100(J031) 1570 1963 2120 2355 2355 465 SLI-261 SLI-190 IHC (Any Three)-J150 4500 5625 6075 6750 6750 466 SLI-262 14262 IHC (EGFR).J077 1900 2375 2565 2850 2850 467 SLI-263 SLI-14539 IHC ALK-I (J147) 1570 1963 2120 2355 2355 468 SLI-264 SLI-358 IHC ANY FIVE(J151) 5200 6500 7020 7800 7800 469 SLI-265 14152 IHC- CD - 138(J146) 1570 1963 2120 2355 2355 470 SLI-266 SLI-359 IHC CUSTOM PANEL(Z700) 6000 7500 8100 9000 9000 471 SLI-267 16135 IHC SINGLE MARKER (ONCQUEST). 1650 2063 2228 2475 2475 472 SLI-268 SLI-360 IHC-BCL-2.(J094) 1570 1963 2120 2355 2355 473 SLI-269 16136 IHC-CLONALITY(ONCQEST). 4950 6188 6683 7425 7425 474 SLI-270 14784 IHC-ER, PR, HER 2 (ONCQUEST). 3000 3750 4050 4500 4500 475 SLI-271 14600 IHC-FINAL DIAGNOSIS 6000 7500 8100 9000 9000 476 SLI-272 SLI-361 IHC-GFAP(J034) 1570 1963 2120 2355 2355 477 SLI-273 15989 IHC-KAPPA LIGHT CHAINS(J139) 1900 2375 2565 2850 2850 478 SLI-274 SLI-362 IHC-KI-67(J046) 1900 2375 2565 2850 2850 479 SLI-275 15990 IHC-LAMBDA LIGHT CHAINS(J138) 1900 2375 2565 2850 2850 480 SLI-276 SLI-194 IMMUNO FIXATION ELECTRO PHORESIS SERUM (E005) 6200 7750 8370 9300 9300 481 SLI-277 SLI-195 IMMUNO FIXATION ELECTRO PHORESIS -URINE(E006) 8000 10000 10800 12000 12000 482 SLI-278 SLI-196 IMMUNOGLOBULIN IgM-SERUM (B079) 430 538 581 645 645 483 SLI-279 SLI-187 IMMUNOGLOBULIN- IgE-TOTAL(S028) 830 1038 1121 1245 1245 484 SLI-280 16398 IMMUNOGLOBULIN IGG SUBCLASS 4 6500 8125 8775 9750 9750 485 SLI-281 SLI-197 IMMUNOGLOBULIN SERUM IgA(B078) 350 438 473 525 525 486 SLI-282 SLI-198 IMMUNOGLOBULIN SERUM IgG(B077) 350 438 473 525 525 487 SLI-283 SLI-199 INSULIN (FASTING)-R039 800 1000 1080 1200 1200 488 SLI-284 SLI-200 INSULIN (PP)-R042 800 1000 1080 1200 1200 489 SLI-285 SLI-1450 INSULIN ANTIBODIES.(S133) 1990 2488 2687 2985 2985 490 SLI-286 SLI-203 ISLET CELL ANTI BODY(S134) 1790 2238 2417 2685 2685 491 SLI-287 SLI-324 JAK 2 MUTATION QUALITATIVE PCR(N039) 5300 6625 7155 7950 7950 492 SLI-288 14795 JAPANESE ENCEPHALITIS PCR (OS-157) 3500 4375 4725 5250 5250 493 SLI-289 SLI-205 KALA AZAR ANTIBODY IgG(S025) 1600 2000 2160 2400 2400 494 SLI-290 SLI-206 KAPPA LAMBDA, LIGHT CHAINS, FREE (SERUM)-B148 6500 8125 8775 9750 9750 495 SLI-291 SLI-207 KAPPA LAMBDA, LIGHT CHAINS, FREE (URINE)-U079 6500 8125 8775 9750 9750

Any new service/tariff may be changed/added/deleted without prior notice. 36 Schedule of Charges 2019-20 ISIC

496 SLI-292 16111 KARYOTYPING (GENX). 2500 3125 3375 3750 3750 497 SLI-293 BIOC-69 LACTATE,PLASMA* 970 1213 1310 1455 1455 498 SLI-294 SLI-213 LAP-SCORE(H050) 830 1038 1121 1245 1245 499 SLI-295 SLI-214 LEAD(C030) 1640 2050 2214 2460 2460 500 SLI-296 SLI-215 LEISHMANIA ANTIBODY IgG(S025) 1600 2000 2160 2400 2400 501 SLI-297 SLI-216 LEPTO SPIRA IgG & IgM ANTIBODIES(Z302). 2500 3125 3375 3750 3750 502 SLI-298 15179 LEPTOSPIRA IGM(S197). 1350 1688 1823 2025 2025 503 SLI-299 OUT-1000 LEUKEMIA DIAGNOSTIC PANEL-ACUTE LEUKEMIA (TBORM). 9000 11250 12150 13500 13500 504 SLI-300 SLI-217 LH (LUTEINISING HORMONE)-R081 530 663 716 795 795 505 SLI-301 SLI-218 LIPASE(B059) 630 788 851 945 945 506 SLI-302 SLI-219 LIPO PROTEIN(a)-B101 920 1150 1242 1380 1380 507 SLI-303 SLI-220 LITHIUM-SERUM(B069) 300 375 405 450 450 508 SLI-304 SLI-211 Liver kidney microsomal (LKM) ANTIBODY(S164) 1600 2000 2160 2400 2400 509 SLI-305 14271 LUNG CANCER MUTATIONAL PANEL 16000 20000 21600 24000 24000 510 SLI-306 SLI-221 LUPUS ANTI COAGULANT (dRvT)-H123 1700 2125 2295 2550 2550 511 SLI-307 SLI-222 LUPUS ANTI COAGULANT (PANEL)-Z168 2730 3413 3686 4095 4095 512 SLI-308 SLI-223 LYME DISEASE (BORRELIA) ANTIBODIES(S092) 3300 4125 4455 4950 4950 513 SLI-309 14834 MANGANESE -BLOOD(C064) 1900 2375 2565 2850 2850 514 SLI-310 14806 MATERNAL BLOOD-FETAL-DNA(NO-75) 25000 31250 33750 37500 37500 515 SLI-311 SLI-224 MEASLES ANTIBODY IgG(S072) 1600 2000 2160 2400 2400 516 SLI-312 SLI-225 MEASLES ANTIBODY IgM 1600 2000 2160 2400 2400 517 SLI-313 14815 MERCURY (C 029) 3240 4050 4374 4860 4860 518 SLI-314 14818 METAL SCREEN 2 BLOOD (Z 820). 11000 13750 14850 16500 16500 519 SLI-315 14668 MITOCHONDRIAL Ab(AMA) IFA IN DILUTIONS (S085) 2900 3625 3915 4350 4350 520 SLI-316 H184 MIXING STUDY APTT. 2800 3500 3780 4200 4200 521 SLI-317 SLI-227 MONO TEST( INFECTIOUS MONO NUCLEOSIS) 1100 1375 1485 1650 1650 522 SLI-318 14236 MTB-RRNA(AMTD)-N094 2500 3125 3375 3750 3750 523 SLI-319 SLI-228 MTHFR- QUALITATIVE-N049 3200 4000 4320 4800 4800 524 SLI-320 14280 MULTIPLE MYELOMA SCREENING PANEL(2781) 8000 10000 10800 12000 12000 525 SLI-321 SLI-229 MUMPS IgG ANTIBODY(S037) 1600 2000 2160 2400 2400 526 SLI-322 14846 MUMPS VIRUS IGM AB(S075). 1600 2000 2160 2400 2400 527 SLI-323 14281 MUSK ANTIBODY(243). 5500 6875 7425 8250 8250

Any new service/tariff may be changed/added/deleted without prior notice. 37 Schedule of Charges 2019-20 ISIC

528 SLI-324 SLI-14238 MYASTHENIA GRAVIS PANEL.(Z174) 5450 6813 7358 8175 8175 529 SLI-325 SLI-326 MYCO COMBI PANEL (TB .COM) 2700 3375 3645 4050 4050 530 SLI-326 SLI-266 MYCOBACTERIUM TUBERCULOSIS COMPLEX(Real Time PCR)* 2000 2500 2700 3000 3000 531 SLI-327 SLI-230 MYCOPLASMA PNEUMONIA IGG, IGM(Z677) 3600 4500 4860 5400 5400 532 SLI-328 SLI-231 MYELIN BASIC PROTEIN (CSF)-RW135 6050 7563 8168 9075 9075 533 SLI-329 SLI-232 MYOGLOBIN- SERUM(B102) 4000 5000 5400 6000 6000 534 SLI-330 14677 MYOSITIS PROFILE (S-245). 7000 8750 9450 10500 10500 535 SLI-331 16295 NEURO VIRUSES COMPREHENSIVE PANEL. 7500 9375 10125 11250 11250 536 SLI-332 16076 NEURON SPECIFIC ENOLASE(FO19). 3200 4000 4320 4800 4800 537 SLI-333 14420 NEURONAL PARA NEOPLASTIC AUTO-ANTI BODIES (S 232) 9000 11250 12150 13500 13500 538 SLI-334 SLI-524 NMDA RECEPTOR Ab. (S-239) 6250 7813 8438 9375 9375 539 SLI-335 SLI-235 OSMOTIC FRAGILITY. 490 613 662 735 735 540 SLI-336 14235 OSTEO CALCIN. 2730 3413 3686 4095 4095 541 SLI-337 SLI-236 OSTEOCALCIN, ESTRADIOL, DPYD 5370 6713 7250 8055 8055 542 SLI-338 SLI-238 OSTEOPOROSIS PANEL- Z 159 11500 14375 15525 17250 17250 543 SLI-339 SLI-240 PARVO VIRUS B19 IgG &IgM (Z185) 4550 5688 6143 6825 6825 544 SLI-340 SLI-241 PHENOBARBITONE(D050) 920 1150 1242 1380 1380 545 SLI-341 SLI-242 PHENYTOIN(D049) 970 1213 1310 1455 1455 546 SLI-342 SLI-243 PHOSPHOLIPID SYNDROME PANE. 4500 5625 6075 6750 6750 547 SLI-343 SLI-244 PLASMA AMMONIA 1150 1438 1553 1725 1725 548 SLI-344 SLI-245 PLASMA RENIN (R072) 5200 6500 7020 7800 7800 549 SLI-345 SLI-247 PNH (CD55,CD59) CONFIRMATION 6300 7875 8505 9450 9450 550 SLI-346 SPL-364 PROCOLLAGEN TYPE-I AMINO TERMINAL PROPEPTIDE-TOTAL(B165) 1450 1813 1958 2175 2175 551 SLI-347 SLI-248 PROGESTERONE 550 688 743 825 825 552 SLI-348 SLI-249 PROLACTIN(R082) 520 650 702 780 780 553 SLI-349 SLI-251 PROTEIN-C -FUNCTIONAL(H061) 3950 4938 5333 5925 5925 554 SLI-350 SLI-252 PROTEIN-S -FUNCTIONAL(H-180) 5000 6250 6750 7500 7500 555 SLI-351 14395 PROTHROMBIN GENE MUTATION ANALYSIS (N048) 3300 4125 4455 4950 4950 556 SLI-352 SLI-253 PSA TOTAL & FREE(Z262) 1450 1813 1958 2175 2175 557 SLI-353 SLI-254 PYRUVATE(G148) 3250 4063 4388 4875 4875 558 SLI-354 SLI-255 QUADRUPLE TEST(Z514) 3290 4113 4442 4935 4935 559 SLI-355 14478 RESPIRATORY PANEL-7 (N-104) 3000 3750 4050 4500 4500

Any new service/tariff may be changed/added/deleted without prior notice. 38 Schedule of Charges 2019-20 ISIC

560 SLI-356 SPL-100 Ri ANTIBODY (METRO). 5000 6250 6750 7500 7500 561 SLI-357 14417 ROMA (Z-673). 3000 3750 4050 4500 4500 562 SLI-358 SLI-257 RUBELLA IgG & IgM ANTIBODIES(Z190) 1050 1313 1418 1575 1575 563 SLI-359 SLI-258 RUBELLA-IgG(S040) 600 750 810 900 900 564 SLI-360 SLI-259 RUBELLA-IgM(S016) 600 750 810 900 900 565 SLI-361 14681 SCA PANEL 11000 13750 14850 16500 16500 566 SLI-362 SLI-113 SERUM CRYPTO COCCUS-ANTIGEN(S112) 2000 2500 2700 3000 3000 567 SLI-363 SLI-365 SEX HORMONE BINDING GLOBULIN 2350 2938 3173 3525 3525 568 SLI-364 SLI-262 SMITH IgG ANTIBODIES(S038) 970 1213 1310 1455 1455 569 SLI-365 16332 SPINAL MUSCULAR ATROPHY MUTATION DETECTION (N119) 3000 3750 4050 4500 4500 570 SLI-366 SLI-256 SSA(RO) SSB(LA) 2900 3625 3915 4350 4350 571 SLI-367 SLI-264 STONE ANALYSIS (GALL BLADER) 1050 1313 1418 1575 1575 572 SLI-368 SLI-263 STONE ANALYSIS(C031) 1050 1313 1418 1575 1575 573 SLI-369 15126 TACROLIMUS, FK506 (G160) 3600 4500 4860 5400 5400 574 SLI-370 SLI-265 TB GOLD (GAMMA INTERFERON)(B160) 2550 3188 3443 3825 3825 575 SLI-371 15000 TB PLATINUM (M230) 2000 2500 2700 3000 3000 576 SLI-372 SLI-267 TESTOSTERONE FREE & TOTAL(Z384) 2300 2875 3105 3450 3450 577 SLI-373 SLI-268 TESTOSTERONE FREE(R009) 1850 2313 2498 2775 2775 578 SLI-374 SLI-269 TESTOSTERONE, TOTAL(R010) 600 750 810 900 900 579 SLI-375 16337 THALLIUM (C-042). 0 0 0 0 0 580 SLI-376 SLI-366 THROMBOPHILIA COMPREHENSIVE PROFILE(Z497) 15800 19750 21330 23700 23700 581 SLI-377 SLI-272 THYRO GLOBULIN ANTIBODIES(S095) 1300 1625 1755 1950 1950 582 SLI-378 SLI-273 THYROGLOBULIN(F012) 1700 2125 2295 2550 2550 583 SLI-379 SLI-329 TNF - ALPHA(B146) 3900 4875 5265 5850 5850 584 SLI-380 SLI-274 TORCH IgG ,IgM ANTIBODIES((Z028) 2500 3125 3375 3750 3750 585 SLI-381 SLI-275 TORCH IgG ANTIBODIES(B155) 1300 1625 1755 1950 1950 586 SLI-382 SLI-276 TORCH IgM ANTIBODIES(Z026) 1300 1625 1755 1950 1950 587 SLI-383 14796 TOXICOLOGY STUDY-BLOOD ( RW-186). 8100 10125 10935 12150 12150 588 SLI-384 SLI-278 TOXO PLASMA IgG ANTIBODIES(S039) 580 725 783 870 870 589 SLI-385 SLI-279 TOXO PLASMA IgM ANTIBODIES(S015) 580 725 783 870 870 590 SLI-386 SLI-281 TOXOPLASMA IgG & IgM ANTIBODIES(Z197) 1000 1250 1350 1500 1500 591 SLI-387 SLI-282 TPHA(S001) 550 688 743 825 825

Any new service/tariff may be changed/added/deleted without prior notice. 39 Schedule of Charges 2019-20 ISIC

592 SLI-388 SLI-283 TRANSFERRIN(H128) 1100 1375 1485 1650 1650 593 SLI-389 SLI-284 TRIPLE TEST(Z266) 2700 3375 3645 4050 4050 594 SLI-390 OUT-1000 tTG -IgA(TISSUE TRANSGLUTAMINASE)(S196) 1000 1250 1350 1500 1500 595 SLI-391 SLI-285 tTG(TISSUE TRANSGLUTAMINASE ) DGP SCREEN (S228) 1900 2375 2565 2850 2850 596 SLI-392 15697 URINE HAEMOGLOBIN 200 250 270 300 300 597 SLI-393 16088 URINE 9 DRUG PANEL. 6150 7688 8303 9225 9225 598 SLI-394 SLI-330 URINE BARBITURATE(K014) 700 875 945 1050 1050 599 SLI-395 SLI-331 URINE BENZODIAZEPINE(K002) 700 875 945 1050 1050 600 SLI-396 SLI-287 URINE BETA-2 MICRO GLOBULIN(U051) (RANDOM) 1300 1625 1755 1950 1950 601 SLI-397 14832 URINE CADMIUM (C009). 3200 4000 4320 4800 4800 602 SLI-398 SLI-288 URINE CATECHOLAMINES(U043) 4500 5625 6075 6750 6750 603 SLI-399 14761 URINE CHYLE (P072). 490 613 662 735 735 604 SLI-400 U URINE CITRATE(G147) 800 1000 1080 1200 1200 605 SLI-401 SLI-332 URINE COCAINE.(K011) 690 863 932 1035 1035 606 SLI-402 SLI-108 URINE COPPER 24 Hrs(C017) 1850 2313 2498 2775 2775 607 SLI-403 14816 URINE METAL SCREEN 3 (Z 821). 14000 17500 18900 21000 21000 608 SLI-404 SLI-325 URINE METANEPHRINES(U035) 10800 13500 14580 16200 16200 609 SLI-405 14245 URINE METHADONE(K022) 700 875 945 1050 1050 610 SLI-406 SLI-250 URINE PROTEIN ELECTROPHORESIS(E003) 3900 4875 5265 5850 5850 611 SLI-407 14833 URINE ZINC (C035). 1800 2250 2430 2700 2700 612 SLI-408 SLI-29 URINE 17-KETOSTEROID(U005) 5700 7125 7695 8550 8550 613 SLI-409 SLI-9987 URINE 24 HRS OXALATES(U055) 1700 2125 2295 2550 2550 614 SLI-410 14247 URINE AMPHETAMINE(K013) 700 875 945 1050 1050 615 SLI-411 SLI-357 URINE BETA 2 MICRO GLOBULIN 1300 1625 1755 1950 1950 616 SLI-412 SLI-289 URINE CORTISONE(RW054) 19800 24750 26730 29700 29700 617 SLI-413 14678 URINE DND (DPYD) 2450 3063 3308 3675 3675 618 SLI-414 SLI-290 URINE FOR VMA 24 Hrs((U006) 3500 4375 4725 5250 5250 619 SLI-415 SLI-333 URINE MARIJUANA(K003) 700 875 945 1050 1050 620 SLI-416 14246 URINE METHAMPHETAMINE(K019) 700 875 945 1050 1050 621 SLI-417 14244 URINE METHAQUALONE(K021) 700 875 945 1050 1050 622 SLI-418 SLI-334 URINE OPIATES(K001) 650 813 878 975 975 623 SLI-419 14243 URINE PHENCYCLIDINE (PCP)-K016 630 788 851 945 945

Any new service/tariff may be changed/added/deleted without prior notice. 40 Schedule of Charges 2019-20 ISIC

624 SLI-420 CPA-20 URINE PORPHOBILINOGEN (QUALITATIVE) 3490 4363 4712 5235 5235 625 SLI-421 16340 URINE PORPHOBILINOGEN QUANTITATIVE(24 HRS)-U098 3490 4363 4712 5235 5235 626 SLI-422 SLI-292 VALPROIC ACID(D031) 800 1000 1080 1200 1200 627 SLI-423 15177 VANCOMYCIN (D053). 4750 5938 6413 7125 7125 628 SLI-424 SLI-369 VARICELLA ZOSTER - IgG & IgM (Z199) 2200 2750 2970 3300 3300 629 SLI-425 15805 VARICELLA ZOSTER IgG(S077). 1120 1400 1512 1680 1680 630 SLI-426 SLI-293 VARICELLA ZOSTER IgM(S074) 1180 1475 1593 1770 1770 631 SLI-427 15988 VARICELLA ZOSTER VIRUS,QUALITATIVE PCR (N128) 3600 4500 4860 5400 5400 632 SLI-428 SLI-335 VGKC AB(S 250) 7150 8938 9653 10725 10725 633 SLI-429 SLI-295 VITAMIN - B1(RW199) 8000 10000 10800 12000 12000 634 SLI-430 SLI-296 VITAMIN - B6(O 525) 10480 13100 14148 15720 15720 635 SLI-431 R174 VITAMIN B12 ACTIVE (R174). 1600 2000 2160 2400 2400 636 SLI-432 16126 VITAMIN D125 (GENX) 3200 4000 4320 4800 4800 637 SLI-433 16107 VITAMIN E (GENX). 4200 5250 5670 6300 6300 638 SLI-434 SLI-297 VITAMIN-D 125 (D3) HYDROXY(R118) 3200 4000 4320 4800 4800 639 SLI-435 SLI-298 VITAMIN-E(R117). 6000 7500 8100 9000 9000 640 SLI-436 SLI-338 von WILLIEBRAND FACTOR(H130) 10000 12500 13500 15000 15000 641 SLI-437 SLI-299 WEIL FELIX(S002) 800 1000 1080 1200 1200 642 SLI-438 14773 YEAST SUSCEPTIBILITY. 1150 1438 1553 1725 1725 643 SLI-439 SLI-300 ZINC-SERUM(C036) 1800 2250 2430 2700 2700

Charges Basis OPD/GW 100% HDU+ICU (all categories) 125% Shared 125% Single 135% Dlx 150% Spr. Dlx 150% Suite 150% Spr. Dlx Suite 150%

Note :- Above Charge basis would also be applicable on all newly added services

Any new service/tariff may be changed/added/deleted without prior notice. 41 Schedule of Charges 2019-20 ISIC

OPERATION THEATRE CHARGES

1 Aneasthesia Charges 45% of Surgeon Fee

2 MAC Aneasthesia Charges 35% of Surgeon Fee

3 Operation Theater Charges 75% of Surgeon Fee

5 Equipment Charges are extra as per the usage (Rates defined in Equipment Charges) As per Medical Eqpmt List Where two surgical procedures are performed in the same sitting, the surgeon fees for procedure costing less will be discounted by 50%. This will not be applicable in cases where a second surgeon has been called or the second procedure is done away from 4 the first area. The charges for the Anesthesia & OT charges will be counted by first procedure charges + 50% of the other procedure unless the 2nd procedure is done after first procedure is over, in which case charges of both will be charged 100%+100%

5 Basic Equipment As per Medical Eqpmt List

6 Only Special Medical Equipment & Consumables would be charged As per Medical Eqpmt List

Any new service/tariff may be changed/added/deleted without prior notice. 42 Schedule of Charges 2019-20 ISIC

RADIOLOGY INVESTIGATIONS/PROCEDURES

X-RAY Shared Single Dlx/ Super Super S.NO. NEW CODE OLD CODE Investigation/Procedure OPD/GW Room/ ICU Room Dlx / Suite Dlx. Suite / HDU 1 XRA-01 XRA-1 CD FOR X-RAY/MRI/CT/DEXA/USG 350 438 473 525 525 2 XRA-02 XRA-2 CONTRAST FOR X-RAY 1200 1500 1620 1800 1800 3 XRA-03 XRA-3 PORTABLE X-RAY ABDOMEN AP 1100 1375 1485 1650 1650 4 XRA-04 XRA-4 PORTABLE X-RAY ABDOMEN LATERAL 1100 1375 1485 1650 1650 5 XRA-05 XRA-5 PORTABLE X-RAY ANKLE AP BOTH 1100 1375 1485 1650 1650 6 XRA-06 XRA-6 PORTABLE X-RAY ANKLE AP LEFT 1100 1375 1485 1650 1650 7 XRA-07 XRA-7 PORTABLE X-RAY ANKLE AP RIGHT 1100 1375 1485 1650 1650 8 XRA-08 XRA-8 PORTABLE X-RAY ANKLE AP/LAT LEFT 2200 2750 2970 3300 3300 9 XRA-09 XRA-9 PORTABLE X-RAY ANKLE AP/LAT RIGHT 2200 2750 2970 3300 3300 10 XRA-10 XRA-10 PORTABLE X-RAY ANKLE LAT BOTH 2200 2750 2970 3300 3300 11 XRA-11 XRA-11 PORTABLE X-RAY ANKLE LAT LEFT 1100 1375 1485 1650 1650 12 XRA-12 XRA-12 PORTABLE X-RAY ANKLE LAT RIGHT 1100 1375 1485 1650 1650 13 XRA-13 XRA-13 PORTABLE X-RAY B/L KNEE AP 1100 1375 1485 1650 1650 PORTABLE X-RAY BILATERAL WRIST FOREARM AP 14 XRA-14 XRA-14 2200 2750 2970 3300 3300 LTERAL 15 XRA-15 XRA-15 PORTABLE X-RAY CERVICAL FLEXION AND EXTENSION 2200 2750 2970 3300 3300 16 XRA-16 XRA-16 PORTABLE X-RAY CERVICAL SPINE AP 1100 1375 1485 1650 1650 17 XRA-17 XRA-17 PORTABLE X-RAY CERVICAL SPINE AP/LAT 2200 2750 2970 3300 3300 18 XRA-18 XRA-18 PORTABLE X-RAY CERVICAL SPINE EXTENSION 1100 1375 1485 1650 1650 19 XRA-19 XRA-19 PORTABLE X-RAY CERVICAL SPINE FLEXION 1100 1375 1485 1650 1650 20 XRA-20 XRA-20 PORTABLE X-RAY CERVICAL SPINE LAT 1100 1375 1485 1650 1650 21 XRA-21 XRA-21 PORTABLE X-RAY CHEST AP 1100 1375 1485 1650 1650 22 XRA-22 XRA-22 PORTABLE X-RAY CHEST AP/LAT 2200 2750 2970 3300 3300 23 XRA-23 XRA-23 PORTABLE X-RAY CHEST LATERAL LEFT 1100 1375 1485 1650 1650 24 XRA-24 XRA-24 PORTABLE X-RAY CHEST LATERAL RIGHT 1100 1375 1485 1650 1650 25 XRA-25 XRA-25 PORTABLE X-RAY CHEST OBLIQUE 1100 1375 1485 1650 1650 26 XRA-26 XRA-26 PORTABLE X-RAY CHEST OBLIQUE LEFT 1100 1375 1485 1650 1650 27 XRA-27 XRA-27 PORTABLE X-RAY CHEST OBLIQUE RIGHT 1100 1375 1485 1650 1650

Any new service/tariff may be changed/added/deleted without prior notice. 43 Schedule of Charges 2019-20 ISIC

28 XRA-28 XRA-28 PORTABLE X-RAY CHEST SITTING AP 1100 1375 1485 1650 1650 29 XRA-29 XRAY-550 PORTABLE X-RAY CLAVICLE AP LEFT 1100 1375 1485 1650 1650 30 XRA-30 XRA-29 PORTABLE X-RAY COCCYX AP VIEW 1100 1375 1485 1650 1650 31 XRA-31 XRA-30 PORTABLE X-RAY COCCYX AP/LAT VIEW 2200 2750 2970 3300 3300 32 XRA-32 XRA-31 PORTABLE X-RAY COCCYX LAT VIEW 1100 1375 1485 1650 1650 33 XRA-33 XRA-32 PORTABLE X-RAY DORSAL SPINE AP 1100 1375 1485 1650 1650 34 XRA-34 XRA-33 PORTABLE X-RAY DORSAL SPINE AP/LAT 2200 2750 2970 3300 3300 35 XRA-35 XRA-34 PORTABLE X-RAY DORSAL SPINE LAT 1100 1375 1485 1650 1650 PORTABLE X-RAY DORSO-LUMBAR SPINE (LT.) SIDE 36 XRA-36 XRA-35 1100 1375 1485 1650 1650 BENDING A.P. PORTABLE X-RAY DORSO-LUMBAR SPINE (RT.) SIDE 37 XRA-37 XRA-36 1100 1375 1485 1650 1650 BENDING A.P. 38 XRA-38 XRA-37 PORTABLE X-RAY DORSO-LUMBAR SPINE A.P.- ERECT 1100 1375 1485 1650 1650 39 XRA-39 XRA-38 PORTABLE X-RAY DORSO-LUMBAR SPINE A.P.- SUPINE 1100 1375 1485 1650 1650 40 XRA-40 XRA-39 PORTABLE X-RAY DORSO-LUMBAR SPINE AP / LATERAL 2200 2750 2970 3300 3300 41 XRA-41 XRA-40 PORTABLE X-RAY DORSO-LUMBAR SPINE AP VIEW 1100 1375 1485 1650 1650 42 XRA-42 XRA-41 PORTABLE X-RAY DORSO-LUMBAR SPINE LATERAL 1100 1375 1485 1650 1650 43 XRA-43 XRA-42 PORTABLE X-RAY ELBOW AP LEFT 1100 1375 1485 1650 1650 44 XRA-44 XRA-43 PORTABLE X-RAY ELBOW AP RIGHT 1100 1375 1485 1650 1650 45 XRA-45 XRA-44 PORTABLE X-RAY ELBOW AP/LAT LEFT 2200 2750 2970 3300 3300 46 XRA-46 XRA-45 PORTABLE X-RAY ELBOW AP/LAT RIGHT 2200 2750 2970 3300 3300 47 XRA-47 XRA-46 PORTABLE X-RAY ELBOW LAT LEFT 1100 1375 1485 1650 1650 48 XRA-48 XRA-47 PORTABLE X-RAY ELBOW LAT RIGHT 1100 1375 1485 1650 1650 49 XRA-49 XRA-48 PORTABLE X-RAY FEMUR AP LEFT 1100 1375 1485 1650 1650 50 XRA-50 XRA-49 PORTABLE X-RAY FEMUR AP RIGHT 1100 1375 1485 1650 1650 51 XRA-51 XRA-50 PORTABLE X-RAY FEMUR AP/LAT LEFT 2200 2750 2970 3300 3300 52 XRA-52 XRA-51 PORTABLE X-RAY FEMUR AP/LAT RIGHT 2200 2750 2970 3300 3300 53 XRA-53 XRA-52 PORTABLE X-RAY FEMUR LAT LEFT 1100 1375 1485 1650 1650 54 XRA-54 XRA-53 PORTABLE X-RAY FEMUR LAT RIGHT 1100 1375 1485 1650 1650 55 XRA-55 XRA-54 PORTABLE X-RAY FOOT AP BOTH 1100 1375 1485 1650 1650 56 XRA-56 XRA-55 PORTABLE X-RAY FOOT AP LEFT 1100 1375 1485 1650 1650 57 XRA-57 XRA-56 PORTABLE X-RAY FOOT AP RIGHT 1100 1375 1485 1650 1650 58 XRA-58 XRA-57 PORTABLE X-RAY FOOT AP/LAT BOTH 3300 4125 4455 4950 4950

Any new service/tariff may be changed/added/deleted without prior notice. 44 Schedule of Charges 2019-20 ISIC

59 XRA-59 XRA-58 PORTABLE X-RAY FOOT AP/LAT LEFT 2200 2750 2970 3300 3300 60 XRA-60 XRA-59 PORTABLE X-RAY FOOT AP/LAT RIGHT 2200 2750 2970 3300 3300 61 XRA-61 XRA-60 PORTABLE X-RAY FOOT AP/LAT/OBLIQUE LEFT 3300 4125 4455 4950 4950 62 XRA-62 XRA-61 PORTABLE X-RAY FOOT AP/LAT/OBLIQUE RIGHT 3300 4125 4455 4950 4950 63 XRA-63 XRA-62 PORTABLE X-RAY FOOT LAT BOTH 2200 2750 2970 3300 3300 64 XRA-64 XRA-63 PORTABLE X-RAY FOOT LAT LEFT 1100 1375 1485 1650 1650 65 XRA-65 XRA-64 PORTABLE X-RAY FOOT LAT RIGHT 1100 1375 1485 1650 1650 66 XRA-66 XRA-65 PORTABLE X-RAY FOOT OBLIQUE BOTH 2200 2750 2970 3300 3300 67 XRA-67 XRA-66 PORTABLE X-RAY FOOT OBLIQUE LEFT 1100 1375 1485 1650 1650 68 XRA-68 XRA-67 PORTABLE X-RAY FOOT OBLIQUE RIGHT 1100 1375 1485 1650 1650 69 XRA-69 XRA-68 PORTABLE X-RAY FOREARM AP LEFT 1100 1375 1485 1650 1650 70 XRA-70 XRA-69 PORTABLE X-RAY FOREARM AP RIGHT 1100 1375 1485 1650 1650 71 XRA-71 XRA-70 PORTABLE X-RAY FOREARM AP/LAT LEFT 2200 2750 2970 3300 3300 72 XRA-72 XRA-71 PORTABLE X-RAY FOREARM AP/LAT RIGHT 2200 2750 2970 3300 3300 73 XRA-73 XRA-72 PORTABLE X-RAY FOREARM LAT LEFT 1100 1375 1485 1650 1650 74 XRA-74 XRA-73 PORTABLE X-RAY FOREARM LAT RIGHT 1100 1375 1485 1650 1650 75 XRA-75 XRA-74 PORTABLE X-RAY FOREARM WITH ELBOW AP LEFT 1100 1375 1485 1650 1650 76 XRA-76 XRA-75 PORTABLE X-RAY FOREARM WITH ELBOW AP RIGHT 1100 1375 1485 1650 1650 77 XRA-77 XRA-76 PORTABLE X-RAY FOREARM WITH ELBOW AP/LAT LEFT 2200 2750 2970 3300 3300 PORTABLE X-RAY FOREARM WITH ELBOW AP/LAT 78 XRA-78 XRA-77 2200 2750 2970 3300 3300 RIGHT 79 XRA-79 XRA-78 PORTABLE X-RAY FOREARM WITH ELBOW LAT LEFT 1100 1375 1485 1650 1650 80 XRA-80 XRA-79 PORTABLE X-RAY FOREARM WITH ELBOW LAT RIGHT 1100 1375 1485 1650 1650 81 XRA-81 XRA-80 PORTABLE X-RAY FROG LEG LAT LEFT 1100 1375 1485 1650 1650 82 XRA-82 XRA-81 PORTABLE X-RAY FROG LEG LAT RIGHT 1100 1375 1485 1650 1650 83 XRA-83 XRA-82 PORTABLE X-RAY HAND AP LEFT 1100 1375 1485 1650 1650 84 XRA-84 XRA-83 PORTABLE X-RAY HAND AP RIGHT 1100 1375 1485 1650 1650 85 XRA-85 XRA-84 PORTABLE X-RAY HAND AP/LAT LEFT 2200 2750 2970 3300 3300 86 XRA-86 XRA-85 PORTABLE X-RAY HAND AP/LAT RIGHT 2200 2750 2970 3300 3300 87 XRA-87 XRA-86 PORTABLE X-RAY HAND AP/LAT/OBLIQUE LEFT 2200 2750 2970 3300 3300 88 XRA-88 XRA-87 PORTABLE X-RAY HAND AP/LAT/OBLIQUE RIGHT 2200 2750 2970 3300 3300 89 XRA-89 XRA-88 PORTABLE X-RAY HAND AP/OBLIQUE LEFT 2200 2750 2970 3300 3300 90 XRA-90 XRA-89 PORTABLE X-RAY HAND AP/OBLIQUE RIGHT 2200 2750 2970 3300 3300

Any new service/tariff may be changed/added/deleted without prior notice. 45 Schedule of Charges 2019-20 ISIC

91 XRA-91 XRA-90 PORTABLE X-RAY HAND LAT LEFT 1100 1375 1485 1650 1650 92 XRA-92 XRA-91 PORTABLE X-RAY HAND LAT RIGHT 1100 1375 1485 1650 1650 93 XRA-93 XRA-92 PORTABLE X-RAY HAND OBLIQUE LEFT 1100 1375 1485 1650 1650 94 XRA-94 XRA-93 PORTABLE X-RAY HAND OBLIQUE RIGHT 1100 1375 1485 1650 1650 95 XRA-95 XRA-94 PORTABLE X-RAY HANDS AP/LAT VIEWS BOTH 2200 2750 2970 3300 3300 96 XRA-96 XRA-95 PORTABLE X-RAY HEEL AP/AXIAL LEFT 2200 2750 2970 3300 3300 97 XRA-97 XRA-96 PORTABLE X-RAY HEEL AP/AXIAL RIGHT 2200 2750 2970 3300 3300 98 XRA-98 XRA-97 PORTABLE X-RAY HEEL AXIAL LEFT 1100 1375 1485 1650 1650 99 XRA-99 XRA-98 PORTABLE X-RAY HEEL AXIAL RIGHT 1100 1375 1485 1650 1650 100 XRA-100 XRA-99 PORTABLE X-RAY HEEL LAT LEFT 1100 1375 1485 1650 1650 101 XRA-101 XRA-100 PORTABLE X-RAY HEEL LAT RIGHT 1100 1375 1485 1650 1650 102 XRA-102 XRA-101 PORTABLE X-RAY HEEL LAT/AXIAL LEFT 2200 2750 2970 3300 3300 103 XRA-103 XRA-102 PORTABLE X-RAY HEEL LAT/AXIAL RIGHT 2200 2750 2970 3300 3300 104 XRA-104 XRA-103 PORTABLE X-RAY HIP AP LEFT 1100 1375 1485 1650 1650 105 XRA-105 XRA-104 PORTABLE X-RAY HIP AP RIGHT 1100 1375 1485 1650 1650 106 XRA-106 XRA-105 PORTABLE X-RAY HUMERUS AP/LAT LEFT 2200 2750 2970 3300 3300 107 XRA-107 XRA-106 PORTABLE X-RAY HUMERUS AP/LAT RIGHT 2200 2750 2970 3300 3300 108 XRA-108 XRA-107 PORTABLE X-RAY HUMERUS ARM AP LEFT 1100 1375 1485 1650 1650 109 XRA-109 XRA-108 PORTABLE X-RAY HUMERUS ARM AP RIGHT 1100 1375 1485 1650 1650 110 XRA-110 XRA-109 PORTABLE X-RAY HUMERUS ARM LAT LEFT 1100 1375 1485 1650 1650 111 XRA-111 XRA-110 PORTABLE X-RAY HUMERUS ARM LAT RIGHT 1100 1375 1485 1650 1650 112 XRA-112 XRA-111 PORTABLE X-RAY KNEE ( LT. ) AP & LATERAL 2200 2750 2970 3300 3300 113 XRA-113 XRA-112 PORTABLE X-RAY KNEE ( RT ) AP & LATERAL 2200 2750 2970 3300 3300 114 XRA-114 XRA-113 PORTABLE X-RAY KNEE ( STANDING ) AP/LAT LEFT 2200 2750 2970 3300 3300 115 XRA-115 XRA-114 PORTABLE X-RAY KNEE AP BOTH 1100 1375 1485 1650 1650 116 XRA-116 XRA-115 PORTABLE X-RAY KNEE AP LEFT 1100 1375 1485 1650 1650 117 XRA-117 XRA-116 PORTABLE X-RAY KNEE AP RIGHT 1100 1375 1485 1650 1650 PORTABLE X-RAY KNEE JOINT AP ( STANDING) 118 XRA-118 XRA-117 2200 2750 2970 3300 3300 LATERAL 119 XRA-119 XRA-118 PORTABLE X-RAY KNEE LAT BOTH 2200 2750 2970 3300 3300 120 XRA-120 XRA-119 PORTABLE X-RAY KNEE LAT RIGHT 1100 1375 1485 1650 1650 121 XRA-121 XRA-120 PORTABLE X-RAY KNEE LATERAL LEFT 1100 1375 1485 1650 1650 122 XRA-122 XRA-162 PORTABLE X-RAY KNEE LATERAL RIGHT 1100 1375 1485 1650 1650

Any new service/tariff may be changed/added/deleted without prior notice. 46 Schedule of Charges 2019-20 ISIC

123 XRA-123 XRA-121 PORTABLE X-RAY L.S. SPINE (LT) SIDE BENDING A.P. 1100 1375 1485 1650 1650 124 XRA-124 XRA-122 PORTABLE X-RAY L.S. SPINE (RT) SIDE BENDING A.P. 1100 1375 1485 1650 1650 125 XRA-125 XRA-123 PORTABLE X-RAY L.S. SPINE A.P. ERECT 1100 1375 1485 1650 1650 126 XRA-126 XRA-124 PORTABLE X-RAY L.S. SPINE A.P. SUPINE 1100 1375 1485 1650 1650 127 XRA-127 XRA-125 PORTABLE X-RAY L.S. SPINE AP 1100 1375 1485 1650 1650 128 XRA-128 XRA-126 PORTABLE X-RAY L.S. SPINE AP/LAT 2200 2750 2970 3300 3300 129 XRA-129 XRA-127 PORTABLE X-RAY L.S. SPINE LAT 1100 1375 1485 1650 1650 130 XRA-130 XRA-128 PORTABLE X-RAY LEFT KNEE WITH LEFT AND ANKLE AP 2200 2750 2970 3300 3300 PORTABLE X-RAY LEFT KNEE WITH LEG AND ANKLE 131 XRA-131 XRA-129 1100 1375 1485 1650 1650 LATERAL 132 XRA-132 XRA-130 PORTABLE X-RAY LEG AP/LAT RIGHT 2200 2750 2970 3300 3300 133 XRA-133 XRA-131 PORTABLE X-RAY LEG AP BOTH 1100 1375 1485 1650 1650 134 XRA-134 XRA-132 PORTABLE X-RAY LEG AP LEFT 1100 1375 1485 1650 1650 135 XRA-135 XRA-133 PORTABLE X-RAY LEG AP RIGHT 1100 1375 1485 1650 1650 136 XRA-136 XRA-134 PORTABLE X-RAY LEG AP/LAT LEFT 2200 2750 2970 3300 3300 137 XRA-137 XRA-135 PORTABLE X-RAY LEG LAT BOTH 2200 2750 2970 3300 3300 138 XRA-138 XRA-136 PORTABLE X-RAY LEG LAT LEFT 1100 1375 1485 1650 1650 139 XRA-139 XRA-137 PORTABLE X-RAY LEG LAT RIGHT 1100 1375 1485 1650 1650 140 XRA-140 XRA-138 PORTABLE X-RAY PELVIS AP 1100 1375 1485 1650 1650 141 XRA-141 XRA-139 PORTABLE X-RAY PELVIS P.A. 1100 1375 1485 1650 1650 142 XRA-142 XRA-140 PORTABLE X-RAY SACRUM AP VIEW 1100 1375 1485 1650 1650 143 XRA-143 XRA-141 PORTABLE X-RAY SACRUM AP/LAT VIEW 2200 2750 2970 3300 3300 144 XRA-144 XRA-142 PORTABLE X-RAY SACRUM LAT VIEW 1100 1375 1485 1650 1650 145 XRA-145 XRA-143 PORTABLE X-RAY SHOULDER AP & AXIAL VIEWS LEFT 2200 2750 2970 3300 3300 146 XRA-146 XRA-144 PORTABLE X-RAY SHOULDER AP LEFT 1100 1375 1485 1650 1650 147 XRA-147 XRA-145 PORTABLE X-RAY SHOULDER AP RIGHT 1100 1375 1485 1650 1650 148 XRA-148 XRA-146 PORTABLE X-RAY SHOULDER AP/LAT LEFT 2200 2750 2970 3300 3300 149 XRA-149 XRA-147 PORTABLE X-RAY SHOULDER AP/LAT RIGHT 2200 2750 2970 3300 3300 150 XRA-150 XRA-148 PORTABLE X-RAY SHOULDER LAT LEFT 1100 1375 1485 1650 1650 151 XRA-151 XRA-149 PORTABLE X-RAY SHOULDER LAT RIGHT 1100 1375 1485 1650 1650 152 XRA-152 XRA-150 PORTABLE X-RAY SKULL AP 1100 1375 1485 1650 1650 153 XRA-153 XRA-151 PORTABLE X-RAY SKULL AP/LAT 2200 2750 2970 3300 3300 154 XRA-154 XRA-152 PORTABLE X-RAY SKULL LAT 1100 1375 1485 1650 1650

Any new service/tariff may be changed/added/deleted without prior notice. 47 Schedule of Charges 2019-20 ISIC

155 XRA-155 XRA-153 PORTABLE X-RAY THIGH WITH KNEE JOINT AP/LAT 2200 2750 2970 3300 3300 156 XRA-156 XRA-154 PORTABLE X-RAY WRIST AP LEFT 1100 1375 1485 1650 1650 157 XRA-157 XRA-1118 PORTABLE X-RAY WRIST AP RIGHT 1100 1375 1485 1650 1650 158 XRA-158 XRA-1119 PORTABLE X-RAY WRIST AP/LAT LEFT 2200 2750 2970 3300 3300 159 XRA-159 XRA-1120 PORTABLE X-RAY WRIST AP/LAT RIGHT 2200 2750 2970 3300 3300 160 XRA-160 XRA-1121 PORTABLE X-RAY WRIST AP/LAT/OBLIQUE LEFT 2200 2750 2970 3300 3300 161 XRA-161 XRA-1122 PORTABLE X-RAY WRIST AP/LAT/OBLIQUE RIGHT 2200 2750 2970 3300 3300 162 XRA-162 XRA-1123 PORTABLE X-RAY WRIST LAT LEFT 1100 1375 1485 1650 1650 163 XRA-163 XRA-161 PORTABLE X-RAY WRIST LAT RIGHT 1100 1375 1485 1650 1650 164 XRA-164 XRA-163 X-RAY ABDOMEN AP 550 688 743 825 825 165 XRA-165 XRA-164 X-RAY ABDOMEN DECUBITUS AP 550 688 743 825 825 166 XRA-166 XRA-1001 X-RAY ABDOMEN DECUBITUS LAT 550 688 743 825 825 167 XRA-167 XRA-167 X-RAY ABDOMEN ERECT & SUPINE AP VIEW 1100 1375 1485 1650 1650 168 XRA-168 XRA-1002 X-RAY ABDOMEN ERECT 550 688 743 825 825 169 XRA-169 XRA-1003 X-RAY ABDOMEN LATERAL 550 688 743 825 825 170 XRA-170 XRA-1004 X-RAY ABDOMEN OBLIQUE LEFT 550 688 743 825 825 171 XRA-171 XRA-1005 X-RAY ABDOMEN OBLIQUE RIGHT 550 688 743 825 825 172 XRA-172 XRA-1006 X-RAY ABDOMEN PA 550 688 743 825 825 173 XRA-173 XRA-1007 X-RAY AC JOINT AP LEFT 550 688 743 825 825 174 XRA-174 XRA-1008 X-RAY AC JOINT AP RIGHT 550 688 743 825 825 175 XRA-175 XRA-174 X-RAY ANKLE AP LEFT 550 688 743 825 825 176 XRA-176 XRA-1009 X-RAY ANKLE AP RIGHT 550 688 743 825 825 177 XRA-177 XRA-176 X-RAY ANKLE AP STANDING LEFT 550 688 743 825 825 178 XRA-178 XRA-177 X-RAY ANKLE AP STANDING RIGHT 550 688 743 825 825 179 XRA-179 XRA-178 X-RAY ANKLE AP/LAT LEFT 1100 1375 1485 1650 1650 180 XRA-180 XRA-179 X-RAY ANKLE AP/LAT RIGHT 1100 1375 1485 1650 1650 181 XRA-181 XRA-180 X-RAY ANKLE AP/LAT STANDING LEFT 1100 1375 1485 1650 1650 182 XRA-182 XRA-181 X-RAY ANKLE AP/LAT STANDING RIGHT 1100 1375 1485 1650 1650 183 XRA-183 XRA-182 X-RAY ANKLE AP/LAT/OBLIQUE LEFT 1650 2063 2228 2475 2475 184 XRA-184 XRA-183 X-RAY ANKLE AP/LAT/OBLIQUE RIGHT 1650 2063 2228 2475 2475 185 XRA-185 14770 X-RAY ANKLE AP/OBLIQUE LEFT 1100 1375 1485 1650 1650 186 XRA-186 14771 X-RAY ANKLE AP/OBLIQUE RIGHT 1100 1375 1485 1650 1650

Any new service/tariff may be changed/added/deleted without prior notice. 48 Schedule of Charges 2019-20 ISIC

187 XRA-187 XRA-184 X-RAY ANKLE BOTH FLEXION LEFT 1100 1375 1485 1650 1650 188 XRA-188 XRA-185 X-RAY ANKLE BOTH FLEXION RIGHT 1100 1375 1485 1650 1650 189 XRA-189 XRA-186 X-RAY ANKLE DORSI FLEXION RIGHT 550 688 743 825 825 190 XRA-190 14980 X-RAY ANKLE DORSI FLEXTION LEFT 550 688 743 825 825 191 XRA-191 XRA-187 X-RAY ANKLE LAT LEFT 550 688 743 825 825 192 XRA-192 XRA-188 X-RAY ANKLE LAT RIGHT 550 688 743 825 825 193 XRA-193 XRA-189 X-RAY ANKLE LAT STANDING LEFT 550 688 743 825 825 194 XRA-194 XRA-190 X-RAY ANKLE LAT STANDING RIGHT 550 688 743 825 825 195 XRA-195 XRA-193 X-RAY ANKLE LAT VIEW LEFT 550 688 743 825 825 196 XRA-196 XRA-194 X-RAY ANKLE LAT VIEW RIGHT 550 688 743 825 825 197 XRA-197 XRA-191 X-RAY ANKLE MORTIS AP VIEW LEFT 550 688 743 825 825 198 XRA-198 XRA-192 X-RAY ANKLE MORTIS AP VIEW RIGHT 550 688 743 825 825 199 XRA-199 XRA-195 X-RAY ANKLE OBLIQUE LEFT 550 688 743 825 825 200 XRA-200 XRA-196 X-RAY ANKLE OBLIQUE RIGHT 550 688 743 825 825 201 XRA-201 XRA-197 X-RAY ANKLE PLANTER FLEXION RIGHT 550 688 743 825 825 202 XRA-202 XRA-198 X-RAY ANKLE STRES VIEW BOTH 1100 1375 1485 1650 1650 203 XRA-203 XRA-199 X-RAY ANKLE STRESS VIEW LEFT 550 688 743 825 825 204 XRA-204 XRA-200 X-RAY ANKLE STRESS VIEW RIGHT 550 688 743 825 825 205 XRA-205 XRA-201 X-RAY ANKLE WITH FOOT A.P./LAT. RIGHT 1100 1375 1485 1650 1650 206 XRA-206 XRA-702 X-RAY ANKLE WITH FOOT AP / LAT 1100 1375 1485 1650 1650 207 XRA-207 XRA-202 X-RAY ARM AP & LATERAL VIEWS RIGHT 1100 1375 1485 1650 1650 208 XRA-208 XRA-703 X-RAY ARM AP / LAT LEFT 1100 1375 1485 1650 1650 209 XRA-209 XRA-702 X-RAY ASU 4100 5125 5535 6150 6150 210 XRA-210 XRA-704 X-RAY BARIUM ENEMA 6000 7500 8100 9000 9000 211 XRA-211 XRA-705 X-RAY BARIUM ENEMA DOUBLE CONTRAST 8220 10275 11097 12330 12330 212 XRA-212 XRA-706 X-RAY BARIUM MEAL 4100 5125 5535 6150 6150 213 XRA-213 XRA-707 X-RAY BARIUM MEAL COMPLETE 7000 8750 9450 10500 10500 214 XRA-214 XRA-708 X-RAY BARIUM MEAL FOLLOW THROUGH 8220 10275 11097 12330 12330 215 XRA-215 XRA-709 X-RAY BARIUM SWALLOW 4100 5125 5535 6150 6150 216 XRA-216 XRA-710 X-RAY BARIUM UPPER G. I. (U.G.I.) 4100 5125 5535 6150 6150 217 XRA-217 XRA-203 X-RAY BOTH ANKLE AP 550 688 743 825 825 218 XRA-218 XRA-204 X-RAY BOTH ANKLE LAT 1100 1375 1485 1650 1650

Any new service/tariff may be changed/added/deleted without prior notice. 49 Schedule of Charges 2019-20 ISIC

219 XRA-219 XRA-205 X-RAY BOTH HANDS A.P. & OBLIQUE 1100 1375 1485 1650 1650 220 XRA-220 14792 X-RAY BOTH HANDS A.P. VIEW 550 688 743 825 825 221 XRA-221 XRA-206 X-RAY BOTH HANDS AP & LAT VIEWS 1100 1375 1485 1650 1650 222 XRA-222 XRA-207 X-RAY BOTH HANDS P.A. VIEW 550 688 743 825 825 223 XRA-223 XRA-208 X-RAY BOTH KNEE JOINTS AP & LATERAL 1650 2063 2228 2475 2475 224 XRA-224 XRA-209 X-RAY BOTH KNEE JOINTS AP ( STANDING) LAT 1650 2063 2228 2475 2475 225 XRA-225 XRA-210 X-RAY BOTH KNEE JOINTS LAT / SKYLINE VIEW 1650 2063 2228 2475 2475 226 XRA-226 XRA-211 X-RAY BOTH KNEES - STANDING AP /LAT VIEWS 1650 2063 2228 2475 2475 227 XRA-227 XRA-212 X-RAY BOTH KNEES AP VIEW 550 688 743 825 825 X-RAY BOTH KNEES-STANDING AP/LAT & SKYLINE 228 XRA-228 XRA-213 2200 2750 2970 3300 3300 VIEWS 229 XRA-229 XRA-214 X-RAY BOTH T.M JOINT CLOSE & OPEN MOUTH 2200 2750 2970 3300 3300 230 XRA-230 XRA-215 X-RAY BOTH T.M. JOINT 1100 1375 1485 1650 1650 231 XRA-231 XRA-216 X-RAY CERVICAL SPINE AP LEFT BENDING 550 688 743 825 825 232 XRA-232 XRA-217 X-RAY CERVICAL SPINE AP OPEN MOUTH 550 688 743 825 825 233 XRA-233 XRA-218 X-RAY CERVICAL SPINE AP RIGHT BENDING 550 688 743 825 825 234 XRA-234 XRA-219 X-RAY CERVICAL SPINE AP RIGHT/LEFT BENDING 1100 1375 1485 1650 1650 235 XRA-235 XRA-220 X-RAY CERVICAL SPINE AP VIEW 550 688 743 825 825 236 XRA-236 XRA-221 X-RAY CERVICAL SPINE AP/FLEXION/EXTENSION VIEWS 1650 2063 2228 2475 2475 237 XRA-237 XRA-223 X-RAY CERVICAL SPINE AP/LAT VIEWS 1100 1375 1485 1650 1650 X-RAY CERVICAL SPINE AP/LAT/FLEXION/EXTENSION 238 XRA-238 XRA-224 2200 2750 2970 3300 3300 VIEW 239 XRA-239 XRA-222 X-RAY CERVICAL SPINE AP/LAT/OPEN MOUTH 1650 2063 2228 2475 2475 240 XRA-240 XRA-225 X-RAY CERVICAL SPINE EXTENSION VIEW 550 688 743 825 825 241 XRA-241 XRA-226 X-RAY CERVICAL SPINE EXTENSION/FLEXION VIEW 1100 1375 1485 1650 1650 242 XRA-242 XRA-227 X-RAY CERVICAL SPINE FLEXION VIEW 550 688 743 825 825 243 XRA-243 XRA-228 X-RAY CERVICAL SPINE LAT OPEN MOUTH 550 688 743 825 825 X-RAY CERVICAL SPINE LAT/FLEXION/EXTENSION 244 XRA-244 XRA-229 1650 2063 2228 2475 2475 VIEWS 245 XRA-245 XRA-230 X-RAY CERVICAL SPINE LATERAL VIEW 550 688 743 825 825 246 XRA-246 XRA-231 X-RAY CERVICAL SPINE OBLIQUE LEFT 550 688 743 825 825 247 XRA-247 XRA-232 X-RAY CERVICAL SPINE OBLIQUE RIGHT 550 688 743 825 825 248 XRA-248 XRA-233 X-RAY CERVICO-DORSAL SPINE ( SWIMMER''S VIEW) 550 688 743 825 825 249 XRA-249 XRA-234 X-RAY CERVICO-DORSAL SPINE AP VIEW 550 688 743 825 825

Any new service/tariff may be changed/added/deleted without prior notice. 50 Schedule of Charges 2019-20 ISIC

250 XRA-250 XRA-235 X-RAY CERVICO-DORSAL SPINE AP/LAT VIEW 1100 1375 1485 1650 1650 X-RAY CERVICO-DORSAL SPINE FLEXION/EXTENSION 251 XRA-251 XRA-238 1100 1375 1485 1650 1650 VIEW 252 XRA-252 XRA-236 X-RAY CERVICO-DORSAL SPINE LAT EXTENSION VIEW 550 688 743 825 825 253 XRA-253 XRA-237 X-RAY CERVICO-DORSAL SPINE LAT FLEXION VIEW 550 688 743 825 825 254 XRA-254 XRA-239 X-RAY CERVICO-DORSAL SPINE LATERAL VIEW 550 688 743 825 825 255 XRA-255 XRA-240 X-RAY CHEST A.P VIEW 550 688 743 825 825 256 XRA-256 XRA-241 X-RAY CHEST AP SITTING 550 688 743 825 825 257 XRA-257 XRA-242 X-RAY CHEST AP/LAT VIEW 1100 1375 1485 1650 1650 258 XRA-258 XRA-243 X-RAY CHEST APICOGRAM 550 688 743 825 825 259 XRA-259 XRA-244 X-RAY CHEST FALLS RIBS AP VIEW 550 688 743 825 825 260 XRA-260 XRA-245 X-RAY CHEST FALLS RIBS AP/LAT VIEW 1100 1375 1485 1650 1650 261 XRA-261 XRA-246 X-RAY CHEST FALLS RIBS LAT VIEW 550 688 743 825 825 262 XRA-262 XRA-247 X-RAY CHEST FOR DECUBITUS LEFT 550 688 743 825 825 263 XRA-263 XRA-248 X-RAY CHEST FOR DECUBITUS RIGHT 550 688 743 825 825 264 XRA-264 XRA-249 X-RAY CHEST FOR RIBS AP VIEW 550 688 743 825 825 265 XRA-265 XRA-250 X-RAY CHEST FOR RIBS AP/LAT VIEW 1100 1375 1485 1650 1650 266 XRA-266 XRA-251 X-RAY CHEST FOR RIBS LATERAL VIEW 550 688 743 825 825 267 XRA-267 XRA-252 X-RAY CHEST LATERAL LEFT 550 688 743 825 825 268 XRA-268 XRA-253 X-RAY CHEST LATERAL RIGHT 550 688 743 825 825 269 XRA-269 XRA-254 X-RAY CHEST OBLIQUE LEFT 550 688 743 825 825 270 XRA-270 XRA-255 X-RAY CHEST OBLIQUE RIGHT 550 688 743 825 825 271 XRA-271 XRA-256 X-RAY CHEST P.A VIEW 550 688 743 825 825 272 XRA-272 XRA-257 X-RAY CHEST PA SITTING 550 688 743 825 825 273 XRA-273 XRA-258 X-RAY CLAVICLE AP LEFT 550 688 743 825 825 274 XRA-274 XRA-259 X-RAY CLAVICLE AP RIGHT 550 688 743 825 825 275 XRA-275 XRA-260 X-RAY CLAVICLE AP/LAT LEFT 1100 1375 1485 1650 1650 276 XRA-276 XRA-261 X-RAY CLAVICLE AP/LAT RIGHT 1100 1375 1485 1650 1650 277 XRA-277 XRA-262 X-RAY CLAVICLE LAT LEFT 550 688 743 825 825 278 XRA-278 XRA-263 X-RAY CLAVICLE LAT RIGHT 550 688 743 825 825 279 XRA-279 XRA-264 X-RAY COCCYX AP / LATERAL VIEWS 1100 1375 1485 1650 1650 280 XRA-280 XRA-265 X-RAY COCCYX AP VIEW 550 688 743 825 825 281 XRA-281 14981 X-RAY COCCYX LAT SITTING 550 688 743 825 825

Any new service/tariff may be changed/added/deleted without prior notice. 51 Schedule of Charges 2019-20 ISIC

282 XRA-282 14982 X-RAY COCCYX LAT STANDING 550 688 743 825 825 283 XRA-283 XRA-266 X-RAY COCCYX LATERAL VIEW 550 688 743 825 825 284 XRA-284 XRA-711 X-RAY CONTRAST ENEMA 6580 8225 8883 9870 9870 285 XRA-285 XRA-712 X-RAY CONTRAST SWALLOW 4100 5125 5535 6150 6150 286 XRA-286 14955 X-RAY D. SPINE PRONE LAT 550 688 743 825 825 287 XRA-287 14959 X-RAY D. SPINE PRONE PA 550 688 743 825 825 288 XRA-288 14965 X-RAY D.L. SPINE AP SITTING 550 688 743 825 825 289 XRA-289 14969 X-RAY D.L. SPINE EXT. SITTING 550 688 743 825 825 290 XRA-290 14968 X-RAY D.L. SPINE FLEX SITTING 550 688 743 825 825 291 XRA-291 14967 X-RAY D.L. SPINE FLEX/EXT. SITTING 1100 1375 1485 1650 1650 292 XRA-292 14966 X-RAY D.L. SPINE LAT SITTING 550 688 743 825 825 293 XRA-293 14954 X-RAY D.L. SPINE PRONE LAT 550 688 743 825 825 294 XRA-294 14958 X-RAY D.L. SPINE PRONE PA 550 688 743 825 825 295 XRA-295 15818 X-RAY DORSAL LUMBAR SPINE LAT SITTING 550 688 743 825 825 296 XRA-296 15819 X-RAY DORSAL LUMBAR SPINE LAT SUPINE 550 688 743 825 825 297 XRA-297 XRA-267 X-RAY DORSAL SPINE A.P VIEW 550 688 743 825 825 298 XRA-298 XRA-268 X-RAY DORSAL SPINE AP / LATERAL 1100 1375 1485 1650 1650 299 XRA-299 XRA-269 X-RAY DORSAL SPINE AP BENDING LEFT 550 688 743 825 825 300 XRA-300 XRA-270 X-RAY DORSAL SPINE AP BENDING RIGHT 550 688 743 825 825 301 XRA-301 XRA-271 X-RAY DORSAL SPINE AP FLEXION & EXTENSION VIEW 1650 2063 2228 2475 2475 302 XRA-302 XRA-272 X-RAY DORSAL SPINE AP STANDING 550 688 743 825 825 303 XRA-303 XRA-273 X-RAY DORSAL SPINE AP/LAT STANDING 1100 1375 1485 1650 1650 X-RAY DORSAL SPINE AP/LAT/FLEXION/EXTENSION 304 XRA-304 XRA-274 2200 2750 2970 3300 3300 VIEW 305 XRA-305 XRA-275 X-RAY DORSAL SPINE BENDING BOTH 1100 1375 1485 1650 1650 306 XRA-306 XRA-276 X-RAY DORSAL SPINE BENDING BOTH STANDING 1100 1375 1485 1650 1650 307 XRA-307 XRA-277 X-RAY DORSAL SPINE BENDING LEFT 550 688 743 825 825 308 XRA-308 XRA-278 X-RAY DORSAL SPINE BENDING LEFT STANDING 550 688 743 825 825 309 XRA-309 XRA-279 X-RAY DORSAL SPINE BENDING RIGHT 550 688 743 825 825 310 XRA-310 XRA-280 X-RAY DORSAL SPINE BENDING RIGHT STANDING 550 688 743 825 825 311 XRA-311 XRA-281 X-RAY DORSAL SPINE EXTENSION VIEW 550 688 743 825 825 312 XRA-312 XRA-282 X-RAY DORSAL SPINE EXTENSION VIEW STANDING 550 688 743 825 825 313 XRA-313 XRA-283 X-RAY DORSAL SPINE FLEXION & EXTENSION VIEW 1100 1375 1485 1650 1650

Any new service/tariff may be changed/added/deleted without prior notice. 52 Schedule of Charges 2019-20 ISIC

X-RAY DORSAL SPINE FLEXION & EXTENSION VIEW 314 XRA-314 XRA-284 1100 1375 1485 1650 1650 STANDING 315 XRA-315 XRA-285 X-RAY DORSAL SPINE FLEXION VIEW 550 688 743 825 825 316 XRA-316 XRA-286 X-RAY DORSAL SPINE FLEXION VIEW STANDING 550 688 743 825 825 317 XRA-317 XRA-287 X-RAY DORSAL SPINE LAT STANDING 550 688 743 825 825 318 XRA-318 XRA-288 X-RAY DORSAL SPINE LAT/FLEXION/EXTENSION VIEW 1650 2063 2228 2475 2475 319 XRA-319 XRA-289 X-RAY DORSAL SPINE LATERAL VIEW 550 688 743 825 825 320 XRA-320 XRA-290 X-RAY DORSAL SPINE OBLIQUE BOTH 1100 1375 1485 1650 1650 321 XRA-321 XRA-291 X-RAY DORSAL SPINE OBLIQUE VIEW LEFT 550 688 743 825 825 322 XRA-322 XRA-292 X-RAY DORSAL SPINE OBLIQUE VIEW RIGHT 550 688 743 825 825 323 XRA-323 XRA-293 X-RAY DORSAL-SPINE AP/LAT VIEW STANDING 1100 1375 1485 1650 1650 324 XRA-324 XRA-294 X-RAY DORSO-LUMBAR SPINE A.P.- ERECT 550 688 743 825 825 325 XRA-325 XRA-295 X-RAY DORSO-LUMBAR SPINE A.P.- SUPINE 550 688 743 825 825 X-RAY DORSO-LUMBAR SPINE AP / FLEXION AND 326 XRA-326 XRA-296 1650 2063 2228 2475 2475 EXTENSION 327 XRA-327 XRA-297 X-RAY DORSO-LUMBAR SPINE AP / SIDE BENDING LEFT 550 688 743 825 825 328 XRA-328 XRA-298 X-RAY DORSO-LUMBAR SPINE AP / SIDE BENDING RIGHT 550 688 743 825 825 329 XRA-329 XRA-299 X-RAY DORSO-LUMBAR SPINE AP / STANDING 550 688 743 825 825 330 XRA-330 XRA-300 X-RAY DORSO-LUMBAR SPINE AP VIEW 550 688 743 825 825 331 XRA-331 XRA-301 X-RAY DORSO-LUMBAR SPINE AP/LAT 1100 1375 1485 1650 1650 332 XRA-332 XRA-302 X-RAY DORSO-LUMBAR SPINE AP/LAT/FLEX/EXTN VIEW 2200 2750 2970 3300 3300 333 XRA-333 XRA-303 X-RAY DORSO-LUMBAR SPINE BENDING BOTH 1100 1375 1485 1650 1650 X-RAY DORSO-LUMBAR SPINE BENDING BOTH 334 XRA-334 XRA-304 1100 1375 1485 1650 1650 STANDING 335 XRA-335 XRA-305 X-RAY DORSO-LUMBAR SPINE BENDING LEFT 550 688 743 825 825 336 XRA-336 XRA-306 X-RAY DORSO-LUMBAR SPINE BENDING LEFT STANDING 550 688 743 825 825 337 XRA-337 XRA-307 X-RAY DORSO-LUMBAR SPINE BENDING RIGHT 550 688 743 825 825 X-RAY DORSO-LUMBAR SPINE BENDING RIGHT 338 XRA-338 XRA-308 550 688 743 825 825 STANDING 339 XRA-339 XRA-309 X-RAY DORSO-LUMBAR SPINE EXTENSION VIEW 550 688 743 825 825 X-RAY DORSO-LUMBAR SPINE EXTENSION VIEW 340 XRA-340 XRA-310 550 688 743 825 825 STANDING X-RAY DORSO-LUMBAR SPINE FLEXION AND EXTENSION 341 XRA-341 XRA-311 1100 1375 1485 1650 1650 VIEW 342 XRA-342 XRA-312 X-RAY DORSO-LUMBAR SPINE FLEXION VIEW 550 688 743 825 825

Any new service/tariff may be changed/added/deleted without prior notice. 53 Schedule of Charges 2019-20 ISIC

343 XRA-343 XRA-313 X-RAY DORSO-LUMBAR SPINE FLEXION VIEW STANDING 550 688 743 825 825 344 XRA-344 XRA-314 X-RAY DORSO-LUMBAR SPINE LAT STANDING 550 688 743 825 825 345 XRA-345 XRA-315 X-RAY DORSO-LUMBAR SPINE LATERAL VIEW 550 688 743 825 825 X-RAY DORSO-LUMBAR SPINE 346 XRA-346 XRA-316 1650 2063 2228 2475 2475 LATERAL/FLEXION/EXTENSION 347 XRA-347 XRA-317 X-RAY DORSO-LUMBAR SPINE OBLIQUE VIEW BOTH 1100 1375 1485 1650 1650 348 XRA-348 XRA-318 X-RAY DORSO-LUMBAR SPINE OBLIQUE VIEW LEFT 550 688 743 825 825 349 XRA-349 XRA-319 X-RAY DORSO-LUMBAR SPINE OBLIQUE VIEW RIGHT 550 688 743 825 825 350 XRA-350 XRA-320 X-RAY ELBOW AP BOTH 1100 1375 1485 1650 1650 351 XRA-351 XRA-321 X-RAY ELBOW AP LEFT 550 688 743 825 825 352 XRA-352 XRA-322 X-RAY ELBOW AP RIGHT 550 688 743 825 825 353 XRA-353 XRA-323 X-RAY ELBOW AP/LAT LEFT 1100 1375 1485 1650 1650 354 XRA-354 XRA-324 X-RAY ELBOW AP/LAT RIGHT 1100 1375 1485 1650 1650 355 XRA-355 XRA-325 X-RAY ELBOW AXIAL LEFT 550 688 743 825 825 356 XRA-356 XRA-326 X-RAY ELBOW AXIAL RIGHT 550 688 743 825 825 357 XRA-357 XRA-327 X-RAY ELBOW LAT BOTH 1100 1375 1485 1650 1650 358 XRA-358 XRA-328 X-RAY ELBOW LAT EXTENSION LEFT 550 688 743 825 825 359 XRA-359 XRA-329 X-RAY ELBOW LAT EXTENSION RIGHT 550 688 743 825 825 360 XRA-360 XRA-330 X-RAY ELBOW LAT FLEXION LEFT 550 688 743 825 825 361 XRA-361 XRA-331 X-RAY ELBOW LAT FLEXION RIGHT 550 688 743 825 825 362 XRA-362 XRA-332 X-RAY ELBOW LAT FLEXION/EXTENSION LEFT 1100 1375 1485 1650 1650 363 XRA-363 XRA-333 X-RAY ELBOW LAT FLEXION/EXTENSION RIGHT 1100 1375 1485 1650 1650 364 XRA-364 XRA-334 X-RAY ELBOW LAT LEFT 550 688 743 825 825 365 XRA-365 XRA-335 X-RAY ELBOW LAT RIGHT 550 688 743 825 825 366 XRA-366 14974 X-RAY ELBOW LT OBLIQUE 550 688 743 825 825 367 XRA-367 14973 X-RAY ELBOW RT OBLIQUE 550 688 743 825 825 368 XRA-368 XRA-336 X-RAY ELBOW WITH (HUMERUS) LAT LEFT 550 688 743 825 825 369 XRA-369 XRA-337 X-RAY ELBOW WITH ARM (HUMERUS) AP LEFT 550 688 743 825 825 370 XRA-370 XRA-338 X-RAY ELBOW WITH ARM (HUMERUS) AP RIGHT 550 688 743 825 825 371 XRA-371 XRA-339 X-RAY ELBOW WITH ARM (HUMERUS) AP/LAT LEFT 1100 1375 1485 1650 1650 372 XRA-372 XRA-340 X-RAY ELBOW WITH ARM (HUMERUS) LAT RIGHT 550 688 743 825 825 373 XRA-373 XRA-341 X-RAY ELBOW WITH ARM (HUMERUS)AP/LAT RIGHT 1100 1375 1485 1650 1650 374 XRA-374 XRA-342 X-RAY ELBOW WITH FOREARM AP LEFT 550 688 743 825 825

Any new service/tariff may be changed/added/deleted without prior notice. 54 Schedule of Charges 2019-20 ISIC

375 XRA-375 XRA-343 X-RAY ELBOW WITH FOREARM AP RIGHT 550 688 743 825 825 376 XRA-376 XRA-344 X-RAY ELBOW WITH FOREARM AP/LAT LEFT 1100 1375 1485 1650 1650 377 XRA-377 XRA-345 X-RAY ELBOW WITH FOREARM AP/LAT RIGHT 1100 1375 1485 1650 1650 378 XRA-378 XRA-346 X-RAY ELBOW WITH FOREARM LAT LEFT 550 688 743 825 825 379 XRA-379 XRA-347 X-RAY ELBOW WITH FOREARM LAT RIGHT 550 688 743 825 825 380 XRA-380 XRA-348 X-RAY EXTRA FILM 440 550 594 660 660 381 XRA-381 XRA-349 X-RAY FEMUR AP RIGHT 550 688 743 825 825 382 XRA-382 XRA-350 X-RAY FEMUR AP/LAT LEFT 1100 1375 1485 1650 1650 383 XRA-383 XRA-351 X-RAY FEMUR AP/LAT RIGHT 1100 1375 1485 1650 1650 384 XRA-384 14799 X-RAY FEMUR AP/LAT/OBLIQUE (LEFT) 1650 2063 2228 2475 2475 385 XRA-385 14800 X-RAY FEMUR AP/LAT/OBLIQUE (RIGHT) 1650 2063 2228 2475 2475 386 XRA-386 XRA-352 X-RAY FINGER AP LEFT 550 688 743 825 825 387 XRA-387 XRA-353 X-RAY FINGER AP RIGHT 550 688 743 825 825 388 XRA-388 XRA-354 X-RAY FINGER AP/LAT LEFT 550 688 743 825 825 389 XRA-389 XRA-355 X-RAY FINGER AP/LAT RIGHT 550 688 743 825 825 390 XRA-390 XRA-356 X-RAY FINGER AP/LAT/OBLIQUE LEFT 550 688 743 825 825 391 XRA-391 XRA-357 X-RAY FINGER AP/LAT/OBLIQUE RIGHT 550 688 743 825 825 392 XRA-392 XRA-358 X-RAY FINGER LAT LEFT 550 688 743 825 825 393 XRA-393 XRA-359 X-RAY FINGER LAT RIGHT 550 688 743 825 825 394 XRA-394 XRA-360 X-RAY FINGER OBLIQUE LEFT 550 688 743 825 825 395 XRA-395 XRA-361 X-RAY FINGER OBLIQUE RIGHT 550 688 743 825 825 396 XRA-396 XRA-713 X-RAY FISTULOGRAM 4100 5125 5535 6150 6150 397 XRA-397 XRA-362 X-RAY FOOT AP BOTH (Single Shoot) 550 688 743 825 825 398 XRA-398 XRA-363 X-RAY FOOT AP LEFT 550 688 743 825 825 399 XRA-399 XRA-364 X-RAY FOOT AP RIGHT 550 688 743 825 825 400 XRA-400 XRA-365 X-RAY FOOT AP STANDING LEFT 550 688 743 825 825 401 XRA-401 XRA-366 X-RAY FOOT AP STANDING RIGHT 550 688 743 825 825 402 XRA-402 XRA-367 X-RAY FOOT AP/LAT BOTH 1650 2063 2228 2475 2475 403 XRA-403 XRA-368 X-RAY FOOT AP/LAT LEFT 1100 1375 1485 1650 1650 404 XRA-404 XRA-369 X-RAY FOOT AP/LAT RIGHT 1100 1375 1485 1650 1650 405 XRA-405 XRA-370 X-RAY FOOT AP/LAT STANDING LEFT 1100 1375 1485 1650 1650 406 XRA-406 XRA-371 X-RAY FOOT AP/LAT STANDING RIGHT 1100 1375 1485 1650 1650

Any new service/tariff may be changed/added/deleted without prior notice. 55 Schedule of Charges 2019-20 ISIC

407 XRA-407 XRA-372 X-RAY FOOT AP/LAT/OBLIQUE BOTH 2810 3513 3794 4215 4215 408 XRA-408 XRA-373 X-RAY FOOT AP/LAT/OBLIQUE LEFT 1650 2063 2228 2475 2475 409 XRA-409 XRA-374 X-RAY FOOT AP/LAT/OBLIQUE RIGHT 1650 2063 2228 2475 2475 410 XRA-410 XRA-375 X-RAY FOOT AP/OBLIQUE LEFT 1100 1375 1485 1650 1650 411 XRA-411 XRA-376 X-RAY FOOT AP/OBLIQUE RIGHT 1100 1375 1485 1650 1650 412 XRA-412 XRA-377 X-RAY FOOT LAT BOTH 1100 1375 1485 1650 1650 413 XRA-413 XRA-378 X-RAY FOOT LAT LEFT 550 688 743 825 825 414 XRA-414 XRA-379 X-RAY FOOT LAT RIGHT 550 688 743 825 825 415 XRA-415 XRA-380 X-RAY FOOT LAT STANDING LEFT 550 688 743 825 825 416 XRA-416 XRA-381 X-RAY FOOT LAT STANDING RIGHT 550 688 743 825 825 417 XRA-417 XRA-382 X-RAY FOOT OBLIQUE BOTH 1100 1375 1485 1650 1650 418 XRA-418 XRA-383 X-RAY FOOT OBLIQUE LEFT 550 688 743 825 825 419 XRA-419 XRA-384 X-RAY FOOT OBLIQUE RIGHT 550 688 743 825 825 420 XRA-420 XRA-385 X-RAY FOREARM AP LEFT 550 688 743 825 825 421 XRA-421 XRA-386 X-RAY FOREARM AP RIGHT 550 688 743 825 825 422 XRA-422 XRA-387 X-RAY FOREARM AP/LAT LEFT 1100 1375 1485 1650 1650 423 XRA-423 XRA-388 X-RAY FOREARM AP/LAT RIGHT 1100 1375 1485 1650 1650 424 XRA-424 XRA-389 X-RAY FOREARM LAT LEFT 550 688 743 825 825 425 XRA-425 XRA-390 X-RAY FOREARM LAT RIGHT 550 688 743 825 825 426 XRA-426 14827 X-RAY FROG LEG LAT LEFT 550 688 743 825 825 427 XRA-427 XRA-391 X-RAY FROG LEG LAT RIGHT 550 688 743 825 825 428 XRA-428 XRA-392 X-RAY FULL LIMB AP 1650 2063 2228 2475 2475 429 XRA-429 XRA-393 X-RAY FULL SPINE 1650 2063 2228 2475 2475 430 XRA-430 XRA-714 X-RAY GASTROGRAFFIN FOR STOMACH 4100 5125 5535 6150 6150 431 XRA-431 XRA-715 X-RAY H.S.G. 5740 7175 7749 8610 8610 432 XRA-432 16257 X-RAY HAND AP BOTH 550 688 743 825 825 433 XRA-433 XRA-394 X-RAY HAND AP LEFT 550 688 743 825 825 434 XRA-434 XRA-395 X-RAY HAND AP RIGHT 550 688 743 825 825 435 XRA-435 XRA-396 X-RAY HAND AP/LAT LEFT 550 688 743 825 825 436 XRA-436 XRA-397 X-RAY HAND AP/LAT RIGHT 550 688 743 825 825 437 XRA-437 XRA-398 X-RAY HAND AP/LAT/OBLIQUE LEFT 1650 2063 2228 2475 2475 438 XRA-438 XRA-399 X-RAY HAND AP/LAT/OBLIQUE RIGHT 1650 2063 2228 2475 2475

Any new service/tariff may be changed/added/deleted without prior notice. 56 Schedule of Charges 2019-20 ISIC

439 XRA-439 XRA-400 X-RAY HAND AP/OBLIQUE LEFT 1100 1375 1485 1650 1650 440 XRA-440 XRA-401 X-RAY HAND AP/OBLIQUE RIGHT 1100 1375 1485 1650 1650 441 XRA-441 XRA-402 X-RAY HAND LAT BOTH 1100 1375 1485 1650 1650 442 XRA-442 XRA-403 X-RAY HAND LAT LEFT 550 688 743 825 825 443 XRA-443 XRA-404 X-RAY HAND LAT RIGHT 550 688 743 825 825 444 XRA-444 XRA-405 X-RAY HAND OBLIQUE BOTH 1100 1375 1485 1650 1650 445 XRA-445 XRA-406 X-RAY HAND OBLIQUE LEFT 550 688 743 825 825 446 XRA-446 XRA-407 X-RAY HAND OBLIQUE RIGHT 550 688 743 825 825 447 XRA-447 XRA-408 X-RAY HAND PA BOTH (Single Shoot) 550 688 743 825 825 448 XRA-448 XRA-409 X-RAY HAND PA LEFT 550 688 743 825 825 449 XRA-449 XRA-410 X-RAY HAND PA RIGHT 550 688 743 825 825 450 XRA-450 XRA-411 X-RAY HEEL AP/AXIAL LEFT 1100 1375 1485 1650 1650 451 XRA-451 XRA-412 X-RAY HEEL AP/AXIAL RIGHT 1100 1375 1485 1650 1650 452 XRA-452 14670 X-RAY HEEL AP/LAT (LEFT) 1100 1375 1485 1650 1650 453 XRA-453 14669 X-RAY HEEL AP/LAT (RIGHT) 1100 1375 1485 1650 1650 454 XRA-454 XRA-413 X-RAY HEEL AXIAL LEFT 550 688 743 825 825 455 XRA-455 XRA-414 X-RAY HEEL AXIAL RIGHT 550 688 743 825 825 456 XRA-456 XRA-415 X-RAY HEEL LAT AXIAL LEFT 550 688 743 825 825 457 XRA-457 XRA-416 X-RAY HEEL LAT AXIAL RIGHT 550 688 743 825 825 458 XRA-458 XRA-417 X-RAY HEEL LAT LEFT 550 688 743 825 825 459 XRA-459 XRA-418 X-RAY HEEL LAT RIGHT 550 688 743 825 825 460 XRA-460 XRA-419 X-RAY HIP AP EXTERNAL LEFT 550 688 743 825 825 461 XRA-461 XRA-420 X-RAY HIP AP EXTERNAL RIGHT 550 688 743 825 825 462 XRA-462 XRA-421 X-RAY HIP AP INTERNAL LEFT 550 688 743 825 825 463 XRA-463 XRA-422 X-RAY HIP AP INTERNAL RIGHT 550 688 743 825 825 464 XRA-464 XRA-423 X-RAY HIP AXIAL LEFT 550 688 743 825 825 465 XRA-465 XRA-424 X-RAY HIP AXIAL RIGHT 550 688 743 825 825 466 XRA-466 XRA-425 X-RAY HIP FROG LEG LAT LEFT 550 688 743 825 825 467 XRA-467 XRA-426 X-RAY HIP JOINT AP VIEW LEFT 550 688 743 825 825 468 XRA-468 XRA-427 X-RAY HIP JOINT AP VIEW RIGHT 550 688 743 825 825 469 XRA-469 XRA-428 X-RAY HIP JOINT AP/LAT BOTH 1650 2063 2228 2475 2475 470 XRA-470 XRA-429 X-RAY HIP JOINT AP/LAT VIEW LEFT 1100 1375 1485 1650 1650

Any new service/tariff may be changed/added/deleted without prior notice. 57 Schedule of Charges 2019-20 ISIC

471 XRA-471 XRA-430 X-RAY HIP JOINT AP/LAT VIEW RIGHT 1100 1375 1485 1650 1650 472 XRA-472 XRA-431 X-RAY HIP JOINT LATERAL LEFT 550 688 743 825 825 473 XRA-473 XRA-432 X-RAY HIP JOINT LATERAL RIGHT 550 688 743 825 825 474 XRA-474 XRA-433 X-RAY HIP WITH FEMUR AP LEFT 550 688 743 825 825 475 XRA-475 XRA-434 X-RAY HIP WITH FEMUR AP RIGHT 550 688 743 825 825 476 XRA-476 XRA-435 X-RAY HIP WITH FEMUR AP/LAT LEFT 1100 1375 1485 1650 1650 477 XRA-477 XRA-436 X-RAY HIP WITH FEMUR AP/LAT RIGHT 1100 1375 1485 1650 1650 478 XRA-478 XRA-437 X-RAY HIP WITH FEMUR LAT LEFT 550 688 743 825 825 479 XRA-479 XRA-438 X-RAY HIP WITH FEMUR LAT RIGHT 550 688 743 825 825 480 XRA-480 XRA-439 X-RAY HIP WITH THIGH AP / LATERAL 1100 1375 1485 1650 1650 481 XRA-481 14983 X-RAY HIP WITH THIGH WITH KNEE AP (ADULT) 1100 1375 1485 1650 1650 482 XRA-482 14942 X-RAY HIP WITH THIGH WITH KNEE LT AP (ADULT) 1100 1375 1485 1650 1650 483 XRA-483 14946 X-RAY HIP WITH THIGH WITH KNEE LT AP/LAT (ADULT) 2200 2750 2970 3300 3300 484 XRA-484 14944 X-RAY HIP WITH THIGH WITH KNEE LT LAT (ADULT) 1100 1375 1485 1650 1650 485 XRA-485 14941 X-RAY HIP WITH THIGH WITH KNEE RT AP (ADULT) 1100 1375 1485 1650 1650 486 XRA-486 14945 X-RAY HIP WITH THIGH WITH KNEE RT AP/LAT (ADULT) 2200 2750 2970 3300 3300 487 XRA-487 14943 X-RAY HIP WITH THIGH WITH KNEE RT LAT (ADULT) 1100 1375 1485 1650 1650 488 XRA-488 XRA-440 X-RAY HUMEROUS (ARM) AP/LAT RIGHT 1100 1375 1485 1650 1650 489 XRA-489 XRA-441 X-RAY HUMERUS (ARM) AP LEFT 550 688 743 825 825 490 XRA-490 XRA-442 X-RAY HUMERUS (ARM) AP RIGHT 550 688 743 825 825 491 XRA-491 XRA-443 X-RAY HUMERUS (ARM) LAT LEFT 550 688 743 825 825 492 XRA-492 XRA-444 X-RAY HUMERUS (ARM) LAT RIGHTS 550 688 743 825 825 493 XRA-493 XRA-445 X-RAY HUMERUS AP/LAT LEFT 1100 1375 1485 1650 1650 494 XRA-494 XRA-717 X-RAY IVP CONTRAST 1640 2050 2214 2460 2460 495 XRA-495 XRA-718 X-RAY IVP WITH MCU 7390 9238 9977 11085 11085 496 XRA-496 XRA-446 X-RAY KINEE VARUS STRESS LEFT 550 688 743 825 825 497 XRA-497 XRA-447 X-RAY KNEE ( STANDING ) AP / LATERAL VIEWS LEFT 1100 1375 1485 1650 1650 498 XRA-498 XRA-448 X-RAY KNEE AP BOTH (SINGLE SHOOT) 550 688 743 825 825 499 XRA-499 XRA-449 X-RAY KNEE AP LEFT 550 688 743 825 825 500 XRA-500 XRA-450 X-RAY KNEE AP RIGHT 550 688 743 825 825 501 XRA-501 XRA-452 X-RAY KNEE AP STANDING/LAT BOTH 1650 2063 2228 2475 2475 502 XRA-502 XRA-453 X-RAY KNEE AP STANDING/LAT LEFT 1100 1375 1485 1650 1650

Any new service/tariff may be changed/added/deleted without prior notice. 58 Schedule of Charges 2019-20 ISIC

503 XRA-503 XRA-454 X-RAY KNEE AP/LAT BOTH 1650 2063 2228 2475 2475 504 XRA-504 XRA-455 X-RAY KNEE AP/LAT LEFT 1100 1375 1485 1650 1650 505 XRA-505 XRA-456 X-RAY KNEE AP/LAT MORTRIS VIEW LEFT 1100 1375 1485 1650 1650 506 XRA-506 XRA-457 X-RAY KNEE AP/LAT MORTRIS VIEW RIGHT 1100 1375 1485 1650 1650 507 XRA-507 XRA-458 X-RAY KNEE AP/LAT RIGHT 1100 1375 1485 1650 1650 508 XRA-508 14797 X-RAY KNEE AP/LAT/OBLIQUE (LEFT) 1650 2063 2228 2475 2475 509 XRA-509 14798 X-RAY KNEE AP/LAT/OBLIQUE (RIGHT) 1650 2063 2228 2475 2475 510 XRA-510 XRA-459 X-RAY KNEE JOINT AP ( STANDING) LATERAL 1100 1375 1485 1650 1650 511 XRA-511 XRA-460 X-RAY KNEE LAT BOTH 1100 1375 1485 1650 1650 512 XRA-512 XRA-461 X-RAY KNEE LAT LEFT 550 688 743 825 825 513 XRA-513 XRA-462 X-RAY KNEE LAT RIGHT 550 688 743 825 825 514 XRA-514 XRA-463 X-RAY KNEE MARCHENTS VIEW BOTH 1100 1375 1485 1650 1650 515 XRA-515 XRA-464 X-RAY KNEE MARCHENTS VIEW LEFT 550 688 743 825 825 516 XRA-516 XRA-465 X-RAY KNEE MARCHENTS VIEW RIGHT 550 688 743 825 825 517 XRA-517 XRA-466 X-RAY KNEE MORTRIS VIEW AP RIGHT 550 688 743 825 825 518 XRA-518 XRA-467 X-RAY KNEE MORTRIS VIEW LEFT 550 688 743 825 825 519 XRA-519 XRA-468 X-RAY KNEE SKYLINE BOTH (SINGLE SHOOT) 550 688 743 825 825 520 XRA-520 XRA-469 X-RAY KNEE SKYLINE LEFT 550 688 743 825 825 521 XRA-521 XRA-470 X-RAY KNEE SKYLINE RIGHT 550 688 743 825 825 522 XRA-522 XRA-451 X-RAY KNEE STANDING AP/LAT RIGHT 1100 1375 1485 1650 1650 523 XRA-523 XRA-471 X-RAY KNEE STRESS LAT LEFT 550 688 743 825 825 524 XRA-524 XRA-472 X-RAY KNEE STRESS LAT RIGHT 550 688 743 825 825 525 XRA-525 XRA-473 X-RAY KNEE VALGUS STRESS BOTH 1100 1375 1485 1650 1650 526 XRA-526 XRA-474 X-RAY KNEE VALGUS STRESS LEFT 550 688 743 825 825 527 XRA-527 XRA-475 X-RAY KNEE VALGUS STRESS RIGHT 550 688 743 825 825 528 XRA-528 16067 X-RAY KNEE VARUS STRESS LEFT 550 688 743 825 825 529 XRA-529 XRA-476 X-RAY KNEE VARUS STRESS RIGHT 550 688 743 825 825 530 XRA-530 XRA-477 X-RAY KNEE WITH LEG AP LEFT 550 688 743 825 825 531 XRA-531 XRA-478 X-RAY KNEE WITH LEG AP RIGHT 550 688 743 825 825 532 XRA-532 XRA-479 X-RAY KNEE WITH LEG AP/LAT 1100 1375 1485 1650 1650 533 XRA-533 14838 X-RAY KNEE WITH LEG AP/LAT LEFT 1100 1375 1485 1650 1650 534 XRA-534 XRA-480 X-RAY KNEE WITH LEG AP/LAT RIGHT 1100 1375 1485 1650 1650

Any new service/tariff may be changed/added/deleted without prior notice. 59 Schedule of Charges 2019-20 ISIC

535 XRA-535 XRA-481 X-RAY KNEE WITH LEG LAT LEFT 550 688 743 825 825 536 XRA-536 XRA-482 X-RAY KNEE WITH LEG LAT RIGHT 550 688 743 825 825 537 XRA-537 14948 X-RAY KNEE WITH LEG WITH ANKLE LT AP (ADULT) 1100 1375 1485 1650 1650 538 XRA-538 14952 X-RAY KNEE WITH LEG WITH ANKLE LT AP/LAT (ADULT) 2200 2750 2970 3300 3300 539 XRA-539 14950 X-RAY KNEE WITH LEG WITH ANKLE LT LAT (ADULT) 1100 1375 1485 1650 1650 540 XRA-540 14947 X-RAY KNEE WITH LEG WITH ANKLE RT AP (ADULT) 1100 1375 1485 1650 1650 541 XRA-541 14951 X-RAY KNEE WITH LEG WITH ANKLE RT AP/LAT (ADULT) 2200 2750 2970 3300 3300 542 XRA-542 14949 X-RAY KNEE WITH LEG WITH ANKLE RT LAT (ADULT) 1100 1375 1485 1650 1650 543 XRA-543 15739 X-RAY KNEE WITH THIGH AP LEFT 550 688 743 825 825 544 XRA-544 15741 X-RAY KNEE WITH THIGH AP RIGHT 550 688 743 825 825 545 XRA-545 15738 X-RAY KNEE WITH THIGH LAT LEFT 550 688 743 825 825 546 XRA-546 15740 X-RAY KNEE WITH THIGH LAT RIGHT 550 688 743 825 825 547 XRA-547 XRA-483 X-RAY KUB 550 688 743 825 825 548 XRA-548 XRA-484 X-RAY KUB WITH PELVIS AP VIEW 1100 1375 1485 1650 1650 549 XRA-549 XRA-485 X-RAY L - S SPINE AP / LAT / FLEXION & EXTENSION 2200 2750 2970 3300 3300 550 XRA-550 XRA-486 X-RAY L.S. SPINE (LT) SIDE BENDING A.P. 550 688 743 825 825 551 XRA-551 XRA-487 X-RAY L.S. SPINE (RT) SIDE BENDING A.P. 550 688 743 825 825 552 XRA-552 XRA-488 X-RAY L.S. SPINE A.P. ERECT 550 688 743 825 825 553 XRA-553 XRA-489 X-RAY L.S. SPINE A.P. SUPINE 550 688 743 825 825 554 XRA-554 14960 X-RAY L.S. SPINE AP SITTING 550 688 743 825 825 555 XRA-555 14964 X-RAY L.S. SPINE EXT. SITTING 550 688 743 825 825 556 XRA-556 14963 X-RAY L.S. SPINE FLEX. SITTING 550 688 743 825 825 557 XRA-557 14962 X-RAY L.S. SPINE FLEX/EXT. SITTING 1100 1375 1485 1650 1650 558 XRA-558 14961 X-RAY L.S. SPINE LAT SITTING 550 688 743 825 825 559 XRA-559 14953 X-RAY L.S. SPINE PRONE LAT 550 688 743 825 825 560 XRA-560 14957 X-RAY L.S. SPINE PRONE PA 550 688 743 825 825 561 XRA-561 XRA-490 X-RAY LEG AP/LAT RIGHT 1100 1375 1485 1650 1650 562 XRA-562 XRA-491 X-RAY LEG AP BOTH (SINGLE SHOOT) 550 688 743 825 825 563 XRA-563 XRA-492 X-RAY LEG AP LEFT 550 688 743 825 825 564 XRA-564 XRA-493 X-RAY LEG AP RIGHT 550 688 743 825 825 565 XRA-565 XRA-494 X-RAY LEG AP/LAT BOTH 1650 2063 2228 2475 2475 566 XRA-566 XRA-495 X-RAY LEG AP/LAT LEFT 1100 1375 1485 1650 1650

Any new service/tariff may be changed/added/deleted without prior notice. 60 Schedule of Charges 2019-20 ISIC

567 XRA-567 XRA-496 X-RAY LEG LAT BOTH 1100 1375 1485 1650 1650 568 XRA-568 XRA-497 X-RAY LEG LAT LEFT 550 688 743 825 825 569 XRA-569 16049 X-RAY LEG LAT RIGHT 550 688 743 825 825 570 XRA-570 XRA-498 X-RAY LEG WITH ANKLE AP LEFT 550 688 743 825 825 571 XRA-571 XRA-499 X-RAY LEG WITH ANKLE AP RIGHT 550 688 743 825 825 572 XRA-572 XRA-500 X-RAY LEG WITH ANKLE AP/LAT LEFT 1100 1375 1485 1650 1650 573 XRA-573 XRA-501 X-RAY LEG WITH ANKLE AP/LAT RIGHT 1100 1375 1485 1650 1650 574 XRA-574 XRA-502 X-RAY LEG WITH ANKLE LAT LEFT 550 688 743 825 825 575 XRA-575 XRA-503 X-RAY LEG WITH ANKLE LAT RIGHT 550 688 743 825 825 576 XRA-576 XRA-504 X-RAY LORDOTIC VIEW 550 688 743 825 825 577 XRA-577 XRA-505 X-RAY LUMBO-SACRAL SPINE AP / LAT VIEW 1100 1375 1485 1650 1650 578 XRA-578 XRA-506 X-RAY LUMBO-SACRAL SPINE AP BENDING LEFT 550 688 743 825 825 579 XRA-579 XRA-507 X-RAY LUMBO-SACRAL SPINE AP BENDING RIGHT 550 688 743 825 825 580 XRA-580 XRA-509 X-RAY LUMBO-SACRAL SPINE AP STANDING 550 688 743 825 825 581 XRA-581 XRA-510 X-RAY LUMBO-SACRAL SPINE AP VIEW 550 688 743 825 825 X-RAY LUMBO-SACRAL SPINE AP/FLEXION AND 582 XRA-582 XRA-508 1650 2063 2228 2475 2475 EXTENSION 583 XRA-583 XRA-511 X-RAY LUMBO-SACRAL SPINE AP/LAT VIEW STANDING 1100 1375 1485 1650 1650 584 XRA-584 XRA-512 X-RAY LUMBO-SACRAL SPINE AP/LAT/FLEX/EXTN VIEW 2200 2750 2970 3300 3300 585 XRA-585 XRA-513 X-RAY LUMBO-SACRAL SPINE BENDING BOTH 1100 1375 1485 1650 1650 X-RAY LUMBO-SACRAL SPINE BENDING BOTH 586 XRA-586 XRA-514 1100 1375 1485 1650 1650 STANDING 587 XRA-587 XRA-515 X-RAY LUMBO-SACRAL SPINE BENDING LEFT STANDING 550 688 743 825 825 X-RAY LUMBO-SACRAL SPINE BENDING RIGHT 588 XRA-588 XRA-516 550 688 743 825 825 STANDING 589 XRA-589 XRA-517 X-RAY LUMBO-SACRAL SPINE EXTENSION VIEW 550 688 743 825 825 X-RAY LUMBO-SACRAL SPINE EXTENSION VIEW 590 XRA-590 XRA-518 550 688 743 825 825 STANDING X-RAY LUMBO-SACRAL SPINE FLEXION AND EXTENSION 591 XRA-591 XRA-519 1100 1375 1485 1650 1650 VIEW 592 XRA-592 XRA-520 X-RAY LUMBO-SACRAL SPINE FLEXION VIEW 550 688 743 825 825 593 XRA-593 XRA-521 X-RAY LUMBO-SACRAL SPINE FLEXION VIEW STANDING 550 688 743 825 825 594 XRA-594 15820 X-RAY LUMBO-SACRAL SPINE LAT SITTING 550 688 743 825 825 595 XRA-595 XRA-522 X-RAY LUMBO-SACRAL SPINE LAT STANDING 550 688 743 825 825 596 XRA-596 15821 X-RAY LUMBO-SACRAL SPINE LAT SUPINE 550 688 743 825 825

Any new service/tariff may be changed/added/deleted without prior notice. 61 Schedule of Charges 2019-20 ISIC

X-RAY LUMBO-SACRAL SPINE LATERAL / FLEXION AND 597 XRA-597 XRA-523 1650 2063 2228 2475 2475 EXTENSION 598 XRA-598 XRA-524 X-RAY LUMBO-SACRAL SPINE LATERAL VIEW 550 688 743 825 825 599 XRA-599 XRA-525 X-RAY LUMBO-SACRAL SPINE OBLIQUE VIEW BOTH 1100 1375 1485 1650 1650 600 XRA-600 XRA-526 X-RAY LUMBO-SACRAL SPINE OBLIQUE VIEW LEFT 550 688 743 825 825 601 XRA-601 XRA-527 X-RAY LUMBO-SACRAL SPINE OBLIQUE VIEW RIGHT 550 688 743 825 825 602 XRA-602 XRA-528 X-RAY MANDIBLE A.P VIEW 550 688 743 825 825 603 XRA-603 XRA-529 X-RAY MANDIBLE BOTH LATERAL OBLIQUE 1100 1375 1485 1650 1650 604 XRA-604 XRA-530 X-RAY MANDIBLE LAT BOTH 1100 1375 1485 1650 1650 605 XRA-605 XRA-531 X-RAY MANDIBLE LAT LEFT 550 688 743 825 825 606 XRA-606 XRA-532 X-RAY MANDIBLE LAT RIGHT 550 688 743 825 825 607 XRA-607 XRA-533 X-RAY MANDIBLE P.A VIEW 550 688 743 825 825 608 XRA-608 XRA-534 X-RAY MASTOID (BOTH) AP 1100 1375 1485 1650 1650 609 XRA-609 XRA-535 X-RAY MASTOID (LT.) OBLIQUE 550 688 743 825 825 610 XRA-610 XRA-536 X-RAY MASTOID (RT.) OBLIQUE 550 688 743 825 825 611 XRA-611 XRA-719 X-RAY MCU (MICTURATING CYSTOURETHOGRAM) 4100 5125 5535 6150 6150 612 XRA-612 XRA-720 X-RAY MCU + CONTRAST 4000 5000 5400 6000 6000 613 XRA-613 XRA-721 X-RAY MYLOGRAM 8140 10175 10989 12210 12210 614 XRA-614 XRA-537 X-RAY NASAL BONE AP 550 688 743 825 825 615 XRA-615 XRA-538 X-RAY NASAL BONE AP/LAT 1100 1375 1485 1650 1650 616 XRA-616 XRA-539 X-RAY NASAL BONE LAT 550 688 743 825 825 617 XRA-617 XRA-540 X-RAY NECK (SOFT TISSUE ) AP/LATERAL VIEW 1100 1375 1485 1650 1650 618 XRA-618 XRA-541 X-RAY NECK (SOFT TISSUE ) LATERAL VIEW 550 688 743 825 825 X-RAY ORAL CONTRAST STUDY (GASTROGRAPHIN 619 XRA-619 XRA-722 5420 6775 7317 8130 8130 STUDY) 620 XRA-620 XRA-542 X-RAY ORBIT AP/ LAT ( FOR OPTIC CANAL) 1100 1375 1485 1650 1650 621 XRA-621 XRA-543 X-RAY ORBIT AP/LAT BOTH 1650 2063 2228 2475 2475 622 XRA-622 XRA-545 X-RAY PARANASAL SINUSES ( WATER'S VIEW ) 550 688 743 825 825 623 XRA-623 XRA-544 X-RAY PARANASAL SINUSES 550 688 743 825 825 624 XRA-624 XRA-546 X-RAY PATELLA ( SKYLINE ) 550 688 743 825 825 625 XRA-625 XRA-547 X-RAY PELVIS AP VIEW 550 688 743 825 825 626 XRA-626 XRA-548 X-RAY PELVIS AP WITH BOTH HIP JOINT 550 688 743 825 825 627 XRA-627 14508 X-RAY PELVIS AP/LATERAL VIEW 1100 1375 1485 1650 1650

Any new service/tariff may be changed/added/deleted without prior notice. 62 Schedule of Charges 2019-20 ISIC

628 XRA-628 14956 X-RAY PELVIS FROG LEG LAT 550 688 743 825 825 629 XRA-629 XRA-549 X-RAY PELVIS INLET VIEW 550 688 743 825 825 630 XRA-630 1006 X-RAY PELVIS JUDET VIEW LT 1100 1375 1485 1650 1650 631 XRA-631 1005 X-RAY PELVIS JUDET VIEW RT. 1100 1375 1485 1650 1650 632 XRA-632 XRA-550 X-RAY PELVIS JUGULAR VIEW BOTH 1100 1375 1485 1650 1650 633 XRA-633 XRA-551 X-RAY PELVIS JUGULAR VIEW LEFT 550 688 743 825 825 634 XRA-634 XRA-552 X-RAY PELVIS JUGULAR VIEW RIGHT 550 688 743 825 825 635 XRA-635 14507 X-RAY PELVIS LATERAL VIEW 550 688 743 825 825 636 XRA-636 XRA-553 X-RAY PELVIS OUTLET VIEW 550 688 743 825 825 637 XRA-637 XRA-554 X-RAY PELVIS P.A. 550 688 743 825 825 638 XRA-638 14586 X-RAY REPORTING CHAGES 240 300 324 360 360 639 XRA-639 XRA-725 X-RAY RGU 4100 5125 5535 6150 6150 640 XRA-640 XRA-555 X-RAY S I JOINT AP VIEW 550 688 743 825 825 641 XRA-641 XRA-556 X-RAY S I JOINT AP/BOTH OBLIQUE 1650 2063 2228 2475 2475 642 XRA-642 XRA-557 X-RAY S I JOINT AP/LEFT OBLIQUE 1100 1375 1485 1650 1650 643 XRA-643 XRA-558 X-RAY S I JOINT AP/RIGHT OBLIQUE 1100 1375 1485 1650 1650 644 XRA-644 XRA-559 X-RAY SACROILIAC JOINTS PA 550 688 743 825 825 645 XRA-645 XRA-560 X-RAY SACROILIAC JOINTS RIGHT & LEFT OBLIQUE 1100 1375 1485 1650 1650 646 XRA-646 XRA-561 X-RAY SACRUM AP VIEW 550 688 743 825 825 647 XRA-647 XRA-562 X-RAY SACRUM AP/LAT VIEW 1100 1375 1485 1650 1650 648 XRA-648 XRA-563 X-RAY SACRUM LAT VIEW 550 688 743 825 825 649 XRA-649 XRA-564 X-RAY SCAPULA AP LEFT 550 688 743 825 825 650 XRA-650 XRA-565 X-RAY SCAPULA AP RIGHT 550 688 743 825 825 651 XRA-651 XRA-566 X-RAY SCAPULA LAT LEFT 550 688 743 825 825 652 XRA-652 XRA-567 X-RAY SCAPULA LAT RIGHT 550 688 743 825 825 653 XRA-653 XRA-568 X-RAY SELLA 550 688 743 825 825 654 XRA-654 XRA-569 X-RAY SHOUDER WITH HUMERUS LAT RIGHT 550 688 743 825 825 655 XRA-655 XRA-570 X-RAY SHOULDER ( AXIAL ) VIEW RIGHT 550 688 743 825 825 656 XRA-656 XRA-571 X-RAY SHOULDER A.P VIEW LEFT 550 688 743 825 825 657 XRA-657 XRA-572 X-RAY SHOULDER A.P VIEW RIGHT 550 688 743 825 825 658 XRA-658 XRA-574 X-RAY SHOULDER AP & AXIAL VIEWS LEFT 1100 1375 1485 1650 1650 659 XRA-659 XRA-575 X-RAY SHOULDER AP & AXIAL VIEWS RIGHT 1100 1375 1485 1650 1650

Any new service/tariff may be changed/added/deleted without prior notice. 63 Schedule of Charges 2019-20 ISIC

660 XRA-660 XRA-576 X-RAY SHOULDER AP / LATERAL VIEWS LEFT 1100 1375 1485 1650 1650 661 XRA-661 XRA-577 X-RAY SHOULDER AP / LATERAL VIEWS RIGHT 1100 1375 1485 1650 1650 662 XRA-662 XRA-578 X-RAY SHOULDER AP LEFT 550 688 743 825 825 663 XRA-663 XRA-579 X-RAY SHOULDER AP/LAT LEFT 1100 1375 1485 1650 1650 664 XRA-664 XRA-580 X-RAY SHOULDER AP\LAT RIGHT 1100 1375 1485 1650 1650 665 XRA-665 XRA-573 X-RAY SHOULDER AXIAL BOTH 1100 1375 1485 1650 1650 666 XRA-666 XRA-581 X-RAY SHOULDER AXIAL LEFT 550 688 743 825 825 667 XRA-667 XRA-582 X-RAY SHOULDER BOTH AP 1100 1375 1485 1650 1650 668 XRA-668 XRA-583 X-RAY SHOULDER EXTERNAL ROTATION BOTH 1100 1375 1485 1650 1650 669 XRA-669 XRA-584 X-RAY SHOULDER EXTERNAL ROTATION LEFT 550 688 743 825 825 670 XRA-670 XRA-585 X-RAY SHOULDER EXTERNAL ROTATION RIGHT 550 688 743 825 825 671 XRA-671 XRA-586 X-RAY SHOULDER HUMERUS AP/LAT LEFT 1100 1375 1485 1650 1650 672 XRA-672 XRA-587 X-RAY SHOULDER INTERNAL ROTATION BOTH 1100 1375 1485 1650 1650 673 XRA-673 XRA-588 X-RAY SHOULDER INTERNAL ROTATION LEFT 550 688 743 825 825 674 XRA-674 XRA-589 X-RAY SHOULDER INTERNAL ROTATION RIGHT 550 688 743 825 825 675 XRA-675 XRA-590 X-RAY SHOULDER LAT BOTH 1100 1375 1485 1650 1650 676 XRA-676 XRA-591 X-RAY SHOULDER LAT LEFT 550 688 743 825 825 677 XRA-677 XRA-592 X-RAY SHOULDER LAT RIGHT 550 688 743 825 825 678 XRA-678 XRA-593 X-RAY SHOULDER WITH ARM AP / LATERAL 1100 1375 1485 1650 1650 679 XRA-679 XRA-1102 X-RAY SHOULDER WITH HUMERUS AP LEFT 550 688 743 825 825 680 XRA-680 XRA-1103 X-RAY SHOULDER WITH HUMERUS AP RIGHT 550 688 743 825 825 681 XRA-681 XRA-1104 X-RAY SHOULDER WITH HUMERUS AP/LAT RIGHT 1100 1375 1485 1650 1650 682 XRA-682 XRA-1105 X-RAY SHOULDER WITH HUMERUS LAT LEFT 550 688 743 825 825 683 XRA-683 XRA-1100 X-RAY SHOULDER Y VIEW BOTH 1100 1375 1485 1650 1650 684 XRA-684 XRA-1101 X-RAY SHOULDER Y VIEW LEFT 550 688 743 825 825 685 XRA-685 XRA-600 X-RAY SHOULDER Y VIEW RIGHT 550 688 743 825 825 686 XRA-686 XRA-601 X-RAY SI JOINT BOTH OBLIQUE 1100 1375 1485 1650 1650 687 XRA-687 16422 X-RAY SI JOINT LAT VIEW 550 688 743 825 825 688 XRA-688 XRA-602 X-RAY SI JOINT LEFT OBLIQUE 550 688 743 825 825 689 XRA-689 XRA-603 X-RAY SI JOINT PA VIEW 550 688 743 825 825 690 XRA-690 XRA-604 X-RAY SI JOINT RIGHT OBLIQUE 550 688 743 825 825 691 XRA-691 XRA-723 X-RAY SINOGRAM 4100 5125 5535 6150 6150

Any new service/tariff may be changed/added/deleted without prior notice. 64 Schedule of Charges 2019-20 ISIC

692 XRA-692 XRA-605 X-RAY SKULL ( LATERAL ) VIEW 550 688 743 825 825 693 XRA-693 XRA-606 X-RAY SKULL AP & LATERAL VIEWS 1100 1375 1485 1650 1650 694 XRA-694 XRA-607 X-RAY SKULL AP VIEW 550 688 743 825 825 695 XRA-695 XRA-608 X-RAY SKULL BASAL VIEW 550 688 743 825 825 696 XRA-696 14984 X-RAY SKULL COLD-WELL VIEW 550 688 743 825 825 697 XRA-697 XRA-609 X-RAY SKULL FACE LAT VIEW 550 688 743 825 825 698 XRA-698 XRA-610 X-RAY SKULL MASTOID LAT. OBLIQUE BOTH 1100 1375 1485 1650 1650 699 XRA-699 XRA-611 X-RAY SKULL MASTOID LAT. OBLIQUE LEFT 550 688 743 825 825 700 XRA-700 XRA-612 X-RAY SKULL MASTOID LAT. OBLIQUE RIGHT 550 688 743 825 825 701 XRA-701 XRA-613 X-RAY SKULL ORBIT AP 550 688 743 825 825 702 XRA-702 XRA-614 X-RAY SKULL ORBIT LAT RIGHT 550 688 743 825 825 703 XRA-703 XRA-615 X-RAY SKULL ORBIT LEFT 550 688 743 825 825 704 XRA-704 XRA-616 X-RAY SKULL ORBIT PA 550 688 743 825 825 705 XRA-705 XRA-617 X-RAY SKULL PA 550 688 743 825 825 706 XRA-706 XRA-618 X-RAY SKULL PA/LAT 1100 1375 1485 1650 1650 707 XRA-707 XRA-619 X-RAY SKULL PNS (WATERS VIEW) 550 688 743 825 825 708 XRA-708 XRA-620 X-RAY SKULL PNS AP 550 688 743 825 825 709 XRA-709 XRA-621 X-RAY SKULL PNS AP-LAT 1100 1375 1485 1650 1650 710 XRA-710 XRA-622 X-RAY SKULL PNS LAT 550 688 743 825 825 711 XRA-711 XRA-623 X-RAY SKULL SCHULLERS LAT OBLIQUE BOTH 1100 1375 1485 1650 1650 712 XRA-712 XRA-624 X-RAY SKULL SCHULLERS LAT OBLIQUE LEFT 550 688 743 825 825 713 XRA-713 XRA-625 X-RAY SKULL SCHULLERS LAT OBLIQUE RIGHT 550 688 743 825 825 714 XRA-714 XRA-626 X-RAY SKULL SELLA 550 688 743 825 825 715 XRA-715 XRA-627 X-RAY SKULL- STENVER'S VIEW ( FOR I.A.M) 550 688 743 825 825 716 XRA-716 14986 X-RAY SKULL STYLOID PROCESS 550 688 743 825 825 717 XRA-717 XRA-628 X-RAY SKULL TM JOINT AP 550 688 743 825 825 718 XRA-718 14985 X-RAY SKULL TM JOINT CLENCHED VIEW 550 688 743 825 825 719 XRA-719 XRA-629 X-RAY SKULL TM JOINT CLOSE MOUTH LEFT 550 688 743 825 825 720 XRA-720 XRA-630 X-RAY SKULL TM JOINT CLOSE MOUTH RIGHT 550 688 743 825 825 721 XRA-721 XRA-631 X-RAY SKULL TM JOINT OPEN AND CLOSE MOUTH BOTH 2200 2750 2970 3300 3300 722 XRA-722 XRA-632 X-RAY SKULL TM JOINT OPEN MOUTH BOTH 1100 1375 1485 1650 1650 723 XRA-723 XRA-633 X-RAY SKULL TM JOINT OPEN MOUTH LEFT 550 688 743 825 825

Any new service/tariff may be changed/added/deleted without prior notice. 65 Schedule of Charges 2019-20 ISIC

724 XRA-724 XRA-634 X-RAY SKULL TM JOINT OPEN MOUTH RIGHT 550 688 743 825 825 725 XRA-725 XRA-635 X-RAY SKULL TM JONIT CLOSE MOUTH BOTH 1100 1375 1485 1650 1650 726 XRA-726 XRA-636 X-RAY SKULL TOWNS VIEW 550 688 743 825 825 727 XRA-727 XRA-637 X-RAY SKULL ZYGOMATIC BONE 550 688 743 825 825 728 XRA-728 XRA-638 X-RAY STERNO CLAVICULAR JOINT AP VIEW 550 688 743 825 825 729 XRA-729 XRA-639 X-RAY STERNO CLAVICULAR JOINT PA VIEW 550 688 743 825 825 730 XRA-730 XRA-640 X-RAY STERNUM AP VIEW 550 688 743 825 825 731 XRA-731 XRA-641 X-RAY STERNUM AP/LAT VIEW 1100 1375 1485 1650 1650 732 XRA-732 XRA-642 X-RAY STERNUM LAT VIEW 550 688 743 825 825 733 XRA-733 XRA-643 X-RAY STRESS VIEW 550 688 743 825 825 734 XRA-734 XRA-644 X-RAY STRESS VIEW LEFT 550 688 743 825 825 735 XRA-735 XRA-724 X-RAY T TUBE CHOLEANGIOGRAM 4100 5125 5535 6150 6150 736 XRA-736 XRA-645 X-RAY THIGH AP & LATERAL 1100 1375 1485 1650 1650 737 XRA-737 XRA-646 X-RAY THIGH AP LEFT 550 688 743 825 825 738 XRA-738 XRA-647 X-RAY THIGH AP RIGHT 550 688 743 825 825 739 XRA-739 XRA-648 X-RAY THIGH LATERAL LEFT 550 688 743 825 825 740 XRA-740 XRA-649 X-RAY THIGH LATERAL RIGHT 550 688 743 825 825 741 XRA-741 XRA-650 X-RAY THIGH WITH KNEE JOINT APL/AT 1100 1375 1485 1650 1650 742 XRA-742 XRA-651 X-RAY THUMB AP LEFT 550 688 743 825 825 743 XRA-743 XRA-652 X-RAY THUMB AP RIGHT 550 688 743 825 825 744 XRA-744 XRA-653 X-RAY THUMB AP/LAT LEFT 550 688 743 825 825 745 XRA-745 XRA-654 X-RAY THUMB AP/LAT RIGHT 550 688 743 825 825 746 XRA-746 XRA-655 X-RAY THUMB AP/LAT/OBLIQUE LEFT 1100 1375 1485 1650 1650 747 XRA-747 XRA-656 X-RAY THUMB AP/LAT/OBLIQUE RIGHT 1100 1375 1485 1650 1650 748 XRA-748 XRA-657 X-RAY THUMB LAT LEFT 550 688 743 825 825 749 XRA-749 XRA-658 X-RAY THUMB LAT RIGHT 550 688 743 825 825 750 XRA-750 XRA-659 X-RAY THUMB OBLIQUE RIGHT 550 688 743 825 825 751 XRA-751 XRA-660 X-RAY TOE AP LEFT 550 688 743 825 825 752 XRA-752 XRA-661 X-RAY TOE AP RIGHT 550 688 743 825 825 753 XRA-753 XRA-662 X-RAY TOE AP/LAT LEFT 550 688 743 825 825 754 XRA-754 XRA-663 X-RAY TOE AP/LAT RIGHT 550 688 743 825 825 755 XRA-755 XRA-664 X-RAY TOE AP/LAT/OBLIQUE LEFT 1100 1375 1485 1650 1650

Any new service/tariff may be changed/added/deleted without prior notice. 66 Schedule of Charges 2019-20 ISIC

756 XRA-756 XRA-665 X-RAY TOE AP/LAT/OBLIQUE RIGHT 1100 1375 1485 1650 1650 757 XRA-757 XRA-666 X-RAY TOE AP/OBLIQUE LEFT 550 688 743 825 825 758 XRA-758 XRA-667 X-RAY TOE AP/OBLIQUE RIGHT 550 688 743 825 825 759 XRA-759 XRA-668 X-RAY TOE LAT LEFT 550 688 743 825 825 760 XRA-760 XRA-669 X-RAY TOE LAT RIGHT 550 688 743 825 825 761 XRA-761 XRA-670 X-RAY TOE OBLIQUE LEFT 550 688 743 825 825 762 XRA-762 XRA-671 X-RAY TOE OBLIQUE RIGHT 550 688 743 825 825 763 XRA-763 XRA-672 X-RAY WHOLE EXTERMITIES AP RIGHT (UPPER) 1100 1375 1485 1650 1650 764 XRA-764 XRA-673 X-RAY WHOLE EXTERMITIES LAT RIGHT (UPPER) 1100 1375 1485 1650 1650 765 XRA-765 XRA-674 X-RAY WHOLE LOWER EXTEREMITIES AP 1100 1375 1485 1650 1650 766 XRA-766 XRA-675 X-RAY WHOLE LOWER EXTEREMITIES AP/LAT 2200 2750 2970 3300 3300 767 XRA-767 XRA-676 X-RAY WHOLE LOWER EXTEREMITIES LAT 1100 1375 1485 1650 1650 768 XRA-768 XRA-677 X-RAY WHOLE SPINE AP 1650 2063 2228 2475 2475 769 XRA-769 1004 X-RAY WHOLE SPINE AP LAT. EXTENSION 3370 4213 4550 5055 5055 770 XRA-770 1003 X-RAY WHOLE SPINE AP LAT. FLEXION 3370 4213 4550 5055 5055 771 XRA-771 1002 X-RAY WHOLE SPINE AP LT. BENDING 1650 2063 2228 2475 2475 772 XRA-772 1001 X-RAY WHOLE SPINE AP RT. BENDING 1650 2063 2228 2475 2475 773 XRA-773 14970 X-RAY WHOLE SPINE AP SITTING 1650 2063 2228 2475 2475 774 XRA-774 XRA-678 X-RAY WHOLE SPINE AP/LAT 3370 4213 4550 5055 5055 775 XRA-775 14972 X-RAY WHOLE SPINE AP/LAT SITTING 3370 4213 4550 5055 5055 776 XRA-776 14735 X-RAY WHOLE SPINE FLEX/EXTN 3370 4213 4550 5055 5055 777 XRA-777 XRA-679 X-RAY WHOLE SPINE LAT 1650 2063 2228 2475 2475 778 XRA-778 14971 X-RAY WHOLE SPINE LAT SITTING 1650 2063 2228 2475 2475 779 XRA-779 14935 X-RAY WHOLE SPINE NEUTRAL VIEW 1650 2063 2228 2475 2475 780 XRA-780 XRA-680 X-RAY WRIST AP BOTH (SINGLE SHOOT) 550 688 743 825 825 781 XRA-781 XRA-681 X-RAY WRIST AP LEFT 550 688 743 825 825 782 XRA-782 XRA-682 X-RAY WRIST AP RIGHT 550 688 743 825 825 783 XRA-783 XRA-683 X-RAY WRIST AP ULNAR DEVIATION LEFT 550 688 743 825 825 784 XRA-784 XRA-684 X-RAY WRIST AP ULNAR DEVIATION RIGHT 550 688 743 825 825 785 XRA-785 XRA-685 X-RAY WRIST AP/LAT BOTH 1100 1375 1485 1650 1650 786 XRA-786 XRA-686 X-RAY WRIST AP/LAT LEFT 550 688 743 825 825 787 XRA-787 XRA-687 X-RAY WRIST AP/LAT RIGHT 550 688 743 825 825

Any new service/tariff may be changed/added/deleted without prior notice. 67 Schedule of Charges 2019-20 ISIC

788 XRA-788 XRA-688 X-RAY WRIST AP/LAT/OBLIQUE LEFT 1100 1375 1485 1650 1650 789 XRA-789 XRA-689 X-RAY WRIST AP/LAT/OBLIQUE RIGHT 1100 1375 1485 1650 1650 790 XRA-790 XRA-690 X-RAY WRIST AP/OBLIQUE LEFT 550 688 743 825 825 791 XRA-791 XRA-691 X-RAY WRIST AP/OBLIQUE RIGHT 550 688 743 825 825 792 XRA-792 XRA-692 X-RAY WRIST AXIAL VIEW LEFT 550 688 743 825 825 793 XRA-793 XRA-693 X-RAY WRIST AXIAL VIEW RIGHT 550 688 743 825 825 794 XRA-794 XRA-704 X-RAY WRIST LAT BOTH (SINGLE SHOOT) 550 688 743 825 825 795 XRA-795 XRA-694 X-RAY WRIST LAT BOTH 1100 1375 1485 1650 1650 796 XRA-796 XRA-695 X-RAY WRIST LAT LEFT 550 688 743 825 825 797 XRA-797 XRA-696 X-RAY WRIST LAT RIGHT 550 688 743 825 825 798 XRA-798 XRA-697 X-RAY WRIST OBLIQUE LEFT 550 688 743 825 825 799 XRA-799 XRA-698 X-RAY WRIST OBLIQUE RIGHT 550 688 743 825 825 XRA-800 14929 X-RAY WRIST PA RIGHT 550 688 743 825 825 XRA-801 14930 X-RAY WRIST PA/LAT LEFT 550 688 743 825 825 XRA-802 14789 X-RAY WRIST PA/LAT RIGHT 550 688 743 825 825 XRA-803 XRA-699 X-RAY WRIST SCAPHOID LEFT 550 688 743 825 825 XRA-804 XRA-700 X-RAY WRIST SCAPHOID RIGHT 550 688 743 825 825 XRA-805 XRA-701 X-RAY WRIST STRESS VIEW RIGHT 550 688 743 825 825 BONE DENSITOMETRY Shared Single Dlx/Super Super S.No. OLD CODE NEW CODE Investigation/Procedure OPD/GW Room/ICU/ Room Dlx / Suite Dlx. Suite HDU 1 BDA-1 BDA-7 BONE DENSITOMETRY (FIVE SITES) 11320 14150 15282 16980 16980 2 BDA-2 BDA-6 BONE DENSITOMETRY (FOUR SITES) 9320 11650 12582 13980 13980 3 BDA-3 BDA-1 BONE DENSITOMETRY (SINGLE SITE) 3650 4563 4928 5475 5475 4 BDA-4 BDA-8 BONE DENSITOMETRY (SIX SITES) 13310 16638 17969 19965 19965 5 BDA-5 BDA-2 BONE DENSITOMETRY (WHOLE BODY) 7330 9163 9896 10995 10995 6 BDA-6 BDA-3 BONE DENSITOMETRY(DOUBLE SITE) 5320 6650 7182 7980 7980 7 BDA-7 BDA-4 BONE DENSITOMETRY(THREE SITES) 7330 9163 9896 10995 10995 8 BDA-8 BDA-5 BONE SCAN WHOLE BODY 8700 10875 11745 13050 13050 ULTRASOUND 1 USG-01 USG-1 REPOSITION OF CATHETERS (RADIO) 1700 2125 2295 2550 2550 ULTRASOUND GUIDED DIAGNOSTIC NEEDLE TAP 2 USG-02 USG-2 4000 5000 5400 6000 6000 (RADIO)

Any new service/tariff may be changed/added/deleted without prior notice. 68 Schedule of Charges 2019-20 ISIC

ULTRASOUND GUIDED THERAPEUTIC NEEDLE TAP 3 USG-03 USG-3 6500 8125 8775 9750 9750 (RADIO) ULTRASOUND GUIDED THERAPEUTICCATHETER 4 USG-04 USG-4 10630 13288 14351 15945 15945 DRAINAGE INCLUDING PNC/PTB (RADIO) 5 USG-05 USG-700 ULTRASOUND TRUS 2500 3125 3375 3750 3750 6 USG-06 USG-5 USG ABDOMEN (WITHOUT FILM) 550 688 743 825 825 7 USG-07 USG-6 USG AORTIC DOPLLER 3800 4750 5130 5700 5700 8 USG-08 USG-7 USG AORTO-ILIAC DOPPLER 3800 4750 5130 5700 5700 9 USG-09 USG-8 USG BILATERAL JOINTS 3800 4750 5130 5700 5700 10 USG-10 USG-9 USG BIOPHYSICAL PROFILE 2300 2875 3105 3450 3450 11 USG-11 USG-10 USG BOTH CHEST (BEDSIDE) 2000 2500 2700 3000 3000 12 USG-12 USG-11 USG BOTH CHEST 1045 1306 1411 1568 1568 13 USG-13 USG-12 USG BOTH CHEST EMGNCY 2000 2500 2700 3000 3000 14 USG-14 USG-13 USG BREAST 1700 2125 2295 2550 2550 15 USG-15 USG-14 USG CAROTID DOPLLER 3800 4750 5130 5700 5700 16 USG-16 USG-17 USG CHEST 700 875 945 1050 1050 17 USG-17 USG-18 USG COLOR DOPPLER THYROID 2700 3375 3645 4050 4050 18 USG-18 USG-19 USG COLOR DOPPLER U/A 3500 4375 4725 5250 5250 USG COLOUR DOPPLER ARTERIAL/VENOUS RT/LT 19 USG-19 USG-67 4400 5500 5940 6600 6600 LOWER LIMB 20 USG-20 USG-15 USG COLOUR DOPPLER BOTH LIMBS ARTERIAL 4400 5500 5940 6600 6600 21 USG-21 USG-66 USG COLOUR DOPPLER BOTH LIMBS VENOUS 4400 5500 5940 6600 6600 22 USG-22 14915 USG COLOUR DOPPLER LIMBS (EMERGENCY) 7000 8750 9450 10500 10500 23 USG-23 USG-16 USG COLOUR DOPPLER LOWER LIMBS ART & VENOUS 6000 7500 8100 9000 9000 24 USG-24 USG-20 USG CR UPPER LIMB ART & VENOUS 4000 5000 5400 6000 6000 25 USG-25 USG-21 USG CRANIAL 1400 1750 1890 2100 2100 26 USG-26 USG-22 USG EXTREMITIES ARTERIAL DOPPLER (SINGLE) 2700 3375 3645 4050 4050 27 USG-27 USG-23 USG FOETAL DOPPLER 2500 3125 3375 3750 3750 28 USG-28 USG-24 USG FOLLICLE STUDY 2500 3125 3375 3750 3750 29 USG-29 USG-25 USG GALL BLADDER 800 1000 1080 1200 1200 30 USG-30 USG-26 USG GUIDED ASPIRATION 1700 2125 2295 2550 2550 31 USG-31 USG-27 USG GUIDED FNAC 2500 3125 3375 3750 3750 32 USG-32 USG-28 USG KUB (BED SIDE) 2000 2500 2700 3000 3000 33 USG-33 USG-29 USG KUB 1100 1375 1485 1650 1650

Any new service/tariff may be changed/added/deleted without prior notice. 69 Schedule of Charges 2019-20 ISIC

34 USG-34 USG-30 USG KUB EMGNCY 2000 2500 2700 3000 3000 35 USG-35 USG-31 USG KUB WITH PVR 1600 2000 2160 2400 2400 36 USG-36 USG-32 USG LEVEL II 2100 2625 2835 3150 3150 37 USG-37 USG-33 USG LOWER ABDOMEN (BEDSIDE) 2500 3125 3375 3750 3750 38 USG-38 USG-34 USG LOWER ABDOMEN 1600 2000 2160 2400 2400 39 USG-39 USG-35 USG LOWER ABDOMEN EMGNCY 10PM-7AM 2500 3125 3375 3750 3750 40 USG-40 USG-36 USG MUSCULO SKELETAL SCREENING (FOUR JOINTS) 3800 4750 5130 5700 5700 41 USG-41 USG-37 USG MUSCULO SKELETAL SCREENING (SINGLE JOINT) 1300 1625 1755 1950 1950 42 USG-42 USG-38 USG MUSCULO SKELETAL SCREENING (TWO JOINTS) 2600 3250 3510 3900 3900 43 USG-43 USG-39 USG NECK 1400 1750 1890 2100 2100 44 USG-44 USG-40 USG OBSTETRIC (BEDSIDE) 2500 3125 3375 3750 3750 45 USG-45 USG-41 USG OBSTETRIC 1400 1750 1890 2100 2100 46 USG-46 USG-42 USG OBSTETRIC EMGNCY 2500 3125 3375 3750 3750 47 USG-47 USG-44 USG OF HAND JOINTS FOR SINOBITS AND EROSIONS 2600 3250 3510 3900 3900 48 USG-48 USG-45 USG PELVIS 1400 1750 1890 2100 2100 49 USG-49 USG-46 USG PENILE DOPPLER 4900 6125 6615 7350 7350 50 USG-50 USG-47 USG PROSTATIC BIOPSY (TRUS GUIDED) 3800 4750 5130 5700 5700 51 USG-51 USG-48 USG PVR 800 1000 1080 1200 1200 52 USG-52 USG-49 USG RENAL DOPPLER 4400 5500 5940 6600 6600 53 USG-53 USG-50 USG RENAL GRAFT DOPPLER 4400 5500 5940 6600 6600 54 USG-54 USG-51 USG SCREENING 650 813 878 975 975 55 USG-55 USG-52 USG SCROTAL DOPPLER 2600 3250 3510 3900 3900 56 USG-56 USG-53 USG SCROTUM 1400 1750 1890 2100 2100 57 USG-57 USG-54 USG SINGLE JOINTS 2500 3125 3375 3750 3750 58 USG-58 USG-55 USG SMALL PART 1600 2000 2160 2400 2400 59 USG-59 USG-56 USG SPLANCHNIC DOPPLER 3800 4750 5130 5700 5700 60 USG-60 USG-57 USG THYROID 1500 1875 2025 2250 2250 61 USG-61 USG-58 USG TRANSRECTAL 2000 2500 2700 3000 3000 62 USG-62 USG-59 USG TRANS-VAGINAL 1800 2250 2430 2700 2700 63 USG-63 USG-60 USG UPPER ABDOMEN (BEDSIDE) 2600 3250 3510 3900 3900 64 USG-64 USG-62 USG UPPER ABDOMEN (EMERGENCY) 2600 3250 3510 3900 3900 65 USG-65 USG-61 USG UPPER ABDOMEN 1300 1625 1755 1950 1950

Any new service/tariff may be changed/added/deleted without prior notice. 70 Schedule of Charges 2019-20 ISIC

66 USG-66 USG-63 USG WHOLE ABDOMEN (BEDSIDE) 4000 5000 5400 6000 6000 67 USG-67 USG-65 USG WHOLE ABDOMEN (EMERGENCY ) 4000 5000 5400 6000 6000 68 USG-68 USG-64 USG WHOLE ABDOMEN 1800 2250 2430 2700 2700 MRI Shared Single Dlx/Super Super S.No. OLD CODE NEW CODE Investigation/Procedure OPD/GW Room/ICU/ Room Dlx / Suite Dlx. Suite HDU 1 MRI-01 MRI-1 ANAESTHESIA FOR MRI 2400 3000 3240 3600 3600 2 MRI-02 MRI-2 CD FOR MRI 350 438 473 525 525 6 MRI-06 14489 IAC PROTOCOL 5000 6250 6750 7500 7500 7 MRI-07 MRI-3 MRA BRAIN ANGIO SCREENING 5000 6250 6750 7500 7500 8 MRI-08 MRI-4 MRA NECK 9000 11250 12150 13500 13500 9 MRI-09 MRI-5 MRA NECK ANGIO SCREENING 5000 6250 6750 7500 7500 10 MRI-10 MRI-6 MRCP 9000 11250 12150 13500 13500 MRI (CERVICAL-DORSAL SPINE FLEX & EXTN) 11 MRI-11 MRI-501 6500 8125 8775 9750 9750 SCREENING 12 MRI-12 MRI-502 MRI (DORSAL SPINE FLEX & EXTN) SCREENING 6500 8125 8775 9750 9750 13 MRI-13 MRI-503 MRI (DORSO-LUMBAR SPINE FLEX & EXTN) SCREENING 6500 8125 8775 9750 9750 14 MRI-14 MRI-1000 MRI (LT ARM) SCREENING 5000 6250 6750 7500 7500 15 MRI-15 MRI-999 MRI (RT ARM) SCREENING 5000 6250 6750 7500 7500 16 MRI-16 MRI-7 MRI ABDOMEN AORTA ANGIO 20930 26163 28256 31395 31395 17 MRI-17 MRI-8 MRI ABDOMEN FOR KUB 9000 11250 12150 13500 13500 18 MRI-18 MRI-9 MRI ABDOMEN FOR KUB EXTENDED SCREENING 3900 4875 5265 5850 5850 19 MRI-19 MRI-10 MRI ABDOMEN FOR KUB SCREENING 5000 6250 6750 7500 7500 20 MRI-20 MRI-11 MRI ABDOMEN FOR KUB WITH CONTRAST 14000 17500 18900 21000 21000 21 MRI-21 MRI-12 MRI ANGIOGRAPHY-BRAIN 9000 11250 12150 13500 13500 22 MRI-22 MRI-13 MRI ANGIOGRAPHY-NECK 9000 11250 12150 13500 13500 23 MRI-23 MRI-14 MRI ANKLE JOINT 9000 11250 12150 13500 13500 24 MRI-24 MRI-384 MRI ANKLE LEFT 9000 11250 12150 13500 13500 25 MRI-25 MRI-15 MRI ANKLE LEFT EXTENDED SCREENING 5000 6250 6750 7500 7500 26 MRI-26 MRI-16 MRI ANKLE LEFT SCREENING 5000 6250 6750 7500 7500 27 MRI-27 MRI-17 MRI ANKLE LEFT WITH CONTRAST 14000 17500 18900 21000 21000 28 MRI-28 MRI-18 MRI ANKLE RIGHT 9000 11250 12150 13500 13500 29 MRI-29 MRI-19 MRI ANKLE RIGHT EXTENDED SCREENING 3900 4875 5265 5850 5850

Any new service/tariff may be changed/added/deleted without prior notice. 71 Schedule of Charges 2019-20 ISIC

30 MRI-30 MRI-20 MRI ANKLE RIGHT SCREENING 5000 6250 6750 7500 7500 31 MRI-31 MRI-21 MRI ANKLE WITH FOOT LEFT 9000 11250 12150 13500 13500 32 MRI-32 MRI-22 MRI ANKLE WITH FOOT LEFT EXTENDED SCREENING 3900 4875 5265 5850 5850 33 MRI-33 MRI-23 MRI ANKLE WITH FOOT LEFT SCREENING 5000 6250 6750 7500 7500 34 MRI-34 MRI-24 MRI ANKLE WITH FOOT LEFT WITH CONTRAST 14000 17500 18900 21000 21000 35 MRI-35 MRI-25 MRI ANKLE WITH FOOT RIGHT 9000 11250 12150 13500 13500 36 MRI-36 MRI-26 MRI ANKLE WITH FOOT RIGHT EXTENDED SCREENING 3900 4875 5265 5850 5850 37 MRI-37 MRI-27 MRI ANKLE WITH FOOT RIGHT SCREENING 5000 6250 6750 7500 7500 38 MRI-38 MRI-28 MRI ANKLE WITH FOOT RIGHT WITH CONTRAST 14000 17500 18900 21000 21000 39 MRI-39 MRI-29 MRI ARM (LEFT) 9000 11250 12150 13500 13500 40 MRI-40 MRI-30 MRI ARM (RIGHT) 9000 11250 12150 13500 13500 41 MRI-41 MRI-31 MRI BRACHIAL PLEXUS 9000 11250 12150 13500 13500 42 MRI-42 MRI-32 MRI BRACHIAL PLEXUS EXTENDED SCREENING 3900 4875 5265 5850 5850 43 MRI-43 MRI-33 MRI BRACHIAL PLEXUS SCREENING 5000 6250 6750 7500 7500 44 MRI-44 MRI-34 MRI BRACHIAL PLEXUS WITH CONTRAST 14000 17500 18900 21000 21000 45 MRI-45 MRI-35 MRI BRAIN & ORBITS WITH CONTRAST 19000 23750 25650 28500 28500 46 MRI-46 MRI-36 MRI BRAIN + MRI ANGIOGRAPHY 14000 17500 18900 21000 21000 47 MRI-47 MRI-37 MRI BRAIN + VENOGRAPHY 14000 17500 18900 21000 21000 48 MRI-48 MRI-38 MRI BRAIN 9000 11250 12150 13500 13500 49 MRI-49 MRI-39 MRI BRAIN ANGIO 9000 11250 12150 13500 13500 50 MRI-50 MRI-40 MRI BRAIN ANGIO WITH NECK ANGIO 10000 12500 13500 15000 15000 51 MRI-51 MRI-41 MRI BRAIN DWI WITH CONTRAST 18000 22500 24300 27000 27000 52 MRI-52 MRI-42 MRI BRAIN EXTENDED SCREENING 3900 4875 5265 5850 5850 53 MRI-53 MRI-43 MRI BRAIN SCREENING 5000 6250 6750 7500 7500 54 MRI-54 MRI-44 MRI BRAIN SCREENING WITH ANGIO 9000 11250 12150 13500 13500 55 MRI-55 MRI-45 MRI BRAIN SCREENING WITH CONTRAST 9000 11250 12150 13500 13500 56 MRI-56 MRI-46 MRI BRAIN VENOGRAM SCREENING ONLY 5000 6250 6750 7500 7500 57 MRI-57 MRI-47 MRI BRAIN VENOGRAPHY 9000 11250 12150 13500 13500 58 MRI-58 MRI-48 MRI BRAIN WITH ANGIO WITH NECK ANGIOGRAM 19000 23750 25650 28500 28500 59 MRI-59 MRI-49 MRI BRAIN WITH ANGIOGRAM 14000 17500 18900 21000 21000 60 MRI-60 MRI-500 MRI BRAIN WITH BOTH MASTOID 14000 17500 18900 21000 21000 61 MRI-61 MRI-51 MRI BRAIN WITH BOTH MASTOID WITH CONTRAST 19000 23750 25650 28500 28500

Any new service/tariff may be changed/added/deleted without prior notice. 72 Schedule of Charges 2019-20 ISIC

62 MRI-62 MRI-52 MRI BRAIN WITH BOTH TM JOINTS 14000 17500 18900 21000 21000 63 MRI-63 MRI-53 MRI BRAIN WITH BOTH TM JOINTS WITH CONTRAST 19000 23750 25650 28500 28500 64 MRI-64 MRI-54 MRI BRAIN WITH CONTRAST 14000 17500 18900 21000 21000 65 MRI-65 MRI-55 MRI BRAIN WITH CSF FLOW STUDY 14000 17500 18900 21000 21000 66 MRI-66 MRI-56 MRI BRAIN WITH CV JUNCTION 14000 17500 18900 21000 21000 67 MRI-67 MRI-57 MRI BRAIN WITH CV JUNCTION WITH CONTRAST 19000 23750 25650 28500 28500 68 MRI-68 MRI-59 MRI BRAIN WITH DWI SCREENING 9000 11250 12150 13500 13500 69 MRI-69 MRI-60 MRI BRAIN WITH DWI WITH ANGIO / BRAIN 18000 22500 24300 27000 27000 70 MRI-70 MRI-61 MRI BRAIN WITH DWI WITH CONTRAST 18000 22500 24300 27000 27000 71 MRI-71 MRI-62 MRI BRAIN WITH DWI WITH SPECTROSCOPY 18000 22500 24300 27000 27000 72 MRI-72 MRI-63 MRI BRAIN WITH EPILEPSY PROTOCOL 14000 17500 18900 21000 21000 73 MRI-73 MRI-64 MRI BRAIN WITH EPILEPSY PROTOCOL WITH CONTRAST 19000 23750 25650 28500 28500 74 MRI-74 MRI-65 MRI BRAIN WITH FACE 14000 17500 18900 21000 21000 75 MRI-75 MRI-660 MRI BRAIN WITH FACE WITH CONTRAST 19000 23750 25650 28500 28500 76 MRI-76 MRI-67 MRI BRAIN WITH IAC PROTOCOL 14000 17500 18900 21000 21000 77 MRI-77 MRI-680 MRI BRAIN WITH LEFT MASTOID 14000 17500 18900 21000 21000 78 MRI-78 MRI-690 MRI BRAIN WITH LEFT MASTOID WITH CONTRAST 19000 23750 25650 28500 28500 79 MRI-79 MRI-700 MRI BRAIN WITH LEFT TM JOINT 14000 17500 18900 21000 21000 80 MRI-80 MRI-710 MRI BRAIN WITH LEFT TM JOINT WITH CONTRAST 19000 23750 25650 28500 28500 81 MRI-81 MRI-720 MRI BRAIN WITH MANDIBLE 14000 17500 18900 21000 21000 82 MRI-82 MRI-730 MRI BRAIN WITH MANDIBLE WITH CONTRAST 19000 23750 25650 28500 28500 83 MRI-83 MRI-74 MRI BRAIN WITH ORBIT 14000 17500 18900 21000 21000 84 MRI-84 MRI-750 MRI BRAIN WITH PITUITARY FOSSA WITH CONTRAST 19000 23750 25650 28500 28500 85 MRI-85 MRI-760 MRI BRAIN WITH PNS 14000 17500 18900 21000 21000 86 MRI-86 MRI-770 MRI BRAIN WITH PNS WITH CONTRAST 19000 23750 25650 28500 28500 87 MRI-87 MRI-78 MRI BRAIN WITH RIGHT MASTOID 14000 17500 18900 21000 21000 88 MRI-88 MRI-790 MRI BRAIN WITH RIGHT MASTOID WITH CONTRAST 19000 23750 25650 28500 28500 89 MRI-89 MRI-80 MRI BRAIN WITH RIGHT TM JOINT WITH CONTRAST 19000 23750 25650 28500 28500 90 MRI-90 MRI-81 MRI BRAIN WITH RIGHT TM JOINTS 14000 17500 18900 21000 21000 91 MRI-91 MRI-82 MRI BRAIN WITH SELLA 14000 17500 18900 21000 21000 92 MRI-92 MRI-83 MRI BRAIN WITH SELLA WITH CONTRAST 19000 23750 25650 28500 28500 93 MRI-93 MRI-84 MRI BRAIN WITH SPECTROSCOPY 14000 17500 18900 21000 21000

Any new service/tariff may be changed/added/deleted without prior notice. 73 Schedule of Charges 2019-20 ISIC

94 MRI-94 MRI-85 MRI BRAIN WITH SPECTROSCOPY WITH CONTRAST 19000 23750 25650 28500 28500 95 MRI-95 MRI-86 MRI CERVICAL SPINE & BRACHIAL PLEXUS 14000 17500 18900 21000 21000 96 MRI-96 MRI-87 MRI CERVICAL SPINE & C.V. JUNCTION 14000 17500 18900 21000 21000 97 MRI-97 14916 MRI CERVICAL SPINE (FLEX & EXTENSION) SCREENING 6500 8125 8775 9750 9750 98 MRI-98 MRI-89 MRI CERVICAL SPINE 9000 11250 12150 13500 13500 99 MRI-99 MRI-90 MRI CERVICAL SPINE EXTENDED SCREENING 3900 4875 5265 5850 5850 100 MRI-100 MRI-91 MRI CERVICAL SPINE SCREENING 5000 6250 6750 7500 7500 MRI CERVICAL SPINE WITH BRACHIAL PLEXUS WITH 101 MRI-101 MRI-92 19000 23750 25650 28500 28500 CONTRAST 102 MRI-102 MRI-93 MRI CERVICAL SPINE WITH CONTRAST 14000 17500 18900 21000 21000 MRI CERVICAL SPINE WITH CV JUNCTION WITH 103 MRI-103 MRI-94 19000 23750 25650 28500 28500 CONTRAST 104 MRI-104 MRI-95 MRI CERVICO DORSAL SPINE EXTENDED SCREENING 3900 4875 5265 5850 5850 105 MRI-105 MRI-96 MRI CERVICO DORSAL SPINE SCREENING 5000 6250 6750 7500 7500 106 MRI-106 MRI-97 MRI CERVICO DORSAL SPINE WITH CONTRAST 14000 17500 18900 21000 21000 107 MRI-107 MRI-98 MRI CERVICO-DORSAL SPINE 9000 11250 12150 13500 13500 108 MRI-108 MRI-419 MRI CERVICO-DORSAL SPINE FLEX & EXTN 6500 8125 8775 9750 9750 109 MRI-109 MRI-99 MRI CHEST 9000 11250 12150 13500 13500 110 MRI-110 MRI-100 MRI CHEST EXTENDED SCREENING 3900 4875 5265 5850 5850 111 MRI-111 MRI-101 MRI CHEST FOR RIBS 9000 11250 12150 13500 13500 112 MRI-112 MRI-102 MRI CHEST FOR RIBS WITH CONTRAST 14000 17500 18900 21000 21000 113 MRI-113 MRI-103 MRI CHEST SCREENING 4900 6125 6615 7350 7350 114 MRI-114 MRI-104 MRI CHEST WITH CONTRAST 14000 17500 18900 21000 21000 115 MRI-115 MRI-105 MRI CISTENROGRAPHY 9000 11250 12150 13500 13500 116 MRI-116 MRI-106 MRI CISTENROGRAPHY WITH CONTRAST 14000 17500 18900 21000 21000 117 MRI-117 MRI-107 MRI CONTRAST 5000 6250 6750 7500 7500 118 MRI-118 MRI-108 MRI CONTRAST FOR ANGIO PERIPHERAL 17710 22138 23909 26565 26565 119 MRI-119 MRI-109 MRI CONTRAST FOR ANGIO RENAL 11240 14050 15174 16860 16860 120 MRI-120 MRI-110 MRI CV JUNCTION EXTENDED SCREENING 3900 4875 5265 5850 5850 121 MRI-121 MRI-111 MRI CV JUNCTION ONLY 9000 11250 12150 13500 13500 122 MRI-122 MRI-112 MRI CV JUNCTION SCREENING 5000 6250 6750 7500 7500 123 MRI-123 MRI-113 MRI CV JUNCTION WITH CONTRAST 14000 17500 18900 21000 21000 124 MRI-124 MRI-114 MRI DORSAL SPINE 9000 11250 12150 13500 13500

Any new service/tariff may be changed/added/deleted without prior notice. 74 Schedule of Charges 2019-20 ISIC

125 MRI-125 MRI-115 MRI DORSAL SPINE EXTENDED SCREENING 3900 4875 5265 5850 5850 126 MRI-126 MRI-116 MRI DORSAL SPINE SCREENING 5000 6250 6750 7500 7500 127 MRI-127 MRI-117 MRI DORSAL SPINE WITH CONTRAST 14000 17500 18900 21000 21000 128 MRI-128 MRI-118 MRI DORSO-LUMBAR SPINE 9000 11250 12150 13500 13500 129 MRI-129 MRI-4181 MRI DORSO-LUMBAR SPINE FLEX & EXTN 6500 8125 8775 9750 9750 130 MRI-130 MRI-119 MRI DORSO-LUMBAR SPINE SCREENING 5000 6250 6750 7500 7500 131 MRI-131 MRI-120 MRI DORSO-LUMBAR SPINE WITH CONTRAST 14000 17500 18900 21000 21000 132 MRI-132 MRI-121 MRI DWI ONLY 4000 5000 5400 6000 6000 133 MRI-133 MRI-122 MRI ELBOW EXTENDED SCREENING LEFT 3900 4875 5265 5850 5850 134 MRI-134 MRI-123 MRI ELBOW EXTENDED SCREENING RIGHT 3900 4875 5265 5850 5850 135 MRI-135 MRI-124 MRI ELBOW LEFT 9000 11250 12150 13500 13500 136 MRI-136 MRI-125 MRI ELBOW RIGHT 9000 11250 12150 13500 13500 137 MRI-137 MRI-126 MRI ELBOW SCREENING LEFT 5000 6250 6750 7500 7500 138 MRI-138 MRI-127 MRI ELBOW SCREENING RIGHT 5000 6250 6750 7500 7500 139 MRI-139 MRI-128 MRI ELBOW WITH CONTRAST LEFT 14000 17500 18900 21000 21000 140 MRI-140 MRI-129 MRI ELBOW WITH CONTRAST RIGHT 14000 17500 18900 21000 21000 MRI ELBOW WITH FOREARM EXTENDED SCREENING 141 MRI-141 MRI-130 3900 4875 5265 5850 5850 LEFT MRI ELBOW WITH FOREARM EXTENDED SCREENING 142 MRI-142 MRI-131 3900 4875 5265 5850 5850 RIGHT 143 MRI-143 MRI-132 MRI ELBOW WITH FOREARM LEFT 9000 11250 12150 13500 13500 144 MRI-144 MRI-133 MRI ELBOW WITH FOREARM RIGHT 9000 11250 12150 13500 13500 145 MRI-145 MRI-134 MRI ELBOW WITH FOREARM SCREENING LEFT 5000 6250 6750 7500 7500 146 MRI-146 MRI-135 MRI ELBOW WITH FOREARM SCREENING RIGHT 5000 6250 6750 7500 7500 147 MRI-147 MRI-136 MRI ELBOW WITH FOREARM WITH CONTRAST LEFT 14000 17500 18900 21000 21000 148 MRI-148 MRI-137 MRI ELBOW WITH FOREARM WITH CONTRAST RIGHT 14000 17500 18900 21000 21000 MRI ELBOW WITH UPPER ARM EXTENDED SCREENING 149 MRI-149 MRI-138 3900 4875 5265 5850 5850 LEFT MRI ELBOW WITH UPPER ARM EXTENDED SCREENING 150 MRI-150 MRI-139 3900 4875 5265 5850 5850 RIGHT 151 MRI-151 MRI-140 MRI ELBOW WITH UPPER ARM LEFT 9000 11250 12150 13500 13500 152 MRI-152 MRI-141 MRI ELBOW WITH UPPER ARM RIGHT 9000 11250 12150 13500 13500 153 MRI-153 MRI-142 MRI ELBOW WITH UPPER ARM SCREENING LEFT 5000 6250 6750 7500 7500 154 MRI-154 MRI-143 MRI ELBOW WITH UPPER ARM SCREENING RIGHT 5000 6250 6750 7500 7500

Any new service/tariff may be changed/added/deleted without prior notice. 75 Schedule of Charges 2019-20 ISIC

155 MRI-155 MRI-144 MRI ELBOW WITH UPPER ARM WITH CONTRAST LEFT 14000 17500 18900 21000 21000 156 MRI-156 MRI-145 MRI ELBOW WITH UPPER ARM WITH CONTRAST RIGHT 14000 17500 18900 21000 21000 157 MRI-157 MRI-146 MRI EPILEPSY PROTOCOL 5000 6250 6750 7500 7500 158 MRI-158 MRI-147 MRI EXTENDED SCREENING 3900 4875 5265 5850 5850 159 MRI-159 MRI-148 MRI EXTRA FILM (ONE FILM) 400 500 540 600 600 160 MRI-160 MRI-151 MRI FACE 9000 11250 12150 13500 13500 161 MRI-161 MRI-152 MRI FACE WITH CONTRAST 14000 17500 18900 21000 21000 162 MRI-162 MRI-153 MRI FINGER EXTENDED SCREENING LEFT 3900 4875 5265 5850 5850 163 MRI-163 MRI-154 MRI FINGER EXTENDED SCREENING RIGHT 3900 4875 5265 5850 5850 164 MRI-164 MRI-155 MRI FINGER LEFT 9000 11250 12150 13500 13500 165 MRI-165 MRI-156 MRI FINGER RIGHT 9000 11250 12150 13500 13500 166 MRI-166 MRI-157 MRI FINGER SCREENING LEFT 5000 6250 6750 7500 7500 167 MRI-167 MRI-158 MRI FINGER SCREENING RIGHT 5000 6250 6750 7500 7500 168 MRI-168 MRI-159 MRI FINGER WITH CONTRAST LEFT 14000 17500 18900 21000 21000 169 MRI-169 MRI-160 MRI FINGER WITH CONTRAST RIGHT 15000 18750 20250 22500 22500 170 MRI-170 MRI-161 MRI FISTOLOGRAM 9000 11250 12150 13500 13500 171 MRI-171 MRI-162 MRI FOOT LEFT 9000 11250 12150 13500 13500 172 MRI-172 MRI-163 MRI FOOT LEFT EXTENDED SCREENING 3900 4875 5265 5850 5850 173 MRI-173 MRI-164 MRI FOOT LEFT SCREENING 5000 6250 6750 7500 7500 174 MRI-174 MRI-165. MRI FOOT LEFT WITH CONTRAST 14000 17500 18900 21000 21000 175 MRI-175 MRI-166 MRI FOOT RIGHT 9000 11250 12150 13500 13500 176 MRI-176 MRI-167 MRI FOOT RIGHT EXTENDED SCREENING 3900 4875 5265 5850 5850 177 MRI-177 MRI-168 MRI FOOT RIGHT SCREENING 5000 6250 6750 7500 7500 178 MRI-178 MRI-169 MRI FOOT RIGHT WITH CONTRAST 14000 17500 18900 21000 21000 179 MRI-179 MRI-170 MRI FOREARM EXTENDED SCREENING RIGHT 3900 4875 5265 5850 5850 180 MRI-180 MRI-171 MRI FOREARM EXTRENDED SCREENING LEFT 3900 4875 5265 5850 5850 181 MRI-181 MRI-172 MRI FOREARM LEFT 9000 11250 12150 13500 13500 182 MRI-182 MRI-173 MRI FOREARM RIGHT 9000 11250 12150 13500 13500 183 MRI-183 MRI-174 MRI FOREARM SCREENING LEFT 5000 6250 6750 7500 7500 184 MRI-184 MRI-175 MRI FOREARM SCREENING RIGHT 5000 6250 6750 7500 7500 185 MRI-185 MRI-176 MRI FOREARM WITH CONTRAST LEFT 14000 17500 18900 21000 21000 186 MRI-186 MRI-177 MRI FOREARM WITH CONTRAST RIGHT 14000 17500 18900 21000 21000

Any new service/tariff may be changed/added/deleted without prior notice. 76 Schedule of Charges 2019-20 ISIC

MRI FOREARM WITH WRIST EXTENDED SCREENING 187 MRI-187 MRI-0178 3900 4875 5265 5850 5850 LEFT MRI FOREARM WITH WRIST EXTENDED SCREENING 188 MRI-188 MRI-179 3900 4875 5265 5850 5850 RIGHT 189 MRI-189 MRI-180 MRI FOREARM WITH WRIST LEFT 9000 11250 12150 13500 13500 190 MRI-190 MRI-181 MRI FOREARM WITH WRIST RIGHT 9000 11250 12150 13500 13500 191 MRI-191 MRI-182 MRI FOREARM WITH WRIST SCREENING LEFT 5000 6250 6750 7500 7500 192 MRI-192 MRI-183 MRI FOREARM WITH WRIST SCREENING RIGHT 5000 6250 6750 7500 7500 193 MRI-193 MRI-184 MRI FOREARM WITH WRIST WITH CONTRAST LEFT 14000 17500 18900 21000 21000 194 MRI-194 MRI-185 MRI FOREARM WITH WRIST WITH CONTRAST RIGHT 14000 17500 18900 21000 21000 195 MRI-195 MRI-186 MRI FOREARM WRIST RIGHT 9000 11250 12150 13500 13500 196 MRI-196 MRI-187 MRI FOREARM WRIST WITH CONTRAST RIGHT 14000 17500 18900 21000 21000 197 MRI-197 MRI-188 MRI HAND EXTENDED SCREENING LEFT 3900 4875 5265 5850 5850 198 MRI-198 MRI-189 MRI HAND EXTENDED SCREENING RIGHT 3900 4875 5265 5850 5850 199 MRI-199 MRI-190 MRI HAND LEFT 9000 11250 12150 13500 13500 200 MRI-200 MRI-191 MRI HAND RIGHT 9000 11250 12150 13500 13500 201 MRI-201 MRI-192 MRI HAND SCREENING LEFT 5000 6250 6750 7500 7500 202 MRI-202 MRI-193 MRI HAND SCREENING RIGHT 5000 6250 6750 7500 7500 203 MRI-203 MRI-194 MRI HAND WITH CONTRAST LEFT 14000 17500 18900 21000 21000 204 MRI-204 MRI-195 MRI HAND WITH CONTRAST RIGHT 14000 17500 18900 21000 21000 205 MRI-205 MRI-387 MRI HEEL (LEFT) 9000 11250 12150 13500 13500 206 MRI-206 MRI-388 MRI HEEL (right) 9000 11250 12150 13500 13500 207 MRI-207 MRI-196 MRI HIP BOTH EXTENDED SCREENING 3900 4875 5265 5850 5850 208 MRI-208 MRI-197 MRI HIP BOTH SCREENING 6600 8250 8910 9900 9900 209 MRI-209 MRI-198 MRI HIP BOTH WITH CONTRAST 14000 17500 18900 21000 21000 210 MRI-210 MRI-199 MRI HIP JOINTS 9000 11250 12150 13500 13500 211 MRI-211 MRI-200 MRI HIP WITH THIGH LEFT 9000 11250 12150 13500 13500 212 MRI-212 MRI-201 MRI HIP WITH THIGH LEFT EXTENDED SCREENING 3900 4875 5265 5850 5850 213 MRI-213 MRI-202 MRI HIP WITH THIGH LEFT SCREENING 6600 8250 8910 9900 9900 214 MRI-214 MRI-203 MRI HIP WITH THIGH LEFT WITH CONTRAST 14000 17500 18900 21000 21000 215 MRI-215 MRI-204 MRI HIP WITH THIGH RIGHT 9000 11250 12150 13500 13500 216 MRI-216 MRI-205 MRI HIP WITH THIGH RIGHT EXTENDED SCREENING 3900 4875 5265 5850 5850 217 MRI-217 MRI-0206 MRI HIP WITH THIGH RIGHT SCREENING 6600 8250 8910 9900 9900

Any new service/tariff may be changed/added/deleted without prior notice. 77 Schedule of Charges 2019-20 ISIC

218 MRI-218 MRI-207 MRI HIP WITH THIGH RIGHT WITH CONTRAST 14000 17500 18900 21000 21000 219 MRI-219 MRI-208 MRI KNEE LEFT 9000 11250 12150 13500 13500 220 MRI-220 MRI-209 MRI KNEE LEFT EXTENDED SCREENING 3900 4875 5265 5850 5850 221 MRI-221 MRI-210 MRI KNEE LEFT SCREENING 6600 8250 8910 9900 9900 222 MRI-222 MRI-211 MRI KNEE LEFT WITH CONTRAST 14000 17500 18900 21000 21000 223 MRI-223 MRI-212 MRI KNEE RIGHT 9000 11250 12150 13500 13500 224 MRI-224 MRI-213 MRI KNEE RIGHT EXTENDED SCREENING 3900 4875 5265 5850 5850 225 MRI-225 MRI-214 MRI KNEE RIGHT SCREENING 6600 8250 8910 9900 9900 226 MRI-226 MRI-215 MRI KNEE RIGHT WITH CONTRAST 14000 17500 18900 21000 21000 227 MRI-227 MRI-216 MRI KNEE WITH UPPER LEG LEFT 9000 11250 12150 13500 13500 MRI KNEE WITH UPPER LEG LEFT EXTENDED 228 MRI-228 MRI-217 3900 4875 5265 5850 5850 SCREENING 229 MRI-229 MRI-218 MRI KNEE WITH UPPER LEG LEFT SCREENING 6600 8250 8910 9900 9900 230 MRI-230 MRI-219 MRI KNEE WITH UPPER LEG LEFT WITH CONTRAST 14000 17500 18900 21000 21000 231 MRI-231 MRI-220 MRI KNEE WITH UPPER LEG RIGHT 9000 11250 12150 13500 13500 MRI KNEE WITH UPPER LEG RIGHT EXTENDED 232 MRI-232 MRI-221 3900 4875 5265 5850 5850 SCREENING 233 MRI-233 MRI-222 MRI KNEE WITH UPPER LEG RIGHT SCREENING 6600 8250 8910 9900 9900 234 MRI-234 MRI-223 MRI KNEE WITH UPPER LEG RIGHT WITH CONTRAST 14000 17500 18900 21000 21000 235 MRI-235 MRI-224 MRI LEG LEFT 9000 11250 12150 13500 13500 236 MRI-236 MRI-225 MRI LEG LEFT EXTENDED SCREENING 3900 4875 5265 5850 5850 237 MRI-237 MRI-226 MRI LEG LEFT SCREENING 6600 8250 8910 9900 9900 238 MRI-238 MRI-227 MRI LEG LEFT WITH CONTRAST 14000 17500 18900 21000 21000 239 MRI-239 MRI-228 MRI LEG RIGHT 9000 11250 12150 13500 13500 240 MRI-240 MRI-229 MRI LEG RIGHT EXTENDED SCREENING 3900 4875 5265 5850 5850 241 MRI-241 MRI-230 MRI LEG RIGHT SCREENING 6600 8250 8910 9900 9900 242 MRI-242 MRI-231 MRI LEG RIGHT WITH CONTRAST 14000 17500 18900 21000 21000 243 MRI-243 MRI-232 MRI LEG WITH ANKLE LEFT 9000 11250 12150 13500 13500 244 MRI-244 MRI-233 MRI LEG WITH ANKLE LEFT EXTENDED SCREENING 3900 4875 5265 5850 5850 245 MRI-245 MRI-234 MRI LEG WITH ANKLE LEFT SCREENING 6600 8250 8910 9900 9900 246 MRI-246 MRI-235 MRI LEG WITH ANKLE LEFT WITH CONTRAST 14000 17500 18900 21000 21000 247 MRI-247 MRI-236 MRI LEG WITH ANKLE RIGHT 9000 11250 12150 13500 13500 248 MRI-248 MRI-237 MRI LEG WITH ANKLE RIGHT EXTENDED SCREENING 3900 4875 5265 5850 5850

Any new service/tariff may be changed/added/deleted without prior notice. 78 Schedule of Charges 2019-20 ISIC

249 MRI-249 MRI-238 MRI LEG WITH ANKLE RIGHT SCREENING 6600 8250 8910 9900 9900 250 MRI-250 MRI-239 MRI LEG WITH ANKLE RIGHT WITH CONTRAST 14000 17500 18900 21000 21000 251 MRI-251 MRI-240 MRI LOWER ABDOMEN 9000 11250 12150 13500 13500 252 MRI-252 MRI-241 MRI LOWER ABDOMEN EXTENDED SCREENING 3900 4875 5265 5850 5850 253 MRI-253 MRI-242 MRI LOWER ABDOMEN SCREENING 6600 8250 8910 9900 9900 254 MRI-254 MRI-243 MRI LOWER ABDOMEN WITH CONTRAST 14000 17500 18900 21000 21000 255 MRI-255 MRI-244 MRI LOWER CHEST 9000 11250 12150 13500 13500 256 MRI-256 MRI-245 MRI LOWER CHEST EXTENDED SCREENING 3900 4875 5265 5850 5850 257 MRI-257 MRI-246 MRI LOWER CHEST SCREENING 6600 8250 8910 9900 9900 258 MRI-258 MRI-247 MRI LOWER CHEST WITH CONTRAST 14000 17500 18900 21000 21000 259 MRI-259 MRI-248 MRI LOWER CHEST WITH UPPER ABDOMEN 9000 11250 12150 13500 13500 MRI LOWER CHEST WITH UPPER ABDOMEN EXTENDED 260 MRI-260 MRI-249 3900 4875 5265 5850 5850 SCREENING 261 MRI-261 MRI-250 MRI LOWER CHEST WITH UPPER ABDOMEN SCREENING 6600 8250 8910 9900 9900 MRI LOWER CHEST WITH UPPER ABDOMEN WITH 262 MRI-262 MRI-251 14000 17500 18900 21000 21000 CONTRAST 263 MRI-263 MRI-252 MRI LUMBAR SPINE (FLEXION & EXTENSION) 6500 8125 8775 9750 9750 264 MRI-264 MRI-253 MRI LUMBAR SPINE WITH MYLOGRAM 14000 17500 18900 21000 21000 MRI LUMBO SACRAL SPINE (FLEX & EXTENSION) 265 MRI-265 14917 6500 8125 8775 9750 9750 SCREENING 266 MRI-266 MRI-254 MRI LUMBO-SACRAL SPINE 9000 11250 12150 13500 13500 267 MRI-267 MRI-255 MRI LUMBO-SACRAL SPINE EXTENDED SCREENING 3900 4875 5265 5850 5850 268 MRI-268 MRI-256 MRI LUMBO-SACRAL SPINE SCREENING 5000 6250 6750 7500 7500 269 MRI-269 MRI-257 MRI LUMBO-SACRAL SPINE WITH CONTRAST 14000 17500 18900 21000 21000 270 MRI-270 MRI-258 MRI MANDIBLE 9000 11250 12150 13500 13500 271 MRI-271 MRI-259 MRI MANDIBLE WITH CONTRAST 14000 17500 18900 21000 21000 272 MRI-272 MRI-260 MRI MYLOGRAM ONLY 4000 5000 5400 6000 6000 273 MRI-273 MRI-261 MRI NASOPHARYNX & PARANASAL SINUSES 9000 11250 12150 13500 13500 274 MRI-274 MRI-262 MRI NECK 9000 11250 12150 13500 13500 275 MRI-275 MRI-263 MRI NECK ANGIO WITH CONTRAST 22560 28200 30456 33840 33840 276 MRI-276 MRI-264 MRI NECK EXTENDED SCREENING 3900 4875 5265 5850 5850 277 MRI-277 MRI-265 MRI NECK SCREENING 6600 8250 8910 9900 9900 278 MRI-278 MRI-266 MRI NECK VESSELS ( CAR & VER ) 9000 11250 12150 13500 13500 279 MRI-279 MRI-267 MRI NECK WITH ANGIO 14000 17500 18900 21000 21000

Any new service/tariff may be changed/added/deleted without prior notice. 79 Schedule of Charges 2019-20 ISIC

280 MRI-280 MRI-268 MRI NECK WITH CONTRAST 14000 17500 18900 21000 21000 281 MRI-281 MRI-269 MRI ORBIT LEFT 9000 11250 12150 13500 13500 282 MRI-282 MRI-270 MRI ORBIT LEFT WITH CONTRAST 14000 17500 18900 21000 21000 283 MRI-283 MRI-271 MRI ORBIT RIGHT 9000 11250 12150 13500 13500 284 MRI-284 MRI-272 MRI ORBIT RIGHT WITH CONTRAST 14000 17500 18900 21000 21000 285 MRI-285 MRI-273 MRI ORBITS BOTH 9000 11250 12150 13500 13500 286 MRI-286 MRI-274 MRI ORBITS BOTH WITH CONTRAST 14000 17500 18900 21000 21000 287 MRI-287 MRI-275 MRI PARANASAL SINUSES 9000 11250 12150 13500 13500 288 MRI-288 MRI-276 MRI PELVIS 9000 11250 12150 13500 13500 289 MRI-289 MRI-277 MRI PELVIS EXTENDED SCREENING 3900 4875 5265 5850 5850 290 MRI-290 MRI-278 MRI PELVIS FOR CERVIX 9000 11250 12150 13500 13500 291 MRI-291 MRI-279 MRI PELVIS FOR CERVIX EXTENDED SCREENING 3900 4875 5265 5850 5850 292 MRI-292 MRI-280 MRI PELVIS FOR CERVIX SCREENING 6600 8250 8910 9900 9900 293 MRI-293 MRI-281 MRI PELVIS FOR CERVIX WITH CONTRAST 14000 17500 18900 21000 21000 294 MRI-294 MRI-282 MRI PELVIS FOR PROSTATE 9000 11250 12150 13500 13500 295 MRI-295 MRI-283 MRI PELVIS FOR PROSTATE EXTENDED SCREENING 3900 4875 5265 5850 5850 296 MRI-296 MRI-284 MRI PELVIS FOR PROSTATE SCREENING 6600 8250 8910 9900 9900 297 MRI-297 MRI-285 MRI PELVIS FOR PROSTATE WITH CONTRAST 14000 17500 18900 21000 21000 298 MRI-298 MRI-286 MRI PELVIS SCREENING 6600 8250 8910 9900 9900 299 MRI-299 MRI-287 MRI PELVIS WITH BOTH HIP JOINTS 9000 11250 12150 13500 13500 300 MRI-300 MRI-288 MRI PELVIS WITH CONTRAST 14000 17500 18900 21000 21000 301 MRI-301 MRI-289 MRI PERIPHERAL (CONTRAST ONLY) 17710 22138 23909 26565 26565 302 MRI-302 MRI-290 MRI PERIPHERAL ANGIO 27350 34188 36923 41025 41025 303 MRI-303 MRI-291 MRI PITUITARY FOSSA 9000 11250 12150 13500 13500 304 MRI-304 MRI-292 MRI PITUITARY FOSSA WITH CONTRAST 14000 17500 18900 21000 21000 305 MRI-305 MRI-293 MRI PITUITARY FOSSA+BRAIN 14000 17500 18900 21000 21000 306 MRI-306 MRI-418 MRI PROSTATE WITH ENDORECTAL 19000 23750 25650 28500 28500 307 MRI-307 MRI-294 MRI RENAL ANGIO 22570 28213 30470 33855 33855 308 MRI-308 13762 MRI REPORTING CHARGES 1600 2000 2160 2400 2400 309 MRI-309 MRI-296 MRI RIGHT FOOT 9000 11250 12150 13500 13500 310 MRI-310 MRI-297 MRI RIGHT KNEE 9000 11250 12150 13500 13500 311 MRI-311 MRI-298 MRI SACROILIAC JOINTS 9000 11250 12150 13500 13500

Any new service/tariff may be changed/added/deleted without prior notice. 80 Schedule of Charges 2019-20 ISIC

312 MRI-312 MRI-299 MRI SACROILIAC JOINTS EXTENDED SCREENING 3900 4875 5265 5850 5850 313 MRI-313 MRI-300 MRI SACROILIAC JOINTS SCREENING 5000 6250 6750 7500 7500 314 MRI-314 MRI-301 MRI SCREENING 5000 6250 6750 7500 7500 315 MRI-315 MRI-302 MRI SCROILIAC JOINTS WITH CONTRAST 14000 17500 18900 21000 21000 316 MRI-316 MRI-303 MRI SELLA 9000 11250 12150 13500 13500 317 MRI-317 MRI-304 MRI SELLA WITH CONTRAST 14000 17500 18900 21000 21000 318 MRI-318 MRI-305 MRI SHOULDER LEFT 9000 11250 12150 13500 13500 319 MRI-319 MRI-306 MRI SHOULDER LEFT EXTENDED SCREENING 3900 4875 5265 5850 5850 320 MRI-320 MRI-307 MRI SHOULDER LEFT ORTHOGRAM 14000 17500 18900 21000 21000 321 MRI-321 MRI-308 MRI SHOULDER LEFT SCREENING 5000 6250 6750 7500 7500 322 MRI-322 MRI-309 MRI SHOULDER LEFT WITH CONTRAST 14000 17500 18900 21000 21000 323 MRI-323 MRI-310 MRI SHOULDER RIGHT 9000 11250 12150 13500 13500 324 MRI-324 MRI-311 MRI SHOULDER RIGHT EXTENDED SCREENING 3900 4875 5265 5850 5850 325 MRI-325 MRI-312 MRI SHOULDER RIGHT SCREENING 6000 7500 8100 9000 9000 326 MRI-326 MRI-313 MRI SHOULDER RIGHT WITH CONTRAST 14000 17500 18900 21000 21000 327 MRI-327 MRI-314 MRI SHOULDER RIGHT WITH ORTHOGRAM 14000 17500 18900 21000 21000 MRI SHOULDER WITH UPPER ARM EXTENDED 328 MRI-328 MRI-315 3900 4875 5265 5850 5850 SCREENING LEFT MRI SHOULDER WITH UPPER ARM EXTENDED 329 MRI-329 MRI-316 3900 4875 5265 5850 5850 SCREENING RIGHT 330 MRI-330 MRI-317 MRI SHOULDER WITH UPPER ARM LEFT 9000 11250 12150 13500 13500 331 MRI-331 MRI-318 MRI SHOULDER WITH UPPER ARM RIGHT 9000 11250 12150 13500 13500 332 MRI-332 MRI-319 MRI SHOULDER WITH UPPER ARM SCREENING LEFT 6000 7500 8100 9000 9000 333 MRI-333 MRI-320 MRI SHOULDER WITH UPPER ARM SCREENING RIGHT 6000 7500 8100 9000 9000 334 MRI-334 MRI-321 MRI SHOULDER WITH UPPER ARM WITH CONTRAST LEFT 14000 17500 18900 21000 21000 MRI SHOULDER WITH UPPER ARM WITH CONTRAST 335 MRI-335 MRI-322 14000 17500 18900 21000 21000 RIGHT 336 MRI-336 MRI-323 MRI SPECTROSCOPY 9000 11250 12150 13500 13500 337 MRI-337 MRI-324 MRI SPINE ANGIO 24160 30200 32616 36240 36240 338 MRI-338 MRI-325 MRI STERNUM 9000 11250 12150 13500 13500 339 MRI-339 MRI-326 MRI STERNUM EXTENDED SCREENING 3900 4875 5265 5850 5850 340 MRI-340 MRI-327 MRI STERNUM SCREENING 6000 7500 8100 9000 9000 341 MRI-341 MRI-328 MRI STERNUM WITH CONTRAST 14000 17500 18900 21000 21000 342 MRI-342 MRI-329 MRI T.M. JOINTS 9000 11250 12150 13500 13500

Any new service/tariff may be changed/added/deleted without prior notice. 81 Schedule of Charges 2019-20 ISIC

343 MRI-343 MRI-330 MRI THIGH LEFT 9000 11250 12150 13500 13500 344 MRI-344 MRI-331 MRI THIGH LEFT EXTENDED SCREENING 3900 4875 5265 5850 5850 345 MRI-345 MRI-332 MRI THIGH LEFT SCREENING 6600 8250 8910 9900 9900 346 MRI-346 MRI-333 MRI THIGH LEFT WITH CONTRAST 14000 17500 18900 21000 21000 347 MRI-347 MRI-334 MRI THIGH LEFT WITH KNEE 9000 11250 12150 13500 13500 348 MRI-348 MRI-335 MRI THIGH LEFT WITH KNEE EXTENDED SCREENING 3900 4875 5265 5850 5850 349 MRI-349 MRI-336 MRI THIGH LEFT WITH KNEE SCREENING 6600 8250 8910 9900 9900 350 MRI-350 MRI-337 MRI THIGH LEFT WITH KNEE WITH CONTRAST 14000 17500 18900 21000 21000 351 MRI-351 MRI-338 MRI THIGH RIGHT 9000 11250 12150 13500 13500 352 MRI-352 MRI-339 MRI THIGH RIGHT EXTENDED SCREENING 3900 4875 5265 5850 5850 353 MRI-353 MRI-340 MRI THIGH RIGHT SCREENING 6600 8250 8910 9900 9900 354 MRI-354 MRI-341 MRI THIGH RIGHT WITH CONTRAST 14000 17500 18900 21000 21000 355 MRI-355 MRI-342 MRI THIGH RIGHT WITH KNEE 9000 11250 12150 13500 13500 356 MRI-356 MRI-343 MRI THIGH RIGHT WITH KNEE EXTENDED SCREENING 3900 4875 5265 5850 5850 357 MRI-357 MRI-344 MRI THIGH RIGHT WITH KNEE SCREENING 6600 8250 8910 9900 9900 358 MRI-358 MRI-345 MRI THIGH RIGHT WITH KNEE WITH CONTRAST 14000 17500 18900 21000 21000 359 MRI-359 MRI-346 MRI UPPER ABDOMEN 9000 11250 12150 13500 13500 360 MRI-360 MRI-347 MRI UPPER ABDOMEN EXTENDED SCREENING 3900 4875 5265 5850 5850 361 MRI-361 MRI-348 MRI UPPER ABDOMEN SCREENING 6600 8250 8910 9900 9900 362 MRI-362 MRI-349 MRI UPPER ABDOMEN WITH CONTRAST 14000 17500 18900 21000 21000 363 MRI-363 MRI-350 MRI UPPER ABDOMEN WITH MRCP 14000 17500 18900 21000 21000 364 MRI-364 MRI-351 MRI UPPER CHEST WITH NECK 9000 11250 12150 13500 13500 365 MRI-365 MRI-352 MRI UPPER CHEST WITH NECK EXTENDING SCREENING 3900 4875 5265 5850 5850 366 MRI-366 MRI-353 MRI UPPER CHEST WITH NECK SCREENING 6600 8250 8910 9900 9900 367 MRI-367 MRI-354 MRI UPPER CHEST WITH NECK WITH CONTRAST 14000 17500 18900 21000 21000 368 MRI-368 MRI-355 MRI UPPER LIMB BOTH ANGIO 25000 31250 33750 37500 37500 369 MRI-369 MRI-356 MRI UPPER LIMB LEFT SIDE ANGIO 19000 23750 25650 28500 28500 370 MRI-370 MRI-357 MRI UPPER LIMB RIGHT SIDE ANGIO 19000 23750 25650 28500 28500 371 MRI-371 MRI-358 MRI WHOLE ABDOMEN 18000 22500 24300 27000 27000 372 MRI-372 MRI-359 MRI WHOLE ABDOMEN EXTENDED SCREENING 7000 8750 9450 10500 10500 373 MRI-373 MRI-360 MRI WHOLE ABDOMEN SCREENING 13200 16500 17820 19800 19800 374 MRI-374 MRI-361 MRI WHOLE ABDOMEN WITH CONTRAST 23000 28750 31050 34500 34500

Any new service/tariff may be changed/added/deleted without prior notice. 82 Schedule of Charges 2019-20 ISIC

375 MRI-375 MRI-362 MRI WHOLE ABDOMEN WITH MRCP 23000 28750 31050 34500 34500 376 MRI-376 MRI-363 MRI WHOLE BODY SCREENING 19000 23750 25650 28500 28500 377 MRI-377 MRI-364 MRI WHOLE SPINE SCREENING 5000 6250 6750 7500 7500 378 MRI-378 MRI-365 MRI WRIST EXTENDED SCREENING LEFT 3900 4875 5265 5850 5850 379 MRI-379 MRI-366 MRI WRIST EXTENDED SCREENING RIGHT 3900 4875 5265 5850 5850 380 MRI-380 MRI-367 MRI WRIST LEFT 9000 11250 12150 13500 13500 381 MRI-381 MRI-368 MRI WRIST RIGHT 9000 11250 12150 13500 13500 382 MRI-382 MRI-369 MRI WRIST SCREENING LEFT 5000 6250 6750 7500 7500 383 MRI-383 MRI-370 MRI WRIST SCREENING RIGHT 5000 6250 6750 7500 7500 384 MRI-384 MRI-371 MRI WRIST WITH CONTRAST LEFT 14000 17500 18900 21000 21000 385 MRI-385 MRI-372 MRI WRIST WITH CONTRAST RIGHT 14000 17500 18900 21000 21000 386 MRI-386 MRI-373 MRI WRIST WITH HAND EXTENDED SCREENING LEFT 3900 4875 5265 5850 5850 387 MRI-387 MRI-374 MRI WRIST WITH HAND EXTENDED SCREENING RIGHT 3900 4875 5265 5850 5850 388 MRI-388 MRI-375 MRI WRIST WITH HAND LEFT 9000 11250 12150 13500 13500 389 MRI-389 MRI-376 MRI WRIST WITH HAND RIGHT 9000 11250 12150 13500 13500 390 MRI-390 MRI-377 MRI WRIST WITH HAND SCREENING LEFT 5000 6250 6750 7500 7500 391 MRI-391 MRI-378 MRI WRIST WITH HAND SCREENING RIGHT 5000 6250 6750 7500 7500 392 MRI-392 MRI-379 MRI WRIST WITH HAND WITH CONTRAST LEFT 14000 17500 18900 21000 21000 393 MRI-393 MRI-380 MRI WRIST WITH HAND WITH CONTRAST RIGHT 14000 17500 18900 21000 21000 394 MRI-394 MRI-419 MRS 9000 11250 12150 13500 13500 395 MRI-395 MRI-382 MRV 9000 11250 12150 13500 13500

CT - SCAN Shared Single Dlx/Super Super S.No. NEW CODE OLD CODE Investigation/Procedure OPD/GW Room/ICU/ Room Dlx / Suite Dlx. Suite HDU 1 CTS-01 CTS-1 ANAESTHESIA FOR CT 2000 2500 2700 3000 3000 2 CTS-02 CTS-2 CECT & HRCT CHEST 15000 18750 20250 22500 22500 3 CTS-03 CTS-3 CECT ANKLE BOTH 10000 12500 13500 15000 15000 4 CTS-04 CTS-4 CECT ANKLE LEFT 8000 10000 10800 12000 12000 5 CTS-05 CTS-5 CECT ANKLE RIGHT 8000 10000 10800 12000 12000 6 CTS-06 CTS-6 CECT ARM LEFT 8000 10000 10800 12000 12000 7 CTS-07 CTS-7 CECT ARM RIGHT 8000 10000 10800 12000 12000

Any new service/tariff may be changed/added/deleted without prior notice. 83 Schedule of Charges 2019-20 ISIC

8 CTS-08 CTS-800 CECT ARM WITH ELBOW BOTH 14000 17500 18900 21000 21000 9 CTS-09 CTS-9 CECT ARM WITH ELBOW LEFT 9000 11250 12150 13500 13500 10 CTS-10 CTS-10 CECT ARM WITH ELBOW RIGHT 9000 11250 12150 13500 13500 11 CTS-11 CTS-11 CECT BRAIN - EMERG 5500 6875 7425 8250 8250 12 CTS-12 CTS-12 CECT BRAIN (HEAD) 5500 6875 7425 8250 8250 13 CTS-13 CTS-13 CECT CERVICAL SPINE 8500 10625 11475 12750 12750 14 CTS-14 CTS-14 CECT CERVICAL SPINE WITH DORSAL 10000 12500 13500 15000 15000 15 CTS-15 CTS-15 CECT CHEST 10000 12500 13500 15000 15000 16 CTS-16 CTS-16 CECT CHEST WITH LOWER NECK 13000 16250 17550 19500 19500 17 CTS-17 CTS-17 CECT CHEST WITH UPPER ABDOMEN 18000 22500 24300 27000 27000 18 CTS-18 CTS-18 CECT DORSAL SPINE 9000 11250 12150 13500 13500 19 CTS-19 CTS-19 CECT DORSOLUMBAR SPINE 9000 11250 12150 13500 13500 20 CTS-20 CTS-20 CECT ELBOW LEFT 8500 10625 11475 12750 12750 21 CTS-21 CTS-21 CECT ELBOW RIGHT 8500 10625 11475 12750 12750 22 CTS-22 CTS-22000 CECT ELBOW WITH FOREARM BOTH 15000 18750 20250 22500 22500 23 CTS-23 CTS-23 CECT ELBOW WITH FOREARM LEFT 9000 11250 12150 13500 13500 24 CTS-24 CTS-24 CECT ELBOW WITH FOREARM RIGHT 9000 11250 12150 13500 13500 25 CTS-25 CTS-25 CECT FACE 8000 10000 10800 12000 12000 26 CTS-26 CTS-26 CECT FEMUR BOTH 16000 20000 21600 24000 24000 27 CTS-27 CTS-27 CECT FEMUR LEFT 9000 11250 12150 13500 13500 28 CTS-28 CTS-28 CECT FEMUR RIGHT 9000 11250 12150 13500 13500 29 CTS-29 CTS-29 CECT FOOT BOTH 10000 12500 13500 15000 15000 30 CTS-30 CTS-30 CECT FOOT LEFT 8500 10625 11475 12750 12750 31 CTS-31 CTS-3100 CECT FOOT RIGHT 8500 10625 11475 12750 12750 32 CTS-32 CTS-3200 CECT FOREARM LEFT 8500 10625 11475 12750 12750 33 CTS-33 CTS-33 CECT FOREARM RIGHT 8500 10625 11475 12750 12750 34 CTS-34 CTS-34 CECT FOREARM WITH WRIST BOTH 13000 16250 17550 19500 19500 35 CTS-35 CTS-35 CECT FOREARM WITH WRIST LEFT 8500 10625 11475 12750 12750 36 CTS-36 CTS-36 CECT FOREARM WITH WRIST RIGHT 8500 10625 11475 12750 12750 37 CTS-37 CTS-37 CECT HAND LEFT 8500 10625 11475 12750 12750 38 CTS-38 CTS-38 CECT HAND RIGHT 8500 10625 11475 12750 12750 39 CTS-39 CTS-39 CECT HEAD WITH ORBIT (AXIAL & CORONAL) 9000 11250 12150 13500 13500

Any new service/tariff may be changed/added/deleted without prior notice. 84 Schedule of Charges 2019-20 ISIC

40 CTS-40 CTS-40 CECT HEAD WITH ORBIT AXIAL 6500 8125 8775 9750 9750 41 CTS-41 CTS-41 CECT HEAD WITH PNS (AXIAL & CORONAL) 9000 11250 12150 13500 13500 42 CTS-42 CTS-42 CECT HEAD WITH PNS AXIAL ONLY 6500 8125 8775 9750 9750 43 CTS-43 CTS-43 CECT HIP JOINT BOTH 10000 12500 13500 15000 15000 44 CTS-44 CTS-44 CECT HIP JOINT LEFT 10000 12500 13500 15000 15000 45 CTS-45 CTS-45 CECT HIP JOINT RIGHT 10000 12500 13500 15000 15000 46 CTS-46 CTS-1150 CECT HIP LEFT 7500 9375 10125 11250 11250 47 CTS-47 CTS-46 CECT HIP LEFT WITH FEMUR 10000 12500 13500 15000 15000 48 CTS-48 CTS-47 CECT HIP RIGHT WITH FEMUR 10000 12500 13500 15000 15000 49 CTS-49 CTS-48 CECT KNEE BOTH 15000 18750 20250 22500 22500 50 CTS-50 CTS-49 CECT KNEE LEFT 10000 12500 13500 15000 15000 51 CTS-51 CTS-50 CECT KNEE RIGHT 10000 12500 13500 15000 15000 52 CTS-52 CTS-51 CECT KNEE WITH LOWER THIGH (LT) 10000 12500 13500 15000 15000 53 CTS-53 CTS-52 CECT KNEE WITH LOWER THIGH (RT) 10000 12500 13500 15000 15000 54 CTS-54 CTS-53 CECT KNEE WITH LOWER THIGH BOTH 15000 18750 20250 22500 22500 55 CTS-55 CTS-54 CECT KNEE WITH UPPER LEG (LT) 10000 12500 13500 15000 15000 56 CTS-56 CTS-55 CECT KNEE WITH UPPER LEG (RT) 10000 12500 13500 15000 15000 57 CTS-57 CTS-560 CECT KUB 13000 16250 17550 19500 19500 58 CTS-58 CTS-57 CECT LEG BOTH 15000 18750 20250 22500 22500 59 CTS-59 CTS-58 CECT LEG LEFT 10000 12500 13500 15000 15000 60 CTS-60 CTS-59 CECT LEG RIGHT 10000 12500 13500 15000 15000 61 CTS-61 CTS-60 CECT LEG WITH ANKLE BOTH 10000 12500 13500 15000 15000 62 CTS-62 CTS-61 CECT LEG WITH ANKLE LEFT 10000 12500 13500 15000 15000 63 CTS-63 CTS-62 CECT LEG WITH ANKLE RIGHT 11000 13750 14850 16500 16500 64 CTS-64 CTS-64 CECT LOWER ABDOMEN + RECTAL 11000 13750 14850 16500 16500 65 CTS-65 CTS-63 CECT LOWER ABDOMEN 11000 13750 14850 16500 16500 66 CTS-66 CTS-65 CECT LOWER CHEST 9000 11250 12150 13500 13500 67 CTS-67 CTS-66 CECT LOWER CHEST WITH UPPER 17000 21250 22950 25500 25500 68 CTS-68 CTS-67 CECT LOWER THORAX 9000 11250 12150 13500 13500 69 CTS-69 CTS-68 CECT LUMBOSACRAL SPINE 11000 13750 14850 16500 16500 70 CTS-70 CTS-69 CECT MYELOGRAM 9000 11250 12150 13500 13500 71 CTS-71 CTS-70 CECT NECK 10000 12500 13500 15000 15000

Any new service/tariff may be changed/added/deleted without prior notice. 85 Schedule of Charges 2019-20 ISIC

72 CTS-72 CTS-71 CECT NECK WITH UPPER CHEST 13000 16250 17550 19500 19500 73 CTS-73 CTS-72 CECT ORBIT (AXIAL + CORONAL) 7500 9375 10125 11250 11250 74 CTS-74 CTS-73 CECT PARANASAL SINUSES ( AXIAL & CORONAL) 7500 9375 10125 11250 11250 75 CTS-75 CTS-74 CECT PARANASAL SINUSES ( AXIAL VIEW ) 5000 6250 6750 7500 7500 76 CTS-76 CTS-75 CECT PARANASAL SINUSES ( CORONAL VIEW) 5000 6250 6750 7500 7500 77 CTS-77 CTS-76 CECT PELVIS 11000 13750 14850 16500 16500 78 CTS-78 CECT-13697 CECT PULMONARY ANGIO 15000 18750 20250 22500 22500 79 CTS-79 CTS-7700 CECT SACROCOCCYGEAL SPINE 9000 11250 12150 13500 13500 80 CTS-80 CTS-7800 CECT SACROLLIAC JOINTS 9000 11250 12150 13500 13500 81 CTS-81 CTS-79 CECT SELLA 6000 7500 8100 9000 9000 82 CTS-82 CTS-80 CECT SHOULDER BOTH 15000 18750 20250 22500 22500 83 CTS-83 CTS-81 CECT SHOULDER LEFT 9000 11250 12150 13500 13500 84 CTS-84 CTS-82 CECT SHOULDER RIGHT 9000 11250 12150 13500 13500 85 CTS-85 CTS-83 CECT SHOULDER WITH ARM BOTH 15000 18750 20250 22500 22500 86 CTS-86 CTS-84 CECT SHOULDER WITH ARM LEFT 11000 13750 14850 16500 16500 87 CTS-87 CTS-85 CECT SHOULDER WITH ARM RIGHT 11000 13750 14850 16500 16500 88 CTS-88 CTS-86 CECT STERNUM 9500 11875 12825 14250 14250 89 CTS-89 CTS-87 CECT TEMPORAL BONE 11000 13750 14850 16500 16500 90 CTS-90 CTS-88 CECT UPPER ABDOMEN 11000 13750 14850 16500 16500 91 CTS-91 CTS-89 CECT UPPER CHEST 9000 11250 12150 13500 13500 92 CTS-92 CTS-90 CECT UPPER THORAX 9000 11250 12150 13500 13500 93 CTS-93 CTS-91 CECT UROGRAPHY (KUB) 13310 16638 17969 19965 19965 94 CTS-94 CTS-92 CECT WHOLE ABDOMEN 14000 17500 18900 21000 21000 95 CTS-95 CTS-93 CECT WRIST LEFT 8500 10625 11475 12750 12750 96 CTS-96 CTS-94 CECT WRIST RIGHT 8500 10625 11475 12750 12750 97 CTS-97 CTS-95 CECT WRIST WITH HAND BOTH 11000 13750 14850 16500 16500 98 CTS-98 CTS-96 CECT WRIST WITH HAND LEFT 8500 10625 11475 12750 12750 99 CTS-99 CTS-97 CECT WRIST WITH HAND RIGHT 8500 10625 11475 12750 12750 100 CTS-100 CTS-98 CERVICO-DORSAL SPINE FLEXION/EXTN 10000 12500 13500 15000 15000 101 CTS-101 CTS-99 CONSTRAST FOR PELVIS 4000 5000 5400 6000 6000 102 CTS-102 CTS-100 CONTRAST FOR ABDOMEN 4000 5000 5400 6000 6000 103 CTS-103 CTS-101 CONTRAST FOR CHEST 3990 4988 5387 5985 5985

Any new service/tariff may be changed/added/deleted without prior notice. 86 Schedule of Charges 2019-20 ISIC

104 CTS-104 CTS-102 CONTRAST FOR HEAD 3330 4163 4496 4995 4995 105 CTS-105 CTS-103 CONTRAST FOR KUB 2000 2500 2700 3000 3000 106 CTS-106 CTS-104 CONTRAST FOR NECK 3990 4988 5387 5985 5985 107 CTS-107 CTS-105 CONTRAST FOR PNS 2000 2500 2700 3000 3000 108 CTS-108 CTS-106 CONTRAST ORAL ONLY 670 838 905 1005 1005 109 CTS-109 CTS-1070 CONTRAST RECTAL ONLY 670 838 905 1005 1005 110 CTS-110 14567 CT 3 PHSE ABDOMEN 15000 18750 20250 22500 22500 111 CTS-111 14566 CT 3D SCAN 5000 6250 6750 7500 7500 112 CTS-112 CTS-108 CT 3D SPINE - MAHAJAN IMAGING 15070 18838 20345 22605 22605 113 CTS-113 14565 CT ANGIO 13000 16250 17550 19500 19500 114 CTS-114 14570 CT ANGIO ABDOMEN 13000 16250 17550 19500 19500 115 CTS-115 14571 CT ANGIO CHEST 13000 16250 17550 19500 19500 116 CTS-116 CTS-187 CT CONTRAST 0 0 0 0 0 117 CTS-117 CTS-112 CT FOOT BOTH CONTRAST 10000 12500 13500 15000 15000 118 CTS-118 CTS-113 CT GUIDED BIOPSY 6660 8325 8991 9990 9990 119 CTS-119 CTS-114 CT GUIDED DIAGNOSTIC NEEDLE TAP (RADIO) 5000 6250 6750 7500 7500 CT GUIDED THERAPEUTIC CATHETER DRAINAGE 120 CTS-120 CTS-115 13000 16250 17550 19500 19500 (RADIO) 121 CTS-121 CTS-116 CT GUIDED THERAPEUTIC NEEDLE TAP (RADIO) 7500 9375 10125 11250 11250 122 CTS-122 15012 CT LEFT SHOULDER ARTHROGRAM 9000 11250 12150 13500 13500 123 CTS-123 15013 CT RIGHT SHOULDER ARTHROGRAM 9000 11250 12150 13500 13500 124 CTS-124 CTS-1170 EXTRA CONTRAST (A) 670 838 905 1005 1005 125 CTS-125 CTS-118 EXTRA CONTRAST (B) 1330 1663 1796 1995 1995 126 CTS-126 CTS-119 EXTRA CONTRAST (C) 2000 2500 2700 3000 3000 127 CTS-127 CTS-120 HRCT CHEST 5000 6250 6750 7500 7500 128 CTS-128 CTS-121 HR-CT Temporal Bone 9990 12488 13487 14985 14985 129 CTS-129 CTS-2040 NCCT & CECT ANKLE BOTH 9000 11250 12150 13500 13500 130 CTS-130 CTS-2050 NCCT & CECT ANKLE LEFT 8500 10625 11475 12750 12750 131 CTS-131 CTS-206 NCCT & CECT ANKLE RIGHT 8500 10625 11475 12750 12750 132 CTS-132 CTS-207 NCCT & CECT ARM LT 10000 12500 13500 15000 15000 133 CTS-133 CTS-2080 NCCT & CECT ARM RT 10000 12500 13500 15000 15000 134 CTS-134 CTS-2090 NCCT & CECT ARM WITH ELBOW BOTH 16000 20000 21600 24000 24000 135 CTS-135 CTS-2100 NCCT & CECT ARM WITH ELBOW LEFT 9500 11875 12825 14250 14250

Any new service/tariff may be changed/added/deleted without prior notice. 87 Schedule of Charges 2019-20 ISIC

136 CTS-136 CTS-2110 NCCT & CECT ARM WITH ELBOW RIGHT 9500 11875 12825 14250 14250 137 CTS-137 CTS-2120 NCCT & CECT BRAIN 6000 7500 8100 9000 9000 138 CTS-138 CTS-2130 NCCT & CECT CERVICAL SPINE 9000 11250 12150 13500 13500 139 CTS-139 CTS-2140 NCCT & CECT CERVICAL SPINE WITH DORSAL SPINE 11000 13750 14850 16500 16500 140 CTS-140 CTS-2150 NCCT & CECT CHEST 15000 18750 20250 22500 22500 141 CTS-141 CTS-2160 NCCT & CECT CHEST WITH LOWER NECK 15000 18750 20250 22500 22500 142 CTS-142 CTS-2170 NCCT & CECT CHEST WITH UPPER ABDOMEN 19000 23750 25650 28500 28500 143 CTS-143 CTS-2180 NCCT & CECT DORSAL SPINE 12000 15000 16200 18000 18000 144 CTS-144 CTS-219 NCCT & CECT DORSOLUMBER SPINE 11000 13750 14850 16500 16500 145 CTS-145 CTS-220 NCCT & CECT ELBOW LEFT 8500 10625 11475 12750 12750 146 CTS-146 CTS-2210 NCCT & CECT ELBOW RIGHT 8500 10625 11475 12750 12750 147 CTS-147 CTS-2220 NCCT & CECT ELBOW WITH FOREARM BOTH 16000 20000 21600 24000 24000 148 CTS-148 CTS-223 NCCT & CECT ELBOW WITH FOREARM LT 9000 11250 12150 13500 13500 149 CTS-149 CTS-2240 NCCT & CECT ELBOW WITH FOREARM RT 9000 11250 12150 13500 13500 150 CTS-150 CTS-2250 NCCT & CECT FACE 9000 11250 12150 13500 13500 151 CTS-151 CTS-2260 NCCT & CECT FEMUR BOTH 11000 13750 14850 16500 16500 152 CTS-152 CTS-2270 NCCT & CECT FEMUR LEFT 11000 13750 14850 16500 16500 153 CTS-153 CTS-2280 NCCT & CECT FEMUR RIGHT 11000 13750 14850 16500 16500 154 CTS-154 CTS-229 NCCT & CECT FOOT BOTH 11000 13750 14850 16500 16500 155 CTS-155 CTS-230 NCCT & CECT FOOT LEFT 11000 13750 14850 16500 16500 156 CTS-156 CTS-231 NCCT & CECT FOOT RIGHT 11000 13750 14850 16500 16500 157 CTS-157 CTS-232 NCCT & CECT FOREARM LEFT 8500 10625 11475 12750 12750 158 CTS-158 CTS-233 NCCT & CECT FOREARM RIGHT 8500 10625 11475 12750 12750 159 CTS-159 CTS-234 NCCT & CECT FOREARM WITH WRIST BOTH 16000 20000 21600 24000 24000 160 CTS-160 CTS-235 NCCT & CECT FOREARM WITH WRIST LT 9000 11250 12150 13500 13500 161 CTS-161 CTS-236 NCCT & CECT FOREARM WITH WRIST RT 9000 11250 12150 13500 13500 162 CTS-162 CTS-237 NCCT & CECT HAND LEFT 7500 9375 10125 11250 11250 163 CTS-163 CTS-238 NCCT & CECT HAND RIGHT 7500 9375 10125 11250 11250 164 CTS-164 CTS-241 NCCT & CECT HEAD WITH ORBIT AXIAL & CORONAL 11000 13750 14850 16500 16500 165 CTS-165 CTS-240 NCCT & CECT HEAD WITH ORBIT AXIAL 8500 10625 11475 12750 12750 166 CTS-166 CTS-243 NCCT & CECT HEAD WITH PNS AXIAL & CORONAL 11000 13750 14850 16500 16500 167 CTS-167 CTS-242 NCCT & CECT HEAD WITH PNS AXIAL 8000 10000 10800 12000 12000

Any new service/tariff may be changed/added/deleted without prior notice. 88 Schedule of Charges 2019-20 ISIC

168 CTS-168 CTS-244 NCCT & CECT HIP JOINT BOTH 10000 12500 13500 15000 15000 169 CTS-169 CTS-245 NCCT & CECT HIP JOINT LEFT 10000 12500 13500 15000 15000 170 CTS-170 CTS-246 NCCT & CECT HIP JOINT RIGHT 10000 12500 13500 15000 15000 171 CTS-171 CTS-247 NCCT & CECT HIP LEFT 10000 12500 13500 15000 15000 172 CTS-172 CTS-248 NCCT & CECT HIP LEFT WITH FEMUR 12000 15000 16200 18000 18000 173 CTS-173 CTS-249 NCCT & CECT HIP RIGHT 10000 12500 13500 15000 15000 174 CTS-174 CTS-250 NCCT & CECT HIP RIGHT WITH FEMUR 12000 15000 16200 18000 18000 175 CTS-175 CTS-251 NCCT & CECT KNEE BOTH 14000 17500 18900 21000 21000 176 CTS-176 CTS-252 NCCT & CECT KNEE LEFT 9000 11250 12150 13500 13500 177 CTS-177 CTS-253 NCCT & CECT KNEE RIGHT 9000 11250 12150 13500 13500 178 CTS-178 CTS-254 NCCT & CECT KNEE WITH LOWER THIGH BOTH 14000 17500 18900 21000 21000 179 CTS-179 CTS-255 NCCT & CECT KNEE WITH LOWER THIGH LT 11000 13750 14850 16500 16500 180 CTS-180 CTS-256 NCCT & CECT KNEE WITH LOWER THIGH RT 11000 13750 14850 16500 16500 181 CTS-181 CTS-257 NCCT & CECT KNEE WITH UPPER LEG BOTH 13000 16250 17550 19500 19500 182 CTS-182 CTS-258 NCCT & CECT KNEE WITH UPPER LEG LT 11000 13750 14850 16500 16500 183 CTS-183 CTS-259 NCCT & CECT KNEE WITH UPPER LEG RT 11000 13750 14850 16500 16500 184 CTS-184 CTS-260 NCCT & CECT LEG BOTH 14000 17500 18900 21000 21000 185 CTS-185 CTS-261 NCCT & CECT LEG LEFT 9000 11250 12150 13500 13500 186 CTS-186 CTS-262 NCCT & CECT LEG RIGHT 9000 11250 12150 13500 13500 187 CTS-187 CTS-263 NCCT & CECT LEG WITH ANKLE BOTH 11000 13750 14850 16500 16500 188 CTS-188 CTS-264 NCCT & CECT LEG WITH ANKLE LEFT 9000 11250 12150 13500 13500 189 CTS-189 CTS-265 NCCT & CECT LEG WITH ANKLE RIGHT 9000 11250 12150 13500 13500 190 CTS-190 CTS-266 NCCT & CECT LOWER ABDOMEN 14000 17500 18900 21000 21000 191 CTS-191 CTS-267 NCCT & CECT LOWER CHEST 12000 15000 16200 18000 18000 NCCT & CECT LOWER CHEST WITH UPPER ABDOMEN + 192 CTS-192 CTS-269 15000 18750 20250 22500 22500 ORAL 193 CTS-193 CTS-268 NCCT & CECT LOWER CHEST WITH UPPER ABDOMEN 15000 18750 20250 22500 22500 194 CTS-194 CTS-270 NCCT & CECT LUMBOSACRAL SPINE 9000 11250 12150 13500 13500 195 CTS-195 CTS-271 NCCT & CECT NECK 14500 18125 19575 21750 21750 196 CTS-196 CTS-272 NCCT & CECT ORBIT 9500 11875 12825 14250 14250 197 CTS-197 CTS-273 NCCT & CECT SACROCOCCYGEAL 8500 10625 11475 12750 12750 198 CTS-198 CTS-274 NCCT & CECT SACROILIAC JOINTS 8500 10625 11475 12750 12750 199 CTS-199 CTS-275 NCCT & CECT SELLA 7500 9375 10125 11250 11250

Any new service/tariff may be changed/added/deleted without prior notice. 89 Schedule of Charges 2019-20 ISIC

200 CTS-200 CTS-276 NCCT & CECT SHOULDER BOTH 14000 17500 18900 21000 21000 201 CTS-201 CTS-277 NCCT & CECT SHOULDER LEFT 9500 11875 12825 14250 14250 202 CTS-202 CTS-278 NCCT & CECT SHOULDER RIGHT 9500 11875 12825 14250 14250 203 CTS-203 CTS-279 NCCT & CECT SHOULDER WITH ARM BOTH 15000 18750 20250 22500 22500 204 CTS-204 CTS-280 NCCT & CECT SHOULDER WITH ARM LT 11000 13750 14850 16500 16500 205 CTS-205 CTS-281 NCCT & CECT SHOULDER WITH ARM RT 11000 13750 14850 16500 16500 206 CTS-206 CTS-282 NCCT & CECT TEMPORAL BONE 13000 16250 17550 19500 19500 207 CTS-207 CTS-2930 NCCT & CECT UPPER ABDOMEN 14000 17500 18900 21000 21000 208 CTS-208 CTS-284 NCCT & CECT UPPER CHEST 12500 15625 16875 18750 18750 209 CTS-209 CTS-286 NCCT & CECT WRIST LEFT 7500 9375 10125 11250 11250 210 CTS-210 CTS-287 NCCT & CECT WRIST RIGHT 7500 9375 10125 11250 11250 211 CTS-211 CTS-288 NCCT & CECT WRIST WITH HAND BOTH 14500 18125 19575 21750 21750 212 CTS-212 CTS-289 NCCT & CECT WRIST WITH HAND LT 9500 11875 12825 14250 14250 213 CTS-213 CTS-290 NCCT & CECT WRIST WITH HAND RT 9500 11875 12825 14250 14250 214 CTS-214 CTS-291 NCCT + CECT + HRCT CHEST 22000 27500 29700 33000 33000 215 CTS-215 CTS-122 NCCT ANKLE BOTH 9000 11250 12150 13500 13500 216 CTS-216 CTS-293 NCCT ANKLE JOINT (RIGHT) 4500 5625 6075 6750 6750 217 CTS-217 CTS-123 NCCT ANKLE LEFT 6500 8125 8775 9750 9750 218 CTS-218 CTS-124 NCCT ANKLE RIGHT 6500 8125 8775 9750 9750 219 CTS-219 CTS-125 NCCT ARM LEFT 6500 8125 8775 9750 9750 220 CTS-220 CTS-126 NCCT ARM RIGHT 6500 8125 8775 9750 9750 221 CTS-221 CTS-127 NCCT ARM WITH ELBOW BOTH 13000 16250 17550 19500 19500 222 CTS-222 CTS-128 NCCT ARM WITH ELBOW LEFT 7500 9375 10125 11250 11250 223 CTS-223 CTS-129 NCCT ARM WITH ELBOW RIGHT 7500 9375 10125 11250 11250 224 CTS-224 CTS-130 NCCT BRAIN - EMERG 4660 5825 6291 6990 6990 225 CTS-225 CTS-131 NCCT BRAIN (HEAD INJURY) 4660 5825 6291 6990 6990 226 CTS-226 CTS-132 NCCT BRAIN 3540 4425 4779 5310 5310 227 CTS-227 14987 NCCT C.V.J (FLEX & EXTENSION) 8000 10000 10800 12000 12000 228 CTS-228 CTS-133 NCCT CERVICAL SPINE - EMRG 4000 5000 5400 6000 6000 229 CTS-229 14988 NCCT CERVICAL SPINE (FLEX & EXTENSION) 8000 10000 10800 12000 12000 230 CTS-230 CTS-134 NCCT CERVICAL SPINE 6500 8125 8775 9750 9750 231 CTS-231 CTS-135 NCCT CERVICAL SPINE WITH DORSAL 7500 9375 10125 11250 11250

Any new service/tariff may be changed/added/deleted without prior notice. 90 Schedule of Charges 2019-20 ISIC

232 CTS-232 CTS-136 NCCT CHEST 7330 9163 9896 10995 10995 233 CTS-233 CTS-137 NCCT CHEST WITH LOWER NECK 9500 11875 12825 14250 14250 234 CTS-234 CTS-138 NCCT CHEST WITH UPPER ABDOMEN 14640 18300 19764 21960 21960 235 CTS-235 CTS-139 NCCT CHEST+HRCT 12000 15000 16200 18000 18000 236 CTS-236 CTS-140 NCCT DORSAL SPINE 7500 9375 10125 11250 11250 237 CTS-237 CTS-141 NCCT DORSO-LUMBAR SPINE 7500 9375 10125 11250 11250 238 CTS-238 CTS-142 NCCT ELBOW LEFT 6500 8125 8775 9750 9750 239 CTS-239 CTS-143 NCCT ELBOW RIGHT 6500 8125 8775 9750 9750 240 CTS-240 CTS-144 NCCT ELBOW WITH FOREARM BOTH 14000 17500 18900 21000 21000 241 CTS-241 CTS-145 NCCT ELBOW WITH FOREARM LEFT 7500 9375 10125 11250 11250 242 CTS-242 CTS-146 NCCT ELBOW WITH FOREARM RIGHT 7500 9375 10125 11250 11250 243 CTS-243 MAH-01 NCCT EXTREMITIES JOINT- MAHAJAN IMAGING 13000 16250 17550 19500 19500 244 CTS-244 CTS-147 NCCT FACE 6500 8125 8775 9750 9750 245 CTS-245 CTS-148 NCCT FEMUR BOTH 13000 16250 17550 19500 19500 246 CTS-246 CTS-149 NCCT FEMUR LEFT 7500 9375 10125 11250 11250 247 CTS-247 CTS-150 NCCT FEMUR RIGHT 7500 9375 10125 11250 11250 248 CTS-248 CTS-151 NCCT FOEARM WITH WRIST BOTH 9000 11250 12150 13500 13500 249 CTS-249 CTS-152 NCCT FOOT BOTH 8500 10625 11475 12750 12750 250 CTS-250 CTS-153 NCCT FOOT LEFT + CONTRAST 8500 10625 11475 12750 12750 251 CTS-251 CTS-154 NCCT FOOT LEFT 6500 8125 8775 9750 9750 252 CTS-252 CTS-155 NCCT FOOT RIGHT 6500 8125 8775 9750 9750 253 CTS-253 CTS-156 NCCT FOREARM LEFT 6500 8125 8775 9750 9750 254 CTS-254 CTS-157 NCCT FOREARM RIGHT 6500 8125 8775 9750 9750 255 CTS-255 CTS-158 NCCT FOREARM WITH WRIST LEFT 6500 8125 8775 9750 9750 256 CTS-256 CTS-159 NCCT FOREARM WITH WRIST RIGHT 6500 8125 8775 9750 9750 257 CTS-257 CTS-160 NCCT HAND LEFT 6500 8125 8775 9750 9750 258 CTS-258 CTS-1610 NCCT HAND RIGHT 6500 8125 8775 9750 9750 259 CTS-259 CTS-1620 NCCT HEAD WITH ORBIT AXIAL & CORONAL 8500 10625 11475 12750 12750 260 CTS-260 CTS-1630 NCCT HEAD WITH ORBIT AXIAL 5000 6250 6750 7500 7500 261 CTS-261 CTS-1640 NCCT HEAD WITH PNS AXIAL & CORONAL 8000 10000 10800 12000 12000 262 CTS-262 CTS-1650 NCCT HEAD WITH PNS AXIAL 5000 6250 6750 7500 7500 263 CTS-263 CTS-166 NCCT HIP JOINTS 8500 10625 11475 12750 12750

Any new service/tariff may be changed/added/deleted without prior notice. 91 Schedule of Charges 2019-20 ISIC

264 CTS-264 CTS-1670 NCCT HIP LEFT 8500 10625 11475 12750 12750 265 CTS-265 CTS-1680 NCCT HIP LEFT WITH FEMUR 8500 10625 11475 12750 12750 266 CTS-266 CTS-1069 NCCT HIP RIGHT 8500 10625 11475 12750 12750 267 CTS-267 CTS-170 NCCT HIP RIGHT WITH FEMUR 8500 10625 11475 12750 12750 268 CTS-268 CTS-1710 NCCT KNEE BOTH 11000 13750 14850 16500 16500 269 CTS-269 CTS-172 NCCT KNEE LEFT 8500 10625 11475 12750 12750 270 CTS-270 CTS-1730 NCCT KNEE RIGHT 8500 10625 11475 12750 12750 271 CTS-271 CTS-174 NCCT KNEE WITH LOWER THIGH BOTH 13000 16250 17550 19500 19500 272 CTS-272 CTS-175 NCCT KNEE WITH LOWER THIGH LT 8500 10625 11475 12750 12750 273 CTS-273 CTS-176 NCCT KNEE WITH LOWER THIGH RT 8500 10625 11475 12750 12750 274 CTS-274 CTS-177 NCCT KNEE WITH UPPER LEG BOTH 15000 18750 20250 22500 22500 275 CTS-275 CTS-178 NCCT KNEE WITH UPPER LEG LT 8500 10625 11475 12750 12750 276 CTS-276 CTS-179 NCCT KNEE WITH UPPER LEG RT 8500 10625 11475 12750 12750 277 CTS-277 CTS-180 NCCT KUB 9000 11250 12150 13500 13500 278 CTS-278 CTS-181 NCCT LEG BOTH 13000 16250 17550 19500 19500 279 CTS-279 CTS-182 NCCT LEG LEFT 8500 10625 11475 12750 12750 280 CTS-280 CTS-1083 NCCT LEG RIGHT 8500 10625 11475 12750 12750 281 CTS-281 CTS-184 NCCT LEG WITH ANKLE BOTH 8500 10625 11475 12750 12750 282 CTS-282 CTS-1850 NCCT LEG WITH ANKLE LEFT 8500 10625 11475 12750 12750 283 CTS-283 CTS-1860 NCCT LEG WITH ANKLE RIGHT 8500 10625 11475 12750 12750 284 CTS-284 CTS-187 NCCT LIMITED STUDY 3500 4375 4725 5250 5250 285 CTS-285 CTS-188 NCCT LOWER ABDOMEN (ORAL + RECTAL) 7500 9375 10125 11250 11250 286 CTS-286 CTS-189 NCCT LOWER ABDOMEN 6500 8125 8775 9750 9750 287 CTS-287 CTS-190 NCCT LOWER CHEST 6500 8125 8775 9750 9750 288 CTS-288 14569 NCCT LOWER EXTREMITY 14000 17500 18900 21000 21000 289 CTS-289 CTS-191 NCCT LOWER THORAX 6500 8125 8775 9750 9750 290 CTS-290 16026 NCCT LUMBAR SPINE 7500 9375 10125 11250 11250 291 CTS-291 CTS-2030 NCCT LUMBO SACRAL SPINE FLEXION/EXTN 8000 10000 10800 12000 12000 292 CTS-292 CTS-192 NCCT LUMBO-SACRAL SPINE 7500 9375 10125 11250 11250 293 CTS-293 CTS-193 NCCT NECK + ORAL CONTRAST 7500 9375 10125 11250 11250 294 CTS-294 CTS-194 NCCT NECK 7000 8750 9450 10500 10500 295 CTS-295 CTS-195 NCCT NECK WITH UPPER CHEST 11000 13750 14850 16500 16500

Any new service/tariff may be changed/added/deleted without prior notice. 92 Schedule of Charges 2019-20 ISIC

296 CTS-296 CTS-196 NCCT ORBIT (AXIAL & CORONAL) 5500 6875 7425 8250 8250 297 CTS-297 CTS-197 NCCT PARANASAL SINUSES ( AXIAL & CORONAL) 5500 6875 7425 8250 8250 298 CTS-298 CTS-198 NCCT PARANASAL SINUSES ( AXIAL VIEW ) 2500 3125 3375 3750 3750 299 CTS-299 CTS-199 NCCT PARANASAL SINUSES ( CORONAL VIEW) 3000 3750 4050 4500 4500 300 CTS-300 CTS-200 NCCT PELVIS 7500 9375 10125 11250 11250 301 CTS-301 CTS-201 NCCT SACROCOCCYGEAL SPINE 7500 9375 10125 11250 11250 302 CTS-302 CTS-202 NCCT SACROILIAC JOINT 7500 9375 10125 11250 11250 303 CTS-303 CTS-203 NCCT SCANOGRAM 2500 3125 3375 3750 3750 304 CTS-304 CTS-204 NCCT SELLA 4500 5625 6075 6750 6750 305 CTS-305 CTS-205 NCCT SHOULDER BOTH 13000 16250 17550 19500 19500 306 CTS-306 CTS-0206 NCCT SHOULDER LEFT 7500 9375 10125 11250 11250 307 CTS-307 CTS-2070 NCCT SHOULDER RIGHT 7500 9375 10125 11250 11250 308 CTS-308 CTS-208 NCCT SHOULDER WITH ARM BOTH 13000 16250 17550 19500 19500 309 CTS-309 CTS-209 NCCT SHOULDER WITH ARM LEFT 9500 11875 12825 14250 14250 310 CTS-310 CTS-210 NCCT SHOULDER WITH ARM RIGHT 9500 11875 12825 14250 14250 311 CTS-311 CTS-211 NCCT SINOGRAM 6500 8125 8775 9750 9750 312 CTS-312 CTS-212 NCCT STERNUM 6500 8125 8775 9750 9750 313 CTS-313 CTS-213 NCCT TEMPORAL BONE 7500 9375 10125 11250 11250 314 CTS-314 CTS-214 NCCT UPPER ABDOMEN + ORAL CONTRAST 7500 9375 10125 11250 11250 315 CTS-315 CTS-215 NCCT UPPER ABDOMEN 7000 8750 9450 10500 10500 316 CTS-316 CTS-216 NCCT UPPER CHEST 6660 8325 8991 9990 9990 317 CTS-317 CTS-217 NCCT UPPER THORAX 6660 8325 8991 9990 9990 318 CTS-318 CTS-218 NCCT WHOLE ABDOMEN + ORAL CONTRAST 10500 13125 14175 15750 15750 319 CTS-319 CTS-21125 NCCT WHOLE ABDOMEN (ORAL + RECTAL) 11000 13750 14850 16500 16500 320 CTS-320 CTS-2200 NCCT WHOLE ABDOMEN + RECTAL 10500 13125 14175 15750 15750 321 CTS-321 CTS-221 NCCT WHOLE ABDOMEN 10000 12500 13500 15000 15000 322 CTS-322 14568 NCCT WHOLE SPINE 14000 17500 18900 21000 21000 323 CTS-323 CTS-377 NCCT WHOLE SPINE 3D 11000 13750 14850 16500 16500 324 CTS-324 CTS-222 NCCT WRIST LEFT 6500 8125 8775 9750 9750 325 CTS-325 CTS-2230 NCCT WRIST RIGHT 6500 8125 8775 9750 9750 326 CTS-326 CTS-224 NCCT WRIST WITH HAND BOTH 9000 11250 12150 13500 13500 327 CTS-327 CTS-225 NCCT WRIST WITH HAND LT 6500 8125 8775 9750 9750

Any new service/tariff may be changed/added/deleted without prior notice. 93 Schedule of Charges 2019-20 ISIC

328 CTS-328 CTS-226 NCCT WRIST WITH HAND RT 6500 8125 8775 9750 9750 329 CTS-329 CTS-227 TRU CUT BIOPSY FNAC CHEST CT 5000 6250 6750 7500 7500 330 CTS-330 CTS-393 WHOLE SPINE AP 1400 1750 1890 2100 2100 331 CTS-331 CTS-394 WHOLE SPINE AP/LATERAL 2800 3500 3780 4200 4200 332 CTS-332 CTS-395 WHOLE SPINE LATERAL 1400 1750 1890 2100 2100 SPECIAL RADIOLOGICAL INVESTIGATIONS Shared Single Dlx/Super Super S.NO. NEW CODE OLD CODE Investigation/Procedure OPD/GW Room/ICU/ Room Dlx / Suite Dlx. Suite HDU 1 SRI-01 SRI-1 99M-TC THYROID SCAN 6190 7738 8357 9285 9285 2 SRI-02 SRI-2 CT- PULMONARY ANGIO 16830 21038 22721 25245 25245 3 SRI-03 SRI-3 DTPA DYNAMIC RENAL SCAN 7980 9975 10773 11970 11970 4 SRI-04 SRI-4 PET SCAN 37040 46300 50004 55560 55560 5 SRI-05 14977 RADIOLOGIST SECOND OPINION CHARGES 1210 1513 1634 1815 1815 6 SRI-06 SRI-12 X-RAY BARIUM MEAL (FT) 6000 7500 8100 9000 9000 7 SRI-07 SRI-13 X-RAY H.S.G 3500 4375 4725 5250 5250 8 SRI-08 SRI-9 X-RAY IVP 5000 6250 6750 7500 7500 9 SRI-09 SRI-11 X-RAY MCU & ASU 5000 6250 6750 7500 7500 10 SRI-10 SRI-10 X-RAY MCU 5000 6250 6750 7500 7500

Charges Basis OPD/GW 100% HDU+ICU (all categories) 125% Shared 125% Single 135% Dlx 150% Spr. Dlx 150% Suite 150% Spr. Dlx Suite 150%

Note :- Above Charge basis would also be applicable on all newly added services

Any new service/tariff may be changed/added/deleted without prior notice. 94 Schedule of Charges 2019-20 ISIC

PHYSIOTHERAPY

Shared Dlx/ Super NEW OLD Single S.No. Services OPD/GW Room/ Super Dlx Dlx. CODE CODE Room ICU/HDU / Suite Suite 1 PHY-1 PHY-100 AQUA AEROBICS (12 SESSIONS)-VALIDITY-1 MONTH 4390 5488 5927 6585 6585 2 PHY-2 PHY-99 AQUA AEROBICS (SINGLE SESSION) 880 1100 1188 1320 1320 AQUA AEROBICS FOR A COUPLE-12 SITTINGS (VALIDITY-1 3 PHY-3 15702 8470 10588 11435 12705 12705 MONTH) AQUA AEROBICS FOR GROUP(6 PEOPLE)-12 SITTINGS 4 PHY-4 15704 24200 30250 32670 36300 36300 (VALIDITY-1 MONTH) 5 PHY-5 PHY-01 BALANCE MASTER 1070 1338 1445 1605 1605 6 PHY-6 PHY-04 BED SIDE SHORT CASE (PT) 730 913 986 1095 1095 7 PHY-7 PHY-05 BEDSIDE LONG CASE (PT) 940 1175 1269 1410 1410 8 PHY-8 PHY-06 BIOFEED BACK 1100 1375 1485 1650 1650 9 PHY-9 PHY-07 CHEST PHYSIOTHERAPY (BEDSIDE) 660 825 891 990 990 10 PHY-10 PHY-08 CHEST PHYSIOTHERAPY (WITH SUCTION) 1080 1350 1458 1620 1620 11 PHY-11 PHY-09 CONSULTATION AND ASSESSMENT 1000 1250 1350 1500 1500 12 PHY-12 PHY-10 CPM BILATERAL 1210 1513 1634 1815 1815 13 PHY-13 PHY-11 CPM UNILATERAL 750 938 1013 1125 1125 14 PHY-14 PHY-12 CYCLING 430 538 581 645 645 15 PHY-15 PHY-13 DIADENS 610 763 824 915 915 16 PHY-16 PHY-57 DRY NEEDLING 1000 1250 1350 1500 1500 17 PHY-17 PHY-58 DRY NEEDLING+TAPING (PACKAGE) 1250 1563 1688 1875 1875 18 PHY-18 PHY-14 EVALUATION (PT) 610 763 824 915 915 19 PHY-19 PHY-15 EXERCISE DEMONSTRATION (PT) 440 550 594 660 660 20 PHY-20 PHY-16 EXERCISES THERAPY SHORT CASE 650 813 878 975 975 21 PHY-21 PHY-17 FUNCTIONAL ELECTRICAL STIMULATOR (FES) 1070 1338 1445 1605 1605 22 PHY-22 PHY-18 GAIT TRAINING 650 813 878 975 975 23 PHY-23 PHY-20 HOT / COLD PACK (PT) 430 538 581 645 645 24 PHY-24 14140 HYDROTHERAPY ( THRICE A WEEK/ALTERNATIVE DAYS ) 2000 2500 2700 3000 3000 25 PHY-25 PHY-21 HYDROTHERAPY (PT) 660 825 891 990 990 26 PHY-26 PHY-22 HYDROTHERAPY WEEKLY (PT) 3250 4063 4388 4875 4875 27 PHY-27 PHY-23 IFT 430 538 581 645 645

Any new service/tariff may be changed/added/deleted without prior notice. 95 Schedule of Charges 2019-20 ISIC

28 PHY-28 14158 INTERNSHIP ( PER MONTH) 1320 1650 1782 1980 1980 29 PHY-29 PHY-26 LASER 550 688 743 825 825 MONTHLY PACKAGE PT & OT-VALID 1 MONTH(NON- 30 PHY-30 PHY-27 50600 63250 68310 75900 75900 REFUNDABLE) 31 PHY-31 PHY-28 MWD 430 538 581 645 645 32 PHY-32 PHY-29 NEURO REHAB LONG CASE (PT) - 1 SESSION 1330 1663 1796 1995 1995 33 PHY-33 PHY-60 NEURO REHAB LONG CASE (PT) - WEEKLY 6660 8325 8991 9990 9990 34 PHY-34 PHY-61 NEURO REHAB SHORT CASE (PT) - WEEKLY 4680 5850 6318 7020 7020 35 PHY-35 PHY-30 NEURO REHAB SHORT CASE (PT) 1 SESSION 940 1175 1269 1410 1410 36 PHY-36 PHY-54 NEURO REHAB WEEKLY PACKAGE (PT+OT)) 13320 16650 17982 19980 19980 37 PHY-37 PHY-63 ORTHO REHAB LONG CASE (PT) - WEEKLY 6660 8325 8991 9990 9990 38 PHY-38 PHY-31 ORTHO REHAB LONG CASE (PT) 1330 1663 1796 1995 1995 39 PHY-39 PHY-62 ORTHO REHAB SHORT CASE (PT) - WEEKLY 4680 5850 6318 7020 7020 40 PHY-40 PHY-32 ORTHO REHAB SHORT CASE (PT) 940 1175 1269 1410 1410 41 PHY-41 PHY-55 ORTHO REHAB WEEKLY PACKAGE (PT+OT) 13320 16650 17982 19980 19980 42 PHY-42 PHY-33 PAIN PACKAGE-WEEKLY-VALID 6 DAYS(NON-REFUNDABLE) 7520 9400 10152 11280 11280 43 PHY-43 PHY-34 PHYSIOTHERAPY CHARGES 0 0 0 0 0 44 PHY-44 PHY-35 PHYSIOTHERAPY MONTHLY PACKAGE 31000 38750 41850 46500 46500 PHYSIOTHERAPY MONTHLY PACKAGE INCLUDING 45 PHY-45 PHY-36 47190 58988 63707 70785 70785 HYDROTHERAPY 46 PHY-46 PHY-38 SPORTS THERAPY WEEKLY 730 913 986 1095 1095 47 PHY-47 PHY-39 STANDING FRAME 430 538 581 645 645 48 PHY-48 PHY-40 STIMULATION (PT) 430 538 581 645 645 49 PHY-49 PHY-41 SUCTIONING 280 350 378 420 420 50 PHY-50 PHY-42 SWD 430 538 581 645 645 51 PHY-51 PHY-43 TAPING PER AREA 850 1063 1148 1275 1275 52 PHY-52 PHY-44 TENS 430 538 581 645 645 53 PHY-53 PHY-45 THERAPEUTIC RIDING 1000 1250 1350 1500 1500 54 PHY-54 PHY-46 TILT TABLE 670 838 905 1005 1005 55 PHY-55 PHY-47 TRACTION 430 538 581 645 645 56 PHY-56 PHY-48 TREADMILL 670 838 905 1005 1005 57 PHY-57 PHY-49 ULTRASONIC 430 538 581 645 645 58 PHY-58 PHY-50 UNWEIGHING HARNESS 1100 1375 1485 1650 1650

Any new service/tariff may be changed/added/deleted without prior notice. 96 Schedule of Charges 2019-20 ISIC

59 PHY-59 PHY-205 VEDIC HEALING (PER SESSION) 850 1063 1148 1275 1275 60 PHY-60 PHY-51 VEDIC HEALING (WEEKLY PACKAGE) 4250 5313 5738 6375 6375 61 PHY-61 PHY-52 VIBRATOR (20 MIN) 350 438 473 525 525 62 PHY-62 PHY-53 VIRTUAL TRAINING 500 625 675 750 750 63 PHY-63 14255 VOLUNTARY TRAINING-PT (MONTHLY) 1320 1650 1782 1980 1980 64 PHY-64 PHY-55 WAX ONE JOINT (PT) 430 538 581 645 645 65 PHY-65 PHY-56 WAX TWO JOINTS (PT) 730 913 986 1095 1095 66 PHY-66 16234 YOGA THERAPY(PACKAJE FOR 6 SESSION) 1650 2063 2228 2475 2475 67 PHY-67 16233 YOGA THERAPY(PER SESSION) 330 413 446 495 495 68 PHY-68 16232 YOGA WEIGHT MANAGEMENT PROGRAM(12 CLASSES) 3300 4125 4455 4950 4950 REHAB HOME CARE SERVICES Shared Super NEW OLD Single Dlx/Super S.No. Services OPD/GW Room/ICU Dlx. CODE CODE Room Dlx / Suite /HDU Suite 1 RHC-01 14785 REHAB HOME CARE PROG. (1 VISIT)-LONG CASE 1650 2063 2228 2475 2475 2 RHC-02 15104 REHAB HOME CARE PROG. (1 VISIT)-SHORT CASE 1320 1650 1782 1980 1980 3 RHC-03 15106 REHAB HOME CARE PROG. (15 DAYS) 18150 22688 24503 27225 27225 4 RHC-04 15105 REHAB HOME CARE PROG. (MONTHLY PKG) 33000 41250 44550 49500 49500 5 RHC-05 14786 REHAB HOME CARE PROG. (WEEKLY PKG) 9240 11550 12474 13860 13860 6 RHC-06 15182 REHAB HOME CARE WEEKLY PROG.(THRICE A WEEK) 4290 5363 5792 6435 6435 7 RHC-07 15183 REHAB HOME CARE WEEKLY PROG.(TWICE A WEEK) 2970 3713 4010 4455 4455 OCCUPATIONAL THERAPY Shared Super NEW OLD Single Dlx/Super S.No. Services OPD/GW Room/ICU Dlx. CODE CODE Room Dlx / Suite /HDU Suite 1 OCU-1 OCU-1 ACTIVITIES 550 688 743 825 825 2 OCU-2 OCU-2 ADL TRAINING 550 688 743 825 825 3 OCU-3 OCU-04 BED SIDE OT (Long Case) 940 1175 1269 1410 1410 4 OCU-4 OCU-3 BED SIDE OT (Short Case) 730 913 986 1095 1095 5 OCU-5 OCU-4 CAR DRIVING TRAINING 800 1000 1080 1200 1200 6 OCU-6 OCU-5 CLAY THERAPY 500 625 675 750 750 7 OCU-7 OCU-6 COGNITIVE THERAPY 1000 1250 1350 1500 1500 8 OCU-8 OCC-33 COMA STIMULATION (ICU) 800 1000 1080 1200 1200 9 OCU-9 OCU-8 CPM BILATERAL (UPPER LIMB) 1210 1513 1634 1815 1815

Any new service/tariff may be changed/added/deleted without prior notice. 97 Schedule of Charges 2019-20 ISIC

10 OCU-10 OCU-9 CPM UNILATERAL (UPPER LIMB) 750 938 1013 1125 1125 11 OCU-11 OCU-37 DRY NEEDLING(OT) + TAPPING(OT) 1250 1563 1688 1875 1875 12 OCU-12 OCU-36 DRY NEEDLING(OT) 1000 1250 1350 1500 1500 13 OCU-13 14897 DYSPHASIA RX 800 1000 1080 1200 1200 14 OCU-14 OCU-10 EVALUATION OT 610 763 824 915 915 15 OCU-15 OCU-11 EXERCISE DEMONSTRATION (OT) 440 550 594 660 660 16 OCU-16 OCU-12 GROUP THERAPY WEEKLY PKG. (YOGA & W/C SKILL TRG.) 940 1175 1269 1410 1410 17 OCU-17 1202 GYM (15 DAYS) 2400 3000 3240 3600 3600 18 OCU-18 OCU-13 GYM (PER SITTING) 400 500 540 600 600 19 OCU-19 OCU-14 GYM MONTHALY PACKAGE 4400 5500 5940 6600 6600 20 OCU-20 OCU-15 HOT / COLD PACK (OT) 430 538 581 645 645 21 OCU-21 OCU-16 HYDROTHERAPY (OT) 700 875 945 1050 1050 22 OCU-22 1200 HYDROTHERAPY (THRICE A WEEK / ALTERNATE DAYS) 2000 2500 2700 3000 3000 23 OCU-23 OCU-17 HYDROTHERAPY WEEKLY 3500 4375 4725 5250 5250 24 OCU-24 14159 INTERNSHIP (PER MONTH) 1320 1650 1782 1980 1980 25 OCU-25 14241 MASS PRACTICE WITH STIMULATION 530 663 716 795 795 26 OCU-26 14240 MASS PRACTICE WITH STIMULATION WEEKLY (FIVE DAYS) 2130 2663 2876 3195 3195 27 OCU-27 OCU-18 MONTHLY PT&OT PACKAGE 50600 63250 68310 75900 75900 28 OCU-28 OCU-50 NEURO REHAB LONG CASE (OT) - WEEKLY 6660 8325 8991 9990 9990 29 OCU-29 OCU-54 NEURO REHAB LONG CASE (PT+OT)) - WEEKLY 13320 16650 17982 19980 19980 30 OCU-30 OCU-51 NEURO REHAB SHORT CASE (OT) - WEEKLY 4680 5850 6318 7020 7020 31 OCU-31 OCU-19 NEUROLOGICAL REHAB LONG CASE (OT)-1 SESSION 1330 1663 1796 1995 1995 32 OCU-32 OCU-20 NEUROLOGICAL REHAB SHORT CASE (OT)-1 SESSION 940 1175 1269 1410 1410 33 OCU-33 OCU-24 OCC. THERAPY MONTHLY PACKAGE 31000 38750 41850 46500 46500 34 OCU-34 OCU-23 OCC. THERAPY MONTHLY PACKAGE WITH HYDROTHERAPY 47920 59900 64692 71880 71880 35 OCU-35 OCU-53 ORTHO REHAB LONG CASE (OT) - WEEKLY 6660 8325 8991 9990 9990 36 OCU-36 OCU-55 ORTHO REHAB LONG CASE (PT+OT) - WEEKLY 13320 16650 17982 19980 19980 37 OCU-37 OCU-52 ORTHO REHAB SHORT CASE (OT) - WEEKLY 4680 5850 6318 7020 7020 38 OCU-38 OCU-21 ORTHOPAEDIC REHAB LONG CASE (OT) 1330 1663 1796 1995 1995 39 OCU-39 OCU-22 ORTHOPAEDIC REHAB SHORT CASE (OT) 940 1175 1269 1410 1410 40 OCU-40 OCU-25 PAEDIATRIC REHAB 1000 1250 1350 1500 1500 41 OCU-41 OCU-26 PULLEY / SHOULDER WHEEL / SANDING 350 438 473 525 525

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42 OCU-42 OCU-27 SENSORY RE-EDUCATION 800 1000 1080 1200 1200 43 OCU-43 OCU-39 SHOULDER/ELBOW MOBILIZER 440 550 594 660 660 44 OCU-44 1203 SPLINTING 440 550 594 660 660 45 OCU-45 OCU-28 STIMULATION (OT) 430 538 581 645 645 46 OCU-46 OCU-29 UL STRENGTHENING 610 763 824 915 915 47 OCU-47 1201 ULTRASONIC THERAPY 430 538 581 645 645 48 OCU-48 OCU-30 UPPERTONE 400 500 540 600 600 49 OCU-49 OCCU-300 VEDIC HEALING (PER SESSION) 850 1063 1148 1275 1275 50 OCU-50 OCCU-301 VEDIC HEALING (WEEKLY PACKAGE) 4250 5313 5738 6375 6375 51 OCU-51 OCU-34 VIRTUAL TRAINING 500 625 675 750 750 52 OCU-52 14256 VOLUNTARY TRAINING-OT (MONTHLY) 1320 1650 1782 1980 1980 53 OCU-53 OCU-40 WAX ONE JOINT (OT) 430 538 581 645 645 54 OCU-54 OCU-41 WAX TWO JOINTS (OT) 730 913 986 1095 1095 OCU-32 WHEELCHAIR TRAINING 610 763 824 915 915 OCU-42 WRIST / FINGER MOBILIZATION 440 550 594 660 660 ASSISTIVE TECHNOLOGY Shared Super NEW OLD Single Dlx/Super S.No. Services OPD/GW Room/ICU Dlx. CODE CODE Room Dlx / Suite /HDU Suite 1 AST-1 AST-1 ADAPTED MOUSE 670 838 905 1005 1005 2 AST-2 AST-2 ADAPTIVE AT DEVICE FABRICATION - TYPE-I 910 1138 1229 1365 1365 3 AST-3 AST-3 ADAPTIVE AT DEVICE FABRICATION - TYPE-II 1450 1813 1958 2175 2175 4 AST-4 AST-4 ADL ASSESSMENT 910 1138 1229 1365 1365 5 AST-5 AST-5 ADL DEVICE ADAPTATION 430 538 581 645 645 6 AST-6 AST-6 ADL SPLINT 910 1138 1229 1365 1365 7 AST-7 AST-7 ALTERNATIVE COMMUNICATION - COMMUNICATION BOARD 970 1213 1310 1455 1455 8 AST-8 AST-8 ANTI-TIPPER 2900 3625 3915 4350 4350 9 AST-9 AST-9 ASSESSMENT FOR ALTERNATIVE COMMUNICATION 910 1138 1229 1365 1365 10 AST-10 AST-10 ASSISTIVE TECHNOLOGY CONSULTATION COMPLETE 1820 2275 2457 2730 2730 11 AST-11 AST-11 ASSISTIVE TECHNOLOGY DEVICE REPAIR 550 688 743 825 825 12 AST-12 AT-520 ASSISTIVE TECHNOLOGY REGISTRATION 190 238 257 285 285 13 AST-13 AST-72 AT DEVICE HANDLING & MAINTAINENCE COUNSELLING 850 1063 1148 1275 1275 14 AST-14 AST-12 AT DEVICE TRAINING 670 838 905 1005 1005

Any new service/tariff may be changed/added/deleted without prior notice. 99 Schedule of Charges 2019-20 ISIC

15 AST-15 AST-73 AT SERVICE CHARGES-MINIMUM 360 450 486 540 540 16 AST-16 AST-13 BOTTLE HOLDER 730 913 986 1095 1095 17 AST-17 AST-14 BOUTENNIERE SPLINT 1450 1813 1958 2175 2175 18 AST-18 AST-15 CANE HOLDER 670 838 905 1005 1005 19 AST-19 AST-16 CHIN STICK 1880 2350 2538 2820 2820 20 AST-20 AST-17 COMMUNICATION BOARD 910 1138 1229 1365 1365 21 AST-21 AST-18 COMPUTER ACCESS ASSESSMENT 1090 1363 1472 1635 1635 22 AST-22 AST-19 COMPUTER ACCESSIBILITY TRAINING 610 763 824 915 915 23 AST-23 AST-20 CUSTOMISED ABDUCTOR 910 1138 1229 1365 1365 24 AST-24 AST-21 CUSTOMISED BACK SUPPORT 2420 3025 3267 3630 3630 25 AST-25 AST-22 CUSTOMISED CUSHION 3510 4388 4739 5265 5265 26 AST-26 AST-23 CUSTOMISED LEG/FOOT SUPPORTS 1400 1750 1890 2100 2100 27 AST-27 AST-24 DYNAMIC SPLINT 1760 2200 2376 2640 2640 28 AST-28 AST-25 ECONOMY CUSHION WITHOUT CONTOURED SHAPE 1880 2350 2538 2820 2820 29 AST-29 AST-26 HEAD POINTER 1760 2200 2376 2640 2640 30 AST-30 AST-27 HOME/WORKSITE MODIFICATION GUIDELINES 910 1138 1229 1365 1365 31 AST-31 AST-28 KEYBOARD HAND POINT 1400 1750 1890 2100 2100 32 AST-32 AST-29 LAP TRAY 1820 2275 2457 2730 2730 33 AST-33 AST-30 LATERAL SUPPORT 1090 1363 1472 1635 1635 34 AST-34 AST-31 MANUAL WHEELCHAIR SERVICE 1400 1750 1890 2100 2100 35 AST-35 AST-32 MOBILE HOLDER 1090 1363 1472 1635 1635 36 AST-36 AST-33 MOBILITY AND SEATING PRESCRIPTION 910 1138 1229 1365 1365 37 AST-37 AST-34 MOBILITY ASSESSMENT 910 1138 1229 1365 1365 38 AST-38 AST-35 MOBILITY BASED MODIFICATION 910 1138 1229 1365 1365 39 AST-39 AST-36 MOTORIZED WHEELCHAIR SERVICE 2660 3325 3591 3990 3990 40 AST-40 AST-37 MOUTH STICK 1400 1750 1890 2100 2100 41 AST-41 AST-38 MULTIFUNCTION SPLINT FOR HAND - TYPE COBRA 2000 2500 2700 3000 3000 42 AST-42 AST-39 PAGE TURNER 910 1138 1229 1365 1365 43 AST-43 AT-100 PRESSURE MAPPING ASSESSMENT 1090 1363 1472 1635 1635 44 AST-44 AST-40 REPAIR AND MAINTENANCE - MAJOR 1450 1813 1958 2175 2175 45 AST-45 AST-41 REPAIR AND MAINTENANCE - MINOR 910 1138 1229 1365 1365 46 AST-46 AST-42 SAFETY BELTS 670 838 905 1005 1005

Any new service/tariff may be changed/added/deleted without prior notice. 100 Schedule of Charges 2019-20 ISIC

47 AST-47 AST-43 SEATING & POSSITIONING EVALUATION 910 1138 1229 1365 1365 48 AST-48 13106 SEATING COUNSELLING 910 1138 1229 1365 1365 49 AST-49 AST-44 SPOON/ BRUSH HOLDER 550 688 743 825 825 50 AST-50 AST-45 STATIC SPLINT 1400 1750 1890 2100 2100 51 AST-51 AST-46 SUPPORT STRAPS 670 838 905 1005 1005 52 AST-52 AST-47 SWAN-NECK SPLINT 1450 1813 1958 2175 2175 53 AST-53 AST-48 THUMB SPICA 1450 1813 1958 2175 2175 54 AST-54 AST-49 TRANSFER BOARD (PLASTIC) 2420 3025 3267 3630 3630 55 AST-55 AST-50 TRANSFER BOARD (WOODEN) 2420 3025 3267 3630 3630 56 AST-56 AST-51 TRANSPORTATION MODIFICATION GUIDELINES 910 1138 1229 1365 1365 57 AST-57 AST-52 VOCATIONAL COUNSELLING 360 450 486 540 540 58 AST-58 AST-53 VOICE OPERATING SOFTWARE TRAINING (PACKAGE) 2420 3025 3267 3630 3630 VOICE OPERATING SOFTWARE TRAINING(INSTALLATION & 59 AST-59 AST-54 910 1138 1229 1365 1365 FREE TRIAL) 60 AST-60 AST-55 WHEEL CHAIR HANDLES (BILATERAL) 1450 1813 1958 2175 2175 61 AST-61 AST-56 WHEEL CHAIR MOBILIZATION 550 688 743 825 825 62 AST-62 AST-57 WHEELCHAIR ASSEMBLY & FITTING 670 838 905 1005 1005 63 AST-63 AST-58 WHEELCHAIR ASSESSMENT 910 1138 1229 1365 1365 64 AST-64 AST-59 WHEELCHAIR ASSESSMENT AND PRESCRIPTION 910 1138 1229 1365 1365 65 AST-65 AST-60 WHEELCHAIR ASSESSMENT FOLLOW-UP 910 1138 1229 1365 1365 66 AST-66 AST-61 WHEELCHAIR GLOVES 1090 1363 1472 1635 1635 67 AST-67 AST-62 WHEELCHAIR MOBILIZATION TRAINING: BASIC 910 1138 1229 1365 1365 68 AST-68 AST-63 WHEELCHAIR MODIFICATION 1160 1450 1566 1740 1740 69 AST-69 AST-64 WHEELCHAIR PARTS REPLACEMENT (MAJOR) 1400 1750 1890 2100 2100 70 AST-70 AST-65 WHEELCHAIR PARTS REPLACEMENT (MINOR) 910 1138 1229 1365 1365 71 AST-71 AST-66 WHEELCHAIR PRESCRIPTION 910 1138 1229 1365 1365 72 AST-72 AST-67 WHEELCHAIR PUSH-RIM ADAPTATION 1210 1513 1634 1815 1815 73 AST-73 AST-68 WHEELCHAIR SEATING MODIFICATION 910 1138 1229 1365 1365 74 AST-74 AST-69 WHEELCHAIR TRIAL & FITTING(PACKAGE) 1400 1750 1890 2100 2100 75 AST-75 AST-70 WHEELCHAIR TRIAL & TRAINING(PACKAGE) 1400 1750 1890 2100 2100 76 AST-76 AST-71 WRITING ASSITIVE DEVICE 1400 1750 1890 2100 2100 PSYCHOLOGY PROCEDURES S.No. NEW OLD Services OPD/GW Shared Single Dlx/Super Super

Any new service/tariff may be changed/added/deleted without prior notice. 101 Schedule of Charges 2019-20 ISIC

CODE CODE Room/ICU Room Dlx / Suite Dlx. /HDU Suite 1 PSY-1 PSY-24 CAREER COUNSELLING 5320 6650 7182 7980 7980 2 PSY-2 PSY-01 COGNITIVE REMEDIATION (30 MINS) 770 963 1040 1155 1155 3 PSY-3 PSY-02 CONGNITIVE REMEDIATION (60 MINS) 1100 1375 1485 1650 1650 4 PSY-4 PSY-23 EMOTIONAL ASSESSMENT 4660 5825 6291 6990 6990 5 PSY-5 14896 HYPNOTHERAPY 22000 27500 29700 33000 33000 6 PSY-6 PSY-22 IQ ASSESSMENT 2790 3488 3767 4185 4185 7 PSY-7 PSY-07 NEURO FEEDBACK (LONG SESSION) 1100 1375 1485 1650 1650 8 PSY-8 PSY-06 NEURO FEEDBACK (SHORT SESSION) 940 1175 1269 1410 1410 9 PSY-9 PSY-20 PSYCHOLOGICAL ASSESSMENT (30 MINS) 1200 1500 1620 1800 1800 10 PSY-10 PSY-21 PSYCHOLOGICAL ASSESSMENT (60 MINS) 2400 3000 3240 3600 3600 11 PSY-11 PSY-04 PSYCHOLOGY COUNSELLING 610 763 824 915 915 VOCATIONAL THERAPY PROCEDURES Shared Super NEW OLD Single Dlx/Super S.No. Service OPD/GW Room/ICU Dlx. CODE CODE Room Dlx / Suite /HDU Suite 1 VOC-1 VOC-1 ART & CRAFT 440 550 594 660 660 2 VOC-2 VOC-2 C (NON W/C) 3000 3750 4050 4500 4500 3 VOC-3 VOC-3 C (W/C) 2150 2688 2903 3225 3225 4 VOC-4 VOC-4 C++ (NON W/C) 3430 4288 4631 5145 5145 5 VOC-5 VOC-5 C++ (W/C) 2560 3200 3456 3840 3840 6 VOC-6 VOC-6 CA & C (NON W/C) 4500 5625 6075 6750 6750 7 VOC-7 VOC-7 CA & C (W/C) 3430 4288 4631 5145 5145 8 VOC-8 VOC-8 CA & MSO & NET (NON W/C) 4280 5350 5778 6420 6420 9 VOC-9 VOC-9 CA & MSO & NET (W/C) 3220 4025 4347 4830 4830 10 VOC-10 VOC-10 CA & WD (NON W/C) 4930 6163 6656 7395 7395 11 VOC-11 VOC-11 CA & WD (W/C) 3860 4825 5211 5790 5790 12 VOC-12 VOC-12 CA &C++ (NON W/C) 4940 6175 6669 7410 7410 13 VOC-13 VOC-13 CAC (NON W/C) 1510 1888 2039 2265 2265 14 VOC-14 VOC-14 CLAY THERAPY 440 550 594 660 660 15 VOC-15 VOC-15 COMPUTER ADVANCE COURSE NON W/C 4930 6163 6656 7395 7395 16 VOC-16 VOC-16 COMPUTER ADVANCE COURSE W/C 3860 4825 5211 5790 5790 17 VOC-17 VOC-17 COMPUTER BASIC COURSE NON W/C 4280 5350 5778 6420 6420

Any new service/tariff may be changed/added/deleted without prior notice. 102 Schedule of Charges 2019-20 ISIC

18 VOC-18 VOC-18 COMPUTER BASIC COURSE W/C (1 MONTH) 2150 2688 2903 3225 3225 19 VOC-19 VOC-19 COMPUTER BASIC COURSE W/C (3 MONTHS) 5370 6713 7250 8055 8055 20 VOC-20 VOC-20 COMPUTER BASIC PROGRAMMING NON W/C 8570 10713 11570 12855 12855 21 VOC-21 VOC-21 COMPUTER BASIC PROGRAMMING W/C 4280 5350 5778 6420 6420 22 VOC-22 VOC-22 INTERNET SURFING CHARGES (1 MONTH) 2150 2688 2903 3225 3225 23 VOC-23 VOC-23 INTERNET SURFING CHARGES (1/2 HR.) 70 88 95 105 105 24 VOC-24 VOC-24 INTERNET SURGING CHARGES (1 HR.) 110 138 149 165 165 25 VOC-25 VOC-25 MSO & INTERNET (NON W/C) 2790 3488 3767 4185 4185 26 VOC-26 VOC-26 MSO & INTERNET (W/C) 1930 2413 2606 2895 2895 27 VOC-27 VOC-27 TYPING (1 HR.) 110 138 149 165 165 28 VOC-28 VOC-28 TYPING (1/2 HR.) 70 88 95 105 105 29 VOC-29 VOC-29 W D (NON W/C) 3430 4288 4631 5145 5145 30 VOC-30 VOC-30 W D (W/C) 2560 3200 3456 3840 3840 GERIATRIC CLINIC (ATTENTION & MEMORY) Shared Super NEW OLD Single Dlx/Super S.No. Service OPD/GW Room/ICU Dlx. CODE CODE Room Dlx / Suite /HDU Suite 1 GERI-1 1901 ANKLE TOE MOVEMENTS 130 163 176 195 195 ATTENTION & MEMORY DISORDERS REHAB CLINIC FIRST 2 GERI-2 GR-12995 1210 1513 1634 1815 1815 CONS - GERI REHAB ATTENTION & MEMORY DISORDERS REHAB CLINIC 3 GERI-3 GR-13007 800 1000 1080 1200 1200 FOLLOWUP CONS - GERI REHAB 4 GERI-4 1902 BALANCE TRAINING 220 275 297 330 330 5 GERI-5 13158 BASIC ADL TRAINING 530 663 716 795 795 6 GERI-6 GERI-550 COMA STIMULATION (ICU) 800 1000 1080 1200 1200 7 GERI-7 14893 COMMA ASSESSMENT 440 550 594 660 660 8 GERI-8 14894 COMMA MANAGEMENT 440 550 594 660 660 9 GERI-9 1903 COORDINATION EXERCISE 220 275 297 330 330 10 GERI-10 1904 COORDINATION TESTING 220 275 297 330 330 11 GERI-11 1905 FINGER EXERCISE 220 275 297 330 330 12 GERI-12 1906 GAIT EXERCISE 220 275 297 330 330 13 GERI-13 1907 GAIT TRAINING 650 813 878 975 975 14 GERI-14 13159 IADL TRAINING 480 600 648 720 720 15 GERI-15 13155 MANAGEMENT OF APRAXIA 480 600 648 720 720

Any new service/tariff may be changed/added/deleted without prior notice. 103 Schedule of Charges 2019-20 ISIC

16 GERI-16 13152 MANAGEMENT OF COGNITION 480 600 648 720 720 17 GERI-17 13154 MANAGEMENT OF EXECUTIVE FUNCTIONS 480 600 648 720 720 18 GERI-18 13153 MANAGEMENT OF PERCEPTION 480 600 648 720 720 19 GERI-19 1908 MAT EXERCISE 220 275 297 330 330 20 GERI-20 14164 MONTHLY PT&OT PACKAGE 50600 63250 68310 75900 75900 21 GERI-21 13157 MULTISENSORY STIMULATION 480 600 648 720 720 22 GERI-22 1919 NEUROLOGICAL ASESSMENT & HOME PROGRAM 1460 1825 1971 2190 2190 23 GERI-23 1917 NEUROLOGICAL ASSESSMENT 730 913 986 1095 1095 24 GERI-24 1918 NEUROLOGICAL MANAGEMENT 800 1000 1080 1200 1200 25 GERI-25 14165 NEUROLOGICAL REHAB LONG CASE (OT) 1330 1663 1796 1995 1995 26 GERI-26 14166 NEUROLOGICAL REHAB SHORT CASE (OT) 940 1175 1269 1410 1410 27 GERI-27 14892 ORAL MOTOR THERAPY 440 550 594 660 660 28 GERI-28 14167 OT MONTHLY PACKAGE 31460 39325 42471 47190 47190 29 GERI-29 1909 PASSIVE/ACTIVE/ACTIVE ASSISTED 220 275 297 330 330 30 GERI-30 1910 PELVIC FLEXION EXERCISE 220 275 297 330 330 31 GERI-31 1911 POST POLIO EXERCISE 220 275 297 330 330 32 GERI-32 1912 POSTURE CORRECTION 220 275 297 330 330 33 GERI-33 1913 POSTURE EXAMINATION 220 275 297 330 330 34 GERI-34 1914 STRENGTHENING EXERCISE 220 275 297 330 330 35 GERI-35 1915 STRETCHING EXERCISE 220 275 297 330 330 36 GERI-36 1916 UPPER LIMB STRENGTHENING 220 275 297 330 330 37 GERI-37 13156 VIRTUAL REALITY TRAINING (COGNITION & PERCEPTION) 480 600 648 720 720 GERIATRIC CLINIC (FALL PREVENTION) Shared Super NEW OLD Single Dlx/Super Service OPD/GW Room/ICU Dlx. CODE CODE Room Dlx / Suite /HDU Suite 1 GERI-38 14197 BALANCE MASTER 1070 1338 1445 1605 1605 2 GERI-39 14198 BIOFEED BACK 1100 1375 1485 1650 1650 3 GERI-40 GERI-144 BLADDER TRAINING (10 SESSIONS) 8660 10825 11691 12990 12990 4 GERI-41 GERI-145 BLADDER TRAINING (15 SESSIONS) 11980 14975 16173 17970 17970 5 GERI-42 GERI-146 BLADDER TRAINING (20 SESSIONS) 14640 18300 19764 21960 21960 6 GERI-43 14199 CYCLING 430 538 581 645 645 7 GERI-44 14200 EXERCISE DEMOSTRATION(PT) 440 550 594 660 660

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8 GERI-45 14201 EXERCISES THERAPY SHORT CASE 650 813 878 975 975 FALL RISK ASSESSMENT & FALL PREVENTION CLINIC FIRST 9 GERI-46 GR-12993 1100 1375 1485 1650 1650 CONS - GERI REHAB FALL RISK ASSESSMENT & FALL PREVENTION CLINIC 10 GERI-47 GR-13005 740 925 999 1110 1110 FOLLOWUP CONS - GERI REHAB 11 GERI-48 14202 FUNCTIONAL ELECTRICAL STIMULATOR (FES) 1070 1338 1445 1605 1605 12 GERI-49 14203 GAIT TRAINING 650 813 878 975 975 13 GERI-50 14204 HOT & COLD PACK (PT) 430 538 581 645 645 14 GERI-51 14205 HYDROTHERAPY (PT) 660 825 891 990 990 15 GERI-52 14206 HYDROTHERAPY WEEKLY (PT) 3300 4125 4455 4950 4950 16 GERI-53 14207 IFT 430 538 581 645 645 17 GERI-54 14208 LASER 550 688 743 825 825 18 GERI-55 14209 MASS PRACTICE WITH STIMULATION 570 713 770 855 855 MONTHLY PACKAGE PT & OT-VALID 1 MONTH(NON- 19 GERI-56 14210 50600 63250 68310 75900 75900 REFUNDABLE) 20 GERI-57 14211 PAIN PACKAGE-WEEKLY-VALID 6 DAYS(NON-REFUNDABLE) 7520 9400 10152 11280 11280 21 GERI-58 13210 PHY 21 HYDROTHERAPY 660 825 891 990 990 22 GERI-59 13211 PHY 22 HYDROTHERAPY: WEEKLY 3250 4063 4388 4875 4875 23 GERI-60 13209 PHY 53 VIRTUAL REALITY 500 625 675 750 750 24 GERI-61 14212 PHYSIOTHERAPY MONTHLY PACKAGE 31000 38750 41850 46500 46500 PHYSIOTHERAPY MONTHLY PACKAGE INCLUDING 25 GERI-62 14213 47190 58988 63707 70785 70785 HYDROTHERAPY 26 GERI-63 14919 RECONDITIONING SHORT CASE SESSION: 14 SESSIONS 9080 11350 12258 13620 13620 27 GERI-64 14920 RECONDITIONING SHORT CASE SESSION: 28 SESSIONS 18150 22688 24503 27225 27225 28 GERI-65 14918 RECONDITIONING SHORT CASE SESSION: 7 SESSIONS 4660 5825 6291 6990 6990 29 GERI-66 13208 RECONDITIONING: LONG CASE 14 SESSIONS 13180 16475 17793 19770 19770 30 GERI-67 13206 RECONDITIONING: LONG CASE 28 SESSIONS 24200 30250 32670 36300 36300 31 GERI-68 13207 RECONDITIONING: LONG CASE SESSIONS 6590 8238 8897 9885 9885 32 GERI-69 13205 RECONDITIONING: PER VISIT 1030 1288 1391 1545 1545 33 GERI-70 14214 STANDING FRAME 430 538 581 645 645 34 GERI-71 14215 STIMULATION (PT) 430 538 581 645 645 35 GERI-72 14216 TENS 430 538 581 645 645 36 GERI-73 14217 TILT TABLE 670 838 905 1005 1005 37 GERI-74 14218 TREADMILL 670 838 905 1005 1005

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38 GERI-75 14219 ULTRASONIC 430 538 581 645 645 39 GERI-76 14220 UNWEIGHING HARNESS 1100 1375 1485 1650 1650 40 GERI-77 14221 VIRTUAL TRAINING 500 625 675 750 750 41 GERI-78 14222 VOLUNTEER PT (MONTHLY) 3540 4425 4779 5310 5310 GERIATRIC CLINIC (HEART & LUNG) Shared Super NEW OLD Single Dlx/Super S.No. Service OPD/GW Room/ICU Dlx. CODE CODE Room Dlx / Suite /HDU Suite 1 GERI-79 14629 BALANCE MASTER 1070 1338 1445 1605 1605 2 GERI-80 14612 BED SIDE OT LONG CASE 940 1175 1269 1410 1410 3 GERI-81 14614 BED SIDE SHORT CASE (PT) 730 913 986 1095 1095 4 GERI-82 14607 BEDSIDE LONG CASE (PT) 940 1175 1269 1410 1410 5 GERI-83 14643 BIOFEED BACK 1100 1375 1485 1650 1650 6 GERI-84 13199 BREATHING RETRAINING PROGRAM: FORTNIGHT 3690 4613 4982 5535 5535 7 GERI-85 13200 BREATHING RETRAINING PROGRAM: MONTHLY 7380 9225 9963 11070 11070 8 GERI-86 13197 BREATHING RETRAINING PROGRAM: PER VISIT 410 513 554 615 615 9 GERI-87 13198 BREATHING RETRAINING PROGRAM: WEEKLY 2050 2563 2768 3075 3075 10 GERI-88 13203 CARDIO AND WEIGHT TRAINING: FORTNIGHT 2880 3600 3888 4320 4320 11 GERI-89 13204 CARDIO AND WEIGHT TRAINING: MONTHLY 8700 10875 11745 13050 13050 12 GERI-90 13201 CARDIO AND WEIGHT TRAINING: PER VISIT 480 600 648 720 720 13 GERI-91 13202 CARDIO AND WEIGHT TRAINING: WEEKLY 2410 3013 3254 3615 3615 14 GERI-92 14649 CHEST PHYSIOTHERAPY (BEDSIDE) 600 750 810 900 900 15 GERI-93 14630 CHEST PHYSIOTHERAPY (WITH SUCTION) 1080 1350 1458 1620 1620 16 GERI-94 14654 CPM BILATERAL 1210 1513 1634 1815 1815 17 GERI-95 14631 CPM UNILATERAL 750 938 1013 1125 1125 18 GERI-96 14617 CYCLING 430 538 581 645 645 19 GERI-97 14632 DIADENS 610 763 824 915 915 20 GERI-98 14656 DRY NEEDLING 1000 1250 1350 1500 1500 21 GERI-99 14657 DRY NEEDLING+TAPING (PACKAGE) 1250 1563 1688 1875 1875 22 GERI-100 14634 EVALUATION (PT) 610 763 824 915 915 23 GERI-101 14635 EXERCISE DEMONSTRATION (PT) 440 550 594 660 660 24 GERI-102 14645 EXERCISES THERAPY SHORT CASE 650 813 878 975 975 25 GERI-103 14651 FUNCTIONAL ELECTRICAL STIMULATOR (FES) 1070 1338 1445 1605 1605

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26 GERI-104 14636 GAIT TRAINING 650 813 878 975 975 27 GERI-105 GR-12994 HEART & LUNG REHAB CLINIC FIRST CONS - GERI REHAB 730 913 986 1095 1095 HEART & LUNG REHAB CLINIC FOLLOWUP CONS - GERI 28 GERI-106 GR-13006 730 913 986 1095 1095 REHAB 29 GERI-107 14616 HOT / COLD PACK (PT) 430 538 581 645 645 30 GERI-108 14618 IFT 430 538 581 645 645 31 GERI-109 14633 LASER 550 688 743 825 825 32 GERI-110 14619 MWD 430 538 581 645 645 33 GERI-111 14637 NEURO REHAB LONG CASE (PT) - 1 SESSION 1300 1625 1755 1950 1950 34 GERI-112 14661 NEURO REHAB LONG CASE (PT) - WEEKLY 6660 8325 8991 9990 9990 35 GERI-113 14662 NEURO REHAB SHORT CASE (PT) - WEEKLY 4680 5850 6318 7020 7020 36 GERI-114 14638 NEURO REHAB SHORT CASE (PT) 1 SESSION 940 1175 1269 1410 1410 37 GERI-115 14665 NEURO REHAB WEEKLY PACKAGE (PT+OT)) 13320 16650 17982 19980 19980 38 GERI-116 14664 ORTHO REHAB LONG CASE (PT) - WEEKLY 6660 8325 8991 9990 9990 39 GERI-117 14639 ORTHO REHAB LONG CASE (PT) 1330 1663 1796 1995 1995 40 GERI-118 14663 ORTHO REHAB SHORT CASE (PT) - WEEKLY 4680 5850 6318 7020 7020 41 GERI-119 14640 ORTHO REHAB SHORT CASE (PT) 940 1175 1269 1410 1410 42 GERI-120 14666 ORTHO REHAB WEEKLY PACKAGE (PT+OT) 13320 16650 17982 19980 19980 43 GERI-121 14646 PAIN PACKAGE-WEEKLY-VALID 6 DAYS(NON-REFUNDABLE) 7520 9400 10152 11280 11280 44 GERI-122 13210 PHY 21 HYDROTHERAPY 660 825 891 990 990 45 GERI-123 13211 PHY 22 HYDROTHERAPY: WEEKLY 3300 4125 4455 4950 4950 46 GERI-124 13209 PHY 53 VIRTUAL REALITY 500 625 675 750 750 47 GERI-125 14647 PHYSIOTHERAPY MONTHLY PACKAGE 31000 38750 41850 46500 46500 PHYSIOTHERAPY MONTHLY PACKAGE INCLUDING 48 GERI-126 14650 47190 58988 63707 70785 70785 HYDROTHERAPY 49 GERI-127 13208 RECONDITIONING: FORTNIGHT 7250 9063 9788 10875 10875 50 GERI-128 13208 RECONDITIONING: MONTHLY 14500 18125 19575 21750 21750 51 GERI-129 13205 RECONDITIONING: PER VISIT 800 1000 1080 1200 1200 52 GERI-130 13206 RECONDITIONING: WEEKLY 4030 5038 5441 6045 6045 53 GERI-131 14611 Sensory Re-education 0 0 0 0 0 54 GERI-132 14653 SPORTS THERAPY WEEKLY 800 1000 1080 1200 1200 55 GERI-133 14620 STANDING FRAME 430 538 581 645 645 56 GERI-134 14621 STIMULATION (PT) 430 538 581 645 645

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57 GERI-135 14609 SUCTIONING 280 350 378 420 420 58 GERI-136 14622 SWD 430 538 581 645 645 59 GERI-137 14652 TAPING PER AREA 850 1063 1148 1275 1275 60 GERI-138 14623 TENS 430 538 581 645 645 61 GERI-139 14615 THERAPEUTIC RIDING 1000 1250 1350 1500 1500 62 GERI-140 14624 TILT TABLE 670 838 905 1005 1005 63 GERI-141 14625 TRACTION 430 538 581 645 645 64 GERI-142 14642 TREADMILL 670 838 905 1005 1005 65 GERI-143 14626 ULTRASONIC 430 538 581 645 645 66 GERI-144 14644 UNWEIGHING HARNESS 1100 1375 1485 1650 1650 67 GERI-145 14608 VIBRATOR (20 MIN) 350 438 473 525 525 68 GERI-146 14627 WAX ONE JOINT (PT) 430 538 581 645 645 69 GERI-147 14628 WAX TWO JOINTS (PT) 730 913 986 1095 1095 GERIATRIC CLINIC (JOINT REPLACEMENT) Shared Super NEW OLD Single Dlx/Super S.No. Service OPD/GW Room/ICU Dlx. CODE CODE Room Dlx / Suite /HDU Suite 1 GERI-148 13895 BALANCE MASTER-SIRFC 1070 1338 1445 1605 1605 2 GERI-149 JRC-02 BED SIDE SHORT CASE (JRC) 730 913 986 1095 1095 3 GERI-150 JRC-01 BEDSIDE LONG CASE (JRC) 940 1175 1269 1410 1410 4 GERI-151 JRC-03 CHEST PHYSIOTHERAPY (BEDSIDE-JRC) 660 825 891 990 990 5 GERI-152 13935 CONSULTATION FEE-SIRFC 660 825 891 990 990 6 GERI-153 13936 CORE TRAINING MONTHLY-SIRFC 3660 4575 4941 5490 5490 7 GERI-154 JRC-04 CPM BILATERAL 1200 1500 1620 1800 1800 8 GERI-155 JRC-05 CPM UNILATERAL 750 938 1013 1125 1125 9 GERI-156 JRC-06 CYCLING-JRC 430 538 581 645 645 10 GERI-157 JRC-07 EXERCISE THERAPY SHORT CASE-(JRC) 650 813 878 975 975 11 GERI-158 GERI-JR-3 EXERCISES 400 500 540 600 600 12 GERI-159 13937 EXERCISE-SIRFC 400 500 540 600 600 FROZEN SHOULDER THERAPY PKG FOR RESEARCH(24 13 GERI-160 GERI-199 8720 10900 11772 13080 13080 SESSIONS/3 MONTHS) 14 GERI-161 JRC-10 GAIT TRAINING-(JRC ) 650 813 878 975 975 15 GERI-162 14004 HOME PROGRAM WITH SUPERVISED FOLLOW UP 3990 4988 5387 5985 5985 16 GERI-163 GERI-JR-1 HOT PACK/COLD PACK 430 538 581 645 645

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17 GERI-164 13938 HOT PACK/COLD PACK-SIRFC 430 538 581 645 645 18 GERI-165 13939 HYDROTHERAPY-SIRFC 660 825 891 990 990 19 GERI-166 13940 HYDROTHERAPY-WEEKLY-SIRFC 3250 4063 4388 4875 4875 20 GERI-167 13941 IFT-SIRFC 430 538 581 645 645 JOINT REPLACEMENT REHAB CLINIC FIRST CONS- GERI 21 GERI-168 GR-12992 660 825 891 990 990 REHAB JOINT REPLACEMENT REHAB CLINIC FOLLOWUP CONS- GERI 22 GERI-169 GR-13004 660 825 891 990 990 REHAB 23 GERI-170 13942 LASER-SIRFC 550 688 743 825 825 24 GERI-171 13943 MOBILIZATION/SOFT TISSUE MANIPULATION-SIRFC 520 650 702 780 780 25 GERI-172 13944 MWD-SIRFC 430 538 581 645 645 26 GERI-173 13945 NINTENDO-SIRFC 440 550 594 660 660 27 GERI-174 JRC-08 ORTHO REHAB LONG CASE (JRC) 1330 1663 1796 1995 1995 28 GERI-175 JRC-09 ORTHO REHAB SHORT CASE (PT) 940 1175 1269 1410 1410 29 GERI-176 13949 PACKAGE BILATERAL JOINT/TWO JOINT 1 WEEK-SIRFC 10250 12813 13838 15375 15375 30 GERI-177 13950 PACKAGE BILATERAL JOINT/TWO JOINT FORTNIGHT-SIRFC 21970 27463 29660 32955 32955 31 GERI-178 13951 PACKAGE BILATERAL JOINT/TWO JOINT MONTHLY-SIRFC 43920 54900 59292 65880 65880 32 GERI-179 13952 PACKAGE SINGLE JOINT 1 WEEK-SIRFC 7330 9163 9896 10995 10995 33 GERI-180 13953 PACKAGE SINGLE JOINT FORTNIGHT-SIRFC 14640 18300 19764 21960 21960 34 GERI-181 13954 PACKAGE SINGLE JOINT MONTHLY-SIRFC 29280 36600 39528 43920 43920 35 GERI-182 14021 PHY 21 HYDROTHERAPY 660 825 891 990 990 36 GERI-183 14022 PHY 22 HYDROTHERAPY:WEEKLY 3250 4063 4388 4875 4875 37 GERI-184 14023 PHY 53 VIRTUAL REALITY 500 625 675 750 750 PRESSURE BIOFEEDBACK UNIT TESTING AND TRAINING- 38 GERI-185 13946 220 275 297 330 330 SIRFC 39 GERI-186 13947 PWB ONE JOINT-SIRFC 430 538 581 645 645 40 GERI-187 13948 PWB TWO JOINT-SIRFC 730 913 986 1095 1095 41 GERI-188 14024 RECONDITIONING:FORTNIGHT 6590 8238 8897 9885 9885 42 GERI-189 14025 RECONDITIONING:MONTHLY 13180 16475 17793 19770 19770 43 GERI-190 14026 RECONDITIONING:PER VISIT 740 925 999 1110 1110 44 GERI-191 14027 RECONDITIONING:WEEKLY 3660 4575 4941 5490 5490 45 GERI-192 13955 SWD-SIRFC 430 538 581 645 645 46 GERI-193 13956 SWISS BALL TRAINING-SIRFC 520 650 702 780 780 47 GERI-194 13957 TAPING PER AREA-SIRFC 850 1063 1148 1275 1275

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48 GERI-195 13958 TENS-SIRFC 430 538 581 645 645 49 GERI-196 13959 THERA BAND EXERCISE MONTHLY-SIRFC 3660 4575 4941 5490 5490 50 GERI-197 13960 TRACTION-SIRFC 430 538 581 645 645 51 GERI-198 GERI-JR-2 ULTRASONIC 430 538 581 645 645 52 GERI-199 13961 US-SIRFC 430 538 581 645 645 SHOULDER CLINIC PROCEDURES Shared Super NEW OLD Single Dlx/Super S.No. Service OPD/GW Room/ICU Dlx. CODE CODE Room Dlx / Suite /HDU Suite FROZEN SHOULDER THERAPY PKG FOR RESEARCH(24 1 SC-01 SC-12 8720 10900 11772 13080 13080 SESSIONS/3 MONTHS) 2 SC-02 SC-09 SHOULDER CLINIC- PACKAGE- EXT. (1 WEEK/ 3 SESSIONS) 2000 2500 2700 3000 3000 3 SC-03 SC-07 SHOULDER CLINIC- PACKAGE-I (2 WEEKS/ 6 SESSIONS) 4330 5413 5846 6495 6495 4 SC-04 SC-08 SHOULDER CLINIC- PACKAGE-II (4 WEEKS/ 12 SESSIONS) 8650 10813 11678 12975 12975 5 SC-05 SC-05 SHOULDER CLINIC-EMG ASSESSMENT- SC 400 500 540 600 600 6 SC-06 SC-06 SHOULDER CLINIC-EMG BIOFEEDBACK TRAINING- SC 930 1163 1256 1395 1395 7 SC-07 SC-03 SHOULDER CLINIC-EVALUATION CHARGES 470 588 635 705 705 8 SC-08 SC-04 SHOULDER CLINIC-EXERCISE DEMONSTRATION CHARGES 400 500 540 600 600 SHOULDER CLINIC-POST OPERATIVE- LONG PACKAGE (12 9 SC-09 SC-11 7990 9988 10787 11985 11985 SESSIONS) SHOULDER CLINIC-POST OPERATIVE- SHORT PACKAGE (6 10 SC-10 SC-10 3990 4988 5387 5985 5985 SESSIONS) TELE REHABILITATION Shared Super NEW OLD Single Dlx/Super S.No. Service OPD/GW Room/ICU Dlx. CODE CODE Room Dlx / Suite /HDU Suite 1 TELE-1 14332 BALANCE EXERCISE(SITTING) 1 MONTH(4 Consultations) 1980 2475 2673 2970 2970 2 TELE-2 14335 BALANCE EXERCISE(STANDING) 1 MONTH(4 Consultations) 2200 2750 2970 3300 3300 3 TELE-3 14341 BED MOBILITY EXERCISES 1 MONTH(4 Consultations) 1980 2475 2673 2970 2970 4 TELE-4 14359 BREATHING RETRAINING PROGRAM 1 MONTH(4 Consultations) 3080 3850 4158 4620 4620 5 TELE-5 14344 CORE STRENGTHENING EXERCISE 1 MONTH(4 Consultations) 1100 1375 1485 1650 1650 6 TELE-6 14342 CORE STRENGTHENING EXERCISE 6 WEEKS(6 Consultations) 1540 1925 2079 2310 2310 7 TELE-7 TELE-02 E-HOME MODIFICATION FOLLOW-UP SERVICE(1 Consultation) 390 488 527 585 585 8 TELE-8 14378 FOLLOW-UP CARE/MONITORING/REVIEW(1 Consultation) 330 413 446 495 495 9 TELE-9 14338 GAIT TARINING/WALKING EXERCISE 1 MONTH(4 Consultations) 2420 3025 3267 3630 3630

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10 TELE-10 14356 HAND THERAPY 1 MONTH(4 Consultations) 1650 2063 2228 2475 2475 11 TELE-11 14371 HIGH PARA THERAPY PROGRAM 1 MONTH(4 Consultations) 4180 5225 5643 6270 6270 HIGH TETRAPLEGIA THERAPY PROGRAM 1 MONTH(4 12 TELE-12 14365 2860 3575 3861 4290 4290 Consultations) 13 TELE-13 TELE-03 INTL-E-REHAB CONSULTATION 1190 1488 1607 1785 1785 INTL-HOME MODIFICATION FOLLOW-UP SERVICE(1 14 TELE-14 TELE-56 460 575 621 690 690 CONSULTATION) 15 TELE-15 14374 LOW PARA THERAPY PROGRAM 1 MONTH(4 Consultations) 2860 3575 3861 4290 4290 LOW TETRAPLEGIA THERAPY PROGRAME 1 MONTH(4 16 TELE-16 14368 4180 5225 5643 6270 6270 Consultations) MOTOR INCOMPLETE SCI THERAPY PROGRAM 1 MONTH(4 17 TELE-17 14377 4180 5225 5643 6270 6270 Consultations) NEUROLOGICAL SHORT CASE FOLLOW-UP REHAB CARE 1 18 TELE-18 14329 2200 2750 2970 3300 3300 MONTH(4 Consultations) NEUROLOGY LONG CASE FOLLOW-UP REHAB CARE 1 19 TELE-19 14327 4180 5225 5643 6270 6270 MONTH(4 Consultations) O-FRAME PARALLELBAR/WALKER/CRUTCHES ASSISTED 20 TELE-20 14347 2200 2750 2970 3300 3300 EXERCISE 1 MONTH ORTHO LONG CASE FOLLOW-UP REHAB CARE 1 MONTH(4 21 TELE-21 14323 4180 5225 5643 6270 6270 Consultations) ORTHO SHORT CASE FOLLOW-UP REHAB CARE 1 MONTH(4 22 TELE-22 14325 2200 2750 2970 3300 3300 Consultations) 23 TELE-23 TELE-01 REHAB FOLLOW-UP CONSULTATION (3 Consultations) 990 1238 1337 1485 1485 STRENGTHENING PRORAM (UPPER/LOWER LIMB/TRUNK)1 24 TELE-24 14321 2200 2750 2970 3300 3300 MONTH(4 Consultations) STRETCHING EXERCISES(BACK/LOWER LIMB) 1 MONTH(4 25 TELE-25 14350 1980 2475 2673 2970 2970 Consultations) THERABAND EXERICISE(UPPER/LOWER LIMB)1 MONTH(4 26 TELE-26 14353 2420 3025 3267 3630 3630 Consultations)

Charges Basis

OPD/GW 100%

HDU+ICU (all categories) 125%

Shared 125%

Single 135%

Dlx 150%

Spr. Dlx 150%

Suite 150%

Spr. Dlx Suite 150%

Any new service/tariff may be changed/added/deleted without prior notice. 111 Schedule of Charges 2019-20 ISIC

GERIATRIC REHABE PROCEDURE

Shared Super NEW OLD Single Dlx/Super S.No. Service OPD/GW Room/ICU Dlx. CODE CODE Room Dlx / Suite /HDU Suite 1 GR-01 GR-01 MYOFASCIAL RELEASE (LONG CASE-6 DAYS) 6600 8250 8910 9900 9900 2 GR-02 GR-02 MYOFASCIAL RELEASE (LONG CASE-SINGLE SESSION) 1320 1650 1782 1980 1980 3 GR-03 GR-03 MYOFASCIAL RELEASE (PER AREA-6 DAYS) 3250 4063 4388 4875 4875 4 GR-04 GR-04 MYOFASCIAL RELEASE (PER AREA-SINGLE SESSION) 660 825 891 990 990 5 GR-05 GR-05 MYOFASCIAL RELEASE (TWO AREA-6 DAYS) 5000 6250 6750 7500 7500 6 GR-06 GR-06 MYOFASCIAL RELEASE (TWO AREA-SINGLE SESSION) 1000 1250 1350 1500 1500 Charges Basis

OPD/GW 100%

HDU+ICU (all categories) 125%

Shared 125%

Single 135%

Dlx 150%

Spr. Dlx 150%

Suite 150%

Spr. Dlx Suite 150%

Note :- Above Charge basis would also be applicable on all newly added services ADVANCE REHAB MANAGEMENT SERVICES Shared Super NEW OLD Single Dlx/Super S.No. Services OPD/GW Room/ICU Dlx. CODE CODE Room Dlx / Suite /HDU Suite 1 ARM-01 ARM-02 ACTIVITIES 830 830 830 830 830 2 ARM-02 ARM-03 ADL TRAINING 830 830 830 830 830 ADVANCED FUNCTIONAL MOBILITY PACKAGE(VALID FOR 1 3 ARM-03 ARM-01 77000 77000 77000 77000 77000 MONTH) 4 ARM-04 15730 BALANCE & POSTURE TRAINING (SITTING) - PER SESSION 1100 1100 1100 1100 1100 5 ARM-05 16222 BALANCE & POSTURE TRAINING (SITTING)- (15 SESSIONS) 14850 14850 14850 14850 14850 BALANCE & POSTURE TRAINING (SITTING)- WEEKLY (6 6 ARM-06 16217 6050 6050 6050 6050 6050 SESSIONS) BALANCE & POSTURE TRAINING (SITTING+STANDING) - PER 7 ARM-07 15731 1650 1650 1650 1650 1650 SESSION

Any new service/tariff may be changed/added/deleted without prior notice. 112 Schedule of Charges 2019-20 ISIC

8 ARM-08 15729 BALANCE & POSTURE TRAINING (STANDING) - PER SESSION 1100 1100 1100 1100 1100 9 ARM-09 16216 BALANCE & POSTURE TRAINING (STANDING)- (15 SESSIONS) 14850 14850 14850 14850 14850 BALANCE & POSTURE TRAINING (STANDING)- WEEKLY (6 10 ARM-10 16215 6050 6050 6050 6050 6050 SESSIONS) 11 ARM-11 ARM-04 BALANCE MASTER 1600 1600 1600 1600 1600 12 ARM-12 ARM-05 BED SIDE SHORT CASE (PT) 1090 1090 1090 1090 1090 13 ARM-13 ARM-06 BEDSIDE LONG CASE (PT) 1400 1400 1400 1400 1400 14 ARM-14 ARM-07 BIOFEED BACK 1630 1630 1630 1630 1630 15 ARM-15 ARM-08 CAR DRIVING TRAINING 1270 1270 1270 1270 1270 16 ARM-16 ARM-09 CHEST PHYSIOTHERAPY (BEDSIDE) 990 990 990 990 990 17 ARM-17 ARM-10 CHEST PHYSIOTHERAPY (WITH SUCTION) 1620 1620 1620 1620 1620 18 ARM-18 ARM-11 CLAY THERAPY 730 730 730 730 730 19 ARM-19 ARM-12 COGNITIVE THERAPY 1500 1500 1500 1500 1500 20 ARM-20 ARM-13 COMA STIMULATION (ICU) 1200 1200 1200 1200 1200 COMBINED PACKAGE BALANCE & POSTURE TRAINING 21 ARM-21 ARP-100 28600 28600 28600 28600 28600 STANDING & WALKER VIEW (15 SESSIONS) 22 ARM-22 15722 COMPUTERISED FUNCTIONAL ASSESSMENT (PER SESSION) 1650 1650 1650 1650 1650 23 ARM-23 ARM-14 CONSULTATION HOD REHAB 1270 1270 1270 1270 1270 24 ARM-24 ARM-15 CPM BILATERAL 1820 1820 1820 1820 1820 25 ARM-25 ARM-16 CPM UNILATERAL 1190 1190 1190 1190 1190 26 ARM-26 ARM-17 CYCLING 680 680 680 680 680 27 ARM-27 ARM-18 DIADENS 910 910 910 910 910 28 ARM-28 ARM-19 DRY NEEDLING 1630 1630 1630 1630 1630 29 ARM-29 ARM-20 DRY NEEDLING+TAPING (PACKAGE) 2000 2000 2000 2000 2000 30 ARM-30 ARM-21 DYSPHASIA RX 1270 1270 1270 1270 1270 31 ARM-31 ARM-22 EVALUATION OT 910 910 910 910 910 32 ARM-32 ARM-23 EXERCISE DEMONSTRATION (PT) 660 660 660 660 660 33 ARM-33 ARM-24 EXERCISES THERAPY SHORT CASE 1010 1010 1010 1010 1010 34 ARM-34 ARM-25 FUNCTIONAL ELECTRICAL STIMULATOR (FES) 1600 1600 1600 1600 1600 35 ARM-35 ARM-26 GAIT TRAINING 1010 1010 1010 1010 1010 36 ARM-36 ARM-27 GROUP THERAPY WEEKLY PKG. (YOGA & W/C SKILL TRG.) 1400 1400 1400 1400 1400 37 ARM-37 ARM-28 GYM (15 DAYS) 3630 3630 3630 3630 3630 38 ARM-38 ARM-29 GYM (PER SITTING) 590 590 590 590 590

Any new service/tariff may be changed/added/deleted without prior notice. 113 Schedule of Charges 2019-20 ISIC

39 ARM-39 ARM-30 GYM MONTHALY PACKAGE 6600 6600 6600 6600 6600 40 ARM-40 ARM-31 HOT / COLD PACK (PT) 640 640 640 640 640 41 ARM-41 ARM-32 HYDROTHERAPY ( THRICE A WEEK/ALTERNATIVE DAYS ) 2970 2970 2970 2970 2970 42 ARM-42 ARM-33 HYDROTHERAPY (OT) 1070 1070 1070 1070 1070 43 ARM-43 ARM-34 HYDROTHERAPY WEEKLY 5360 5360 5360 5360 5360 44 ARM-44 ARM-35 IFT 640 640 640 640 640 45 ARM-45 ARM-36 LASER 910 910 910 910 910 46 ARM-46 ARM-37 MASS PRACTICE WITH STIMULATION 790 790 790 790 790 47 ARM-47 ARM-38 MASS PRACTICE WITH STIMULATION WEEKLY (FIVE DAYS) 3200 3200 3200 3200 3200 MONTHLY PACKAGE PT & OT-VALID 1 MONTH(NON- 48 ARM-48 ARM-39 83490 83490 83490 83490 83490 REFUNDABLE) 49 ARM-49 ARM-40 MWD 640 640 640 640 640 50 ARM-50 15724 NEURO REHAB (PER SESSION)(BALANCE+POSTURE+GAIT) 3300 3300 3300 3300 3300 51 ARM-51 ARM-41 NEURO REHAB LONG CASE (OT) - WEEKLY 10990 10990 10990 10990 10990 52 ARM-52 ARM-42 NEURO REHAB LONG CASE (PT) - 1 SESSION 2000 2000 2000 2000 2000 53 ARM-53 ARM-43 NEURO REHAB LONG CASE (PT+OT)) - WEEKLY 21960 21960 21960 21960 21960 54 ARM-54 ARM-44 NEURO REHAB SHORT CASE (OT) - WEEKLY 7390 7390 7390 7390 7390 55 ARM-55 ARM-45 NEUROLOGICAL REHAB SHORT CASE (OT)-1 SESSION 1400 1400 1400 1400 1400 56 ARM-56 ARM-46 ORTHO REHAB LONG CASE (OT) - WEEKLY 10990 10990 10990 10990 10990 57 ARM-57 ARM-47 ORTHO REHAB LONG CASE (PT) 2000 2000 2000 2000 2000 58 ARM-58 ARM-48 ORTHO REHAB LONG CASE (PT) - WEEKLY 10990 10990 10990 10990 10990 59 ARM-59 ARM-49 ORTHO REHAB LONG CASE (PT+OT) - WEEKLY 21960 21960 21960 21960 21960 60 ARM-60 ARM-50 ORTHO REHAB SHORT CASE (OT) - WEEKLY 7390 7390 7390 7390 7390 61 ARM-61 ARM-51 ORTHO REHAB SHORT CASE (PT) 1400 1400 1400 1400 1400 62 ARM-62 ARM-52 ORTHO REHAB WEEKLY PACKAGE (PT+OT) 21960 21960 21960 21960 21960 ORTHOPAEDIC REHAB (PER 63 ARM-63 15725 3300 3300 3300 3300 3300 SESSION)(BALANCE+POSTURE+GAIT) 64 ARM-64 ARM-53 PAEDIATRIC REHAB 1500 1500 1500 1500 1500 65 ARM-65 ARM-54 PAIN PACKAGE-WEEKLY-VALID 6 DAYS(NON-REFUNDABLE) 11290 11290 11290 11290 11290 66 ARM-66 ARM-55 PULLEY / SHOULDER WHEEL / STANDING 540 540 540 540 540 67 ARM-67 15726 SCI REHAB (PER SESSION)(BALANCE+POSTURE+GAIT) 3300 3300 3300 3300 3300 68 ARM-68 ARM-56 SENSORY RE-EDUCATION 1200 1200 1200 1200 1200 69 ARM-69 ARM-57 SHOULDER/ELBOW MOBILIZER 660 660 660 660 660

Any new service/tariff may be changed/added/deleted without prior notice. 114 Schedule of Charges 2019-20 ISIC

70 ARM-70 ARM-58 SPLINTING 660 660 660 660 660 71 ARM-71 15723 SPORTS REHAB (PER SESSION)(BALANCE+POSTURE+GAIT) 3300 3300 3300 3300 3300 72 ARM-72 ARM-59 SPORTS THERAPY WEEKLY 1200 1200 1200 1200 1200 73 ARM-73 ARM-60 STANDING FRAME 640 640 640 640 640 74 ARM-74 ARM-61 STIMULATION (PT) 640 640 640 640 640 75 ARM-75 ARM-62 SUCTIONING 410 410 410 410 410 76 ARM-76 ARM-63 SWD 640 640 640 640 640 77 ARM-77 ARM-64 TAPING PER AREA 1400 1400 1400 1400 1400 78 ARM-78 ARM-65 TENS 640 640 640 640 640 79 ARM-79 ARM-66 THERAPEUTIC RIDING 1600 1600 1600 1600 1600 80 ARM-80 ARM-67 TILT TABLE 1010 1010 1010 1010 1010 81 ARM-81 ARM-68 TRACTION 640 640 640 640 640 82 ARM-82 ARM-69 TREADMILL 1010 1010 1010 1010 1010 83 ARM-83 ARM-70 UL STRENGTHENING 910 910 910 910 910 84 ARM-84 ARM-71 ULTRASONIC THERAPY 640 640 640 640 640 85 ARM-85 ARM-72 UNWEIGHING HARNESS 1630 1630 1630 1630 1630 86 ARM-86 ARM-73 UPPERTONE 590 590 590 590 590 87 ARM-87 ARM-74 VIBRATOR (20 MIN) 540 540 540 540 540 88 ARM-88 ARM-75 VIRTUAL TRAINING 730 730 730 730 730 89 ARM-89 ARM-76 VOLUNTARY TRAINING-OT (MONTHLY) 1980 1980 1980 1980 1980 90 ARM-90 15727 WALKER VIEW (PER SESSION) 1100 1100 1100 1100 1100 91 ARM-91 16221 WALKER VIEW + SMART GRAVITY (15 SESSIONS) 22000 22000 22000 22000 22000 92 ARM-92 16220 WALKER VIEW + SMART GRAVITY (6 SESSIONS) 9350 9350 9350 9350 9350 93 ARM-93 15728 WALKER VIEW + SMART GRAVITY (PER SESSION) 1650 1650 1650 1650 1650 94 ARM-94 16219 WALKER VIEW-WEEKLY (15 SESSIONS) 14850 14850 14850 14850 14850 95 ARM-95 16218 WALKER VIEW-WEEKLY (6 SESSIONS) 6050 6050 6050 6050 6050 96 ARM-96 ARM-77 WAX ONE JOINT (PT) 640 640 640 640 640 97 ARM-97 ARM-78 WAX TWO JOINTS (OT) 1090 1090 1090 1090 1090 98 ARM-98 ARM-79 WHEELCHAIR TRAINING 910 910 910 910 910 99 ARM-99 ARM-80 WRIST / FINGER MOBILIZATION 660 660 660 660 660

Note:- Charges are fixed for all bed categories

Any new service/tariff may be changed/added/deleted without prior notice. 115 Schedule of Charges 2019-20 ISIC

TRADITIONAL MEDICINE PROCEDURES

Shared Dlx/Super Super NEW OLD Single S.No. Service OPD/GW Room/ICU Dlx / Dlx. CODE CODE Room /HDU Suite Suite 1 TM-01 TM18 ABHYANGA-PER SITTING 1320 1650 1782 1980 1980 2 TM-02 TM44 ADDITIONAL AREA (PER AREA-EACH) 330 413 446 495 495 3 TM-03 TM01 AGE CONTROLL FACIAL 1900 2375 2565 2850 2850 4 TM-04 TM10 AYURVEDA CONSULTATION ABOUT 30MIN 660 825 891 990 990 5 TM-05 16260 BACK PAIN THERAPY 1360 1700 1836 2040 2040 6 TM-06 TM39 BASTIKARMA(ENEMA)-PER SITTING 880 1100 1188 1320 1320 7 TM-07 16261 CERVICAL PAIN THERAPY 1360 1700 1836 2040 2040 8 TM-08 16268 DE-STRESS THERAPY 2480 3100 3348 3720 3720 9 TM-09 TM25 DHUMAPANA-PER SITTING 370 463 500 555 555 10 TM-10 16266 DISC BULGE/SPONDYLOSIS 1360 1700 1836 2040 2040 11 TM-11 TM12 FOLLOW UP (TRADITIONAL MEDICINE) UPTO 15 MINS 330 413 446 495 495 12 TM-12 16262 FROZEN SHOULDER(SINGLE) 840 1050 1134 1260 1260 13 TM-13 16263 FULL BACK THERAPY 1360 1700 1836 2040 2040 14 TM-14 16265 FULL BODY DETOXIFICATION 1850 2313 2498 2775 2775 15 TM-15 TM11 FULL BODY PROFILING (1 HOUR) 1650 2063 2228 2475 2475 16 TM-16 TM21 GREEVABASTI-PER SITTING 970 1213 1310 1455 1455 17 TM-17 TM42 HOMECARE-1 770 963 1040 1155 1155 18 TM-18 TM43 HOMECARE-2 1100 1375 1485 1650 1650 19 TM-19 16269 INTESTINE/COLON DETOXIFICATION 1230 1538 1661 1845 1845 20 TM-20 TM34 ISTIKA SWEDA-PER SITTING 600 750 810 900 900 21 TM-21 TM19 JANUBASTI FOR ONE LIMB-PER SITTING 600 750 810 900 900 22 TM-22 TM20 JANUBASTI FOR TWO LIMB-PER SITTING 1100 1375 1485 1650 1650 23 TM-23 TM22 KATIBASTI- PER SITTING 970 1213 1310 1455 1455 24 TM-24 TM28 KAYASEKA-PER SITTING 1270 1588 1715 1905 1905

Any new service/tariff may be changed/added/deleted without prior notice. 116 Schedule of Charges 2019-20 ISIC

25 TM-25 16264 KNEE JOINT PAIN THERAPY (SINGLE) 840 1050 1134 1260 1260 26 TM-26 TM31 KUKKUTANDA TWAK SWEDA-PER SITTING 1300 1625 1755 1950 1950 27 TM-27 TM14 LEPA-PER SITTING 1100 1375 1485 1650 1650 28 TM-28 TM33 NASYAKARMA-PER SITTING 800 1000 1080 1200 1200 29 TM-29 TM41 NETRA TARPAN 910 1138 1229 1365 1365 30 TM-30 TM29 PATRA-PINDA SWEDA-PER SITTING 1520 1900 2052 2280 2280 31 TM-31 TM30 PATRA-PINDA SWEDA-SINGLE PART 960 1200 1296 1440 1440 32 TM-32 TM27 PATTAVESTANA-PER SITTING 600 750 810 900 900 33 TM-33 TM40 RAKTA MOKSHANA-PER SITTING 930 1163 1256 1395 1395 34 TM-34 TM23 SADYOVIRECHANA-PER SITTING 600 750 810 900 900 35 TM-35 16267 SCIATICA PAIN THERAPY 2200 2750 2970 3300 3300 36 TM-36 TM35 SHASTIKA SHALI PINDA SWEDA-PER SITTING 1650 2063 2228 2475 2475 37 TM-37 TM36 SHASTIKA SHALI PINDA SWEDA-SINGLE PART 960 1200 1296 1440 1440 38 TM-38 TM17 SHIROABYANGA-PER SITTING 600 750 810 900 900 39 TM-39 TM16 SHIROBASTI-PER SITTING 1260 1575 1701 1890 1890 40 TM-40 TM26 SHIRODHARA-PER SITTING 1770 2213 2390 2655 2655 41 TM-41 TM13 SHIROPICHU-PER SITTING 600 750 810 900 900 42 TM-42 16273 SINUS THERAPY 1120 1400 1512 1680 1680 43 TM-43 16271 SLIMMING THERAPY 1960 2450 2646 2940 2940 44 TM-44 16272 SPECIFIC AREA (SMALL) THERAPY 460 575 621 690 690 45 TM-45 TM06 STEAM BATH 990 1238 1337 1485 1485 46 TM-46 16270 THERAPY FOR CONSIPATION 1700 2125 2295 2550 2550 47 TM-47 TM05 TREATMENT OF PAIN (PER AREA)-PER SITTING 600 750 810 900 900 48 TM-48 TM02 TREATMENT OF PRESSURE SORE (10DAYS) 6000 7500 8100 9000 9000 49 TM-49 TM04 TREATMENT OF RIGIDITY (PER AREA)-PER SITTING 600 750 810 900 900 50 TM-50 TM03 TREATMENT OF STIFFNESS (PER AREA) 600 750 810 900 900 51 TM-51 TM24 UDWARTANA-PER SITTING 1400 1750 1890 2100 2100 52 TM-52 TM15 UPANAHA-PER SITTING 1200 1500 1620 1800 1800

Any new service/tariff may be changed/added/deleted without prior notice. 117 Schedule of Charges 2019-20 ISIC

53 TM-53 TM32 VALUKA SWEDA-PER SITTING 600 750 810 900 900 54 TM-54 TM37 VAMANA WITH SNEHAPANA 5930 7413 8006 8895 8895 55 TM-55 TM38 VIRECHANA WITH SNEHAPANA 2440 3050 3294 3660 3660 56 TM-56 TM08 YOGA THERAPY (GROUP MINIMUM OF 6 ERSON-MONTHLY) 1500 1875 2025 2250 2250 57 TM-57 TM07 YOGA THERAPY (PER PERSON-MONTHLY) 6000 7500 8100 9000 9000

Charges Basis OPD/GW 100% HDU+ICU (all categories) 125% Shared 125% Single 135% Dlx 150% Spr. Dlx 150% Suite 150% Spr. Dlx Suite 150%

Note :- Above Charge basis would also be applicable on all newly added services

Any new service/tariff may be changed/added/deleted without prior notice. 118 Schedule of Charges 2019-20 ISIC

ANAESTHESIA PROCEDURES

Anaesthesia Charges for Surgeries 45% of Surgeon Fee

MAC Anaesthesia 35% of Seugeon Fee Super NEW Shared Single Dlx/Super S.NO. OLD CODE Procedures OPD/GW Dlx. CODE Room/ICU/HDU Room Dlx / Suite Suite ACTIVE VASCULAR IMAGING NAVIGATION FOR 1 ANAE-01 16282 990 1238 1337 1485 1485 DIFFICULT PERIPHERAL VEINOUS CANNULATION (AVIN) 2 ANAE-02 ANAE-20 ADDUCTOR CANAL BLOCK-BILATERAL KNEE 5850 7313 7898 8775 8775

3 ANAE-03 ANAE-19 ADDUCTOR CANAL BLOCK-SINGLE KNEE 2930 3663 3956 4395 4395

4 ANAE-04 ANAE-1 ARTERIAL LINE (ANAE) IN ICU 1950 2438 2633 2925 2925

5 ANAE-05 ANAE-2 CARDIOPULMONARY RESUSCITATION (ANAE) 3890 4863 5252 5835 5835

6 ANAE-06 ANAE-3 CHEMOPORT INSERTION (ANAE) 3220 4025 4347 4830 4830

7 ANAE-07 ANAE-4 CVP LINE (ANAE) 2930 3663 3956 4395 4395 ENDOTRACHEAL INTUBATION WITH 8 ANAE-08 16213 6600 8250 8910 9900 9900 VIDEOLARYNGOSCOPE 9 ANAE-09 ANAE-5 EPIDURAL INJECTION (ANAE) 4880 6100 6588 7320 7320

10 ANAE-10 14883 FIBER OPTIC BRANCTOSCOPY 10890 13613 14702 16335 16335 INITIATION OF VENTILATION INCLUDING INTUBATION 11 ANAE-11 ANAE-6 3890 4863 5252 5835 5835 (ANAE) 12 ANAE-12 14847 INTRATHECAL LUMBER DRAINAGE 6660 8325 8991 9990 9990

13 ANAE-13 ANAE-7 LUMBAR PUNCTURE (ANAE) 5370 6713 7250 8055 8055

14 ANAE-14 14882 LUMBER DRAIN INSERTION 6050 7563 8168 9075 9075

15 ANAE-15 ANAE-8 PAEDIATRIC ARTERIAL LINE (ANAE) 2150 2688 2903 3225 3225

16 ANAE-16 ANAE-9 PAEDIATRIC CVP LINE / PIC LINE (ANAE) 2930 3663 3956 4395 4395

17 ANAE-17 ANAE-10 POST - OP - PAIN REGIONAL BLOCK (ANAE) 4280 5350 5778 6420 6420

Any new service/tariff may be changed/added/deleted without prior notice. 119 Schedule of Charges 2019-20 ISIC

18 ANAE-18 ANAE-11 STAND BY ANAESTHESIA FOR MRI / CT (ANAE) 1950 2438 2633 2925 2925

19 ANAE-19 ANAE-12 SWANGANZ LINE (ANAE) 3220 4025 4347 4830 4830

20 ANAE-20 ANAE-21 VIDEOLARYNGOSCOPY WITH INSTRUMENTATION 3990 4988 5387 5985 5985

Charges Basis OPD/GW 100% HDU+ICU (all categories) 125% Shared 125% Single 135% Dlx 150% Spr. Dlx 150% Suite 150% Spr. Dlx Suite 150%

Any new service/tariff may be changed/added/deleted without prior notice. 120 Schedule of Charges 2019-20 ISIC

OPD / BED SIDE PROCEDURE

Shared Super NEW OLD Room/ Single Dlx/Super S.No. Procedure Name OPD/GW Dlx. CODE CODE ICU/ Room Dlx / Suite Suite HDU 1 BSP-01 BSP-1 APPLICATION OF OSTOMY DEVICE 4190 5238 5657 6285 6285 2 BSP-02 BSP-2 ARM CHEST STRAPPING 340 425 459 510 510 3 BSP-03 BSP-3 Arterial Line Monitoring (BSP) 290 363 392 435 435 4 BSP-04 BSP-4 ARTICAST APPLICATION 2930 3663 3956 4395 4395 5 BSP-05 BSP-5 ARTICAST BELOW KNEE & ELBOW 2050 2563 2768 3075 3075 6 BSP-06 BSP-6 ARTICAST REMOVAL 570 713 770 855 855 7 BSP-07 BSP-7 ASPIRATION (KNEE) 1180 1475 1593 1770 1770 8 BSP-08 BSP-8 ASPIRATION (WRIST) 970 1213 1310 1455 1455 9 BSP-09 BSP-9 ASPIRATION ANKLE 1180 1475 1593 1770 1770 10 BSP-10 BSP-10 ASPIRATION SACRO ILLIAC JOINT 970 1213 1310 1455 1455 11 BSP-11 BSP-11 ASPIRATION SHOULDER 1180 1475 1593 1770 1770 12 BSP-12 BSP-12 BIOPSY PROCEDURE 1380 1725 1863 2070 2070 13 BSP-13 BSP-13 Biopsy Superficial Lymph Node (BSP) 3310 4138 4469 4965 4965 14 BSP-14 BSP-14 BLADDER IRRIGATION (BSP) 200 250 270 300 300 15 BSP-15 BSP-15 Blood sugar monitoring (BSP) 150 188 203 225 225 16 BSP-16 BSP-16 BLOOD SUGAR RBS CHARGES 180 225 243 270 270 17 BSP-17 BSP-17 BLOOD TRANSFUSION (BSP) 200 250 270 300 300 18 BSP-18 BSP-167 BOTOX INJECTION INTRAMUSCULAR 6340 7925 8559 9510 9510 19 BSP-19 BSP-18 BOWEL WASH(BSP) 290 363 392 435 435 20 BSP-20 BSP-19 BP monitoring (BSP) 70 88 95 105 105 21 BSP-21 BSP-20 BURN SITE DRESSING - LARGE 2790 3488 3767 4185 4185 22 BSP-22 BSP-21 Casting of Brace (BSP) 280 350 378 420 420 23 BSP-23 BSP-22 CATHETERISATION - CIC (BSP) 320 400 432 480 480 24 BSP-24 BSP-23 CATHETERISATION - CONDOM DRAINAGE (BSP) 80 100 108 120 120 25 BSP-25 BSP-24 CATHETERISATION - PUC (BSP) 510 638 689 765 765 26 BSP-26 BSP-25 CATHETERISATION SET 110 138 149 165 165

Any new service/tariff may be changed/added/deleted without prior notice. 121 Schedule of Charges 2019-20 ISIC

27 BSP-27 BSP-26 Change of endotracheal tube(BSP) 1950 2438 2633 2925 2925 28 BSP-28 BSP-27 Change of tracheostomy (BSP) 970 1213 1310 1455 1455 29 BSP-29 BSP-28 CHEMOTHERAPY 3300 4125 4455 4950 4950 30 BSP-30 BSP-171 CHEST PHYSIOTHERAPY (BY NURSES) 660 825 891 990 990 31 BSP-31 BSP-1006 CIRCUMCISION (BEDSIDE) 10470 13088 14135 15705 15705 32 BSP-32 BSP-29 CLOSED REDUCTION (PHULLENGES & METATARSALS) 5580 6975 7533 8370 8370 33 BSP-33 BSP-30 CLOSED REDUCTION SHOULDER 8360 10450 11286 12540 12540 34 BSP-34 BSP-31 Closed reduction under sedation Elbow(BSP) 2790 3488 3767 4185 4185 35 BSP-35 BSP-32 Closed reduction under sedation Knee (BSP) 4190 5238 5657 6285 6285 36 BSP-36 BSP-33 Closed reduction under sedation Shoulder(BSP) 8370 10463 11300 12555 12555 37 BSP-37 BSP-34 CLOSED REDUCTION(FINGER) 3310 4138 4469 4965 4965 38 BSP-38 BSP-35 CLOSED REDUCTION(WRIST) 3710 4638 5009 5565 5565 39 BSP-39 BSP-36 Closure of tracheostomy (BSP) 860 1075 1161 1290 1290 40 BSP-40 BSP-37 COLOSTOMY DRESSING AND BAG CHANGING 2790 3488 3767 4185 4185 41 BSP-41 BSP-38 CUT DOWN SET 110 138 149 165 165 42 BSP-42 BSP-39 CVP CATHETERISATION - FEMORAL (BSP) 3960 4950 5346 5940 5940 43 BSP-43 BSP-40 Debridement (BSP) 1660 2075 2241 2490 2490 44 BSP-44 BSP-41 Dressing - Extra large (BSP) 480 600 648 720 720 45 BSP-45 BSP-42 DRESSING - LARGE (BSP) 290 363 392 435 435 46 BSP-46 BSP-43 DRESSING - MEDIUM (BSP) 200 250 270 300 300 47 BSP-47 BSP-44 DRESSING - SMALL (BSP) 100 125 135 150 150 48 BSP-48 BSP-45 DRESSING CHANGE-MASSIVE (FULL LIMB/FULL TRUNK) 4190 5238 5657 6285 6285 49 BSP-49 BSP-46 DRESSING CHANGE-MEDIUM(PART OF LIMB/ONE FOURTH TRU 2830 3538 3821 4245 4245 50 BSP-50 BSP-47 DRESSING CHANGE-MINOR(PART OF LIMB/ONE FOURTH TRUN 1950 2438 2633 2925 2925 51 BSP-51 BSP-48 DRESSING CHARGES-LARGE (BSP) 290 363 392 435 435 52 BSP-52 BSP-49 DRESSING SET 110 138 149 165 165 53 BSP-53 BSP-50 Elective cardio inversion(BSP) 1950 2438 2633 2925 2925 54 BSP-54 BSP-51 Endotracheal Intubation (BSP) 4980 6225 6723 7470 7470 55 BSP-55 BSP-52 ENEMA PRACTOCLYS (BSP) 320 400 432 480 480 56 BSP-56 BSP-53 Enema Soap/Water (BSP) 570 713 770 855 855 57 BSP-57 BSP-54 ENT SET 110 138 149 165 165

Any new service/tariff may be changed/added/deleted without prior notice. 122 Schedule of Charges 2019-20 ISIC

58 BSP-58 BSP-56 EPIDURAL INTERVENTION 2790 3488 3767 4185 4185 59 BSP-59 BSP-57 EXCISION BIOPSY OF SUPERFICIAL LUMBS 4190 5238 5657 6285 6285 60 BSP-60 BSP-58 EXCISION BIOPSY OF ULCER 2790 3488 3767 4185 4185 61 BSP-61 BSP-59 Excision(BSP) 1660 2075 2241 2490 2490 62 BSP-62 15798 EXPANSION OF EXPANDER WITH SALINE (PER EXPANSION) 610 763 824 915 915 63 BSP-63 BSP-90 EXTERNAL VENTRICULARS DRAINAGE (NEUROSURGERY-BSP)) 27870 34838 37625 41805 41805 64 BSP-64 BSP-60 FELLOW FINGER STRAPPING 170 213 230 255 255 65 BSP-65 BSP-61 Finger strapping(BSP) 170 213 230 255 255 66 BSP-66 BSP-62 FIXATOR REMOVAL 670 838 905 1005 1005 67 BSP-67 BSP-63 FOREIGN BODY REMOVAL (General) 2550 3188 3443 3825 3825 68 BSP-68 BSP-66 GANGLION ASPIRATION + INJECTION 840 1050 1134 1260 1260 69 BSP-69 BSP-65 GANGLION ASPIRATION 510 638 689 765 765 70 BSP-70 BSP-67 GANGLION EXCISION 1660 2075 2241 2490 2490 71 BSP-71 BSP-68 Gastric Lavage (BSP) 320 400 432 480 480 72 BSP-72 BSP-69 GAUSE PACKET 20 25 27 30 30 73 BSP-73 BSP-70 GAUZE PAD 20 25 27 30 30 74 BSP-74 BSP-71 HALLOW BRACE 4190 5238 5657 6285 6285 75 BSP-75 BSP-72 I.V. INTERVENTION (PAIN MGMT) 2530 3163 3416 3795 3795 76 BSP-76 BSP-73 I/D SET 150 188 203 225 225 77 BSP-77 BSP-74 I/M INJECTION (BSP) 150 188 203 225 225 78 BSP-78 BSP-75 I/V CANNULATION(BSP) 150 188 203 225 225 79 BSP-79 BSP-76 I/V INJECTION (BSP) 150 188 203 225 225 80 BSP-80 BSP-77 I/V TRANSFUSION (BSP) 200 250 270 300 300 81 BSP-81 BSP-78 ICD REMOVAL 1380 1725 1863 2070 2070 82 BSP-82 BSP-79 INCISION & DRAINAGE(BIG) 3310 4138 4469 4965 4965 83 BSP-83 BSP-80 INCISION & DRAINAGE(MEDIUM) 1660 2075 2241 2490 2490 84 BSP-84 BSP-81 INCISION & DRAINAGE(SMALL) 1660 2075 2241 2490 2490 85 BSP-85 BSP-82 INFILTRATION BLOCKS 2830 3538 3821 4245 4245 86 BSP-86 BSP-83 INGROWING TOE NAIL 5070 6338 6845 7605 7605 87 BSP-87 BSP-84 Insertion of metallic tube (tracheostomy)(BSP) 970 1213 1310 1455 1455 88 BSP-88 BSP-85 INTRA ARTICULAR INJECTION (BSP) 860 1075 1161 1290 1290

Any new service/tariff may be changed/added/deleted without prior notice. 123 Schedule of Charges 2019-20 ISIC

89 BSP-89 BSP-178 INTRAARTICULAR INJECTION 5070 6338 6845 7605 7605 90 BSP-90 BSP-86 Intradermal injection(BSP) 100 125 135 150 150 91 BSP-91 BSP-87 IVP LINE MONITORING (BSP) 280 350 378 420 420 92 BSP-92 13766 JOINT LAUAG UNDER LA 1930 2413 2606 2895 2895 93 BSP-93 BSP-88 K-WIRE REMOVAL 2280 2850 3078 3420 3420 94 BSP-94 BSP-179 LACERATION OF FACE REPAIR 11690 14613 15782 17535 17535 95 BSP-95 BSP-89 LOCAL STERIOD INJECTION 860 1075 1161 1290 1290 96 BSP-96 BSP-180 LOCAL STEROID INJECTION FOR OTHER INDICATIONS 1420 1775 1917 2130 2130 97 BSP-97 BSP-181 LOCAL STEROID INJECTION FOR PLANTAR FASCIITIS 1420 1775 1917 2130 2130 98 BSP-98 BSP-182 LOCAL STEROID INJECTION FOR TENDINITIS / BURSITIS 1420 1775 1917 2130 2130 99 BSP-99 BSP-90 MANUAL EVACUATION (BSP) 860 1075 1161 1290 1290 100 BSP-100 BSP-91 MATERIAL CHARGES 90 113 122 135 135 101 BSP-101 BSP-92 NASAL PACK APPLICATION 1660 2075 2241 2490 2490 102 BSP-102 BSP-93 NASAL PACK REMOVAL 840 1050 1134 1260 1260 103 BSP-103 BSP-94 NEBULISATION - MASK (BSP) 650 813 878 975 975 104 BSP-104 BSP-95 NEBULISATION - TRACHEOSTOMY (BSP) 790 988 1067 1185 1185 105 BSP-105 BSP-96 NEEDLE ASPIRATION (FOR TESTS) 860 1075 1161 1290 1290 106 BSP-106 14148 NERVE BLOCK WITH LOCAL ANAESTHESIA(BEDSIDE) 6240 7800 8424 9360 9360 107 BSP-107 BSP-199 OPEN SPC (URO) UNDER LA 8370 10463 11300 12555 12555 108 BSP-108 BSP-97 OXYGEN ADMINISTRATION (BSP) 130 163 176 195 195 109 BSP-109 BSP-98 P.V. SET 110 138 149 165 165 110 BSP-110 BSP-164 PAC (ASA GR. I/II) 1600 2000 2160 2400 2400 111 BSP-111 BSP-165 PAC (ASA GR. III/IV/V/VI/E) 3190 3988 4307 4785 4785 112 BSP-112 BSP-101 PACKING - ANTERIAL NASAL 4280 5350 5778 6420 6420 113 BSP-113 BSP-102 PACKING - POSTERIOR NASAL 5580 6975 7533 8370 8370 114 BSP-114 BSP-183 PAINFUL SCAR INJECTION 2650 3313 3578 3975 3975 115 BSP-115 BSP-103 PERICARDIAL TAPPING 13930 17413 18806 20895 20895 116 BSP-116 BSP-104 PERIMETRY (AUTOMATED) 5580 6975 7533 8370 8370 117 BSP-117 BSP-184 Peritoneal Dialysis (BSP) 1400 1750 1890 2100 2100 118 BSP-118 BSP-105 Peritoneal tapping(BSP) 1190 1488 1607 1785 1785 119 BSP-119 BSP-106 PILES BINDING 2790 3488 3767 4185 4185

Any new service/tariff may be changed/added/deleted without prior notice. 124 Schedule of Charges 2019-20 ISIC

120 BSP-120 BSP-107 PLASTIC SURGERY EAR REPAIR 5070 6338 6845 7605 7605 121 BSP-121 BSP-108 PLATELET CONCENTRATE TRANSFUSION 3610 4513 4874 5415 5415 122 BSP-122 BSP-109 POP application - Above Elbow (BSP) 2790 3488 3767 4185 4185 123 BSP-123 BSP-110 POP application - Above knee (BSP) 2790 3488 3767 4185 4185 124 BSP-124 BSP-111 POP application - Below Elbow (BSP) 1660 2075 2241 2490 2490 125 BSP-125 BSP-112 POP application - Below knee (BSP) 1660 2075 2241 2490 2490 126 BSP-126 BSP-113 POP jacket application (BSP) 4190 5238 5657 6285 6285 127 BSP-127 BSP-114 POP removal (BSP) 390 488 527 585 585 128 BSP-128 BSP-115 POP removal synthetic (BSP) 430 538 581 645 645 129 BSP-129 BSP-116 POP slab application ABOVE ELBOW (BSP) 1160 1450 1566 1740 1740 130 BSP-130 BSP-117 POP slab application ABOVE KNEE & ABOVE ELBOW 3050 3813 4118 4575 4575 131 BSP-131 BSP-118 POP slab application ABOVE KNEE (BSP) 1160 1450 1566 1740 1740 132 BSP-132 BSP-119 POP slab application BELOW ELBOW (BSP) 570 713 770 855 855 133 BSP-133 BSP-120 POP slab application BELOW KNEE & BELOW ELBOW 3050 3813 4118 4575 4575 134 BSP-134 BSP-121 POP SLAB APPLICATION BELOW KNEE (BSP) 650 813 878 975 975 135 BSP-135 BSP-122 PROTO SCOPE 110 138 149 165 165 136 BSP-136 BSP-123 REDUCTION BIG TOE UNDER L.A. WITH POP 3310 4138 4469 4965 4965 137 BSP-137 BSP-124 REMOVAL OF COPPER-T 1160 1450 1566 1740 1740 138 BSP-138 BSP-125 Removal of ICD (BSP) 2530 3163 3416 3795 3795 139 BSP-139 BSP-126 Removal of mole (BSP) 700 875 945 1050 1050 140 BSP-140 BSP-127 Removal of surgical drain (BSP) 1400 1750 1890 2100 2100 141 BSP-141 BSP-128 RYLES TUBE ASPIRATION(BSP) 90 113 122 135 135 142 BSP-142 BSP-129 RYLES TUBE FEEDING (BSP) 150 188 203 225 225 143 BSP-143 BSP-130 Ryles Tube insertion (BSP) 580 725 783 870 870 144 BSP-144 BSP-186 SEDATION CHARGES FOR PROCEDURE 1420 1775 1917 2130 2130 145 BSP-145 BSP-131 SIMPLE NAIL REMOVAL 680 850 918 1020 1020 146 BSP-146 BSP-132 Skeletal Traction (BSP) 2540 3175 3429 3810 3810 147 BSP-147 BSP-133 Skin Traction - Continuous (BSP) 8780 10975 11853 13170 13170 148 BSP-148 BSP-134 Skin Traction - Intermittent (BSP) 680 850 918 1020 1020 149 BSP-149 BSP-135 Skull Tongue Application (BSP) 2790 3488 3767 4185 4185 150 BSP-150 14871 SOB PROFILE TEST 3330 4163 4496 4995 4995

Any new service/tariff may be changed/added/deleted without prior notice. 125 Schedule of Charges 2019-20 ISIC

151 BSP-151 BSP-136 Spica Application (BSP) 5070 6338 6845 7605 7605 152 BSP-152 BSP-137 SPO2 (HRLY) 860 1075 1161 1290 1290 153 BSP-153 BSP-138 STAPLES APPLICATION 1010 1263 1364 1515 1515 154 BSP-154 BSP-139 STEAM INHALATION (BSP) 150 188 203 225 225 155 BSP-155 BSP-140 STRAPPING - FINGER 170 213 230 255 255 156 BSP-156 BSP-141 STRAPPING # METACAPAL WITH POP 1660 2075 2241 2490 2490 157 BSP-157 BSP-142 STRAPPING BIG OF 8 FOR # CLAVICLE 2280 2850 3078 3420 3420 158 BSP-158 BSP-143 SUBCUTANEOUS INJECTION(BSP) 130 163 176 195 195 159 BSP-159 14731 SUBDURAL TAPPING / ASPIRATION 9050 11313 12218 13575 13575 160 BSP-160 BSP-144 SUCTIONING (BSP) 130 163 176 195 195 161 BSP-161 BSP-145 SUPRABIC CYSTOSTOMY (BSP) 14030 17538 18941 21045 21045 162 BSP-162 BSP-146 Suture removal (BSP) 390 488 527 585 585 163 BSP-163 BSP-147 SUTURE REMOVAL SET 110 138 149 165 165 164 BSP-164 BSP-148 SUTURE SET 110 138 149 165 165 165 BSP-165 BSP-149 Suturing - Major (BSP) 1180 1475 1593 1770 1770 166 BSP-166 BSP-150 Suturing - Minor (BSP) 1010 1263 1364 1515 1515 167 BSP-167 BSP-151 SUTURING ACCIDENTAL WOUNDS -MULTIPLE CUTS 15210 19013 20534 22815 22815 168 BSP-168 BSP-152 Synthetic cast application Above elbow(BSP) 2530 3163 3416 3795 3795 169 BSP-169 BSP-153 Synthetic cast application above knee(BSP) 2530 3163 3416 3795 3795 170 BSP-170 BSP-154 Synthetic cast application Below elbow(BSP) 1660 2075 2241 2490 2490 171 BSP-171 BSP-155 Synthetic cast application Below knee(BSP) 1660 2075 2241 2490 2490 172 BSP-172 BIO-172 TENDON REPAIR 10250 12813 13838 15375 15375 173 BSP-173 BSP-157 THOMAS SPLINT MATERIAL CHARGES 880 1100 1188 1320 1320 174 BSP-174 BSP-158 THROMBOLYSIS (BSP) 1400 1750 1890 2100 2100 175 BSP-175 BSP-175 TRACHEOSTOMY (NEURO - BSP) 10710 13388 14459 16065 16065 176 BSP-176 BSP-187 TRIGGER POINT INJECTION 2650 3313 3578 3975 3975 177 BSP-177 BSP-159 ULTRASOUND GUIDED RENAL BIOPSY 1400 1750 1890 2100 2100 178 BSP-178 BSP-160 USG GUIDED ABCESS ASPIRATION 10130 12663 13676 15195 15195 179 BSP-179 BSP-161 USG GUIDED INTRA ARTICULAR INJECTION 2330 2913 3146 3495 3495 180 BSP-180 13741 VAC-DRESSING (LARGE) 19330 24163 26096 28995 28995 181 BSP-181 13742 VAC-DRESSING (MEDIUM) 16100 20125 21735 24150 24150

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182 BSP-182 13743 VAC-DRESSING (SMALL) 12890 16113 17402 19335 19335 183 BSP-183 BSP-162 WALKING HEEL APPLICATION 320 400 432 480 480

Charges Basis OPD/GW 100% HDU+ICU (all categories) 125% Shared 125% Single 135% Dlx 150% Spr. Dlx 150% Suite 150% Spr. Dlx Suite 150%

Note :- Above Charge basis would also be applicable on all newly added services

Any new service/tariff may be changed/added/deleted without prior notice. 127 Schedule of Charges 2019-20 ISIC

CARDIOLOGY PROCEDURES

Shared Super NEW Single Dlx/Super S.No. OLD CODE Investigation/Procedure OPD/GW Room/ICU Dlx. CODE Room Dlx / Suite /HDU Suite 1 CARD-1 CARD-1 CAROTID DOPPLER 4430 5538 5981 6645 6645 2 CARD-2 CARD-2 DOBUTAMINE STRESS ECHOCARDIOGRAM 7330 9163 9896 10995 10995 3 CARD-3 CARD-4 ECG (BEDSIDE) 610 763 824 915 915 4 CARD-4 CARD-3 ECG 530 663 716 795 795 5 CARD-5 CARD-5 ECHO (EMERGENCY) 6660 8325 8991 9990 9990 6 CARD-6 CARD-26 ECHO (EMERGENCY) PORTABLE 7330 9163 9896 10995 10995 7 CARD-7 CARD-7 ECHO COLOR DOPPLER (PORTABLE) 5850 7313 7898 8775 8775 8 CARD-8 CARD-6 ECHO COLOR DOPPLER 4390 5488 5927 6585 6585 9 CARD-9 CARD-12 ECHO SCREENING 2200 2750 2970 3300 3300 10 CARD-10 CARD-13 ECHO SCREENING (PORTABLE) 2930 3663 3956 4395 4395 11 CARD-11 CARD-15 ECHO VALVULAR (PORTABLE) 5850 7313 7898 8775 8775 12 CARD-12 CARD-14 ECHO VALVULAR 4390 5488 5927 6585 6585 13 CARD-13 CARD-30 EMERGENCY P.F.T. 2930 3663 3956 4395 4395 14 CARD-14 CARD-16 GATED STRESS MYOCARDIAL PERFUSION 23570 29463 31820 35355 35355 15 CARD-15 CARD-17 HOLTER 4100 5125 5535 6150 6150 16 CARD-16 C-18 PERICARDIAL TAPPING 9080 11350 12258 13620 13620 17 CARD-17 CARD-18 PERIPHERAL DOPPLER OF LOWER LIMB 4430 5538 5981 6645 6645 18 CARD-18 CARD-19 PERIPHERAL DOPPLER OF UPPER LIMB 4430 5538 5981 6645 6645 19 CARD-19 CARD-32 RBS(Cardiology)-Thru GLUCOMETER 220 275 297 330 330 20 CARD-20 CARD-20 RENAL ARTERY DOPPLER 4390 5488 5927 6585 6585 21 CARD-21 CARD-27 STANDBY CARDIOLOGIST IN OT 6660 8325 8991 9990 9990 22 CARD-22 CARD-21 STRESS ECHOCARDIOGRAM 6660 8325 8991 9990 9990 23 CARD-23 CARD-22 TILT TEST 5320 6650 7182 7980 7980 24 CARD-24 CARD-23 TMT (TREAD MILL STRESS TEST) 3330 4163 4496 4995 4995 25 CARD-25 CARD-24 TMT/ECHO (as advised by Cardiologist) 3330 4163 4496 4995 4995

Any new service/tariff may be changed/added/deleted without prior notice. 128 Schedule of Charges 2019-20 ISIC

26 CARD-26 CARD-28 TPI INSERTION (BEDSIDE) 8790 10988 11867 13185 13185 27 CARD-27 CARD-29 TPI INSERTION (BEDSIDE)-EMERG 11320 14150 15282 16980 16980 28 CARD-28 CARD-25 TRANS ESOPHAGEAL ECHO (T.E.E.) 7330 9163 9896 10995 10995

Charges Basis OPD/GW 100% HDU+ICU (all categories) 125% Shared 125% Single 135% Dlx 150% Spr. Dlx 150% Suite 150% Spr. Dlx Suite 150%

Note :- Above Charge basis would also be applicable on all newly added services

Any new service/tariff may be changed/added/deleted without prior notice. 129 Schedule of Charges 2019-20 ISIC

INTERVENTIONAL CARDIAC PACKAGES

S.No. NEW CODES OLD CODES Surgery Charges

1 CARDP-1 C-7 ASD / PDA CLOSURE + COST OF DEVICE EXTRA -I (2 DAYS) 90750 2 CARDP-2 C-7 ASD / PDA CLOSURE + COST OF DEVICE EXTRA -II (2 DAYS) 78650

3 CARDP-3 C-5 CAROTID ANGIOPLASTY - I (2 DAYS) 139150

4 CARDP-4 C-5 CAROTID ANGIOPLASTY - II (2 DAYS) 121000

5 CARDP-5 C-2 CHECK ANGIOGRAPHY DAY CARE -I 11500

6 CARDP-6 C-2 CHECK ANGIOGRAPHY DAY CARE -II 9080

7 CARDP-7 C-20 CORONARY ANGIOGRAPHY - I (1 DAY) 21780

8 CARDP-8 C-21 CORONARY ANGIOGRAPHY - II (1 DAY) 18150

9 CARDP-9 C-1 CORONARY ANGIOGRAPHY / CARDIAC CATHETERIZATION - I (1 DAY) 21780

10 CARDP-10 C-1 CORONARY ANGIOGRAPHY CATHETERIZATION -I (1 DAY) 19970

11 CARDP-11 C-3 ELECTIVE/PRIMARY CORONARY ANGIOPLASTY - I (2 DAYS) 181500

12 CARDP-12 C-3 ELECTIVE/PRIMARY CORONARY ANGIOPLASTY - II (2 DAYS) 163350

13 CARDP-13 C-9 EPS DIAGNOSTIC - (1 DAY) 18150

14 CARDP-14 C-11 EPS MAJOR EPS - (1 DAY) 36300

15 CARDP-15 C-10 EPS RF ABLATION - (1 DAY) 72600

16 CARDP-16 C-1 PERIPHERAL ANGIOGRAPHY - I (1 DAY) 21780

17 CARDP-17 C-8 PROCEDURE CHARGES (BMV)- (2 DAYS) 90750

18 CARDP-18 15009 PTCA EMERGENCY CHARGES 30250

19 CARDP-19 C-6 PTCA WITH ROTABLATION- I (2 DAYS) 211750

20 CARDP-20 C-6 PTCA WITH ROTABLATION- II (2 DAYS) 187550

21 CARDP-21 C-4 RENAL / PERIPHERAL ANGIOPLASTY - I (2 DAYS) 139150

Any new service/tariff may be changed/added/deleted without prior notice. 130 Schedule of Charges 2019-20 ISIC

22 CARDP-22 C-4 RENAL / PERIPHERAL ANGIOPLASTY - II (2 DAYS) 121000

23 CARDP-23 C-13 SINGLE/DOUBLE CHAMBER PACEMAKER 60500

24 CARDP-24 C-12 TEMPORARY PACEMAKER INSERTATION 9080

Note :- Cost of Device/Implant would be extra Above rates are for Heart Command Centre In case of Surgeries/ procedure performed in Emergency / Holidays, 20% extra would be charged. Above Charge basis would also be applicable on all newly added services

Any new service/tariff may be changed/added/deleted without prior notice. 131 Schedule of Charges 2019-20 ISIC

DENTAL PROCEDURES

Shared Dlx/ Super NEW OLD OPD / Room/ Single Super S.NO. DENTAL PROCEDURES Dlx. CODE CODE GW ICU/ Room Dlx / Suite HDU Suite CONSERVATIVE/RESTORATIVE 1 DEN-01 DEN-1 BLEACHING GRADE I 7500 9375 10125 11250 11250 2 DEN-02 DEN-II BLEACHING GRADE II 9500 11875 12825 14250 14250 3 DEN-03 DEN-5 COMPLETE DENTURE (ACRYLIC) - DOUBLE 21550 26938 29093 32325 32325 4 DEN-04 DEN-2 COMPLETE DENTURE (ACRYLIC) - SINGLE 12710 15888 17159 19065 19065 5 DEN-05 DEN-3 CROWN (ACRYLIC) 1100 1375 1485 1650 1650 6 DEN-06 DEN-4 CROWN CERAMIC (GR -1) 4950 6188 6683 7425 7425 7 DEN-07 DEN-5 CROWN CERAMIC (GR- 2) 6380 7975 8613 9570 9570 8 DEN-08 DEN-6 CROWN CERAMIC (GR- 3) 6930 8663 9356 10395 10395 9 DEN-09 DEN-7 CROWN CERAMIC (GR- 4) 9900 12375 13365 14850 14850 10 DEN-10 DEN-8 CROWN CERAMIC (GR- 5) 16500 20625 22275 24750 24750 11 DEN-11 DEN-9 CROWN-METAL 3300 4125 4455 4950 4950 12 DEN-12 DEN-10 FLAP SURGERY PER SEGMENT (GR.-I) 2640 3300 3564 3960 3960 13 DEN-13 DEN-11 FLAP SURGERY PER SEGMENT (GR.-II) 4400 5500 5940 6600 6600 14 DEN-14 DEN-12 FLAP SURGERY PER SEGMENT (GR.-III) 6600 8250 8910 9900 9900 15 DEN-15 DEN-13 FLAP SURGERY WITH BONE GRAFTING PER SEGMENT (GR.-I) 7050 8813 9518 10575 10575 16 DEN-16 DEN-14 FLAP SURGERY WITH BONE GRAFTING PER SEGMENT (GR.-II) 8660 10825 11691 12990 12990 17 DEN-17 DEN-15 FLAP SURGERY WITH BONE GRAFTING PER SEGMENT (GR.-III) 9990 12488 13487 14985 14985 18 DEN-18 DEN-16 FLUORIDE TREATMENT 1270 1588 1715 1905 1905 19 DEN-19 DEN-17 FULL CREAM/PURE GOLD (GR- 6) 32230 40288 43511 48345 48345 20 DEN-20 DEN-18 GINGIVECTOMY PER SEGMENT 4400 5500 5940 6600 6600 21 DEN-21 DEN-19 GINGIVOPLASTY PER SEGMENT 4400 5500 5940 6600 6600 22 DEN-22 DEN-20 GLASS IONOMER FILLING 1270 1588 1715 1905 1905 23 DEN-23 DEN-21 IMPLANT PER TOOTH I 35000 43750 47250 52500 52500 24 DEN-24 DEN-52 IMPLANT PER TOOTH II 45000 56250 60750 67500 67500

Any new service/tariff may be changed/added/deleted without prior notice. 132 Schedule of Charges 2019-20 ISIC

25 DEN-25 DEN-54 IMPLANT PER TOOTH III 66550 83188 89843 99825 99825 26 DEN-26 DEN-22 LIGHT CURE COMPOSITE FILLING (GR-1) 1000 1250 1350 1500 1500 27 DEN-27 DEN-23 LIGHT CURE COMPOSITE FILLING (GR-2) 1500 1875 2025 2250 2250 28 DEN-28 DEN-24 LIGHT CURE COMPOSITE FILLING (GR-3) 2000 2500 2700 3000 3000 29 DEN-29 DEN-25 LIGHT CURE COMPOSITE FILLING (GR-4) 2500 3125 3375 3750 3750 30 DEN-30 DEN-26 OCCLUSAL CONTOURING (GR-I) 630 788 851 945 945 31 DEN-31 DEN-27 OCCLUSAL CONTOURING (GR-II) 1070 1338 1445 1605 1605 32 DEN-32 DEN-28 OCCLUSAL GRINDING (GR-I) 260 325 351 390 390 33 DEN-33 DEN-29 OCCLUSAL GRINDING (GR-II) 530 663 716 795 795 34 DEN-34 16208 OCCLUSAL NIGHT GUARD(SPLINT) 5500 6875 7425 8250 8250 35 DEN-35 DEN-30 PARTIAL DENTURE -ACRYLIC 2640 3300 3564 3960 3960 36 DEN-36 DEN-31 PARTIAL DENTURE -METAL 18700 23375 25245 28050 28050 37 DEN-37 DEN-32 PARTIAL DENTURE-FLEXIBLE (GR -1) 17600 22000 23760 26400 26400 38 DEN-38 DEN-33 PARTIAL DENTURE-FLEXIBLE (GR -2) 19800 24750 26730 29700 29700 39 DEN-39 DEN-34 PARTIAL DENTURE-FLEXIBLE (GR -3) 24200 30250 32670 36300 36300 40 DEN-40 DEN-36 PARTIAL DENTURE-ONE ADDNL TOOTH 720 900 972 1080 1080 41 DEN-41 DEN-37 POST AND CORE 3190 3988 4307 4785 4785 42 DEN-42 DEN-38 PULPOTOMY 2310 2888 3119 3465 3465 43 DEN-43 DEN-39 RELINING OF DENTURE (ONE) 3190 3988 4307 4785 4785 44 DEN-44 DEN-40 REPAIR/RELINING OFDENTURE 1380 1725 1863 2070 2070 45 DEN-45 DEN-41 ROOT CANAL (ANTERIOR) I 4000 5000 5400 6000 6000 46 DEN-46 DEN-56 ROOT CANAL (ANTERIOR) II 5500 6875 7425 8250 8250 47 DEN-47 DEN-57 ROOT CANAL (ANTERIOR) III 6500 8125 8775 9750 9750 48 DEN-48 DEN-42 ROOT CANAL (POSTERIOR) I 5500 6875 7425 8250 8250 49 DEN-49 DEN-58 ROOT CANAL (POSTERIOR) II 6500 8125 8775 9750 9750 50 DEN-50 DEN-59 ROOT CANAL (POSTERIOR) III 7500 9375 10125 11250 11250 51 DEN-51 DEN-44 SCALING AND POLISHING (GR-1) 1000 1250 1350 1500 1500 52 DEN-52 DEN-45 SCALING AND POLISHING (GR-2) 1500 1875 2025 2250 2250 53 DEN-53 DEN-46 SCALING AND POLISHING (GR-3) 2500 3125 3375 3750 3750 54 DEN-54 DEN-47 SCALING AND POLISHING (GR-4) 3000 3750 4050 4500 4500

Any new service/tariff may be changed/added/deleted without prior notice. 133 Schedule of Charges 2019-20 ISIC

55 DEN-55 DEN-48 TEMPORARY FILLING (GR-I) 200 250 270 300 300 56 DEN-56 DEN-49 TEMPORARY FILLING (GR-II) 260 325 351 390 390 57 DEN-57 DEN-50 TEMPORARY FILLING (GR-III) 330 413 446 495 495 DENTAL ORAL PROCEDURES 58 DEN-58 DEN-51 ALL WISDOM MOLAR I 6000 7500 8100 9000 9000 59 DEN-59 DEN-60 ALL WISDOM MOLAR II 8000 10000 10800 12000 12000 60 DEN-60 DEN-61 ALL WISDOM MOLAR III 10000 12500 13500 15000 15000 61 DEN-61 DEN-52 ALVEOLECTOMY (GR-I) 1070 1338 1445 1605 1605 62 DEN-62 DEN-53 ALVEOLECTOMY (GR-II) 2150 2688 2903 3225 3225 63 DEN-63 DEN-54 ALVEOLOPLASTY (GR-I) 4000 5000 5400 6000 6000 64 DEN-64 DEN-55 ALVEOLOPLASTY (GR-II) 6000 7500 8100 9000 9000 65 DEN-65 DEN-56 APEXIFICATION 3220 4025 4347 4830 4830 66 DEN-66 DEN-57 APICOECTOMY PER TOOTH- ANT 8000 10000 10800 12000 12000 67 DEN-67 DEN-58 APICOECTOMY PER TOOTH- POST 12000 15000 16200 18000 18000 68 DEN-68 DEN-59 ARCH BAR WIRING GR-1 PER ARCH 12000 15000 16200 18000 18000 69 DEN-69 DEN-60 ARCH BAR WIRING GR-2 PER ARCH 16000 20000 21600 24000 24000 70 DEN-70 DEN-61 ARCH BAR WIRING GR-3 PER ARCH 20000 25000 27000 30000 30000 71 DEN-71 DEN-62 CYST ENUCLEATIONS I 10000 12500 13500 15000 15000 72 DEN-72 DEN-63 CYST ENUCLEATIONS II 14000 17500 18900 21000 21000 73 DEN-73 DEN-64 CYST ENUCLEATIONS III 18000 22500 24300 27000 27000 74 DEN-74 DEN-63 CYST MURSUPIALIZATION I 9000 11250 12150 13500 13500 75 DEN-75 DEN-66 CYST MURSUPIALIZATION II 12000 15000 16200 18000 18000 76 DEN-76 DEN-64 DENTAL BIOPSY (GR-I) 2000 2500 2700 3000 3000 77 DEN-77 DEN-65 DENTAL BIOPSY (GR-II) 4000 5000 5400 6000 6000 78 DEN-78 DEN-66 DENTAL BIOPSY (GR-III) 6000 7500 8100 9000 9000 79 DEN-79 DEN-67 DENTAL BIOPSY (GR-IV) 8000 10000 10800 12000 12000 80 DEN-80 DEN-71 EXCISION BIOPSY- GR-1 4000 5000 5400 6000 6000 81 DEN-81 DEN-72 EXCISION BIOPSY- GR-2 6000 7500 8100 9000 9000 82 DEN-82 DEN-70 EXCISION BIOPSY- GR-3 8000 10000 10800 12000 12000 83 DEN-83 DEN-73 EXCISION OF BONY TUMOR OF JAW GR-1 20000 25000 27000 30000 30000

Any new service/tariff may be changed/added/deleted without prior notice. 134 Schedule of Charges 2019-20 ISIC

84 DEN-84 DEN-74 EXCISION OF BONY TUMOR OF JAW GR-2 30000 37500 40500 45000 45000 85 DEN-85 DEN-75 EXCISION OF BONY TUMOR OF JAW GR-3 40000 50000 54000 60000 60000 86 DEN-86 DEN-76 EXTRACTION PER TOOTH UNDER G.A 5320 6650 7182 7980 7980 87 DEN-87 DEN-77 EXTRACTION-PER TOOTH (GR -1) 1000 1250 1350 1500 1500 88 DEN-88 DEN-78 EXTRACTION-PER TOOTH (GR -2) 1500 1875 2025 2250 2250 89 DEN-89 DEN-79 EXTRACTION-PER TOOTH (GR -3) 2500 3125 3375 3750 3750 90 DEN-90 DEN-81 FRACTURE CLOSED REDUCTION (GR1) 24000 30000 32400 36000 36000 91 DEN-91 DEN-82 FRACTURE CLOSED REDUCTION (GR2) 32000 40000 43200 48000 48000 92 DEN-92 DEN-83 FRACTURE CLOSED REDUCTION (GR3) 40000 50000 54000 60000 60000 93 DEN-93 DEN-84 FRACTURE OPEN REDUCTION (GR-I) 40000 50000 54000 60000 60000 94 DEN-94 DEN-85 FRACTURE OPEN REDUCTION (GR-II) 50000 62500 67500 75000 75000 95 DEN-95 DEN-86 FRACTURE OPEN REDUCTION (GR-III) 60000 75000 81000 90000 90000 96 DEN-96 DEN-87 FRENECTOMY I 4000 5000 5400 6000 6000 97 DEN-97 DEN-69 FRENECTOMY II 9000 11250 12150 13500 13500 98 DEN-98 DEN-88 IMPACTION PER TOOTH (GR.-1) 6000 7500 8100 9000 9000 99 DEN-99 DEN-89 IMPACTION PER TOOTH (GR.-2) 8000 10000 10800 12000 12000 100 DEN-100 DEN-90 IMPACTION PER TOOTH (GR.-3) 10000 12500 13500 15000 15000 101 DEN-101 DEN-94 INCISION & DRAINAGE (GR.-I) 3000 3750 4050 4500 4500 102 DEN-102 DEN-95 INCISION & DRAINAGE (GR.-II) 6000 7500 8100 9000 9000 103 DEN-103 DEN-96 INCISION & DRAINAGE (GR.-III) 12000 15000 16200 18000 18000 104 DEN-104 DEN-100 IOPA X-RAY 200 250 270 300 300 105 DEN-105 DEN-101 MID FACE FRACTURES GR-2 48000 60000 64800 72000 72000 106 DEN-106 DEN-102 MID FACE FRACTURES GR-3 60000 75000 81000 90000 90000 107 DEN-107 DEN-103 MID FACE FRACTURES GR-I 36000 45000 48600 54000 54000 108 DEN-108 DEN-104 REIMPLANTING OF TOOTH 6000 7500 8100 9000 9000 109 DEN-109 DEN-105 REPAIR OF ORO ANTRAL FISTULA GR-1 10000 12500 13500 15000 15000 110 DEN-110 DEN-106 REPAIR OF ORO ANTRAL FISTULA GR-2 18000 22500 24300 27000 27000 111 DEN-111 DEN-107 REPAIR OF ORO ANTRAL FISTULA GR-3 24000 30000 32400 36000 36000 112 DEN-112 DEN-108 SURGICAL EXTRACTION (GR.1) 4000 5000 5400 6000 6000 113 DEN-113 DEN-109 SURGICAL EXTRACTION (GR.2) 5000 6250 6750 7500 7500

Any new service/tariff may be changed/added/deleted without prior notice. 135 Schedule of Charges 2019-20 ISIC

ORTHODONTICS 114 DEN-114 DEN-112 ACRYLIC SPLINT 2410 3013 3254 3615 3615 115 DEN-115 DEN-113 FIXED APPL.+ RETENTION PLATE-METAL (GR- 1) 45000 56250 60750 67500 67500 116 DEN-116 DEN-114 FIXED APPL.+RETENTION PLATE-METAL (GR.-2 60000 75000 81000 90000 90000 117 DEN-117 DEN-115 FIXED APPL.+RETENTION PLATE-METAL (GR.-3) 75000 93750 101250 112500 112500 118 DEN-118 DEN-116 FIXED GROWTH MODIFICATION APPL. (GR-I) 18000 22500 24300 27000 27000 119 DEN-119 DEN-117 FIXED GROWTH MODIFICATION APPL. (GR-II) 28000 35000 37800 42000 42000 120 DEN-120 DEN-118 FIXED RETAINER (SINGLE) 4000 5000 5400 6000 6000 121 DEN-121 DEN-119 FUNCTIONAL APPLIANCE 24000 30000 32400 36000 36000 122 DEN-122 DEN-120 HABIT BREAKING APPLIANCE (GR.-I) 6450 8063 8708 9675 9675 123 DEN-123 DEN-121 HABIT BREAKING APPLIANCE (GR.-II) 8540 10675 11529 12810 12810 124 DEN-124 DEN-122 HABIT BREAKING APPLIANCE (GR.-III) 10710 13388 14459 16065 16065 125 DEN-125 DEN-123 HABIT BREAKING APPLIANCE (GR.-IV) 12870 16088 17375 19305 19305 126 DEN-126 DEN-124 HABIT BREAKING APPLIANCE (GR.-V) 13930 17413 18806 20895 20895 127 DEN-127 DEN-70 INVISALIGN GRADE I 250000 312500 337500 375000 375000 128 DEN-128 DEN-71 INVISALIGN GRADE II 450000 562500 607500 675000 675000 129 DEN-129 DEN-125 MAXIOLLOFACIAL PROSTHESIS (GR.-I) 5000 6250 6750 7500 7500 130 DEN-130 DEN-126 MAXIOLLOFACIAL PROSTHESIS (GR.-II) 7500 9375 10125 11250 11250 131 DEN-131 DEN-127 MAXIOLLOFACIAL PROSTHESIS (GR.-III) 10000 12500 13500 15000 15000 132 DEN-132 DEN-128 OBTURATOR (GR.-1) 3330 4163 4496 4995 4995 133 DEN-133 DEN-129 OBTURATOR (GR.-II) 3990 4988 5387 5985 5985 134 DEN-134 DEN-130 OBUTRAT0R (GRADE-III) 5370 6713 7250 8055 8055 135 DEN-135 DEN-131 REMOVABLE APPLIACE / RETENTION PLATE 6450 8063 8708 9675 9675 136 DEN-136 DEN-132 REMOVABLE GROWTH MODIFICATION APPL. (GR-I) 17150 21438 23153 25725 25725 137 DEN-137 DEN-133 REMOVABLE GROWTH MODIFICATION APPL. (GR-II) 21430 26788 28931 32145 32145 138 DEN-138 DEN-134 REMOVABLE GROWTH MODIFICATION APPL. (GR-III) 27860 34825 37611 41790 41790 139 DEN-139 DEN-135 SPACE MAINTAINER 4000 5000 5400 6000 6000 140 DEN-140 DEN-136 SPL. BRACES (GR -1) 90000 112500 121500 135000 135000 141 DEN-141 DEN-137 SPL. BRACES (GR -2) 110000 137500 148500 165000 165000 142 DEN-142 DEN-138 SPL. BRACES (GR -3) 130000 162500 175500 195000 195000

Any new service/tariff may be changed/added/deleted without prior notice. 136 Schedule of Charges 2019-20 ISIC

143 DEN-143 DEN-139 SPL. BRACES (GR -4) 150000 187500 202500 225000 225000 144 DEN-144 DEN-140 TOOTH COLOUR FIXED APPL. + RETENTION PLATE (GR1) 65000 81250 87750 97500 97500 145 DEN-145 DEN-141 TOOTH COLOUR FIXED APPL. + RETENTION PLATE (GR2) 90000 112500 121500 135000 135000 146 DEN-146 DEN-142 TOOTH COLOUR FIXED APPL.+ RETENTION PLATE (GR3) 110000 137500 148500 165000 165000

Charges Basis OPD/GW 100% HDU+ICU (all categories) 125% Shared 125% Single 135% Dlx 150% Spr. Dlx 150% Suite 150% Spr. Dlx Suite 150%

Note :- Above Charge basis would also be applicable on all newly added services

Any new service/tariff may be changed/added/deleted without prior notice. 137 Schedule of Charges 2019-20 ISIC

DERMATOLOGICAL PROCEDURE

Super Charges Shared Single Dlx/Super S.No. NEW CODE OLD CODE PROCEDURE LIST Dlx. (OPD/GW) Room/ICU/HDU Room Dlx / Suite Suite

1 DER-01 DER-1 CHEMICAL CAUTERY (PER SITTING) 2,150.00 2688 2903 3225 3225

2 DER-02 DER-2 ELECTRO CAUTERY (PER SITTING) 4,280.00 5350 5778 6420 6420

3 DER-03 DER-3 INTRALESIONAL INJECTION (PER VISIT) 1,070.00 1338 1445 1605 1605

4 DER-04 DER-4 SKIN BIOPSY 3,220.00 4025 4347 4830 4830

Charges Basis OPD/GW 100% HDU+ICU (all categories) 125% Shared 125% Single 135% Dlx 150% Spr. Dlx 150% Suite 150% Spr. Dlx Suite 150%

Note :- Above Charge basis would also be applicable on all newly added services

Any new service/tariff may be changed/added/deleted without prior notice. 138 Schedule of Charges 2019-20 ISIC

DIABETIC FOOT CARE PROCEDURES

Super OLD Shared Single Dlx/Super S.No. NEW CODE PROCEDURE NAME OPD/GW Dlx. CODE Room/ICU/HDU Room Dlx / Suite Suite 1 FCA-01 FCA-01 CALLUS DEBRIDEMENT 1070 1338 1445 1605 1605 2 FCA-02 FCA-02 CORN RESECTION IN OPD 1070 1338 1445 1605 1605 3 FCA-03 FCA-03 CORN RESECTION IN OT UNDER LA 5370 6713 7250 8055 8055 4 FCA-04 FCA-04 DIABETIC FOOT ULCER DEBRIDEMENT FOLLOW UP 1070 1338 1445 1605 1605 5 FCA-05 FCA-05 DIABETIC FOOT ULCER DEBRIDEMENT IST VISIT 3220 4025 4347 4830 4830 6 FCA-06 FCA-9 INGROWN TOENAIL CORRECTION SINGLE SIDE 3220 4025 4347 4830 4830 7 FCA-07 FCA-7 NAIL CORRECTION 1070 1338 1445 1605 1605 8 FCA-08 FCA-8 OFFLOADING IN OPD OF FOOT ULCER 3220 4025 4347 4830 4830

Charges Basis OPD/GW 100% HDU+ICU (all categories) 125% Shared 125% Single 135% Dlx 150% Spr. Dlx 150% Suite 150% Spr. Dlx Suite 150%

Note :- Above Charge basis would also be applicable on all newly added services

Any new service/tariff may be changed/added/deleted without prior notice. 139 Schedule of Charges 2019-20 ISIC

ENT PROCEDURES

Shared Dlx/ Super OLD Single S.No. NEW CODE Procedures Name OPD/GW Room/ICU Super Dlx. CODE Room /HDU Dlx/Suite Suite 1 ENTP-01 ENTP-4 Cauterization-Aural (ENT) 2350 2938 3173 3525 3525 2 ENTP-02 ENTP-5 Cauterization-Nasal (ENT) 2050 2563 2768 3075 3075 3 ENTP-03 ENTP-6 Cauterization-Oral (ENT) 2350 2938 3173 3525 3525 4 ENTP-04 ENTP-7 CAUTERIZATION-OROPHARYNX (ENT) 2350 2938 3173 3525 3525 5 ENTP-05 ENTP-8 Chemical Cauterisation-Ear (ENT) 1180 1475 1593 1770 1770 6 ENTP-06 ENTP-9 Chemical Cauterisation-Nose (ENT) 1180 1475 1593 1770 1770 7 ENTP-07 ENTP-10 Consultation by speech therapy (ENT) 430 538 581 645 645 8 ENTP-08 ENTP-11 DEPTH PERCEPTION 840 1050 1134 1260 1260 9 ENTP-09 ENTP-12 EAR LOBULE REPAIR - BOTH EAR 4870 6088 6575 7305 7305 10 ENTP-10 ENTP-13 EAR LOBULE REPAIR - ONE EAR 4870 6088 6575 7305 7305 11 ENTP-11 ENTP-14 ENT DOCTOR EQPMT CHARGES 1870 2338 2525 2805 2805 12 ENTP-12 ENTP-15 Eustachian Tube function test (ENT) 980 1225 1323 1470 1470 13 ENTP-13 ENTP-16 EXAMINATION UNDER MICROSCOPE(ENT) 1950 2438 2633 2925 2925 14 ENTP-14 ENTP-17 FLEXIBLE FIBREOPTIC LARYNGOSCOPY 7510 9388 10139 11265 11265 15 ENTP-15 ENTP-18 Foreign Body Removal-Ear (ENT) 1070 1338 1445 1605 1605 16 ENTP-16 ENTP-19 Foreign Body Removal-Nose (ENT) 750 938 1013 1125 1125 17 ENTP-17 ENT-44 FOREIGN BODY REMOVAL-THROAT (ENT) 4390 5488 5927 6585 6585 18 ENTP-18 ENTP-20 Hearing aid consultation (ENT) 480 600 648 720 720 19 ENTP-19 ENTP-21 Impedance Audiometry (ENT) 1070 1338 1445 1605 1605 20 ENTP-20 ENTP-22 Intralesional injection Oral, Palate, Nose (ENT) 980 1225 1323 1470 1470 21 ENTP-21 ENTP-44 NASAL ENDOSCOPY 4870 6088 6575 7305 7305 22 ENTP-22 ENTP-23 PACKING OF HYPOPHARYNX 6440 8050 8694 9660 9660 23 ENTP-23 ENTP-24 Peritonsilar Abscess drainaige with Anaesthesia (ENT) 13930 17413 18806 20895 20895 24 ENTP-24 ENTP-25 Peritonsilar Abscess drainaige without Anaesthesia (ENT) 6820 8525 9207 10230 10230 25 ENTP-25 ENTP-26 Pre-auricular Sinus Excision (ENT) 9750 12188 13163 14625 14625 26 ENTP-26 ENTP-27 Punch Biopsy-Oral Cavity (ENT) 1510 1888 2039 2265 2265 27 ENTP-27 ENTP-28 Punch Biopsy-Oropharynx (ENT) 1180 1475 1593 1770 1770 29 ENTP-29 CGHS-232 PURE TONE AUDIOGRAM (AUDIOMETRY)- 1 SITTING 730 913 986 1095 1095 30 ENTP-30 14676 SEPTAL ABCESS DRAIN (NASAL) 3990 4988 5387 5985 5985

Any new service/tariff may be changed/added/deleted without prior notice. 140 Schedule of Charges 2019-20 ISIC

31 ENTP-31 ENTP-29 Special Audiological test (ENT) 980 1225 1323 1470 1470 32 ENTP-32 ENTP-30 Speech counselling (ENT) 650 813 878 975 975 33 ENTP-33 ENTP-31 Speech therapy by ST per-sitting (ENT) 580 725 783 870 870 34 ENTP-34 ENTP-32 Stitching of CLW-Ear (ENT) 3890 4863 5252 5835 5835 35 ENTP-35 ENTP-33 Stitching of CLW-Nose (ENT) 2930 3663 3956 4395 4395 36 ENTP-36 ENTP-34 Submandibular Gland Excision (ENT) 10300 12875 13905 15450 15450 37 ENTP-37 ENTP-35 SYRINGING OF EAR (1 EAR) 580 725 783 870 870 38 ENTP-38 ENTP-36 SYRINGING OF EAR (BOTH EARS) 980 1225 1323 1470 1470 39 ENTP-39 ENTP-37 Therapeutic Removal of Granulations-Aural (ENT) 2330 2913 3146 3495 3495 40 ENTP-40 ENTP-38 Therapeutic Removal of Granulations-Nasal (ENT) 1950 2438 2633 2925 2925 41 ENTP-41 ENTP-39 Therapeutic Removal of Granulations-Oropharynx (ENT) 2330 2913 3146 3495 3495 42 ENTP-42 ENTP-40 Thyroglossal fistula/sinus excision (ENT) 11580 14475 15633 17370 17370 43 ENTP-43 ENTP-41 Tympanogram (ENT) 1550 1938 2093 2325 2325 44 ENTP-44 ENTP-42 Vestibular funciton test (ENT) 1070 1338 1445 1605 1605 ENTP-43 Voice therapy (ENT) 580

Charges Basis OPD/GW 100% HDU+ICU (all categories) 125% Shared 125% Single 135% Dlx 150% Spr. Dlx 150% Suite 150% Spr. Dlx Suite 150%

Note :- Above Charge basis would also be applicable on all newly added services

Any new service/tariff may be changed/added/deleted without prior notice. 141 Schedule of Charges 2019-20 ISIC

GASTROENTEROLOGY PROCEDURES

Dlx/ Shared Super New Single Super S.No. Old Codes PROCEDURE NAME OPD/GW Room/ICU Dlx. Code Room Dlx / /HDU Suite Suite 1 GAS-01 GAS-54 ASSITIC TAPPING (GASTRO) 2500 3125 3375 3750 3750 2 GAS-02 GAS-55 ASSITIC TAPPING (GASTRO)-THERAPEUTIC 4300 5375 5805 6450 6450 3 GAS-03 GAS-1 EMERGENCY BEDSIDE ENDOSCOPY (SVE) 9500 11875 12825 14250 14250 4 GAS-04 GAS-2 ENDOPROSTHESIS (STENT) PLACEMENT 16850 21063 22748 25275 25275 5 GAS-05 GAS-3 ENDOSCOPIC BANDING 11080 13850 14958 16620 16620 6 GAS-06 GAS-4 ENDOSCOPIC BIOPSY 1500 1875 2025 2250 2250 7 GAS-07 GAS-5 ENDOSCOPIC COLONOSCOPY - FULL 9970 12463 13460 14955 14955 8 GAS-08 GAS-6 ENDOSCOPIC COLONOSCOPY - LIMITED (LEFT) 6860 8575 9261 10290 10290 9 GAS-09 GAS-7 ENDOSCOPIC COLONOSCOPY BIOPSY 880 1100 1188 1320 1320 10 GAS-10 GAS-8 ENDOSCOPIC COLONOSCOPY LT SIDE-EMERGENCY BEDSIDE 7760 9700 10476 11640 11640 11 GAS-11 GAS-9 ENDOSCOPIC COLONOSCOPY WHOLE EMERGENCY BEDSIDE 13290 16613 17942 19935 19935 12 GAS-12 GAS-10 ENDOSCOPIC DILATATION 11080 13850 14958 16620 16620 13 GAS-13 GAS-11 ENDOSCOPIC DILATATION 2ND SITTING 6640 8300 8964 9960 9960 14 GAS-14 GAS-12 ENDOSCOPIC DILATATION OF ACHALASIA 13500 16875 18225 20250 20250 15 GAS-15 GAS-13 ENDOSCOPIC ENTEROSCOPY 9750 12188 13163 14625 14625 16 GAS-16 GAS-14 ENDOSCOPIC ERCP (DIAGNOSTIC) 11080 13850 14958 16620 16620 17 GAS-17 GAS-15 ENDOSCOPIC ERCP WITH (SPHINCTEROTOMY) 22150 27688 29903 33225 33225 18 GAS-18 GAS-16 ENDOSCOPIC ERCP WITH BASKETING 26580 33225 35883 39870 39870 19 GAS-19 GAS-17 ENDOSCOPIC ERCP WITH EPT (PAPILLOTOMY) 15510 19388 20939 23265 23265 20 GAS-20 GAS-18 ENDOSCOPIC ERCP WITH MECH LITHOTROPSY Out source 44300 55375 59805 66450 66450 21 GAS-21 GAS-19 ENDOSCOPIC ERCP WITH STENTING BILIARY / PANCREATIC 31010 38763 41864 46515 46515 22 GAS-22 GAS-20 ENDOSCOPIC ESOPHAGOSCOPY 2650 3313 3578 3975 3975 23 GAS-23 GAS-21 ENDOSCOPIC FLEXIBLE SIGMODOSCOPY 3990 4988 5387 5985 5985

Any new service/tariff may be changed/added/deleted without prior notice. 142 Schedule of Charges 2019-20 ISIC

24 GAS-24 GAS-23 ENDOSCOPIC H.PYLORI TESTING 1200 1500 1620 1800 1800 25 GAS-25 GAS-24 ENDOSCOPIC INSERTION OF N.G. TUBE 10650 13313 14378 15975 15975 26 GAS-26 GAS-25 ENDOSCOPIC INSERTION OF NBD (NASOBILIARY DRAIN) 19930 24913 26906 29895 29895 27 GAS-27 GAS-26 ENDOSCOPIC INSERTION OF NJ TUBE (NASOJEJUNAL TUBE) 18120 22650 24462 27180 27180 28 GAS-28 GAS-27 ENDOSCOPIC LARYNGOSCOPY 2650 3313 3578 3975 3975 29 GAS-29 GAS-29 ENDOSCOPIC PAPILLOTOMY (EPT) 22150 27688 29903 33225 33225 30 GAS-30 GAS-30 ENDOSCOPIC PEG 14500 18125 19575 21750 21750 31 GAS-31 GAS-53 ENDOSCOPIC PEG REMOVAL 9320 11650 12582 13980 13980 32 GAS-32 GAS-31 ENDOSCOPIC PH MONITORING 6640 8300 8964 9960 9960 33 GAS-33 GAS-32 ENDOSCOPIC PHOTOGRAPH 330 413 446 495 495 34 GAS-34 GAS-34 ENDOSCOPIC PLACEMENT OF RYLES TUBE - EMERGENCY BEDSIDE 11080 13850 14958 16620 16620 35 GAS-35 GAS-33 ENDOSCOPIC PLACEMENT OF RYLES TUBE 6860 8575 9261 10290 10290 36 GAS-36 GAS-35 ENDOSCOPIC POLYPECTOMY 18120 22650 24462 27180 27180 37 GAS-37 GAS-37 ENDOSCOPIC REMOVAL OF FOREIGN BODY (FB) 13290 16613 17942 19935 19935 38 GAS-38 GAS-39 ENDOSCOPIC SCLEROTHERAPY (EST) - EMERGENCY BEDSIDE 19040 23800 25704 28560 28560 39 GAS-39 GAS-38 ENDOSCOPIC SCLEROTHERAPY (EST) 11080 13850 14958 16620 16620 40 GAS-40 GAS-40 ENDOSCOPIC SCLEROTHERAPY (EST) 2ND SITTING 7760 9700 10476 11640 11640 41 GAS-41 GAS-42 ENDOSCOPIC SCLEROTHERAPY OF ULCER 12180 15225 16443 18270 18270 42 GAS-42 GAS-41 ENDOSCOPIC SCLEROTHERAPY OF ULCER - EMERGENCY BEDSIDE 15300 19125 20655 22950 22950 43 GAS-43 GAS-43 ENDOSCOPIC SENGSTAKEIN TUBE PLACEMENT 4430 5538 5981 6645 6645 44 GAS-44 GAS-44 ENDOSCOPIC SIGMOIDOSCOPY - EMERGENCY BEDSIDE 4390 5488 5927 6585 6585 45 GAS-45 GAS-45 ENDOSCOPIC SIGMOIDOSCOPY 3370 4213 4550 5055 5055 46 GAS-46 GAS-46 ENDOSCOPIC SUBSEQUENT BANDING 8860 11075 11961 13290 13290 47 GAS-47 GAS-47 ENDOSCOPIC VARICEAL LIGATION (EVL - BANDING) 11080 13850 14958 16620 16620 48 GAS-48 GAS-48 ENDOSCOPY (UGI) - EMERGENCY BEDSIDE 8860 11075 11961 13290 13290 49 GAS-49 GAS-49 ENDOSCOPY (UGI) 5040 6300 6804 7560 7560 50 GAS-50 GAS-50 ENDOSCOPY BIOPSY 1500 1875 2025 2250 2250 51 GAS-51 GAS-51 HELICORAPT SLIDE 450 563 608 675 675

Any new service/tariff may be changed/added/deleted without prior notice. 143 Schedule of Charges 2019-20 ISIC

52 GAS-52 GAS-52 LIVER & SPLEEN COLLOID SCAN 5530 6913 7466 8295 8295 53 GAS-53 15908 OVER THE SCOPE HEMOSTATIC CLIPPING(ENDOSCOPIC) 12180 15225 16443 18270 18270

Charges Basis OPD/GW 100% HDU+ICU (all categories) 125% Shared 125% Single 135% Dlx 150% Spr. Dlx 150% Suite 150% Spr. Dlx Suite 150%

Note:- Above Charge basis would also be applicable on all newly added services

Any new service/tariff may be changed/added/deleted without prior notice. 144 Schedule of Charges 2019-20 ISIC

INTERNAL MEDICINE PROCEDURES

Super Shared Single Dlx/Super S.NO. NEW CODE OLD CODE Service Name OPD/GW Dlx. Room/ICU/HDU Room Dlx / Suite Suite 1 MED-01 MED-01 ABDOMINAL PARACENTESIS (DIAG) 6200 7750 8370 9300 9300 2 MED-02 MED-09 ABDOMINAL PARACENTESIS (THERAPEUTIC) 8060 10075 10881 12090 12090 3 MED-03 MED-08 BONE MARROW ASPIRATION & BIOPSY 8860 11075 11961 13290 13290 4 MED-04 MED-07 BONE MARROW ASPIRATION (BSP) 6200 7750 8370 9300 9300 5 MED-05 MED-03 INTERCOSTAL TUBE INSERTION 8860 11075 11961 13290 13290 6 MED-06 MED-04 INTERCOSTAL TUBE REMOVAL 4430 5538 5981 6645 6645 7 MED-07 MED-6 LIVER ABSCESS DRAINAGE 8860 11075 11961 13290 13290 8 MED-08 MED-5 LIVER BIOPSY 7980 9975 10773 11970 11970 9 MED-09 5694 PLEURAL TAPPING (DIAGNOSTIC) 6200 7750 8370 9300 9300 10 MED-10 14914 PLEURAL TAPPING (THERAPEUTIC) 8060 10075 10881 12090 12090

Charges Basis OPD/GW 100% HDU + ICU (all categories) 125% Shared 125% Single 135% Dlx 150% Spr. Dlx 150% Suite 150% Spr. Dlx Suite 150%

Note :- Above Charge basis would also be applicable on all newly added services

Any new service/tariff may be changed/added/deleted without prior notice. 145 Schedule of Charges 2019-20 ISIC

GENERAL PROCEDURES

Shared Super Single Dlx/Super S.NO. NEW CODE OLD CODE Service Name OPD/GW Room/ICU/ Dlx. Room Dlx / Suite HDU Suite

1 GENP-01 GENP-01 ABG (ICU-BLOOD GAS ANALYSER) 1400 1750 1890 2100 2100

2 GENP-03 GENP-02 HAEMORRHOID - BAND LIGATION 3380 4225 4563 5070 5070

3 GENP-04 GENP03 INJECTION HAEMORRHOIDS/KELOIDS 3630 4538 4901 5445 5445

4 GENP-05 GENP-04 VASECTOMY 13930 17413 18806 20895 20895

Charges Basis OPD/GW 100% HDU + ICU (all categories) 125% Shared 125% Single 135% Dlx 150% Spr. Dlx 150% Suite 150% Spr. Dlx Suite 150%

Note :- Above Charge basis would also be applicable on all newly added services

Any new service/tariff may be changed/added/deleted without prior notice. 146 Schedule of Charges 2019-20 ISIC

DIALYSIS (NEPHROLOGY) PROCEDURES

Shared Super NEW OLD Single Dlx/Super S.No. PROCEDURE LIST OPD/GW Room/ICU Dlx. CODE CODE Room Dlx / Suite /HDU Suite 1 NEPH-01 NEPH-1 CAVH (NEPHRO) 14180 17725 19143 21270 21270 2 NEPH-02 NEPH-2 CVVH (NEPHRO) 14180 17725 19143 21270 21270 3 NEPH-03 NEPH-3 DIALYSIS - FIRST (NEPHRO) 3310 4138 4469 4965 4965 4 NEPH-04 NEPH-4 DIALYSIS - SUBSEQUENT/REUSE (NEPHRO) 2420 3025 3267 3630 3630 5 NEPH-05 NEPH-5 DIALYSIS (BEDSIDE) 4900 6125 6615 7350 7350 6 NEPH-06 NEPH-6 DIALYSIS (EMERGENCY) 4900 6125 6615 7350 7350 7 NEPH-07 15128 DIALYSIS CGHS SERONEGATIVE 1610 2013 2174 2415 2415 8 NEPH-08 15127 DIALYSIS CGHS SEROPOSITIVE 1898 2373 2562 2847 2847 9 NEPH-09 NEPH-7 DIALYSIS FIRST (NEPHRO) F6 DIALYSIS (Single Use) 3150 3938 4253 4725 4725 10 NEPH-10 NEPH-8 DIALYSIS FIRST (NEPHRO) F8 DIALYSER (Single Use) 3630 4538 4901 5445 5445 11 NEPH-11 NEPH-16 DIALYSIS REUSE F6 2420 3025 3267 3630 3630 12 NEPH-12 NEPH-19 DIALYSIS REUSE F60 2920 3650 3942 4380 4380 13 NEPH-13 NEPH-17 DIALYSIS REUSE F8 2530 3163 3416 3795 3795 14 NEPH-14 NEPH-18 DIALYSIS REUSE F80 3860 4825 5211 5790 5790 15 NEPH-15 NEPH-25 DIALYSIS SINGLE USE F6 (HBsAg/HIV PTS) 4320 5400 5832 6480 6480 16 NEPH-16 NEPH-20 DIALYSIS SINGLE USE F6 (HCV PTS.) 3460 4325 4671 5190 5190 17 NEPH-17 NEPH-28 DIALYSIS SINGLE USE F60 (HBsAg/HIV PTS) 5900 7375 7965 8850 8850 18 NEPH-18 NEPH-26 DIALYSIS SINGLE USE F60 (HCV PTS.) 5500 6875 7425 8250 8250 19 NEPH-19 NEPH-23 DIALYSIS SINGLE USE F60 5190 6488 7007 7785 7785 20 NEPH-20 NEPH-22 DIALYSIS SINGLE USE F8 (FOR HCV PTS) 4400 5500 5940 6600 6600 21 NEPH-21 NEPH-26 DIALYSIS SINGLE USE F8 (HBsAg/HIV PTS) 4990 6238 6737 7485 7485 22 NEPH-22 NEPH-29 DIALYSIS SINGLE USE F80 (HBsAg/HIV PTS) 6820 8525 9207 10230 10230 23 NEPH-23 NEPH-27 DIALYSIS SINGLE USE F80 (HCV PTS) 6010 7513 8114 9015 9015 24 NEPH-24 NEPH-24 DIALYSIS SINGLE USE F80 5460 6825 7371 8190 8190 25 NEPH-25 NEPH-27 DIALYSIS SINGLE USE FX8 (HBsAg/HIV PTS) 4320 5400 5832 6480 6480 26 NEPH-26 NEPH-25 DIALYSIS SINGLE USE FX8 (HCV PTS) 3810 4763 5144 5715 5715 27 NEPH-27 NEPH-21 DIALYSIS SINGLE USE FX8 3470 4338 4685 5205 5205

Any new service/tariff may be changed/added/deleted without prior notice. 147 Schedule of Charges 2019-20 ISIC

28 NEPH-28 NEPH-9 FEMORAL CATHETERISATION (NEPHRO) 3330 4163 4496 4995 4995 29 NEPH-29 NEPH-10 JUGULAR CATHETERISATION (NEPHRO) 5060 6325 6831 7590 7590 30 NEPH-30 NEPH-11 KIDNEY BX. BIOPSY (NEPHRO) 7040 8800 9504 10560 10560 31 NEPH-31 NEPH-12 PERITONEAL DIALYSIS (NEPHRO) 5850 7313 7898 8775 8775 32 NEPH-32 NEPH-13 PLASMAPHARESIS CASH BILLS-Excl. Filter (NEPHRO) 9750 12188 13163 14625 14625 33 NEPH-33 NEPH-14 SLED (NEPHRO) 10730 13413 14486 16095 16095 34 NEPH-34 NEPH-15 SUBCLAVIAN CATHETERISATION (NEPHRO) 5060 6325 6831 7590 7590

Charges Basis OPD/GW 100% HDU + ICU (all categories) 125% Shared 125% Single 135% Dlx 150% Spr. Dlx 150% Suite 150% Spr. Dlx Suite 150%

Note :- Above Charge basis would also be applicable on all newly added services

Any new service/tariff may be changed/added/deleted without prior notice. 148 Schedule of Charges 2019-20 ISIC

NEUROLOGY PROCEDURES

Shared Dlx/Super Super NEW Single S.No. OLD CODE PROCEDURE NAME OPD/GW Room/ICU Dlx / Dlx. CODE Room /HDU Suite Suite 1 NEUP-01 NEUP-1 BED-SIDE EEG 8050 10063 10868 12075 12075 2 NEUP-02 NEUP-24 BEDSIDE NCV ALL FOUR LIMBS 16840 21050 22734 25260 25260 3 NEUP-03 NEUP-25 BEDSIDE NCV BOTH LOWER LIMBS 8050 10063 10868 12075 12075 4 NEUP-04 NEUP-26 BEDSIDE NCV BOTH UPPER LIMBS 8050 10063 10868 12075 12075 5 NEUP-05 NEUP-2 BLINK REFLEX 4390 5488 5927 6585 6585 6 NEUP-06 NEUP-3 BRAIN STEAM AUDITORY RESPONSE 5130 6413 6926 7695 7695 7 NEUP-07 NEUP-33 DIAGNOSTIC POLYSOMNOGRAPHY 17570 21963 23720 26355 26355 8 NEUP-08 NEUP-4 EMG (ELECTROMYOGRAPHY) 5130 6413 6926 7695 7695 9 NEUP-09 NEUP-5 FACIAL NERVE STUDY 4830 6038 6521 7245 7245 10 NEUP-10 NEUP-29 INJ BOTOX BEDSIDE (ONE LIMB) 4390 5488 5927 6585 6585 11 NEUP-11 14912 INTRAVENTRICULAR ANTIBIOTIC INSTILLATION 3630 4538 4901 5445 5445 12 NEUP-12 NEUP-6 IOM TIBIAL SSEP 44300 55375 59805 66450 66450 13 NEUP-13 NEUP-7 MEGNETIC MOTOR NERVE STIMULATION(MMNS) 5310 6638 7169 7965 7965 14 NEUP-14 NEUP-8 NCV - 1 LOWER LIMB 3190 3988 4307 4785 4785 15 NEUP-15 NEUP-9 NCV - 1 UPPER + 1 LOWER LIMB 6130 7663 8276 9195 9195 16 NEUP-16 NEUP-10 NCV - 1 UPPER LIMB 3190 3988 4307 4785 4785 17 NEUP-17 NEUP-11 NCV 1 UPPER LIMB WITH BRACHIAL PLEXUS STUDY 5060 6325 6831 7590 7590 18 NEUP-18 NEUP-12 NCV ALL FOUR LIMBS 9500 11875 12825 14250 14250 19 NEUP-19 NEUP-13 NCV BOTH LOWER LIMBS 6390 7988 8627 9585 9585 20 NEUP-20 NEUP-14 NCV BOTH UPPER LIMBS 6390 7988 8627 9585 9585 21 NEUP-21 NEUP-15 NCV BOTH UPPER LIMBS WITH BRACHIAL PLEXUS STUDY 8790 10988 11867 13185 13185 22 NEUP-22 NEUP-16 OVER NIGHT SLEEP EEG (PER HOUR) 2410 3013 3254 3615 3615 23 NEUP-23 NEUP-27 R - R INTERVAL 2930 3663 3956 4395 4395 24 NEUP-24 NEUP-17 REPETITIVE NERVE STIMULATION(RNS,DECREMENT) 6190 7738 8357 9285 9285 25 NEUP-25 NEUP-18 ROUTINE DIGITAL EEG 3500 4375 4725 5250 5250 26 NEUP-26 NEUP-19 SHORT TERM VIDEO EEG (STVEEG) 8000 10000 10800 12000 12000 27 NEUP-27 NEUP-20 SLEEP DEPRIVED EEG - (1 HOUR 15 MIN RECORDING) 6000 7500 8100 9000 9000 28 NEUP-28 NEUP-30 Sleep Study-Diagnostic+CPAP Titration 18000 22500 24300 27000 27000

Any new service/tariff may be changed/added/deleted without prior notice. 149 Schedule of Charges 2019-20 ISIC

29 NEUP-29 NEUP-21 SSEP-LL (SOMATO SENSORY EVOKED POTENTIALS) 4660 5825 6291 6990 6990 30 NEUP-30 NEUP-22 SSEP-UL (SOMATO SENSORY EVOKED POTENTIAL) 4660 5825 6291 6990 6990 31 NEUP-31 NEUP-28 SSR 2930 3663 3956 4395 4395 32 NEUP-32 NEUP-31 TCD (TRANSCRANIAL DOPPLER) 7330 9163 9896 10995 10995 33 NEUP-33 NEUP-30 TCD ICU MONITORING 14640 18300 19764 21960 21960 34 NEUP-34 NEUP-32 TCD SCREENING (TRANSCRANIAL DOPPLER SCREENING) 4390 5488 5927 6585 6585 35 NEUP-35 NEURO-105 TILT TABLE TEST 2490 3113 3362 3735 3735 36 NEUP-36 NEUP-23 VISUAL EVOKED POTENTIALS(VEP) 4660 5825 6291 6990 6990

OPD/GW 100% HDU + ICU (all categories) 125% Shared 125% Single 135% Dlx 150% Spr. Dlx 150% Suite 150% Spr. Dlx Suite 150%

Note :- Above Charge basis would also be applicable on all newly added services

Any new service/tariff may be changed/added/deleted without prior notice. 150 Schedule of Charges 2019-20 ISIC

OPTHALMOLOGY PROCEDURES

Dlx/Super Super NEW OLD OPD/ Shared Single S.No. Procedure Name Dlx / Dlx. CODE CODE GW Room/ICU/HDU Room Suite Suite

1 OPTH-01 OPTH-1 BIOPSY (OPTHO) 3890 4863 5252 5835 5835

2 OPTH-02 14248 COLOR VISION 740 925 999 1110 1110

3 OPTH-03 OPTH-2 CRYOPEXY FOR RETINAL HOLE/LATTICE/TEAR BOTH EYES 25330 31663 34196 37995 37995

4 OPTH-04 OPTH-3 CRYOPEXY FOR RETINAL HOLE/LATTICE/TEAR ONE EYE 12660 15825 17091 18990 18990

5 OPTH-05 OPTH-4 DI-URNAL VARIATION (OPTHO) 10710 13388 14459 16065 16065

6 OPTH-06 OPTH-5 Fluorescein Angioscopy 4870 6088 6575 7305 7305

7 OPTH-07 OPTH-6 FOREIGN BODY REMOVAL, SUPERFICIAL - BOTH EYES (OPTHO) 3890 4863 5252 5835 5835

8 OPTH-08 OPTH-7 FOREIGN BODY REMOVAL, SUPERFICIAL - ONE EYE (OPTHO) 1950 2438 2633 2925 2925

9 OPTH-09 OPTH-8 FUNDUS EXAMINATION 1760 2200 2376 2640 2640

10 OPTH-10 OPTH-9 GONIOSCOPY (OPTHO) 2330 2913 3146 3495 3495

11 OPTH-11 OPTH-12 I & D LID ABSCESS (OPTHO) 1760 2200 2376 2640 2640

12 OPTH-12 OPTH-11 I&C OF CHALAZION (MULTIPLE) 15020 18775 20277 22530 22530

13 OPTH-13 OPTH-10 I&C OF CHALAZION 7510 9388 10139 11265 11265

14 OPTH-14 OPTH-13 INDIRECT OPHTHALMOSCOPY (OPTHO) 2930 3663 3956 4395 4395

15 OPTH-15 OPTH-14 IOP RECORDING 980 1225 1323 1470 1470

16 OPTH-16 OPTH-15 REFRACTION (OPHTHO) 1180 1475 1593 1770 1770

17 OPTH-17 14937 SURGICAL TARSORRHAPHY 5450 6813 7358 8175 8175

18 OPTH-18 OPTH-16 SUTURING OF CONJUNCTIVAL TEAR 10710 13388 14459 16065 16065

Any new service/tariff may be changed/added/deleted without prior notice. 151 Schedule of Charges 2019-20 ISIC

19 OPTH-19 OPTH-17 UN-COMPLICATED LID - TEAR (OPTHO) 11720 14650 15822 17580 17580

20 OPTH-20 OPTH-18 WATER DRINKING TEST (OPTHO) 6820 8525 9207 10230 10230

Charges Basis OPD/GW 100% HDU + ICU (all categories) 125% Shared 125% Single 135% Dlx 150% Spr. Dlx 150% Suite 150% Spr. Dlx Suite 150%

Note :- Above Charge basis would also be applicable on all newly added services

Any new service/tariff may be changed/added/deleted without prior notice. 152 Schedule of Charges 2019-20 ISIC

PAEDIATRIC PROCEDURES

Shared Super NEW Single Dlx/Super S.No. OLD CODE PROCEDURES NAME OPD/GW Room/ICU Dlx. CODE Room Dlx / Suite /HDU Suite

1 PAED-01 PAED-1 ARTERIAL LINE (PAEDIATRICS) 4280 5350 5778 6420 6420 2 PAED-02 PAED-2 BONE MARROW ASPIRATION (PAEDIATRICS) 10300 12875 13905 15450 15450 3 PAED-03 PAED-3 BONE MARROW BIOPSY (PAEDIATRICS) 10300 12875 13905 15450 15450 4 PAED-04 PAED-4 CHEST TUBE/ICD (PAEDIATRICS) 8140 10175 10989 12210 12210 5 PAED-05 PAED-5 CUT DOWN (PAEDIATRICS) 6450 8063 8708 9675 9675 6 PAED-06 PAED-6 DRESSING BIG (PAEDIATRICS) 2570 3213 3470 3855 3855 7 PAED-07 PAED-7 DRESSING SMALL (PAEDIATRICS) 1290 1613 1742 1935 1935 8 PAED-08 PAED-9 FORIEGN BODY REMOVAL (PAEDIATRICS) 5370 6713 7250 8055 8055 GASTRIC LAVAGE (GASTRIC ASPIRATION) 9 PAED-09 PAED-10 1290 1613 1742 1935 1935 (PAEDIATRICS) 10 PAED-10 PAED-11 I & D DEEP (PAEDIATRICS) 7510 9388 10139 11265 11265 11 PAED-11 PAED-12 I & D SUPERFICIAL (PAEDIATRICS) 4280 5350 5778 6420 6420 12 PAED-12 PAED-13 I/V CANULATION (PAEDIATRICS) 1070 1338 1445 1605 1605 13 PAED-13 PAED-14 INTUBATION (PAEDIATRICS) 1850 2313 2498 2775 2775 14 PAED-14 PAED-15 LIVER BIOPSY (PAEDIATRICS) 5150 6438 6953 7725 7725 15 PAED-15 PAED-16 LN BIOPSY/FNAC (PAEDIATRICS) 4280 5350 5778 6420 6420 16 PAED-16 PAED-17 LUMBAR PUNCTURE (PAEDIATRICS) 4730 5913 6386 7095 7095 17 PAED-17 PAED-19 RESUSCITATION (PAEDIATRICS) 5370 6713 7250 8055 8055 18 PAED-18 PAED-20 SKIN BIOPSY (PAEDIATRICS) 4280 5350 5778 6420 6420 19 PAED-19 PAED-21 SUBCLAVIAN (PAEDIATRICS) 9650 12063 13028 14475 14475 SUPRAPUBIC DRAINAGE OF URINE (TROCHAR 20 PAED-20 PAED-22 1140 1425 1539 1710 1710 CANULA) PAEDIATRICS 21 PAED-21 PAED-24 SUTURING BIG (PAEDIATRICS) 6970 8713 9410 10455 10455

Any new service/tariff may be changed/added/deleted without prior notice. 153 Schedule of Charges 2019-20 ISIC

22 PAED-22 PAED-25 SUTURING SMALL (PAEDIATRICS) 4280 5350 5778 6420 6420 23 PAED-23 PAED-26 URINE CATHETOR (PAEDIATRICS) 3220 4025 4347 4830 4830 24 PAED-24 PAED-27 VENTILATION (PAEDIATRICS) 4280 5350 5778 6420 6420

Charges Basis OPD/GW 100% HDU + ICU (all categories) 125% Shared 125% Single 135% Dlx 150% Spr. Dlx 150% Suite 150% Spr. Dlx Suite 150%

Note :- Above Charge basis would also be applicable on all newly added services

Any new service/tariff may be changed/added/deleted without prior notice. 154 Schedule of Charges 2019-20 ISIC

PAIN MEDICINE PROCEDURES

Shared Dlx/Super Super NEW OLD Single S.NO. Procedure Name OPD/GW Room/ICU Dlx / Dlx. CODE CODE Room /HDU Suite Suite 1 PAINP-01 PAINP-01 BOTOX INJECTION INTRAMUSCULAR (Pain Clinic) 6340 7925 8559 9510 9510 2 PAINP-02 PAINP-02 INTRA ARTICULAR INJECTION (Floroscopic/USG guided) (Pain Clinic) 5070 6338 6845 7605 7605 3 PAINP-03 16250 LIDOCAINE INFUSION 11000 13750 14850 16500 16500 4 PAINP-04 PAINP-03 LOCAL STEROID INJECTION FOR OTHER INDICATIONS (Pain Clinic) 1420 1775 1917 2130 2130 5 PAINP-05 PAINP-04 LOCAL STEROID INJECTION FOR PLANTAR FASCIITIS (Pain Clinic) 1420 1775 1917 2130 2130 6 PAINP-06 PAINP-05 LOCAL STEROID INJECTION FOR TENDINITIS / BURSITIS (Pain Clinic) 1420 1775 1917 2130 2130 7 PAINP-07 PAINP-06 NERVE BLOCK WITH LOCAL ANAESTHETIC (Pain Clinic) 6960 8700 9396 10440 10440 8 PAINP-08 PAINP-07 PAINFUL SCAR INJECTION (PAIN CLINIC) 2650 3313 3578 3975 3975 9 PAINP-09 PAINP-08 POST OPERATIVE PAIN REGIONAL BLOCK (Pain Clinic) 5640 7050 7614 8460 8460 10 PAINP-10 PAINP-09 TRIGGER POINT INJECTION (Pain Clinic) 2650 3313 3578 3975 3975 ULTRASOUND GUIDED CONTINOUS NERVE BLOCK THROUGH 11 PAINP-11 PAINP-10 12460 15575 16821 18690 18690 PERINEURAL CATHETER

Charges Basis OPD/GW 100% HDU + ICU (all categories) 125% Shared 125% Single 135% Dlx 150% Spr. Dlx 150% Suite 150% Spr. Dlx Suite 150%

Note :- Above Charge basis would also be applicable on all newly added services

Any new service/tariff may be changed/added/deleted without prior notice. 155 Schedule of Charges 2019-20 ISIC

RESPIRATORY MEDICINE PROCEDURES

Shared Super NEW OLD Single Dlx/Super Procedure Name OPD/GW Room/ICU Dlx. S.NO. CODE CODE Room Dlx / Suite /HDU Suite 1 RESP-01 RESP-1 BIPAP (FOR A DAY) (RESP) 3210 4013 4334 4815 4815 2 RESP-02 RESP-2 BPF CLOSURE OR DECORTICATION (RESP) 42870 53588 57875 64305 64305 3 RESP-03 RESP-28 BRONCHOSCOPY WITH BAL WITH BIOPSY 18630 23288 25151 27945 27945 4 RESP-04 15719 BRONCHOSCOPY WITH CONVENTIONAL TBNA 17550 21938 23693 26325 26325 5 RESP-05 RESP-29 BRONCHOSCOPY WITH SUCTIONING-EMERGENCY 15970 19963 21560 23955 23955 6 RESP-06 RESP-5 BRONCHOSCOPY WITH TBLB 17550 21938 23693 26325 26325 7 RESP-07 RESP-7 C-PAP TITRATION (RESP) 21440 26800 28944 32160 32160 FIBEROPTIC BRONCHOSCOPY SCREENING SUCTION & 8 RESP-08 RESP-8 14520 18150 19602 21780 21780 LAVAGE 9 RESP-09 RESP-9 FIBEROPTIC E T TUBE INTUBATION 12100 15125 16335 18150 18150 10 RESP-10 RESP-10 ICD MANIPULATION 1610 2013 2174 2415 2415 11 RESP-11 RESP-11 INTERCOSTAL DRAINAGE 11280 14100 15228 16920 16920 12 RESP-12 RESP-13 MEDIASTINOSCOPY (RESP) 17150 21438 23153 25725 25725 13 RESP-13 RESP-14 MEDIASTINOSCOPY TUMOUR REMOVAL (RESP) 51450 64313 69458 77175 77175 14 RESP-14 RESP-29 MEDICAL THORACOSCOPY 16200 20250 21870 24300 24300 15 RESP-15 RESP-15 Open Lung Biopsy or Pleural Biopsy (RESP) 19490 24363 26312 29235 29235 16 RESP-16 RESP-16 PERCUTANEOUS DILATATIONAL TRACHEOSTOMY 10710 13388 14459 16065 16065 17 RESP-17 16353 PIG TAIL INSERTION WITH PLEURODESIS 5500 6875 7425 8250 8250 18 RESP-18 RESP-17 PLEURAL ASPIRATION DIAGNOSTIC (RESP) 4030 5038 5441 6045 6045 19 RESP-19 RESP-18 PLEURAL ASPIRATION THERAPEUTIC (RESP) 5640 7050 7614 8460 8460 20 RESP-20 RESP-19 PLEURAL BIOPSY 9750 12188 13163 14625 14625 21 RESP-21 RESP-20 PLEURODESIS (RESP) 11280 14100 15228 16920 16920 22 RESP-22 RESP-31 PULMANARY FUNCTION TEST 2200 2750 2970 3300 3300 23 RESP-23 RESP-22 RIB RESECTION (RESP) 12860 16075 17361 19290 19290 24 RESP-24 RESP-23 SCREENING FOR DIAPHRAGMATIC MOVEMENTS 3210 4013 4334 4815 4815 25 RESP-25 RESP-24 SLEEP STUDY (DIAGNOSTIC) (RESP) 12860 16075 17361 19290 19290

Any new service/tariff may be changed/added/deleted without prior notice. 156 Schedule of Charges 2019-20 ISIC

26 RESP-26 RESP-30 SLEEP STUDY TEST (Package) 19330 24163 26096 28995 28995 27 RESP-27 RESP-25 THORACOSCOPIC PLEURAL BIOPSY 24200 30250 32670 36300 36300 28 RESP-28 RESP-26 TONGUE TIE RELEASE (BEDSIDE) 6440 8050 8694 9660 9660

Charges Basis OPD/GW 100% HDU + ICU (all categories) 125% Shared 125% Single 135% Dlx 150% Spr. Dlx 150% Suite 150% Spr. Dlx Suite 150%

Note :- Above Charge basis would also be applicable on all newly added services

Any new service/tariff may be changed/added/deleted without prior notice. 157 Schedule of Charges 2019-20 ISIC

UROLOGY PROCEDURES

Shared Super NEW OLD Single Dlx/Super S.No. Service Name OPD/GW Room/ICU Dlx. CODES CODES Room Dlx / Suite /HDU Suite 1 UROP-01 14801 BLADDER WASH 2660 3325 3591 3990 3990 2 UROP-02 UROP-15 CATHETERISATION 2000 2500 2700 3000 3000 3 UROP-03 UROP-02 CIC TEACHING TECH. 2660 3325 3591 3990 3990 4 UROP-04 14802 CLOT EVACUATION 2660 3325 3591 3990 3990 5 UROP-05 UROP-16 CYSTOSCOPY 8050 10063 10868 12075 12075 6 UROP-06 UROP-3 DIAG CYSTOSCOPY 8050 10063 10868 12075 12075 7 UROP-07 UROP-4 DIFFICULT CATHETERISATION 3220 4025 4347 4830 4830 8 UROP-08 UROP-17 DJ STANT REMOVAL (BILATERAL) 9660 12075 13041 14490 14490 9 UROP-09 UROP-18 DJ STANT REMOVAL (UNILATERAL) 6450 8063 8708 9675 9675 10 UROP-10 UROP-5 FLEXIBLE CYSTOSCOPY (FOR THERAPEUTIC PURPOSE) 8050 10063 10868 12075 12075 FLEXIBLE CYSTOURETHROSCOPY (FOR DIAGNOSTIC 11 UROP-11 UROP-6 6450 8063 8708 9675 9675 PURPOSE) 12 UROP-12 UROP-7 I.C.V TESTING 4030 5038 5441 6045 6045 13 UROP-13 UROP-19 MEATOTOMY 8050 10063 10868 12075 12075 14 UROP-14 UROP-20 MEATOTOPLASTY 9660 12075 13041 14490 14490 15 UROP-15 UROP-13 PCN (UNILATERAL)-USG GUIDED (BEDSIDE) 16100 20125 21735 24150 24150 16 UROP-16 UROP-21 PENILE - VIBRATOR TREATMENT 2000 2500 2700 3000 3000 17 UROP-17 UROP-27 REDUCTION OF PARAPHIMOSIS 2200 2750 2970 3300 3300 18 UROP-18 UROP-8 SEXUALITY EVALUATION 2000 2500 2700 3000 3000 19 UROP-19 UROP-100 TENS/PTNS (URO) 640 800 864 960 960 20 UROP-20 UROP-22 TESTICULAR BIOPSY (B/L) 8050 10063 10868 12075 12075 21 UROP-21 UROP-9 TROCER SPC (USG GUIDED) 12080 15100 16308 18120 18120 22 UROP-22 UROP-13 URETHRA CALIBRATION WITH FOLLEYS NO. 16F 1610 2013 2174 2415 2415 23 UROP-23 UROP-23 URETHRAL DILATION UNDER L.A. 2410 3013 3254 3615 3615 24 UROP-24 UROP-99 URETHRAL REPAIR (BEDSIDE) 12890 16113 17402 19335 19335

Any new service/tariff may be changed/added/deleted without prior notice. 158 Schedule of Charges 2019-20 ISIC

25 UROP-25 UROP-10 URODYNAMIC STUDY 9660 12075 13041 14490 14490 26 UROP-26 UROP-12 UROFLOMETRY (URO) 1450 1813 1958 2175 2175 27 UROP-27 UROP-24 VACCUM ERECTIVE DEVICE (VED) APPLICATION 2000 2500 2700 3000 3000

Charges Basis OPD/GW 100% HDU+ICU (all categories) 125% Shared 125% Single 135% Dlx 150% Spr. Dlx 150% Suite 150% Spr. Dlx Suite 150%

Note :- Above Charge basis would also be applicable on all newly added services

Any new service/tariff may be changed/added/deleted without prior notice. 159 Schedule of Charges 2019-20 ISIC

DENTAL SURGERIES

NEW OLD General Shared Single Dlx/Super Super S.No. SURGERY CODE CODE Ward Room/ICU/HDU Room Dlx / Suite Dlx. Suite 1 DENS-01 DENS-1 ACRYLIC SPLINT 1586 2196 2440 3416 4270 2 DENS-02 DENS-2 ALL WISDOM MOLAR 7280 10080 11200 15680 19600 3 DENS-03 DENS-3 ALVEOLECTOMY (GR-I) 2600 3600 4000 5600 7000 4 DENS-04 DENS-4 ALVEOLECTOMY (GR-II) 3900 5400 6000 8400 10500 5 DENS-05 DENS-5 ALVEOLOPLASTY (GR-I) 2600 3600 4000 5600 7000 6 DENS-06 DENS-6 ALVEOLOPLASTY (GR-II) 3900 5400 6000 8400 10500 7 DENS-07 DENS-7 APEXIFICATION 2191 3033 3370 4718 5898 8 DENS-08 DENS-8 APICOECTOMY PER TOOTH- ANT 7280 10080 11200 15680 19600 9 DENS-09 DENS-9 APICOECTOMY PER TOOTH- POST 11655 16137 17930 25102 31378 10 DENS-10 DENS-10 ARCH BAR WIRING GR-1 PER ARCH 10179 14094 15660 21924 27405 11 DENS-11 DENS-11 ARCH BAR WIRING GR-2 PER ARCH 13137 18189 20210 28294 35368 12 DENS-12 DENS-12 ARCH BAR WIRING GR-3 PER ARCH 16036 22203 24670 34538 43173 13 DENS-13 DENS-19 CYST ENUCLEATIONS 7280 10080 11200 15680 19600 14 DENS-14 DENS-20 CYST REMOVAL 14567 20169 22410 31374 39218 15 DENS-15 DENS-21 CYST REMOVAL WITH GRAFTING 29127 40329 44810 62734 78418 16 DENS-16 DENS-22 DENTAL BIOPSY (GR-I) 1300 1800 2000 2800 3500 17 DENS-17 DENS-23 DENTAL BIOPSY (GR-II) 2600 3600 4000 5600 7000 18 DENS-18 DENS-24 DENTAL BIOPSY (GR-III) 3900 5400 6000 8400 10500 19 DENS-19 DENS-25 DENTAL BIOPSY (GR-IV) 5200 7200 8000 11200 14000 20 DENS-20 DENS-28 EXCISION BIOPSY - GR-3 6559 9081 10090 14126 17658 21 DENS-21 DENS-29 EXCISION BIOPSY- GR-1 3647 5049 5610 7854 9818 22 DENS-22 DENS-30 EXCISION BIOPSY- GR-2 5103 7065 7850 10990 13738 23 DENS-23 DENS-31 EXCISION OF BONY TUMOR OF JAW GR-1 13000 18000 20000 28000 35000 24 DENS-24 DENS-32 EXCISION OF BONY TUMOR OF JAW GR-2 19500 27000 30000 42000 52500 25 DENS-25 DENS-33 EXCISION OF BONY TUMOR OF JAW GR-3 26000 36000 40000 56000 70000 26 DENS-26 DENS-34 EXTRACTION PER TOOTH UNDER G.A 3647 5049 5610 7854 9818 27 DENS-27 DENS-35 EXTRACTION-PER TOOTH (GR -1) 650 900 1000 1400 1750 28 DENS-28 DENS-36 EXTRACTION-PER TOOTH (GR -2) 975 1350 1500 2100 2625

Any new service/tariff may be changed/added/deleted without prior notice. 160 Schedule of Charges 2019-20 ISIC

29 DENS-29 DENS-37 EXTRACTION-PER TOOTH (GR -3) 1625 2250 2500 3500 4375 30 DENS-30 DENS-44 FIXED RETAINER (SINGLE) 5798 8028 8920 12488 15610 31 DENS-31 DENS-45 FRACTURE CLOSED REDUCTION (GR1) 15600 21600 24000 33600 42000 32 DENS-32 DENS-46 FRACTURE CLOSED REDUCTION (GR2) 20800 28800 32000 44800 56000 33 DENS-33 DENS-47 FRACTURE CLOSED REDUCTION (GR3) 26000 36000 40000 56000 70000 34 DENS-34 DENS-48 FRACTURE CLOSED REDUCTION (ONE ARCH) 7280 10080 11200 15680 19600 35 DENS-35 DENS-49 FRACTURE OPEN REDUCTION (GR-I) 26000 36000 40000 56000 70000 36 DENS-36 DENS-50 FRACTURE OPEN REDUCTION (GR-II) 32500 45000 50000 70000 87500 37 DENS-37 DENS-51 FRACTURE OPEN REDUCTION (GR-III) 39000 54000 60000 84000 105000 38 DENS-38 DENS-52 FRENECTOMY-I 2600 3600 4000 5600 7000 39 DENS-39 DENS-53 FRENECTOMY-II 5850 8100 9000 12600 15750 40 DENS-40 DENS-54 GINGIVECTOMY PER SEGMENT 2912 4032 4480 6272 7840 41 DENS-41 DENS-55 GINGIVOPLASTY PER SEGMENT 2912 4032 4480 6272 7840 42 DENS-42 DENS-56 GLASS IONOMER FILLING 728 1008 1120 1568 1960 43 DENS-43 DENS-62 IMPACTION PER TOOTH (GR.-1) 3900 5400 6000 8400 10500 44 DENS-44 DENS-63 IMPACTION PER TOOTH (GR.-2) 5200 7200 8000 11200 14000 45 DENS-45 DENS-64 IMPACTION PER TOOTH (GR.-3) 6500 9000 10000 14000 17500 46 DENS-46 DENS-68 IMPLANT PER TOOTH 58266 80676 89640 125496 156870 47 DENS-47 DENS-69 INCISION & DRAINAGE (GR.-I) 1950 2700 3000 4200 5250 48 DENS-48 DENS-70 INCISION & DRAINAGE (GR.-II) 3900 5400 6000 8400 10500 49 DENS-49 DENS-71 INCISION & DRAINAGE (GR.-III) 7800 10800 12000 16800 21000 50 DENS-50 DENS-79 MAXIOLLOFACIAL PROSTHESIS (GR.-I) 3250 4500 5000 7000 8750 51 DENS-51 DENS-80 MAXIOLLOFACIAL PROSTHESIS (GR.-II) 4875 6750 7500 10500 13125 52 DENS-52 DENS-81 MAXIOLLOFACIAL PROSTHESIS (GR.-III) 6500 9000 10000 14000 17500 53 DENS-53 DENS-82 MID FACE FRACTURES GR-2 31200 43200 48000 67200 84000 54 DENS-54 DENS-83 MID FACE FRACTURES GR-3 39000 54000 60000 84000 105000 55 DENS-55 DENS-84 MID FACE FRACTURES GR-I 23400 32400 36000 50400 63000 56 DENS-56 DENS-85 OBTURATOR (GR.-1) 2191 3033 3370 4718 5898 57 DENS-57 DENS-86 OBTURATOR (GR.-II) 2626 3636 4040 5656 7070 58 DENS-58 DENS-87 OBUTRAT0R (GRADE-III) 3647 5049 5610 7854 9818 59 DENS-59 DENS-89 PULPOTOMY 1456 2016 2240 3136 3920 60 DENS-60 DENS-90 REIMPLANTING OF TOOTH 3900 5400 6000 8400 10500

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61 DENS-61 DENS-95 REPAIR OF ORO ANTRAL FISTULA GR-1 6500 9000 10000 14000 17500 62 DENS-62 DENS-96 REPAIR OF ORO ANTRAL FISTULA GR-2 11700 16200 18000 25200 31500 63 DENS-63 DENS-97 REPAIR OF ORO ANTRAL FISTULA GR-3 15600 21600 24000 33600 42000 64 DENS-64 DENS-98 ROOT CANAL TREATMENT 4225 5850 6500 9100 11375 65 DENS-65 DENS-100 SURGICAL EXTRACTION (GR.1) 2600 3600 4000 5600 7000 66 DENS-66 DENS-101 SURGICAL EXTRACTION (GR.2) 3250 4500 5000 7000 8750

Charges Basis GW 65% HDU + ICU (all categories) 90% Shared 90% Single 100% Dlx 140% Spr. Dlx 140% Suite 140% Spr. Dlx. Suite 175%

Note :- Cost of Device/Implant would be extra In case of Surgeries performed in Emergency / Holidays, 20% extra would be charged. Above Charge basis would also be applicable on all newly added services

Any new service/tariff may be changed/added/deleted without prior notice. 162 Schedule of Charges 2019-20 ISIC

ENT SURGERIES

Dlx/ Shared Super NEW OLD Single Super S.No. SURGERY Gen. Ward Room/ICU Dlx. CODE CODE Room Dlx / /HDU Suite Suite 1 ENT-01 ENT-1 ADENOIDECTOMY 5831 8073 8970 12558 15698 2 ENT-02 ENT-4 BRACHING OF SINECHIA 2919 4041 4490 6286 7858 3 ENT-03 ENT-5 CALDWEL LUCS OPERATION BILATERAL 10205 14130 15700 21980 27475 4 ENT-04 ENT-6 CALDWEL LUCS OPERATION UNILATERAL 6559 9081 10090 14126 17658 5 ENT-05 ENT-7 CHANGE OF TRACHEOSTOMY TUBE 1092 1512 1680 2352 2940 6 ENT-06 ENT-8 CHOANAL ATRESIA PECONSTRUCTION 8736 12096 13440 18816 23520 COMBINED LATERAL RHINOTOMY AND TRANSPLATAL 7 ENT-07 ENT-9 17485 24210 26900 37660 47075 AUGIOFIBROMA EXCISION 8 ENT-08 ENT-10 DIALATATION STRICTURE STAGED PROCEDURE-FIRST 3790 5247 5830 8162 10203 9 ENT-09 ENT-11 DIALATATION STRICTURE STAGED PROCEDURE-SUBSEQUENT 3062 4239 4710 6594 8243 10 ENT-10 ENT-12 DIRECT LARYNOGOSCOPY 3640 5040 5600 7840 9800 11 ENT-11 ENT-13 DIRECT LARYNOGOSCOPY AND BIOPSY 4076 5643 6270 8778 10973 12 ENT-12 ENT-14 EAR - AURAL POLYPECTOMY 2626 3636 4040 5656 7070 13 ENT-13 ENT-15 EAR EXAMINATION UNDER MICROSCOPE 1307 1809 2010 2814 3518 14 ENT-14 ENT-16 EAR LOBULE REPAIR-BOTH EAR 3497 4842 5380 7532 9415 15 ENT-15 ENT-17 EAR LOBULE REPAIR-ONE EAR 1898 2628 2920 4088 5110 16 ENT-16 ENT-18 EAR MYRINGOTOMY 2184 3024 3360 4704 5880 17 ENT-17 ENT-19 ENDOLYMPHATIC SAC ECOMPRESSION 14866 20583 22870 32018 40023 18 ENT-18 ENT-20 ENDOSCOPIC CLOSURE CSF RHINORRHOEA 26221 36306 40340 56476 70595 19 ENT-19 ENT-21 ENDOSCOPIC HARVESTING OF AUTOLOGOUS NASAL MUCOSA 24037 33282 36980 51772 64715 20 ENT-20 ENT-22 ENDOSCOPIC SINUS SURGERY-BILATERAL 11655 16137 17930 25102 31378 21 ENT-21 ENT-23 ENDOSCOPIC SINUS SURGERY-UNILATERAL 11655 16137 17930 25102 31378 22 ENT-22 ENT-24 ETHMOIDECTOMY-EXTERNAL ETHMOIDECTOMY 17485 24210 26900 37660 47075 23 ENT-23 ENT-25 ETHMOIDECTOMY-INTRA NASAL 17485 24210 26900 37660 47075 24 ENT-24 ENT-26 ETHMOIDECTOMY-RADICAL FRONTO ETHMOIDECTOMY 14567 20169 22410 31374 39218 25 ENT-25 ENT-91 EXCISION CAROTID BODY TUMOUR 14567 20169 22410 31374 39218 26 ENT-26 ENT-92 EXCISION CYSTIC HYGROMA-MAJOR 11655 16137 17930 25102 31378 27 ENT-27 ENT-93 EXCISION CYSTIC HYGROMA-MINOR 7280 10080 11200 15680 19600

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28 ENT-28 ENT-27 EXCISION TRAGAL CYST 11655 16137 17930 25102 31378 EXTENDED ENDOSCOPIC SINUS SURGERY & REMOVAL OF TUMOUR 29 ENT-29 ENT-95 24076 33336 37040 51856 64820 SINUS 30 ENT-30 ENT-28 FACIAL NERVE DECOMPRESSION 26221 36306 40340 56476 70595 31 ENT-31 ENT-29 FLEXIBLE FIBREOTIC LARYNGOSCOPY 5103 7065 7850 10990 13738 32 ENT-32 ENT-30 FRACTURE REDUCTION NOSE 6559 9081 10090 14126 17658 33 ENT-33 ENT-31 FRACTURE REDUCTION NOSE WITH SEPTAL 8736 12096 13440 18816 23520 34 ENT-34 ENT-32 HYPOPHARYNGOSCOPY 4368 6048 6720 9408 11760 35 ENT-35 ENT-33 I&D SEPTAL ABSSESS 2340 3240 3600 5040 6300 36 ENT-36 ENT-34 INTRANASAL ANTROSTOMY-UNILATERAL 2919 4041 4490 6286 7858 37 ENT-37 ENT-35 LATERAL RHINOTOMY 26221 36306 40340 56476 70595 38 ENT-38 ENT-14504 MANAGEMENT OF TRACHEAL STENOSIS 22614 31311 34790 48706 60883 39 ENT-39 ENT-36 MASTOID, ABSCESS I&D 5831 8073 8970 12558 15698 40 ENT-40 ENT-37 MASTOIDECTOMY WITH TYMPANOPLASTY 21853 30258 33620 47068 58835 41 ENT-41 ENT-38 MAXILLECTOMY-PARTIAL 26221 36306 40340 56476 70595 42 ENT-42 ENT-39 MAXILLECTOMY-TOTAL 40794 56484 62760 87864 #### 43 ENT-43 ENT-40 MICROLARYNGEAL SURGERY-MAJOR 21853 30258 33620 47068 58835 44 ENT-44 ENT-41 MICROLARYNGEAL SURGERY-MINOR 14567 20169 22410 31374 39218 45 ENT-45 ENT-42 MYRINGOPLASY (TYPE I TYMPANOPLASTY) 13111 18153 20170 28238 35298 46 ENT-46 ENT-43 MYRINGOTOMY WITH GROMET INSERTION-BOTH EARS 7280 10080 11200 15680 19600 47 ENT-47 ENT-44 MYRINGOTOMY WITH GROMET INSERTION-ONE EAR 5103 7065 7850 10990 13738 48 ENT-48 ENT-46 NASAL CAUTERISATION 1456 2016 2240 3136 3920 49 ENT-49 ENT-47 NASAL ENDOSCOPY 2886 3996 4440 6216 7770 50 ENT-50 ENT-48 NASAL POLYPECTOMY-BILATERAL 10205 14130 15700 21980 27475 51 ENT-51 ENT-49 NASAL POLYPECTOMY-UNILATERAL 7280 10080 11200 15680 19600 52 ENT-52 ENT-50 NASOPHARYNGOSCOPY AND BIOPSY 2919 4041 4490 6286 7858 53 ENT-53 ENT-96 NECK EXPLORATION REMOVAL OF FOREIGN BODY 15652 21672 24080 33712 42140 54 ENT-54 ENT-51 OESOPHOGOSCOPY 3790 5247 5830 8162 10203 55 ENT-55 ENT-52 OESOPHOGOSCOPY AND FOREIGN BODY REMOVAL 7579 10494 11660 16324 20405 56 ENT-56 ENT-53 ORBITAL DECOMPRESSION (ENDOSCOPIC) 20391 28233 31370 43918 54898 57 ENT-57 ENT-54 PACKING-ANTERIAL OR NASAL 2340 3240 3600 5040 6300 58 ENT-58 ENT-55 PACKING-POSTERIOR NASAL 4368 6048 6720 9408 11760 59 ENT-59 ENT-97 PAN ENDOSCOPY 11798 16335 18150 25410 31763

Any new service/tariff may be changed/added/deleted without prior notice. 164 Schedule of Charges 2019-20 ISIC

60 ENT-60 ENT-56 PARAPHARYNGEAL SPACE OPERATION-ABSCEESS I&D 5239 7254 8060 11284 14105 61 ENT-61 ENT-57 PARAPHARYNGEAL SPACE OPERATION-EXPLORATION & BIOSPY 6559 9081 10090 14126 17658 62 ENT-62 ENT-58 PARAPHARYNGEAL SPACE OPERATION-TUMOR EXCISION 10205 14130 15700 21980 27475 63 ENT-63 ENT-45 PASSING RYLES TUBE 1456 2016 2240 3136 3920 64 ENT-64 ENT-59 REMOVAL OF FOREIGN BODY SUBLABIAL APPROACH 11655 16137 17930 25102 31378 65 ENT-65 ENT-60 REMOVAL OF MONTGOMERY T TUBE 3205 4437 4930 6902 8628 66 ENT-66 ENT-61 REMOVAL OF SUBMANDIBULAR CALCALI - IMPACTED 10205 14130 15700 21980 27475 67 ENT-67 ENT-62 REPAIR OF OROANTRAL FISTULA 8736 12096 13440 18816 23520 68 ENT-68 ENT-63 RETROPHARYNGEAL ABSCESS I&D 4342 6012 6680 9352 11690 69 ENT-69 ENT-64 RHINOPLASTY (ENT) 29127 40329 44810 62734 78418 70 ENT-70 ENT-65 RIGID BRONCHOSCOPY -DIAGNOSTIC 5974 8271 9190 12866 16083 71 ENT-71 ENT-66 RIGID BRONCHOSCOPY -THERAPEUTIC 7579 10494 11660 16324 20405 72 ENT-72 ENT-67 SEPTO RHINOPLASTY 21853 30258 33620 47068 58835 73 ENT-73 ENT-68 SEPTOPLASTY/SMR 11655 16137 17930 25102 31378 74 ENT-74 ENT-69 SINUS ENDOSCOPY 4368 6048 6720 9408 11760 75 ENT-75 ENT-70 STAPEDECTOMY OR OSSICULOPLASTY 17485 24210 26900 37660 47075 76 ENT-76 ENT-71 SUBGLOTIC STANOSIS LASER EXCISION AND T-TUBE 17485 24210 26900 37660 47075 77 ENT-77 ENT-72 SUBGLOTIC STENOSIS REPAIR 13397 18549 20610 28854 36068 78 ENT-78 ENT-98 SUBMUCOSAL CONCHOPEXY 9633 13338 14820 20748 25935 SUBMUCOSAL DIATHERMY CAUTERIZATION PARTIAL 79 ENT-79 ENT-73 7280 10080 11200 15680 19600 TURBINECTOMY-BILATERAL SUBMUCOSAL DIATHERMY CAUTERIZATION PARTIAL 80 ENT-80 ENT-74 4368 6048 6720 9408 11760 TURBINECTOMY-UNILATERAL 81 ENT-81 ENT-75 SURGERY INTRANASAL ANTROSTOMY-BILATERAL 7280 10080 11200 15680 19600 82 ENT-82 ENT-76 THROAT STYLOIDECTOMY-BOTH SIDE 13111 18153 20170 28238 35298 83 ENT-83 ENT-77 THROAT STYLOIDECTOMY-ONE SIDE 6123 8478 9420 13188 16485 84 ENT-84 ENT-78 THROAT TONSILLECTOMY 10927 15129 16810 23534 29418 85 ENT-85 ENT-79 THROAT-DIVERTICULUM EXCISION 17485 24210 26900 37660 47075 86 ENT-86 ENT-80 THROAT-EXCISION OF PHARYNGEAL POUCH 10927 15129 16810 23534 29418 87 ENT-87 ENT-81 THYROPLASTY 17154 23751 26390 36946 46183 88 ENT-88 ENT-82 TRACHEAL STENTING 17485 24210 26900 37660 47075 89 ENT-89 ENT-83 TRACHEOSTOMY 7280 10080 11200 15680 19600 90 ENT-90 ENT-84 TRACHEOSTOMY CLOSURE 3640 5040 5600 7840 9800

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91 ENT-91 ENT-340 TRACHEOSTOMY FISTULA REPAIR 6786 9396 10440 14616 18270 92 ENT-92 ENT-85 TRANSANTRAL BIOPSY 4076 5643 6270 8778 10973 93 ENT-93 ENT-86 TRANSPALATAL PROCEDURES-ANGIOFIBROMA EXCISION 14567 20169 22410 31374 39218 94 ENT-94 ENT-87 TRANSPALATAL PROCEDURES-BIOPSY 3205 4437 4930 6902 8628 95 ENT-95 ENT-88 TRANSPALATAL PROCEDURES-EXCISION OF CYST 4804 6651 7390 10346 12933 96 ENT-96 ENT-89 TYMPANOPLASTY INCLUDING OSSICULOPLASTY 17485 24210 26900 37660 47075 97 ENT-97 ENT-90 VIDIAN NERVE SECTION 6123 8478 9420 13188 16485

Charges Basis GW 65% HDU + ICU (all categories) 90% Shared 90% Single 100% Dlx 140% Spr. Dlx 140% Suite 140% Spr. Dlx. Suite 175%

Any new service/tariff may be changed/added/deleted without prior notice. 166 Schedule of Charges 2019-20 ISIC

GENERAL SURGERY

Shared Dlx/Super NEW OLD General Single Super S.No. SURGERY NAME Room/ICU Dlx / CODE CODE Ward Room Dlx. Suite /HDU Suite ABDOMINOPERINEAL PULL THROUGH RESECTION WITH 1 GSU-01 GSU-1 43700 60507 67230 94122 117653 COLORECTAL ANASTONOSIS 2 GSU-02 GSU-2 ABDOMINOPERINEAL RESECTION OF A RECTUM 39735 55017 61130 85582 106978 3 GSU-03 GSU-3 ABDOMINOPLASTY (WITH PANNICULECTOMY) 43700 60507 67230 94122 117653 4 GSU-04 GSU-4 ABDOMINOPLASTY (WITHOUT PANNICULECTOMY) 29127 40329 44810 62734 78418 5 GSU-05 GSU-321 ACHALASIA CARDIA 18402 25479 28310 39634 49543 6 GSU-06 GSU-5 ADDUCTOR ABSCESS INCISION & DRAINAGE 7280 10080 11200 15680 19600 7 GSU-07 GSU-6 ADHESIOLYSIS / DIVISION OF BANDS 19864 27504 30560 42784 53480 8 GSU-08 GSU-7 ADRENAL GLANDS-BILATERAL TOTAL ADRENALECTOMY 50986 70596 78440 109816 137270 9 GSU-09 GSU-8 ADRENAL GLANDS-NEOPLASM OF ADRENAL GLAND 36413 50418 56020 78428 98035 10 GSU-10 GSU-9 ADRENAL GLANDS-SUBTOTAL ADRENALECTOMY 36413 50418 56020 78428 98035 11 GSU-11 GSU-10 ANAL DIALATATION / LORDS PROCEDURE 5298 7335 8150 11410 14263 12 GSU-12 GSU-322 ANAL SPHINCTER REPAIR 13683 18945 21050 29470 36838 13 GSU-13 GSU-11 ANTERIOR RESECTION 39735 55017 61130 85582 106978 14 GSU-14 GSU-12 APPENDIX-APPENDECTOMY 18044 24984 27760 38864 48580 15 GSU-15 GSU-13 APPENDIX-APPENDICULAR ABSCESS DRAINAGE 14567 20169 22410 31374 39218 16 GSU-16 GSU-14 ASPIRATION BONEMARROW/ SPLEEN 4368 6048 6720 9408 11760 17 GSU-17 GSU-15 ASPIRATION OF COLD ABSCESS 3640 5040 5600 7840 9800 18 GSU-18 GSU-16 ASPIRATION OF LIVER ABSCESS 7280 10080 11200 15680 19600 19 GSU-19 GSU-323 AXILLARY DISSECTION 16419 22734 25260 35364 44205 BILIARY SYSTEM-CHOLECYSTECTOMY AND CHOLEDOCHO 20 GSU-20 GSU-18 31785 44010 48900 68460 85575 LITHOTOMY BILIARY SYSTEM-CHOLECYSTECTOMY AND CHOLEDOCHODUO 21 GSU-21 GSU-19 33105 45837 50930 71302 89128 DENOSTOMY BILIARY SYSTEM-CHOLECYSTECTOMY AND 22 GSU-22 GSU-20 30459 42174 46860 65604 82005 TRANSDUODENAL/SPHINCTEROTOMY / SPHINCTEROPLASTY 23 GSU-23 GSU-21 BILIARY SYSTEM-REPAIR OF BILE DUCT STRICTURE 36114 50004 55560 77784 97230

Any new service/tariff may be changed/added/deleted without prior notice. 167 Schedule of Charges 2019-20 ISIC

BILIARY SYSTEM-RESECTION OF GROWTH OF COMMON 24 GSU-24 GSU-22 46352 64179 71310 99834 124793 HEPATICDUCT AND REPAIR 25 GSU-25 GSU-23 BILIARY SYSTSEM-HEPATICO - JEJUNOSTOMY 43700 60507 67230 94122 117653 26 GSU-26 GSU-324 BIOPSY LYMPH NODE 4375 6057 6730 9422 11778 27 GSU-27 GSU-24 BONE MARROW BIOPSY - OPEN (UNGER GA) 5831 8073 8970 12558 15698 28 GSU-28 GSU-325 BREAST CONSERVATION SURGERY 18057 25002 27780 38892 48615 29 GSU-29 GSU-25 BREAST-EXCISION FIBROADENOMA 11655 16137 17930 25102 31378 30 GSU-30 GSU-26 BREAST-EXCISION MAMMARY FISTULA 8736 12096 13440 18816 23520 BREAST-HALSTEDS RADICAL MASTECTOMY, *PATEYS 31 GSU-31 GSU-27 29127 40329 44810 62734 78418 OPERATION, MRM 32 GSU-32 GSU-28 BREAST-LUMPECTOMY AND AXILLARY CLEARANCE 21853 30258 33620 47068 58835 33 GSU-33 GSU-29 BREAST-LUMPECTOMY AND AXILLARY SAMPLING 17485 24210 26900 37660 47075 BREAST-SECTORAL MASTECTOMY/ MICRODOCHECTOMY/ 34 GSU-34 GSU-30 17485 24210 26900 37660 47075 LUMPECTOMY 35 GSU-35 GSU-31 BREAST-SIMPLE MASTECTOMY 17485 24210 26900 37660 47075 36 GSU-36 GSU-32 BREAST-WEDGE BIOPSY 8736 12096 13440 18816 23520 37 GSU-37 GSU-327 BREST ABSCESS DRAINAGE 8210 11367 12630 17682 22103 38 GSU-38 GSU-33 BURST ABDOMEN REPAIR (SECONDARY SUTURING) 9854 13644 15160 21224 26530 39 GSU-39 GSU-34 CAECOPEXY 11655 16137 17930 25102 31378 40 GSU-40 GSU-326 CAPD CATHETER IMPLANT 8762 12132 13480 18872 23590 41 GSU-41 GSU-328 CARBUNCLE (LARGE) 8762 12132 13480 18872 23590 42 GSU-42 GSU-329 CARBUNCLE (SMALL) 6565 9090 10100 14140 17675 43 GSU-43 GSU-35 CHOLECYSTECTOMY (OPEN) 19864 27504 30560 42784 53480 44 GSU-44 GSU-330 CHOLEDOCHAL CYST 26267 36369 40410 56574 70718 45 GSU-45 GSU-36 CHOLENGIOGRAPHY 7280 10080 11200 15680 19600 46 GSU-46 GSU-331 CIRCUMCISION 7118 9855 10950 15330 19163 47 GSU-47 GSU-37 CLOSED LATERAL SPHINCTEROTOMY 11655 16137 17930 25102 31378 48 GSU-48 GSU-38 CLOSURE OF COLOSTOMY 15886 21996 24440 34216 42770 49 GSU-49 GSU-39 COLECTOMY AND ILEORECTAL ANASTOMISIS 43700 60507 67230 94122 117653 50 GSU-50 GSU-41 COLOSTOMY 14567 20169 22410 31374 39218

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51 GSU-51 GSU-332 COLOSTOMY CLOSURE 13683 18945 21050 29470 36838 52 GSU-52 GSU-40 COLOSTOMY OPENING 4368 6048 6720 9408 11760 53 GSU-53 GSU-42 COMPLETE RECTAL PROLAPSE REPAIR 26221 36306 40340 56476 70595 54 GSU-54 15752 CYSTOCOELE AND RECTOCOELE REPAIR 12747 17649 19610 27454 34318 55 GSU-55 GSU-43 CYSTS AND BENIGN TUMOUR OF THE PALATE 14567 20169 22410 31374 39218 56 GSU-56 GSU-44 DEBRIDEMENT OF WOUNDS - MAJOR (GR-I) 4368 6048 6720 9408 11760 57 GSU-57 GSU-45 DEBRIDEMENT OF WOUNDS - MAJOR (GR-II) 5831 8073 8970 12558 15698 58 GSU-58 GSU-46 DEBRIDEMENT OF WOUNDS - MAJOR (GR-III) 7280 10080 11200 15680 19600 59 GSU-59 GSU-47 DEBRIDEMENT OF WOUNDS - MAJOR (GR-IV) 10205 14130 15700 21980 27475 60 GSU-60 GSU-48 DEBRIDEMENT OF WOUNDS - MINOR 2919 4041 4490 6286 7858 61 GSU-61 GSU-333 DEBULKING FOR OVARIAN CANCER 24076 33336 37040 51856 64820 DECORTICATING, PLEURECTOMY & EXCISION OF EMPYEMA 62 GSU-62 GSU-49 36413 50418 56020 78428 98035 WITHOUT LUNG RESECTION 63 GSU-63 GSU-50 DENTAL CYSTS AND TUMOURS 13111 18153 20170 28238 35298 64 GSU-64 GSU-51 DENTAL CYSTS AND TUMOURS WITH RECONSTRUCTION OF JAW 36413 50418 56020 78428 98035 65 GSU-65 GSU-52 DIAGNOSTIC LAPROSCOPY 14567 20169 22410 31374 39218 66 GSU-66 GSU-53 DIAPHRAGMATIC HERNIA-ONLY SAC NO CONTENTS 29127 40329 44810 62734 78418 67 GSU-67 GSU-54 DIAPHRAGMATIC HERNIA-WITH CONTENTS 36413 50418 56020 78428 98035 68 GSU-68 GSU-334 DISTAL PANCREATECTOMY 24076 33336 37040 51856 64820 DRAINAGE OF SUB DIAPHREGMATIC ABSCESS / PERIGASTRIC- 69 GSU-69 GSU-56 10205 14130 15700 21980 27475 EXTRA PERITONEAL DRAINAGE OF SUB DIAPHREGMATIC ABSCESS / PERIGASTRIC- 70 GSU-70 GSU-57 13111 18153 20170 28238 35298 TRANS PERITONEAL DRAINAGE/EXCISION/REPAIR OF ABDOMINAL WALL 71 GSU-71 GSU-320 11941 16533 18370 25718 32148 HAEMATOMA/CYST/ABSCESS 72 GSU-72 GSU-58 DUODENAL DIVERTICULUM 17485 24210 26900 37660 47075 73 GSU-73 GSU-59 DUODENOSTOMY 14567 20169 22410 31374 39218 74 GSU-74 GSU-60 EMERGENCY ACUTE CHOLECYSTECTOMY 29127 40329 44810 62734 78418 75 GSU-75 GSU-61 EMERGENCY APPENDECTOMY 23309 32274 35860 50204 62755 EMERGENCY EXPLORATION LAPAROTOMY FOR OBSTRUCTED 76 GSU-76 GSU-62 26221 36306 40340 56476 70595 HERNIA WITH PRITONITIS

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77 GSU-77 GSU-63 EMERGENCY LAPAROTOMY 21853 30258 33620 47068 58835 78 GSU-78 GSU-64 EMERGENCY LAPAROTOMY IN SHOCK AND SPLENECTOMY 36413 50418 56020 78428 98035 EMERGENCY LAPAROTOMY UNDER RUNNING OF BLEEDING 79 GSU-79 GSU-65 29127 40329 44810 62734 78418 ULCER EMERGENCY LAPAROTOMY WITH REPAIR OF LIVER INJURY 80 GSU-80 GSU-66 36413 50418 56020 78428 98035 WITH CLOSURE OF PERFORATION EMERGENCY LAPRATOMY WITH RESECTION AND 81 GSU-81 GSU-67 36413 50418 56020 78428 98035 ANAESTAMOSIS OF LARGE INTESTINE EMERGENCY LAPRATOMY WITH RESECTION AND 82 GSU-82 GSU-68 29127 40329 44810 62734 78418 ANAESTAMOSIS OF SMALL INTESTINE 83 GSU-83 GSU-319 ENDOSCOPIC VARICOSE VEINS(SEPS)B/L 46352 64179 71310 99834 124793 84 GSU-84 GSU-320 ENDOSCOPIC VARICOSE VEINS(SEPS)U/L 33105 45837 50930 71302 89128 85 GSU-85 GSU-69 EPGASTRIC HERNIA 15886 21996 24440 34216 42770 86 GSU-86 GSU-70 EXCISION BIOPSY OF LARGE LUMPS 5831 8073 8970 12558 15698 87 GSU-87 GSU-71 EXCISION BIOPSY OF SUPERFICIAL LUMPS 5103 7065 7850 10990 13738 88 GSU-88 GSU-72 EXCISION BIOPSY OF ULCER 4368 6048 6720 9408 11760 89 GSU-89 GSU-73 EXCISION BRANCHIAL CYST FISTULA/SINUS 11655 16137 17930 25102 31378 90 GSU-90 GSU-74 EXCISION CARBUNCLE* 11655 16137 17930 25102 31378 91 GSU-91 GSU-75 EXCISION DIABETIC * <5 CM 10205 14130 15700 21980 27475 92 GSU-92 GSU-76 EXCISION DIABETIC * >5 CM 13111 18153 20170 28238 35298 EXCISION FILARIAL SCROTUM- GIGANTIC 50 CM 93 GSU-93 GSU-77 21853 30258 33620 47068 58835 CIRCUMFERENCE EXCISION FILARIAL SCROTUM-UPTO 50 CM CIRCUMFERENCE 94 GSU-94 GSU-78 14567 20169 22410 31374 39218 REGULAR 95 GSU-95 GSU-79 EXCISION INFECTED URACHAL CYST UMBILECYOMY 11655 16137 17930 25102 31378 96 GSU-96 GSU-80 EXCISION LARGE LIPOMA / SKIN TUMOR 11921 16506 18340 25676 32095 97 GSU-97 GSU-81 EXCISION MULTIPLE CYSTS 7280 10080 11200 15680 19600 98 GSU-98 GSU-82 EXCISION OF MULTIPLE SCROTAL CYST 7280 10080 11200 15680 19600 EXCISION OF PHARYNGEAL POUCH CRIOPHARYNGEAL 99 GSU-99 GSU-83 14567 20169 22410 31374 39218 MYOTOMY 100 GSU-100 GSU-84 EXCISION OF RETROPERITONIAL TUMOUR 29127 40329 44810 62734 78418 101 GSU-101 GSU-85 EXCISION OF THROMBSED PILE 5831 8073 8970 12558 15698 102 GSU-102 GSU-86 EXCISION OF THYROGLOSSAL CYST SINUS/FISTULA 14567 20169 22410 31374 39218

Any new service/tariff may be changed/added/deleted without prior notice. 170 Schedule of Charges 2019-20 ISIC

EXCISION SEBACEOUS CYST/SMALL SUPERFICIAL 103 GSU-103 GSU-87 TUMOUR/NEURO FIBROMA/GRANGLION/DERMOID 10205 14130 15700 21980 27475 CYST/LIPOMA > 5 CM. EXCISION SEBACEOUS CYST/SMALL SUPERFICIAL 104 GSU-104 GSU-88 TUMOUR/NEUROFIBROMA/GRANGLION/DERMOID CYST/LIPOMA 7280 10080 11200 15680 19600 < 5 CM. 105 GSU-105 GSU-89 EXCISION SOFT TISSUE TUMOUR MUSCLE GROUP 17485 24210 26900 37660 47075 106 GSU-106 GSU-90 EXCISION SUBMUCOUS CYST 4368 6048 6720 9408 11760 107 GSU-107 GSU-91 EXPLORATION ABDOMINAL SINUS 8736 12096 13440 18816 23520 EXPLORATION NECK WOUND + DEBRIBEMENT + 108 GSU-108 GSU-92 26221 36306 40340 56476 70595 TRECHEOSTOMY & REPAIR EXPLORATOMY LAPROTOMY THORACO ABDOMINAL ROUT 109 GSU-109 GSU-93 43700 60507 67230 94122 117653 REPAIR OF DIAPHRAMATIC TEAR 110 GSU-110 GSU-94 EXPLORATORY LAPAROTOMY 19864 27504 30560 42784 53480 111 GSU-111 GSU-95 EXPLORATORY LAPAROTOMY FOR PERITONITITS 23836 33003 36670 51338 64173 EXPLORATORY LAPAROTOMY WITH EXCISION OF URACHUS 112 GSU-112 GSU-96 23309 32274 35860 50204 62755 WITH UMBILECTOMY EXPLORATORY LAPAROTOMY WITH EXTENSIUS WOUND 113 GSU-113 GSU-97 26221 36306 40340 56476 70595 DEBRIDEMENT 114 GSU-114 GSU-98 EXPLORATORY LAPRATOMY & MULTIPLE BIOPSIES 21853 30258 33620 47068 58835 EXPLORATORY LAPROTOMY+CLOSURE MULTIPLE 115 GSU-115 GSU-99 PORFORATIONS+REPAIR MULTIPLE MESENTRIC TEARS+DEEP 36413 50418 56020 78428 98035 TESNION CLO FACIAL NERVE SUTURING AND GRAFTING UNDER MICROSCOPY 116 GSU-116 GSU-100 21853 30258 33620 47068 58835 HYPOGLOSSAL ANASTOMASIS 117 GSU-117 GSU-101 FEMORAL HERNIA/HERNIORRAPHY 15886 21996 24440 34216 42770 118 GSU-118 GSU-102 FISSURE (SPHINCTEROTOMY / FISSURECTOMY) 11655 16137 17930 25102 31378 119 GSU-119 GSU-323 FISSURE IN ANO-HIGH LEVEL (GR-I) 17485 24210 26900 37660 47075 120 GSU-120 GSU-324 FISSURE IN ANO-HIGH LEVEL (GR-II) 17485 24210 26900 37660 47075 121 GSU-121 GSU-325 FISSURE IN ANO-HIGH LEVEL (GR-III) 17485 24210 26900 37660 47075 122 GSU-122 GSU-326 FISSURE IN ANO-HIGH LEVEL (GR-IV) 21853 30258 33620 47068 58835 123 GSU-123 GSU-327 FISSURE IN ANO-HIGH LEVEL (GR-V) 14567 20169 22410 31374 39218 124 GSU-124 GSU-328 FISSURE IN ANO-LOW LEVEL 14567 20169 22410 31374 39218 125 GSU-125 GSU-103 FISTULA IN ANO-HIGH LEVEL (GR-I) 17485 24210 26900 37660 47075

Any new service/tariff may be changed/added/deleted without prior notice. 171 Schedule of Charges 2019-20 ISIC

126 GSU-126 GSU-104 FISTULA IN ANO-HIGH LEVEL (GR-II) 17485 24210 26900 37660 47075 127 GSU-127 GSU-105 FISTULA IN ANO-HIGH LEVEL (GR-III) 17485 24210 26900 37660 47075 128 GSU-128 GSU-106 FISTULA IN ANO-HIGH LEVEL (GR-IV) 21853 30258 33620 47068 58835 129 GSU-129 GSU-107 FISTULA IN ANO-HIGH LEVEL (GR-V) 21853 30258 33620 47068 58835 130 GSU-130 GSU-108 FISTULA IN ANO-LOW LEVEL 14567 20169 22410 31374 39218 131 GSU-131 GSU-336 FOREIGN BODY REMOVAL- DEEP, GA 9302 12879 14310 20034 25043 132 GSU-132 GSU-337 FOREIGN BODY REMOVAL- LOCAL ANAESTHESIA 3835 5310 5900 8260 10325 GASTERIC SLEEVE RESECTION OF LIEOMYOMA STOMACH 133 GSU-133 GSU-109 29127 40329 44810 62734 78418 (THORECO ABDOMINAL) 134 GSU-134 GSU-338 GASTRECTOMY SUBTOTAL 20248 28035 31150 43610 54513 135 GSU-135 GSU-339 GASTRECTOMY TOTAL 24622 34092 37880 53032 66290 136 GSU-136 GSU-110 GASTRO JEJUNOSTOMY 17485 24210 26900 37660 47075 137 GSU-137 GSU-111 GASTROSTOMY OR JEJUNOSTOMY 13111 18153 20170 28238 35298 138 GSU-138 GSU-112 GIANT FIBROADENOMA BREAST LUMPECTOMY 14567 20169 22410 31374 39218 139 GSU-139 GSU-113 GIANT SOFT TISSUE TUMOR (S/C) 17485 24210 26900 37660 47075 140 GSU-140 GSU-341 GYNAECOMASTIA, BILATERAL 18057 25002 27780 38892 48615 141 GSU-141 GSU-342 GYNAECOMASTIA, UNILATERAL 13683 18945 21050 29470 36838 142 GSU-142 GSU-115 HAEMORHOIDECTOMY (MILLIGAN MORGAN) 14567 20169 22410 31374 39218 143 GSU-143 GSU-114 HAEMORHOIDECTOMY 14567 20169 22410 31374 39218 144 GSU-144 GSU-116 HAEMORRHOID- BAND LIGATION 3640 5040 5600 7840 9800 145 GSU-145 GSU-343 HAEMORRHOIDECTOMY STAPLED 17511 24246 26940 37716 47145 146 GSU-146 GSU-117 HAEMORRHOID-Subsequent Banding 2184 3024 3360 4704 5880 147 GSU-147 GSU-118 HEMIGLOSSECTOMY 21853 30258 33620 47068 58835 148 GSU-148 GSU-119 HEMITHYROIDECTOMY-PARTIAL THYROIDECTOMY 23309 32274 35860 50204 62755 149 GSU-149 GSU-120 HEMITHYROIDECTOMY-TOTAL THYROIDECTOMY 29127 40329 44810 62734 78418 HENITITYROIDECTOMY WITH EXCISION RESTROSTORNAL 150 GSU-150 GSU-121 29127 40329 44810 62734 78418 EXTENSION 151 GSU-151 GSU-122 HERNIA-INGUINAL HERNIOTOMY-BILATERAL 14567 20169 22410 31374 39218 152 GSU-152 GSU-123 HERNIA-INGUINAL HERNIOTOMY-UNILATERAL 11655 16137 17930 25102 31378 153 GSU-153 GSU-124 HERNIOPLASTY LICHTENSTIENS B/L / DARNING 21853 30258 33620 47068 58835

Any new service/tariff may be changed/added/deleted without prior notice. 172 Schedule of Charges 2019-20 ISIC

154 GSU-154 GSU-125 HERNIOPLASTY LICHTENSTIENS U/L / DARNING 14567 20169 22410 31374 39218 155 GSU-155 GSU-126 HIGH FISTULA IN ANO SETON CHANGE 4368 6048 6720 9408 11760 156 GSU-156 GSU-127 HIGH FISTULA IN ANO SETONING 10205 14130 15700 21980 27475 157 GSU-157 GSU-128 HIGHLY SELECTIVE VAGOTOMY 21853 30258 33620 47068 58835 158 GSU-158 GSU-129 HIRSCHSPRUNGLS PULL THROUGH 29127 40329 44810 62734 78418 159 GSU-159 GSU-130 HYDATID CYST OF THE LIVER 29127 40329 44810 62734 78418 160 GSU-160 GSU-131 HYDROCOELE-BILATERAL 14567 20169 22410 31374 39218 161 GSU-161 GSU-132 HYDROCOELE-UNILATERAL 8736 12096 13440 18816 23520 162 GSU-162 GSU-133 ILEOSTOMY 11655 16137 17930 25102 31378 163 GSU-163 GSU-134 IMPERFORATE ANUS WITH LOW OPENING 8736 12096 13440 18816 23520 164 GSU-164 GSU-135 INCISION AND DRAINAGE SMALL/ LARGE ABSCESS 5831 8073 8970 12558 15698 165 GSU-165 GSU-136 INCISIONAL HERNIA REPAIR-WITH MARLEX MESH 29127 40329 44810 62734 78418 166 GSU-166 GSU-137 INCISIONAL HERNIA REPAIR-WITHOUT MARLEX MESH 21853 30258 33620 47068 58835 167 GSU-167 GSU-138 IND OF WEB SPACE INFECTION FOOT RIGHT 4368 6048 6720 9408 11760 168 GSU-168 GSU-139 INGROWING TOE NAIL 4368 6048 6720 9408 11760 169 GSU-169 GSU-140 INGUINAL ABSCESS 7280 10080 11200 15680 19600 INGUIUAL HERNIA REPAIR HERNIOGRAPHY WITH MESH (COST 170 GSU-170 GSU-141 14567 20169 22410 31374 39218 OF MESH BY PATIENT-UNILATERAL INGUIUAL HERNIA REPAIR HERNIOGRAPHY WITHOUT MESH 171 GSU-171 GSU-142 11655 16137 17930 25102 31378 (COST OF MESH BY PATIENT-UNILATERAL INGUIUAL HERNIA REPAIR HERNIOGRAPHY WITH MESH (COST 172 GSU-172 GSU-143 21853 30258 33620 47068 58835 OF MESH BY PATIENT-BILATERAL INGUIUAL HERNIA REPAIR HERNIOGRAPHY WITHOUT MESH 173 GSU-173 GSU-144 17485 24210 26900 37660 47075 (COST OF MESH BY PATIENT-BILATERAL 174 GSU-174 GSU-345 INJECTION GANGLION 1976 2736 3040 4256 5320 175 GSU-175 GSU-145 INJECTION HAEMORRHOIDS/ KELOIDS 2919 4041 4490 6286 7858 176 GSU-176 GSU-146 INJECTION VARICOSE VEINS 2919 4041 4490 6286 7858 177 GSU-177 GSU-147 INTERCOSTAL TUBE DRAINAGE 7280 10080 11200 15680 19600 178 GSU-178 GSU-149 INTESTINAL FISTULA 29127 40329 44810 62734 78418 179 GSU-179 GSU-150 INTESTINAL PERFORATION 21853 30258 33620 47068 58835 180 GSU-180 GSU-346 INTESTINAL RESECTION & ANASTOMOSIS 20248 28035 31150 43610 54513

Any new service/tariff may be changed/added/deleted without prior notice. 173 Schedule of Charges 2019-20 ISIC

181 GSU-181 GSU-151 INTRA-ORAL REMOVAL OF SUBMANDIBULAR DUET CALCULUS 8736 12096 13440 18816 23520 182 GSU-182 GSU-152 INTUSSUSCEPTION (SIMPLE REDUCTAL) 13111 18153 20170 28238 35298 183 GSU-183 GSU-154 ISCHIORECTAC & GLUTEIL ABSCES & I & D DEROOFING 8736 12096 13440 18816 23520 184 GSU-184 GSU-153 ISCHIO-RECTAL ABSCESS 8736 12096 13440 18816 23520 KUNTZ REPAIR (INGUINAL HERNIORRAPHY WITH 185 GSU-185 GSU-155 20391 28233 31370 43918 54898 ORCHIDECTOMY) 186 GSU-186 GSU-156 LAP CONVERTED CHOLYCYSTECTOMY 29127 40329 44810 62734 78418 187 GSU-187 GSU-157 LAPAROSCOPIC ADHESIOLYSIS 20391 28233 31370 43918 54898 188 GSU-188 GSU-158 LAPAROSCOPIC ADRENALECTOMY 33105 45837 50930 71302 89128 189 GSU-189 GSU-159 LAPAROSCOPIC APPENDICECTOMY 19864 27504 30560 42784 53480 190 GSU-190 GSU-160 LAPAROSCOPIC APR 46352 64179 71310 99834 124793 LAPAROSCOPIC ASSISTED RIGHT HEMICOLECTOMY EITH ILEO 191 GSU-191 GSU-161 36413 50418 56020 78428 98035 TRANSVERSE ANASTOMOSIS LAPAROSCOPIC BILATERAL INGUINAL HERNIA REPAIR WITH 192 GSU-192 GSU-162 32045 44370 49300 69020 86275 MESH 193 GSU-193 GSU-163 LAPAROSCOPIC CBD EXPLORATION 26481 36666 40740 57036 71295 194 GSU-194 GSU-164 LAPAROSCOPIC CHOLECYSTECTOMY 21853 30258 33620 47068 58835 195 GSU-195 GSU-165 LAPAROSCOPIC COLOSTOMY (ASSISTED) 29127 40329 44810 62734 78418 LAPAROSCOPIC GASTROPEXY (TANNERS FOR GASTRIC 196 GSU-196 GSU-166 33105 45837 50930 71302 89128 VOLVULOUS) 197 GSU-197 GSU-167 LAPAROSCOPIC HARTMANSS REVERSAL 33105 45837 50930 71302 89128 198 GSU-198 GSU-168 LAPAROSCOPIC IN SEPTIC ABDOMEN 26221 36306 40340 56476 70595 199 GSU-199 GSU-169 LAPAROSCOPIC INCISIONAL HERNIA REPAIR 32045 44370 49300 69020 86275 LAPAROSCOPIC INTESTINAL PERFORATION REPAIR / RESECTION 200 GSU-200 GSU-170 33105 45837 50930 71302 89128 ANASTOMOSIS 201 GSU-201 GSU-171 LAPAROSCOPIC LIVER HYDATID EXCISION 29127 40329 44810 62734 78418 202 GSU-202 GSU-172 LAPAROSCOPIC LOW ANT RESECTION 46352 64179 71310 99834 124793 203 GSU-203 GSU-174 LAPAROSCOPIC MECKELLS DIVERTICULUM EXCISION 23836 33003 36670 51338 64173 204 GSU-204 GSU-175 LAPAROSCOPIC NEPHRECTOMY 29127 40329 44810 62734 78418 205 GSU-205 GSU-176 LAPAROSCOPIC NISSIN FUNDOPLICATION (FOR HIATUS HERNIA) 33105 45837 50930 71302 89128 206 GSU-206 GSU-177 LAPAROSCOPIC PYELOPASTY / REDO PYELOPLASTY 29127 40329 44810 62734 78418

Any new service/tariff may be changed/added/deleted without prior notice. 174 Schedule of Charges 2019-20 ISIC

207 GSU-207 GSU-178 LAPAROSCOPIC RECTOPEXY (RECTAL PROLAPSE) 33105 45837 50930 71302 89128 208 GSU-208 GSU-179 LAPAROSCOPIC ROUX N Y GASTRIC BYPASS 105944 146691 162990 228186 285233 209 GSU-209 GSU-180 LAPAROSCOPIC SPLENECTOMY 40794 56484 62760 87864 109830 210 GSU-210 GSU-181 LAPAROSCOPIC UMBILICAL HERNIA REPAIR 29127 40329 44810 62734 78418 LAPAROSCOPIC UNILATERAL INGUINAL HERNIA REPAIR WITH 211 GSU-211 GSU-182 26221 36306 40340 56476 70595 MESH 212 GSU-212 GSU-183 LAPAROSCOPIC VENTRAL HERNIA REPAIR 29127 40329 44810 62734 78418 213 GSU-213 GSU-184 LAPAROSCOPY DIAGNOSTIC WITH OR WITHOUT BIOPSY 14567 20169 22410 31374 39218 214 GSU-214 GSU-185 LAPAROTOMY 14567 20169 22410 31374 39218 LAPAROTOMY AND PEDICLED OMENTAL PATCHING CLOSURE 215 GSU-215 GSU-187 19864 27504 30560 42784 53480 DUODENDAL PERFORATION - LAPAROSCOPIC LAPAROTOMY AND PEDICLED OMENTAL PATCHING CLOSURE 216 GSU-216 GSU-186 21853 30258 33620 47068 58835 DUODENDAL PERFORATION 217 GSU-217 GSU-188 LAPARSCOPIC INGUINAL HERNIOTOMY (PAED HERNIA) 23836 33003 36670 51338 64173 LAPRATOMY WITH RESECTION AND ANAESTAMOSIS OF SMALL 218 GSU-218 GSU-189 29127 40329 44810 62734 78418 INTESTINE LAPROSCOPIC ANTERIOR RESECTION/ABDOMINO PERINEAL 219 GSU-219 GSU-190 43700 60507 67230 94122 117653 RESECTION (APR) 220 GSU-220 GSU-191 LAPROSCOPIC ASSISTED TOTAL PROCTO-COLECTOMY 50986 70596 78440 109816 137270 LAPROSCOPIC BARIATRIC SURGERY (GASTRIC SLEEVE 221 GSU-221 GSU-192 65553 90765 100850 141190 176488 RESECTION / BY PASS) 222 GSU-222 GSU-193 LARGE DEEP TUMOUR WIDE EXCISION & RECONSTRUCTION 14567 20169 22410 31374 39218 223 GSU-223 GSU-194 LARGE SUPERFICIAL TUMOUR 10205 14130 15700 21980 27475 224 GSU-224 GSU-195 LEFT HEMICOLECTOMY 29127 40329 44810 62734 78418 225 GSU-225 GSU-196 LEFT LOBECTOMY 43700 60507 67230 94122 117653 226 GSU-226 GSU-197 LIENO - RENAL/ PORTO CAVAL / MESO-CAVAL/ SHUNTS * 36413 50418 56020 78428 98035 227 GSU-227 GSU-198 LINGUAL THYROID EXCISION 11655 16137 17930 25102 31378 228 GSU-228 GSU-199 LUMBAR SYMPETHECTOMY - LAPARSCOPIC / OPEN 14567 20169 22410 31374 39218 229 GSU-229 GSU-200 LYMPH NODE BIOPSY 5831 8073 8970 12558 15698 230 GSU-230 GSU-201 MAJOR ARTERY ANASTAMOSES & REPAIR WITH GRAFT 43700 60507 67230 94122 117653 231 GSU-231 GSU-202 MAJOR VEIN ANASTAMOSES & REPAIR WITH GRAFT 43700 60507 67230 94122 117653 232 GSU-232 GSU-204 MESENTRIC CYST EXCISION / MECKELS DIVERTICULUM 14567 20169 22410 31374 39218

Any new service/tariff may be changed/added/deleted without prior notice. 175 Schedule of Charges 2019-20 ISIC

233 GSU-233 GSU-203 MESENTRIC CYST EXCISION 17485 24210 26900 37660 47075 234 GSU-234 GSU-205 MESENTRIC CYST EXCISION LAPAROSCOPIC 29127 40329 44810 62734 78418 235 GSU-235 GSU-206 MESH REPAIR RECURRENT INCISIONAL HERNIA 32045 44370 49300 69020 86275 236 GSU-236 GSU-207 MUSCLE BIOPSY 4368 6048 6720 9408 11760 237 GSU-237 GSU-208 NAIL EXCISION WITH NAIL BED WODGE RESECTION 5103 7065 7850 10990 13738 238 GSU-238 GSU-209 NEAR TOTAL THYROID ECTOMY 29127 40329 44810 62734 78418 239 GSU-239 GSU-210 OBSTRUCTED HERNIA (ANY TYPE) 21853 30258 33620 47068 58835 240 GSU-240 GSU-211 OMENTECTOMY 14567 20169 22410 31374 39218 241 GSU-241 GSU-212 OMONTAL BIOPSY 5831 8073 8970 12558 15698 242 GSU-242 GSU-213 OPEN CHOLECYTOSTOMY FOR EMPYEMA GALL BLADDER 14567 20169 22410 31374 39218 243 GSU-243 GSU-214 OPEN DRAINAGE OF LIVER ABSCEUS 11655 16137 17930 25102 31378 244 GSU-244 GSU-215 OPEN DRAINAGE PERINEPHRIC ABSCEUS 11655 16137 17930 25102 31378 245 GSU-245 GSU-216 OPEN LIVER BIOPSY 10205 14130 15700 21980 27475 PANCREAS-NECROSECTOMY AND OPEN DRAINAGE OF 246 GSU-246 GSU-217 36413 50418 56020 78428 98035 PANCREATIC ABSCEUS 247 GSU-247 GSU-218 PANCREAS-OPERATIONS IN THE PANCREAS FOR INSULINOMAS 36413 50418 56020 78428 98035 248 GSU-248 GSU-219 PANCREAS-PANCREATECTOMY 43700 60507 67230 94122 117653 249 GSU-249 GSU-220 PANCREAS-PANCREATIC-CYSTO GASTROSTOMY JEJUNOSTOMY 36413 50418 56020 78428 98035 250 GSU-250 GSU-221 PANCREAS-PANCREATICO JEJUNOSTOMY 36413 50418 56020 78428 98035 251 GSU-251 GSU-222 PANCREAS-PARTIAL PANCREATECTOMY 36413 50418 56020 78428 98035 252 GSU-252 GSU-223 PANCREAS-PSEUDOPANCREATIC CYST DRAINAGE 36413 50418 56020 78428 98035 253 GSU-253 GSU-224 PANCREAS-TRIPLE BY-PASS FOR A HEAD OF PANCREAS 36413 50418 56020 78428 98035 254 GSU-254 GSU-225 PANCREAS-WHIPPLES OPERATION 50986 70596 78440 109816 137270 255 GSU-255 GSU-226 PARATHYROIDECTOMY 29127 40329 44810 62734 78418 256 GSU-256 GSU-348 PARTIAL EXCISION & RECONSTRUCTION OF LIP 14021 19413 21570 30198 37748 257 GSU-257 GSU-227 PARTIAL GASTRECTOMY 26221 36306 40340 56476 70595 258 GSU-258 GSU-228 PARTIAL GLOSSECTOMY 14567 20169 22410 31374 39218 PARTIAL RESECTION OF THE LIVER LATERAL 259 GSU-259 GSU-229 50986 70596 78440 109816 137270 SEGMENTECTOMY 260 GSU-260 GSU-231 PELOIC ABSCESS DRAINAGE-TRANS PERITONEAL 13137 18189 20210 28294 35368

Any new service/tariff may be changed/added/deleted without prior notice. 176 Schedule of Charges 2019-20 ISIC

261 GSU-261 GSU-230 PELVIC ABSCESS DRAINAGE-TRANS RECTAL 10946 15156 16840 23576 29470 262 GSU-262 13115 PELVIC FLOOR REPAIR 16419 22734 25260 35364 44205 263 GSU-263 GSU-233 PENIS, TESTIS & SCROTUM-PARTIAL AMPUTATION PENIS 14567 20169 22410 31374 39218 264 GSU-264 GSU-234 PENIS, TESTIS & SCROTUM-TOTAL AMPUTATION PENIS 26221 36306 40340 56476 70595 265 GSU-265 GSU-235 PERIANAL ABSCESS (SUPERFICIAL) 7280 10080 11200 15680 19600 266 GSU-266 GSU-236 PER-OP CHOLANGIO 11655 16137 17930 25102 31378 267 GSU-267 GSU-237 PILONIDAL SINUS-EXCISION ONLY 14567 20169 22410 31374 39218 268 GSU-268 GSU-238 PILONIDAL SINUS-PRIMARY CLOSURE 17485 24210 26900 37660 47075 269 GSU-269 GSU-239 PROCTO COLECTOMY (OPEN) 43700 60507 67230 94122 117653 PSEUDO PANCREATIC CYST INTERNAL DRAINAGE (CYSTO 270 GSU-270 GSU-241 33105 45837 50930 71302 89128 GASTROSTOMY) (LAPAROSCOPIC) PSEUDO PANCREATIC CYST INTERNAL DRAINAGE (CYSTO 271 GSU-271 GSU-240 29127 40329 44810 62734 78418 GASTROSTOMY) 272 GSU-272 GSU-243 PSOAS ABSCESS DRAINAGE (LAPAROSCOPIC) 15886 21996 24440 34216 42770 273 GSU-273 GSU-242 PSOAS ABSCESS DRAINAGE 11655 16137 17930 25102 31378 274 GSU-274 GSU-244 PULL THROUGH TOTAL GLOSSECTOMY 36413 50418 56020 78428 98035 275 GSU-275 GSU-245 RADICAL NECK DISSECTION 29127 40329 44810 62734 78418 276 GSU-276 GSU-246 RAMSTEDTS OPERATION 14567 20169 22410 31374 39218 277 GSU-277 GSU-247 RANNULA EXCISION 7280 10080 11200 15680 19600 278 GSU-278 GSU-248 RARE HERNIA-LUMBAR 17485 24210 26900 37660 47075 279 GSU-279 GSU-249 RARE HERNIA-OBTURATOR 17485 24210 26900 37660 47075 280 GSU-280 GSU-250 RARE HERNIA-SPIGELIAN 17485 24210 26900 37660 47075 281 GSU-281 GSU-251 RECTAL POLYP EXCISION 7280 10080 11200 15680 19600 282 GSU-282 GSU-347 RECTOPEXY (OPEN/LAP) 24076 33336 37040 51856 64820 REDUCTION OBSTRUCTED HERNIA WITH LICHTENSTIENS 283 GSU-283 GSU-252 21853 30258 33620 47068 58835 REPAIR 284 GSU-284 GSU-253 REDUCTION OF PARAPHIMOSIS 2919 4041 4490 6286 7858 285 GSU-285 GSU-254 REMOVAL OF FOREIGN BODY (DEEP) 5831 8073 8970 12558 15698 286 GSU-286 GSU-255 REMOVAL OF FOREIGN BODY (SUPERFICIAL) 3640 5040 5600 7840 9800 287 GSU-287 GSU-319 REMOVAL OF PAROTID DUCT CALCULUS 11941 16533 18370 25718 32148

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288 GSU-288 GSU-256 REPAIR CONGENITAL DIAPHRAGMATIC HERNIA (BOCHDALEKS) 36413 50418 56020 78428 98035 289 GSU-289 GSU-257 REPAIR OF HIATUS HERNIA 36413 50418 56020 78428 98035 290 GSU-290 GSU-258 REPAIR OF PERITONEAL TEAR 14567 20169 22410 31374 39218 291 GSU-291 GSU-259 REPAIR OF TORN EAR LOBULES / GROWTH 3835 5310 5900 8260 10325 292 GSU-292 GSU-260 REPAIR RECURRENT INCISIONAL HERNIA-WITH MESH 29127 40329 44810 62734 78418 293 GSU-293 GSU-261 REPAIR RECURRENT INCISIONAL HERNIA-WITHOUT MESH 21853 30258 33620 47068 58835 294 GSU-294 GSU-262 RESECTION AND ANASTOMOSIS MULTIPLE - SMALL INTESTINE 29127 40329 44810 62734 78418 295 GSU-295 GSU-263 RESECTION AND ANASTOMOSIS SINGLE - SMALL INTESTINE 21853 30258 33620 47068 58835 296 GSU-296 GSU-264 RESECTION OF LARGE BOWEL 36413 50418 56020 78428 98035 297 GSU-297 GSU-265 RETROPERITOREAL ABSCESS DRAINAGE 11655 16137 17930 25102 31378 298 GSU-298 GSU-266 REVISION COLOSTOMY 17485 24210 26900 37660 47075 299 GSU-299 GSU-267 RIGHT HEMICOLECTOMY 26221 36306 40340 56476 70595 300 GSU-300 GSU-268 RIGHT LOBECTOMY 50986 70596 78440 109816 137270 301 GSU-301 GSU-269 SALPINGO OOPHORECTOMY UNILATRAL 11655 16137 17930 25102 31378 302 GSU-302 GSU-270 SCALENE NODE BIOPSY 7280 10080 11200 15680 19600 303 GSU-303 GSU-271 SIGMOID AND DESCENDING COLECTOMY 29127 40329 44810 62734 78418 304 GSU-304 GSU-272 SIGMOID MYOTOMY 14567 20169 22410 31374 39218 305 GSU-305 GSU-273 SIGMOIDOSCOPY 6019 8334 9260 12964 16205 306 GSU-306 GSU-274 SIGMOIDOSCOPY WITH OR WITHOUT BIOPSY 5831 8073 8970 12558 15698 SIMPLE CLOSURE OF PERFORATED ULCER (GASTRIC / 307 GSU-307 GSU-275 14567 20169 22410 31374 39218 DUODENAL) 308 GSU-308 GSU-276 SOFT TISSUE SARCOMA-EXCISION/RECONSTRUCTION 36413 50418 56020 78428 98035 309 GSU-309 GSU-277 SPLENECTOMY 29127 40329 44810 62734 78418 310 GSU-310 GSU-278 SPLENORRAPHY 21853 30258 33620 47068 58835 311 GSU-311 GSU-279 STAPLED HERMOIDECTOMY 20391 28233 31370 43918 54898 312 GSU-312 GSU-281 STRANGULATED HERNIA (ANY TYPE) 21853 30258 33620 47068 58835 313 GSU-313 GSU-282 STRICTUROPLASTY 17485 24210 26900 37660 47075 SUBCARDIAC POST AZYGOS DISCONNECTION AND 314 GSU-314 GSU-283 DEVASCULARISATION OF LOWER PESOPHAGUS / 43700 60507 67230 94122 117653 TRANSECTION*

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315 GSU-315 GSU-284 SUB-MANDIBULAR SALIVARY GLAND REMOVAL 14567 20169 22410 31374 39218 316 GSU-316 GSU-285 SUBTOTAL GASTRECTOMY 26221 36306 40340 56476 70595 317 GSU-317 GSU-286 SUPERFICIAL PAROTIDECTOMY 26221 36306 40340 56476 70595 318 GSU-318 GSU-287 SURGICAL REPAIR OF ANAL SPHINCTER FOLLOWING INJURY 21853 30258 33620 47068 58835 319 GSU-319 GSU-288 SUTURE LARGE LACERATIONS/ MAJOR WOUND / SEC SUTURING 5831 8073 8970 12558 15698 320 GSU-320 GSU-289 SUTURE OF SMALL LACERATIONS / MINOR WOUNDS 3640 5040 5600 7840 9800 321 GSU-321 GSU-290 SUTURING LIVER LACERATION CAUDATE LOBE 21853 30258 33620 47068 58835 322 GSU-322 GSU-291 THIERSCHS OPERATION / WIRING 4368 6048 6720 9408 11760 323 GSU-323 GSU-292 THYROID ADENOMA RESECTION/LOBECTOMY ENUCLEATION 27859 38574 42860 60004 75005 324 GSU-324 GSU-293 TONGUE TIE RELEASE 4368 6048 6720 9408 11760 325 GSU-325 GSU-19 TOTAL / RADICAL THYROIDECTOMY 27859 38574 42860 60004 75005 TOTAL AMPUTATION PENIS WITH BLOCK DISSECTION- 326 GSU-326 GSU-294 36413 50418 56020 78428 98035 BILATERAL TOTAL AMPUTATION PENIS WITH BLOCK DISSECTION- 327 GSU-327 GSU-295 29127 40329 44810 62734 78418 UNILATERAL 328 GSU-328 GSU-296 TOTAL GASTRECTOMY 36413 50418 56020 78428 98035 TOTAL LAPAROSCOPIC HYSTERECTOMY WITH B/L SALPINGO- 329 GSU-329 GSU-297 50986 70596 78440 109816 137270 OOPHERECTOMY 330 GSU-330 GSU-298 TOTAL PAROTIDECTOMY 29127 40329 44810 62734 78418 331 GSU-331 GSU-299 TRANSECTION OESOPHAGUS THROUGH CHEST 21853 30258 33620 47068 58835 332 GSU-332 GSU-300 TRANSECTION OESOPHAGUS USING EEA STAPLER 29127 40329 44810 62734 78418 333 GSU-333 GSU-301 TRANSVERSE COLECTOMY - ILEOTRANSVERSE COLOSTOMY 29127 40329 44810 62734 78418 334 GSU-334 GSU-302 TRISEGMENTECTOMY 58266 80676 89640 125496 156870 335 GSU-335 GSU-303 TRUCUT / NEEDLE BIOPSY 4368 6048 6720 9408 11760 336 GSU-336 GSU-304 TUBE CAECOSTOMY 7280 10080 11200 15680 19600 UMBILECTOMY WITH ENTERING PERITONEAL CAVITY - 337 GSU-337 GSU-306 19864 27504 30560 42784 53480 LAPAROSCOPY 338 GSU-338 GSU-305 UMBILECTOMY WITH ENTERING PERITONEAL CAVITY 14567 20169 22410 31374 39218 339 GSU-339 GSU-307 UMBILECTOMY WITHOUT ENTERING PERITONEAL CAVITY 11655 16137 17930 25102 31378 340 GSU-340 GSU-308 VAGOTOMY AND GASTROJEJUNOSTOMY/ PYELOROPLASTY 29127 40329 44810 62734 78418 341 GSU-341 GSU-309 VARICOSE VEINS - SUBFACIAL LIGATION / TRENDENBERGS - 26221 36306 40340 56476 70595

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BILATERAL VARICOSE VEINS - SUBFACIAL LIGATION / TRENDENBERGS - 342 GSU-342 GSU-310 17485 24210 26900 37660 47075 UNILATERAL 343 GSU-343 GSU-322 VARICOSE VEINS SHORT SAPHENOUS 11655 16137 17930 25102 31378 344 GSU-344 GSU-323 VARICOSE VEINS SYSTEM SAPHENOUS 17485 24210 26900 37660 47075 345 GSU-345 GSU-311 VASO-VASOSTOMY 11655 16137 17930 25102 31378 346 GSU-346 GSU-312 VENTRAL HERNIA OR UMBILICAL HERNIA 20391 28233 31370 43918 54898 VENTRAL HERNIA REPAIR WITH MARLEX MESH (MESH 347 GSU-347 GSU-313 26221 36306 40340 56476 70595 CHARGES PAYABLE BY PATIENT) 348 GSU-348 GSU-314 VOLVULUS LARGE BOWEL - RESECTION ANASTOMOSIS 32045 44370 49300 69020 86275 349 GSU-349 GSU-315 VOLVULUS OF SIGMOID COLON WITH (SIMPLE UNTWIST)* 14567 20169 22410 31374 39218 350 GSU-350 GSU-316 WHIPPLES PANCREATICO DUODENECTOMY 50986 70596 78440 109816 137270 351 GSU-351 GSU-317 WOUND INSPECTION 2184 3024 3360 4704 5880 ZOLLINGER ELLISON SYNDROME TOTAL GASTRECTOMY AND 352 GSU-352 GSU-318 43700 60507 67230 94122 117653 MANAGEMENT OF PRIMARY LESION

Charges Basis GW 65% HDU + ICU (all categories) 90% Shared 90% Single 100% Dlx 140% Spr. Dlx 140% Suite 140% Spr. Dlx. Suite 175%

Any new service/tariff may be changed/added/deleted without prior notice. 180 Schedule of Charges 2019-20 ISIC

GYNAECOLOGY SURGERIES

Shared Dlx/Super Super NEW General Room/ Single S.No. OLD CODE Surgery Dlx / Dlx. CODE Ward ICU/ Room Suite Suite HDU 1 GYN-01 GYN-1 ABDOMINAL MYOMECTOMY 40794 56484 62760 87864 109830 AB-TOTAL ABDOMINAL HYSTERECTOMY WITH SALPINYE 2 GYN-02 GYN-2 39800 55107 61230 85722 107153 OOPHORECTOMY 3 GYN-03 GYN-3 ADHESIOLYSIS OPEN 14567 20169 22410 31374 39218 4 GYN-04 GYN-4 B/L TUBAL LIGATION 12383 17145 19050 26670 33338 5 GYN-05 GYN-24 BARTHOIIN CYST(ABSCESS) REMOVAL MARSUPILIZATION 10595 14670 16300 22820 28525 6 GYN-06 GYN-5 CERVICAL BIOPSY 5831 8073 8970 12558 15698 7 GYN-07 GYN-6 CERVICAL BIOPSY WITH CERVICAL CAUTERIZATION 9464 13104 14560 20384 25480 8 GYN-08 GYN-25 COLPOSCOPY 4375 6057 6730 9422 11778 9 GYN-09 GYN-38 CRYOCAUTERIZATION OF CERVIX 6338 8775 9750 13650 17063 10 GYN-10 GYN-32 CYSTOCOELE REPAIR 11765 16290 18100 25340 31675 11 GYN-11 GYN-7 D&C (DUATATION & CURRATEGE) 7280 10080 11200 15680 19600 12 GYN-12 GYN-8 D&C ENDOMETRIAL BIOPSY 7280 10080 11200 15680 19600 13 GYN-13 GYN-9 DIAGNOSTIC HYSTROSCOPY 11655 16137 17930 25102 31378 DIAGNOSTIC LAPROSCOPY WITH CHROMOPERTUBATION WITH 14 GYN-14 GYN-10 20391 28233 31370 43918 54898 OVARIAN LAPROSCOPIC ECTOPIC DRILLING 15 GYN-15 15001 ELECTIVE CAESAREAN SECTION (LSCS) 23023 31878 35420 49588 61985 16 GYN-16 GYN-36 EPISIOTOMY REPAIR 9048 12528 13920 19488 24360 17 GYN-17 GYN-29 EXPLORATORY LAPAROTOMY 25324 35064 38960 54544 68180 EXPLORATORY LAPAROTOMY F/B CORPUS LUTEUM CYSTRUPTURE 18 GYN-18 GYNAE-300 25955 35937 39930 55902 69878 REPAIR 19 GYN-19 GYN-39 HYSTROSCOPIC ADHESIOLYSIS (ASPERMAN SYSNDROME) 23517 32562 36180 50652 63315 20 GYN-20 GYN-12 HYSTROSCOPIC MYOMECTOMY 27957 38709 43010 60214 75268 21 GYN-21 GYN-13 HYSTROSCOPIC POLYPEETOMY 21853 30258 33620 47068 58835

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22 GYN-22 GYN-40 IUCD INSERTION 3289 4554 5060 7084 8855 23 GYN-23 GYN-41 IUCD REMOVAL 1359 1881 2090 2926 3658 24 GYN-24 GYN-11 LAPAROTOMY ECOTOPIC PREGNANCY 27138 37575 41750 58450 73063 25 GYN-25 GYN-14 LAPROSCOPIC ASSISTED VAGINAL HYSTERECTOMY 35757 49509 55010 77014 96268 26 GYN-26 GYN-42 LAPROSCOPIC MYOMECTOMY 40703 56358 62620 87668 109585 27 GYN-27 GYN-43 LAPROSCOPIC OVERIAN BIOPSY 16283 22545 25050 35070 43838 28 GYN-28 GYN-44 LAPROSCOPIC SALPINGO OOPHORECTOMY 27138 37575 41750 58450 73063 29 GYN-29 GYN-30 LAPROSCOPIC SALPINGOSTOMY 23849 33021 36690 51366 64208 LAPROTOMY WITH SALPINGECTOMY FOR RAPTURED ECTOPIC 30 GYN-30 GYN-15 29855 41337 45930 64302 80378 (ECTOPIC LAPAROTOMY) 31 GYN-31 GYN-16 MANCHESTER REPAIR FOR UTEROVAGINAL PROLAPSE 34424 47664 52960 74144 92680 32 GYN-32 GYN-28 NDVH 36179 50094 55660 77924 97405 33 GYN-33 GYN-17 OVARIAN CANCER SURGERY 46352 64179 71310 99834 124793 34 GYN-34 GYN-18 OVARIAN CYSTECTOMY LAPAROSPIC 22516 31176 34640 48496 60620 PAN - ABDOMINAL HYSTERCOTOMY [TOTAL ABDOMINAL 35 GYN-35 GYN-19 34424 47664 52960 74144 92680 HYSTERCOTOMY WITH BIL SALPING OOPHORECOTOMY 36 GYN-36 GYN-20 POLYPECTOMY WITH ENDOMETRIAL AND CERVICAL BIOPSY 20391 28233 31370 43918 54898 37 GYN-37 GYN-26 POST HYSTERECTOMY VAULT PROLAPSE REPAIR (OPEN) 34372 47592 52880 74032 92540 38 GYN-38 GYN-33 RECTOCOELE REPAIR 11765 16290 18100 25340 31675 39 GYN-39 GYN-35 RECTOVAGINAL FISTULA REPAIR (RVF REPAIR) 27794 38484 42760 59864 74830 40 GYN-40 GYN-47 SIMPLE VULVECTOMY 23517 32562 36180 50652 63315 41 GYN-41 GYN-46 SLING OPERATION FOR INCONTINENCE 31662 43839 48710 68194 85243 42 GYN-42 GYN-45 TOTAL LAPROSCOPIC HYSTERECTOMY (TLH) 39468 54648 60720 85008 106260 43 GYN-43 GYN-31 TUBAL RECANALIZATION 28945 40077 44530 62342 77928 44 GYN-44 GYN-27 UNILATERAL SALPINGO OOPERECTOMY FOR T O MASS 18090 25047 27830 38962 48703 45 GYN-45 GYN-21 VAGINAL HYSTERECTOMY WITH ANTERIOR & POSTERIOR REPAIR 36179 50094 55660 77924 97405 46 GYN-46 GYN-22 VAGINAL TEAR REPAIR 8736 12096 13440 18816 23520

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47 GYN-47 GYN-34 VAGINOPLASTY FOR VAGINAL AGENESIS 34372 47592 52880 74032 92540 48 GYN-48 GYN-37 VVF REPAIR 29601 40986 45540 63756 79695 49 GYN-49 GYN-23 WERTHEIM'S HYSTERECTOMY 60255 83430 92700 129780 162225

Charges Basis GW 65% HDU + ICU (all categories) 90% Shared 90% Single 100% Dlx 140% Spr. Dlx 140% Suite 140% Spr. Dlx. Suite 175%

Any new service/tariff may be changed/added/deleted without prior notice. 183 Schedule of Charges 2019-20 ISIC

NEURO SURGERY

Shared Super NEW OLD Single Dlx/Super S.No. SURGERY NAME Gen. Ward Room/ICU Dlx. CODE CODE Room Dlx / Suite /HDU Suite 1 NUES-01 NEUS-1 ANEURSYM/AVM ** 66281 91773 101970 142758 178448 2 NUES-02 NEUS-2 ANTERIOR ENCEPHALOCOELE 37869 52434 58260 81564 101955 3 NUES-03 NEUS-43 ASPIRATION OF LUMBAR COLLECTION XLA 14443 19998 22220 31108 38885 4 NUES-04 NEUS-7 BILATERAL CHRONIC SUBDURAL HAEMATOMA 39325 54450 60500 84700 105875 5 NUES-05 14886 BONE FLAP REMOVAL 34535 47817 53130 74382 92978 6 NUES-06 NEUS-3 BRACHIAL PLEXUS 56810 78660 87400 122360 152950 7 NUES-07 14888 BRAIN ABSCESS DRAINAGE 53450 74007 82230 115122 143903 8 NUES-08 NEUS-4 BURR HOLE 18941 26226 29140 40796 50995 9 NUES-09 NEUS-49 BURR HOLE ASPIRATION OF ABSCESS 17875 24750 27500 38500 48125 10 NUES-10 14908 BURR HOLES MULTIPLE 32890 45540 50600 70840 88550 11 NUES-11 NEUS-5 CAROTID ENDARTRECTOMY 66281 91773 101970 142758 178448 12 NUES-12 14910 CARPAL TUNNEL SURGERY 16445 22770 25300 35420 44275 13 NUES-13 NEUS-6 CHRONIC SUBDURAL HAEMATOMA (UNILATERAL) 37869 52434 58260 81564 101955 14 NUES-14 NEUS-46 CRANIAL ENDOSCOPIC PROCEDURE 28600 39600 44000 61600 77000 15 NUES-15 NEUS-8 CRANIAL SYNOSTOSIS 49238 68175 75750 106050 132563 16 NUES-16 NEUS-9 CRANIOPLASTY 47346 65556 72840 101976 127470 17 NUES-17 NEUS-10 CRANIOTOMY - CSF RHINOERHEA 56810 78660 87400 122360 152950 18 NUES-18 NEUS-11 CRANIOTOMY BASAL TUMORS 66281 91773 101970 142758 178448 19 NUES-19 NEUS-12 CRANIOTOMY FOR HEAD INJURY WITH DUROPLASTY 66281 91773 101970 142758 178448 20 NUES-20 NEUS-13 CRANIOTOMY HEAD INJURY/STROKE HEMATOMA 49400 68400 76000 106400 133000 21 NUES-21 NEUS-14 CRANIOTOMY MENINGIOMA 49400 68400 76000 106400 133000 22 NUES-22 NEUS-15 CRANIOTOMY POSTERIOR FOSSA TUMOR 57636 79803 88670 124138 155173 23 NUES-23 NEUS-16 CRANIOTOMY TUMOR SUPRATENTORIAL 49400 68400 76000 106400 133000 CRANIOTOMY WITH ENDOSCOPIC EVACUATION OF 24 NUES-24 NEUS-17 66281 91773 101970 142758 178448 INTRACEREBRAL HEMATOMA 25 NUES-25 NEUS-18 CRANIOVERTEBRAL OPERATION 66281 91773 101970 142758 178448 26 NUES-26 NEUS-19 CSF SHUNT PROCEDURES (FROM SPINAL CORD) 28405 39330 43700 61180 76475 27 NUES-27 14905 DEBRIDEMENT (NEURO) 3289 4554 5060 7084 8855

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28 NUES-28 14887 DECOMPRESSIVE CRANIOTOMY 53450 74007 82230 115122 143903 29 NUES-29 NEUS-20 DETETHERING AND DUROPLASTY 37869 52434 58260 81564 101955 30 NUES-30 16367 DURAPLASTY 7800 10800 12000 16800 21000 ENDOSCOPIC PTERYGOPALATINE & INFRATEMPORAL 31 NUES-31 NEUS-63 32832 45459 50510 70714 88393 SURGERY 32 NUES-32 NEUS-61 ENDOSCOPIC TRANSPHENOID SURGERY 66281 91773 101970 142758 178448 33 NUES-33 NEUS-22 EXCISION OF RIGHT TEMPORALIS CYSTICERCUS CYST 28405 39330 43700 61180 76475 34 NUES-34 NEUS-23 EXTERNAL VENTRICULAR DRAINAGE 18941 26226 29140 40796 50995 35 NUES-35 NEUS-24 FRONTAL AND TEMPORAL LOBECTOMY 56810 78660 87400 122360 152950 36 NUES-36 14907 ICP MONITORING / TWIST DRILL 12337 17082 18980 26572 33215 37 NUES-37 NEUS-25 INTRA CEREBRAL HAEMATOMA HEAD INJURY 56810 78660 87400 122360 152950 LAMINECTOMY WITH SYRINGOSTOMY AND 38 NUES-38 NEUS-26 53027 73422 81580 114212 142765 SYRINGOPERTONIAL SHUNT 39 NUES-39 NEUS-27 LOCAL NEURECTOMY 28405 39330 43700 61180 76475 40 NUES-40 16366 LUMBAR DRAIN 5200 7200 8000 11200 14000 41 NUES-41 NEUS-28 LUMBAR MENINGOCOELE 32929 45594 50660 70924 88655 42 NUES-42 NEUS-29 MICRO DISECTOMY 47346 65556 72840 101976 127470 43 NUES-43 NEUS-45 MICROSCOPIC SURGERY 28600 39600 44000 61600 77000 44 NUES-44 NEUS-30 MICROVASCULAR DECOMPRESSION POSTEROR FOSSA 56810 78660 87400 122360 152950 45 NUES-45 14906 NERVE / MUSCLE BIOPSY 4115 5697 6330 8862 11078 46 NUES-46 NEUS-31 NERVE ENTRAPMENT 37869 52434 58260 81564 101955 47 NUES-47 NEUS-32 NERVE NEUROLYSIS 28405 39330 43700 61180 76475 48 NUES-48 NEUS-33 OCCIPITAL ENCEPHALOCOELE 41171 57006 63340 88676 110845 49 NUES-49 NEUS-34 OCCIPITO CERVICAL DECOMPRESSION 66281 91773 101970 142758 178448 50 NUES-50 14909 PERIPHERAL NERVE SURGERY 46046 63756 70840 99176 123970 51 NUES-51 NEUS-35 REPAIR OF SCALP AVULSION 18941 26226 29140 40796 50995 52 NUES-52 NEUS-36 SCALP FLAP ASPIRATION 9464 13104 14560 20384 25480 53 NUES-53 14911 SKULL BONE TUMOR 41113 56925 63250 88550 110688 54 NUES-54 14889 SPINAL DYSRAPHISM(COMPLEX) 57558 79695 88550 123970 154963 55 NUES-55 14885 SPINAL DYSRAPHISM(SIMPLE) 34320 47520 52800 73920 92400 56 NUES-56 14899 SPINAL TUMOR - EXTRADURAL 45227 62622 69580 97412 121765 57 NUES-57 14901 SPINAL TUMOR - INTRADURAL - COMPLEX 55913 77418 86020 120428 150535 58 NUES-58 14900 SPINAL TUMOR - INTRADURAL - SIMPLE 50980 70587 78430 109802 137253

Any new service/tariff may be changed/added/deleted without prior notice. 185 Schedule of Charges 2019-20 ISIC

59 NUES-59 14903 SPINAL TUMOR - INTRAMEDULLARY - COMPLEX 57558 79695 88550 123970 154963 60 NUES-60 14902 SPINAL TUMOR - INTRAMEDULLARY - SIMPLE 53450 74007 82230 115122 143903 61 NUES-61 NEUS-38 STEREOTACTIC PROCEDURES 53521 74106 82340 115276 144095 62 NUES-62 NEUS-39 SUBDURAL ASPIRATION 9464 13104 14560 20384 25480 SURGERY FOR ARNOLD CHIARI MALFORMATION AND 63 NUES-63 NEUS-40 47346 65556 72840 101976 127470 SYRINGONYELIA 64 NUES-64 14884 SURGERY FOR SCALP TUMOR 8223 11385 12650 17710 22138 65 NUES-65 14898 SYRINGOSUBARACHNOID SHUNT 53027 73422 81580 114212 142765 66 NUES-66 NEUS-41 TEMPORAL RHIZOTOMY (SURGICAL) 56810 78660 87400 122360 152950 TRANS ENDOSCOPIC TRANSETHMOID & TRANSANTRUM 67 NUES-67 NEUS-62 32832 45459 50510 70714 88393 SURGERY 68 NUES-68 NEUS-42 TRANSPHENOIDAL PROCEDURES 49400 68400 76000 106400 133000 69 NUES-69 14890 VASCULAR SURGERY FOR BRAIN/SPINE 64350 89100 99000 138600 173250 70 NUES-70 14904 VENTRICULAR PUNCTURE 3289 4554 5060 7084 8855 71 NUES-71 NEUS-37 VENTRICULO PERITONEAL SHUNT 28405 39330 43700 61180 76475

Charges Basis GW 65% HDU + ICU (all categories) 90% Shared 90% Single 100% Dlx 140% Spr. Dlx 140% Suite 140% Spr. Dlx. Suite 175%

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ORTHOPAEDIC SURGERIES

Dlx/ Shared Super NEW OLD Gen. Single Super S.No. SURGERY NAME Room/ICU Dlx. CODE CODE Ward Room Dlx / /HDU Suite Suite 1 ORT-01 ORT-1 ABOVE ELBOW AMPUTATION 22731 31473 34970 48958 61198 2 ORT-02 ORT-50 ACETABULAPLASTY 34086 47196 52440 73416 91770 ACROMIOCLAVIRCULAR JOINT- DIS-LOCATION - OPEN 3 ORT-03 ORT-2 22731 31473 34970 48958 61198 REDUCTION & INTERNAL FIXATION ACROMIOCLAVIRCULAR JOINT- EXCISION OF LATERAL END OF 4 ORT-04 ORT-3 11362 15732 17480 24472 30590 CLAVICLE 5 ORT-05 ORT-4 ACROMIOCLAVIRCULAR JOINT- SUB- ACROMIAL BURSECTOMY 13572 18792 20880 29232 36540 6 ORT-06 ORT-5 AMPUTATION OF TOE 11362 15732 17480 24472 30590 7 ORT-07 ORT-453 AMPUTATION SYMES 15912 22032 24480 34272 42840 8 ORT-08 ORT-6 ANKLE- ARTHRODESIS - WITH INT. FIX. 27268 37755 41950 58730 73413 9 ORT-09 ORT-7 ANKLE- ARTHROSCOPY 15912 22032 24480 34272 42840 ANKLE- ARTHROSCOPY & POWER SAVING & 10 ORT-10 ORT-471 26267 36369 40410 56574 70718 MICROFRACTURE/DRILLING 11 ORT-11 ORT-12032 ANKLE- ARTHROSCOPY & POWER SAVING 22731 31473 34970 48958 61198 12 ORT-12 ORT-8 ANKLE- ARTHROTOMY AND SUB-TOTAL SYNOVECTOMY 19312 26739 29710 41594 51993 13 ORT-13 ORT-9 ANKLE- ASPIRATION / INJECTION 800 1107 1230 1722 2153 14 ORT-14 ORT-11 ANKLE- DISARTICULATION 17043 23598 26220 36708 45885 15 ORT-15 ORT-12 ANKLE- DISLOCATION : ANKLE / PERI TALAR ;OPEN REDUCTION 22731 31473 34970 48958 61198 16 ORT-16 ORT-13 ANKLE- DISLOCATION : ANKLE / PERI TALAR; MUA & POP 10231 14166 15740 22036 27545 17 ORT-17 ORT-14 ANKLE- DISLOCATION REDUCTION- CLOSED 4524 6264 6960 9744 12180 18 ORT-18 ORT-10 ANKLE- FRACTURE MALLEOLUS BI-MALLEOLAR 17043 23598 26220 36708 45885 19 ORT-19 ORT-502 ANKLE- FRACTURE MALLEOLUS TRI-MALLEOLAR 25623 35478 39420 55188 68985 20 ORT-20 ORT-501 ANKLE- FRACTURE MALLEOLUS UNI-MALLEOLAR 7612 10539 11710 16394 20493 21 ORT-21 ORT-15 ANKLE- PILON FRACTURE : INT FIX & BONE GRAFT 22731 31473 34970 48958 61198 22 ORT-22 ORT-16 ANKLE- SYNOVECTOMY OF TENDONS 13637 18882 20980 29372 36715 23 ORT-23 ORT-17 ANKLE- TOTAL REPLACEMENT 45455 62937 69930 97902 122378 24 ORT-24 ORT-18 ANKLE- TRI-MALLEOLAR OPEN RED. 20449 28314 31460 44044 55055 25 ORT-25 ORT-20 ANKLE- WATSONS - JONES OP FOR UNSTABLE ANKLE 11362 15732 17480 24472 30590 26 ORT-26 ORT-473 APPLICATION OF VACUUM ASSISTED CLOSURE (APPLICATION 13683 18945 21050 29470 36838

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VAC)- LARGE APPLICATION OF VACUUM ASSISTED CLOSURE (APPLICATION 27 ORT-27 ORT-474 10946 15156 16840 23576 29470 VAC)- MEDIUM APPLICATION OF VACUUM ASSISTED CLOSURE (APPLICATION 28 ORT-28 ORT-475 5473 7578 8420 11788 14735 VAC)- SMALL 29 ORT-29 ORT-23 ARM- AMPUTATION - FORE QUARTER OR HIND QUARTER 27268 37755 41950 58730 73413 30 ORT-30 ORT-22 ARM- AMPUTATION 17043 23598 26220 36708 45885 ARM- CHR. OSTEOMYELITIS DEBRIDEMENT SAUCERISATION & 31 ORT-31 ORT-24 22731 31473 34970 48958 61198 BONE-GRAFT / MUSCLE PEDICLE 32 ORT-32 ORT-25 ARM- CURRETTAGE & BONEGRAFT : LARGE BONE LESION 18174 25164 27960 39144 48930 33 ORT-33 ORT-26 ARM- FRACTURE HUMERAL SHAFT : EXTERNAL FIXATION 13637 18882 20980 29372 36715 ARM- FRACTURE HUMERAL SHAFT : INTERNAL FIXATION 34 ORT-34 ORT-504 27736 38403 42670 59738 74673 (COMPLEX) ARM- FRACTURE HUMERAL SHAFT : INTERNAL FIXATION 35 ORT-35 ORT-503 24876 34443 38270 53578 66973 (INTERMEDIATE) 36 ORT-36 ORT-27 ARM- FRACTURE HUMERAL SHAFT : INTERNAL FIXATION (SIMPLE) 22731 31473 34970 48958 61198 ARM- FRACTURE NECK OF HUMERUS THREE PART OPEN 37 ORT-37 ORT-28 29536 40896 45440 63616 79520 REDUCTION : INTERNAL FIXATION 38 ORT-38 ORT-29 ARM- FRACTURE SHAFT HUMERULS : MUA & POP 7956 11016 12240 17136 21420 39 ORT-39 ORT-30 ARM- FRACTURE SHAFT HUMERUS FOR BONE GRAFTING 18174 25164 27960 39144 48930 40 ORT-40 ORT-31 ARM- NON UNION HUMERUL: BONE GRAFT& INT FIX 29536 40896 45440 63616 79520 ARM- SUPRA- CONDYLAR FRACTURE : OPEN REDUCTION - 41 ORT-41 ORT-32 22731 31473 34970 48958 61198 INTERNAL FIXATION 42 ORT-42 ORT-34 ARM- SUPRA-CONDYLAR FRACTURE : MUA & K-WIRE 10231 14166 15740 22036 27545 43 ORT-43 ORT-33 ARM- SUPRA-CONDYLAR FRACTURE : MUA 7956 11016 12240 17136 21420 ARM-CORRECTIVE OSTEOTOMY LOWER END OF HUMEROUS 44 ORT-44 ORT-35 17043 23598 26220 36708 45885 (SUPRA CONDYLAR) 45 ORT-45 ORT-244 ARM-HUMRUS INTERLOCKING NAILING AND BONE GRAFTING 29536 40896 45440 63616 79520 46 ORT-46 ORT-36 ARTHOSCOPIC BASKETS + ARTHOSCOPIC SLAP REPAIR 36179 50094 55660 77924 97405 47 ORT-47 ORT-37 ARTHROSCOPIC ACL RECONSTRUCTION 34086 47196 52440 73416 91770 48 ORT-48 ORT-38 ARTHROSCOPIC PCL RECONSTRUCTION 45455 62937 69930 97902 122378 49 ORT-49 ORT-39 ARTHROSCOPIC POWER SHAVING IN SHOULDER 22731 31473 34970 48958 61198 50 ORT-50 ORT-40 ARTHROSCOPIC ROTATOR CUFF REPAIR 34086 47196 52440 73416 91770 51 ORT-51 ORT-41 ARTHROSCOPIC SUBACROMIAL DECOMPRESSION 34086 47196 52440 73416 91770 52 ORT-52 ORT-42 ARTHROSCOPIC SYROIVAL BIOPSY 22731 31473 34970 48958 61198 53 ORT-53 ORT-43 ARTHROSCOPY & MINI OPEN REPAIR 34086 47196 52440 73416 91770

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ARTHROSCOPY ANTERIOR CRUCITATE LIGAMENT 54 ORT-54 ORT-44 27268 37755 41950 58730 73413 RECONSTRUCTION 55 ORT-55 ORT-45 BILATERAL HIP REPLACEMENT 80672 111699 124110 173754 217193 56 ORT-56 ORT-46 BONE BIOPSY- NEEDLE - SUPERFICIAL - GA 3413 4725 5250 7350 9188 57 ORT-57 ORT-47 BONE BIOPSY- NEEDLE - SUPERFICIAL - LA 1138 1575 1750 2450 3063 58 ORT-58 ORT-48 BONE BIOPSY- OPEN - DEEP 17043 23598 26220 36708 45885 59 ORT-59 ORT-49 BONE BIOPSY- OPEN - SUPERFICIAL 11362 15732 17480 24472 30590 60 ORT-60 ORT-57 BONE GRAFTING - SMALL BONE 7956 11016 12240 17136 21420 61 ORT-61 ORT-53 BONE GRAFTING- BONE - TUMORS 11362 15732 17480 24472 30590 BONE GRAFTING- EXCISION OF TUMORS OF BONES - AXIAL 62 ORT-62 ORT-54 22731 31473 34970 48958 61198 SKELETON WITH BONE GRAFTING 63 ORT-63 ORT-55 BONE GRAFTING- LONE BONE - TWO DONOR SITE 17043 23598 26220 36708 45885 64 ORT-64 ORT-56 BONE GRAFTING- LONG BONE - ONE DONOR SITE 13637 18882 20980 29372 36715 65 ORT-65 ORT-58 BONE MARROW ASPIRATION SINGLE SITE / 1 6812 9432 10480 14672 18340 66 ORT-66 ORT-59 BONE MARROW ASPIRATION TWO SITE / 2 9087 12582 13980 19572 24465 67 ORT-67 ORT-60 CARPAL TUNNEL RELEASE 3413 4725 5250 7350 9188 68 ORT-68 ORT-61 CHANGE OF ACETABULAR CUP ONLY 15152 20979 23310 32634 40793 69 ORT-69 ORT-62 CHANGE OF DRESSING +POP CAST B/K AND B/E 5688 7875 8750 12250 15313 70 ORT-70 ORT-476 CHANGE OF FEMORAL COMPONENT OF TKR 16419 22734 25260 35364 44205 71 ORT-71 ORT-477 CHANGE OF FEMORAL HEAD JOINT REPLACEMENT/HIP 5473 7578 8420 11788 14735 72 ORT-72 ORT-478 CHANGE OF FEMORAL HEAD POST TKR 7657 10602 11780 16492 20615 73 ORT-73 ORT-468 CHANGE OF HIP ACETABULAR LINER 8762 12132 13480 18872 23590 74 ORT-74 ORT-63 CHEVERONS OSTEOTOMY OF 1ST METATARSAL 5688 7875 8750 12250 15313 75 ORT-75 ORT-64 CLAVICLE- CLAVICLE FRACTURE : OPEN RED & INT FIX 15912 22032 24480 34272 42840 76 ORT-76 ORT-65 CLAVICLE- CLAVICLE NON UNION : BONE GRAFT & INT FIX 22731 31473 34970 48958 61198 77 ORT-77 ORT-67 CONTRACTURE RELEASE - CAPSULOTOMY 17043 23598 26220 36708 45885 78 ORT-78 ORT-68 CONTRACTURE RELEASE - INTRA ARTICULAR 22731 31473 34970 48958 61198 79 ORT-79 ORT-69 CONTRACTURE RELEASE - MUSCLES 13637 18882 20980 29372 36715 80 ORT-80 ORT-70 CONTRACTURE RELEASE SKIN / SCAR 6812 9432 10480 14672 18340 81 ORT-81 ORT-71 CORE DECOMPRESSION-HIP 22731 31473 34970 48958 61198 82 ORT-82 ORT-72 CURRATAGE AND BIOPSY (LARGE) 22731 31473 34970 48958 61198 83 ORT-83 ORT-467 DEBRIDEMENT AND SEQUESTRECTOMY OF SMALL BONE/JOINT 3309 4581 5090 7126 8908 84 ORT-84 ORT-73 DIAGNOSTIC SHOULDER ARTHROSCOPY 22731 31473 34970 48958 61198

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85 ORT-85 ORT-81 DRAINAGE OF PSOAS ABSCESS BILATERAL 13637 18882 20980 29372 36715 86 ORT-86 ORT-506 DRESSING-LARGE 5850 8100 9000 12600 15750 87 ORT-87 ORT-505 DRESSING-MEDIUM 3705 5130 5700 7980 9975 88 ORT-88 ORT-82 DRESSING-SMALL 2275 3150 3500 4900 6125 89 ORT-89 ORT-83 DURAPLASTY 22731 31473 34970 48958 61198 90 ORT-90 ORT-84 DYNAMIC LIGAMENT RECONSTRUCTION & BALANCING OF KNEE 68166 94383 104870 146818 183523 91 ORT-91 ORT-85 E U A OF KNEE 5688 7875 8750 12250 15313 92 ORT-92 ORT-86 ELBOW JOINT- ARTHRODESIS - WITH INTERNAL FIXATION 27268 37755 41950 58730 73413 93 ORT-93 ORT-87 ELBOW JOINT- ARTHRODESIS - WITHOUT INTERNAL FIXATION 22731 31473 34970 48958 61198 94 ORT-94 ORT-88 ELBOW JOINT- ARTHROSCOPY OF ELBOW 14775 20457 22730 31822 39778 95 ORT-95 ORT-89 ELBOW JOINT- ARTHROTOMY 6812 9432 10480 14672 18340 96 ORT-96 ORT-90 ELBOW JOINT- ARTHROTOMY AND SUB-TOTAL SYNOVECTOMY 18174 25164 27960 39144 48930 97 ORT-97 ORT-91 ELBOW JOINT- DISARTICULATION 17043 23598 26220 36708 45885 98 ORT-98 ORT-92 ELBOW JOINT- DISLOCATION CLOSED REDUCTION 6812 9432 10480 14672 18340 99 ORT-99 ORT-94 ELBOW JOINT- DISLOCATION OPEN REDUCTION 22731 31473 34970 48958 61198 100 ORT-100 ORT-95 ELBOW JOINT- EXCISION ARTHROPLASTY 18174 25164 27960 39144 48930 101 ORT-101 ORT-96 ELBOW JOINT- EXCISION - MYOSITIS OSSIFICANS GRADE-I 14775 20457 22730 31822 39778 102 ORT-102 ORT-507 ELBOW JOINT- EXCISION - MYOSITIS OSSIFICANS GRADE-II 18350 25407 28230 39522 49403 103 ORT-103 ORT-508 ELBOW JOINT- EXCISION - MYOSITIS OSSIFICANS GRADE-III 21210 29367 32630 45682 57103 104 ORT-104 ORT-97 ELBOW JOINT- FRACTURE CAPITELLUM : INT FIX / EXCISION 11362 15732 17480 24472 30590 105 ORT-105 ORT-101 ELBOW JOINT- RADIAL HEAD FRACTURE : OPEN RED / INT FIX 17043 23598 26220 36708 45885 106 ORT-106 ORT-102 ELBOW JOINT- RADIUS HEAD EXCISION 11362 15732 17480 24472 30590 107 ORT-107 ORT-103 ELBOW JOINT- RECURRENT DISLOCATION OF ELBOW 27268 37755 41950 58730 73413 108 ORT-108 ORT-104 ELBOW JOINT- REVISION-TOTAL ELBOW REPLACEMENT 56810 78660 87400 122360 152950 109 ORT-109 ORT-105 ELBOW JOINT- TENNIS ELBOW- SURGICAL RELEASE 5688 7875 8750 12250 15313 110 ORT-110 ORT-106 ELBOW JOINT- TOTAL ELBOW REPLACEMENT 45455 62937 69930 97902 122378 ELBOW JOINT-FRACTURE NON-UNION LATERAL CONDYLE 111 ORT-111 ORT-107 11362 15732 17480 24472 30590 HUMUEROUS-ORIF 112 ORT-112 ORT-322 ELBOW ORIF FRACTURE LATERAL CONDYLE HUMERUS FRACTURE 5688 7875 8750 12250 15313 113 ORT-113 ORT-77 ELBOW RADIAL HEAD FRACTURE : OPEN RED / INT FIX 17043 23598 26220 36708 45885 114 ORT-114 ORT-78 ELBOW RADIUS HEAD EXCISION 11362 15732 17480 24472 30590 115 ORT-115 ORT-109 EXCISION OF BONE FRAGMENT 2275 3150 3500 4900 6125 116 ORT-116 ORT-110 EXCISION OF HETERO TROPHIC OSSIFICATION BONE MASS GRADE- 18174 25164 27960 39144 48930

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I EXCISION OF HETERO TROPHIC OSSIFICATION BONE MASS GRADE- 117 ORT-117 ORT-508 21749 30114 33460 46844 58555 II EXCISION OF HETERO TROPHIC OSSIFICATION BONE MASS GRADE- 118 ORT-118 ORT-509 24609 34074 37860 53004 66255 III 119 ORT-119 ORT-111 EXCISION OF SOFT TISSUE TUMOUR / MUSCLE GROUP 17043 23598 26220 36708 45885 EXCISION OFLARGE BONE TUMOR FOR LIMB CONSERVATION AND 120 ORT-120 ORT-112 45455 62937 69930 97902 122378 PROSTHETIC RECONSTRUCTION 121 ORT-121 ORT-113 EXPLORATION OF HIP CHANGE OF MODULAR CONE 17043 23598 26220 36708 45885 122 ORT-122 ORT-114 EXPLORATION OF POPLETEAL FOSSA 22731 31473 34970 48958 61198 123 ORT-123 ORT-115 EXPLORATION OF SURGICAL WOUND & DEBRIDEMENT (MAJOR) 17043 23598 26220 36708 45885 124 ORT-124 ORT-116 EXPLORATION OF SURGICAL WOUND & DEBRIDEMENT (MINOR) 11362 15732 17480 24472 30590 125 ORT-125 ORT-119 EXT. FIXATOR RE-ADJUSMENT 3413 4725 5250 7350 9188 126 ORT-126 ORT-120 EXTERNAL FIXATOR .MONOPOLAR LEG 18174 25164 27960 39144 48930 127 ORT-127 ORT-121 EXTERNAL FIXATOR BIPOLAR LEG 22731 31473 34970 48958 61198 128 ORT-128 ORT-123 EXTERNAL FIXATOR MONOPOLAR ARM 15912 22032 24480 34272 42840 129 ORT-129 ORT-124 EXTERNAL FIXATOR MONOPOLAR FOREARM 15912 22032 24480 34272 42840 130 ORT-130 ORT-125 EXTERNAL FIXATOR MONOPOLAR THIGH 22731 31473 34970 48958 61198 131 ORT-131 14382 FEMUR DISTAL LOCKING OF FEMORAL NAIL 7956 11016 12240 17136 21420 132 ORT-132 ORT-128 FEMUR-CHRONIC OSTEOMYELITIS DEBRIDEMENT SAUCERATION 22731 31473 34970 48958 61198 133 ORT-133 ORT-129 FOOT (FASCIOTOMY) 14937 20682 22980 32172 40215 134 ORT-134 ORT-131 FOOT- AMPUTATION - DIGITS 7956 11016 12240 17136 21420 135 ORT-135 ORT-130 FOOT- AMPUTATION 11362 15732 17480 24472 30590 136 ORT-136 ORT-132 FOOT- ARTHRODESIS WITH INT. FIX. ONE JOINT 11362 15732 17480 24472 30590 137 ORT-137 ORT-510 FOOT- ARTHRODESIS WITH INT. FIX. THREE JOINT 16367 22662 25180 35252 44065 138 ORT-138 ORT-511 FOOT- ARTHRODESIS WITH INT. FIX. TWO JOINT 14937 20682 22980 32172 40215 139 ORT-139 ORT-133 FOOT- ARTHRODESIS WITHOUT INT. FIX. 6812 9432 10480 14672 18340 FOOT- ARTHROTOMY AND SUB-TOTAL SYNOVECTOMY - SMALL 140 ORT-140 ORT-134 14775 20457 22730 31822 39778 JOINTS FOOT- CHR. OSTEOMYELITIS DEBRIDEMENT SAUCERYSATION & 141 ORT-141 ORT-135 11362 15732 17480 24472 30590 BONE-GRAFT / MUSCLE PEDICLE 142 ORT-142 ORT-136 FOOT- CLUB FOOT : EXTENSIVE SOFT TISSUE SURGICAL RELEASE 22731 31473 34970 48958 61198 143 ORT-143 ORT-137 FOOT- CLUB FOOT ; MUA & POP 7956 11016 12240 17136 21420 144 ORT-144 ORT-138 FOOT- CURRETTAGE & BONEGRAFT; SMALL BONE LESION 18174 25164 27960 39144 48930 145 ORT-145 ORT-139 FOOT- DWYERS CALCANEAL OSTEOTOMY 18090 25047 27830 38962 48703

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146 ORT-146 ORT-140 FOOT- EXCISITION OF GANGLION / EXOSTOSIS 7956 11016 12240 17136 21420 147 ORT-147 ORT-141 FOOT- FRACTURE CALCANEUM : BONE GRAFT & INT FIX 22731 31473 34970 48958 61198 148 ORT-148 ORT-142 FOOT- FRACTURE CALCANEUM : CLOSE RED & POP 7956 11016 12240 17136 21420 FOOT- FRACTURE OF PHALANGES / METATARSALS : INT FIX - 149 ORT-149 ORT-144 22731 31473 34970 48958 61198 MULTIPLE FOOT- FRACTURE OF PHALANGES / METATARSALS : INT FIX - 150 ORT-150 ORT-145 13637 18882 20980 29372 36715 SINGLE 151 ORT-151 ORT-146 FOOT- FRACTURE OF PHALANGES / METATARSALS : INT FIX - TWO 18174 25164 27960 39144 48930 152 ORT-152 ORT-147 FOOT- FRACTURE OF PHALANGES / METATARSLS : CLOSE RED 4550 6300 7000 9800 12250 153 ORT-153 ORT-143 FOOT- FRACTURE TALUS INT. FIX. 22731 31473 34970 48958 61198 154 ORT-154 ORT-148 FOOT- GREAT TOE : MTP JOINT - ARTHRODESIS 18090 25047 27830 38962 48703 155 ORT-155 ORT-149 FOOT- GRICES PROCEDURE SUB TALAR BONE BLOCK 11362 15732 17480 24472 30590 FOOT- HELAL OSTEOTOMY / METATARSAL HEAD EXCISION OF 156 ORT-156 ORT-150 11362 15732 17480 24472 30590 LESSER TOE (BILATERAL) 157 ORT-157 ORT-151 FOOT- INGROWING TOE NAIL : WEDGE EXCISION 3413 4725 5250 7350 9188 158 ORT-158 ORT-152 FOOT- INGROWING TOE NAIL : ZADEKS PROCEDURE 4550 6300 7000 9800 12250 FOOT IST METATARSAL OSTEOTOMY + CONRRECTION 1 LESSER 159 ORT-159 ORT-13675 19702 27279 30310 42434 53043 TOE FOOT IST METATARSAL OSTEOTOMY + CONRRECTION MULTIPLE 160 ORT-160 ORT-13677 26267 36369 40410 56574 70718 LESSER TOES 161 ORT-161 ORT-153 FOOT- JONES PROCEDURE FOR GREAT TOE 7956 11016 12240 17136 21420 162 ORT-162 ORT-154 FOOT- MID - TARSAL CORRECTIVE OSTEOTOMY 18174 25164 27960 39144 48930 163 ORT-163 ORT-155 FOOT- MID FOOT DISLOCATION RED & K WIRE FIX 11362 15732 17480 24472 30590 164 ORT-164 ORT-156 FOOT- RETRO- CALCANEAL EXOSTOSIS / BURSA EXCISION 5688 7875 8750 12250 15313 FOOT SCARF/ CHEVRON OSTEOTOMY IST METATARSAL+/- AKIN 165 ORT-165 ORT-13674 16419 22734 25260 35364 44205 OSTEOTOMY BIG TOE 166 ORT-166 ORT-157 FOOT- TENDO ACHILLIS LENGTHENING 11362 15732 17480 24472 30590 167 ORT-167 ORT-158 FOOT- TENDO ACHILLIS REPAIR 14775 20457 22730 31822 39778 168 ORT-168 ORT-159 FOOT-CURRETAGE FOOT BONE JOINT 9087 12582 13980 19572 24465 169 ORT-169 ORT-160 FOOT-K WIRE FIXATION 5688 7875 8750 12250 15313 FORE ARM - FRACTURE RADIUS & ULNA-CLOSE REDUCTION & POP 170 ORT-170 ORT-166 5688 7875 8750 12250 15313 ABOVE ELBOW FORE ARM - K WIRE FIXATION FOR FRACTURE LOWER END OF 171 ORT-171 ORT-167 3413 4725 5250 7350 9188 RADIUS (PEDIATRIC) 172 ORT-172 ORT-168 FORE ARM- AMPUTATION 11362 15732 17480 24472 30590 173 ORT-173 ORT-170 FORE ARM- CHR. OSTEOMYELITIS DEBRIDEMENT SAUCERISATION 18174 25164 27960 39144 48930

Any new service/tariff may be changed/added/deleted without prior notice. 192 Schedule of Charges 2019-20 ISIC

& BONE-GRAFT / MUSCLE PEDICLE 174 ORT-174 ORT-171 FORE ARM- COLLES / SMITHS FRACTURE ; OPEN RED. INT. FIX. 14775 20457 22730 31822 39778 175 ORT-175 ORT-173 FORE ARM- COLLES FRACTURE: MUA & EXTERNAL FIXATOR 14775 20457 22730 31822 39778 176 ORT-176 ORT-174 FORE ARM- COLLES FRACTURE: MUA & K - WIRE FIXATION 9087 12582 13980 19572 24465 177 ORT-177 ORT-172 FORE ARM- COLLES FRACTURE: MUA 6812 9432 10480 14672 18340 178 ORT-178 ORT-175 FORE ARM- CORRECTION / CONTRACTURES ( OPEN) 15912 22032 24480 34272 42840 179 ORT-179 ORT-176 FORE ARM- CURRETTAGE & BONEGRAFT; LARGE BONE LESION 18174 25164 27960 39144 48930 180 ORT-180 ORT-177 FORE ARM- DE QUERVAINS DECOMPRESSION 6812 9432 10480 14672 18340 181 ORT-181 ORT-178 FORE ARM- EXCISION -DISTAL END ULNA 11362 15732 17480 24472 30590 182 ORT-182 ORT-180 FORE ARM- FASCIOTOMY 17043 23598 26220 36708 45885 183 ORT-183 ORT-181 FORE ARM- FRACTURE BOTH BONES : MUA & POP 7956 11016 12240 17136 21420 184 ORT-184 ORT-182 FORE ARM- FRACTURE OLECRANON : OPEN RED & INT FIX 11362 15732 17480 24472 30590 185 ORT-185 ORT-183 FORE ARM- FRACTURE RADIUS & ULNA SHAFT: INT FIX 22731 31473 34970 48958 61198 186 ORT-186 ORT-184 FORE ARM- FRACTURE RADIUS OR ULNA SHAFT: INT FIX 15912 22032 24480 34272 42840 FORE ARM- NON UNION / MAL UNION BOTH FOREARM BONES : 187 ORT-187 ORT-185 22731 31473 34970 48958 61198 BONE GRAFTING / OSTESTOMY & INT FIX 188 ORT-188 ORT-186 FORE ARM- OLECRANON BURSA EXCISION 5688 7875 8750 12250 15313 189 ORT-189 ORT-187 FORE ARM- VOLKMANS CONTRACTURE : MUSCLE SLIDE 22731 31473 34970 48958 61198 FOREARM FRACTURE RADIUS & ULNA CLOSED REDUCTION & A/E 190 ORT-190 ORT-189 5688 7875 8750 12250 15313 POP FOREARM OLECRANON - FIXATION WITH T.B.W (TENSION BAND 191 ORT-191 ORT-484 13137 18189 20210 28294 35368 WIRING) 192 ORT-192 ORT-190 FRACTURE RADIUS & ULNA CLOSED REDUCTION & A/E SLAB 5688 7875 8750 12250 15313 193 ORT-193 ORT-192 GANGLION EXCISION 5688 7875 8750 12250 15313 194 ORT-194 ORT-193 GLENOIDPLASTY OF SHOULDER 45455 62937 69930 97902 122378 195 ORT-195 ORT-194 GREATER TROCHANTEC PIN INSERTION 3413 4725 5250 7350 9188 196 ORT-196 ORT-196 HAND- AMPUTATION 11362 15732 17480 24472 30590 197 ORT-197 ORT-197 HAND- AMPUTATION - DIGITS 7956 11016 12240 17136 21420 198 ORT-198 ORT-198 HAND- ARTHRODESIS WITH INTERIOR FIXATION 11362 15732 17480 24472 30590 199 ORT-199 ORT-199 HAND- ARTHRODESIS WITHOUT INTERIOR FIXATION 6812 9432 10480 14672 18340 HAND- ARTHROTOMY AND SUB-TOTAL SYNOVECTOMY - SMALL 200 ORT-200 ORT-200 15912 22032 24480 34272 42840 JOINTS 202 ORT-202 ORT-466 HAND- BONE ENDOSCOPY 0 0 0 0 0 HAND- CHR. OSTEOMYELITIS DEBRIDEMENT SAUCERISATION & 203 ORT-203 ORT-201 7956 11016 12240 17136 21420 BONE-GRAFT / MUSCLE PEDICLE

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204 ORT-204 ORT-203 HAND- CORRECTIVE OSTEOTOMY FIRST METALARPAL 15912 22032 24480 34272 42840 205 ORT-205 ORT-204 HAND- CURRETTAGE & BONEGRAFT; SMALL BONE LEGION 18174 25164 27960 39144 48930 206 ORT-206 ORT-205 HAND- EXCISION OF SUPER NUMARY DIGIT 6812 9432 10480 14672 18340 HAND- FRACTURE OF PHALANGES / METACARPALS: CLOSED 207 ORT-207 ORT-206 5688 7875 8750 12250 15313 REDUCTION 208 ORT-208 ORT-207 HAND- FRACTURE OF PHALANGES / METACARPALS: INT FIX 11362 15732 17480 24472 30590 209 ORT-209 ORT-188 HAND FRACTURE OF PHALANGES- EXTERNAL FIXATION 8223 11385 12650 17710 22138 210 ORT-210 ORT-208 HAND- SMALL FINGER JOINT REPLACEMENT 22731 31473 34970 48958 61198 211 ORT-211 ORT-209 HAND- TRIGGER FINGER: SURGICAL RELEASE 4524 6264 6960 9744 12180 212 ORT-212 ORT-210 HAND-ARTHRODOSIS OF M.P. JOINT OF THUMB 3790 5247 5830 8162 10203 213 ORT-213 ORT-211 HAND-K WIRE FIXATION 5688 7875 8750 12250 15313 214 ORT-214 ORT-212 HAND-M.P. JOINTS ARTHROPLASTY OF FINGER (1 FINGER) 9464 13104 14560 20384 25480 215 ORT-215 ORT-213 HAND-M.P. JOINTS ARTHROPLASTY OF FINGER (2 FINGERS) 18941 26226 29140 40796 50995 216 ORT-216 ORT-214 HAND-M.P. JOINTS ARTHROPLASTY OF FINGER (3 FINGERS) 28405 39330 43700 61180 76475 217 ORT-217 ORT-215 HAND-M.P. JOINTS ARTHROPLASTY OF FINGER (4 FINGERS) 37869 52434 58260 81564 101955 218 ORT-218 ORT-216 HAND-SURGERY OF CARPAL BONES 6812 9432 10480 14672 18340 219 ORT-219 ORT-219 HIP- ARHTRODESIS WITH INT. FIX. 27268 37755 41950 58730 73413 220 ORT-220 ORT-220 HIP- ARHTRODESIS WITHOUT INT. FIX. 22731 31473 34970 48958 61198 221 ORT-221 ORT-484 HIP- ARTHROSCOPIC DIAGNOSTIC 11362 15732 17480 24472 30590 222 ORT-222 ORT-221 HIP- ARTHROTOMY 18174 25164 27960 39144 48930 223 ORT-223 ORT-222 HIP- ARTHROTOMY AND SUB-TOTAL SYNOVECTOMY 18174 25164 27960 39144 48930 224 ORT-224 ORT-223 HIP- ASPIRATION OF LEFT HIP 1138 1575 1750 2450 3063 225 ORT-225 ORT-224 HIP- BIOPSY - SYNOVIAL 11362 15732 17480 24472 30590 226 ORT-226 ORT-225 HIP- BI-POLAR HIP REPLACEMENT 34086 47196 52440 73416 91770 227 ORT-227 ORT-226 HIP- CANNULATED SCREW FIXATION 45455 62937 69930 97902 122378 228 ORT-228 ORT-227 HIP- DEFORMITY: SOFT TISSUE RELEASE PROCEDURE (BILATERAL) 18174 25164 27960 39144 48930 HIP- DEFORMITY: SOFT TISSUE RELEASE PROCEDURE 229 ORT-229 ORT-228 11362 15732 17480 24472 30590 (UNILATERAL) 230 ORT-230 ORT-230 HIP- DISARTICULATION OF HIP & HIND QUARTER AMPUTATION 34086 47196 52440 73416 91770 231 ORT-231 ORT-229 HIP- DISARTICULATION OF HIP 27268 37755 41950 58730 73413 232 ORT-232 ORT-231 HIP- DISLOCATION CLOSED 4550 6300 7000 9800 12250 233 ORT-233 ORT-232 HIP- DISLOCATION OPEN REDUCTION 22731 31473 34970 48958 61198 234 ORT-234 ORT-239 HIP- FEMUR HEAD FRACTURE-ORIF 28405 39330 43700 61180 76475

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235 ORT-235 ORT-234 HIP- GIRDLE STONE PSEUDO - ARTHROPLASTY 18174 25164 27960 39144 48930 236 ORT-236 ORT-235 HIP- HIP - SPICA OR MINERVA OR BODY CAST 11362 15732 17480 24472 30590 237 ORT-237 ORT-236 HIP- HIP ARTHROTOMY FOR INFECTION 18174 25164 27960 39144 48930 238 ORT-238 ORT-237 HIP- INSIDE O.T - WITH ANLAGESIA 5688 7875 8750 12250 15313 239 ORT-239 ORT-238 HIP- MUA FOR ACUTE HIP DISLOCATION 11362 15732 17480 24472 30590 240 ORT-240 ORT-240 HIP- OUTSIDE O.T - WITH ANASTHESIA 7956 11016 12240 17136 21420 241 ORT-241 ORT-241 HIP- REVISION TOTAL HIP REPLACEMENT 68166 94383 104870 146818 183523 242 ORT-242 ORT-242 HIP- TOTAL HIP REPLACEMENT 44226 61236 68040 95256 119070 243 ORT-243 ORT-320 HIP-OPEN REDUCTION ,VALGUS OSTEOTOMY HIP 45455 62937 69930 97902 122378 244 ORT-244 ORT-248 HIP-SUFE INT. FIXATION IN SITU 45455 62937 69930 97902 122378 245 ORT-245 ORT-245 ILLIZAROVS RING FIXATOR -CORTICOTOMY 11362 15732 17480 24472 30590 246 ORT-246 ORT-246 ILLIZAROVS RING FIXATOR -LEG 27268 37755 41950 58730 73413 247 ORT-247 ORT-247 ILLIZAROVS RING FIXATOR -THIGH 34086 47196 52440 73416 91770 248 ORT-248 ORT-249 INTER- LOCKING NAIL REMOVAL 11362 15732 17480 24472 30590 249 ORT-249 ORT-250 KELLERS OPERATION FOR HALLUS VALGUS 7956 11016 12240 17136 21420 250 ORT-250 ORT-251 KNEE JOINT- ARHTRODESIS WITH INT. FIX. 34086 47196 52440 73416 91770 251 ORT-251 ORT-252 KNEE JOINT- ARHTRODESIS WITHOUT INT. FIX. 22731 31473 34970 48958 61198 252 ORT-252 ORT-253 KNEE JOINT- ARTHROSCOPIC MENISCAL EXCISION 22731 31473 34970 48958 61198 253 ORT-253 ORT-254 KNEE JOINT- ARTHROSCOPIC MENISCAL REPAIR 34086 47196 52440 73416 91770 254 ORT-254 ORT-255 KNEE JOINT- ARTHROSCOPIC DIAGNOSTIC 11362 15732 17480 24472 30590 255 ORT-255 ORT-256 KNEE JOINT- ARTHROSCOPIC POWER SHAVING 22731 31473 34970 48958 61198 KNEE JOINT- ARTHROSCOPIC REMOVAL OF LOOSE / FOREIGN- 256 ORT-256 ORT-257 22731 31473 34970 48958 61198 BODY 257 ORT-257 ORT-258 KNEE JOINT- ARTHROTOMY AND SUB-TOTAL SYNOVECTOMY 18174 25164 27960 39144 48930 258 ORT-258 ORT-259 KNEE JOINT- ASPIRATION / INJECTION 800 1107 1230 1722 2153 259 ORT-259 ORT-260 KNEE JOINT- BIOPSY - SYNOVIAL 7956 11016 12240 17136 21420 260 ORT-260 ORT-261 KNEE JOINT- CLOSE WEDGE OSTEOTOMY CORRECTION 34086 47196 52440 73416 91770 261 ORT-261 ORT-262 KNEE JOINT- DISARTICULATION 17043 23598 26220 36708 45885 262 ORT-262 ORT-466 KNEE JOINT- DISLOCATION CLOSED REDUCTION 6624 9171 10190 14266 17833 263 ORT-263 ORT-263 KNEE JOINT- DISLOCATION REDUCTION OPEN 22731 31473 34970 48958 61198 264 ORT-264 ORT-264 KNEE JOINT- EXCISION OF BUNION & BURSA 6812 9432 10480 14672 18340 265 ORT-265 ORT-265 KNEE JOINT- FRACTURE DISLOCATION KNEE 22731 31473 34970 48958 61198 266 ORT-266 ORT-266 KNEE JOINT- MED / LAT, LIG REPAIR / RECONSTRUCTION 19312 26739 29710 41594 51993

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267 ORT-267 ORT-267 KNEE JOINT- OPEN CRUCIATE LIG : RECON. BY AUTO GRAFT 27268 37755 41950 58730 73413 268 ORT-268 ORT-268 KNEE JOINT- OPEN CRUCIATE LIG : RECON. BY PROSTHETIC GRAFT 29536 40896 45440 63616 79520 269 ORT-269 ORT-269 KNEE JOINT- OPEN MENISCECTOMY 11362 15732 17480 24472 30590 270 ORT-270 ORT-513 KNEE JOINT- OPEN WEDGE OSTEOTOMY CORRECTION 34086 47196 52440 73416 91770 271 ORT-271 ORT-270 KNEE JOINT- REVISION TOTAL KNEE REPLACEMENT 56810 78660 87400 122360 152950 272 ORT-272 ORT-271 KNEE JOINT- TOTAL KNEE REPLACEMENT 44226 61236 68040 95256 119070 273 ORT-273 ORT-273 K-WIRE FIXATION OF PHALANGES OF HAND/FOOT <1 NO. 5688 7875 8750 12250 15313 274 ORT-274 ORT-274 LAT RELEASE AND MEDIAL CAPSULE PLICATION 17043 23598 26220 36708 45885 275 ORT-275 ORT-276 LEG - INTER FRAGMENTARY SCREW FIXATION OF TIBIA 11362 15732 17480 24472 30590 276 ORT-276 ORT-278 LEG- AMPUTATION (LARGE) - BELOW KNEE 27268 37755 41950 58730 73413 277 ORT-277 ORT-277 LEG AMPUTATION (SMALL) - BELOW KNEE 12493 17298 19220 26908 33635 LEG- CHR. OSTEOMYELITIS DEBRIDEMENT SAUCERISATION & 278 ORT-278 ORT-280 19312 26739 29710 41594 51993 BONE-GRAFT / MUSCLE PEDICLE 279 ORT-279 ORT-281 LEG- CURRETTAGE & BONEGRAFT; LARGE BONE LEGION 29536 40896 45440 63616 79520 280 ORT-280 ORT-279 LEG- FASCIOTOMY 17043 23598 26220 36708 45885 281 ORT-281 ORT-515 LEG- FRACTURE PROXIMAL TIBIAL CONDYLE : INT FIX COMPLEX 29166 40383 44870 62818 78523 LEG- FRACTURE PROXIMAL TIBIAL CONDYLE : INT FIX 282 ORT-282 ORT-514 26306 36423 40470 56658 70823 INTERMEDIATE 283 ORT-283 ORT-282 LEG- FRACTURE PROXIMAL TIBIAL CONDYLE : INT FIX SIMPLE 22731 31473 34970 48958 61198 284 ORT-284 ORT-283 LEG- FRACTURE SHAFT TIBIA : OPED RED & PLATING 18174 25164 27960 39144 48930 285 ORT-285 ORT-284 LEG- FRACTURE TIBIAL SHAFT : CLOSE RED & POP 11362 15732 17480 24472 30590 286 ORT-286 ORT-285 LEG- FRACTURE TIBIAL SHAFT : INTERLOCKING NAIL - CLOSED 34086 47196 52440 73416 91770 287 ORT-287 ORT-286 LEG- FRACTURE TIBIAL SHAFT : INTERLOCKING NAIL - OPEN 22731 31473 34970 48958 61198 LEG- MAL UNION TIBIA CORRECTIVE OSTEOTOMY AND 288 ORT-288 ORT-287 29536 40896 45440 63616 79520 INTERLOCKING NAILING 289 ORT-289 ORT-288 LEG- MAL UNION TIBIA CORRECTIVE OSTEOTOMY AND PLATING 22731 31473 34970 48958 61198 290 ORT-290 ORT-289 LEG- NON UNION TIBIA : BONE GRAFT 18174 25164 27960 39144 48930 291 ORT-291 ORT-290 LEG- NON UNION TIBIA : BONE GRAFT & INT LOCKING NAIL 29536 40896 45440 63616 79520 292 ORT-292 ORT-291 LEG- NON UNION TIBIA : BONE GRAFT & PLATING 22731 31473 34970 48958 61198 LEG- OPEN FRACTURE TIBIAL SHAFT : DEBRIDEMENT & 293 ORT-293 ORT-292 18174 25164 27960 39144 48930 EXTERNAL FIXATOR APPLICATION LEG- OPEN FRACTURE TIBIAL SHAFT : DEBRIDEMENT & 294 ORT-294 ORT-293 22731 31473 34970 48958 61198 UNREAMED AO NAILING 295 ORT-295 ORT-294 LEG- OSTEOTOMY HIGH TIBIAL 22731 31473 34970 48958 61198 296 ORT-296 ORT-295 LEG- RECONSTRUCTION OF UPPER END OF FIBULA 34086 47196 52440 73416 91770

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297 ORT-297 ORT-297 LEG- RELOCATION OF TIBIAL TUBERCLE ( EG. HAUSERS ) 15912 22032 24480 34272 42840 298 ORT-298 ORT-298 LIGAMENT REPAIR - ANKLE/WRIST 17043 23598 26220 36708 45885 299 ORT-299 ORT-299 LIGAMENT REPAIR - ELBOW 17043 23598 26220 36708 45885 300 ORT-300 ORT-300 LIMB LENTHENING - MAJOR BONES (TIBIA ) 29536 40896 45440 63616 79520 301 ORT-301 ORT-301 LIMB LENTHENING - MINOR BONES 18174 25164 27960 39144 48930 302 ORT-302 ORT-302 LOCAL INFILTRATION ON PLANTAR FACIA 1138 1575 1750 2450 3063 M.C.L REPAIR WITH DOUBLE BREATHING OF CAPSULE / AND 303 ORT-303 ORT-304 38630 53487 59430 83202 104003 SLING OF SAITOUIS 304 ORT-304 ORT-305 MANIPULATION & POP APPLICATION - LEG (BILATERAL) 22731 31473 34970 48958 61198 305 ORT-305 ORT-306 MANIPULATION AND POP OF KNEE 7579 10494 11660 16324 20405 306 ORT-306 ORT-307 METATARSAL HEAD EXCISION 1-3 7956 11016 12240 17136 21420 307 ORT-307 ORT-308 METATARSAL HEAD EXCISION 3-5 11362 15732 17480 24472 30590 308 ORT-308 ORT-309 MOBILISATION OF KNEE 2275 3150 3500 4900 6125 309 ORT-309 ORT-310 MUSTARDS & SHARRARDAS OPERATION 11362 15732 17480 24472 30590 310 ORT-310 ORT-311 NEEDLE BONE BIOPSY / JOINT LESION 3413 4725 5250 7350 9188 311 ORT-311 ORT-312 NERVE SURGERY- CABLE NERVE GRAFTING 34086 47196 52440 73416 91770 312 ORT-312 ORT-313 NERVE SURGERY- REPAIR 18174 25164 27960 39144 48930 313 ORT-313 ORT-314 NERVE SURGERY- TRANSPOSITION 15912 22032 24480 34272 42840 314 ORT-314 ORT-315 NEURECTOMY 7956 11016 12240 17136 21420 315 ORT-315 ORT-316 NON UNION - INFECTED MAJOR BONES 45455 62937 69930 97902 122378 316 ORT-316 ORT-317 NON UNION - INFECTED MINOR BONES 22731 31473 34970 48958 61198 318 ORT-318 ORT-319 OPEN BIOPSY MUSCULO-SKELETAL LESION 6812 9432 10480 14672 18340 320 ORT-320 ORT-323 PARAVERTEBRAL ABCESS DRAINAGE (BOTH SIDE) 17043 23598 26220 36708 45885 321 ORT-321 ORT-325 PATELLA- PATELLECTOMY : INT FIX 17043 23598 26220 36708 45885 322 ORT-322 ORT-324 PATELLA- PATELLECTOMY 17043 23598 26220 36708 45885 323 ORT-323 ORT-326 PATELLA- PRE PATELLAR BURSA EXCISION 6812 9432 10480 14672 18340 324 ORT-324 ORT-327 PATELLA- RECURRENT DISLOCATION 18174 25164 27960 39144 48930 325 ORT-325 ORT-328 PEDICLE SCREW FIXATION - 2 LEVEL 45455 62937 69930 97902 122378 326 ORT-326 ORT-329 PEDICLE SCREW FIXATION - 4 LEVEL 56810 78660 87400 122360 152950 327 ORT-327 ORT-330 PEDICLE SCREW FIXATION - MORE THAN 4 LEVEL 63629 88101 97890 137046 171308 PELVIS - RECONSTRUCTION OF FRACTURE ACETABULUM-1 328 ORT-328 ORT-331 17043 23598 26220 36708 45885 COLUMN PELVIS - RECONSTRUCTION OF FRACTURE ACETABULUM-2 329 ORT-329 ORT-516 21255 29430 32700 45780 57225 COLUMN

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330 ORT-330 ORT-2017 PELVIS - RECONSTRUCTION OF FRACTURE ACETABULUM-WALL 17043 23598 26220 36708 45885 331 ORT-331 ORT-332 PELVIS- EXTERNAL FIXATION 18174 25164 27960 39144 48930 332 ORT-332 ORT-333 PELVIS- HEMI - PELVECTOMY 68166 94383 104870 146818 183523 333 ORT-333 ORT-334 PELVIS- INTERNAL FIXATION ANTERIOR 45455 62937 69930 97902 122378 334 ORT-334 ORT-521 PELVIS- INTERNAL FIXATION COMBINED 59755 82737 91930 128702 160878 335 ORT-335 ORT-520 PELVIS- INTERNAL FIXATION POSTERIOR 45455 62937 69930 97902 122378 336 ORT-336 ORT-335 PELVIS- SALTERS PELVIC OSTEOTOMY 29536 40896 45440 63616 79520 POLIO SURGERY- BACHELOR / GRICE GREEN ARTHRODESIS 337 ORT-337 ORT-337 13637 18882 20980 29372 36715 CALCQUEAL OSTEOTOMY 338 ORT-338 ORT-338 POLIO SURGERY- CORRECTIVE OSTEOTOMY OF LONG BONES 17043 23598 26220 36708 45885 339 ORT-339 ORT-339 POLIO SURGERY- EPIPHYSEAL STIMULATION / EPIPHYSE ODESIS 11362 15732 17480 24472 30590 340 ORT-340 ORT-340 POLIO SURGERY- EXCISION ARTHROPLASTY OF LARGE JOINTS 19312 26739 29710 41594 51993 341 ORT-341 ORT-341 POLIO SURGERY- EXCISION ARTHROPLASTY OF SMALL JOINTS 7956 11016 12240 17136 21420 342 ORT-342 ORT-342 POLIO SURGERY- HALLUS VALGUS 7956 11016 12240 17136 21420 343 ORT-343 ORT-343 POLIO SURGERY- LENGTH. / SHORTENING 15912 22032 24480 34272 42840 344 ORT-344 ORT-344 POLIO SURGERY- OSTEOTOMY + FIX. OF FIXATOR 22731 31473 34970 48958 61198 345 ORT-345 ORT-345 POLIO SURGERY- SOULTERS,YOUNTS RELEASE 13637 18882 20980 29372 36715 346 ORT-346 ORT-346 POP APPLICATION- AK/AE 3413 4725 5250 7350 9188 347 ORT-347 ORT-347 POP APPLICATION- BK/BE 2275 3150 3500 4900 6125 348 ORT-348 ORT-348 POP APPLICATION- CONG. DISL. OF HIP 4089 5661 6290 8806 11008 349 ORT-349 ORT-349 POP APPLICATION- HIP / SHOULDER SPICA 5688 7875 8750 12250 15313 350 ORT-350 ORT-350 POP APPLICATION- MANIPULATION & POP OF CLUB FOOT 4089 5661 6290 8806 11008 351 ORT-351 ORT-351 POP APPLICATION- SLABS - AE/AK 1482 2052 2280 3192 3990 352 ORT-352 ORT-352 POP APPLICATION- SLABS - BE / BK 1138 1575 1750 2450 3063 353 ORT-353 ORT-353 POP REPAIR OF POP CAST / SLAB 1138 1575 1750 2450 3063 QUADRICEPS RECONSTRATION OF KNEE WITH LATERIAL RELEASE 354 ORT-354 ORT-354 42608 58995 65550 91770 114713 AND RECONSTRATION OF THE QUADRICEPS APPARTUS 355 ORT-355 ORT-356 RE-CORTICOTOMY & ADJUSTMENT OF FIXATOR 14775 20457 22730 31822 39778 356 ORT-356 ORT-357 REMOVAL OF BROKEN IMPLANT 22731 31473 34970 48958 61198 357 ORT-357 ORT-358 REMOVAL OF DEEP SCREWS / TENSION BAND 7956 11016 12240 17136 21420 358 ORT-358 ORT-80 REMOVAL OF DRAIN 4550 6300 7000 9800 12250 359 ORT-359 ORT-359 REMOVAL OF ELBOW REPLACEMENT PROSTHESIS 34086 47196 52440 73416 91770 360 ORT-360 ORT-360 REMOVAL OF EXOSTOSIS FROM LONG BONES 10231 14166 15740 22036 27545

Any new service/tariff may be changed/added/deleted without prior notice. 198 Schedule of Charges 2019-20 ISIC

361 ORT-361 ORT-361 REMOVAL OF EXT. FIXATOR / IMPLANTS 7956 11016 12240 17136 21420 362 ORT-362 ORT-362 REMOVAL OF EXTERNAL FIXATOR 5688 7875 8750 12250 15313 363 ORT-363 ORT-363 REMOVAL OF HIP REPLACEMENT PROSTHESIS 34086 47196 52440 73416 91770 364 ORT-364 ORT-364 REMOVAL OF K - INTERMEDULLARY NAIL 7956 11016 12240 17136 21420 365 ORT-365 ORT-365 REMOVAL OF K- WIRES 3413 4725 5250 7350 9188 366 ORT-366 ORT-366 REMOVAL OF NAILS - DYNAMIZATION OF TIBIAL NAIL 5688 7875 8750 12250 15313 367 ORT-367 ORT-367 REMOVAL OF NAILS-FEMUR-KIM 9087 12582 13980 19572 24465 368 ORT-368 ORT-368 REMOVAL OF NAILS-FEMUR-LOCKED 9087 12582 13980 19572 24465 369 ORT-369 ORT-369 REMOVAL OF NAILS-FOREARM-1 NAIL 3413 4725 5250 7350 9188 370 ORT-370 ORT-370 REMOVAL OF NAILS-FOREARM-2 NAIL 5688 7875 8750 12250 15313 371 ORT-371 ORT-371 REMOVAL OF NAILS-HEMURUS-LOCKED 9087 12582 13980 19572 24465 372 ORT-372 ORT-372 REMOVAL OF NAILS-TIBIA-LOCKED 9087 12582 13980 19572 24465 373 ORT-373 ORT-373 REMOVAL OF NAILS-TIBIA-PLAIN 8190 11340 12600 17640 22050 374 ORT-374 ORT-374 REMOVAL OF PLATE : FEMUR, HUMERUS, DCS, DHS 11362 15732 17480 24472 30590 375 ORT-375 ORT-375 REMOVAL OF PLATES-FEMUR 11817 16362 18180 25452 31815 376 ORT-376 ORT-376 REMOVAL OF PLATES-FOREARM-1 PLATE 6812 9432 10480 14672 18340 377 ORT-377 ORT-377 REMOVAL OF PLATES-FOREARM-2 PLATE 11362 15732 17480 24472 30590 378 ORT-378 ORT-378 REMOVAL OF PLATES-HUMERUS 9087 12582 13980 19572 24465 379 ORT-379 ORT-379 REMOVAL OF PLATES-TIBIA 10231 14166 15740 22036 27545 380 ORT-380 ORT-387 REMOVAL SCREW - SINGLE 5688 7875 8750 12250 15313 381 ORT-381 ORT-380 REPAIR BICEPS TENDON EXPOSER SHOULDER 22731 31473 34970 48958 61198 382 ORT-382 ORT-381 RESUTURING - TOE (LARGE) 2275 3150 3500 4900 6125 383 ORT-383 ORT-382 REVISION ACETABU LAM 34086 47196 52440 73416 91770 384 ORT-384 ORT-383 REVISION BACLOFEN PUMP IMPLANTATION 22731 31473 34970 48958 61198 385 ORT-385 ORT-384 RIB EXCISSION 34086 47196 52440 73416 91770 386 ORT-386 ORT-385 SACROILIAC JOINT - ARTHRODESIS 22731 31473 34970 48958 61198 387 ORT-387 ORT-386 SCAPULA RECONSTRUCTION 45455 62937 69930 97902 122378 388 ORT-388 ORT-388 SHLOUDER JOINT - FRACTURE DISLOCATION OF SHOULDER ORIF 34086 47196 52440 73416 91770 389 ORT-389 ORT-397 SHOULDER : MUA 5434 7524 8360 11704 14630 390 ORT-390 ORT-389 SHOULDER INJECTION UNDER IMAGE 3413 4725 5250 7350 9188 391 ORT-391 ORT-390 SHOULDER JOINT-ARTHRODESIS WITH INT. FIX. 22731 31473 34970 48958 61198 392 ORT-392 ORT-391 SHOULDER JOINT-ARTHRODESIS WITHOUT INT. FIX. 18174 25164 27960 39144 48930

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393 ORT-393 ORT-392 SHOULDER JOINT-ARTHROSCOPY DIAGNOSTICS 18174 25164 27960 39144 48930 SHOULDER JOINT-ARTHROSCOPY FOR REMOVAL OF LOOSE BODY 394 ORT-394 ORT-393 18174 25164 27960 39144 48930 OR SYNOVECTOMY 395 ORT-395 ORT-394 SHOULDER JOINT-ARTHROTOMY AND SUB-TOTAL SYNOVECTOMY 18174 25164 27960 39144 48930 396 ORT-396 ORT-395 SHOULDER JOINT-BIOPSY - SYNOVIAL 7956 11016 12240 17136 21420 397 ORT-397 ORT-396 SHOULDER JOINT-DIS ARTICULATION THROUGH SHOULDER 27268 37755 41950 58730 73413 398 ORT-398 ORT-398 SHOULDER JOINT-DISLOCATION : CLOSED 5005 6930 7700 10780 13475 399 ORT-399 ORT-399 SHOULDER JOINT-DISLOCATION : CLOSED REDUCTION 5688 7875 8750 12250 15313 400 ORT-400 ORT-400 SHOULDER JOINT-DISLOCATION OPEN REDUCTION 22731 31473 34970 48958 61198 SHOULDER JOINT-DISLOCATION RECURRENT : OPERATION BY 401 ORT-401 ORT-401 34086 47196 52440 73416 91770 OPEN REDUCTION SHOULDER JOINT-DISLOCATION RECURRENT :OPERATION BY 402 ORT-402 ORT-402 27268 37755 41950 58730 73413 ARTHOSCOPY 403 ORT-403 ORT-403 SHOULDER JOINT-EXAMINATION UNDER ANAESTHESIA 2275 3150 3500 4900 6125 404 ORT-404 ORT-404 SHOULDER JOINT-EXCISION OF BUNION & BURSA 6812 9432 10480 14672 18340 405 ORT-405 ORT-405 SHOULDER JOINT-HEMI ARTHROPLASTY BY PROSTHESIS 34086 47196 52440 73416 91770 406 ORT-406 ORT-406 SHOULDER JOINT-ROTATOR CUFF REPAIR 22731 31473 34970 48958 61198 407 ORT-407 ORT-407 SHOULDER JOINT-SHOULDER SPICA CAST 5688 7875 8750 12250 15313 408 ORT-408 ORT-408 SHOULDER JOINT-SUB-TROCH OSTEOTOMY WITH: INT FIX 18174 25164 27960 39144 48930 409 ORT-409 ORT-409 SHOULDER JOINT-TOTAL JOINT REPLACEMENT 44226 61236 68040 95256 119070 410 ORT-410 ORT-1452 SHOULDER LATARJET PROCEDURE 22614 31311 34790 48706 60883 411 ORT-411 ORT-410 SHOULDER SUBACROMIAL DECOMPRESSION 28405 39330 43700 61180 76475 412 ORT-412 ORT-411 SINGLE CHAMBER PPI 17043 23598 26220 36708 45885 413 ORT-413 ORT-412 SINGLE SCREW REMOVAL (TIBIA) 2841 3933 4370 6118 7648 414 ORT-414 ORT-413 SKELETAL STABILIZATION RIGHT ANKLE 4732 6552 7280 10192 12740 415 ORT-415 ORT-414 SKIN TRACTION LOWER LIMB 3413 4725 5250 7350 9188 416 ORT-416 ORT-415 SPINAL PROCESS WING -CABLE WIRING 34086 47196 52440 73416 91770 STABILISATION OF TIBIA + SOFT TISSUE COVERAGE WITH MUSCLE 417 ORT-417 ORT-416 11362 15732 17480 24472 30590 FLAP +SSG STABILISATION OF TIBIA + SOFT TISSUE COVERAGE WITH MUSCLE 418 ORT-418 ORT-417 11362 15732 17480 24472 30590 FLAP +SSG(EXT FIXATION) STABILISATION OF TIBIA + SOFT TISSUE COVERAGE WITH MUSCLE 419 ORT-419 ORT-418 15912 22032 24480 34272 42840 FLAP +SSG(INTERNAL) 420 ORT-420 ORT-419 STEINMENN PIN INSERTION 2275 3150 3500 4900 6125 421 ORT-421 ORT-420 STEINMENN PIN INSERTION FEMUR 2275 3150 3500 4900 6125

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422 ORT-422 ORT-421 SURGERY OVER PHALYINX 2275 3150 3500 4900 6125 423 ORT-423 ORT-79 SYNOVECTOMY OF TENDONS 15912 22032 24480 34272 42840 424 ORT-424 ORT-422 TENDON SURGERY- LENGTHENING 15912 22032 24480 34272 42840 425 ORT-425 ORT-423 TENDON SURGERY- RELEASE OF STERNOMASTOID 15912 22032 24480 34272 42840 426 ORT-426 ORT-424 TENDON SURGERY- REPAIR - MORE THAN ONE 17043 23598 26220 36708 45885 427 ORT-427 ORT-425 TENDON SURGERY- REPAIR - SINGLE 13637 18882 20980 29372 36715 428 ORT-428 ORT-426 TENDON SURGERY- TENOTOMY - OPEN 11362 15732 17480 24472 30590 429 ORT-429 ORT-427 TENDON SURGERY- TENOTOMY ( SUBCUTANEOUS) 11362 15732 17480 24472 30590 430 ORT-430 ORT-428 TENDON SURGERY- TRANSFER - ONE 11362 15732 17480 24472 30590 431 ORT-431 ORT-429 TENDON SURGERY- TRANSFER - THREE 22731 31473 34970 48958 61198 432 ORT-432 ORT-430 TENDON SURGERY- TRANSFER - TWO 17043 23598 26220 36708 45885 433 ORT-433 ORT-431 TENSION BAND WIRING 17043 23598 26220 36708 45885 434 ORT-434 ORT-433 THIGH- AMPUTATION - FORE QUARTER OR HIND QUARTER 27268 37755 41950 58730 73413 435 ORT-435 ORT-432 THIGH- AMPUTATION 17043 23598 26220 36708 45885 THIGH- CHR. OSTEOMYELITIS DEBRIDEMENT SAUCERISATION & 436 ORT-436 ORT-434 17043 23598 26220 36708 45885 BONE-GRAFT / MUSCLE PEDICLE 437 ORT-437 ORT-435 THIGH- CURRETTAGE & BONEGRAFT; LARGE BONE LESION 29536 40896 45440 63616 79520 438 ORT-438 ORT-519 THIGH- DISTAFEMORAL FRACTURE; ORIF COMPLEX 29166 40383 44870 62818 78523 439 ORT-439 ORT-518 THIGH- DISTAFEMORAL FRACTURE; ORIF INTERMEDIATE 26306 36423 40470 56658 70823 440 ORT-440 ORT-436 THIGH- DISTAFEMORAL FRACTURE; ORIF SIMPLE 22731 31473 34970 48958 61198 THIGH- FEMORAL NECK OSTEOTOMY FOR SCFE EG. DUNNS WITH 441 ORT-441 ORT-437 34086 47196 52440 73416 91770 INT FIX 442 ORT-442 ORT-438 THIGH- FRACTURE NECK OF FEMUR : SCREW FIX 27268 37755 41950 58730 73413 THIGH- FRACTURE NECK OF FEMUR NON UNION : BONE GRAFT + 443 ORT-443 ORT-439 34086 47196 52440 73416 91770 INT FIX + OSTEOTOMY 444 ORT-444 ORT-440 THIGH- FRACTURE PROXIMAL FEMUR : DHS 22731 31473 34970 48958 61198 THIGH- FRACTURE SHAFT FEMUR : INT FIX BY AO INTER LOCKING 445 ORT-445 ORT-441 27268 37755 41950 58730 73413 NAIL 446 ORT-446 ORT-442 THIGH- FRACTURE SHAFT FEMUR : MUA & TRACTION 17043 23598 26220 36708 45885 447 ORT-447 ORT-443 THIGH- FRACTURE SHAFT FEMUR : OPEN RED & PLATING 22731 31473 34970 48958 61198 THIGH- INNOMINATE OSTEOTOMY WITH RECONSTRUCTION OF 448 ORT-448 ORT-444 34086 47196 52440 73416 91770 ACETABULUM THIGH- INNOMINATE OSTEOTOMY WITHOUT RECONSTRUCTION 449 ORT-449 ORT-445 22731 31473 34970 48958 61198 OF ACETABULUM 450 ORT-450 ORT-446 THIGH- QUADRICEPS PLASTY 18174 25164 27960 39144 48930

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451 ORT-451 ORT-447 THIGH- REPAIR OF QUADS OR PATELLAR TENDONS 15912 22032 24480 34272 42840 452 ORT-452 ORT-448 THIGH- SUPRA- CONDYLAR CORRECTIVE OSTEOTOMY 18174 25164 27960 39144 48930 453 ORT-453 ORT-449 THIGH- SUPRA- CONDYLAR FEMORAL OSTEOTOMY WITH INT FIX 27268 37755 41950 58730 73413 454 ORT-454 ORT-452 THIGH- SUPRA-CONDYLAR FRACTURE; MUA & K- WIRE 18174 25164 27960 39144 48930 455 ORT-455 ORT-451 THIGH- SUPRA-CONDYLAR FRACTURE; MUA 17043 23598 26220 36708 45885 456 ORT-456 ORT-454 TOTAL KNEE REPLACEMENT (BILATERAL) 66339 91854 102060 142884 178605 457 ORT-457 ORT-455 TOTAL KNEE REPLACEMENT (SINGLE) 44226 61236 68040 95256 119070 458 ORT-458 ORT-456 TRAPEZIAL JOINT REPLACEMENT 18174 25164 27960 39144 48930 459 ORT-459 ORT-457 TRIPLE ARTHRODESIS LAMBRUNDI PROCEDURE 29536 40896 45440 63616 79520 460 ORT-460 ORT-458 TUMOUR PROSTHESIS UPPER END TIBIA 45455 62937 69930 97902 122378 461 ORT-461 ORT-486 VAC-DRESING (LARGE) 13137 18189 20210 28294 35368 462 ORT-462 ORT-487 VAC-DRESING (MEDIUM) 10946 15156 16840 23576 29470 463 ORT-463 ORT-488 VAC-DRESING (SMALL) 8762 12132 13480 18872 23590 464 ORT-464 ORT-459 WEDGING & POP CAST 2275 3150 3500 4900 6125 465 ORT-465 ORT-460 WOUND OPENING & CEMENTING 2275 3150 3500 4900 6125 466 ORT-466 ORT-461 WRIST - CARPAL TUNNEL DECOMPRESSION OPEN RELEASE 19442 26919 29910 41874 52343 467 ORT-467 ORT-469 WRIST ARTHOSCOPY - DIAGNOSTIC 14775 20457 22730 31822 39778 468 ORT-468 ORT-470 WRIST ARTHOSCOPY - THERAPEOTIC 22731 31473 34970 48958 61198 469 ORT-469 ORT-74 WRIST DISLOCATION : CARPUS OR PERI CARPAL: MUA. 4524 6264 6960 9744 12180 470 ORT-470 ORT-75 WRIST EXCISION OF RADIAL STYLOID PROCESS 11362 15732 17480 24472 30590 471 ORT-471 ORT-191 WRIST FRACTURE SCAPHOID ORIF 15152 20979 23310 32634 40793 472 ORT-472 ORT-512 WRIST FRACTURE SCAPHOID ORIF WITH BONE GRAFT 19442 26919 29910 41874 52343 473 ORT-473 ORT-462 WRIST JOINT- ARTHRODESIS 17043 23598 26220 36708 45885 474 ORT-474 ORT-463 WRIST JOINT- ARTHROTOMY AND SUB-TOTAL SYNOVECTOMY 13637 18882 20980 29372 36715 475 ORT-475 ORT-464 WRIST JOINT- ASPIRATION / INJECTION 683 945 1050 1470 1838 WRIST JOINT- DISLOCATION : CARPUS OR PERI CARPAL: OPEN 476 ORT-476 ORT-465 22731 31473 34970 48958 61198 RED. 477 ORT-477 ORT-318 WRIST NON UNION SCAPHOID ; BONE GRAFTING 18174 25164 27960 39144 48930 WRIST OPEN REDUCTION AND INTERNAL FIXATION OF FRACTURE 478 ORT-478 ORT-171 22731 31473 34970 48958 61198 SCAPHOID 479 ORT-479 ORT-24 WRIST PROXIMAL ROW CORPECTOMY 17043 23598 26220 36708 45885

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Charges Basis GW 65% HDU + ICU (all categories) 90% Shared 90% Single 100% Dlx 140% Spr. Dlx 140% Suite 140% Spr. Dlx. Suite 175%

Any new service/tariff may be changed/added/deleted without prior notice. 203 Schedule of Charges 2019-20 ISIC

PAIN CLINIC SURGERIES

Shared Super NEW OLD General Single Dlx/Super S.No. Surgery Name Room/ICU Dlx. CODE CODE Ward Room Dlx / Suite /HDU Suite 1 PAIN-01 PAIN-29 ATLANTOAXIAL JOINT BLOCK 9165 12690 14100 19740 24675 2 PAIN-02 PAIN-30 ATLANTOOCCIPITAL JOINT BLOCK 9165 12690 14100 19740 24675 3 PAIN-03 PAIN-2 BACLOFEN INJECTION (TRIAL) 7280 10080 11200 15680 19600 4 PAIN-04 PAIN-3 BACLOFEN/MORPHINE PUMP IMPLANTATION 43700 60507 67230 94122 117653 5 PAIN-05 PAIN-4 BOTOX INJECTION 6624 9171 10190 14266 17833 C2/3 FACET JOINT INJECTION / THIRD OCCIPITAL NERVE BLOCK 6 PAIN-06 PAIN-31 9464 13104 14560 20384 25480 (DIAGNOSTIC) 7 PAIN-07 PAIN-5 CAUDAL EPIDURAL INJECTION 7280 10080 11200 15680 19600 8 PAIN-08 PAIN-32 CAUDAL EPIDURAL INJECTION WITH EPIDUROGRAPHY 8015 11097 12330 17262 21578 9 PAIN-09 PAIN-33 CERVICAL DRG PRF 15899 22014 24460 34244 42805 10 PAIN-10 PAIN-6 CERVICAL/THORACIC EPIDURAL INJECTION 11655 16137 17930 25102 31378 11 PAIN-11 PAIN-7 COELIAC PLEXUS BLOCK 15886 21996 24440 34216 42770 12 PAIN-12 PAIN-9 EPIDURAL ADHESIONOLYSIS 13241 18333 20370 28518 35648 FACET JOINT/MEDICAL BRANCH 13 PAIN-13 PAIN-12 9464 13104 14560 20384 25480 BLOCK(LUMBAR/THORACIC/CERVICAL) 14 PAIN-14 PAIN-34 FACET MEDIAN BRANCH RF (CERVICAL) 17875 24750 27500 38500 48125 15 PAIN-15 PAIN-35 FACET MEDIAN BRANCH RF NEUROABLATION (LUMBAR) 14827 20529 22810 31934 39918 16 PAIN-16 PAIN-36 GANGLION OF IMPAR BLOCK/ IMPAR PLEXUS BLOCK 7280 10080 11200 15680 19600 17 PAIN-17 PAIN-37 GANGLION OF IMPAR NEUROLYTIC 8736 12096 13440 18816 23520 18 PAIN-18 PAIN-38 GANGLION OF IMPAR RF/PRF 10205 14130 15700 21980 27475 GASSERIAN GANGLION (TRIGEMINAL ) RF 19 PAIN-19 PAIN-39 14827 20529 22810 31934 39918 THERMOCOAGULATION 20 PAIN-20 PAIN-40 GASSERIAN GANGLION (TRIGEMINAL) BLOCK 10595 14670 16300 22820 28525 21 PAIN-21 PAIN-41 GENICULAR BRANCH BLOCK WITH LOCAL ANAESTHETIC 6364 8811 9790 13706 17133 22 PAIN-22 PAIN-42 GENICULAR BRANCH RF THERMOCOAGULATION 15886 21996 24440 34216 42770 23 PAIN-23 PAIN-43 GLASSOPHARYNGEAL NERVE BLOCK 8476 11736 13040 18256 22820 24 PAIN-24 PAIN-44 GLASSOPHARYNGEAL NERVE PRF 10595 14670 16300 22820 28525 25 PAIN-25 PAIN-45 GREATER OCCIPITAL & LESSER OCCIPITAL NERVE BLOCK 6364 8811 9790 13706 17133 GREATER OCCIPITAL & LESSER OCCIPITAL NERVE RF/ PRF 26 PAIN-26 PAIN-46 8905 12330 13700 19180 23975 LESIONING

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ILIOINGUINAL/ILIOHYPOGASTRIC/ GENITOFEMORAL NERVE 27 PAIN-27 PAIN-47 6364 8811 9790 13706 17133 BLOCK 28 PAIN-28 PAIN-48 INTERARTICULAR/PERIARTICULAR INJECTION 5298 7335 8150 11410 14263 29 PAIN-29 PAIN-49 INTERCOASTAL NERVE RF 8736 12096 13440 18816 23520 30 PAIN-30 PAIN-14 INTERCOSTAL BLOCK 6364 8811 9790 13706 17133 31 PAIN-31 PAIN-50 INTERLAMINAR EPIDURAL INJECTION (CERVICAL) 11655 16137 17930 25102 31378 32 PAIN-32 PAIN-51 INTERLAMINAR EPIDURAL INJECTION (LUMBAR) 6624 9171 10190 14266 17833 33 PAIN-33 PAIN-52 INTERLAMINAR EPIDURAL INJECTION (THORACIC) 11655 16137 17930 25102 31378 34 PAIN-34 PAIN-15 INTRATHECAL MORPHINE/BACLOFEN PUMP 39735 55017 61130 85582 106978 35 PAIN-35 PAIN-53 INTRATHECAL PUMP REFILL 2776 3843 4270 5978 7473 36 PAIN-36 PAIN-16 INTRATICAL LUMBAR DRAINAGE 2184 3024 3360 4704 5880 37 PAIN-37 PAIN-54 LATERAL CUTANEOUS NERVE OF THIGH BLOCK 6364 8811 9790 13706 17133 38 PAIN-38 PAIN-55 LOCAL INJECTION WITH STEROIDS 1489 2061 2290 3206 4008 39 PAIN-39 PAIN-56 LUMBAR DRG PRF 12714 17604 19560 27384 34230 40 PAIN-40 PAIN-11 LUMBAR EPIDURAL INJECTION 6559 9081 10090 14126 17658 41 PAIN-41 PAIN-100 LUMBAR PUNCTURE 4921 6813 7570 10598 13248 42 PAIN-42 PAIN-57 LUMBAR SYMPATHETIC BLOCK (DIAGNOSTIC) 8476 11736 13040 18256 22820 43 PAIN-43 PAIN-58 LUMBAR SYMPATHETIC RF LESIONING/ NEUROLYSIS 12714 17604 19560 27384 34230 44 PAIN-44 PAIN-59 MANDIBULAR/ MAXILLARY NERVE BLOCK 8476 11736 13040 18256 22820 45 PAIN-45 PAIN-60 MANDIBULAR/ MAXILLARY NERVE RF ABLATION 10166 14076 15640 21896 27370 46 PAIN-46 PAIN-61 NERVE BLOCK WITH LOCAL ANAESTHESIA (DIAGNOSTIC) 5720 7920 8800 12320 15400 47 PAIN-47 PAIN-62 NEUROAXIAL/ REGIONAL/PLEXUS/SYMPATHETIC LA BLOCKS 8476 11736 13040 18256 22820 NEUROAXIAL/ REGIONAL/PLEXUS/SYMPATHETIC NEUROLYTIC 48 PAIN-48 PAIN-63 9536 13203 14670 20538 25673 BLOCKS 49 PAIN-49 PAIN-21 OZONE NUCLEOLYSIS (DISCECTOMY) 20027 27729 30810 43134 53918 50 PAIN-50 PAIN-64 PAINFUL SCAR INJECTION 2776 3843 4270 5978 7473 51 PAIN-51 PAIN-65 PARAVERTEBRAL BLOCK 6364 8811 9790 13706 17133 PARAVERTEBRAL BLOCK WITH NEUROLYTIC 52 PAIN-52 PAIN-66 8476 11736 13040 18256 22820 (PHENOL/ALCOHOL) PERCUTANEOUS BALLOON COMPRESSION FOR TRIGEMINAL 53 PAIN-53 PAIN-67 22243 30798 34220 47908 59885 NEURALGIA 54 PAIN-54 PAIN-68 PERCUTANEOUS INTRADISCAL RF TREATMENT (PIRFT) 15886 21996 24440 34216 42770 55 PAIN-55 PAIN-69 PIRIFORMIS MUSCLE INJECTION 7417 10269 11410 15974 19968 56 PAIN-56 PAIN-70 PLEXUS/ REGIONAL BLOCK 8476 11736 13040 18256 22820 57 PAIN-57 PAIN-22 POST-OP PAIN REGIONAL BLOCK 4641 6426 7140 9996 12495

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58 PAIN-58 PAIN-71 PROVOCATIVE DISCOGRAPHY 10595 14670 16300 22820 28525 59 PAIN-59 PAIN-72 PUDENDAL NERVE BLOCK 6364 8811 9790 13706 17133 60 PAIN-60 PAIN-23 RADIOFREQUENCY ABLATION 15886 21996 24440 34216 42770 61 PAIN-61 PAIN-73 RAMI COMMUNICANS BLOCK 8476 11736 13040 18256 22820 62 PAIN-62 PAIN-74 RAMI COMMUNICANS RF LESIONING 15886 21996 24440 34216 42770 63 PAIN-63 PAIN-75 SACRIOLIAC JOINT INJECTION 9464 13104 14560 20384 25480 64 PAIN-64 PAIN-76 SACROILIAC JOINT RF DENERVATION 17875 24750 27500 38500 48125 65 PAIN-65 PAIN-77 SCIATIC NERVE BLOCK 6364 8811 9790 13706 17133 SELECTIVE NERVE ROOT SHEATH BLOCK 66 PAIN-66 PAIN-78 10595 14670 16300 22820 28525 (CERVICAL/THORACIC/LUMBAR/SACRAL) 67 PAIN-67 PAIN-79 SHOULDER INTRAARTICULAR INJECTION 5298 7335 8150 11410 14263 68 PAIN-68 PAIN-80 SOMATIC NERVE BLOCK 6364 8811 9790 13706 17133 69 PAIN-69 PAIN-81 SPHENOPALATINE GANGLION BLOCK 8905 12330 13700 19180 23975 70 PAIN-70 PAIN-82 SPHENOPALATINE GANGLION RF ABLATION 12714 17604 19560 27384 34230 71 PAIN-71 PAIN-83 SPINAL CORD STIMULATOR PERMANENT 43700 60507 67230 94122 117653 72 PAIN-72 PAIN-25 SPINAL CORD STIMULATOR TRIAL 21853 30258 33620 47068 58835 73 PAIN-73 PAIN-84 SPLANCHNIC BLOCK 8476 11736 13040 18256 22820 74 PAIN-74 PAIN-85 SPLANCHNIC NERVES NEUROLYTIC BLOCK 10595 14670 16300 22820 28525 75 PAIN-75 PAIN-86 SPLANCHNIC NERVES RF NEUROABLATION 15886 21996 24440 34216 42770 76 PAIN-76 PAIN-26 STELLATE GANGLION BLOCK 6364 8811 9790 13706 17133 77 PAIN-77 PAIN-87 STELLATE GANGLION RF DENERVATION/ NEUROLYSIS 7280 10080 11200 15680 19600 78 PAIN-78 PAIN-88 SUPERIOR HYPOGASTRIC BLOCK 8905 12330 13700 19180 23975 79 PAIN-79 PAIN-89 SUPERIOR HYPOGASTRIC NEUROLYTIC BLOCK 11440 15840 17600 24640 30800 80 PAIN-80 PAIN-90 SUPRASCAPULAR NERVE BLOCK 6364 8811 9790 13706 17133 81 PAIN-81 PAIN-91 SUPRASCAPULAR NERVE RF/PRF 12714 17604 19560 27384 34230 82 PAIN-82 PAIN-92 TEMPOROMANDIBULAR JOINT INJECTION 5298 7335 8150 11410 14263 83 PAIN-83 PAIN-93 THIRD OCCIPITAL NERVE RF THERMOCOAGULATION 17875 24750 27500 38500 48125 84 PAIN-84 PAIN-94 THORACIC SYMPATHETIC BLOCK 8476 11736 13040 18256 22820 85 PAIN-85 PAIN-95 THORACIC SYMPATHETIC NEUROLYTIC BLOCK 9536 13203 14670 20538 25673 86 PAIN-86 PAIN-96 THORACIC SYMPATHETIC RF LESIONING 15886 21996 24440 34216 42770 87 PAIN-87 PAIN-97 THREE IN ONE BLOCK 6364 8811 9790 13706 17133 88 PAIN-88 PAIN-98 TRANSFORAMINAL EPIDURAL INJECTION (ONE LEVEL) 7417 10269 11410 15974 19968 89 PAIN-89 PAIN-99 TRANSFORAMINAL EPIDURAL INJECTION (TWO LEVEL) 10595 14670 16300 22820 28525 90 PAIN-90 PAIN-100 TRIGEMINAL GANGLION NEUROLYTIC INJECTION 12714 17604 19560 27384 34230

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91 PAIN-91 PAIN-101 TRIGEMINAL GANGLION RF ABLATION 14827 20529 22810 31934 39918 92 PAIN-92 PAIN-28 TRIGEMINAL NERVE BLOCK 10595 14670 16300 22820 28525 93 PAIN-93 PAIN-102 TRIGGER POINT INJECTION 2782 3852 4280 5992 7490 ULTRASOUND GUIDED CONTINOUS NERVE BLOCK THROUGH 94 PAIN-94 16153 12461 17253 19170 26838 33548 PERINEURAL CATHETER

Charges Basis GW 65% HDU + ICU (all categories) 90% Shared 90% Single 100% Dlx 140% Spr. Dlx 140% Suite 140% Spr. Dlx. Suite 175%

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PLASTIC SURGERY

Shared Super NEW OLD General Single Dlx/Super S.No. SURGERY NAME Room/ICU Dlx. CODE CODE Ward Room Dlx / Suite /HDU Suite 1 PLAS-01 15843 ABDOMINOPLASTY 49368 68355 75950 106330 132913 2 PLAS-02 PLAS-1 AO FIXATION OF BONES(FACE) 15730 21780 24200 33880 42350 3 PLAS-03 PLAS-2 AURICULAR SINUS 11655 16137 17930 25102 31378 4 PLAS-04 PLAS-3 A-V FISTULA [A-V FISTULA] 7280 10080 11200 15680 19600 5 PLAS-05 PLAS-69 AV FISTULA 10946 15156 16840 23576 29470 6 PLAS-06 PLAS-4 BAT EARS 14567 20169 22410 31374 39218 7 PLAS-07 15847 BELT LIPECTOMY 116545 161370 179300 251020 313775 8 PLAS-08 PLAS-5 BILATERAL GLUTEAL 14567 20169 22410 31374 39218 9 PLAS-09 PLAS-6 BREAST-BILATERAL AUGMENTATION 21853 30258 33620 47068 58835 10 PLAS-10 PLAS-7 BREAST-BILATERAL REDUCTION 32773 45378 50420 70588 88235 11 PLAS-11 PLAS-8 BREAST-POST MASTECTOMY RECONSTRUCTION 32773 45378 50420 70588 88235 12 PLAS-12 PLAS-9 BREAST-UNILATERAL AUGMENTATION 14567 20169 22410 31374 39218 13 PLAS-13 PLAS-10 BREAST-UNILATERAL REDUCTION 21853 30258 33620 47068 58835 14 PLAS-14 15837 CENTRALISATION FOR RADIAL CLUB HAND 19520 27027 30030 42042 52553 15 PLAS-15 PLAS-11 CLEFT LIP-ALVECOLW 14567 20169 22410 31374 39218 16 PLAS-16 PLAS-12 CLEFT LIP-BILATERAL 17485 24210 26900 37660 47075 17 PLAS-17 PLAS-13 CLEFT LIP-COMPLETE 14567 20169 22410 31374 39218 18 PLAS-18 PLAS-14 CLEFT LIP-INCOMPLETE 14567 20169 22410 31374 39218 19 PLAS-19 PLAS-15 CLEFT LIP-UNILATERAL 14567 20169 22410 31374 39218 20 PLAS-20 PLAS-16 CLEFT PALATE & PRIMARY PHARYNGOPLASTY 17485 24210 26900 37660 47075 21 PLAS-21 PLAS-17 CLEFT PALATE-PALATAL FISTULA 14567 20169 22410 31374 39218 22 PLAS-22 PLAS-18 CLEFT PALATE-PHARYNGOPLASTY 17485 24210 26900 37660 47075 23 PLAS-23 PLAS-19 CLEFT PALATE-REPAIR CLEFT PALATE 14567 20169 22410 31374 39218 24 PLAS-24 PLAS-20 CONTRACTURE RELEASED GRAFTING-EXTENSIVE 21853 30258 33620 47068 58835 CONTRACTURE RELEASED GRAFTING-LARGE(SORE) (LARGE 25 PLAS-25 PLAS-21 21853 30258 33620 47068 58835 KNEE HIP SHOULDER) CONTRACTURE RELEASED GRAFTING-MEDIUM(MODERATE) 26 PLAS-26 PLAS-22 14567 20169 22410 31374 39218 (ELBOW WRIST) 27 PLAS-27 PLAS-23 CONTRACTURE RELEASED GRAFTING-SMALL (MILD) (IP) 7280 10080 11200 15680 19600

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28 PLAS-28 PLAS-24 CONTRACTURE RELEASED GRAFTING-VERY EXTENSIVE 21853 30258 33620 47068 58835 29 PLAS-29 15849 CORRECTION OF CLEFT HAND 20677 28629 31810 44534 55668 30 PLAS-30 PLAS-25 DEBRIDEMENT-MAJOR(WHOLE OF LIMB/TRUNK) 7280 10080 11200 15680 19600 31 PLAS-31 PLAS-26 DEBRIDEMENT-MEDIUM(HALF OF LIMB/TRUNK) 5831 8073 8970 12558 15698 32 PLAS-32 PLAS-27 DEBRIDEMENT-SMALL(PART OF LIMB/ 1/4TH OF TRUNK) 3640 5040 5600 7840 9800 33 PLAS-33 PLAS-28 DEBULKING OF FLAP - LARGE 7280 10080 11200 15680 19600 34 PLAS-34 PLAS-29 DEBULKING OF FLAP - MEDIUM 5103 7065 7850 10990 13738 35 PLAS-35 PLAS-30 DEBULKING OF FLAP - SMALL 3640 5040 5600 7840 9800 36 PLAS-36 PLAS-31 DERMABRASION-FULL FACE 29127 40329 44810 62734 78418 37 PLAS-37 PLAS-32 DERMABRASION-PARTIAL 17485 24210 26900 37660 47075 38 PLAS-38 PLAS-33 DIVISION & INSERTION PEDICLE FLAPS 7280 10080 11200 15680 19600 39 PLAS-39 PLAS-34 DRESSING CHANGE-MASSIVE (FULL LIMB/FULL TRUNK) 2184 3024 3360 4704 5880 DRESSING CHANGE-MEDIUM (PART OF LIMB/ONE FOURTH OF 40 PLAS-40 PLAS-35 1456 2016 2240 3136 3920 TRUNK) DRESSING CHANGE-MINOR (PART OF LIMB/ONE FOURTH OF 41 PLAS-41 PLAS-36 1021 1413 1570 2198 2748 TRUNK) 42 PLAS-42 PLAS-37 EAR DEFORMITY RECONSRUCTION-1 STAGE 17485 24210 26900 37660 47075 43 PLAS-43 PLAS-38 EAR DEFORMITY RECONSTRUCTION-2 STAGE 11655 16137 17930 25102 31378 44 PLAS-44 PLAS-39 EAR DEFORMITY RECONSTRUCTION-3 STAGE 8736 12096 13440 18816 23520 45 PLAS-45 PLAS-40 ELEPHANTIASIS-LARGE 24765 34290 38100 53340 66675 46 PLAS-46 PLAS-41 ELEPHANTIASIS-SMALL 14567 20169 22410 31374 39218 47 PLAS-47 PLAS-42 EXCISION OF SKINTAG SMALL 1989 2754 3060 4284 5355 48 PLAS-48 PLAS-43 EXCISION-FIRST SMALL CYST/MOLE/SCAR 4368 6048 6720 9408 11760 49 PLAS-49 PLAS-44 EXCISION-LARGE CYST/MOLE/SCAR-EACH 7280 10080 11200 15680 19600 50 PLAS-50 PLAS-45 EXCISION-LARGE MOLES 10205 14130 15700 21980 27475 51 PLAS-51 PLAS-46 EXCISION-MULTIPLE CYST/MOLES/SCARS 8736 12096 13440 18816 23520 52 PLAS-52 PLAS-47 EXCISION-SKIN GRAFTING 11655 16137 17930 25102 31378 53 PLAS-53 PLAS-48 EXCISION-Z PLASTY 11655 16137 17930 25102 31378 54 PLAS-54 PLAS-49 EXTENSIVE MID FACE FRACTURE 21853 30258 33620 47068 58835 55 PLAS-55 PLAS-50 EYELID RECONSTRUCTION 17485 24210 26900 37660 47075 56 PLAS-56 PLAS-51 EYELID WRDGE RESECTION 10205 14130 15700 21980 27475 57 PLAS-57 PLAS-54 EYELID COSMETIC-DRESSING IN WARD -SMALL 4368 6048 6720 9408 11760 58 PLAS-58 PLAS-55 FACE LIFT-FULL JOB 43700 60507 67230 94122 117653 59 PLAS-59 PLAS-56 FACE LIFT-PARTIAL 29127 40329 44810 62734 78418

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60 PLAS-60 PLAS-57 FACELIFT COMPLETE 29127 40329 44810 62734 78418 61 PLAS-61 PLAS-58 FACELIFT MINIMUM 21853 30258 33620 47068 58835 62 PLAS-62 PLAS-59 FACIAL FRACTURES-MANDIBLE 11655 16137 17930 25102 31378 63 PLAS-63 PLAS-60 FACIAL FRACTURES-MANDIBLE WITH OPEN REDUCTION 17485 24210 26900 37660 47075 64 PLAS-64 PLAS-61 FACIAL FRACTURES-TM JOINT ANKYLOSIS-BILATERAL 21853 30258 33620 47068 58835 65 PLAS-65 PLAS-62 FACIAL FRACTURES-TM JOINT ANKYLOSIS-UNILATERAL 14567 20169 22410 31374 39218 66 PLAS-66 PLAS-63 FACIAL FRACTURES-ZYGOMA 11655 16137 17930 25102 31378 67 PLAS-67 PLAS-64 FACIAL FRACURES-NOSE 8736 12096 13440 18816 23520 68 PLAS-68 PLAS-65 FACIAL PARALYSIS 17485 24210 26900 37660 47075 69 PLAS-69 PLAS-66 FASCIO CUTANEOUS FLAP 14567 20169 22410 31374 39218 70 PLAS-70 15846 FAT GRAFTING (PER SITE) 9770 13527 15030 21042 26303 FIBRO-OSSEOUS LESIONS EXCISION WITH RE-CONTOURING < 71 PLAS-71 PLAS-67 9464 13104 14560 20384 25480 4CM2 FIBRO-OSSEOUS LESIONS EXCISION WITH RE-CONTOURING > 72 PLAS-72 PLAS-68 12383 17145 19050 26670 33338 4CM2 73 PLAS-73 PLAS-70 FLAPS DELAY 5831 8073 8970 12558 15698 74 PLAS-74 15838 FRACTURE NASAL BONE REDUCTION 9776 13536 15040 21056 26320 FRACTURE REDUCTION - MULTIPLE BONES IN HAND (EACH 75 PLAS-75 15840 8801 12186 13540 18956 23695 FRACTURE) 76 PLAS-76 15839 FRACTURE REDUCTION -2 BONES IN HAND 17609 24381 27090 37926 47408 77 PLAS-77 15842 GYNAECOMASTIA CORRECTION (BILATERAL) 19448 26928 29920 41888 52360 78 PLAS-78 15841 GYNAECOMASTIA CORRECTION (SINGLE) 8834 12231 13590 19026 23783 79 PLAS-79 PLAS-71 HAND SURGERY MAJOR (1 BONE) 10205 14130 15700 21980 27475 80 PLAS-80 PLAS-72 HYPOSPADIAS-FIRST STAGE 10205 14130 15700 21980 27475 81 PLAS-81 PLAS-73 HYPOSPADIAS-FISTULA 10205 14130 15700 21980 27475 82 PLAS-82 PLAS-74 HYPOSPADIAS-MEATOTOMY 3640 5040 5600 7840 9800 83 PLAS-83 PLAS-75 HYPOSPADIAS-ONE STAGE REPAIR 17485 24210 26900 37660 47075 84 PLAS-84 PLAS-76 HYPOSPADIAS-SECOND STAGE 11655 16137 17930 25102 31378 85 PLAS-85 PLAS-77 INTER-MAXILLARY FIXATION 11655 16137 17930 25102 31378 86 PLAS-86 15850 JOINT REPLACEMENT IN HAND SINGLE \EACH 22315 30897 34330 48062 60078 87 PLAS-87 PLAS-78 KELOID-BOTH EAR 8736 12096 13440 18816 23520 88 PLAS-88 PLAS-79 KELOID-ONE EAR 5831 8073 8970 12558 15698 89 PLAS-89 PLAS-80 LIPECTOMY(COSMESIS)-MAJOR (100-200 CM2) 17485 24210 26900 37660 47075 90 PLAS-90 PLAS-81 LIPECTOMY(COSMESIS)-MASSIVE (>200 CM2) 21853 30258 33620 47068 58835

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91 PLAS-91 PLAS-82 LIPECTOMY(COSMESIS)-MINOR (<=100 SQ.CM) 14567 20169 22410 31374 39218 92 PLAS-92 15853 LIPOSUCTION - ONE REGION 29419 40734 45260 63364 79205 93 PLAS-93 15854 LIPOSUCTION - THREE REGIONS 72937 100989 112210 157094 196368 94 PLAS-94 15808 LIPOSUCTION - TWO REGIONS 56804 78651 87390 122346 152933 95 PLAS-95 PLAS-83 LIPOSUCTION-EXTENSIVE 27365 37890 42100 58940 73675 96 PLAS-96 PLAS-84 LIPOSUCTION-MEDIUM 16419 22734 25260 35364 44205 97 PLAS-97 PLAS-85 LIPOSUCTION-SMALL 10946 15156 16840 23576 29470 98 PLAS-98 PLAS-86 MANDIBLE CLOSED REDUCTION 3640 5040 5600 7840 9800 99 PLAS-99 PLAS-87 MANDIBULAR OSTEOTOMY 18213 25218 28020 39228 49035 100 PLAS-100 PLAS-88 MYOCUTANEOUS FLAPS 21853 30258 33620 47068 58835 101 PLAS-101 PLAS-89 NERVE GRAFT 14567 20169 22410 31374 39218 102 PLAS-102 PLAS-90 NERVE REPAIR 14567 20169 22410 31374 39218 103 PLAS-103 PLAS-91 NERVE-NEUROLYSIS 10927 15129 16810 23534 29418 104 PLAS-104 PLAS-92 NEUROVASCULAR FLAPS 21853 30258 33620 47068 58835 105 PLAS-105 15807 NODO - VENOUS SHUNT 16445 22770 25300 35420 44275 106 PLAS-106 PLAS-93 OPEN REDUCTION & INTERNAL FIXATION (LE-FORT I) 16023 22185 24650 34510 43138 107 PLAS-107 PLAS-94 OPEN REDUCTION & INTERNAL FIXATION (LE-FORT II) 18213 25218 28020 39228 49035 108 PLAS-108 PLAS-95 OPEN REDUCTION & INTERNAL FIXATION (LE-FORT III) 20391 28233 31370 43918 54898 109 PLAS-109 PLAS-96 OPEN REDUCTION & INTERNAL FIXATION (SINGLE POINT) 14567 20169 22410 31374 39218 110 PLAS-110 PLAS-97 OPEN REDUCTION & INTERNAL FIXATION (THREE POINT) 20391 28233 31370 43918 54898 111 PLAS-111 PLAS-98 OPEN REDUCTION & INTERNAL FIXATION (TWO POINT) 17485 24210 26900 37660 47075 112 PLAS-112 15844 PANNICULECTOMY 40710 56367 62630 87682 109603 113 PLAS-113 15845 PANNICULECTOMY WITH MESH HERNIOPLASTY 50427 69822 77580 108612 135765 114 PLAS-114 PLAS-99 PEDICAL FLAP-LARGE 14567 20169 22410 31374 39218 115 PLAS-115 PLAS-100 PEDICAL FLAP-MEDIUM 10927 15129 16810 23534 29418 116 PLAS-116 PLAS-101 PEDICAL FLAP-SMALL 8015 11097 12330 17262 21578 117 PLAS-117 PLAS-102 PEDICLE FLAP-LARGE(LEFT) 14567 20169 22410 31374 39218 118 PLAS-118 PLAS-103 PEDICLE FLAP-LARGE(RIGHT) 14567 20169 22410 31374 39218 119 PLAS-119 15810 PENILE FAT GRAFTING 48607 67302 74780 104692 130865 120 PLAS-120 15809 PENILE LENGTHENING 67711 93753 104170 145838 182298 121 PLAS-121 PLAS-104 POLLICIZATION 21853 30258 33620 47068 58835 122 PLAS-122 PLAS-105 PTOTIS-BILATERAL 14567 20169 22410 31374 39218 123 PLAS-123 PLAS-106 PTOTIS-UNILATERAL 10927 15129 16810 23534 29418

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124 PLAS-124 PLAS-107 REMOVAL OF ARCH BARS/WIRES 3640 5040 5600 7840 9800 125 PLAS-125 15858 REMOVAL OF TISSUE EXPANDER 14963 20718 23020 32228 40285 126 PLAS-126 PLAS-108 RE-VASCULARISATION 29127 40329 44810 62734 78418 127 PLAS-127 PLAS-109 RHINOPASTY-IMPLANT 29127 40329 44810 62734 78418 128 PLAS-128 PLAS-110 RHINOPLASTY-BONE GRAFTING 29127 40329 44810 62734 78418 129 PLAS-129 PLAS-111 RHINOPLASTY-FULL JOB 29127 40329 44810 62734 78418 130 PLAS-130 PLAS-112 RHINOPLASTY-RECONSTRUCTION OF BONE 29127 40329 44810 62734 78418 131 PLAS-131 PLAS-113 RHINOPLASTY-SEPTORHINOPLASTY 29127 40329 44810 62734 78418 132 PLAS-132 PLAS-114 RHINOPLASTY-TIP WORK 23309 32274 35860 50204 62755 133 PLAS-133 PLAS-115 RHINOPLASY-HUMP REDUCTION 29127 40329 44810 62734 78418 134 PLAS-134 PLAS-116 SCAR REVISION - MULTIPLE / COMPLICATED 26481 36666 40740 57036 71295 135 PLAS-135 PLAS-117 SCAR REVISION - SIMPLE 13241 18333 20370 28518 35648 136 PLAS-136 PLAS-118 SKIN GRAFTING-EXTENSIVE LACERATION(400 SQ.CM) 16023 22185 24650 34510 43138 137 PLAS-137 PLAS-119 SKIN GRAFTING-LARGE(300 SQ.CM) 17485 24210 26900 37660 47075 138 PLAS-138 PLAS-120 SKIN GRAFTING-MEDIUM(200 SQ.CM) 13111 18153 20170 28238 35298 139 PLAS-139 PLAS-121 SKIN GRAFTINGSMALL(100 SQ.CM) 8736 12096 13440 18816 23520 140 PLAS-140 PLAS-122 SKIN GRAFTING-VERY EXTENSIVE(>500 SQ.CM) 18941 26226 29140 40796 50995 141 PLAS-141 PLAS-123 SPLIT LOBULE-BOTH EARS 2184 3024 3360 4704 5880 142 PLAS-142 PLAS-124 SPLIT LOBULE-ONE EAR 1456 2016 2240 3136 3920 143 PLAS-143 PLAS-126 SUTURING ACCIDENTAL WOUNDS-EXTENSIVE LACERATION 11655 16137 17930 25102 31378 144 PLAS-144 PLAS-125 SUTURING ACCIDENTAL WOUND-SMALL CUT 2184 3024 3360 4704 5880 145 PLAS-145 PLAS-127 SUTURING ACCIDENTAL WOUNDS-MULTIPLE LARGE CUTS 8736 12096 13440 18816 23520 146 PLAS-146 PLAS-128 SUTURING ACCIDENTAL WOUNDS-MULTIPLE SMALL CUTS 4368 6048 6720 9408 11760 147 PLAS-147 PLAS-129 SUTURING ACCIDENTAL WOUNDS-SKIN GRAFTING 11655 16137 17930 25102 31378 148 PLAS-148 PLAS-130 SYNDACTYLY-TWO FINGERS 8736 12096 13440 18816 23520 149 PLAS-149 PLAS-131 SYNDADTYLY-FOUR FINGERS 13111 18153 20170 28238 35298 150 PLAS-150 PLAS-132 TENDON REPAIR(LIKEOS…………………………………….) 10927 15129 16810 23534 29418 151 PLAS-151 15852 TENDON TRANSFER - FOOT 21476 29736 33040 46256 57820 152 PLAS-152 15851 TENDON TRANSFER - MULTIPLE HAND /UPPER LIMB 46579 64494 71660 100324 125405 153 PLAS-153 15813 TENDON TRANSFER - SINGLE HAND / UPPER LIMB 20755 28737 31930 44702 55878 154 PLAS-154 15848 TISSUE EXPANDER IN SUFFLATION 4355 6030 6700 9380 11725 155 PLAS-155 PLAS-137 TISSUE EXPANDER INSERTION 16419 22734 25260 35364 44205 156 PLAS-156 PLAS-133 VAGINOPLASTY 14567 20169 22410 31374 39218

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157 PLAS-157 PLAS-134 VESSEL REPAIR(1CM DIA) 14567 20169 22410 31374 39218 158 PLAS-158 PLAS-135 VESSEL REPAIR-UNDER MICROSCOPE(<.5 CM DIA) 29127 40329 44810 62734 78418 159 PLAS-159 PLAS-136 VESSEL REPAIR-UNDER MICROSCOPE(1-.5 CM DIA) 21853 30258 33620 47068 58835

Charges Basis GW 65% HDU + ICU (all categories) 90% Shared 90% Single 100% Dlx 140% Spr. Dlx 140% Suite 140% Spr. Dlx. Suite 175%

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RESPIRATORY MEDICINE SURGERIES

Shared Super NEW OLD General Single Dlx/Super S.No. SURGERY NAME Room/ICU Dlx. CODE CODE Ward Room Dlx / Suite /HDU Suite 1 RESS-01 RESS-1 BPF CLOSURE OR DECORTICATION 29127 40329 44810 62734 78418 2 RESS-02 RESS-3 BRONCHOSCOPY WITH SUCTIONING 10855 15030 16700 23380 29225 3 RESS-03 RESS-5 BULLECTOMY 21853 30258 33620 47068 58835 4 RESS-04 RESS-6 FIBER OPTIC E T TUBE INTUBATION 7332 10152 11280 15792 19740 5 RESS-05 RESS-7 FNAC LUNG 5103 7065 7850 10990 13738 6 RESS-06 RESS-8 INTERCOASTAL TUBE DRAINAGE 7332 10152 11280 15792 19740 7 RESS-07 RESS-9 MEDIASTINOSCOPY 11655 16137 17930 25102 31378 8 RESS-08 RESS-10 MEDIASTINOSCOPY TUMOR REMOVAL 34964 48411 53790 75306 94133 MEDIATINOSCPY,MULTIPLE MEDIASTUAL LYMPH NODE 9 RESS-09 RESS-11 21853 30258 33620 47068 58835 BIOPSIES AND FINE NEEDLE ASPIRATION 10 RESS-10 RESS-12 OPEN LUNG BIOPSY 10205 14130 15700 21980 27475 11 RESS-11 RESS-13 PERCUTANEOUS DILATATIONAL TRACHEOSTOMY 7280 10080 11200 15680 19600 12 RESS-12 RESS-14 PLEURAL ASPIRATION DIAGNOSTIC 2919 4041 4490 6286 7858 13 RESS-13 RESS-15 PLEURODESIS 7150 9900 11000 15400 19250 14 RESS-14 RESS-16 PULMONOLOGIST STANDBY 5103 7065 7850 10990 13738 15 RESS-15 RESS-17 RIB RESECTION 8736 12096 13440 18816 23520 16 RESS-16 RESS-18 THORACOSCOPIC PLEURAL BIOPSY 21853 30258 33620 47068 58835 17 RESS-17 RESS-19 TRACHEOSTOMY (SURGICAL) 7280 10080 11200 15680 19600 18 RESS-18 RESS-20 VATS SURGERY 36413 50418 56020 78428 98035

Charges Basis GW 65% HDU + ICU (all categories) 90% Shared 90% Single 100% Dlx 140% Spr. Dlx 140% Suite 140% Spr. Dlx. Suite 175%

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SPINE SURGERIES

Shared Dlx/Sup Super NEW OLD Single S.NO. PROCEDURES Gen Ward Room/ICU er Dlx / Dlx. CODE CODE Room /HDU Suite Suite CERVICAL 1 SPIN-01 SPIN-1 ACCF WITH PLATING - 1 LEVEL 56082 77652 86280 120792 150990 2 SPIN-02 SPIN-2 ACCF WITH PLATING - 2 LEVEL 64090 88740 98600 138040 172550 3 SPIN-03 SPIN-3 ACCF WITH PLATING - 3 LEVEL 72118 99855 110950 155330 194163 4 SPIN-04 SPIN-4 ACDF - 1 LEVEL 38454 53244 59160 82824 103530 5 SPIN-05 SPIN-5 ACDF - 2 LEVEL 48068 66555 73950 103530 129413 6 SPIN-06 SPIN-6 ACDF - 3 LEVEL 57688 79875 88750 124250 155313 7 SPIN-07 SPIN-7 ACDF + PLATING - 1 LEVEL 48068 66555 73950 103530 129413 8 SPIN-08 SPIN-8 ACDF + PLATING - 2 LEVEL 57688 79875 88750 124250 155313 9 SPIN-09 SPIN-9 ACDF + PLATING - 3 LEVEL 67295 93177 103530 144942 181178 10 SPIN-10 SPIN-10 ANTERIOR CERVICAL DISCECTOMY - 1 LEVEL 28841 39933 44370 62118 77648 11 SPIN-11 SPIN-11 ANTERIOR CERVICAL DISCECTOMY - 2 LEVEL 38454 53244 59160 82824 103530 12 SPIN-12 SPIN-12 ANTERIOR CERVICAL DISCECTOMY - 3 LEVEL 48068 66555 73950 103530 129413 13 SPIN-13 SPIN-13 C1 - C2 TRANS ARTICULAR SCREW FIXATION 48068 66555 73950 103530 129413 14 SPIN-14 SPIN-14 CERVICAL LAMINECTOMY > 3LEVEL 48068 66555 73950 103530 129413 15 SPIN-15 SPIN-15 CERVICAL LAMINECTOMY<3LEVELS 38454 53244 59160 82824 103530 CERVICAL LAMINOPLASTY WITH INSTRUMENTATION < 3 16 SPIN-16 SPIN-16 56082 77652 86280 120792 150990 LEVELS CERVICAL LAMINOPLASTY WITH INSTRUMENTATION > 3 17 SPIN-17 SPIN-17 65702 90972 101080 141512 176890 LEVELS 18 SPIN-18 SPIN-18 CERVICAL LAMINOPLASTY<3 LEVEL 48068 66555 73950 103530 129413 19 SPIN-19 SPIN-19 CERVICAL LAMINOPLASTY>3 LEVEL 57688 79875 88750 124250 155313 20 SPIN-20 SPIN-20 CERVICAL RIB- CERVICAL RIB OPERATION-BILATERAL 25006 34623 38470 53858 67323 21 SPIN-21 SPIN-21 CERVICAL RIB- CERVICAL RIB OPERATION-UNILATERAL 17310 23967 26630 37282 46603 22 SPIN-22 SPIN-22 DENS SCREW 48068 66555 73950 103530 129413 23 SPIN-23 SPIN-23 HALO APPLICATION 7462 10332 11480 16072 20090 24 SPIN-24 SPIN-24 HARMS FIXATION 56082 77652 86280 120792 150990 HARMS FIXATION C1&C2,C1&C2 LAMINA FUSION WITH GRAFT 25 SPIN-25 SPIN-174 19897 27549 30610 42854 53568 WITH ATLASWIRE

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26 SPIN-26 SPIN-26 INTERSPINOUS WIRING/CABLE + BG 28841 39933 44370 62118 77648 27 SPIN-27 SPIN-25 INTERSPINOUS WIRING/CABLE 25006 34623 38470 53858 67323 28 SPIN-28 SPIN-27 LATERAL MASS PLATING > 2 LEVELS 48068 66555 73950 103530 129413 29 SPIN-29 SPIN-28 LATERAL MASS PLATING UPTO 2 LEVELS 38454 53244 59160 82824 103530 30 SPIN-30 SPIN-29 OCCIPITO CERVICAL FUSION & FIXATION 57688 79875 88750 124250 155313 31 SPIN-31 SPIN-30 OPEN CERVICAL CERVICAL BIOPSY / DRAINAGE OF ABCESS 19227 26622 29580 41412 51765 32 SPIN-32 SPIN-31 POSTERIOR CERVICAL FORAMINOTOMY- 1 LEVEL 28841 39933 44370 62118 77648 33 SPIN-33 SPIN-32 POSTERIOR CERVICAL FORAMINOTOMY- 2 LEVEL 38454 53244 59160 82824 103530 34 SPIN-34 SPIN-33 POSTERIOR CERVICAL FORAMINOTOMY- 3 LEVEL 48068 66555 73950 103530 129413 35 SPIN-35 SPIN-34 SKELETAL TRACTION FOR CERVICAL SPINE 2886 3996 4440 6216 7770 36 SPIN-36 SPIN-35 SPINE- MUA CERVICAL / LUMBAR SPINE 4804 6651 7390 10346 12933 37 SPIN-37 SPIN-36 TORTICOLLIS : CONG : SOFT TISSUE RELEASE 12493 17298 19220 26908 33635 38 SPIN-38 SPIN-37 TOTAL DISC REPLACEMENT CERVICAL - 1 LEVEL 48068 66555 73950 103530 129413 39 SPIN-39 SPIN-38 TOTAL DISC REPLACEMENT CERVICAL - 2 LEVEL 72118 99855 110950 155330 194163 40 SPIN-40 SPIN-39 TOTAL DISC REPLACEMENT CERVICAL - 3 LEVEL 96142 133119 147910 207074 258843 41 SPIN-41 SPIN-40 TRANS ORAL ODONTOID EXCISION 48068 66555 73950 103530 129413 LUMBO-SACRAL ANTERIOR APPROACH + CORPECTOMY + DISC EXCISION + BONE 42 SPIN-42 SPIN-41 46001 63693 70770 99078 123848 GRAFT - 1 LEVEL ANTERIOR APPROACH + CORPECTOMY + DISC EXCISION + BONE 43 SPIN-43 SPIN-42 55614 77004 85560 119784 149730 GRAFT - 2 LEVELS ANTERIOR APPROACH + CORPECTOMY + DISC EXCISION + BONE 44 SPIN-44 SPIN-43 65221 90306 100340 140476 175595 GRAFT - 3 LEVELS ANTERIOR APPROACH + CORPECTOMY + DISC EXCISION + BONE 45 SPIN-45 SPIN-44 50804 70344 78160 109424 136780 GRAFT + INSTRUMENTATION - 1 LEVEL ANTERIOR APPROACH + CORPECTOMY + DISC EXCISION + BONE 46 SPIN-46 SPIN-45 60424 83664 92960 130144 162680 GRAFT + INSTRUMENTATION - 2 LEVELS ANTERIOR APPROACH + CORPECTOMY + DISC EXCISION + BONE 47 SPIN-47 SPIN-46 70038 96975 107750 150850 188563 GRAFT + INSTRUMENTATION - 3 LEVELS ANTERIOR APPROACH ASPIRATION OF COLD ABSCESS - BOTH 48 SPIN-48 SPIN-47 3484 4824 5360 7504 9380 SIDES ANTERIOR APPROACH ASPIRATION OF COLD ABSCESS - SINGLE 49 SPIN-49 SPIN-48 1924 2664 2960 4144 5180 SIDE 50 SPIN-50 SPIN-49 ANTERIOR APPROACH DISC EXCISION - 1 LEVEL 28841 39933 44370 62118 77648 51 SPIN-51 SPIN-50 ANTERIOR APPROACH DISC EXCISION - 2 LEVELS 38454 53244 59160 82824 103530 52 SPIN-52 SPIN-51 ANTERIOR APPROACH DISC EXCISION - 3 LEVELS 48068 66555 73950 103530 129413

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53 SPIN-53 SPIN-52 ANTERIOR APPROACH DISC EXCISION + BONE GRAFT - 1 LEVEL 38454 53244 59160 82824 103530 54 SPIN-54 SPIN-53 ANTERIOR APPROACH DISC EXCISION + BONE GRAFT - 2 LEVEL 48068 66555 73950 103530 129413 55 SPIN-55 SPIN-54 ANTERIOR APPROACH DISC EXCISION + BONE GRAFT - 3 LEVEL 57688 79875 88750 124250 155313 ANTERIOR APPROACH DRAINAGE OF PARA-VEREBRAL 56 SPIN-56 SPIN-55 13137 18189 20210 28294 35368 ABSCESS 57 SPIN-57 SPIN-56 AXIALIF 48068 66555 73950 103530 129413 58 SPIN-58 SPIN-57 DISCOGRAPHY - 1 LEVEL 5772 7992 8880 12432 15540 59 SPIN-59 SPIN-58 DISCOGRAPHY - 2 LEVELS 6624 9171 10190 14266 17833 60 SPIN-60 SPIN-59 DISCOGRAPHY - 3 LEVELS 8600 11907 13230 18522 23153 61 SPIN-61 SPIN-60 DRAINAGE OF PSOAS ABSCESS BILATERAL 13637 18882 20980 29372 36715 62 SPIN-62 SPIN-61 ENDOSCOPIC DISCECTOMY-1 LEVEL (Incl. Endoscope Charges) 50109 69381 77090 107926 134908 63 SPIN-63 SPIN-62 ENDOSCOPIC DISCECTOMY-2 LEVELS (Incl. Endoscope Charges) 54477 75429 83810 117334 146668 64 SPIN-64 SPIN-63 ENDOSCOPIC DISCECTOMY-3 LEVELS (Incl. Endoscope Charges) 60314 83511 92790 129906 162383 65 SPIN-65 SPIN-64 EXCISION OF COCCEYX 21886 30303 33670 47138 58923 66 SPIN-66 SPIN-65 EXCISION OS SACRUM WITH INSTRUMENTATION 67295 93177 103530 144942 181178 67 SPIN-67 SPIN-155 FACET INJECTION - 1 LEVEL 5772 7992 8880 12432 15540 68 SPIN-68 SPIN-156 FACET INJECTION - 2 LEVEL 6728 9315 10350 14490 18113 69 SPIN-69 16227 HEMICORPECTOMY 21450 29700 33000 46200 57750 70 SPIN-70 SPIN-66 INTERSPINOUS DEVICE INSERTION 24037 33282 36980 51772 64715 71 SPIN-71 SPIN-67 KYPHOPLASTY - 1 LEVEL 34626 47943 53270 74578 93223 72 SPIN-72 SPIN-68 KYPHOPLASTY - 2 LEVEL 50642 70119 77910 109074 136343 KYPHOSIS - ANT.CORRECTION & 73 SPIN-73 SPIN-69 POST.INSTRUMENTATION/VERTEBRAL COLUMN 71136 98496 109440 153216 191520 RESECTION(VCR) KYPHOSIS POSTERIOR ONLY INSTRUMENTATION & 74 SPIN-74 SPIN-70 71136 98496 109440 153216 191520 CORRECTION 75 SPIN-75 SPIN-71 LAMINOFORAMINOTOMY - > 2 LEVELS 46352 64179 71310 99834 124793 76 SPIN-76 SPIN-72 LAMINOFORAMINOTOMY - 1 LEVEL 32832 45459 50510 70714 88393 77 SPIN-77 SPIN-73 LAMINOFORAMINOTOMY - 2 LEVELS 38305 53037 58930 82502 103128 78 SPIN-78 SPIN-74 LISTHESIS ANTERIOR APPROACH WITH IMPLANT 27866 38583 42870 60018 75023 79 SPIN-79 SPIN-75 LISTHESIS ANTERIOR APPROACH WITHOUT IMPLANT 43947 60849 67610 94654 118318 80 SPIN-80 SPIN-157 LUMBAR DISCECTOMY > 2 LEVEL 49251 68193 75770 106078 132598 81 SPIN-81 SPIN-158 LUMBAR DISCECTOMY- 1 LEVEL 36667 50769 56410 78974 98718 82 SPIN-82 SPIN-159 LUMBAR DISCECTOMY- 2 LEVEL 42133 58338 64820 90748 113435

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LUMBAR/THORACIC CORPECTOMY WITH ONLY POSTERIOR 83 SPIN-83 SPIN-178 57207 79209 88010 123214 154018 APPROACH+INSTRUMENT 84 SPIN-84 SPIN-76 LUMBO-SACRAL LAMINECTOMY - 1 LEVEL 27866 38583 42870 60018 75023 85 SPIN-85 SPIN-77 LUMBO-SACRAL LAMINECTOMY - 2 LEVEL 40099 55521 61690 86366 107958 86 SPIN-86 SPIN-78 LUMBO-SACRAL LAMINECTOMY - 3 LEVEL 49706 68823 76470 107058 133823 87 SPIN-87 SPIN-79 LUQUE RODS FIXATION 28841 39933 44370 62118 77648 88 SPIN-88 SPIN-80 MICRODISCECTOMY - 1 LEVEL WITH INSTRUMENTATION 44278 61308 68120 95368 119210 89 SPIN-89 SPIN-81 MICRODISCECTOMY - 2 LEVELS WITH INSTRUMENTATION 48659 67374 74860 104804 131005 90 SPIN-90 SPIN-82 MICRODISCECTOMY - 3 LEVELS WITH INSTRUMENTATION 53027 73422 81580 114212 142765 91 SPIN-91 SPIN-160 MINIMALLY INVASIVE CORPECTOMY + FIXATION 76616 106083 117870 165018 206273 MINIMALLY INVASIVE DECOMPRESSION FOR LUMBAR CANAL 92 SPIN-92 SPIN-161 54477 75429 83810 117334 146668 STENOSIS-1 LEVEL MINIMALLY INVASIVE DECOMPRESSION FOR LUMBAR CANAL 93 SPIN-93 SPIN-162 61399 85014 94460 132244 165305 STENOSIS-2 LEVEL MINIMALLY INVASIVE DECOMPRESSION FOR LUMBAR CANAL 94 SPIN-94 SPIN-163 69830 96687 107430 150402 188003 STENOSIS-3 LEVEL 95 SPIN-95 SPIN-164 MINIMALLY INVASIVE TLIF-1 LEVEL 60197 83349 92610 129654 162068 96 SPIN-96 SPIN-165 MINIMALLY INVASIVE TLIF-2 LEVEL 65663 90918 101020 141428 176785 97 SPIN-97 SPIN-166 MINIMALLY INVASIVE TLIF-3 LEVEL 71136 98496 109440 153216 191520 98 SPIN-98 SPIN-83 NERVE ROOT BLOCK - 1 LEVEL 5246 7263 8070 11298 14123 99 SPIN-99 SPIN-84 NERVE ROOT BLOCK - 2 LEVELS 6117 8469 9410 13174 16468 100 SPIN-100 SPIN-85 OPEN BIOPSY 12818 17748 19720 27608 34510 101 SPIN-101 SPIN-167 PERCUTANEOS PEDICLE SCREW FIXATION-2 LEVEL 46352 64179 71310 99834 124793 102 SPIN-102 SPIN-86 PIVD - LEVEL 1 OPEN 38454 53244 59160 82824 103530 103 SPIN-103 SPIN-87 PIVD - LEVEL 2 OPEN 42829 59301 65890 92246 115308 104 SPIN-104 SPIN-88 PIVD - OPEN - MORE THAN 2 LEVEL 47197 65349 72610 101654 127068 105 SPIN-105 SPIN-89 PLIF B/L - 1 LEVEL 44226 61236 68040 95256 119070 106 SPIN-106 SPIN-90 PLIF B/L - 2 LEVELS 58208 80595 89550 125370 156713 107 SPIN-107 SPIN-91 PLIF B/L - 3 LEVELS 63460 87867 97630 136682 170853 108 SPIN-108 SPIN-92 POSTERIOR APPROACH FOR LISTHESIS WITH IMPLANT 46423 64278 71420 99988 124985 109 SPIN-109 SPIN-93 POSTERIOR APPROACH FOR LISTHESIS WITHOUT IMPLANT 36816 50976 56640 79296 99120 POSTERIOR LATERAL FUSION WITH INSTRUMENTATION - 1 110 SPIN-110 SPIN-94 41594 57591 63990 89586 111983 LEVEL POSTERIOR LATERAL FUSION WITH INSTRUMENTATION - 2 111 SPIN-111 SPIN-95 46423 64278 71420 99988 124985 LEVEL

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POSTERIOR LATERAL FUSION WITH INSTRUMENTATION -3 112 SPIN-112 SPIN-96 52832 73152 81280 113792 142240 LEVEL POSTERIOR LATERAL FUSION WITHOUT INSTRUMENTATION - 1 113 SPIN-113 SPIN-97 30401 42093 46770 65478 81848 LEVEL POSTERIOR LATERAL FUSION WITHOUT INSTRUMENTATION - 2 114 SPIN-114 SPIN-98 40027 55422 61580 86212 107765 LEVEL POSTERIOR LATERAL FUSION WITHOUT INSTRUMENTATION - 3 115 SPIN-115 SPIN-99 49634 68724 76360 106904 133630 LEVEL 116 SPIN-116 SPIN-100 POSTERIOR PEDICLE SCREW FIXATION - 2 LEVELS 38454 53244 59160 82824 103530 117 SPIN-117 SPIN-175 POSTERIOR PEDICLE SCREW FIXATION - 3 LEVELS 43232 59859 66510 93114 116393 118 SPIN-118 SPIN-101 POSTERIOR PEDICLE SCREW FIXATION - 4 LEVELS 48068 66555 73950 103530 129413 119 SPIN-119 SPIN-102 POSTERIOR PEDICLE SCREW FIXATION > 4 LEVELS 53840 74547 82830 115962 144953 120 SPIN-120 14117 POSTERIOR STABILIZATION- 3 LEVEL 38805 53730 59700 83580 104475 121 SPIN-121 SPIN-103 REMOVAL OF SPINAL ANTERIOR 34320 47520 52800 73920 92400 122 SPIN-122 SPIN-104 REMOVAL OF SPINAL POSTERIOR 19890 27540 30600 42840 53550 123 SPIN-123 SPIN-181 REPOSITIONING OF SCREW 18090 25047 27830 38962 48703 124 SPIN-124 SPIN-168 REVISION OF LAMINOFORAMINOTOMY - 1 LEVEL 36114 50004 55560 77784 97230 125 SPIN-125 SPIN-169 REVISION OF LAMINOFORAMINOTOMY - 2 LEVEL 42133 58338 64820 90748 113435 126 SPIN-126 SPIN-170 REVISION OF LAMINOFORAMINOTOMY > 2 LEVEL 50986 70596 78440 109816 137270 127 SPIN-127 SPIN-171 REVISION OF LUMBAR DISCECTOMY - 1 LEVEL 48711 67446 74940 104916 131145 128 SPIN-128 SPIN-172 REVISION OF LUMBAR DISCECTOMY - 2 LEVEL 53521 74106 82340 115276 144095 129 SPIN-129 SPIN-173 REVISION OF LUMBAR DISCECTOMY > 2 LEVEL 58325 80757 89730 125622 157028 130 SPIN-130 SPIN-105 SACROILIAC JOINT- ARTHRODESIS 19227 26622 29580 41412 51765 131 SPIN-131 SPIN-106 SACROILIAC JOINT- ASPIRATION / INJECTION 6728 9315 10350 14490 18113 132 SPIN-132 SPIN-107 SACROILIAC JOINT- BIOPSY 6728 9315 10350 14490 18113 SPINE DEBRIDEMENT & SECONDARY CLOSURE - ANTERIOR 133 SPIN-133 SPIN-108 19227 26622 29580 41412 51765 (DEEP) SPINE DEBRIDEMENT & SECONDARY CLOSURE - ANTERIOR 134 SPIN-134 SPIN-109 11219 15534 17260 24164 30205 (SUPERFICIAL) SPINE DEBRIDEMENT & SECONDARY CLOSURE - POSTERIOR 135 SPIN-135 SPIN-110 16023 22185 24650 34510 43138 (DEEP) SPINE DEBRIDEMENT & SECONDARY CLOSURE - POSTERIOR 136 SPIN-136 SPIN-111 8015 11097 12330 17262 21578 (SUPERFICIAL) 137 SPIN-137 SPIN-112 SPINE EXCISION OF LARGE SPINAL TUMOUR AND BONE GRAFT 48068 66555 73950 103530 129413 138 SPIN-138 SPIN-113 SPINO PELVIC FIXATION 49251 68193 75770 106078 132598 139 SPIN-139 SPIN-114 TLIF - 1 LEVEL 48068 66555 73950 103530 129413

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140 SPIN-140 SPIN-115 TLIF - 2 LEVEL 57688 79875 88750 124250 155313 141 SPIN-141 SPIN-116 TLIF - 3 LEVEL 67295 93177 103530 144942 181178 142 SPIN-142 SPIN-117 TOTAL DISC REPLACEMENT LUMBAR - 1 LEVEL 48068 66555 73950 103530 129413 143 SPIN-143 SPIN-118 TOTAL DISC REPLACEMENT LUMBAR - 2 LEVEL 72118 99855 110950 155330 194163 144 SPIN-144 SPIN-119 TOTAL DISC REPLACEMENT LUMBAR - 3 LEVEL 96142 133119 147910 207074 258843 145 SPIN-145 SPIN-120 TRANSFORAMINAL ENDOSCOPIC DISCECTOMY - 1 LEVEL 50109 69381 77090 107926 134908 146 SPIN-146 SPIN-121 TRANSFORAMINAL ENDOSCOPIC DISCECTOMY - 2 LEVEL 54477 75429 83810 117334 146668 147 SPIN-147 SPIN-122 TRANSFORAMINAL ENDOSCOPIC DISCECTOMY - 3 LEVEL 60314 83511 92790 129906 162383 148 SPIN-148 SPIN-123 TRANSFORAMINAL NERVE ROOT BLOCK 7287 10089 11210 15694 19618 149 SPIN-149 SPIN-124 TRANSPEDICULAR BIOPSY 19032 26352 29280 40992 51240 150 SPIN-150 SPIN-125 VATS DRAINAGE OF PARA VEREBRAL ABSCESS 25643 35505 39450 55230 69038 151 SPIN-151 SPIN-126 VERTEBROPLASTY 1 LEVEL 28841 39933 44370 62118 77648 SPIN-152 SPIN-127 VERTEBROPLASTY 2 LEVELS 41665 57690 64100 89740 112175 SCOLIOSIS 152 SPIN-152 SPIN-176 HEMIVERTEBRAE RESECTION 64675 89550 99500 139300 174125 153 SPIN-153 SPIN-128 SCOLIOSIS - ANTERIOR RELEASE 57688 79875 88750 124250 155313 SCOLIOSIS- ANT.+ POST. CORRECTION + INSTRUMENTATION 154 SPIN-154 SPIN-129 96142 133119 147910 207074 258843 BOTH SIDE SCOLIOSIS- ANT.+ POST. CORRECTION + INSTRUMENTATION 155 SPIN-155 SPIN-130 86522 119799 133110 186354 232943 ONESIDE 156 SPIN-156 SPIN-132 SCOLIOSIS- ANTERIOR CORRECTION + INSTRUMENTATION + BG 76915 106497 118330 165662 207078 157 SPIN-157 SPIN-131 SCOLIOSIS- ANTERIOR CORRECTION + INSTRUMENTATION 67295 93177 103530 144942 181178 158 SPIN-158 SPIN-133 SCOLIOSIS IN SITU - POSTERIOR 38454 53244 59160 82824 103530 159 SPIN-159 SPIN-135 SCOLIOSIS- POST CORRECTION + INSTRUMENTATION + BG 76915 106497 118330 165662 207078 160 SPIN-160 SPIN-134 SCOLIOSIS- POST CORRECTION + INSTRUMENTATION 67295 93177 103530 144942 181178 THORACIC ANTERIOR APPROACH THORACOTOMY WITH DIAPHRAGM 161 SPIN-161 SPIN-136 8015 11097 12330 17262 21578 SPLITTING SURGERY 162 SPIN-162 SPINE-400 COSTOPLASTY 21886 30303 33670 47138 58923 163 SPIN-163 SPIN-137 THORACIC ANTERIOR CORPECTOMY + BONE GRAFT - LEVEL 1 48068 66555 73950 103530 129413 164 SPIN-164 SPIN-138 THORACIC ANTERIOR CORPECTOMY + BONE GRAFT - LEVEL 2 57688 79875 88750 124250 155313 165 SPIN-165 SPIN-139 THORACIC ANTERIOR CORPECTOMY + BONE GRAFT - LEVEL 3 67295 93177 103530 144942 181178 THORACIC ANTERIOR CORPECTOMY + PEDICLE SCREWS - 166 SPIN-166 SPIN-140 67295 93177 103530 144942 181178 LEVEL 1

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THORACIC ANTERIOR CORPECTOMY + PEDICLE SCREWS - 167 SPIN-167 SPIN-141 76915 106497 118330 165662 207078 LEVEL 2 THORACIC ANTERIOR CORPECTOMY + PEDICLE SCREWS - 168 SPIN-168 SPIN-142 86522 119799 133110 186354 232943 LEVEL 3 THORACIC ANTERIOR CORPECTOMY LEVEL 1 WITH 169 SPIN-169 SPIN-143 57688 79875 88750 124250 155313 INSTRUMENTATION THORACIC ANTERIOR CORPECTOMY LEVEL 2 WITH 170 SPIN-170 SPIN-144 67295 93177 103530 144942 181178 INSTRUMENTATION THORACIC ANTERIOR CORPECTOMY LEVEL 3 WITH 171 SPIN-171 SPIN-145 76915 106497 118330 165662 207078 INSTRUMENTATION 172 SPIN-172 SPIN-146 THORACIC ANTERIOR DISCECTOMY + BONE GRAFT - LEVEL 3 57688 79875 88750 124250 155313 173 SPIN-173 SPIN-147 THORACIC ANTERIOR-DISECTOMY LEVEL 1 WITH BG 38454 53244 59160 82824 103530 THORACIC ANTERIOR-DISECTOMY LEVEL 1 WITH 174 SPIN-174 SPIN-148 48068 66555 73950 103530 129413 INSTRUMENTATION 175 SPIN-175 SPIN-149 THORACIC ANTERIOR-DISECTOMY LEVEL 2 WITH BG 48068 66555 73950 103530 129413 THORACIC ANTERIOR-DISECTOMY LEVEL 2 WITH 176 SPIN-176 SPIN-150 57688 79875 88750 124250 155313 INSTRUMENTATION THORACIC ANTERIOR-DISECTOMY LEVEL 3 WITH 177 SPIN-177 SPIN-151 67295 93177 103530 144942 181178 INSTRUMENTATION 178 SPIN-178 SPIN-152 THORACIC LAMINECTOMY UPTO 2 LEVEL 38454 53244 59160 82824 103530 179 SPIN-179 SPIN-153 THORACIC LAMINECTOMY UPTO 3 LEVEL 48068 66555 73950 103530 129413 180 SPIN-180 SPIN-154 THORACIC LAMINECTOMY UPTO MORE THAN 4 LEVEL 57688 79875 88750 124250 155313

Charges Basis GW 65% HDU + ICU (all categories) 90% Shared 90% Single 100% Dlx 140% Spr. Dlx 140% Suite 140% Spr. Dlx. Suite 175%

Any new service/tariff may be changed/added/deleted without prior notice. 221 Schedule of Charges 2019-20 ISIC

UROLOGY SURGERIES

Dlx/ Shared Super NEW OLD Gen. Single Super S.No. SURGERY NAME Room/ICU Dlx. CODE CODE Ward Room Dlx / /HDU Suite Suite 1 UROS-01 UROS-1 ADRENELECTOMY 27365 37890 42100 58940 73675 2 UROS-02 UROS-2 ANTEGRADE ENDOPYELOTOMY 21886 30303 33670 47138 58923 3 UROS-03 UROS-3 ARTIFICIAL URETHRAL SPHINCTER IMPLANTATION 27365 37890 42100 58940 73675 4 UROS-04 UROS-4 BLADDER INJURY REPAIR 10946 15156 16840 23576 29470 5 UROS-05 UROS-5 BLADDER NECK RECONSTRUCTION 21886 30303 33670 47138 58923 6 UROS-06 UROS-6 BNI 16419 22734 25260 35364 44205 7 UROS-07 UROS-7 BOARIS FLAP 19702 27279 30310 42434 53043 8 UROS-08 UROS-8 BOTOX INJECTION (INTRAPROSTATIC) 13137 18189 20210 28294 35368 9 UROS-09 UROS-9 BOTOX INJECTION (INTRASPHINTRIC) 13137 18189 20210 28294 35368 10 UROS-10 UROS-10 BOTOX INJECTION (INTRAVESICAL) 13137 18189 20210 28294 35368 11 UROS-11 UROS-128 CHANGE OF PCN 7657 10602 11780 16492 20615 12 UROS-12 UROS-11 CHORDEE CORRECTION 13137 18189 20210 28294 35368 13 UROS-13 UROS-12 CORPORAL DRAINAGE (FOR PRIAPISM) 8762 12132 13480 18872 23590 14 UROS-14 UROS-13 CPE + CLT 16419 22734 25260 35364 44205 15 UROS-15 UROS-14 CPE+BLADDER BIOPSY 8762 12132 13480 18872 23590 16 UROS-16 UROS-15 CUTANEOUS URETEROSTOMY 16419 22734 25260 35364 44205 17 UROS-17 UROS-16 CUTANEOUS VESICOSTOMY 16419 22734 25260 35364 44205 18 UROS-18 URO-127 CYSTOLITHOTOMY 16419 22734 25260 35364 44205 19 UROS-19 UROS-130 CYSTOSCOPY & CLOT EVACUATION 10946 15156 16840 23576 29470 20 UROS-20 UROS-17 CYSTOSCOPY 6565 9090 10100 14140 17675 21 UROS-21 UROS-18 DEFLUX INJECTION (STRESS INCONTINENCE) 13137 18189 20210 28294 35368 22 UROS-22 UROS-19 DEFLUX INJECTION FOR VUR (UNILATERAL) 13137 18189 20210 28294 35368 23 UROS-23 UROS-20 DIAGNOSTIC URETEROSCOPY 6565 9090 10100 14140 17675 24 UROS-24 UROS-21 DIFFICULT CATHETERIZATION 1092 1512 1680 2352 2940 25 UROS-25 UROS-22 DIODE LASER PROSTATE SURGERY 16419 22734 25260 35364 44205 26 UROS-26 UROS-129 DIVERTICULOTOMY 10946 15156 16840 23576 29470 27 UROS-27 UROS-23 DJ STENT REMOVAL (BILATERAL) 8762 12132 13480 18872 23590

Any new service/tariff may be changed/added/deleted without prior notice. 222 Schedule of Charges 2019-20 ISIC

28 UROS-28 UROS-24 DJ STENT REMOVAL (UNILATERAL) 6565 9090 10100 14140 17675 29 UROS-29 UROS-25 DJ STENTING (BILATERAL) 8762 12132 13480 18872 23590 30 UROS-30 UROS-26 DJ STENTING (UNILATERAL) 6565 9090 10100 14140 17675 31 UROS-31 UROS-27 END TO END URETHROPLASTY 16419 22734 25260 35364 44205 32 UROS-32 UROS-28 ENDO-INCISION OF URETEROCELE 13137 18189 20210 28294 35368 33 UROS-33 URO-130 ENDOPYELOTOMY 16419 22734 25260 35364 44205 34 UROS-34 UROS-29 ENDOSCOPIC DRAINAGE OF PROSTATIC ABSCESS 10946 15156 16840 23576 29470 35 UROS-35 UROS-30 ENDOSCOPIC INCISION OF BLADDER DIVERTICULAM 10946 15156 16840 23576 29470 36 UROS-36 UROS-31 ENDOSCOPIC REMOVAL OF BLADDER STONES/CYSTOLITHOLAPAXY 16419 22734 25260 35364 44205 37 UROS-37 UROS-121 EXCISION OF EPIDIDYMAL CYST/SPERMATOCELE 16419 22734 25260 35364 44205 38 UROS-38 UROS-32 EXCISION OF PENICE TUMORS 16419 22734 25260 35364 44205 39 UROS-39 UROS-33 EXCISION OF RENAL CYST 16419 22734 25260 35364 44205 40 UROS-40 UROS-34 FRAYER'S PROSTATECTOMY 19702 27279 30310 42434 53043 41 UROS-41 UROS-35 FRENULOPLASTY 6565 9090 10100 14140 17675 42 UROS-42 UROS-36 HYPOSPADIAS REPAIR 16419 22734 25260 35364 44205 43 UROS-43 UROS-37 ILEAL REPLACEMENT OF URETER 27365 37890 42100 58940 73675 44 UROS-44 UROS-38 IMPACTED DJ STENT REMOVAL 13137 18189 20210 28294 35368 45 UROS-45 UROS-39 INGUINAL LYMPHADENECTOMY 29127 40329 44810 62734 78418 46 UROS-46 UROS-40 LAP ASSISTED ORCHIOPEXY 21886 30303 33670 47138 58923 47 UROS-47 UROS-41 LAP NEPHRECTOMY 27365 37890 42100 58940 73675 48 UROS-48 UROS-42 LAP NEPHROLITHOTOMY 27365 37890 42100 58940 73675 49 UROS-49 UROS-43 LAP PYELOPLASTY 27365 37890 42100 58940 73675 50 UROS-50 UROS-44 LAP RADICAL NEPHROURETERECTOMY 32832 45459 50510 70714 88393 51 UROS-51 UROS-45 LAP URETEROLITHOMY 21886 30303 33670 47138 58923 52 UROS-52 UROS-46 LAP VERICOCELECTOMY 21886 30303 33670 47138 58923 53 UROS-53 UROS-47 LAP VESICAL DIVERTICULECTOMY 21886 30303 33670 47138 58923 54 UROS-54 URO-131 LASER PROSTATE SURGERY 27365 37890 42100 58940 73675 55 UROS-55 UROS-48 MEATOTOMY 5473 7578 8420 11788 14735 56 UROS-56 UROS-49 MEATOTOPLASTY 6565 9090 10100 14140 17675 57 UROS-57 UROS-50 MITROFANOFF PROCEDURE 32832 45459 50510 70714 88393 58 UROS-58 UROS-51 OPEN CYSTOLITHOTOMY 16419 22734 25260 35364 44205 59 UROS-59 UROS-52 OPEN EXTENDED PYELOLITHOTOMY 21886 30303 33670 47138 58923

Any new service/tariff may be changed/added/deleted without prior notice. 223 Schedule of Charges 2019-20 ISIC

60 UROS-60 UROS-53 OPEN NEPHROLITHOTOMY 19702 27279 30310 42434 53043 61 UROS-61 UROS-54 OPEN NEPHROSTOMY 13137 18189 20210 28294 35368 62 UROS-62 UROS-55 OPEN PYELOLITHOTOMY 16419 22734 25260 35364 44205 63 UROS-63 UROS-56 OPEN SPC 8762 12132 13480 18872 23590 64 UROS-64 UROS-57 OPEN SURGERY FOR RETEROCAVAL URETER 19702 27279 30310 42434 53043 65 UROS-65 UROS-58 OPTICAL INTERNAL URETHROTOMY (OIU) 10946 15156 16840 23576 29470 66 UROS-66 UROS-59 ORCHIAECTOMY (BILATERAL) 13137 18189 20210 28294 35368 67 UROS-67 UROS-60 ORCHIDOPEXY (BILATERAL) 16419 22734 25260 35364 44205 68 UROS-68 UROS-61 ORCHIDOPEXY (UNILATERAL) 10946 15156 16840 23576 29470 69 UROS-69 UROS-62 ORCHIEACTOMY (UNILATERAL) 8762 12132 13480 18872 23590 70 UROS-70 UROS-63 PARTIAL CYSTECTOMY 13137 18189 20210 28294 35368 71 UROS-71 UROS-64 PARTIAL NEPHRECTOMY 27365 37890 42100 58940 73675 72 UROS-72 UROS-65 PARTIAL PENECTOMY 21886 30303 33670 47138 58923 73 UROS-73 UROS-66 PCN BILATERAL (USG GUIDED) 16419 22734 25260 35364 44205 74 UROS-74 UROS-67 PCN UNILATERAL (USG GUIDED) 10946 15156 16840 23576 29470 75 UROS-75 UROS-68 PCNL (COMPLICATED) 27365 37890 42100 58940 73675 76 UROS-76 UROS-69 PCNL (SIMPLE) 16419 22734 25260 35364 44205 77 UROS-77 UROS-70 PENILE PROSTHESIS IMPLANTATION (INFLATABLE) 27365 37890 42100 58940 73675 78 UROS-78 UROS-71 PENILE PROSTHESIS IMPLANTATION (RIGID) 21886 30303 33670 47138 58923 79 UROS-79 UROS-72 PERINEAL URETHROSTOMY 13137 18189 20210 28294 35368 80 UROS-80 UROS-73 PROSTATIC STENT PLACEMENT 13137 18189 20210 28294 35368 81 UROS-81 UROS-74 PSOAS HITCH 13137 18189 20210 28294 35368 82 UROS-82 UROS-75 PUV FULGURATION 13137 18189 20210 28294 35368 83 UROS-83 UROS-76 PYELOPLASTY (AH) 16419 22734 25260 35364 44205 84 UROS-84 UROS-77 PYELOPLASTY (FOLEY'S) 16419 22734 25260 35364 44205 85 UROS-85 UROS-78 PYERONIES PLAQUE EXCISION 13137 18189 20210 28294 35368 86 UROS-86 UROS-79 RADICAL CYSTECTOMY (CONTINENT POUCH) 43778 60615 67350 94290 #### 87 UROS-87 UROS-80 RADICAL CYSTECTOMY (ILEAL CONDUIT) 32832 45459 50510 70714 88393 88 UROS-88 UROS-81 RADICAL CYSTECTOMY (NEOBLADDER) 43778 60615 67350 94290 #### 89 UROS-89 UROS-82 RADICAL NEPHRECTOMY 32832 45459 50510 70714 88393 90 UROS-90 UROS-83 RADICAL PROSTATECTOMY 32832 45459 50510 70714 88393 91 UROS-91 UROS-84 RETROGRADE ENDOPYELOTOMY 27365 37890 42100 58940 73675

Any new service/tariff may be changed/added/deleted without prior notice. 224 Schedule of Charges 2019-20 ISIC

92 UROS-92 UROS-85 RGP (RETRO GRADE PYELOGRAM) 5473 7578 8420 11788 14735 93 UROS-93 UROS-86 RPLND 32832 45459 50510 70714 88393 94 UROS-94 UROS-87 S3 NERVE STIMULATOR IMPLANTATION 32832 45459 50510 70714 88393 95 UROS-95 UROS-88 SHUNT SURGERY FOR PRIAPISM 21886 30303 33670 47138 58923 96 UROS-96 UROS-89 SIMPLE NEPHRECOTMY 21886 30303 33670 47138 58923 97 UROS-97 UROS-90 SLING SUSPENSION 13137 18189 20210 28294 35368 98 UROS-98 UROS-91 STAGED URETHROPLASTY (2-STAGE) 16419 22734 25260 35364 44205 99 UROS-99 UROS-92 STAGED URETHROPLASTY (I-STAGE) 16419 22734 25260 35364 44205 100 UROS-100 UROS-93 SUBSTITUTION URETHROPLASTY 19702 27279 30310 42434 53043 101 UROS-101 UROS-132 TESTICULAR BIOPSY (B/L)-OT 6565 9090 10100 14140 17675 102 UROS-102 UROS-94 TESTICULAR PROSTHESIS IMPLANTATION 6565 9090 10100 14140 17675 103 UROS-103 UROS-95 TOT/TVT (STRESS INCONTINENCE) 13137 18189 20210 28294 35368 104 UROS-104 UROS-96 TOTAL CYSTECTOMY 19702 27279 30310 42434 53043 105 UROS-105 UROS-97 TOTAL PENECTOMY 16419 22734 25260 35364 44205 106 UROS-106 UROS-98 TRANSPUBIC URETHROPLASTY 27365 37890 42100 58940 73675 107 UROS-107 UROS-99 TRANSURETERO-URETEROSTOMY 21886 30303 33670 47138 58923 108 UROS-108 UROS-100 TROCAR SPC (USG GUIDED) 8210 11367 12630 17682 22103 109 UROS-109 UROS-101 TRUS GUIDED PROSTATE BIOPSY 4375 6057 6730 9422 11778 110 UROS-110 UROS-102 TURBT (EXTENSIVE TUMOR BURDEN) 27365 37890 42100 58940 73675 111 UROS-111 UROS-103 TURBT (LOW TUMOR BURDEN) 16419 22734 25260 35364 44205 112 UROS-112 UROS-104 TURED 16419 22734 25260 35364 44205 113 UROS-113 UROS-105 TURP (<40 GM) 13137 18189 20210 28294 35368 114 UROS-114 UROS-106 TURP (>40 GM) 16419 22734 25260 35364 44205 115 UROS-115 UROS-107 URETERIC DILATATION (BALLOON/ ENDO) 6565 9090 10100 14140 17675 116 UROS-116 UROS-108 URETERIC REIMPLANTATION (BILATERAL) 19702 27279 30310 42434 53043 117 UROS-117 UROS-109 URETERIC REIMPLANTATION (UNILATERAL) 13137 18189 20210 28294 35368 118 UROS-118 UROS-110 URETEROSCOPY (COMPLICATED) 16419 22734 25260 35364 44205 119 UROS-119 UROS-111 URETEROSCOPY (SIMPLE) 13137 18189 20210 28294 35368 120 UROS-120 UROS-112 URETERO-SIGMOIDOSTOMY 21886 30303 33670 47138 58923 121 UROS-121 UROS-113 URETERO-VAGINAL FISTULA REPAIR 27365 37890 42100 58940 73675 122 UROS-122 UROS-124 URETHRAL CATHETERISATION 1638 2268 2520 3528 4410 123 UROS-123 UROS-122 URETHRAL DILATATION UNDER GA 3283 4545 5050 7070 8838

Any new service/tariff may be changed/added/deleted without prior notice. 225 Schedule of Charges 2019-20 ISIC

124 UROS-124 UROS-123 URETHRAL DILATATION UNDER LA 1638 2268 2520 3528 4410 125 UROS-125 UROS-114 URETHRAL INJURY (RE-ALIGNMENT) 13137 18189 20210 28294 35368 126 UROS-126 UROS-115 URETHRICAL CATHETERIZATION 13241 18333 20370 28518 35648 127 UROS-127 UROS-116 URS+STONE REMOVAL 26481 36666 40740 57036 71295 128 UROS-128 UROS-117 VEA 16419 22734 25260 35364 44205 129 UROS-129 UROS-118 VERICOCELE (UNILATERAL) 13137 18189 20210 28294 35368 130 UROS-130 UROS-119 VVA 16419 22734 25260 35364 44205 131 UROS-131 UROS-120 VVF REPAIR 21886 30303 33670 47138 58923

Charges Basis GW 65% HDU + ICU (all categories) 90% Shared 90% Single 100% Dlx 140% Spr. Dlx 140% Suite 140% Spr. Dlx. Suite 175%

Any new service/tariff may be changed/added/deleted without prior notice. 226 Schedule of Charges 2019-20 ISIC