105 78581/2020/ESTT-NE_HR
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106 78581/2020/ESTT-NE_HR INDEX
1. General Information ( Section A) 3 i. Out Patient Department ii. Ambulance Charges 2. General Information ( Section B) 5 i. Bed charges ii. In patient Consultation fees iii. Billing Of Surgery Anesthesia and OT Charges iv. Billing Of Surgery /Procedure/ others 3. LAB 9 4. Outsouce Lab 16 5. Blood Bank 64 6. Imaging & Radiodiagnosis 65 7. Non – Invasive Lab 80 8. Anesthesia 82 9. Cardiology and Cardiac Surgery 84 10. Critical Care Services 89 11. Baby Care 91 12. Common Procedure 94 13 Dental 94 14 Dermatology 101 15 E N T 105 16 Gastroenterology 110 17 Maxillo Facial Surgery 113 18 Nephrology 116 19 Neuro Diagnostic Lab 118 20 Oncology 112 21 Ophthalmology 136 22 Orthopedies 142 23 OBS & Gynaecology 149 24 Physiotherapy 154 25 Respiratory Medicine 156 26 Surgery & Major Procedures i. General Surgery 158 ii. Pediatric Surgery 165 iii. PlasticSurgery 170 iv. Neuro Surgery 182 27 Urology 185 28 Interventional Radiology 192 29 Interventional Pain Management 194 30 Paediatric Cardiac Surgery 197 31 Bed Side Service Charges200
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107 78581/2020/ESTT-NE_HRSection – A
GENERAL INFORMATION
OUT PATIENT DEPARTMENT OPD Consultations: Superspeciality OPD Consultation * Rs. 700 Specialty OPD Consultation** Rs. 400 to 800 Note: OPD Timing Monday- Saturday ( 8:00AM – 7:00PM) *Super specialty Departments – Cardiac Surgery, Cardiology, Neurology, Neurosurgery, Oncology, Respiratory Medicine, Urology, Plastic Surgery, Gastroenterology, Endocrinology, Paediatric Surgery, Nephrology, Psychiatry, **Specialty Departments – Paediatrics, Dermatology,ENT, Opthalmology, Orthopeadics, Obs & Gynae, Gen.Surgery, Internal Medicine, Dietician, Dental, Physiotherapy, Emergency, Pain Management Clinic (Anesthesia)
Section – A
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108 78581/2020/ESTT-NE_HRGENERAL INFORMATION
AMBULANCE CHARGES
AMBULANCE CHARGES - BLS/ FREEZER
ZONE DESCRIPTION BLS FREEZER CODE RATE CODE RATE ZONE - 0 to 10 KM LOCAL 1 FARIDABAD TCA007 600/- TCA012 700/- ZONE - 11 to 20 KM LOCAL 2 FARIDABAD TCA008 800/- TCA013 1100/- ZONE - 21 to 30 KM LOCAL 3 FARIDABAD TCA009 1200/- TCA014 1500/- ZONE - 31 to 40 KM LOCAL 4 FARIDABAD TCA010 1500/- TCA015 1800/- ZONE - 41 to 50 KM LOCAL 5 FARIDABAD TCA011 1700/- TCA016 2000/- ZONE - TCA021 Rs. 10/- Km (Non AC) TCA022 Rs. 10/- Km (Non AC) 6 OUT OF NCR/ OTHER STATE 200022 Rs. 15/- Km (AC) TCA023 Rs. 15/- Km (AC)
AMBULANCE CHARGES - ACLS
AMB. DR. NURSE VENTILATOR OXYZEN SR.NO DESCRIPTION CODE CHARGE CHARGE CHARGE CHARGE CHARGE TOTAL LOCAL FBD/BALLABHGARH/ Rs. 50/- Hrs ZONE FORTIS/ METRO/ (1 Hrs - 1 QRG/ SARVODYA TCA017 1000/- 1500/- 700/- 3000/- Charge) 6250/- SOUTH DELHI APOLLO/ AIMS/ Rs. 50/- Hrs ZONE SAFDARJUNG/ (2 Hrs - 2 PALWAL TCA018 2500/- 2500/- 700/- 3000/- Charge) 8800/- CENTRAL DELHI RML/ GANGARAM/ GB PANT/ MAHARAJA Rs. 50/- Hrs ZONE AGGARSEN/ ARMY/ (1 Hrs - 3 GURGAON/ NOIDA TCA019 3000/- 2500/- 700/- 3000/- Charge) 9300/- NORTH DELHI Rs. 50/- Hrs ZONE GREATER NOIDA/ (1 Hrs - 4 GHAZIABAD TCA020 3500/- 2500/- 700/- 3000/- Charge) 9800/- ZONE OUT OF NCR OTHER Rs. - 5 STATE TCA003 35/Km 2500/- 700/- 3000/- Rs. 50/- Hrs Section – A
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109 78581/2020/ESTT-NE_HRGENERAL INFORMATION
INPATIENT DEPARTMENT BED CHARGES
Category of Ward Bed charges/Day
General Bed / Ward Rs. 2900
Twin Sharing/Semi. Pvt. Rs. 5000
Single Room /Pvt. Rs. 7000
Suites Rs. 8500
Presidential Suites Rs. 15000
LDR Rs. 7000
NICU/PICU Rs. 6600
Nursery Rs. 4200
ICU/CCU Rs. 9000
RR/IMCU Rs. 7000
SICU/CTVS Rs. 8000
Triple Sharing Rs. 3500
Casuality (Upto 4 Hours) Rs. 1500
Post Natal/AntiNatal Ward Rs. 2400
NIMCU/PIMCU Rs. 5000
Day Care Rs. 1500
Note:
1. For Emergency Ward first four hours charges will be Rs.250. / hr Beyond four hours Patient have to admitted under regular ward category
GENERAL INFORMATION
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110 78581/2020/ESTT-NE_HR BILLING OF BED CHARGES
Basis for computing BED charges
o Upto 8 hrs is counted as half a day
o 8 hours & above upto 24 hours is counted as one day
o Maximum 3 hours grace time is granted on the day of discharges
Bed Transfer
o A bed transfer during the patient stay, the higher category bed charges will be applicable on the day of transfer.
o During the course of treatment, investigation, surgical/procedure charges will be charged as per the higher category of ward.
GENERAL INFORMATION
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111 78581/2020/ESTT-NE_HR
MEDICAL SUPERVISION FEE Doctors Charges: General Bed / Ward 600 Twin Sharing/Semi.Pvt. 700 Single Room /Pvt. 800 Suites 1000 Presidential Suites 1400 NICU/PICU 900 Nursery 700 ICU/CCU 900 RR/IMCU 800 Dietician Charges: Ward 50 Semi. Pvt/ Pvt 100 Suites 250 Presidential Suit 350 PhysiotherapyCharges:
Ward 250 Semi.Pvt. 350 Pvt/ICU/CCU/IMCU 500 Suites 600 Presidential Suit 800 Baby Charges:
Ward 500 Semi.Pvt. 900 Pvt/ICU/CCU/IMCU 1300 Suites 1700 Presidential Suit 2100
Note : Fees are for visits from 8:00AM to 8:00PM Maximum Two visits per day are permitted and will be charged. Any visits after 8:00PM will be treated as Emergency visits and charges will be applicable as per Emergency Tariff i.e. 50% extra of routine medical supervision fee. Two visits per day are permitted in ICU
GENERAL INFORMATION
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112 78581/2020/ESTT-NE_HR BILLING OF SURGERY, ANESTHESIA & OT CHARGES
Surgeon’s Fee
Surgeon fees are as defined in the Surgery tariff section
Procedure and Associate charges
All the procedures in which surgeon fee is more than 4001 ,Procedure and associate Charges will be 150% of Surgeon’s fee which includes Anesthesia charges (45% of Surgeon’s fee) , Asst. Surgeon’s fee (10% of Surgeon’s fee), OT Room/ Cath lab Charges(95% of Surgeon’s fee) .
All the procedures done under Anesthesia in which surgeon fee is Less than 4001,Procedure and associate Charges will be 65% of Surgeon’s fee which includes Anesthesia charges (45% of Surgeon’s fee), OT Room Charges(20% of Surgeon’s fee) .
All the procedures done under Local Aneasthesia in which surgeon fee is Less than 4001, Procedure and associate Charges will be 20% of Surgeon’s fee which includes OT Room Charges (20% of Surgeon’s fee).
Where more than one surgical procedure are carried out in the same sitting, the surgeon fees for the second procedure costing less would be discounted by 50%. The third or forth procedure will be discounted by 50%.However, when a second surgeon has been called 100% fee would be charged.
Vaccum and forceps delivery to be charged pro-rata.
Consumables & Medicine
Consumables, Drugs, Medicines etc., during the course of treatment will be charged additionally on the basis of actual usage.
Emergency Surgery
All Emergency procedures to be charged 50% extra on OT Charges + Anesthesia charges + Surgeon Fee+ Asstt Surgeaon Fee.
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113 78581/2020/ESTT-NE_HRBilling of Surgeries/Procedures/Others
Asian Institute of Medical Sciences has five different Tariff Pattern.
For OPD, General Ward, Patients will be charged as per AIMS Rack rate.
For Semi Private Room, Patients will be charged 20% extra on AIMS Rack rate.
For Private Room, Patients will be charged 40% extra on AIMS Rack rate.
For suites, patients will be charged 60% extra on AIMS rack rate.
For Presidential suite, patients will be charged 100% extra on AIMS rack rate.
MLC Charges
Rs. 500 will be charged per MLC case.
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114 78581/2020/ESTT-NE_HR
LAB
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115 78581/2020/ESTT-NE_HRCode Description Ward Semi Pvt Pvt BC2001 24 Hour Urine Creatinine Clearance 490 490 490 BC2002 24 HOURS URINARY CALCIUM 350 350 350 BC2003 24 HOURS URINARY CHLORIDE 350 350 350 BC2004 24 HOURS URINARY CREATENINE 350 350 350 BC2005 24 HOURS URINARY GLUCOSE 350 350 350 BC2007 24 HOURS URINARY POTASSIUM 350 350 350 BC2008 24 HOURS URINARY PROTEINS 330 330 330 BC2009 24 HOURS URINARY SODIUM 350 350 350 BC2010 24 Hours Urinary Urea Nitrogen 350 350 350 BC2011 24 HOURS URINARY URIC ACID 350 350 350 BCA001 Albumin Serum 260 260 260 BCA002 Albumin Urine Spot Quantitative 350 350 350 BCA003 Alkaline Phosphatase 280 280 280 BCA004 ALT (SGPT) 280 280 280 BCA005 Amylase Serum 490 490 490 BCA006 Amylase - Urine/Body Fluid 510 510 510 BCA007 Ascitic Fluid - Glucose 170 170 170 BCA008 Ascitic Fluid - Protein 280 280 280 BCA009 AST (SGOT) 280 280 280 BCA010 Adenosine Deaminase (ADA) 970 970 970 BCB001 Bilirubin - Direct 200 200 200 BCB002 Bilirubin - Total 180 180 180 BCB003 Bilirubin - Total & Direct 350 350 350 BCB004 Blood Urea Nitrogen-BUN 210 210 210 BCC001 C.S.F. - Chloride 280 280 280 BCC002 C.S.F. - Glucose 170 170 170 BCC003 C.S.F. - Protein 280 280 280 BCC004 Calcium 280 280 280 BCC005 Chloride - Serum 270 270 270 BCC006 Chloride - Spot Urine 330 330 330 BCC007 Cholesterol - HDL, Direct" 350 350 350 BCC008 Cholesterol - LDL, Direct" 350 350 350 BCC009 Cholesterol (Total) 280 280 280 BCC010 CK-MB (CK+CKMB) 1030 1030 1030 BCC011 CPK (Creatinine Phosphokinase) 610 610 610 BCC012 Creatinine - Body Fluid 280 280 280 BCC013 Creatinine - Serum 260 260 260 BCC014 Creatinine - Spot Urine 340 340 340 BCC015 CRP - C Reactive Protein 840 840 840 BCE001 Electrolytes, Serum (Na + K+Cl)" 700 700 700 BCE002 EXTENDED GTT 840 840 840 BCG001 Gamma GT 330 330 330 BCG002 Glucose Tolerance Test (4 Samples - Hourly) 590 590 590
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116 78581/2020/ESTT-NE_HRBCG003 Glucose, Plasma - Random" 170 170 170 BCG004 Glucose, Plasma - Random Reflo" 170 170 170 BCG005 Glucose, Plasma (Fasting)" 170 170 170 BCG006 Glucose, Plasma (PP) Post Prandial" 170 170 170 BCG007 Glucose, Urine (Quantitative)" 170 170 170 BCG008 Glycated Haemoglobin (HbA1C) 890 890 890 BCG010 Glucose Tolerance Test (5 Samples-Half Hourly) 580 580 580 BCG011 Glucose Challenge Test 220 220 220 BCI001 Iron 490 490 490 BCK001 KFT/RFT-Kidney/Renal Panel 1 910 910 910 BCK002 KFT/RFT-Kidney/Renal Panel II 1120 1120 1120 BCL001 LDH 490 490 490 BCL002 Lipid Profile 1240 1240 1240 BCL003 Liver Function Tests (LFT) 1050 1050 1050 BCM001 Magnesium 860 860 860 BCM002 Microalbumin, Urine" 870 870 870 BCM003 METHOTREXATE 4900 4900 4900 BCP001 Pericardial Fluid, Glucose" 170 170 170 BCP002 Pericardial Fluid, Proteins" 280 280 280 BCP003 Phosphorus, Inorganic" 270 270 270 BCP004 Pleural Fluid, Glucose" 170 170 170 BCP005 Pleural Fluid, Proteins" 280 280 280 BCP006 Potassium,Urine Spot" 260 260 260 BCP007 Potassium-Serum 260 260 260 BCP008 Protein, Serum - Total" 280 280 280 BCP009 Proteins, Serum (Tot,Albumin,Globulin,A/GRatio)" 350 350 350 BCP010 Pleural Fluid-LDH 720 720 720 BCP014 Protein, Urine Spot 450 450 450 BCS001 Sodium - Serum 260 260 260 BCS002 Synovial Fluid, Glucose" 170 170 170 BCS003 Synovial Fluid, Proteins" 280 280 280 BCS004 Sodium, Urine Spot 260 260 260 BCT001 Total Iron Binding Capacity (TIBC)+Iron 790 790 790 BCT002 Triglycerides, Body Fluid" 350 350 350 BCT003 Triglycerides, Serum" 470 470 470 BCT004 Triglycerides, Urine Spot" 350 350 350 BCU001 Urea Clearance Test 560 560 560 BCU002 Uric Acid 260 260 260 BCU003 Urinary-Protein/Creatinine Ratio 530 530 530 BCU004 Urine Combo Test 870 870 870 CPB001 Bence Jones Proteins 350 350 350 CPB002 Bile Pigment (Qualitative) 170 170 170 CPB003 Bile Salt (Qualitative) 170 170 170 CPC002 Chyluria (Spot Urine) 260 260 260
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117 78581/2020/ESTT-NE_HRCPK001 Ketone Bodies - Urine 170 170 170 CPP001 pH (Gastric Lavage) 210 210 210 CPP002 pH (Stool) 160 160 160 CPP003 pH (Urine) 160 160 160 CPP005 Pregnancy Test 380 380 380 CPR001 Reducing Substances (Stool) 370 370 370 CPS001 Semen Examination 630 630 630 CPS002 Specific Gravity, Urine" 210 210 210 CPS003 Stool Routine Examination 210 210 210 CPS004 Stool, Occult Blood" 200 200 200 CPS005 SEMEN PREPARATION FOR IUI 3500 3500 3500 CPU002 Urine Billirubin 210 210 210 CPU003 Urine, Routine Examination" 180 180 180 CPU004 Urine-Protein 160 160 160 CPU005 Urine-Sugar 160 160 160 CPU006 Urobilinogen, Urine" 170 170 170 HMA001 ABSOLUTE BASOPHIL COUNT 250 250 250 HMA002 ABSOLUTE EOSINOPHIL COUNT 250 250 250 HMA003 ABSOLUTE LYMPHOCYTE COUNT 250 250 250 HMA004 ABSOLUTE MONOCYTE COUNT 250 250 250 HMA005 ABSOLUTE NEUTROPHIL COUNT 440 440 440 HMA006 ABSOLUTE RETICULOCYTE COUNT 340 340 340 HMA007 APTT - Activated Partial Thrmboplastin 490 490 490 HMA008 Ascitic Fluid û Cytology 420 420 420 HMB001 Blood Group (ABO & Rh) 210 210 210 HMC001 C.S.F. Cytology 510 510 510 HMC003 CBC -1( Complete Blood Count ) 530 530 530 HMC006 Coomb's Test, Direct (DAT)"" 710 710 710 HMC007 Coomb's Test, Indirect (IAT)"" 710 710 710 HMC008 Cytology of Fluids 490 490 490 HMD001 DLC 230 230 230 HME001 ESR 280 280 280 HMG001 G-6-PDH (Qualitative) 1190 1190 1190 HMH001 Haemoglobin 290 290 290 HMH002 Haemogram (CBC+ ESR)/CBC 2 610 610 610 HMH003 Haemogram (CBC+ ESR+Retic Count)/CBC 3 870 870 870 Haemogram (CBC+ ESR+Retic Count+pre HMH004 smear)/CBC 4 1050 1050 1050 HML002 Leucocyte Count - TLC & DLC 350 350 350 HMM001 M.C.H.C. 170 170 170 HMM002 M.C.V. 170 170 170 HMM003 Malarial Parasite (Rapid) Antigen 760 760 760 HMM004 Malarial Parasite Smear Examination 230 230 230 HMM005 MCH 170 170 170
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118 78581/2020/ESTT-NE_HRHMM006 Microfilaria Detection 350 350 350 HMP001 PCV - Packed Cell Volume 230 230 230 HMP002 PCV & Platelet Count 420 420 420 HMP003 Pericardial Fluid, Cytology"" 420 420 420 HMP004 Peripheral Smear Examination 260 260 260 HMP006 Platelet Count 290 290 290 HMP007 Pleural Fluid, Cytology 420 420 420 HMP008 Prothrombin Time (PT) with INR 490 490 490 HMR001 RBC Count 230 230 230 HMR002 RDW - Red Cell Distribution Width 140 140 140 HMR003 Reticulocyte Count 470 470 470 HMS001 Sickling Test 390 390 390 HMS002 Synovial Fluid, Cytology 420 420 420 HMT001 TLC - Total Leucocyte Count 230 230 230 HPA001 AFB Stain For Histopathology 630 630 630 HPB008 Bone Marrow Aspiration Examination 1400 1400 1400 HPB009 Bone Marrow Biopsy Examination 1680 1680 1680 HPB010 BUCCAL SMEAR 590 590 590 HPC002 Cytopathology of Fluids 720 720 720 HPC003 Cytopathology of smears 1330 1330 1330 HPE001 Eosinophil Detection (Urine, Spot) 370 370 370 HPF001 FNAC - Cytological Examination 1060 1060 1060 HPF002 FNAC - Procedure Charges 350 350 350 HPF003 FNAC-Second Opinion 750 750 750 HPF004 Frozen Section (At Lab) for Histopathology 2800 2800 2800 HPG001 Giemsa Stain for Histopathology 610 610 610 HPH001 Histopathology (Large and Complex Specimen) 3500 3500 3500 HPH002 Histopathology (Large Specimen) 2800 2800 2800 HPH003 Histopathology (Medium Specimen) 2100 2100 2100 HPH004 Histopathology (Small Specimen) 1120 1120 1120 HPH005 Histopathology Skin Specimen 1210 1210 1210 HPH006 Histopathology Slides Second Opinion 730 730 730 HPI001 IRON Stain For Histopatholgy 590 590 590 HPI002 Issue of Block & Slide (one) 100 100 100 HPI003 Issue of Block & Slide More than one 370 370 370 HPI004 Imprint Smears 630 630 630 HPM002 MULTIPLE ENDOSCOPIC BIOPSY FOR DIAGNOSIS 3500 3500 3500 HPP001 PAP Smear 1240 1240 1240 HPP002 PAS Stain for Histopathology 1470 1470 1470 HPR001 Reticulin Stain for Histopathology 610 610 610 HPS001 Second Opinion Sent Outside 1080 1080 1080 HPT001 Tzanck Smear Examination 560 560 560 HPU001 Urine for Hemosidrin 370 370 370 MBA001 AFB SMEAR EXAMINATION (ZN STAINING) 420 420 420
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119 78581/2020/ESTT-NE_HRMBA002 Air Bacteriological examination-Settle Plate 840 840 840 MBA003 Albert's Staining for C. diphtheria 340 340 340 MBB001 Blood/Sterile Body Fluids Culture (Aerobic) 1750 1750 1750 MBC002 Culture and Ident. Yeast (Blood/Body Fluids/CSF) 1950 1950 1950 MBC003 Culture and Identification - Yeast 1950 1950 1950 MBC006 Aerobic(Urine/Stool/Sputum/PUS/Swabs)" 1400 1400 1400 MBF002 Fungal preparation 290 290 290 MBG001 Gonococcus, Smear Examination" 360 360 360 MBG002 Gram's Staining 280 280 280 MBG003 Genexpert MTB 3220 3220 3220 MBH001 Hanging Drop fo V. cholerae 280 280 280 MBI001 India Ink Preparation, CSF" 350 350 350 MBK001 KOH Preperation ( Nail Skin Hair etc ) 350 350 350 MBM001 Mantoux Test 230 230 230 MBM002 Modified AFB Staining for Actinomycetes 340 340 340 MBN001 Nocardia Detection by Smear Examination 490 490 490 SRA001 A.S.O. Titre 1050 1050 1050 SRA003 Anti HCV - Total antibodies (HCV) 1400 1400 1400 SRA004 Alpha-Fetoprotein (AFP) 1560 1560 1560 SRB001 Beta HCG 1570 1570 1570 SRC002 Chikungunya Antibodies Test 1400 1400 1400 SRC010 CA 19.9 2660 2660 2660 SRC011 CA 125 2310 2310 2310 SRC012 CEA(CARCINO EMBRYONIC ANTIGEN) 1540 1540 1540 SRD002 Dengue Antibodies (IgG and IgM)+NS1 Antigen 4900 4900 4900 SRE001 ESTRADIOL (E2) 970 970 970 SRF002 Ferritin 1260 1260 1260 SRF003 FSH-Follicle Stimulating Hormone 980 980 980 SRH001 HBsAb - Antibodies to Hepatitis B surface Antigen 1540 1540 1540 SRH002 HBsAg 770 770 770 SRH006 HIV I & II Combo(Antibodies) 980 980 980 SRH008 HAV-IgM (ANTI HAV-IgM ANTIBODY) 1960 1960 1960 SRH009 HBsAG in dilution 1820 1820 1820 SRI002 IMMUNOGLOBULIN IgE, SERUMCSP013 1210 1210 1210 SRI003 Infertility Panel (for Women) 2660 2660 2660 SRL002 LH-Luteinising Hormone 980 980 980 SRN001 NT-pro BNP 3220 3220 3220 SRP001 Procalcitonin 4900 4900 4900 SRP002 PSA (Total) 1540 1540 1540 SRP003 Prolactin 910 910 910 SRP004 PTH (PARATHYROID HORMONE) INTACT 2240 2240 2240 SRR001 RA Factor 700 700 700 SRS001 Serum Vitamin B 12 Level 2100 2100 2100 SRT001 T3, Free 610 610 610
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120 78581/2020/ESTT-NE_HRSRT002 T4, Free 610 610 610 SRT003 Thyroid profile (FT3+FT4+TSH) 1540 1540 1540 SRT004 Troponin I 1680 1680 1680 SRT005 TSH (Ultrasensitive) 700 700 700 SRT007 Typhi Dot(IgM & IgG) 840 840 840 SRT009 Troponin I (High Sensitive) 2100 2100 2100 SRV001 RPR 280 280 280 SRV002 Viral Marker Screening Package for DialysisPatient 1520 1520 1520 SRV003 Vitamin D ( 25 - HYDROXY ) 1500 1500 1500 SRW001 Widal Test 420 420 420 BC2006 24 HOURS URINARY PHOSPHORUS 250 250 250 BC2014 24 HRS URINARY MAGNESIUM 700 700 700 BCB007 BLOOD UREA -BU (POST) 170 170 170 BCB008 BLOOD UREA -BU (PRE) 170 170 170 BCC017 CARDIO C-REACTIVE PROTEIN (HSCRP) 900 900 900 BCL005 SERUM LIPASE 650 650 650 BCM004 MICROALBUMIN CREATININE RATIO 750 750 750 BCP011 P.AMMONIA 1500 1500 1500 BCU005 URINARY - PROTEIN/CREATININE RATIO VALUE 400 400 400 HMG002 GLYCATED HAEMOGLOBIN (HBA1C) 800 800 800 HMH006 HEMOGLOBIN HPLC/ELECTROPHORESIS 800 800 800 HPF005 FROZEN SECTION -ALL MARGINS 6000 6000 6000 FROZEN SECTION - ALL MARGINS WITH PRIMARY HPF006 DIAGNOSIS 7500 7500 7500 HPM003 MULTIPLE PROSTATIC BIOPSY 6 3000 3000 3000 HPM004 MULTIPLE PROSTATIC BIOPSY 10 4200 4200 4200 HPM005 MULTIPLE PROSTATIC BIOPSY 12 5000 5000 5000 SRA005 ANTI-HEV IGM, SERUM 1600 1600 1600 SRA006 ANTI MULLERIAN HARMONE:AMH,SERUM 1800 1800 1800 SRC013 CORTISOL SERUM 550 550 550 SRC014 CORTISOL, EVENING 800 800 800 SRC015 COTININE 500 500 500 SRD003 DENGUE SCREENING TEST 600 600 600 SRT008 TROP-I/CK-MB/MYOGLOBIN/BNP/D-DIMER 2800 2800 2800 SRT010 TROPONIN-T 1500 1500 1500 SRT012 TACROLIMUS 3000 3000 3000 SRT013 TACROLIMUS LEVEL (LA RENON) 3000 3000 3000 SRT014 TACROLIMUS LEVEL (CADILA) 3000 3000 3000 SRT015 TACROLIMUS LEVEL (WOCKHARDT) 3000 3000 3000 SRT016 TACROLIMUS LEVEL (INTAS) 3000 3000 3000 SRT017 TACROLIMUS LEVEL (CONCORD BIOTECH) 3000 3000 3000
CD00001 IHC - PIN4 Marker 4000 4000 4000 CD00002 Mutation Analysis - EGFR (Pulmo Core) 8000 8000 8000
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121 78581/2020/ESTT-NE_HRCD00003 Mutation Analysis - KRas (Pulmo/Colo Core) 7000 7000 7000 CD00004 FISH - ALK (Pulmo Core) 12000 12000 12000 CD00005 FISH - PI3K Pathway (Pulmo Core) 12000 12000 12000 CD00006 IHC - P27 (Pulmo Core) 2000 2000 2000 CD00007 Colo CORE I Multiple - Panel 32000 32000 32000 CD00008 Mutation Analysis - NRas (Colo Core) 7000 7000 7000 CD00009 Mutation Analysis - BRAF (Colo Core) 7000 7000 7000 CD00010 FISH - EGFR (Colo Core) 12000 12000 12000 CD00011 IHC - MMR (Colo Core) 6000 6000 6000 CD00012 FISH - 1P19q (Neuro Core) 12000 12000 12000 CD00013 Dual Core IHC - Unlimited Markers 10000 10000 10000 CD00013 Dual Core IHC - Unlimited Markers 10800 10800 10800 CD00014 Mutation Analysis - Jak 2 Exon 12-15 (Hema Core) 7500 7500 7500 CD00015 Bone Marrow Biopsy decalcified with US review 900 900 900 CD00016 Slide/Block Review(Upto 2 blocks/slide 1000 1000 1000 CD00017 Slide/Block Review(3-5 blocks/slide) 2000 2000 2000 CD00018 Slide/Block Review (>5 blocks/slide) 3000 3000 3000 CD00019 MLH1 - Screening for MSI/Prognosis (Colon) 2000 2000 2000 CD00020 MSH2 - Screening for MSI/Prognosis (Colon) 2000 2000 2000 CD00021 MSH6 - Screening for MSI/Prognosis (Colon) 2000 2000 2000 CD00022 PMS2 - Screening for MSI/Prognosis (Colon) 2000 2000 2000 CD00023 CDX2 - Diff. Diagnosis of Large Intenstine cancers 2000 2000 2000 CD00024 CK 19 - Diagnosis of Pancreatic Cancer 2000 2000 2000 CD00025 MUC5AC - Differential Diagnosis of Gastric Cancer 2000 2000 2000 CD00026 MUC 2 - Diff. Diagnosis of Intestinal Cancer 2000 2000 2000 CD00028 Any 2 IHC Markers 3000 3000 3000 CD00029 Any 3 IHC Markers 4000 4000 4000 CD00030 Any 5 IHC Markers 5000 5000 5000 CD00031 Any 7 IHC Markers 6000 6000 6000 CD00032 MS PCR - MGMT 7000 7000 7000 CD00033 Dual Core IHC - Upto 7 Markers 6000 6000 6000 CD00034 ER PR and Her 2 nue 3000 3000 3000 CD00035 Her 2 nue by FISH 12000 12000 12000 CD00036 MAMMA PRINT 262000 262000 262000 CD00037 Any 1 IHC Marker 2000 2000 2000 CD00038 C- Kit Mutation Analysis( Gastric- Core) 7000 7000 7000 CD00039 PDGFRA(4q12)Tanslocation 4500 4500 4500 CD00040 Liposarcoma, 12q13 Rearrangement, FISH 4500 4500 4500 CD00043 ALK - IHC 8000 8000 8000 CD00044 BONE MARROW BIOPSY & ASPIRATION 1500 1500 1500 CD00045 MDS BY FLOW 11000 11000 11000 CD00046 FISH (PULMO) –ROS1 10000 10000 10000 CD00047 FISH (PULMO) – MET 15600 15600 15600 CD00048 IHC(PULMO) – PD L1 3000 3000 3000
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122 78581/2020/ESTT-NE_HRCD00049 IMATINIB RESIST. MUTATION BONE MARROW 9000 9000 9000 CD00050 MDS BY FISH 9500 9500 9500 CD00051 MULTIPLE MYELOMA FLOW CYTOMETRY 7000 7000 7000 CD00052 BCR – ABL QUANTITATIVE 6500 6500 6500 CD00053 MGMT- NEUROCORE 7000 7000 7000 CD00054 IDH 1 & 2 - NEUROCORE 7000 7000 7000 CD00055 1P19Q- NEUROCORE 12000 12000 12000 CD00056 PDGFRA ( GASTRI CORE) 16000 16000 16000 CD00057 TCR GENE REARRANGEMENT 20000 20000 20000 CD00058 C-MYC GENE REARRANGEMENT (BY FISH) 6000 6000 6000 CD00059 BCL2 (18Q21.3) TRANSLOCATION (BY FISH) 10000 10000 10000 CD00060 BCL6(3Q27) TRANSLOCATION (BY FISH) 10000 10000 10000 CD00061 INSITU HYBIRDIZATION 4500 4500 4500 CD00062 CORE PRIME EGFR 15000 15000 15000 CD00063 CORE PRIME ALK 10000 10000 10000 CD00064 CORE PRIME ROS1 9000 9000 9000 CD00065 CORE PRIME LUNG PANEL(ALK+EGFR) 20000 20000 20000 CD00066 CORE PRIME LUNG(EGFR(PCR)+ALK(IHC)+ROS1(IHC)) 30000 30000 30000 CD00067 SYNOVIAL SARCOMA 10000 10000 10000 CD00068 EWING’S SARCOMA 8000 8000 8000 CD00069 BCR ABL QUANTITATIVE PCR (IS) 6500 6500 6500 CD00070 MYELOID TUMOR PANEL 35000 35000 35000 CD00071 CLL MRD 13000 13000 13000 CD001238 CONGO RED STAIN 550 550 550 DGB0001 BRCA 1+2 GENE TESTING 24900 24900 24900 CIRCULATING TUMOR CELL DETECT ION ( FOLLOW DGB0002 UP) 9500 9500 9500 DGH0001 HEREDITARY BREAST CANCER PANEL 31500 31500 31500 DGL0001 EXACTA 240000 240000 240000 DGL0002 Cancer track for solid organ- Therapy 87000 87000 87000 DGL0003 Chomprehensive tumor gene mutation analysis 35000 35000 35000 DGL0004 Sarco Score 30000 30000 30000 DGL0005 Hereditary Colorectal cancer panel 24900 24900 24900 DGL0006 Sarco Probe 27000 27000 27000 CANCERTRACK-THERAPY MANAGEMENT LUNG DGL0008 CANCER 87000 87000 87000 CANCERTRACK LUNG CANCER BASIC PANEL- DGL0009 MUTATIONS ONLY 19750 19750 19750 CANCERTRACK LUNG CANCER EXT. PANEL- DGL0010 MUT./FUSION 29500 29500 29500 DGL0011 CORRECT CHEMO 28500 28500 28500 DGW0001 WOMEN’S HEREDITARY CANCER PANEL 31500 31500 31500 LI00001 COMBINED FIRST TRIMESTER SCREENING (DUAL+NT) 2500 2500 2500 LI00002 QUADRUPLE MARKER TEST 3000 3000 3000 LI00003 TRIPLE MARKER 2500 2500 2500
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123 78581/2020/ESTT-NE_HRLI00004 DUAL+PLGF 4500 4500 4500 LI00005 SFLT PLGF RATIO 8500 8500 8500 LI00006 FTS QUAD 5000 5000 5000 LI00007 INSIGHT (NIPS - 10 ANUEPLOIDIES) 25000 25000 25000 INSIGHT PLUS (NIPS 10 ANUEPLOIDIES + 63 LI00008 MICRODELETION) 30000 30000 30000 LI00009 KARYOTYPE – CVS/AMNIOTIC FLUID 6500 6500 6500 LI00010 FISH 5 PROBES – CVS/AMNIOTIC FLUID 6500 6500 6500 LI00011 KARYOTYPE + FISH 5 PROBES – CVS/AMNIOTIC FLUID 13000 13000 13000 KARYOTYPE + FISH 5 PROBES+ 22Q 11.2 LI00012 MICRODELETION – CVS/AMNIOTIC FLUID 18000 18000 18000 LI00013 KARYOTYPE – BLOOD 3500 3500 3500 LM001500 (CA) CYFRA 21-1; LUNG CANCER MARKER 2700 2700 2700 17 - HYDROXYCORTICOSTEROIDS & 17 - LM001501 KETOSTEROIDS, 24-HOUR URI 12000 12000 12000 17 - HYDROXYCORTICOSTEROIDS ( 17-OHCS), 24- LM001502 HOUR URINE 6700 6700 6700 LM001503 17 - HYDROXYPROGESTERONE ( 17-OHP) 1300 1300 1300 ACTH STIMULATION TEST FOR 17- LM001504 HYDROXYPROGESTERONE; 17-OHP 2600 2600 2600 17 - HYDROXYPROGESTERONE, NEWBORN SCREEN; LM001505 CAH SCREEN 250 250 250 LM001506 17 - KETOSTEROIDS, 24-HOUR URINE 5700 5700 5700 LM001507 5-alpha - DIHYDROTESTOSTERONE; 5a - DHT 2700 2700 2700 5-HIAA (5-HYDROXYINDOLEACETIC ACID), 24-HOUR LM001508 URINE 2650 2650 2650 5-HIAA (5-HYDROXYINDOLEACETIC ACID), RANDOM LM001509 URINE 2650 2650 2650 LM001515 ACTH 1480 1480 1480 LM001516 Activated Protein C Resistance 3900 3900 3900 LM001518 AFB IDENTIFICATION, RAPID; PNB TEST 1500 1500 1500 LM001520 AFP (ALPHA FETOPROTEIN), AMNIOTIC FLUID 800 800 800 LM001521 AFP (ALPHA FETOPROTEIN), MATERNAL 800 800 800 LM001524 ALBUMIN & IgG, CSF Includes CSF IgG/ Albumin Ratio. 2400 2400 2400 LM001525 ALBUMIN, CSF 1300 1300 1300 LM001527 ALCOHOL SCREEN, BLOOD 680 680 680 ALCOHOL, ETHYL GLUCURONIDE (ETG) & ETHYL LM001528 SULPHATE (ETS) QUANTITATIVE ASSAY, URINE 1000 1000 1000 LM001529 ALDEHYDE CHOPRA TEST FOR KALAAZAR 250 250 250 LM001530 ALDOLASE 690 690 690 LM001531 ALDOSTERONE, 24-HOUR URINE 1600 1600 1600 LM001532 ALDOSTERONE, SERUM 1600 1600 1600 LM001534 ALKALINE PHOSPHATASE,BONE-SPECIFIC; BSAP 4500 4500 4500 ALKALINE PHOSPHATASE ISOENZYMES; ALP LM001535 ISOENZYMES Includes tot 5200 5200 5200 LM001536 ALKAPTONURIA, URINE 280 280 280
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124 78581/2020/ESTT-NE_HRALLERGY COMPREHENSIVE PROFILE : (Includes LM001537 Allergy Scree 10000 10000 10000 LM001538 ALLERGY IND. MARKER, ACACIA (Babool) 1100 1100 1100 LM001539 ALLERGY IND. ALDER 1100 1100 1100 LM001540 ALLERGY IND. ALMOND 1100 1100 1100 LM001541 ALLERGY IND. ALTERNARIA TENUIS 1100 1100 1100 LM001542 ALLERGY IND. APPLE 1100 1100 1100 LM001543 ALLERGY IND. ASPERGILLUS FUMIGATUS 1100 1100 1100 LM001544 ALLERGY IND. MARKER, BAHIA GRASS 1100 1100 1100 LM001545 ALLERGY IND. BANANA 1100 1100 1100 LM001546 ALLERGY IND. BEEF 1100 1100 1100 ALLERGY IND. BERMUDA GRASS (CYNODON LM001547 DACTYLON) 1100 1100 1100 LM001548 ALLERGY IND. BRINJAL 1100 1100 1100 LM001549 ALLERGY IND. MARKER, BUCKWHEAT (Kutu) 1100 1100 1100 LM001550 ALLERGY IND. CABBAGE 1100 1100 1100 LM001551 ALLERGY IND. CANDIDA ALBICANS 1100 1100 1100 LM001552 ALLERGY IND. MARKER, CAROB 1100 1100 1100 LM001553 ALLERGY IND. CARROT 1100 1100 1100 LM001554 ALLERGY IND. CASEIN 1100 1100 1100 LM001555 ALLERGY IND. CASHEWNUT 1100 1100 1100 LM001556 ALLERGY IND. CAT EPITHELIUM 1100 1100 1100 LM001557 ALLERGY IND. CELERY 1100 1100 1100 LM001558 ALLERGY IND. CHEDDAR 1100 1100 1100 LM001559 ALLERGY IND. CHICKEN 1100 1100 1100 LM001560 ALLERGY IND. CHICKPEA 1100 1100 1100 LM001561 ALLERGY IND. CLADOSPORIUM HERBARUM 1100 1100 1100 LM001562 ALLERGY IND. MARKER, COCKLEBUR (Bichha / Kutta) 1100 1100 1100 LM001563 ALLERGY IND. COCOA 1100 1100 1100 LM001564 ALLERGY IND. COCONUT 1100 1100 1100 LM001565 ALLERGY IND.COCKROACH 1100 1100 1100 LM001566 ALLERGY IND. MARKER, COFFEE 1100 1100 1100 ALLERGY IND. MARKER, COMMON PIGWEED LM001567 (Kantewali Chauli) 1100 1100 1100 LM001568 ALLERGY IND. COTTONWOOD 1100 1100 1100 LM001569 ALLERGY IND. MARKER, COW DANDER 1100 1100 1100 LM001570 ALLERGY IND. CUCUMBER 1100 1100 1100 LM001571 ALLERGY IND. DOG DANDER 1100 1100 1100 LM001572 ALLERGY IND. EGG WHITE 1100 1100 1100 LM001573 ALLERGY IND. EGGYOLK 1100 1100 1100 LM001574 ALLERGY IND. MARKER, ELM (Papdi Chibil) 1100 1100 1100 LM001575 ALLERGY IND. MARKER, EUCALYPTUS (Nilgiri / Safeda) 1100 1100 1100 LM001576 ALLERGY IND. FISH 1100 1100 1100 LM001577 ALLERGY IND. GARLIC 1100 1100 1100 LM001578 ALLERGY IND. GLUTEN 1800 1800 1800 20| T a r i f f - AIMS
125 78581/2020/ESTT-NE_HRLM001579 ALLERGY IND. MARKER, GOOSEFOOT (Bathua) 1100 1100 1100 LM001580 ALLERGY IND. HORSE DANDER 1100 1100 1100 LM001581 ALLERGY IND. HOUSE DUST 1100 1100 1100 ALLERGY IND. JOHNSON GRASS (SORGHUM LM001582 HALEPENSE) 1100 1100 1100 LM001583 ALLERGY IND. LEMON 1100 1100 1100 LM001584 ALLERGY IND. LENTIL 1100 1100 1100 LM001585 ALLERGY IND. LOBSTER 1100 1100 1100 LM001586 ALLERGY IND. MAIZE 1100 1100 1100 LM001587 ALLERGY IND. MANGO 1100 1100 1100 ALLERGY IND. MARKER, MEADOW GRASS (Lawn LM001588 grass) 1100 1100 1100 LM001589 ALLERGY IND. MARKER, MELALEUCA 1100 1100 1100 LM001590 ALLERGY IND. MESQUITE 1100 1100 1100 LM001591 ALLERGY IND. MILK 1100 1100 1100 ALLERGY IND. MITES (INCLUDES LM001592 DERMATOPHAGOIDES 1800 1800 1800 LM001593 ALLERGY IND. MUG WORT (ARTEMISIA VULGARIS) 1100 1100 1100 LM001594 ALLERGY IND. MARKER, MULBERRY (Shahtoot) 1100 1100 1100 LM001595 ALLERGY IND. MUTTON 1100 1100 1100 LM001596 ALLERGY IND. MARKER, OAK 1100 1100 1100 LM001597 ALLERGY IND. OAT 1100 1100 1100 LM001598 ALLERGY IND. OLIVE 1100 1100 1100 LM001599 ALLERGY IND. ONION 1100 1100 1100 LM001600 ALLERGY IND. ORANGE 1100 1100 1100 LM001601 ALLERGY IND. PAPRIKA 1100 1100 1100 LM001602 ALLERGY IND. MARKER, PEA (Matar) 1100 1100 1100 LM001603 ALLERGY IND. MARKER, PEAR (Nashpati) 1100 1100 1100 LM001604 ALLERGY IND. MARKER, PEACH (Aaru) 1100 1100 1100 LM001605 ALLERGY IND. MARKER, PECAN 1100 1100 1100 LM001606 ALLERGY IND. PEANUT 1100 1100 1100 LM001607 ALLERGY IND. PENICILLIUM NOTATUM 1100 1100 1100 LM001608 ALLERGY IND. MARKER, PINEAPPLE (Ananas) 1100 1100 1100 LM001609 ALLERGY IND. PISTACHIO 1100 1100 1100 LM001610 ALLERGY IND. MARKER, PORK 1100 1100 1100 LM001611 ALLERGY IND. POTATO 1100 1100 1100 LM001612 ALLERGY IND. RAGWEED 1100 1100 1100 LM001613 ALLERGY IND. RAPESEED 1100 1100 1100 LM001614 ALLERGY IND. RICE 1100 1100 1100 LM001615 ALLERGY IND. MARKER, RYE 1100 1100 1100 LM001616 ALLERGY IND. RYEGRASS 1100 1100 1100 LM001617 ALLERGY IND. SESAME 1100 1100 1100 LM001618 ALLERGY IND. SHRIMP (PRAWN) 1100 1100 1100 LM001619 ALLERGY IND. SOYBEAN 1100 1100 1100 LM001620 ALLERGY IND. SPINACH 1100 1100 1100 21| T a r i f f - AIMS
126 78581/2020/ESTT-NE_HRLM001621 ALLERGY IND. MARKER, STRAWBERRY 1100 1100 1100 LM001622 ALLERGY IND. TOMATO 1100 1100 1100 LM001623 ALLERGY IND. MARKER, TIMOTHY GRASS 1100 1100 1100 LM001624 ALLERGY IND. MARKER, TURKEY 1100 1100 1100 LM001625 ALLERGY IND. WALNUT 1100 1100 1100 LM001626 ALLERGY IND. WHEAT 1100 1100 1100 LM001627 ALLERGY IND. MARKER, WHITE BEAN 1100 1100 1100 LM001628 ALLERGY IND. MARKER, WHITE PINE 1100 1100 1100 LM001629 ALLERGY IND. MARKER, WILLOW 1100 1100 1100 LM001630 ALLERGY IND. YEAST 1100 1100 1100 LM001631 ALLERGY ANY 5 ALLERGENS 5000 5000 5000 LM001632 ALLERGY ANY 10 ALLERGENS 9000 9000 9000 LM001633 ALLERGY POST SCREENING COMPREHENSIVE PROFILE 7500 7500 7500 LM001634 ALLERGY SCREEN (ADULT) 1600 1600 1600 LM001635 ALLERGY ANIMAL PANEL 3500 3500 3500 LM001636 ALLERGY CEREAL PANEL 6500 6500 6500 LM001637 ALLERGY DUST PANEL 3000 3000 3000 LM001638 ALLERGY ECZEMA COMPREHENSIVE PANEL 11000 11000 11000 LM001639 ALLERGY FOOD PANEL 1 5500 5500 5500 LM001640 ALLERGY FRUIT COMPREHENSIVE PANEL 7000 7000 7000 LM001641 ALLERGY PANEL, GRASS 4000 4000 4000 LM001642 ALLERGY MOLD PANEL 3500 3500 3500 ALLERGY NON-VEGETARIAN PANEL 1 * PORK *BEEF LM001643 *TURKEY *EGG *CHICKEN 3700 3700 3700 LM001644 ALLERGY PANEL, NUTS 4000 4000 4000 LM001645 ALLERGY PANEL, PULSES 2500 2500 2500 ALLERGY TREE PANEL $ Includes Acacia, Olive, LM001646 Willow, Melaleuca, White pine & Eucalyptus 4000 4000 4000 LM001648 ALLERGY VEGETABLE COMPREHENSIVE PANEL 6500 6500 6500 LM001649 ALLERGY PANEL, WEED 4000 4000 4000 ALLERGY WHEEZE/RHINITIS COMPREHENSIVE PANEL LM001650 ADULT 13000 13000 13000 ALLERGY WHEEZE/RHINITIS COMPREHENSIVE PANEL LM001651 PEDIATRIC 10500 10500 10500 LM001652 ALPHA-1-ANTITRYPSIN QUANTITATION; AAT 2000 2000 2000 LM001653 ALUMINIUM, DIALYSIS FLUID 2000 2000 2000 LM001654 ALUMINIUM, PLASMA 2000 2000 2000 LM001655 ALUMINIUM, SERUM 2000 2000 2000 AMENORRHOEA / ANDROLOGY SCREEN *FSH *LH LM001656 *Prolactin 1450 1450 1450 AMENORRHOEA PROFILE *ESTRADIOL *FSH *LH LM001657 *PROLACTIN * PROGESTERONE * TSH 2750 2750 2750 LM001658 AMIKACIN 5360 5360 5360 5 - AMINOLEVULINIC ACID ( 5 -ALA [2nd morning LM001659 Urine]), URINE, QUALITATIVE 4000 4000 4000 LM001660 AMINO ACIDS, QUALITATIVE, CSF 1200 1200 1200 22| T a r i f f - AIMS
127 78581/2020/ESTT-NE_HRAMINO ACIDS, QUALITATIVE, ONE DIMENSIONAL, LM001661 URINE 1200 1200 1200 LM001662 AMINO ACIDS, QUALITATIVE, PLASMA 1200 1200 1200 AMINO ACIDS, QUALITATIVE, TWO DIMENSIONAL, LM001663 URINE 1230 1230 1230 LM001664 AMINO ACIDS, QUALITATIVE, URINE & PLASMA 1900 1900 1900 AML ETO T(8;21) GENE REARRANGEMENT, PCR LM001666 QUALITATIVE 4200 4200 4200 LM001668 AMOEBIC SEROLOGY IgG, SERUM 1350 1350 1350 LM001669 AMPHETAMINE SCREEN, URINE 700 700 700 LM001673 ANALYZER 18; SMA 18 TEST PANEL 1500 1500 1500 LM001674 ANALYZER 26; SMA 26 TEST PANEL 2000 2000 2000 LM001675 ANALYZER 30; SMA 30 TEST PANEL 2800 2800 2800 LM001676 ANALYZER 32; SMA 32 TEST PANEL 3300 3300 3300 ANCA-MPO (p-ANCA); ANTI MYELOPEROXIDASE LM001679 ANTIBODIES, EIA 1800 1800 1800 ANCA-PR3 (c-ANCA); SERIN PROTEINASE 3 LM001680 ANTIBODIES, EIA 1800 1800 1800 ANDROLOGY PANEL *FSH *LH *Testosterone, Total & LM001681 Free 3000 3000 3000 LM001682 ANDROSTENEDIONE 1820 1820 1820 LM001683 ACTH STIMULATION TEST FOR ANDROSTENEDIONE 3640 3640 3640 ANEMIA PANEL BASIC * COMPLETE BLOOD COUNT * LM001684 SERUM IRON STUDIES *FERRITIN * CRP 1500 1500 1500 ANEMIA PANEL 2 *ANEMIA PANEL 1 * PROTEIN, TOTAL * ALBUMIN * A:G RATIO * TRANSFERRIN * HB LM001685 ELECTROPHORESIS 3200 3200 3200 ANEMIA PANEL 3 * ANEMIA PANEL 1 * PROTEIN, TOTAL * ALBUMIN * A:G RATIO * TRANSFERRIN * LM001686 LEAD BLOOD 4100 4100 4100 LM001687 ANGIOTENSIN CONVERTING ENZYME; ACE 1000 1000 1000 LM001689 ANTI A TITRE 420 420 420 LM001690 ANTI B TITRE 420 420 420 LM001691 ANTI CYCLIC CITRULLINATED PEPTIDE;ANTI CCP 1750 1750 1750 LM001692 ANTI DS DNA ANTIBODY, CRITHIDIA IFA 1700 1700 1700 ANTI - ds DNA ANTIBODY, CRITHIDIA IFA in LM001693 DILUTIONS 3250 3250 3250 LM001695 ANTI - ss DNA ANTIBODY 2450 2450 2450 LM001696 ANTI DNase B, SERUM; ANTIDEOXYRIBONUCLEASE B 1200 1200 1200 LM001697 ANTI MULLERIAN HORMONE 1850 1850 1850 LM001701 ANTI SOLUBLE LIVER ANTIGEN; SLA 1300 1300 1300 LM001702 ANTISPERM ANTIBODY, SERUM 800 800 800 LM001705 ANTITHYROGLOBULIN ANTIBODY; ANTI Tg 1300 1300 1300 LM001706 ANTITHYROID PEROXIDASE ANTIBODY;ANTI TPO 1300 1300 1300 ANTITHYROID ANTIBODIES PANEL *ANTI Tg*ANTI LM001707 TPO 2500 2500 2500 LM001708 APOLIPOPROTEINS A1 & B INCLUDES APO B/APO A1 680 680 680
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128 78581/2020/ESTT-NE_HRRATIO. LM001709 ARGINASE 1900 1900 1900 LM001711 ARSENIC, BLOOD 2750 2750 2750 LM001712 ARSENIC, 24-HOUR URINE 2750 2750 2750 LM001713 ARSENIC, RANDOM URINE 2750 2750 2750 ARTHRITIS PANEL BASIC *CBC *CRP *RA FACTOR LM001714 *ASO *URIC ACID 1600 1600 1600 ARTHRITIS PANEL 1 *CBC *CRP *RA FACTOR * ANA * LM001715 URIC ACID * ASO 2300 2300 2300 ARTHRITIS PANEL 2 *CBC *CRP *RA FACTOR *ANA * LM001716 URIC ACID * ASO * C3 *C4 3100 3100 3100 LM001717 ASPERGILLUS ANTIBODY, IgG, SERUM 1700 1700 1700 LM001718 ASPERGILLUS ANTIBODY, IgM, SERUM 1700 1700 1700 LM001719 ASPERGILLUS ANTIBODIES PANEL, IgG & IgM, SERUM 3200 3200 3200 LM001720 BACTERIAL MENINGITIS SCREEN 2700 2700 2700 LM001721 BARBITURATE SCREEN, URINE 700 700 700 LM001722 BCR-ABL QUALITATIVE PCR 3100 3100 3100 LM001723 BCR-ABL QUANTITATIVE PCR 6000 6000 6000 LM001724 BENZODIAZEPINE SCREEN, URINE 700 700 700 LM001727 BETA - 2 - MICROGLOBULIN, SERUM 1300 1300 1300 LM001731 BIOTINIDASE DEFICIENCY, QUANTITATIVE, BLOOD 3800 3800 3800 LM001732 BIOTINIDASE, NEWBORN SCREEN 690 690 690 LM001734 BLOOD GAS ANALYSIS, ARTERIAL 800 800 800 LM001735 BLOOD GAS ANALYSIS, VENOUS 800 800 800 BLOOD PICTURE; PERIPHERAL BLOOD SMEAR LM001737 EXAMINATION 140 140 140 LM001738 BNP; B-TYPE NATRIURETIC PEPTIDE 1700 1700 1700 LM001739 BOH PANEL 5100 5100 5100 BONE MARROW EXAMINATION PANEL 1 * LM001740 MICROSCOPY *CBC * SPECIAL STAINS 950 950 950 BONE MARROW EXAMINATION PANEL 2 * MICROSCOPY * CBC * SPECIAL STAINS * LM001741 HISTOPATHOLOGY 1900 1900 1900 LM001742 BONE MARROW, IRON STAIN 430 430 430 BONE MARROW, TREPHINE BIOPSY PANEL * LM001743 Histopathology * Reticulin stain * Iron stain 1100 1100 1100 LM001744 BREAST CANCER PANEL 1 * ER *PR 2400 2400 2400 LM001745 BREAST CANCER PANEL 2 * ER * PR * CATHEPSIN D 4100 4100 4100 BREAST CANCER PANEL 3 * ER * PR * c-erb B2 ( HER-2 LM001746 neu) 3800 3800 3800 LM001747 BREAST METASTATIC MARKER * ER *PR * CA 15-3 3700 3700 3700 LM001748 BREAST MONITOR PANEL * CA 15.3 * CEA 2000 2000 2000 LM001749 BRUCELLA AGGLUTINATION TEST 700 700 700 BUCCAL SMEAR FOR BARR BODIES ( SEX LM001750 CHROMATIN) 350 350 350 LM001752 C. DIFFICILE TOXIN A & B, STOOL 2450 2450 2450
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129 78581/2020/ESTT-NE_HRLM001753 C1 ESTERASE INHIBITOR, PROTEIN QUANTITATION 2200 2200 2200 LM001758 CA 15.3; BREAST CANCER MARKER 1350 1350 1350 LM001760 CA 27.29 & CA 15.3 BREAST CANCER MARKERS PANEL 8000 8000 8000 LM001761 CA 72.4; GASTRIC CANCER MARKER 1450 1450 1450 LM001762 CADMIUM, 24-HOUR URINE 3200 3200 3200 LM001763 CADMIUM, BLOOD 3200 3200 3200 LM001764 CADMIUM, RANDOM URINE 3200 3200 3200 LM001765 CALCITONIN 2150 2150 2150 CALCITONIN STIMULATION BY CALCIUM - PENTAGASTRIN $ For suspected Medullary Thyroid LM001766 Carcinoma. 10750 10750 10750 LM001768 CALCIUM, IONIZED 580 580 580 CANNABINOIDS (DELTA-9-THC LM001771 METABOLITES),SCREEN, URINE; MARIJUANA 680 680 680 LM001772 CARBAMAZEPINE 800 800 800 CARDIAC / MYOCARDIAL INFARCTION PANEL *CPK- LM001773 MB * TROPONIN T * TROPONIN I 3200 3200 3200 LM001774 CARDIOLIPIN ANTIBODIES PANEL *IgG *IgA *IgM 2400 2400 2400 LM001775 CARDIOLIPIN ANTIBODY, IgA 820 820 820 LM001776 CARDIOLIPIN ANTIBODY, IgG 820 820 820 LM001777 CARDIOLIPIN ANTIBODY, IgM, 820 820 820 LM001778 CATECHOLAMINES & VMA, 24-HOURURINE 7800 7800 7800 LM001779 CATECHOLAMINES, 24-HOUR URINE 4500 4500 4500 LM001780 Catecholamines,plasma 7200 7200 7200 LM001782 CATECHOLAMINES, RANDOM URINE 4500 4500 4500 LM001784 CENTROMERE ANTIBODY 1350 1350 1350 LM001785 CERULOPLASMIN 1100 1100 1100 CHLAMYDIA IgG ANTIBODY PANEL*CHLAMYDIA LM001787 TRACHOMATIS *CHLAMYDIA PNEUMONIAE 1400 1400 1400 LM001788 CHLORIDE, 24-HOUR URINE 250 250 250 LM001794 CHOLINESTERASE, SERUM 490 490 490 LM001795 CHROMIUM, 24-HOUR URINE 3200 3200 3200 LM001796 CHROMIUM, BLOOD 3200 3200 3200 LM001797 CHROMIUM, RANDOM URINE 3200 3200 3200 LM001798 CHROMOGRANIN A; CGA 6900 6900 6900 LM001799 CHROMOSOME ANALYSIS (KARYOTYPE) , BLOOD 2850 2850 2850 CHROMOSOME ANALYSIS FOR HEMATOLOGIC LM001800 MALIGNANCY 3200 3200 3200 LM001801 CHROMOSOME ANALYSIS, PHILADELPHIA 2900 2900 2900 LM001802 CHROMOSOME ANALYSIS, SOLID TUMOR 8700 8700 8700 CHROMOSOME ANALYSIS,PRODUCTS OF LM001803 CONCEPTION 6100 6100 6100 LM001804 CHYLE EXAMINATION 490 490 490 LM001805 CITRATE, 24-HOUR URINE 800 800 800 LM001810 COBALT, BLOOD 3200 3200 3200 LM001811 COBALT, 24-HOUR URINE 3200 3200 3200 25| T a r i f f - AIMS
130 78581/2020/ESTT-NE_HRLM001812 COBALT, RANDOM URINE 3200 3200 3200 LM001813 COCAINE & METABOLITE SCREEN, URINE 690 690 690 NTx (COLLAGEN CROSS LINKED N-TELOPEPTIDE), LM001814 URINE 7500 7500 7500 COLLAGEN DISEASE ANTIBODIES PANEL * ANA *ANTI- DS-DNA * SM *SSA /Ro *SSB / La * Scl-70 *Jo-1 $ * LM001815 CENTROMERE *U1RNP 9000 9000 9000 LM001821 COPPER, 24-HOUR URINE, ATOMIC ABSORPTION 1850 1850 1850 LM001822 COPPER, RANDOM URINE, ATOMIC ABSORPTION 1850 1850 1850 LM001823 COPPER, SERUM 1300 1300 1300 LM001824 CORTISOL, FREE, 24-HOUR URINE 800 800 800 LM001832 COXSACKIE ANTIBODY, IgG 3500 3500 3500 LM001832 COXSACKIE ANTIBODY, IgG 1630 1630 1630 LM001833 COXSACKIE ANTIBODY, IgM 3500 3500 3500 CPK ISOENZYME ELECTROPHORESIS; Includes Total LM001835 CPK. 8000 8000 8000 LM001836 C-PEPTIDE, SERUM 1050 1050 1050 LM001837 GLUCAGON STIMULATION TEST FOR C-PEPTIDE 4200 4200 4200 LM001838 C-REACTIVE PROTEIN, CARDIO;hsCRP 750 750 750 LM001845 CRYOGLOBULINS PANEL 5750 5750 5750 LM001846 CRYOGLOBULINS QUALITATIVE TEST 950 950 950 LM001847 CRYPTOCOCCUS ANTIGEN, CSF 2000 2000 2000 LM001848 CRYPTOCOCCUS ANTIGEN, SERUM 2000 2000 2000 CRYPTOSPORIDIUM / ISOSPORA IDENTIFICATION, LM001849 STOOL 330 330 330 CSF & SERUM PROTEIN ELECTROPHORESIS / LM001850 OLIGOCLONAL BANDS 4200 4200 4200 CSF PROTEIN ELECTROPHORESIS / OLIGOCLONAL LM001851 BANDS 4200 4200 4200 CULTURE, ACTINOMYCES Does not include LM001852 ANTIBIOTIC SENSITIVITY 1100 1100 1100 CULTURE, AFB (MYCOBACTERIA), RAPID DOES NOT LM001866 INCLUDE ANTI-TUBERCULAR DRUG SENSITIVITY 1000 1000 1000 CULTURE, AFB (MYCOBACTERIA), RAPID WITH PNB TEST DOES NOT INCLUDE ANTI-TUBERCULAR DRUG LM001867 SENSITIVITY 1600 1600 1600 CULTURE, ANAEROBIC DOES NOT INCLUDE BLOOD LM001868 SAMPLES INCLUDES ANTIBIO 1200 1200 1200 CULTURE, ANAEROBIC, BLOOD, RAPID Includes LM001869 ANTIBIOTIC SENSITI 1200 1200 1200 CULTURE, ANAEROBIC, BODY FLUID,RAPID Includes LM001870 ANTIBIOTIC SEN 1200 1200 1200 CULTURE, CHOLERA Includes ANTIBIOTIC SENSITIVITY LM001871 if indicate 750 750 750 CULTURE, CLOSTRIDIUM DIFFICILE Does not include LM001872 ANTIBIOTIC S 1200 1200 1200 CULTURE, DIPHTHERIA Does not include ANTIBIOTIC LM001873 SENSITIVITY. 1100 1100 1100
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131 78581/2020/ESTT-NE_HRCULTURE, FUNGUS Does not include ANTIFUNGAL LM001874 SENSITIVITY. 1100 1100 1100 CULTURE, FUNGUS, BLOOD / BODY FLUIDS, RAPID LM001875 INCLUDES ANTIBIOTIC SENSITIVIT 1100 1100 1100 CULTURE, GONOCOCCUS Does not include LM001876 ANTIBIOTIC SENSITIVITY 1000 1000 1000 CULTURE, HAEMOPHILUS $ Does not include LM001877 ANTIBIOTIC SENSITIVITY 1000 1000 1000 CULTURE, NOCARDIA Does not include ANTIBIOTIC LM001878 SENSITIVITY. 1200 1200 1200 LM001881 CULTURE,WATER; PRESUMPTIVE COLIFORM COUNT 900 900 900 CULTURED AEROBIC BACTERIA IDENTIFICATION AND LM001882 SENSITIVITY 2000 2000 2000 CULTURED AEROBIC BACTERIA IDENTIFICATION DOES LM001883 NOT INCLUDE ANTIBIOTIC SENSITIVITY 1000 1000 1000 LM001884 CULTURED AEROBIC BACTERIA SENSITIVITY 1000 1000 1000 CULTURED AFB ANTI-TUBERCULAR DRUG SENSITIVITY LM001885 RAPID, 10 DRUGS PANEL 10500 10500 10500 CULTURED AFB ANTI-TUBERCULAR DRUG SENSITIVITY LM001886 RAPID, 11 DRUGS PANEL 11000 11000 11000 CULTURED AFB ANTI-TUBERCULAR DRUG SENSITIVITY LM001887 RAPID, 12 DRUGS PANEL 12000 12000 12000 CULTURED AFB ANTI-TUBERCULAR DRUG SENSITIVITY LM001888 RAPID, 4 DRUGS PANEL 4500 4500 4500 CULTURED AFB ANTI-TUBERCULAR DRUG SENSITIVITY LM001889 RAPID, 5 DRUGS PANEL 6000 6000 6000 CULTURED AFB ANTI-TUBERCULAR DRUG SENSITIVITY LM001890 RAPID, AMIKACIN 2700 2700 2700 CULTURED AFB (MYCOBACTERIUM), ANTITUBERCULAR DRUG SENSITIVITY, RAPID $ Single LM001891 Drug $ *Capreomycin 2700 2700 2700 CULTURED AFB ANTI-TUBERCULAR DRUG SENSITIVITY LM001892 RAPID, CLOFAZIMINE 2700 2700 2700 CULTURED AFB ANTI-TUBERCULAR DRUG SENSITIVITY LM001893 RAPID, ETHAMBUTOL 2700 2700 2700 CULTURED AFB ANTI-TUBERCULAR DRUG SENSITIVITY LM001894 RAPID, ETHIONAMIDE 2700 2700 2700 CULTURED AFB ANTI-TUBERCULAR DRUG SENSITIVITY LM001895 RAPID, OFLOXACIN 2700 2700 2700 CULTURED AFB ANTI-TUBERCULAR DRUG SENSITIVITY LM001896 RAPID, RIFAMPICIN 2700 2700 2700 CULTURED AFB ANTI-TUBERCULAR DRUG SENSITIVITY LM001897 RAPID, PAS 2700 2700 2700 CULTURED AFB ANTI-TUBERCULAR DRUG SENSITIVITY LM001898 RAPID, PYRAZINAMIDE 3700 3700 3700 CULTURED AFB ANTI-TUBERCULAR DRUG SENSITIVITY LM001899 RAPID, ISONIAZID 2700 2700 2700 CULTURED AFB ANTI-TUBERCULAR DRUG SENSITIVITY LM001900 RAPID, STREPTOMYCIN 2700 2700 2700 LM001901 CULTURED AFB ANTI-TUBERCULAR DRUG SENSITIVITY 2700 2700 2700 27| T a r i f f - AIMS
132 78581/2020/ESTT-NE_HRRAPID, KANAMYCIN CULTURED ANAEROBIC BACTERIA IDENTIFICATION LM001902 Does not include 1000 1000 1000 CULTURED FUNGUS IDENTIFICATION DOES NOT LM001903 INCLUDE ANTIFUNGAL SENSITIVITY 1000 1000 1000 LM001904 CYCLOSPORINE 2400 2400 2400 LM001905 CYSTATIN C 1200 1200 1200 LM001906 CYSTICERCOSIS ( TAENIA SOLIUM), IgG 1300 1300 1300 LM001907 CYSTIC FIBROSIS, NEWBORN, SCREEN 550 550 550 LM001908 CYTOLOGY, CELL BLOCK PREPARATION 550 550 550 LM001909 CYTOLOGY, CONSULTATION - SECOND OPINION 550 550 550 LM001910 CYTOLOGY (PAP SMEAR) EXAMINATION 550 550 550 CYTOMEGALOVIRUS (CMV) ANTIBODIES PANEL, IgG & LM001913 IgM 1000 1000 1000 LM001914 CYTOMEGALOVIRUS (CMV) ANTIBODY, IgG 580 580 580 LM001915 CYTOMEGALOVIRUS ANTIBODY, IgM 580 580 580 LM001916 CYTOMEGALOVIRUS (CMV), AVIDITY, IgG 580 580 580 LM001917 CYTOMEGALOVIRUS (CMV), PCR QUALITATIVE 3900 3900 3900 CYTOMEGALOVIRUS (CMV), DNA, QUANTITATIVE, LM001918 PCR 8600 8600 8600 LM001919 D - DIMER, QUANTITATIVE 1200 1200 1200 LM001920 DEEP VEIN THROMBOSIS PANEL;DVT PANEL 12200 12200 12200 LM001924 DHEA; DEHYDROEPIANDROSTERONE 2450 2450 2450 DHEA SULPHATE; DEHYDROEPIANDROSTERONE LM001925 SULPHATE 1000 1000 1000 LM001926 ACTH STIMULATION TEST FOR DHEA 4900 4900 4900 LM001931 DIGOXIN 900 900 900 LM001934 DNPH, URINE 120 120 120 DPYD (DEOXYPYRIDINOLINE) , URINE DOES NOT LM001935 INCLUDE PYRIDINOLINE 2450 2450 2450 LM001936 ECHINOCOCCUS (HYDATID SEROLOGY) IgG, SERUM 1200 1200 1200 ECHINOCOCCUS DETECTION FOR SCOLICES IN LM001937 HYDATID CYST FLUID 500 500 500 LM001947 EPIDERMAL (PEMPHIGUS) ANTIBODY, IFA 2000 2000 2000 EPIDERMAL (PEMPHIGUS) ANTIBODY, IFA in LM001948 DILUTIONS 3900 3900 3900 EPSTEIN BARR VIRUS ANTIBODIES TO VIRAL CAPSID LM001949 ANTIGEN (VCA), IgG & IgM 3000 3000 3000 LM001950 EPSTEIN-BARR VIRUS VCA, IgM 1600 1600 1600 LM001951 EPSTEIN-BARR VIRUS VCA, IgG 1600 1600 1600 LM001952 ERYTHROPOIETIN; EPO 2000 2000 2000 LM001955 ESTRIOL (uE3), UNCONJUGATED, SERUM 1230 1230 1230 LM001957 EVEROLIMUS 4600 4600 4600 LM001958 EXECUTIVE OFFICERS PANEL 1800 1800 1800 LM001961 FABRY DISEASE, QUANTITATIVE, BLOOD 2000 2000 2000 LM001962 FACTOR II, FUNCTIONAL 7200 7200 7200
28| T a r i f f - AIMS
133 78581/2020/ESTT-NE_HRLM001963 FACTOR V, FUNCTIONAL 3200 3200 3200 LM001964 FACTOR V LEIDEN MUTATION ANALYSIS 5500 5500 5500 LM001965 FACTOR VII FUNCTIONAL 2900 2900 2900 LM001966 FACTOR VIII FUNCTIONAL *FACTOR VIII ASSAY *APTT 1400 1400 1400 LM001967 FACTOR IX, FUNCTIONAL 1750 1750 1750 LM001968 FACTOR X, FUNCTIONAL 4700 4700 4700 LM001969 FACTOR XI, FUNCTIONAL 3100 3100 3100 LM001970 FACTOR XII, FUNCTIONAL 3200 3200 3200 FACTOR XIII ( CLOT SOLUBILITY),FUNCTIONAL, LM001971 QUALITATIVE 350 350 350 LM001972 FEBRILE AGGLUTININS PANEL 1230 1230 1230 LM001973 FERRIC CHLORIDE TEST, URINE 120 120 120 LM001977 FIBRINOGEN, CLOTTING ACTIVITY 690 690 690 FIBRINOGEN DEGRADATION PRODUCTS ( FDP), LM001978 BLOOD 980 980 980 LM001979 FILARIA ANTIGEN 790 790 790 LM001980 FISH for 11q 23 or LSI MLL gene breakapart 4300 4300 4300 LM001981 FISH - 14q 32.3 or LSI IGH Gene breakapart 4300 4300 4300 LM001982 FISH for BCR / ABL or Philadelphia translocation 4300 4300 4300 LM001983 FISH for 22q deletion or LSI Di George/VCFS 5600 5600 5600 FISH FOR AMNIO ONE PROBE (TRISOMY 21 / DOWN LM001984 SYNDROME) 3250 3250 3250 LM001985 FISH FOR AMNIO THREE PROBES (TRISOMY 18, X, Y) 7500 7500 7500 LM001986 FISH FOR AMNIO TWO PROBES (TRISOMY 13; 21) 5500 5500 5500 FISH - Bladder cancer recurrence: Chromosomes 3,7, LM001987 17 & p16 gene on chromosome 9 8600 8600 8600 LM001988 FISH FOR OPPOSITE SEX BMT (XX / XY) 4300 4300 4300 FISH for Breast Cancer Her-2/neu oncogene LM001989 amplification 11000 11000 11000 LM001990 FISH FOR CLL PANEL 8600 8600 8600 LM001991 FISH for del 13q or LSI D 13S319 4300 4300 4300 LM001992 FISH for inv (16) or LSI CBFB 4300 4300 4300 LM001993 FISH for MDS Panel - Chromosomes 5q, 7q, 8q & 20q. 8200 8200 8200 LM001994 FISH for Oncology 1p and 19q codeletion 9000 9000 9000 LM001995 FISH for Oncology EGFR gene amplification 8600 8600 8600 LM001996 FISH for Prader-Vili Syndrome SNRPN 6400 6400 6400 LM001997 FISH for t (11;14) or LSI IGH/CCNDI 4400 4400 4400 LM001998 FISH for t (12;21) or LSI TEL/AMLI 4300 4300 4300 LM001999 FISH for t (15;17) or LSI PML/RARA 4300 4300 4300 LM002000 FISH for t (8;21) or LSI ETO/AMLI 4300 4300 4300 LM002001 STRESS CYTOGENETICS FOR FANCONIS ANEMIA 7400 7400 7400 LM002002 FISH for 17P 4600 4600 4600 LM002003 FISH FOR MULTIPLE MYELOMA (5 PROBES) 12200 12200 12200 Flow Cytometry, CD 10 / CALLA (Prognostic ALL LM002004 marker) 2050 2050 2050 LM002005 Flow Cytometry, CD 117 (Myeloid cell marker) 2050 2050 2050 29| T a r i f f - AIMS
134 78581/2020/ESTT-NE_HRLM002006 Flow Cytometry, CD 11c (Hairy cell/NHL marker) 2050 2050 2050 LM002007 Flow Cytometry, CD 13 (Myeloid cell marker) 2050 2050 2050 LM002008 Flow Cytometry, CD 14 (Monocytic cell marker) 2050 2050 2050 LM002009 FLOW CYTOMETRY, INDIVIDUAL MARKER - CD 15 2050 2050 2050 LM002011 Flow Cytometry, CD 19 (Pan B cell marker) 2050 2050 2050 LM002012 Flow Cytometry, CD 2 (Pan T cell marker) 2050 2050 2050 LM002013 Flow Cytometry, CD 20 ( Pan B cell marker) 2050 2050 2050 LM002014 Flow Cytometry, CD 22 (Pan B cell marker) 2050 2050 2050 LM002015 Flow Cytometry, CD 23 (CLL segregation marker) 2050 2050 2050 LM002016 Flow Cytometry, CD 25 (Hairy cell/NHL marker) 2050 2050 2050 LM002017 Flow Cytometry, CD 3( Pan T cell marker) 2050 2050 2050 LM002018 Flow Cytometry, CD 33 ( Myeloid cell marker) 2050 2050 2050 LM002019 Flow Cytometry, CD 34 (Precursor cell marker) 2300 2300 2300 Flow Cytometry, CD 38 (Plasma cell/prognostic CLL LM002020 marker) 2050 2050 2050 LM002021 Flow Cytometry, CD 4 (Helper T cell marker) 1600 1600 1600 LM002022 FLOW CYTOMETRY, INDIVIDUAL MARKER - CD 41a 2050 2050 2050 FLOW CYTOMETRY, CD 45/ LCA (LEUKOCYTE LM002023 COMMON ANTIGEN ) 2050 2050 2050 LM002024 Flow Cytometry, CD 5 ( T cell / B cell subset) 2050 2050 2050 LM002026 FLOW CYTOMETRY, INDIVIDUAL MARKER - CD 61 2050 2050 2050 Flow Cytometry, CD 7 (Pan T cell/early myeloid cell LM002027 marker) 2050 2050 2050 LM002028 Flow Cytometry, CD 79a (B Lymphoid cell marker) 2050 2050 2050 LM002030 Flow Cytometry, CD MPO (Myeloid cell marker) 2050 2050 2050 LM002031 Flow Cytometry, CD103 (Hairy cell marker) 2050 2050 2050 LM002032 Flow Cytometry, FMC-7 (Prognostic CLL/NHLmarker) 2050 2050 2050 LM002033 Flow Cytometry, Glycophorin (Erythroid cell marker) 2050 2050 2050 LM002034 Flow Cytometry, HLA DR ( Activation marker) 2050 2050 2050 FLOW CYTOMETRY, INDIVIDUAL MARKER - IgG LM002039 Heavy Chain (Cytoplasmic) 2050 2050 2050 LM002040 FLOW CYTOMETRY, IGG HEAVY CHAIN SURFACE 2050 2050 2050 FLOW CYTOMETRY, INDIVIDUAL MARKER - IgM LM002041 Heavy Chain (Cytoplasmic) 2050 2050 2050 LM002042 FLOW CYTOMETRY, IGM HEAVY CHAIN SURFACE 2050 2050 2050 LM002043 FLOW CYTOMETRY, KAPPA & LAMBDA LIGHT CHAINS 3900 3900 3900 LM002044 Flow Cytometry,TdT (Precursor cell marker) 2050 2050 2050 LM002045 FLOW CYTOMETRY, ZAP-70 2050 2050 2050 LM002046 Flow Cytometry,CD 138 ( Plasma cell marker) 2050 2050 2050 LM002047 FLOW CYTOMETRY, INDIVIDUAL MARKER - CD 36 2050 2050 2050 LM002048 FLOW CYTOMETRY, CD 64 2050 2050 2050 LM002049 FLOW CYTOMETRY, CD 123 2050 2050 2050 LM002054 FOLATE (FOLIC ACID), RBC Includes Serum Folate. 2100 2100 2100 LM002055 FOLATE (FOLIC ACID), SERUM 1150 1150 1150 LM002056 FRUCTOSAMINE 470 470 470
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135 78581/2020/ESTT-NE_HRGONADOTROPIN RELEASING HORMONE (GnRH) LM002058 STIMULATION TEST FOR F 3800 3800 3800 FUNGUS EXAMINATION, ROUTINE, KOH LM002060 PREPARATION 300 300 300 LM002063 G-6-PD, QUANTITATIVE 830 830 830 LM002064 G-6-PD, NEWBORN SCREEN 250 250 250 LM002065 GAD-65 (GLUTAMIC ACID DECARBOXYLASE- 65), IgG 6200 6200 6200 LM002066 GALACTOSE -1-PHOSPHATE, QUANTITATIVE, BLOOD 1700 1700 1700 LM002067 GALACTOSE, QUANTITATIVE, PLASMA 1600 1600 1600 GALACTOSEMIA CLASSICAL (TRANSFERASE), LM002068 QUANTITATIVE, BLOOD 1900 1900 1900 GALACTOSEMIA (EPIMERASE), QUANTITATIVE, LM002069 BLOOD 2450 2450 2450 LM002070 GALACTOSEMIA, NEWBORN SCREEN 250 250 250 GALACTOSEMIA PANEL 1 *GALACTOSEMIA SCREENING *GALACTOSEMIA CLASSICAL LM002071 (TRANSFERASE) 2450 2450 2450 GALACTOSEMIA PANEL 2 *Galactosemia Panel 1* LM002072 Galactose Plasma 3350 3350 3350 GALACTOSEMIA PANEL 3 *GALACTOSEMIA CLASSICAL LM002073 (TRANSFERASE) *GALACTOSEMIA (EPIMERASE) 3900 3900 3900 LM002074 GALACTOSEMIA SCREENING, BLOOD 700 700 700 LM002076 GASTRIN 1200 1200 1200 LM002077 GASTRIN STIMULATION BY SECRETIN 8400 8400 8400 LM002078 GAUCHER DISEASE, QUANTITATIVE, BLOOD 1900 1900 1900 GFR ( GLOMERULAR FILTRATION RATE) (MDRD LM002079 FORMULA) 200 200 200 GGTP; GGT; GAMMA GT; GAMMA GLUTAMYL LM002080 TRANSPEPTIDASE 250 250 250 LM002081 GIEMSA STAIN 350 350 350 LM002082 GLIADIN ANTIBODIES PANEL, IgA & IgG 3000 3000 3000 LM002083 GLIADIN ANTIBODY, IgA 1700 1700 1700 LM002084 GLIADIN ANTIBODY, IgG 1700 1700 1700 GLOMERULAR BASEMENT MEMBRANE (GBM ) LM002085 ANTIBODY, IFA 1240 1240 1240 LM002098 GM1 GANGLIOSIDOSIS, QUANTITATIVE, BLOOD 1700 1700 1700 GM2 GANGLIOSIDOSIS, QUANTITATIVE, BLOOD; TAY LM002099 SACHS AND SANDHOFF DISEASE 2400 2400 2400 LM002100 GOODPASTURES SYNDROME PANEL *GBM *c-ANCA 3130 3130 3130 GROWTH DISORDER PANEL *Growth Hormone LM002102 *IGFBP-3 *IGF-I 8000 8000 8000 LM002103 GROWTH HORMONE; GH 750 750 750 LM002104 GROWTH HORMONE STIMULATION TEST 3000 3000 3000 LM002105 GROWTH HORMONE SUPPRESSION TEST 2250 2250 2250 HAM TEST; PAROXYSMAL NOCTURNAL LM002107 HEMOGLOBINURIA (PNH), SCREENING TEST 1200 1200 1200 LM002108 HAPTOGLOBIN 1900 1900 1900
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136 78581/2020/ESTT-NE_HRHBDH; ALPHA - HYDROXYBUTYRATE LM002110 DEHYDROGENASE 250 250 250 LM002111 HBV DRUG RESISTANCE & GENOTYPING 10000 10000 10000 LM002112 FREE BETA HCG QUANTITATIVE 690 690 690 LM002114 HCG, BETA, TOTAL, QUANTITATIVE, TUMOR MARKER 650 650 650 LM002118 HEINZ BODIES, PERIPHERAL BLOOD 130 130 130 LM002119 HELICOBACTER PYLORI ANTIBODIES PANEL IgA & IgG 3100 3100 3100 LM002120 HELICOBACTER PYLORI, IgA 1600 1600 1600 LM002121 HELICOBACTER PYLORI, IgG 1600 1600 1600 LM002123 HEMOGLOBIN, FREE, URINE 190 190 190 LM002126 HEMOPHILIA PANEL *APTT *Factor VIII *Factor IX 2800 2800 2800 LM002127 HEMOSIDERIN, URINE 350 350 350 LM002128 HEPATITIS A ANTIBODY (Anti-HAV), IGG 1190 1190 1190 HEPATITIS A DIAGNOSTIC PANEL *Anti - HAV, IgG * LM002129 Anti - HAV, IGM 2200 2200 2200 HEPATITIS ATYPICAL VIRUS CONFIRMATION *CMV IGM *HSV IGM *VARICELLA ZOSTER IGM * EBV (VCA) LM002134 IGM 3780 3780 3780 HEPATITIS A & B VIRUS EVALUATION *Anti-HAV IGG *Anti-HAV IGM *Anti-HBCORE TOTAL * Anti-HBc $ LM002135 IGM * Anti-HBS * HBsAG * Anti-Hbe * HBeAG 6500 6500 6500 HEPATITIS B CHRONIC PANEL *HBSAG * HBeAG * LM002136 Anti-HBe 1900 1900 1900 LM002137 HEPATITIS B CORE ANTIBODY (Anti-HBC), IGM 1100 1100 1100 LM002138 HEPATITIS B CORE ANTIBODY (Anti-HBC), TOTAL 1100 1100 1100 HEPATITIS B IMMUNITY SCREEN *Anti-HBc TOTAL LM002139 *Anti-HBS *HBSAG 2500 2500 2500 HEPATITIS B INFANT FOLLOW-UP PANEL *HBsAG LM002140 *Anti-HBs 1000 1000 1000 HEPATITIS B PROFILE *HBsAG *Anti -HBs *HBEAG LM002141 *Anti-HBe *Anti-HBCORE IGM* Anti-HBCORE TOTAL 4200 4200 4200 HEPATITIS B SURFACE ANTIGEN (HBSAG) LM002144 CONFIRMATION NEUTRALIZATION 650 650 650 HEPATITIS B VIRAL DNA (HBV DNA) QUANTITATIVE, LM002145 REA 7500 7500 7500 HEPATITIS B VIRUS, PCR, QUALITATIVE; HBV DNA LM002146 PCR, QUALITATIVE 4400 4400 4400 LM002147 HEPATITIS BE ANTIBODY; Anti-Hbe 800 800 800 LM002148 HEPATITIS Be ANTIGEN; HBeAg 900 900 900 LM002149 HEPATITIS BE PANEL *Anti- HBe * HBeAG 1500 1500 1500 HCV COMBO (RT PCR) TEST *HCV QNT RT PCR * HCV LM002152 GENOTYPE 15000 15000 15000 HEPATITIS C VIRAL RNA (HCV RNA) QUANTITATIVE, LM002153 REAL TIME PCR 8400 8400 8400 HEPATITIS C VIRAL RNA (HCV RNA) QUANTITATIVE, LM002153 REAL TIME PCR 4500 4500 4500 LM002155 HEPATITIS C VIRAL RNA (HCV RNA), GENOTYPE 6700 6700 6700 LM002156 HEPATITIS C VIRAL(HCV), PCR, QUALITATIVE 4300 4300 4300 32| T a r i f f - AIMS
137 78581/2020/ESTT-NE_HRLM002157 HEPATITIS DELTA ANTIBODY (Anti-HDV) IGM 2550 2550 2550 LM002158 HEPATITIS E ANTIBODY (Anti-HEV), IGG 1600 1600 1600 LM002161 HERPES SIMPLEX VIRUS (HSV) 1+2 , IGG, SERUM 620 620 620 LM002162 HERPES SIMPLEX VIRUS (HSV)1 + 2, IGM, SERUM 620 620 620 HERPES SIMPLEX VIRUS (HSV) 1+2 , IGG & IGM, LM002163 SERUM 1140 1140 1140 HERPES SIMPLEX VIRUS (HSV) TYPE I, PCR, LM002164 QUALITATIVE 3700 3700 3700 HERPES SIMPLEX VIRUS (HSV) TYPE 2, PCR, LM002165 QUALITATIVE 3700 3700 3700 HERPES SIMPLEX VIRUS (HSV) TYPE 1 & 2, PCR, LM002166 QUALITATIVE 6100 6100 6100 HIRSUTISM PANEL *ANDROSTENEDIONE *DHEA LM002167 SULPHATE *FREE TESTOSTERONE 4500 4500 4500 LM002169 HISTONE ANTIBODIES 1350 1350 1350 LM002178 HISTOPATHOLOGY, BIOPSY - SECOND OPINION 800 800 800 LM002197 HISTOPATHOLOGY, KIDNEY BIOPSY PANEL 1 3600 3600 3600 LM002198 HISTOPATHOLOGY, KIDNEY BIOPSY PANEL 2 1700 1700 1700 HISTOPATHOLOGY, SPECIAL STAIN, COPPER LM002204 (RHODANINE) 480 480 480 HISTOPATHOLOGY, SPECIAL STAIN, FONTANA LM002205 MASSON 480 480 480 HISTOPATHOLOGY, SPECIAL STAIN, LM002212 PHOSPHOTUNGSTIC ACID (PTAH) 480 480 480 LM002213 HISTOPATHOLOGY, SPECIAL STAIN, RETICULIN 480 480 480 LM002216 HIV 1 & 2 ANTIBODIES, WESTERN BLOT 3350 3350 3350 LM002217 HIV 1 RNA QUANTITATIVE, REAL TIME PCR 5000 5000 5000 HIV 1 RNA QUANTITATIVE, REAL TIME PCR WITH CD3 LM002218 / CD4 (IMMUNE DEFICIENCY PANEL 4) 6180 6180 6180 HIV 1 RNA QUANTITATIVE, REAL TIME PCR WITH CD3, LM002219 CD4/ CD8 (IMMUNE DEFICIENCY PANEL 2) 7000 7000 7000 LM002220 HLA - T & B CELL LYMPHOCYTE CROSS MATCH 3500 3500 3500 LM002221 HLA - AB (CLASS 1) TYPING 7400 7400 7400 LM002223 HLA-B27 PCR, QUALITATIVE 2900 2900 2900 LM002224 HLA - B5 (51 / 52) 4300 4300 4300 LM002225 HLA-B8 4300 4300 4300 LM002226 HLA - B15 4300 4300 4300 LM002227 HLA - B 38 4300 4300 4300 HLA CELIAC DISEASE ( DQB1*02, 1*03, DQA1*05, LM002228 1*03) 5700 5700 5700 HLA DNA TYPING FOR KIDNEY / LIVER TRANSPLANT, LM002229 PCR (ABDR TYPING) 14800 14800 14800 HLA DNA TYPING FOR BONE MARROW TRANSPLANT, LM002230 PCR (ABC / DR / DQ TYPING) 21000 21000 21000 LM002231 HLA - DR2 (DRB1*02) 4300 4300 4300 LM002232 HLA - DR3 (DRB1*03) 4300 4300 4300 LM002233 HLA - DR4 (DRB1*04) 4300 4300 4300
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138 78581/2020/ESTT-NE_HRLM002234 HLA - DR5 (DRB1*05) 4300 4300 4300 LM002235 HLA - DR7 ( (DRB1*07) 4300 4300 4300 LM002236 HLA - DR (CLASS II) TYPING 7400 7400 7400 HLA - PANEL REACTIVE IgG ANTIBODIES (PRA), LM002237 SCREEN 5790 5790 5790 LM002238 HOMOCYSTEINE, QUANTITATIVE, SERUM 900 900 900 LM002239 HOMOVANILLIC ACID (HVA), 24-HOUR URINE 8000 8000 8000 LM002239 HOMOVANILLIC ACID (HVA), 24-HOUR URINE 4000 4000 4000 LM002240 HOMOVANILLIC ACID (HVA), RANDOM URINE 8000 8000 8000 LM002240 HOMOVANILLIC ACID (HVA), RANDOM URINE 4000 4000 4000 HPV DETECTION AND GENOTYPING, QUALITATIVE LM002241 PCR 1100 1100 1100 LM002245 IGF BINDING PROTEIN - 3; IGFBP - 3 4050 4050 4050 LM002246 IGF - I & GROWTH HORMONE PANEL 4500 4500 4500 LM002247 IGF - I; SOMATOMEDIN - C 3990 3990 3990 IMD PANEL, QUANTITATIVE BLOOD *AMINO ACIDS LM002248 *ORGANIC ACIDS *FATTY ACIDS 4000 4000 4000 IMMUNE DEFICIENCY PANEL 1 * CD3 * CD4 * CD8 * LM002249 CD19 * CD16+/CD56 6200 6200 6200 IMMUNE DEFICIENCY PANEL 2; CD4/CD8 PANEL * LM002250 CD3 * CD4 * CD8 2390 2390 2390 LM002251 IMMUNE DEFICIENCY PANEL 3; CD 3 COUNT 2050 2050 2050 IMMUNE DEFICIENCY PANEL 4; CD 4 COUNTS *CD3 * LM002252 CD4 1600 1600 1600 LM002253 IMMUNE DEFICIENCY PANEL 5 *CD3 * CD19 2600 2600 2600 IMMUNOFIXATION ELECTROPHORESIS (IFE), 24- LM002254 HOUR URINE 8000 8000 8000 LM002255 IMMUNOFIXATION ELECTROPHORESIS (IFE), SERUM 6200 6200 6200 LM002256 IMMUNOGLOBULIN IgA, SERUM 350 350 350 LM002257 IMMUNOGLOBULIN IgD & IgE TYPING, SERUM 6950 6950 6950 LM002258 IMMUNOGLOBULIN IgD & IgE TYPING,URINE 8400 8400 8400 LM002260 IMMUNOGLOBULIN IgG SYNTHESIS INDEX & RATE 2450 2450 2450 LM002261 IMMUNOGLOBULIN IgG, CSF 1380 1380 1380 LM002262 IMMUNOGLOBULIN IgG, SERUM 350 350 350 LM002263 IMMUNOGLOBULIN IgM, SERUM 430 430 430 LM002264 IMMUNOGLOBULIN PROFILE, SERUM *IgG *IgA *IgM 1040 1040 1040 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002271 ACTH 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002272 ACTIN (SMOOTH MUSCLE ACTIN) 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002274 bcl-2 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER,34, LM002275 BETA E12 1940 1940 1940 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002276 CALRETININ 1570 1570 1570 LM002277 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, 1570 1570 1570
34| T a r i f f - AIMS
139 78581/2020/ESTT-NE_HRCATHEPSIN D IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, CD LM002278 15 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, CD LM002279 20 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, CD LM002280 3 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, CD LM002281 30 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, CD LM002282 45 (LCA) 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, CD LM002283 45 RO (PAN T) 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, CD LM002284 68 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, CD LM002285 79a 1900 1900 1900 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, CD LM002286 99 (MIC-2) 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002287 CD10 1900 1900 1900 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002288 CD117 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002289 CD23 1900 1900 1900 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002290 CD31 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002291 CD34 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002292 CD5 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, c- LM002293 erb B2/Her-2-neu 1400 1400 1400 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002294 Chromogranin A 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002295 CYCLIN-D1 1900 1900 1900 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002296 CYTOKERATIN (PANCYTOKERATIN) 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002297 CYTOKERATIN 7 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002298 CYTOKERATIN 20 1900 1900 1900 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002299 Desmin 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002300 EGFR (EPIDERMAL GROWTH FACTOR RECEPTOR) 1900 1900 1900 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002301 EMA (EPITHELIAL MEMBRANE ANTIGEN) 1570 1570 1570 LM002302 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, ER 1300 1300 1300 35| T a r i f f - AIMS
140 78581/2020/ESTT-NE_HR(ESTROGEN RECEPTOR) IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002304 GFAP (GLIAL FIBRILLIARY ACIDIC PROTEIN) 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002305 Growth Hormone 1900 1900 1900 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002306 HMB 45 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002307 INHIBIN 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002308 KAPPA LIGHT CHAINS 1900 1900 1900 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, Ki LM002309 67 1900 1900 1900 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002310 LAMBDA LIGHT CHAINS 1900 1900 1900 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002311 MYELOPEROXIDASE 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002312 NEUROFILAMENT POLYPEPTIDE 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002313 NSE (NEURON SPECIFIC ENOLASE) 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002314 p53 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002317 PSA (PROSTATE SPECIFIC ANTIGEN) 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002318 pS2 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002319 S100 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002320 SYNAPTOPHYSIN 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL LM002321 MARKER,TdT 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002322 Thyroglobulin 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL LM002323 MARKER,TTF-1 1900 1900 1900 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002324 Vimentin 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL LM002325 MARKER,WT-1 1900 1900 1900 LM002331 INHIBIN A, PREGNANCY 750 750 750 LM002332 INHIBIN A, REPRODUCTIVE MARKER 750 750 750 LM002333 INSULIN ANTIBODIES 1990 1990 1990 LM002334 INSULIN, FASTING 800 800 800 LM002335 INSULIN, FASTING (F) & POST PRANDIAL (PP) PANEL 1550 1550 1550 LM002336 INTERLEUKIN 28B GENOTYPING 5200 5200 5200 Inv 16 (p13q22) / t(16;16)(p13;q22) GENE LM002337 REARRANGEMENT, PCR QUALITATIVE 4200 4200 4200
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141 78581/2020/ESTT-NE_HRLM002339 ISLET CELL ANTIBODY 1790 1790 1790 LM002340 ISLET CELL ANTIBODY, IN DILUTIONS 3300 3300 3300 LM002341 JAK 2 MUTATION DETECTION, QUALITATIVE PCR 5300 5300 5300 LM002342 Jo-1 ANTIBODY 1350 1350 1350 LM002343 KAPPA / LAMBDA LIGHT CHAINS, FREE, SERUM 6500 6500 6500 LM002344 KAPPA / LAMBDA LIGHT CHAINS, FREE, URINE 6500 6500 6500 LM002347 STONE ANALYSIS WITH PICTURE 1050 1050 1050 LM002348 KIDNEY STONE FORMATION, DIAGNOSTIC PANEL 5500 5500 5500 KIDNEY STONE FORMATION, THERAPEUTIC LM002349 MONITORING PANEL 4700 4700 4700 LM002350 LACTATE, CSF 970 970 970 LM002351 LACTATE, PLASMA 970 970 970 LM002355 LDL SUBFRACTIONS 5000 5000 5000 LM002356 LE CELL PHENOMENON 350 350 350 LM002357 LEAD POISONING PANEL *5-ALA * LEAD BLOOD 5500 5500 5500 LM002358 LEAD, BLOOD 1640 1640 1640 LM002359 LEAD, 24-HOUR URINE 1640 1640 1640 LM002360 LEAD, RANDOM URINE 1640 1640 1640 LM002361 LEISHMANIA ( KALA AZAR) ANTIBODY, IgG 1600 1600 1600 LM002362 LEPTIN 3900 3900 3900 LEUCOCYTE ALKALINE PHOSPHATASE SCORE; LAP LM002366 SCORE 830 830 830 LM002367 AML CATEGORIZATION, PCR 8000 8000 8000 LM002368 LEUKEMIA DIAGNOSTIC COMPREHENSIVE PROFILE 1 18000 18000 18000 LM002370 LEUKEMIA DIAGNOSTIC COMPREHENSIVE PROFILE 3 13000 13000 13000 LEUKEMIA DIAGNOSTIC PANEL: ACUTE LEUKEMIA - T, LM002372 B or MYELOID 9000 9000 9000 LEUKEMIA DIAGNOSTIC PANEL: AML LM002373 CHARACTERIZATION 10700 10700 10700 LEUKEMIA / LYMPHOMA DIAGNOSTIC PANEL: CHRONIC LYMPHOPROLIFERATIVE DISORDERS, T & B LM002374 CELL 15000 15000 15000 LM002376 LEUKEMIA DIAGNOSTIC PANEL;CLL/HCL/SLL (BASIC) 9000 9000 9000 LM002377 LEUKEMIA MONITORING PANEL: HAIRY CELL 9300 9300 9300 LEUKEMIA DIAGNOSTIC PANEL,CUSTOMIZED, ANY 10 LM002378 MARKERS 9300 9300 9300 LM002381 LIPASE 630 630 630 LM002387 LIPOPROTEIN (a); Lp(a) 920 920 920 LM002388 LITHIUM 300 300 300 LM002389 LIVER KIDNEY MICROSOMAL (LKM) ANTIBODY, IFA 1600 1600 1600 LIVER KIDNEY MICROSOMAL (LKM) ANTIBODY IN LM002390 DILUTIONS, IFA 3100 3100 3100 LM002394 LUPUS ANTICOAGULANT BY DRVVT 1700 1700 1700 LUPUS ANTICOAGULANT PANEL; LAC PANEL *APTT LM002395 *PTT - LA *dRVVT 2730 2730 2730 LM002396 LUPUS ERYTHEMATOSUS PANEL; SLE PANEL *ANA 4150 4150 4150
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142 78581/2020/ESTT-NE_HR*ds DNA LYME DISEASE (BORRELIA BURGDORFERI) LM002397 ANTIBODIES, IgG & IgM 3300 3300 3300 LM002398 LYMPHOMA DIAGNOSTIC PANEL 17000 17000 17000 LM002402 MALARIA ANTIBODY 1100 1100 1100 LM002405 MANGANESE,BLOOD 1900 1900 1900 LM002406 MANGANESE, 24-HOUR URINE 1900 1900 1900 LM002407 MANGANESE, RANDOM URINE 1900 1900 1900 LM002416 MEASLES (RUBEOLA) ANTIBODIES PANEL, IgG & IgM 3000 3000 3000 LM002417 MEASLES (RUBEOLA) ANTIBODY, IgG 1600 1600 1600 LM002418 MEASLES (RUBEOLA) ANTIBODY, IgM 1600 1600 1600 LM002422 MERCURY, 24-HOUR URINE 3240 3240 3240 LM002423 MERCURY, RANDOM URINE 3240 3240 3240 LM002424 METABOLIC SCREEN, BASIC, URINE 630 630 630 METABOLIC SCREEN, COMPREHENSIVE, URINE *METABOLIC SCREEN, BASIC * AMINO ACIDS LM002425 QUALITATIVE 1600 1600 1600 METACHROMATIC LEUCODYSTROPHY, LM002426 QUANTITATIVE, BLOOD 1900 1900 1900 METANEPHRINES, 24-HOUR URINE *METANEPHRINE LM002427 * NORMETANEPHRINE 10800 10800 10800 METANEPHRINES, RANDOM URINE *Metanephrine * LM002428 Normetanephrine 10800 10800 10800 LM002429 METHYLMALONIC ACID, QUALITATIVE, URINE 250 250 250 LM002430 MICROALBUMIN, 24-HOUR URINE 550 550 550 LM002434 MITOCHONDRIAL ANTIBODY (AMA), IFA 1700 1700 1700 MITOCHONDRIAL ANTIBODY (AMA), IFA IN LM002435 DILUTIONS 2900 2900 2900 LM002436 MONO TEST (INFECTIOUS MONONUCLEOSIS) 1100 1100 1100 LM002437 MTHFR GENE MUTATION, QUALITATIVE PCR 3200 3200 3200 LM002438 MUCOPOLYSACCHARIDOSIS (MPS) SCREEN, URINE 350 350 350 MUCOPOLYSACCHARIDOSIS (MPS) TYPING, 24 HOUR LM002439 URINE 3790 3790 3790 MUCOPOLYSACCHARIDOSIS (MPS) TYPE 1 (HURLER), LM002440 QUANTITATIVE, BLOOD 4700 4700 4700 MUCOPOLYSACCHARIDOSIS (MPS) TYPE VI LM002441 (MAROTEAUX LAMY), QUANTITATIVE BLOOD 1640 1640 1640 MULTIPLE SCLEROSIS PANEL 1 *IGG SYNTHESIS INDEX LM002442 & RATE *OLIGOCLONAL BANDS, CSF 5750 5750 5750 MULTIPLE SCLEROSIS PANEL 2 $ *IgG Synthesis Index & Rate *Oligoclonal Bands, CSF *Myelin Basic Protein, LM002443 CSF (Code RW135) 11000 11000 11000 LM002444 MUMPS VIRUS ANTIBODIES PANEL, IgG & IgM 3100 3100 3100 LM002445 MUMPS VIRUS ANTIBODY, IgG 1600 1600 1600 LM002446 MUMPS VIRUS ANTIBODY, IgM 1600 1600 1600 MYCOBACTERIUM COMBINED PANEL; TB. COM *MTB LM002448 PCR * CULTURE AFB * ZN STAIN 2700 2700 2700
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143 78581/2020/ESTT-NE_HRMYCOBACTERIUM TUBERCULOSIS, PCR; MYCOSURE; LM002453 TB PCR 2000 2000 2000 MYELOPEROXIDASE (MPO) STAIN, BLOOD / BONE LM002454 MARROW 450 450 450 LM002458 NATURAL KILLER CELLS *CD3 *CD16 / CD56 3900 3900 3900 NEUROBLASTOMA PROFILE, 24-HOUR URINE *VMA * LM002459 HVA 11000 11000 11000 LM002460 NEURON SPECIFIC ENOLASE (NSE), SERUM 3200 3200 3200 LM002461 NEWBORN SCREENING 1800 1800 1800 LM002462 NEWBORN SCREENING, EXTENDED 5000 5000 5000 LM002463 NICKEL, 24-HOUR URINE 3100 3100 3100 LM002464 NICKEL, RANDOM URINE 3100 3100 3100 LM002465 NIEMANN PICK DISEASE, QUANTITATIVE, BLOOD 2190 2190 2190 LM002466 NITROPRUSSIDE TEST, URINE 120 120 120 LM002467 NITROSONAPHTHOL, URINE 120 120 120 OBSTETRIC FLOW PANEL * Natural Killer (NK) cells * LM002469 CD 19 5300 5300 5300 LM002470 OPIATES SCREEN, RANDOM URINE 650 650 650 LM002471 OROTIC ACID 3500 3500 3500 LM002472 OSMOLALITY, URINE 690 690 690 LM002473 OSMOLALITY, SERUM 690 690 690 LM002474 OSMOTIC FRAGILITY TEST; RBC FRAGILITY TEST 490 490 490 LM002475 OSTEOCALCIN, SERUM; BONE Gla PROTEIN (BGP) 2730 2730 2730 LM002476 OSTEOPOROSIS PANEL 11500 11500 11500 LM002477 OXALATE, 24-HOUR URINE 1700 1700 1700 LM002481 PARIETAL CELL ANTIBODY, IFA 1480 1480 1480 LM002482 PARIETAL CELL ANTIBODY, IFA IN DILUTIONS 2990 2990 2990 PAROXYSMAL NOCTURNAL HEMOGLOBINURIA (PNH), LM002483 CONFIRMATORY TEST 6300 6300 6300 LM002484 MIXING STUDIES - APTT 2800 2800 2800 PARTIAL THROMBOPLASTIN TIME - LUPUS LM002485 ANTICOAGULANT SPECIFIC 660 660 660 PARTIALTHROMBOPLASTIN TIME, ACTIVATED; PTT; LM002486 APTT 500 500 500 LM002487 PARVOVIRUS B - 19 ANTIBODIES PANEL, IgG & IgM 4550 4550 4550 LM002488 PARVOVIRUS B - 19 ANTIBODY, IgG 2450 2450 2450 LM002489 PARVOVIRUS B - 19 ANTIBODY, IgM 2450 2450 2450 PAS ( PERIODIC ACID SCHIFF) STAIN, BLOOD / BONE LM002490 MARROW 490 490 490 LM002491 PCOD (POLYCYSTIC OVARIAN DISEASE) PANEL 3100 3100 3100 LM002492 PERITONEAL DIALYSIS ADEQUACY TEST 880 880 880 LM002493 PERITONEAL EQUILIBRIUM TEST (PET) 1450 1450 1450 LM002494 PERITONEAL EQUILIBRIUM & ADEQUACY TEST 2050 2050 2050 LM002495 PHENCYCLIDINE (PCP), SCREEN, URINE 630 630 630 LM002496 PHENOBARBITONE 920 920 920 LM002497 PHENYLALANINE, NEWBORN SCREEN 250 250 250
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144 78581/2020/ESTT-NE_HRLM002498 PHENYTOIN 970 970 970 PHEOCHROMOCYTOMA PROFILE,CHROMOGRANIN A & 24-HOUR URINE *VMA *METANEPHRINES $ LM002499 *CATECHOLAMINES* 15500 15500 15500 LM002500 PHOSPHATIDYLSERINE ANTIBODIES PANEL, IgG & IgM 4150 4150 4150 LM002501 PHOSPHATIDYLSERINE ANTIBODY, IgG 2200 2200 2200 LM002502 PHOSPHATIDYLSERINE ANTIBODY, IgM 2200 2200 2200 LM002503 PHOSPHOLIPID ANTIBODIES PANEL,IgG & IgM 1400 1400 1400 LM002504 PHOSPHOLIPID ANTIBODY, IgG 800 800 800 LM002505 PHOSPHOLIPID ANTIBODY, IgM 800 800 800 LM002506 PHOSPHOLIPID SYNDROME PANEL 4500 4500 4500 LM002510 PLASMA RENIN ACTIVITY 5200 5200 5200 LM002512 PLATELET DISTRIBUTION WIDTH; PDW 170 170 170 PML-RARA GENE REARRANGEMENT, QUALITATIVE, LM002513 PCR 5200 5200 5200 LM002516 POLARIZING MICROSCOPY, BODY FLUIDS 300 300 300 LM002517 POMPE DISEASE, QUANTITATIVE, BLOOD 2450 2450 2450 LM002518 PORPHOBILINOGEN (PBG), QUALITATIVE, URINE 3490 3490 3490 LM002519 PORPHYRINS TOTAL, QUANTITATIVE, 24-HOUR URINE 4400 4400 4400 LM002520 PORPHYRINS TOTAL, QUALITATIVE, RANDOM URINE 4400 4400 4400 PRENATAL DIAGNOSIS PANEL 2, AMNIOTIC FLUID LM002527 *Mucopolysaccharidoses (MPS) 5000 5000 5000 LM002529 PROGESTERONE RECEPTOR; PR 1300 1300 1300 LM002530 PROGESTERONE, SERUM 550 550 550 LM002533 PROTEIN & IMMUNOGLOBULIN PANEL 1700 1700 1700 LM002534 PROTEIN C, FUNCTIONAL 3950 3950 3950 LM002535 PROTEIN ELECTROPHORESIS & IFE, SERUM 6700 6700 6700 PROTEIN ELECTROPHORESIS, 24-HOUR URINE Does LM002536 not include IFE. 3900 3900 3900 LM002537 PROTEIN ELECTROPHORESIS, SERUM 680 680 680 LM002538 PROTEIN S, FUNCTIONAL 3300 3300 3300 LM002544 PROTHROMBIN GENE MUTATION ANALYSIS 3300 3300 3300 LM002546 PSA ( PROSTATE - SPECIFIC ANTIGEN), FREE 850 850 850 PSA PROFILE *PSA, TOTAL *PSA, FREE *FREE/TOTAL LM002548 PERCENT 1450 1450 1450 LM002551 PYRUVATE; PYRUVIC ACID 3250 3250 3250 LM002552 QUANTIFERON -TB GOLD; GAMMA INTERFERON 2550 2550 2550 LM002553 RAPID TB ANTIGEN MPT 64 600 600 600 RHEUMATOID AUTOIMMUNE COMPREHENSIVE LM002558 PANEL 10000 10000 10000 LM002562 RHEUMATOID FACTOR, IgA 840 840 840 RUBELLA (GERMAN MEASLES) ANTIBODIES PANEL, LM002563 IgG & IgM 1050 1050 1050 LM002564 RUBELLA (GERMAN MEASLES) ANTIBODY, IgG 600 600 600 LM002565 RUBELLA (GERMAN MEASLES) ANTIBODY, IgM 600 600 600 LM002566 RUBELLA (GERMAN MEASLES) AVIDITY, IGG 580 580 580 40| T a r i f f - AIMS
145 78581/2020/ESTT-NE_HRLM002567 Scl-70 (SCLERODERMA ) ANTIBODY 1150 1150 1150 SCLERODERMA PANEL *Scl - 70 *Centromere LM002568 Antibody 2100 2100 2100 LM002569 SELENIUM, 24-HOUR URINE 3100 3100 3100 LM002570 SELENIUM, RANDOM URINE 3100 3100 3100 LM002571 SELENIUM, SERUM 3100 3100 3100 LM002573 SEMEN FRUCTOSE Qualitative 250 250 250 LM002574 SERUM ALBUMIN ASCITES GRADIENT (SAAG) 300 300 300 LM002575 SEX HORMONE BINDING GLOBULIN; SHBG 2350 2350 2350 LM002578 SICKLING, SCREENING TEST 160 160 160 LM002579 SILVER NITROPRUSSIDE TEST, URINE 120 120 120 LM002580 SIROLIMUS ( RAPAMYCIN) 4600 4600 4600 SJOGRENS SYNDROME ANTIBODIES *SS-A/Ro *SS- LM002581 B/La 2500 2500 2500 LM002582 SM (SMITH), ANTIBODY, IGG 970 970 970 LM002583 SMEAR EXAMINATION, GONOCOCCUS 300 300 300 LM002584 SMEAR EXAMINATION, ROUTINE 170 170 170 LM002585 SMOOTH MUSCLE ANTIBODY (ASMA), IFA 1700 1700 1700 SMOOTH MUSCLE ANTIBODY (ASMA), IFA IN LM002586 DILUTIONS 3300 3300 3300 LM002592 SPHINGOLIPIDOSIS PANEL 1 8700 8700 8700 SPHINGOLIPIDOSIS PANEL 2 *GAUCHER DISEASE LM002593 *NIEMANN PICK DISEASE 4050 4050 4050 SPHINGOLIPIDOSIS PANEL 3 $ *GM 1 Gangliosidosis LM002594 *Gaucher Disease *Niemann Pick Disease 5000 5000 5000 LM002599 SS-A/Ro ANTIBODY 1450 1450 1450 LM002600 SS-B/La ANTIBODY 1450 1450 1450 LM002606 STREPTOCOCCUS GROUP B ANTIGEN DETECTION 840 840 840 LM002607 STRIATED / SKELETAL MUSCLE ANTIBODY, IFA 1500 1500 1500 STRIATED / SKELETAL MUSCLE ANTIBODY, IFA IN LM002608 DILUTIONS 3000 3000 3000 LM002609 SUDAN BLACK B STAIN, BLOOD / BONE MARROW 490 490 490 LM002610 SUDAN IV STAIN 490 490 490 LM002618 TESTOSTERONE, FREE 1850 1850 1850 LM002619 TESTOSTERONE PANEL, TOTAL & FREE 2300 2300 2300 TESTOSTERONE, FREE & SEX HORMONE BINDING LM002620 GLOBULIN 4000 4000 4000 LM002621 TESTOSTERONE, TOTAL 600 600 600 LM002622 TESTOSTERONE STIMULATION BY HCG 1200 1200 1200 THALASSEMIA PROFILE *IRON STUDIES *CBC *HB LM002623 ELECTROPHORESIS 1550 1550 1550 LM002624 THALLIUM, 24-HOUR URINE 3100 3100 3100 LM002625 THALLIUM, RANDOM URINE 3100 3100 3100 LM002626 THALLIUM, BLOOD 3100 3100 3100 LM002627 THROMBIN TIME; TT 700 700 700 LM002628 THROMBOPHILIA COMPREHENSIVE PROFILE 15800 15800 15800
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146 78581/2020/ESTT-NE_HRLM002629 THROMBOPHILIA PROFILE 14500 14500 14500 LM002630 THYROGLOBULIN; Tg Cancer Marker 1700 1700 1700 LM002637 TORCH PANEL AVIDITY, IGG 1370 1370 1370 LM002638 TORCH PANEL, IGG & IGM 2500 2500 2500 LM002639 TORCH PANEL, IGG 1300 1300 1300 LM002640 TORCH PANEL, IGM 1300 1300 1300 LM002641 TOXOPLASMA ANTIBODIES PANEL, IgG & IgM 1000 1000 1000 LM002642 TOXOPLASMA ANTIBODY, IgG 580 580 580 LM002643 TOXOPLASMA ANTIBODY, IgM 580 580 580 LM002644 TOXOPLASMA AVIDITY IGG 580 580 580 LM002645 TPHA; TREPONEMA PALLIDUM HEMAGGLUTINATION 550 550 550 LM002646 TRANSFERRIN 1100 1100 1100 LM002654 TSH, NEWBORN SCREEN 250 250 250 LM002655 TSH STIMULATION BY TRH 1100 1100 1100 LM002656 TUMOUR NECROSIS FACTOR (TNF), ALPHA 3900 3900 3900 LM002658 U1 RNP ANTIBODIES 1700 1700 1700 LM002668 URINE, REDUCING SUBSTANCES 120 120 120 LM002669 UROBILINOGEN, QUALITATIVE, 24-HOUR URINE 120 120 120 LM002670 VALPROIC ACID; VALPROATE 800 800 800 VARICELLA ZOSTER VIRUS (VZV) ANTIBODIES PANEL, IGG & IGM ( CHICKEN POX / HERPES ZOSTER/ LM002671 SHINGLES) 2200 2200 2200 VARICELLA ZOSTER VIRUS (VZV) ANTIBODY, IGG ( LM002672 CHICKEN POX / HERPES ZOSTER/ SHINGLES) 1180 1180 1180 VARICELLA ZOSTER VIRUS (VZV) ANTIBODY, IGM ( LM002673 CHICKEN POX / HERPES ZOSTER/ SHINGLES) 1180 1180 1180 LM002674 VDRL, CSF 230 230 230 LM002676 VENOUS THROMBOSIS RISK ANALYSIS, PANEL 5500 5500 5500 LM002677 VITAMIN A (RETINOL) 6000 6000 6000 LM002677 VITAMIN A (RETINOL) 4000 4000 4000 LM002679 VITAMIN D, 1, 25-DIHYDROXY 3200 3200 3200 LM002681 VITAMIN E (TOCOPHEROL) 6000 6000 6000 LM002682 VMA (VANILMANDELIC ACID) , RANDOM URINE 3500 3500 3500 LM002683 VMA (VANILMANDELIC ACID), 24-HOUR URINE 3500 3500 3500 LM002684 von WILLEBRAND FACTOR ANTIGEN; vWF Ag 10000 10000 10000 LM002685 WEIL FELIX TEST *Proteus Antigen OX19, OX 2 & OX K 800 800 800 LM002688 YEAST (CANDIDA SPECIES) IDENTIFICATION 1100 1100 1100 LM002689 YEAST (CANDIDA SPECIES) SUSCEPTIBILITY TESTING 1100 1100 1100 LM002690 ZINC, 24-HOUR URINE 1800 1800 1800 LM002691 ZINC, RANDOM URINE 1800 1800 1800 LM002692 ZINC, SERUM / PLASMA 1800 1800 1800 ASCA (ANTI SACCHAROMYCES CEREVISIAE) LM002693 ANTIBODY, IGA 1400 1400 1400 ASCA (ANTI SACCHAROMYCES CEREVISIAE) LM002694 ANTIBODY, IGG 1400 1400 1400
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147 78581/2020/ESTT-NE_HRLM002695 Courier to USA 1500 1500 1500 LYME DISEASE (BORRELIA BURGDORFERI), IgG & IgM, LM002700 IMMUNOBLOT 11000 11000 11000 CULTURED AFB ANTI-TUBERCULAR DRUG LM002701 SENSITIVITY - CYCLOSERINE 2700 2700 2700 Cultured AFB Anti-tubercular Drug Sensitivity - LM002702 LEVOFLOXACIN 2700 2700 2700 Cultured AFB Anti-tubercular Drug Sensitivity - LM002703 MOXIFLOXACIN 3700 3700 3700 Cultured AFB, Mycobacterium other than tuberculosis( MOTT) Drug sensitivity report for Slow LM002704 growers 8500 8500 8500 Cultured AFB, Mycobacterium other than tuberculosis( MOTT) Drug sensitivity report for Rapid LM002705 growers 7500 7500 7500 LM002706 BETA 2 GLYCOPROTEIN 1, IgG 920 920 920 LM002707 BETA 2 GLYCOPROTEIN 1, IgM 920 920 920 LM002708 BETA-2 GLYCO. PROT-1,IGA 920 920 920 LM002709 BETA-2 GLYCO. PROT-1,PANEL 2600 2600 2600 CULTURED AFB ANTI-TUBERCULAR DRUG SENSITIVITY LM002710 - 15 DRUGS PANEL 16000 16000 16000 IMMUNOHISTOCHEMISTRY,INDIVIDUAL MARKER, LM002713 CD1a 1570 1570 1570 LM002714 ALDOSTERONE/PLASMA RENIN ACTIVITY RATIO 6700 6700 6700 CULTURED AFB ANTI-TUBERCULAR DRUG SENSITIVITY LM002716 RAPID, 10 DRUGS PANEL (SECOND LINE) 10000 10000 10000 CULTURED AFB ANTI-TUBERCULAR DRUG SENSITIVITY LM002717 RAPID, 5 DRUGS PANEL (SECOND LINE) 5500 5500 5500 LM002721 KIDNEY BIOPSY-ELECTRON MICROSCOPY 7000 7000 7000 LM002722 HBV GENO,DRUG RES,QNT.PCR 15500 15500 15500 LM002723 HLA-B7 4300 4300 4300 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, CK LM002726 5/6 1570 1570 1570 LM002727 HAINS MTB 1ST LINE DRUG RESISTANCE PROFILE 1750 1750 1750 LM002728 HLA-ABC (CLASS I) TYPING 10300 10300 10300 LM002729 BK VIRUS 3900 3900 3900 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM002730 CEA ( CARCINO EMBRYONIC ANTIGEN) 1570 1570 1570 IMMUNOHISTOCHEMISTRY, MICROSATELLITE INSTABILITY PANEL FOR COLORECTAL CANCER *MLH- LM002731 1 $ *MSH-2 *MSH-6 *PMS-2 7700 7700 7700 LM002732 HISTOPATHOLOGY, SPECIAL STAINS 480 480 480 LM002733 IHC CUSTOM PANEL 6000 6000 6000 VASCULITIS PANEL *ANA *ANCA-MPO *ANCA PR3 LM002734 *ANTI DS- DNA 5200 5200 5200 LM002735 ANTI TSH RECEPTOR ANTIBODY 3750 3750 3750 LM002736 CHLYMYDIA TRACHOMATIS,PCR 3500 3500 3500 LM002737 BRCA1 AND BRCA2 MUTATIONAL SCREEN 21000 21000 21000 43| T a r i f f - AIMS
148 78581/2020/ESTT-NE_HRBRCA1 AND BRCA2 MUTATION COMPREHENSIVE LM002738 PANEL 33000 33000 33000 LM002739 HISTOPATHOLOGY, LIVER BIOPSY PANEL 1650 1650 1650 ACUTE MYELOID LEUKEMIA (AML), CYTOGENETICS LM002742 PANEL 17500 17500 17500 LM002743 HISTOPATHOLOGY, BIOPSY, MEDIUM SPECIMEN 700 700 700 ALLERGY ASTHMA / RHINITIS SCREENING PANEL LM002744 ADULT 4500 4500 4500 LM002748 FECAL CALPROTECTIN 3680 3680 3680 LM002749 PRA SCREEN & DSA COMBINATION 14500 14500 14500 LM002750 SAB CLASS I 18000 18000 18000 LM002751 DRUGS OF ABUSE, URINE 4000 4000 4000 LM002752 HLADSA CLASS 1 & 2 ANTIGEN- BONE MARROW 10000 10000 10000 LM002753 Enhanced Liver Fibrosis (ELF) Panel 4500 4500 4500 LM002755 Leukemia genetic profile Any 6 markers,PCR,Qualita 6600 6600 6600 LM002758 CHIKUNGUNIA PCR 1000 1000 1000 HLA DNA TYPING HIGH RESOLUTION BY NEXT LM002760 GENERATION SEQUENCING (NGS) 13000 13000 13000 LM002768 CHIMERISM post - engraftment 5700 5700 5700 LM002777 VENOUS THROMBOSIS RISK ANALYSIS PROFILE 5250 5250 5250 LM002782 FLT 3 GENE MUTATION 3200 3200 3200 LM002783 BRUCELLA ANTIBODIES 1850 1850 1850 LM002787 FISH – EOSINOPHILIC LEUKEMIA PANEL 12500 12500 12500 LM002788 DPD GENE MUTATION ( 5- FU TOXICITY) 16000 16000 16000 LM003004 (HSV) 2 ANTIB PANEL, IGG & IGM 1300 1300 1300 ACETYL CHOLINE RECEPTOR BINDING ANTIBODY, LM003014 SERUM 3480 3480 3480 ACETYL CHOLINE RECEPTOR BINDING ANTIBODY, LM003014 SERUM 2170 2170 2170 ACETYL CHOLINE RECEPTOR BINDING ANTIBODY, LM003014 SERUM 4340 4340 4340 ACETYL CHOLINE RECEPTOR BINDING ANTIBODY, LM003014 SERUM 3040 3040 3040 ACETYL CHOLINE RECEPTOR BINDING ANTIBODY, LM003014 SERUM 2610 2610 2610 ACID PHOSPHATASE, PROSTATIC Includes Total Acid LM003018 Phosphatase. 330 330 330 ACUTE LYMPHOBLASTIC LEUKEMIA (ALL), LM003023 CYTOGENETICS PANEL 14000 14000 14000 LM003045 ALPHA THALASSEMIA MUTATION DETECTION 3800 3800 3800 LM003045 ALPHA THALASSEMIA MUTATION DETECTION 4200 4200 4200 AMINO ACIDS QUANTITATIVE, URINE & PLASMA, 45 LM003052 AMINO ACIDS / FULL PANEL 5200 5200 5200 LM003058 AMMONIA, BLOOD 950 950 950 LM003058 AMMONIA, BLOOD 1000 1000 1000 ANTI-PHOSPHOLIPASE A2 RECEPTOR ANTIBODY LM003075 (PLA2R) 5800 5800 5800
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149 78581/2020/ESTT-NE_HRLM003096 BK VIRUS, PCR, QUANTITATIVE 5300 5300 5300 LM003100 BRUCELLA IGM ANTIBODY 1150 1150 1150 LM003101 BRUCELLA IgM & IgG ANTIBODY PANEL 1850 1850 1850 C1 ESTERASE INHIBITOR, FUNCTIONAL LM003103 ACTIVITY; C1 INACTIVATOR, FUNCTIONAL 3650 3650 3650 LM003111 CA 125 ; OVARIAN CANCER MARKER 1200 1200 1200 LM003135 CEBPA MUTATION DETECTION 7200 7200 7200 LM003139 CHIMERISM PRE-ENGRAFTMENT,DONOR &RECIPIENT 10000 10000 10000 LM003141 CHIMERISM,POST-ENGRAFTMENT 4600 4600 4600 LM003160 C-KIT MUTATION DETECTION , PCR 5000 5000 5000 LM003160 C-KIT MUTATION DETECTION , PCR 5400 5400 5400 LM003164 CLOSTRIDIUM DIFFICILE DETECTION, PCR 3700 3700 3700 LM003164 CLOSTRIDIUM DIFFICILE DETECTION, PCR 3960 3960 3960 LM003232 CYSTIC FIBROSIS MUTATION DETECTION 16500 16500 16500 LM003232 CYSTIC FIBROSIS MUTATION DETECTION 9000 9000 9000 LM003261 DPD Gene Mutations (5-FU toxicity) detection 8400 8400 8400 LM003268 EGFR, MUTATIONAL ANALYSIS 7000 7000 7000 LM003270 ENDOMYSIAL ANTIBODY, IgA, IFA 1700 1700 1700 LM003280 FECAL ELASTASE 5000 5000 5000 FISH-EOSINOPHILIC LEUKEMIA PANEL (PDGFRA, LM003294 PDGFRB, FGFR1 AND CBFB) 12500 12500 12500 FISH-EOSINOPHILIC LEUKEMIA PANEL (PDGFRA, LM003294 PDGFRB, FGFR1 AND CBFB) 15000 15000 15000 FISH-T(8;14) OR MYC/IGH FOR BURKITT'S AND NON LM003299 HODGKINS LYMPHOMA 4300 4300 4300 LM003320 G6PD GENE MUTATION DETECTION 5200 5200 5200 LM003320 G6PD GENE MUTATION DETECTION 5040 5040 5040 LM003322 GALACTOMANNAN (ASPERGILLUS AG) 5100 5100 5100 LM003330 GANGLIOSIDE PROFILE , IGG 4000 4000 4000 GeneXpert MTB WITH RIFAMPICIN RESISTANCE, LM003347 QUALITATIVE 2000 2000 2000 LM003384 HELICOBACTER PYLORI ANTIGEN, STOOL 2100 2100 2100 LM003404 HERPES SIMPLEX VIRUS (HSV) 2, IGM, SERUM 1300 1300 1300 LM003410 HISTO\CYTOPATHOLOGY - SLIDE/BLOCK ISSUE 280 280 280 HLA - PANEL REACTIVE IgG ANTIBODIES (PRA), CLASS LM003443 I, QUANTITATIVE 10500 10500 10500 LM003481 IMMATURE PLATELET FRACTION (IPF) 600 600 600 LM003485 IMMUNOGLOBULIN IGG SUBCLASS 4 6500 6500 6500 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM003493 ALK-1 1570 1570 1570 IMMUNOHISTOCHEMISTRY, INDIVIDUAL MARKER, LM003500 CYTOMEGALOVIRUS (CMV) 1650 1650 1650 LM003519 INHIBIN B 1900 1900 1900 LM003534 INSULIN, PP 800 800 800 LM003551 LEGIONELLA ANTIGEN, URINE 2400 2400 2400 LM003556 LEPTOSPIRA DETECTION, PCR 2500 2500 2500
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150 78581/2020/ESTT-NE_HRLM003556 LEPTOSPIRA DETECTION, PCR 2400 2400 2400 LEUKEMIA DIAGNOSTIC PANEL: PLASMA CELL LM003562 DYSCRASIA 7000 7000 7000 LP-PLA2 ( LIPOPROTEIN ASSOCIATED PHOSPHOLIPASE LM003571 A2 ) ACTIVITY 5800 5800 5800 LM003573 LUNG CANCER MUTATION PANEL, ALK-1 EGFR 16000 16000 16000 LM003601 METHYLGUANINE METHYLTRANSFERASE (MGMT) 8400 8400 8400 LM003602 METHYLMALONIC ACID, QUANTITATIVE, SERUM 2000 2000 2000 LM003623 MYCOPLASMA PNEUMONIAE IGM, SERUM 2000 2000 2000 NEURONAL (PARANEOPLASTIC) AUTOANTIBODIES PROFILE (AMPHIPHYSIN CV2 PNMA2(MA2/TA) LM003631 ANNA-1/HU ANNA- 9000 9000 9000 ORGANIC ACIDS, QUANTITATIVE, RANDOM URINE, LM003642 FULL PANEL 5600 5600 5600 ORGANIC ACIDS, QUANTITATIVE, RANDOM URINE, LM003642 FULL PANEL 3500 3500 3500 ORGANIC ACIDS, QUANTITATIVE, RANDOM URINE, LM003642 FULL PANEL 7000 7000 7000 ORGANIC ACIDS, QUANTITATIVE, RANDOM URINE, LM003642 FULL PANEL 4900 4900 4900 ORGANIC ACIDS, QUANTITATIVE, RANDOM URINE, LM003642 FULL PANEL 4200 4200 4200 PML RARA T(15;17)(Q22;Q12) GENE LM003665 REARRANGEMENT QUANTITATIVE, PCR 5200 5200 5200 LM003671 PRENATAL DIAGNOSIS, FABRY DISEASE 3200 3200 3200 LM003699 Respiratory Comprehensive Panel 15000 15000 15000 RICKETTSIA ANTIBODY PANEL Rocky Mountain Spotted Fever IgG & IgM Typhus LM003712 Fever, IgG & I 16000 16000 16000 T-CELL GENE REARRANGEMENT MUTATION LM003761 DETECTION 16800 16800 16800 LM003769 Thrombotic Risk Screen 12500 12500 12500 LM003778 TORCH PANEL, IGG & IGM, EXTENDED 3550 3550 3550 TPMT (THIOPURINE METHYL TRANSFERASE) LM003783 GENOTYPING 5200 5200 5200 LM003814 VITAMIN B1 (THIAMINE) 6500 6500 6500 LM003829 CANCER TARGETED GENE PANEL, LUNG 20000 20000 20000 LM003830 MYCOPLASMA PNEUMONIAE IGM, SERUM 2000 2000 2000 LM003831 AMINO ACIDS,QUANTITATIVE,FULL PANEL 5200 5200 5200 HEPATITIS B VIRAL DNA QUANTITATIVE , REAL TIME LM003832 PCR 7500 7500 7500 CANCER TARGETED GENE PANEL, LM003833 COLON/COLORECTAL 15000 15000 15000 LM003834 IMMATURE PLATELET FRACTION ( IPF) 600 600 600 LM003835 VITAMIN C ; ASCORBIC ACID 6600 6600 6600 LM003836 BRUCELLA ANTIBODIES, IGG & IGM 1850 1850 1850 LM003837 LIQUID BIOPSY, CFDNA,EGFR 12500 12500 12500 LM003839 MUSK (MUSCLE SPECIFIC KINASE) ANTIBODY 8800 8800 8800 46| T a r i f f - AIMS
151 78581/2020/ESTT-NE_HRLM003839 MUSK (MUSCLE SPECIFIC KINASE) ANTIBODY 5500 5500 5500 LM003839 MUSK (MUSCLE SPECIFIC KINASE) ANTIBODY 9900 9900 9900 LM003839 MUSK (MUSCLE SPECIFIC KINASE) ANTIBODY 7700 7700 7700 LM003839 MUSK (MUSCLE SPECIFIC KINASE) ANTIBODY 6600 6600 6600 LM003840 CANCER 50 GENE PANEL, NGS 30000 30000 30000 AMINO ACID, NON-KETOTIC HYPERGLYCINEMIA LM003841 PANEL QUANTITATIVE, CSF & PLASMA 6200 6200 6200 LM003842 DRUG SENSITIVITY MOULD & ANTI FUNGAL CULTURE 10000 10000 10000 LM003843 BCR-ABL QUANTITATIVE,MRD NONITOR 6000 6000 6000 LM003844 AUTOIMMUNE ENCEPHALITIS PANEL (C.S.F) 18000 18000 18000 LM003845 EPSTEIN-BARR VIRUS ( EBV ) QUANTITATIVE PCR 6000 6000 6000 LM003846 IMMUNOHISTOCHEMISTRY,PD-L1 3000 3000 3000 LM003847 MICRSATELLITE INSTABILITY (MSI),PCR 10000 10000 10000 LM003848 ONCOPRO LIQUID BIOPSY 73 GENE PANEL WITH MSI 165000 165000 165000 GROWTH HORMONE SUPPRESSION BY GLUCOSE LM003849 AFTER 60 MIN 750 750 750 HLA SINGLE ANTIGEN BEAD ASSAY FOR CLASS 1 & 2 LM003850 IGG 40000 40000 40000 LM003851 HLA T & B CELL FLOW CYTOMETRY CROSSMATCH 7500 7500 7500 LM003852 HLA DNA TYPING (A,B &DR ),PCR 14800 14800 14800 CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) MUTATIONS LM003853 DETECTION PANEL 1 3500 3500 3500 DNA PROFILING FOR PATERNITY/ KINSHIP/ LINEAGE LM003854 STUDIES (INDIVIDUAL) 7000 7000 7000 CULTURED AFB (MYCOBACTERUIM), LM003855 ANTITUBERCULAR DRUG SENSITIVITY, RAPID - 19 22000 22000 22000 FISH – MICRODELETION DETECTION FOR WILLIAMS LM003856 SYNDROME 6400 6400 6400 LM003857 FISH – ROS 1 (6Q22) REARRANGEMENT 6500 6500 6500 LM003858 IHC IDH- 1 1900 1900 1900 CHIMERISM SPLIT CELL ANALYSIS – MYELOID CELL LM003860 (CD15) 8000 8000 8000 LM003861 MINIMAL RESIDUAL DISEASE T CELL (ALL) 13500 13500 13500 LM003863 GANGLIOSIDE ANTIBODY PROFILE,IGM 4000 4000 4000 LM003864 HTTG- DGP SCREENIG 1900 1900 1900 IMMUNOHISTOCHEMISTRY, LUNG NON SMALL CELL LM003865 CARCINOMA PANEL 13000 13000 13000 LM003866 PNEUMOCYSTIS, IFA 2400 2400 2400 LM003867 DENGUE VIRUS, PCR QUALITATIVE 3200 3200 3200 LM003869 HEPATITIS D VIRUS DETECTION , PCR 6500 6500 6500 PORPHOBILINOGEN (PBG), QUANTITATIVE, 24 HR LM003870 URINE 3490 3490 3490 HYDROXYPROGESTRONE (17-OHP) STIMULATION BY LM003873 ACTH 2600 2600 2600 HYDROXYPROGESTRONE (17-OHP) STIMULATION BY LM003873 ACTH 0 0 0 LM003874 ONCOPRO FOCUS FUSION PANEL FOR SOLID TUMORS 35000 35000 35000
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152 78581/2020/ESTT-NE_HRLM003875 HOMA-IR: INSULIN RESISTANCE INDEX 920 920 920 LM003876 KIR GENOTYPING 10000 10000 10000 ANTI-MOG (MYELIN OLIGODENDROCYTE LM003877 GLYCOPROTEIN) 6500 6500 6500 LM003879 CLINICAL EXOME SEQUENCING, ADVANCED 25000 25000 25000 LM003880 MYOSITIS PROFILE 7000 7000 7000 MP000001 Acetyl Choline Receptor Ab 3100 3100 3100 MP000003 Anti neuronal antibodies Includes Hu,Yo,PNMA2 8000 8000 8000 MP000004 CMV-DNA detection(Qualitative test), CSF 4500 4500 4500 MP000005 CMV-IgG Antibodies to CytoMegalo Virus, CSF 2500 2500 2500 MP000009 Dengue virus-RNA detection, CSF 3700 3700 3700 MP000011 Herpes (Varicella) Zoster- IgG antibodies, CSF 3000 3000 3000 MP000012 Herpes (Varicella) zoster virus-DNA detection, CSF 3000 3000 3000 MP0000124 VITAMIN K1 4000 4000 4000 MP000013 HSV 1 IgG antibodies to Herpes Simplex Virus 1,CSF 2500 2500 2500 MP000018 MUSK Ab (Myasthenia Gravis Profile) 6200 6200 6200 MP000019 NMDA Receptor Antibody 6000 6000 6000 MP000020 NMO (Aquaporin 4) 4300 4300 4300 MP000027 Voltage Gated Potassium Channel (VGKC) 8000 8000 8000 MP000029 JEV- RNA (Japnese Encephalitis virus) CSF 3950 3950 3950 MP000031 HSV DNA Detection 4000 4000 4000 MP000034 BRAF V600 Mutation analysis Tissue 5500 5500 5500 MP000035 BRAF V600 Mutation analysis Hairy cell 5500 5500 5500 MP000036 Hu ( Neuronal antigen) antibody , serum 4500 4500 4500 MP000037 Ri ( Neuronal antigen) antibody , serum 4500 4500 4500 MP000038 Yo( Neuronal antigen) antibody , serum 4500 4500 4500 MP000039 Huntington’s disease test by PCR, blood 4800 4800 4800 MP000040 VDRL in CSF 250 250 250 MP000041 SCA Comprehensive Panel by DNA PCR, blood 12500 12500 12500 MP000042 Leptospira-IgG Antibody,Serum 1200 1200 1200 MP000043 Leptospira-IgM Antibody,Serum 1300 1300 1300 MP000044 Intrinsic Factor Antibody 2300 2300 2300 MP000045 HCV-IgM Antibodies, Serum 1450 1450 1450 MP000046 JC Virus DNA Detection - CSF(PCR) 4000 4000 4000 MP000047 Basal Ganglion Antibody 4000 4000 4000 MP000048 HE4 with ROMA Index 2500 2500 2500 MP000049 Measles (Rubeola) IgG Antibodies Serum 1600 1600 1600 MP000053 SCA 12 ( Spino cerebellar ataxia) 2900 2900 2900 MP000054 Myotonic dystrophy type1-19q 13.3 7000 7000 7000 MP000055 JC virus DNA detection by PCR in CSF 4000 4000 4000 MP000056 Catecholamines levels in plasma 6800 6800 6800 MP000057 Hutington Disease Mutation Analysis 4800 4800 4800 MP000058 Cysticercus IgG Antibody in CSF 1600 1600 1600 MP000059 DPD Gene Mutations 13000 13000 13000
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153 78581/2020/ESTT-NE_HRMP000060 Legionella Pneumophila 2800 2800 2800 MP000061 PLA2 RECEPTOR ANTIBODY 4500 4500 4500 MP000062 Autoimmune Encephalitis Panel 21000 21000 21000 MP000063 Fibrinogen level ( Factor1) 900 900 900 MP000064 Wilson diseaseATP7 B gene mutation ( blood) 42000 42000 42000 MP000065 Allergy individual drug : Diclofenac 1400 1400 1400 MP000066 Allergy individual drug : Disprin 1400 1400 1400 MP000067 Allergy individual drug : Ibuprofen 1400 1400 1400 MP000068 Allergy individual drug : Paracetamol 1400 1400 1400 MP000069 TPMT enzyme activity 4000 4000 4000 MP000070 MAG antibodies 4000 4000 4000 MP000071 CMV DNA detection by rtPCR in urine 4500 4500 4500 MP000072 Allergen individual drug- Amoxicillin 1400 1400 1400 MP000073 Allergen individual drug- Metronidazole 1400 1400 1400 MP000074 Methotrexate level 3000 3000 3000 MP000075 BRCA 1&2 PROFILE COMPLETE GENE SEQUENCING 26000 26000 26000 MP000076 Legionella antibody IgM 2500 2500 2500 MP000077 Legionella antibody IgG 2500 2500 2500 MP000078 ACETYLCHOLINESTRASE OPC POISONING PLASMA 1000 1000 1000 MP000079 ACETYLCHOLINESTRASE OPC POISONING, RBC 1750 1750 1750 MP000080 Sucrose lysis test ( acidified serum test) 800 800 800 MP000081 MITOCHONDRIAL M2 ANTIBODY BY IFA 1800 1800 1800 MP000082 VITAMIN B1 THIAMINE 3300 3300 3300 MP000083 Bile Acids – Total , Serum 1700 1700 1700 MP000084 JAK2(V617F )REF TO JAK 2 EX12,MPL,CALR EX 9, BLD 13500 13500 13500 MP000085 JAK2 MUTATION V617F ,BLOOD 5500 5500 5500 MP000086 LEVETERACETAM 5000 5000 5000 MP000087 LYMPHOMA PANEL BY FISH 12000 12000 12000 MP000088 SCRUB TYPHUS IGM 1100 1100 1100 MP000089 HTLV 1 & 2 VIRUS TOTAL ANTIBODY 4400 4400 4400 MP000090 HIV P24 ANTIGEN (SCREENING) 900 900 900 MP000091 ANTI THROMBIN 3 ANTIGEN, PLASMA 6000 6000 6000 MP000092 ANTI THROMBIN 3 ACTIVITY ,FUNCTIONAL, PLASMA 3600 3600 3600 MP000093 GLYCINE, QUANTITATIVE SERUM 7500 7500 7500 MP000094 DOPAMINE ( PLASMA) LEVEL 2500 2500 2500 MP000095 DOPAMINE ( URINE ,24 HRS) LEVEL 2500 2500 2500 MP000096 ACETONE KETONE, SERUM 700 700 700 MP000097 MYOGLOBIN,URINE 1500 1500 1500 MP000098 ANA BY ELISA ANTI NUCLEAR ANTIBODY SCREENING 700 700 700 ANA BY IFA ANTI NUCLEAR ANTIBODY SCREENING MP000099 END POINT TITRE 950 950 950 ANA BY IFA REFLEX ANA BLOT 17 ANTIGEN MP000100 IMMUNOBLOT IF ANA-IF POSITIVE SERUM 2850 2850 2850 ENA QUALITATIVE (ANA - IMMUNOBLOT 17 MP000101 ANTIGENS) 3300 3300 3300 49| T a r i f f - AIMS
154 78581/2020/ESTT-NE_HRMP000102 ANA PROFILE 5000 5000 5000 MP000103 ANCA BY IFA REFLEX END POINT TITRE 1850 1850 1850 MP000104 ANCA BY IFA REFLEX MPO/PR3 ANTIBODIES 2500 2500 2500 MP000105 C3 COMPLEMENT-3 650 650 650 MP000106 C4 COMPLEMENT-4 650 650 650 DNA (DOUBLE STRAND) ANTIOBODY NCX DNA MP000107 QUANTITATIVE SERUM 1550 1550 1550 MP000108 ENA PROFILE EXTRACTABLE NUCLEAR ANTIGEN 4500 4500 4500 MP000110 HLA B27 STUDIES MICROARRAY 2700 2700 2700 HLA B27 STUDIES FLOW CYTOMETRY REFLEX MP000111 MICROARRAY BLOOD 2100 2100 2100 MP000112 MPO BY EIA P-ANCA 1350 1350 1350 MP000113 HLA B27 STUDIES PCR METHOD BLOOD 3100 3100 3100 MP000114 PR3 BY EIA C-ANCA 1350 1350 1350 MP000115 PLATELET ANTIBODIES QUALITATIVE TEST 6000 6000 6000 ALLERGEN, INDIVIDUAL – DRUG RIFAMPICIN MP000116 ANTIBIOTIC 1400 1400 1400 TRISOMY (ANEUPLODY) FOR CHROMOSOMES 13, 18, MP000117 21, X, Y BLOOD 8000 8000 8000 MP000118 INFLUENZA A VIRUS IGM ANTIBODY 1700 1700 1700 MP000119 METANEPHRINE-FREE PLASMA 4000 4000 4000 ALLERGEN, INDIVIDUAL DRUG CIPROFLOXACIN MP000120 ANTIBIOTIC 1400 1400 1400 ALLERGEN, INDIVIDUAL DRUG METRONIDAZOLE MP000121 ANTIBIOTIC 1400 1400 1400 MP000122 MYOTONIC DYSTROPHY TYPE 2 9000 9000 9000 MP000123 SPINAL MUSCULAR ATROPHY 3300 3300 3300 MP000124 MYOSITIS PROFILE 11 ANTIGEN 8500 8500 8500 MQ0001 IMSI RAPID 30000 30000 30000 OQ0001 LYMPHOMA PANEL BY FISH (G30S11T28) 12000 12000 12000 PBS001 POSITIVE SCREEN LYNCH 35000 35000 35000 PBS002 POSITIVE SCREEN HEREDITARY 55000 55000 55000 PBS003 POSITIVE SELECT-LUNG PANEL 25000 25000 25000 PBS004 POSITIVE SELECT-COLORECTAL CANCER PANEL 25000 25000 25000 PBS005 POSITIVE SELECT LITE 30000 30000 30000 PBS006 POSITIVE SELECT PLUS 65000 65000 65000 PBS007 POSITIVE SELECT IMMUNOTHERAPY 65000 65000 65000 PBS008 POSITIVE SELECT MATCH 85000 85000 85000 PBS009 POSITIVE SELECT ULTIMATE 150000 150000 150000 PBS010 BRAC ANALYSIS 230000 230000 230000 PBS011 BRACA SINGLE SITE 80000 80000 80000 PBS012 BRACA CDX 230000 230000 230000 PBS013 MY RISK 260000 260000 260000 PBS014 ENDO PREDICT 220000 220000 220000 PBS015 PROLARIS 250000 250000 250000 PBS016 COLARIS 300000 300000 300000 50| T a r i f f - AIMS
155 78581/2020/ESTT-NE_HRPBS017 CARIS MOLECULAR INTELLIGENCE 450000 450000 450000 QD000002 QD-Quest Expert Diagnosis 10800 10800 10800 QD000016 Alpha-Fetoprotein (AFP), Tumor Marker 830 830 830 QD000017 QD-AML1-ETO t(8;21) RT PCR 4960 4960 4960 QD000038 Beta-2-Microglobulin, Serum 2840 2840 2840 Chromosome Analysis / Peripheral Blood Leukocyte QD000063 Culture for Genetic Analysis (Karyotype) 2970 2970 2970 Chromosome Analysis, Hematologic Malignancy, QD000066 Blood/Bone Marrow 5300 5300 5300 QD000068 Chromosome Analysis, Mosaicism 3050 3050 3050 QD000116 ER/PR with Interpretation, Paraffin Block 2420 2420 2420 QD000127 FISH, BCR \ ABL 4830 4830 4830 QD000128 FISH, CBFB\M4H11 INV16 4590 4590 4590 QD000129 FISH, ETO/AML1 4960 4960 4960 QD000130 FISH, PML\RARA 5340 5340 5340 QD000131 FISH, TEL/AML1 4590 4590 4590 QD000139 Fructosamine 2360 2360 2360 QD000144 Gliadin Antibody (IgG) 1760 1760 1760 QD000179 Her2, IHC with Interpretation 1770 1770 1770 QD000180 FISH, HER-2/neu, Paraffin Block 11980 11980 11980 QD000193 HPV Genotypes 16 and 18 5480 5480 5480 QD000194 IHC AE1/AE3 with Interpretation (Pan-Cytokeratin) 1880 1880 1880 IHC AE1/AE3 without Interpretation (Pan- QD000195 Cytokeratin) 1520 1520 1520 QD000196 IHC-34 BETA E12 with Interpretation 1940 1940 1940 QD000197 IHC-34 BETA E12 without Interpretation 1520 1520 1520 QD000198 IHC-AFP with Interpretation 1880 1880 1880 QD000199 IHC-AFP without Interpretation 1520 1520 1520 QD000200 IHC-ANNEXIN A1 with Interpretation 1910 1910 1910 QD000201 IHC-ANNEXIN A1 without Interpretation 1520 1520 1520 QD000202 IHC-BCL2 with Interpretation 1880 1880 1880 QD000203 IHC-BCL2 without Interpretation 1520 1520 1520 QD000204 IHC-BCL6 with Interpretation 1910 1910 1910 QD000205 IHC-BCL6 without Interpretation 1520 1520 1520 QD000206 IHC-BER-EP4 with Interpretation 1910 1910 1910 QD000207 IHC-BER-EP4 without Interpretation 1520 1520 1520 QD000212 IHC-CA125 with Interpretation 1910 1910 1910 QD000213 IHC-CA125 without Interpretation 1520 1520 1520 QD000214 IHC-CA19.9 with Interpretation 1910 1910 1910 QD000215 IHC-CA19.9 without Interpretation 1520 1520 1520 QD000216 IHC-Calretinin with Interpretation 1880 1880 1880 QD000217 IHC-Calretinin without Interpretation 1520 1520 1520 QD000218 IHC-CD10 with Interpretation 1940 1940 1940 QD000219 IHC-CD10 without Interpretation 1520 1520 1520 QD000220 IHC-CD138 with Interpretation 1880 1880 1880 51| T a r i f f - AIMS
156 78581/2020/ESTT-NE_HRQD000221 IHC-CD138 without Interpretation 1520 1520 1520 QD000222 IHC-CD15 with Interpretation 1880 1880 1880 QD000223 IHC-CD15 without Interpretation 1520 1520 1520 QD000224 IHC-CD1A with Interpretation 1880 1880 1880 QD000225 IHC-CD1A without Interpretation 1520 1520 1520 QD000226 IHC-CD2 with Interpretation 1910 1910 1910 QD000227 IHC-CD2 without Interpretation 1520 1520 1520 QD000228 IHC-CD20 with Interpretation 1880 1880 1880 QD000229 IHC-CD20 without Interpretation 1520 1520 1520 QD000230 IHC-CD21 with Interpretation 1910 1910 1910 QD000231 IHC-CD21 without Interpretation 1520 1520 1520 QD000232 IHC-CD23 with Interpretation 1940 1940 1940 QD000233 IHC-CD23 without Interpretation 1520 1520 1520 QD000234 IHC-CD3 with Interpretation 1880 1880 1880 QD000235 IHC-CD3 without Interpretation 1520 1520 1520 QD000236 IHC-CD30 with Interpretation 1880 1880 1880 QD000237 IHC-CD30 without Interpretation 1520 1520 1520 QD000238 IHC-CD31 with Interpretation 1880 1880 1880 QD000239 IHC-CD31 without Interpretation 1520 1520 1520 QD000240 IHC-CD34 with Interpretation 1880 1880 1880 QD000241 IHC-CD34 without Interpretation 1520 1520 1520 QD000242 IHC-CD4 with Interpretation 1940 1940 1940 QD000243 IHC-CD4 without Interpretation 1520 1520 1520 QD000244 IHC-CD43 with Interpretation 1910 1910 1910 QD000245 IHC-CD43 without Interpretation 1520 1520 1520 QD000246 IHC-CD45 with Interpretation (LCA myeloma Marker) 1880 1880 1880 IHC-CD45 without Interpretation (LCA myeloma QD000247 Marker) 1580 1580 1580 QD000248 IHC-CD5 with Interpretation 1880 1880 1880 QD000249 IHC-CD5 without Interpretation 1520 1520 1520 QD000250 IHC-CD56 with Interpretation 1880 1880 1880 QD000251 IHC-CD56 without Interpretation 1520 1520 1520 QD000252 IHC-CD61 with Interpretation 1910 1910 1910 QD000253 IHC-CD61 without Interpretation 1520 1520 1520 QD000254 IHC-CD68 with Interpretation 1880 1880 1880 QD000255 IHC-CD68 without Interpretation 1520 1520 1520 QD000256 IHC-CD7 with Interpretation 1910 1910 1910 QD000257 IHC-CD7 without Interpretation 1520 1520 1520 QD000258 IHC-CD79a with Interpretation 1940 1940 1940 QD000259 IHC-CD79a without Interpretation 1520 1520 1520 QD000260 IHC-CD8 with Interpretation 1880 1880 1880 QD000261 IHC-CD8 without Interpretation 1520 1520 1520 QD000262 IHC-CD99 with Interpretation 1880 1880 1880 QD000263 IHC-CD99 without Interpretation 1520 1520 1520
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157 78581/2020/ESTT-NE_HRQD000264 IHC-CDX 2 with Interpretation 1880 1880 1880 QD000265 IHC-CDX 2 without Interpretation 1520 1520 1520 QD000266 IHC-Chromogranin A with Interpretation 1880 1880 1880 QD000267 IHC-Chromogranin A without Interpretation 1520 1520 1520 QD000270 IHC-CK20 with Interpretation 1940 1940 1940 QD000271 IHC-CK20 without Interpretation 1520 1520 1520 QD000272 IHC-CK5/6 with Interpretation 1880 1880 1880 QD000273 IHC-CK5/6 without Interpretation 1520 1520 1520 QD000274 IHC-CK7 with Interpretation 1910 1910 1910 QD000275 IHC-CK7 without Interpretation 1520 1520 1520 QD000278 IHC-CKIT (CD117) with Interpretation 1910 1910 1910 QD000279 IHC-CKIT (CD117) without Interpretation 1580 1580 1580 QD000280 IHC-Collagen IV with Interpretation 1910 1910 1910 QD000281 IHC-Collagen IV without Interpretation 1520 1520 1520 QD000282 IHC-Cyclin D1 with Interpretation 1940 1940 1940 QD000283 IHC-Cyclin D1 without Interpretation 1520 1520 1520 QD000284 IHC-Cytoplasmic IgA with Interpretation 1910 1910 1910 QD000285 IHC-Cytoplasmic IgA without Interpretation 1520 1520 1520 QD000286 IHC-Cytoplasmic IgG with Interpretation 1910 1910 1910 QD000287 IHC-Cytoplasmic IgG without Interpretation 1520 1520 1520 QD000288 IHC-Cytoplasmic IgM with Interpretation 1910 1910 1910 QD000289 IHC-Cytoplasmic IgM without Interpretation 1520 1520 1520 QD000290 IHC-DBA44 with Interpretation 1910 1910 1910 QD000291 IHC-DBA44 without Interpretation 1520 1520 1520 QD000292 IHC-Desmin with Interpretation 1880 1880 1880 QD000293 IHC-Desmin without Interpretation 1520 1520 1520 QD000294 IHC-E Cadherin with Interpretation 1910 1910 1910 QD000295 IHC-E Cadherin without Interpretation 1520 1520 1520 QD000296 IHC-EBV with Interpretation 1910 1910 1910 QD000297 IHC-EBV without Interpretation 1520 1520 1520 QD000300 IHC-EMA with Interpretation 1880 1880 1880 QD000301 IHC-EMA without Interpretation 1520 1520 1520 QD000302 IHC-GFAP with Interpretation 1880 1880 1880 QD000303 IHC-GFAP without Interpretation 1520 1520 1520 QD000304 IHC-HEP PAR-1 with Interpretation 1910 1910 1910 QD000305 IHC-HEP PAR-1 without Interpretation 1520 1520 1520 QD000306 IHC-HLA DR with Interpretation 2060 2060 2060 QD000307 IHC-HLA DR without Interpretation 1520 1520 1520 QD000308 IHC-HMB 45 with Interpretation 1880 1880 1880 QD000309 IHC-HMB 45 without Interpretation 1520 1520 1520 QD000310 IHC-IgD with Interpretation 1880 1880 1880 QD000311 IHC-IgD without Interpretation 1520 1520 1520 QD000312 IHC-INHIBIN with Interpretation 1880 1880 1880 QD000313 IHC-INHIBIN without Interpretation 1520 1520 1520
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158 78581/2020/ESTT-NE_HRQD000314 IHC-Kappa Light Chains with Interpretation 1940 1940 1940 QD000315 IHC-Kappa Light Chains without Interpretation 1520 1520 1520 QD000316 IHC-Ki 67 (MIB) without Interpretation 1940 1940 1940 QD000317 IHC-Ki67 (MIB) with Interpretation 1910 1910 1910 QD000318 IHC-Lambda Light Chain with Interpretation 1940 1940 1940 QD000319 IHC-Lambda Light Chain without Interpretation 1520 1520 1520 QD000320 IHC-MELAN A with Interpretation 1910 1910 1910 QD000321 IHC-MELAN A without Interpretation 1520 1520 1520 QD000324 IHC-MPO with Interpretation 1910 1910 1910 QD000325 IHC-MPO without Interpretation 1520 1520 1520 QD000328 IHC-MUM1 with Interpretation 1910 1910 1910 QD000329 IHC-MUM1 without Interpretation 1520 1520 1520 QD000330 IHC-MYO D1 with Interpretation 1910 1910 1910 QD000331 IHC-MYO D1 without Interpretation 1520 1520 1520 QD000332 IHC-MYOGENIN with Interpretation 1910 1910 1910 QD000333 IHC-MYOGENIN without Interpretation 1520 1520 1520 QD000334 IHC-NSE with Interpretation 1880 1880 1880 QD000335 IHC-NSE without Interpretation 1520 1520 1520 QD000336 IHC-P504S AMACR with Interpretation 1910 1910 1910 QD000337 IHC-P504S AMACR without Interpretation 1520 1520 1520 QD000338 IHC-P53 with Interpretation 1880 1880 1880 QD000339 IHC-P53 without Interpretation 1580 1580 1580 QD000340 IHC-P63 WITH INTERPRETATION 1880 1880 1880 QD000342 IHC-PAX 5 (BSAP) with Interpretation 1910 1910 1910 QD000343 IHC-PAX 5 (BSAP) without Interpretation 1520 1520 1520 QD000344 IHC-pCEA with Interpretation 1910 1910 1910 QD000345 IHC-pCEA without Interpretation 1520 1520 1520 QD000346 IHC-PLAP with Interpretation 1910 1910 1910 QD000347 IHC-PLAP without Interpretation 1520 1520 1520 QD000348 IHC-PSA with Interpretation 1880 1880 1880 QD000349 IHC-PSA without Interpretation 1580 1580 1580 QD000350 IHC-PTEN with Interpretation 1910 1910 1910 QD000351 IHC-PTEN without Interpretation 1520 1520 1520 QD000352 IHC-S100 with Interpretation 1880 1880 1880 QD000353 IHC-S100 without Interpretation 1880 1880 1880 QD000354 IHC-SMA with Interpretation 1880 1880 1880 QD000355 IHC-SMA without Interpretation 1520 1520 1520 QD000356 IHC-Synaptophysin with Interpretation 1880 1880 1880 QD000357 IHC-Synaptophysin without Interpretation 1580 1580 1580 QD000358 IHC-TDT with Interpretation 1880 1880 1880 QD000359 IHC-TDT without Interpretation 1580 1580 1580 QD000360 IHC-Thrombomodulin with Interpretation 1910 1910 1910 QD000361 IHC-Thrombomodulin without Interpretation 1520 1520 1520 QD000362 IHC-Thyroglobin with Interpretation 1880 1880 1880
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159 78581/2020/ESTT-NE_HRQD000363 IHC-Thyroglobin without Interpretation 1580 1580 1580 QD000364 IHC-TTF-I with Interpretation 1940 1940 1940 QD000365 IHC-TTF-I without Interpretation 1940 1940 1940 QD000366 IHC-Vimentin with Interpretation 1880 1880 1880 QD000367 IHC-Vimentin without Interpretation 1520 1520 1520 QD000368 IHC-WT1 with Interpretation 1940 1940 1940 QD000369 IHC-WT1 without Interpretation 1940 1940 1940 QD000370 Immunoglobulin A (IgA), Serum 720 720 720 QD000372 Immunoglobulin G (IgG), Serum 720 720 720 QD000373 Immunoglobulin M (IgM), Serum 720 720 720 QD000374 India Ink, CSF 170 170 170 QD000376 Inhibin A 1910 1910 1910 QD000386 LIVER KIDNEY MICROSOME (LKM-1) 1650 1650 1650 QD000398 Methadone, Urine 660 660 660 QD000399 Methaqualone, Urine 660 660 660 QD000440 Prealbumin (Transthyretin) 5880 5880 5880 QD000441 Pregnancy Associated Plasma Protein - A (PAPP-A) 1350 1350 1350 QD000445 Propoxyphene, Urine 1000 1000 1000 QD000456 Reticulin Stain with Interpretation 940 940 940 QD000457 Reticulin Stain without Interpretation 790 790 790 QD000460 Rotavirus Antigen 1180 1180 1180 QD000465 Saccharomyces (ASCA) IgA 2650 2650 2650 QD000466 Saccharomyces (ASCA) IgG 2650 2650 2650 QD000491 Tissue Transglutaminase (tTG) Antibodies (IgG) 970 970 970 QD000507 Vitamin D, 1, 25 Dihydroxy 3300 3300 3300 Anemia Panel 3 (CBC, Vit B12, Folate, Anti Intrinsic QD000520 Factor Antibody, Reticulocyte Count) 3890 3890 3890 QD000528 QD-Antenatal Panel 8 7910 7910 7910 BOH (Bad Obstetrics History) Panel (ToRCH 10, TSH, Cardiolipin IgA, Cardiolipin IgG, Cardiolipin IgM, QD000546 Antiphospholipid Ab IgA, IgG, IgM, aPTT, dRVVT) 12970 12970 12970 Drug Of Abuse, 5 Drugs with Confirmation (Amphetamines, Cocaine, Marijuana, Opiates (2000), QD000586 Phencyclidine, Urine pH, Urine Creatinine) 5000 5000 5000 QD000587 QD-Drug Panel 11 10710 10710 10710 Drug Panel 9 (Amphetamine, Cocaine, Cannabinoids (THC), Phencyclidine (PCP), Opiates, Propoxyphene, QD000590 Barbiturates, Benzodiazepine, Methadone ) 8280 8280 8280 QD000603 QD-First Trimester Screening (PAPP-A and hCG) wi 1810 1810 1810 QD000604 QD-First Trimester Screening (PAPP-A and hCG) wit 1830 1830 1830 QD000678 QD-Polycystic Ovarian Syndrome Panel 4100 4100 4100 QD000679 QD-Polycystic Ovarian Syndrome Panel 2 4710 4710 4710 Polycystic Ovarian Syndrome Panel 3 (Glucose QD000680 Fasting, Insulin Fasting, LH, Prolactin, FSH, Estradiol) 2700 2700 2700 QD000683 Protein, Total and Protein Electrophoresis 560 560 560 QD000710 ABL Kinase Domain Mutation in CML, Plasma-based, 23820 23820 23820 55| T a r i f f - AIMS
160 78581/2020/ESTT-NE_HRLeumeta™ QD000711 AccuType Clopidogrel CYP2C19 Genotype 7410 7410 7410 QD000712 AccuType IL28B 4920 4920 4920 QD000714 AccuType Warfarin (CYP2C9 and VKORC1) 34300 34300 34300 QD000715 Acetaminophen 3050 3050 3050 QD000716 Acetylcholine Receptor Binding Antibody 7120 7120 7120 QD000717 Acetylcholine Receptor Blocking Antibody 6480 6480 6480 QD000719 ACTIN (Smooth Muscle) Ab (IgG) 2340 2340 2340 QD000720 Activated Protein C- Resistance 5220 5220 5220 QD000721 Acylcarnitine, Plasma 10390 10390 10390 QD000731 Allergy - Mackerel (Rf206) IgE 3090 3090 3090 QD000733 Allergy - Swordfish (Rf312) IgE 3090 3090 3090 QD000742 Alpha 1 Antitrypsin (AAT), Feces, Random 3790 3790 3790 Alpha-1 Antitrypsin (AAT) Mutation Analysis, QD000743 Genotype 6250 6250 6250 QD000745 Alpha-Fetoprotein (AFP) and AFP-L3 20020 20020 20020 QD000746 Alpha-Fetoprotein (AFP), CSF 3630 3630 3630 QD000747 Alpha-Fetoprotein (AFP), Pericardial Fluid 3630 3630 3630 QD000748 Alpha-Fetoprotein (AFP), Peritoneal Fluid 3630 3630 3630 QD000749 Alpha-Fetoprotein (AFP), Pleural Fluid 3630 3630 3630 QD000759 ANAchoice(R) Specific Antibodies Cascading Reflex 2100 2100 2100 QD000762 Angiotensin Converting Enzyme (ACE), CSF 1870 1870 1870 QD000763 Angiotensin II 5270 5270 5270 QD000769 Arylsulfatase A 2640 2640 2640 QD000773 Aspirin Resistance 7060 7060 7060 QD000774 Babesia microti Antibodies (IgG and IgM) 4130 4130 4130 QD000781 Beta 2 Transferrin 6270 6270 6270 QD000783 Beta-2 Microglobulin, CSF 2840 2840 2840 QD000784 Bile Acid, Total 3740 3740 3740 QD000786 Bile Acids, Fractionated & Total, Pregnancy 5610 5610 5610 QD000788 BRAF Mutation Analysis 27120 27120 27120 QD000790 Bupropion or Metabolite Serum / Plasma 19190 19190 19190 QD000791 Burkholderia pseudomallei Antibody Panel, IFA 12120 12120 12120 QD000793 C1 Inhibitor, Protein 3700 3700 3700 QD000799 CA 27.29, CSF 2610 2610 2610 QD000804 Campath® -1H Sensitivity (CD52) 24740 24740 24740 QD000807 Carboxyhemoglobin, Blood 5840 5840 5840 Carcinoembryonic Antigen (CEA) with HAMA QD000808 Treatment 16170 16170 16170 QD000809 Carnitine, LC/MS/MS 2890 2890 2890 QD000823 QD-Chromogranin A 7930 7930 7930 QD000825 c-Kit Mutation, Reflex to PDGFRA 14110 14110 14110 Collagen Cross-Linked N-Telopeptide (NTx), 24 hrs QD000828 Urine 5380 5380 5380 QD000829 Collagen Cross-Linked N-Telopeptide (NTx), Urine 4300 4300 4300 56| T a r i f f - AIMS
161 78581/2020/ESTT-NE_HRQD000830 Collagen Type I C-Telopeptide (CTx) 5150 5150 5150 QD000832 QD-Complement Component C2 3840 3840 3840 QD000833 Complement, Total (CH50) 2810 2810 2810 QD000834 Copper, Serum 3570 3570 3570 QD000836 Cortisol, 11-Deoxy LC/MS/MS 3320 3320 3320 QD000839 Coxsackie A Antibodies, Serum 7040 7040 7040 QD000844 CYP2D6 Genotyping 8490 8490 8490 QD000846 Cystic Fibrosis Screen 6350 6350 6350 QD000847 Cysticercus Antibody ELISA (CSF) 4410 4410 4410 QD000851 DCP (Des-Gamma-Carboxy-Prothrombin) 16870 16870 16870 Dihydropyrimidine Dehydrogenase (DPD) Gene QD000854 Mutation Analysis 10410 10410 10410 QD000856 DNase-B Antibody 2240 2240 2240 QD000858 Donor, C Trachomatis & N Gonorrhoeae, RNA, TMA 8040 8040 8040 QD000859 Donor, HTLV-I/II Antibody Screen 3010 3010 3010 QD000861 Drug Abuse Panel 9, Serum 15080 15080 15080 QD000862 EGFR Mutation Analysis 9900 9900 9900 QD000865 EML-4 ALK Gene Fusion, PCR 17200 17200 17200 QD000866 Endomysial IgA Antibody Screen with Reflex to Titer 3140 3140 3140 QD000867 Epidermal Growth Factor Receptor (EGFR), ELISA 7960 7960 7960 QD000870 Epstein-Barr Virus (EBV) DNA Qualitative RT PCR 8330 8330 8330 QD000871 Epstein-Barr Virus (EBV) DNA Quantitative RT PCR 8330 8330 8330 Epstein-Barr Virus (EBV) Nuclear Antigen, (EBNA) QD000872 (IgG) 1890 1890 1890 Epstein-Barr Virus Antibody Panel (EBV VCA IgM Ab, QD000875 EBV VCA IgG Ab, EBV EA IgG, EBN 2920 2920 2920 ER/PR/DNA/HER2, IHC Paraffin Block, with Reflex to QD000877 HER2 FISH 59740 59740 59740 QD000880 Estrogen, Total, Serum 6240 6240 6240 QD000881 Estrogens, Fractionated, LC/MS/MS 8860 8860 8860 QD000882 Estrone, LC/MS/MS 3460 3460 3460 QD000888 Fecal Lipids, Total 7550 7550 7550 QD000893 FISH, EGFR 42930 42930 42930 QD000894 FISH, Oligoderdroglima, 1P/19Q 42890 42890 42890 QD000895 Florescent Treponemal Ab (FTA-ABS) 3630 3630 3630 Follicular Lymphoma, bcl-2/JH t(14;18), RT PCR, QD000896 Plasma-Based, Leumeta™ 19640 19640 19640 QD000899 GAD 65 (Glutamic Acid Decarboxylase-65) 3470 3470 3470 QD000900 Ganglioside GD1b Antibody (IgM), EIA 4490 4490 4490 QD000901 Ganglioside GQ1B AB (IgG), EIA 7370 7370 7370 QD000902 Gastric Parietal Cell Antibody 2360 2360 2360 QD000905 Glucagon 6880 6880 6880 QD000909 Heavy Metals, Blood 8210 8210 8210 QD000913 Heparin Low Molecule (Xa) 9000 9000 9000 QD000915 Hepatitis B Virus (HBV) Genotype 23970 23970 23970
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162 78581/2020/ESTT-NE_HRQD000918 Hepatocellular Carcinoma Panel 19870 19870 19870 QD000920 HER2, ELISA 15350 15350 15350 QD000921 Hereditary Hemochromatosis DNA Mutation Analysis 4130 4130 4130 QD000925 Herpes Virus 6 DNA, Qualitative Real-Time PCR 13540 13540 13540 QD000926 Herpes Virus 8 (HHV8), IHC with Interpretation 15830 15830 15830 QD000930 HIV 1 DNA Qualitative, RT-PCR 12040 12040 12040 QD000931 HIV 1 Genotype 25100 25100 25100 QD000937 HTLV I/II Antibody with Reflex to Western Blot 18540 18540 18540 QD000939 Human Platelet Antigen 1 Genotype 19950 19950 19950 QD000941 Hydroxyproline, Plasma 12280 12280 12280 QD000942 Hypersensitive Pneumonitis Screen 9300 9300 9300 QD000945 Imipramine & Desipram, Serum 3470 3470 3470 QD000946 Immunofixation (IFE), Urine 7330 7330 7330 QD000948 QD-Inflammatory Bowel Disease Differential Panel 4830 4830 4830 QD000949 Influenzae Type A and Type B Antibodies 4770 4770 4770 QD000951 Insulin Autoantibody 5350 5350 5350 QD000952 Insulin Free 3010 3010 3010 QD000953 Insulin like Growth Factor Binding Protein-1 (IGF BP1) 3530 3530 3530 QD000954 Insulin like Growth Factor Binding Protein-3 (IGF BP3) 2480 2480 2480 QD000955 Insulin like Growth Factor I (IGF-I) 3540 3540 3540 QD000957 Interleukin-6, Highly Sensitive ELISA 9300 9300 9300 QD000958 Intrinsic Factor Blocking Antibody 2870 2870 2870 QD000959 Iodine, 24 hrs Urine 3970 3970 3970 JAK2 Exons 12 and 13 Mutations, Quantitative, QD000962 Leumeta™ 20780 20780 20780 JAK2 V617F Mutation, Qualitative PCR, Leumeta™ QD000964 with Reflex to Exons12,13 17840 17840 17840 QD000967 JC Virus DNA, Quantitative PCR 16820 16820 16820 QD000970 Kras Mutation Analysis 10160 10160 10160 QD000972 Lactic Acid, Plasma 4240 4240 4240 QD000973 Lactoferrin, Quantitative, Stool 19580 19580 19580 QD000974 Lamotrigine, Serum 3600 3600 3600 QD000976 Legionella Antigen, EIA , Urine 5640 5640 5640 QD000980 Levetiracetam 3580 3580 3580 Lyme Disease Antibodies Panel (IgG & IgM), Western QD000984 Blot 5590 5590 5590 QD000985 Lyme Disease Antibodies w/Reflex to Western Blot 2350 2350 2350 Mantle Cell Lymphoma, bcl-1/JH t(11;14), RT PCR, QD000990 Plasma-Based, Leumeta™ 26870 26870 26870 QD000991 Marijuana Metabolites, GC/MS, Urine 3760 3760 3760 QD000993 MDMA and Metabolites, Random Urine 6890 6890 6890 QD000997 Mercury, Blood 2770 2770 2770 QD001000 QD-Metanephrines, Fractionated, Plasma 9740 9740 9740 QD001001 Methotrexate, Serum 8050 8050 8050 QD001004 Methylmalonic Acid, Serum 3840 3840 3840
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163 78581/2020/ESTT-NE_HRQD001005 Micro metastasis Detection in Lymph Nodes 15830 15830 15830 QD001006 Microsatellite Instability (MSI), HNPCC 43170 43170 43170 QD001015 Mycoplasma Pneumoniae Antibody (IgG) By EIA 1920 1920 1920 QD001016 Mycoplasma Pneumoniae Antibody (IgM) 2130 2130 2130 Mycoplasma Pneumoniae Antibody Panel (IgG, IgM), QD001017 EIA 2710 2710 2710 QD001019 Myelin Basic Protein 6290 6290 6290 QD001020 Myeloperoxidase Antibodies (MPO) 2070 2070 2070 QD001023 Neisseria Gonorrhoeae, DNA, SDA 7570 7570 7570 QD001025 Neuroblastoma (NB84), IHC without Interpretation 9950 9950 9950 Neuromyelitis Optica (NMO) Autoantibody, IgG, QD001026 Serum 64370 64370 64370 Neuronal Nuclear (Hu) Antibody with reflex Titer & QD001028 Western Blot 12990 12990 12990 QD001030 N-Mid Ostiocalcin 6430 6430 6430 QD001031 Norepinephrine, Plasma 4140 4140 4140 QD001034 ONTAK® Sensitivity (CD25) 24740 24740 24740 QD001038 Pancreatic Elastase-1 5320 5320 5320 QD001043 Parvovirus B19 DNA, Qualitative RT PCR 11350 11350 11350 QD001044 Phenol Exposure, Urine 12920 12920 12920 QD001046 PIK3CA Mutation Analysis 15980 15980 15980 QD001052 Porphyrins, Fractionated, Plasma 7060 7060 7060 QD001053 Porphyrins, Fractionated, Quantitative, 24 hrs Urine 6120 6120 6120 QD001054 Porphyrins, Total, Plasma 7060 7060 7060 Procollagen Type I Intact N Terminal Propeptide QD001058 (PINP) 9330 9330 9330 QD001060 Proinsulin 4220 4220 4220 QD001061 Protein C Activity and Antigen 5210 5210 5210 Protein Electrophoresis and Total Protein, Random QD001063 Urine 7320 7320 7320 QD001064 Protein S Antigen 2330 2330 2330 Protein, Total and Protein Electrophoresis, 24 hrs QD001065 Urine 4330 4330 4330 QD001066 Proteinase-3 Antibody 2100 2100 2100 QD001067 Prothrombin (Factor II) 20210G>A Mutation Analysis 5510 5510 5510 QD001068 PTH Antibody 4480 4480 4480 QD001069 PTH-Related Protein (PTH-rP) 3300 3300 3300 QD001072 RAS Mutation, Cell-based 25510 25510 25510 QD001073 RAS Mutation, Leumeta™ 25510 25510 25510 QD001077 RETT Syndrome 40560 40560 40560 Rickettsia (Typhus Fever) Antibody (IgG, IgM) with QD001080 reflex to titers 5280 5280 5280 QD001084 Serotonin, Serum 4180 4180 4180 QD001085 Shiga Toxins, EIA with Reflex to E. coli O157 Culture ) 4480 4480 4480 QD001087 Sirolimus (Rapamycin) LC/MS/MS 5610 5610 5610 QD001089 Somatostatin 7040 7040 7040 59| T a r i f f - AIMS
164 78581/2020/ESTT-NE_HRQD001096 T4, Free, Direct Dialysis 6040 6040 6040 Testosterone, Free, Bioavailability and Total, QD001102 LC/MS/MS 5770 5770 5770 QD001104 Tetanus Antitoxoid Antibody (EIA) 3150 3150 3150 QD001105 QD-Thyroxine Binding Globulin (TBG) 5400 5400 5400 QD001106 TNF-Alpha, Highly Sensitivity 9330 9330 9330 QD001107 Topiramate 3240 3240 3240 QD001110 TPMT Genotype 9300 9300 9300 QD001111 TRAcP, IHC with Interpretation 15830 15830 15830 QD001112 Treponema Palladium Antibody, AGG Assay 9090 9090 9090 QD001114 Trypsin 6840 6840 6840 QD001115 Tryptase 6180 6180 6180 QD001116 TSH Antibody 4640 4640 4640 QD001117 TSI (Thyroid Stimulating Immunoglobulin) 9970 9970 9970 QD001118 Tyrosine 12280 12280 12280 QD001119 Tysabri Antibodies, ELISA 5470 5470 5470 QD001120 UGT1A1 Gene Polymorphism (TA Repeat) 29970 29970 29970 QD001131 Vitamin B1, Whole Blood 6080 6080 6080 QD001132 Vitamin B2 5770 5770 5770 QD001133 Vitamin B6 6870 6870 6870 QD001134 Vitamin C 6830 6830 6830 QD001140 Yersinia enterocolitica Antibody Panel (IgG, IgA) 10770 10770 10770 QD001150 QD- Quest Expert Review 7500 7500 7500 QD001151 IgG Subclass 4 4180 4180 4180 QD001152 Tissue Transglutaminase (tTG) Antibodies (IgA) 1160 1160 1160 First Trimester Screening (PAPP-A and hCG) with NT QD001153 Value 1810 1810 1810 First Trimester Screening (PAPP-A and hCG) without QD001154 NT Value 1830 1830 1830 Maternal Serum Screen 3 (Triple Screen) (AFP, Unconjugated Estriol, hCG and Maternal Risk QD001155 Interpretation) by Maciel Method 2340 2340 2340 Maternal Serum Screen 4 (Quad Screen) (AFP, Unconjugated Estriol, hCG, Dimeric Inhibin A, and QD001157 Maternal Risk Interpretation) by Maciel Method 3970 3970 3970 QD001159 ER/PR & HER2, IHC Panel 3560 3560 3560 QD001160 FISH, MDS/ Myeloid Panel 34760 34760 34760 QD001161 ABL Kinase Domain mutation analysis 22470 22470 22470 QD001165 Mitochondrial Antibodies with Reflex to Titer 2470 2470 2470 QD001169 CA 19-9, Serum (Pancreatic Cancer Marker) 1370 1370 1370 QD001174 Fish, B-Cell Chronic Lymphocytic Leukemia 39340 39340 39340 Fish, Hes/ Leukemia, 4Q12 Rearrangement(FIP1L1- QD001175 PDGFRA) 29140 29140 29140 QD001178 PML/RARA bcr1, Cells 4280 4280 4280 QD001179 PML/RARA bcr3, Cells 4280 4280 4280 QD001183 FISH, Multiple Myeloma, IGH/FGFR3 33350 33350 33350 60| T a r i f f - AIMS
165 78581/2020/ESTT-NE_HRQD001184 FISH, Multiple Myeloma, IGH/MAF,T(14;16) 33350 33350 33350 QD001187 FISH, Ewing/PNET, EWSR1, 22q12 rearrangements 34120 34120 34120 QD001189 Melanoma, BRAF V600 Mutation 14950 14950 14950 QD001193 PDGFRA mutation analysis (GIST) 18680 18680 18680 QD001195 RET/PTC Rearrangement, Thyroid Cancer 9560 9560 9560 QD001196 Sarcoma Mutation Analysis Panel, Pediatric, PCR 21950 21950 21950 QD001198 FISH,B-Cell Malignancy,IGH,14q32 Rearrangement 37200 37200 37200 QD001199 Fish, Burkitts/NHL/ALL,IGH/MYC,T(8;14) 37640 37640 37640 QD001202 Chromogranin A 7930 7930 7930 QD001203 AML1-ETO t(8;21) RT PCR 4960 4960 4960 QD001206 Influenza A H1N1 Real Time Real Time - PCR 5880 5880 5880 QD001208 QD-Quest Expert Diagnosis-2 12800 12800 12800 QD001209 Any 05 IHC Panel With Interpretation 5450 5450 5450 QD001210 Any 03 IHC Panel With Interpretation 4600 4600 4600 QD001211 Maternal Serum Screen 5 ( Penta Screen) 7200 7200 7200 QD001213 IHCs - Diagnosis Panel 7150 7150 7150 Hepatitis C Virus RNA (HCV), Quantitative, Real Time QD001214 PCR 14080 14080 14080 QD001215 Hepatitis B Viral DNA (HBV) Quantitative PCR 7700 7700 7700 QD001216 HCV RNA Genotyping 8000 8000 8000 QD-QNATAL,NIPT,Non-Inv Prenatal(Ref to QD001220 Chromosome) 34100 34100 34100 Pap Test By Liquid Based Cytology & High Risk HPV QD001222 DNA 2630 2630 2630 QD001224 Copper, 24 hrs Urine 8130 8130 8130 QD001225 21 HYDROXYLASE AB 2000 2000 2000 QD001225 21 HYDROXYLASE AB 8130 8130 8130 QD001229 FIRST-TRIMESTER, QUAD + NT VALUES 4000 4000 4000 FIRST-TRIMESTER,QUAD+NT VALUES+PREECLAMPSIA QD001230 RISK 5000 5000 5000 QD001232 HERPES VIRUS 6 DNA, QUALITATIVE REAL - TIME PCR 13540 13540 13540 HERPES VIRUS 6 DNA, QUANTITATIVE REAL - TIME QD001233 PCR 13620 13620 13620 QD001234 AMYLOID SUBTYPING 142940 142940 142940 QD001239 HERPES VIRUS 6DNA QUANT. RT-PCR 14330 14330 14330 QD001240 NEUTROPHIL FUNCTION, OXIDATIVE BURST 4770 4770 4770 QD001241 GANGLIOSIDE GM-1 ANTIBODIES (IG G &B IG M) 4860 4860 4860 QD001242 ACHONDROPLASIA MUTATION ANALYSIS 19510 19510 19510 QD001243 ADAMTS13 ACTIVITY WITH REFLEX TO INHIBITOR 13250 13250 13250 QD001244 VERY LONG CHAIN FATTY ACIDS (VLC-FA) 6150 6150 6150 QD001245 OXALATE, SERUM/PLASMA 17330 17330 17330 FIRST TRIMESTER TRIPLE WITH NT+PREECLAMPSIA QD001247 ASSESSMENT 4800 4800 4800 QD001248 PREECLAMPSIA RISK 2400 2400 2400 RL0001 HLA ABDR LOCI (DUO) PATIENT & DONOR BOTH 36000 36000 36000 RL0002 HLA ABDR LOCI 19000 19000 19000 61| T a r i f f - AIMS
166 78581/2020/ESTT-NE_HRRL0003 HLA ABCDR DQ LOCI 26000 26000 26000 RL0004 HLA A LOCUS 6000 6000 6000 RL0005 HLA B LOCUS 6000 6000 6000 RL0006 HLA C LOCUS 8000 8000 8000 RL0007 HLA DR LOCUS 6000 6000 6000 RL0008 HLA DQ LOCUS 6000 6000 6000 RL0009 HLA DP LOCUS 6000 6000 6000 RL0010 HLA DR/DQ LOCUS 10500 10500 10500 RL0011 HLA DP /DQ LOCUS 10500 10500 10500 RL0012 HLA ABCDR LOCI 22000 22000 22000 RL0013 CDC CROSS MATCH 3500 3500 3500 RL0014 FLOW CROSS MATCH 8000 8000 8000 RL0015 HLADSA CLASS 1 & 2 ANTIGEN-SOLID ORGANS 11000 11000 11000 RL0016 PRA SCREEN 6000 6000 6000 RL0017 PRA % CLASS 1 12000 12000 12000 RL0018 PRA % CLASS 2 12000 12000 12000 RL0019 SINGLE ANTIGEN BEAD CLASS 1 23000 23000 23000 RL0020 SINGLE ANTIGEN BEAD CLASS 2 20000 20000 20000 RL0030 SEPSISCREEN 18000 18000 18000 RL0031 THROMBOCHECK TOTAL 22000 22000 22000 RL0032 HLA PLUS 32500 32500 32500 RL0033 HLA TOTAL 40000 40000 40000 RL0034 PAN NEUROTROPIC VIRUS PANEL 7250 7250 7250 COMPREHENSIVE MYELOMA PROTEIN PANEL RL0035 (SERUM) 7200 7200 7200 RL0036 HLA A B C DR DQ DP LOCI 32000 32000 32000 RL0037 AFB CULTURE 1350 1350 1350 RL0038 METHAEMOGLOBIN ESTIMATION 1200 1200 1200 ACUTE LEUKEMIA PANEL BODY FLUID (FLOW RL0039 CYTOMETRY) 10000 10000 10000 RL0040 H1N1 REAL-TIME PCR (SWINE FLU) 4500 4500 4500 RL0041 HLA COMBO 52000 52000 52000 XC001 SES - PAN CNS 29580 29580 29580 XC002 SES - MENINGITIS 22870 22870 22870 XC003 SES - MENINGITIS WITH ANTIBIOTIC RESISTANCE 37360 37360 37360 XC004 SES - MENINGOENCEPHALITIS 16010 16010 16010 XC005 SES - ACUTE ENCEPHALITIC SYNDROME 35990 35990 35990 XC006 SES - RNA VIRUS 22110 22110 22110 XC008 SES - SEPSIS 22870 22870 22870 XC009 SES - ANTIBIOTIC RESISTANCE 22870 22870 22870 XC010 SES - SEPSIS WITH ANTIBIOTIC RESISTANCE 37360 37360 37360 SES - FEBRILE NEUTROPENIA/POST XC011 TRANSPLANTINF/ANTIB 53370 53370 53370 XC012 SES - INFECTIOUS ENCEPHALITIS 8400 8400 8400 XC013 SES - VIRAL RETINITIS 12810 12810 12810 62| T a r i f f - AIMS
167 78581/2020/ESTT-NE_HRXC014 SES - FUCH's 13110 13110 13110 XC015 SES - UVEITIS 13110 13110 13110 XC016 SES - PAN UVEITIS 25460 25460 25460 XC017 SES - ACUTE PYREXIA + DENGUE IgM 17600 17600 17600 XC018 MYCOBACTERIUM CHIP 8400 8400 8400 SES-FEBRILE NEUTROPENIA/POST TRANSPLANT XC025 INF/PNEUM. 38880 38880 38880 XC029 SES TRANSPLANT VIRAL PANEL 16010 16010 16010 XC030 PNEUMOCYSTIS JIROVECI (FUNGUS) 5500 5500 5500 XC031 SES ANTIBIOTIC RESISTANCE MARKER (6 CLASS) 22870 22870 22870
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168 78581/2020/ESTT-NE_HR
BLOOD BANK
Code Description Ward Semi Pvt Pvt BBA001 ANTI A TITRE 600 600 600 BBA002 ANTI B TITRE 600 600 600 BBB001 Blood Transfusion Bag 150 150 150 BBB002 * BLOOD GROUP (ABO & RH) 150 150 150 BBC001 Cross Matching per unit 120 120 120 BBC002 Cryoprecipitate 620 620 620 BBC003 COOMB'S TEST, DIRECT (DAT) 710 710 710 BBC004 COOMB'S TEST, INDIRECT (IAT) 710 710 710 64| T a r i f f - AIMS
169 78581/2020/ESTT-NE_HRBBD001 Donor Blood Grouping 210 210 210 BBD002 DOCKING CHARGES 1000 1000 1000 BBD003 Donor screening 1820 1820 1820 BBF001 F.F.P. (Random Donor) per unit 820 820 820 BBG001 GRANULOCYTE HARVESTING ONCOLOGY 20000 20000 20000 BBL001 Leuco Apheresis 28560 28560 28560 BBM001 Misc charges for blood bank 840 840 840 BBP001 Packed Cell per unit 2800 2800 2800 BBP002 Platelet (Random Donor) per unit 1960 1960 1960 BBP003 Plasmaapheresis 21000 21000 21000 BBP004 Plateletapheresis 21000 21000 21000 Pediatric whole blood/ PRBC units BBP005 (Volume<=70ml) 1540 1540 1540
BBP006 Plateletapheresis for Dengue Patient 11000 11000 11000 BBP007 Platelet (Random Donor) unit for Dengue Patient 820 820 820 BBT001 Therapeutic Phlebotomy 980 980 980 THERAPEUTIC LEUCOAPHERESIS BBT002 PROCEDURE 21000 21000 21000 BBW001 Whole Blood per unit 2070 2070 2070
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170 78581/2020/ESTT-NE_HR
IMAGING & RADIODIAGNOSIS
Code Description Ward Semi Pvt Pvt CTA018 CT-ANGIOGRAPHY PORTOVENOGRAPHY 20160 20160 20160 CTA019 CT-ANGIOGRAPHY PULMONARY 18200 18200 18200 CTA020 CT-ANGIOGRAPHY RENAL 18200 18200 18200 CTA021 CT-ANGIOGRAPHY THORACIC AORTA 18200 18200 18200 CTA022 CT-ANGIOGRAPHY UPPER ABDOMINAL AORTA. 18200 18200 18200 CTB001 CT-Both Lower Limbs 11760 11760 11760 CTC001 CT-CALCIUM SCORE 5500 5500 5500
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171 78581/2020/ESTT-NE_HRCTC002 CT-CHEST + WHOLE ABDOMEN PLAIN & CONTRAST 18200 18200 18200 CTC003 CT-CHEST PLAIN 5320 5320 5320 CTC004 CT-CHEST PLAIN & CONTRAST 7000 7000 7000 CTC006 CT-CHOLANGIOGRAPHY 10080 10080 10080 CTD001 Denta scan -1 4830 4830 4830 CTD002 Denta scan -2 4040 4040 4040 CTE002 CT-EMERGN. CHRG. FOR HEAD PLAIN 1400 1400 1400 CTE004 CT-Extended Study 2100 2100 2100 CTE006 CT-ENTROGRAPHY 16100 16100 16100 CTE007 CT-EMERGENCY CHARGES(EXTRA) 1850 1850 1850 CTF001 CT-FNAC(CT GUIDED) 4900 4900 4900 CTF002 CT-FOOT PLAIN 4900 4900 4900 CTF003 CT-FOOT PLAIN AND CONTRAST 6300 6300 6300 CTF004 CT-FORE-ARM PLAIN AND CONTRAST BOTH LIMB 7000 7000 7000 CTF005 CT-FORE-ARM PLAIN AND CONTRAST EACH LIMB 6300 6300 6300 CTF006 CT-FOREARM PLAIN BOTH LIMB 6300 6300 6300 CTF007 CT-FORE-ARM PLAIN EACH LIMB 4900 4900 4900 CTG001 Ct Guided Procedure FNAC/BIOPSY 7700 7700 7700 CTH001 CT-HAND PLAIN 4900 4900 4900 CTH002 CT-HAND PLAIN AND CONTRAST 6300 6300 6300 CTH003 CT-HEAD ONLY CONTRAST 3500 3500 3500 CTH004 CT-HEAD PLAIN 2940 2940 2940 CTH005 CT-HEAD PLAIN AND CONTRAST 4900 4900 4900 CTH006 CT-HRCT CHEST - CONTRAST 8120 8120 8120 CTH007 CT-HRCT CHEST - PLAIN 6720 6720 6720 CTH008 CT-HRCT PARANASAL SINUSES PLAIN 6300 6300 6300 CTH009 CT-HRCT PARANASAL SINUSES PLAIN AND CONTRAST 7000 7000 7000 CTH010 CT-HRCT TEMPORAL BONE/ MASTOIDS - PLAIN 5880 5880 5880 CTH011 CT-HRCT TEMPORAL BONE/ MASTOIDS PLAIN & CONTRAST 7000 7000 7000 CTK001 CT-Kidney Urinary Bladder Plain 5600 5600 5600 CTK002 CT-Kidney Urinary Bladder with Contrast 7700 7700 7700 CTL001 CT-LEG PLAIN BOTH SIDE 7000 7000 7000 CTL002 CT-LEG PLAIN AND CONTRAST BOTH SIDE 8400 8400 8400 CTL003 CT-LEG PLAIN AND CONTRAST EACH SIDE 7000 7000 7000 CTL004 CT-LEG PLAIN EACH SIDE 5600 5600 5600 CTL005 CT-LIMBS ONE PART FOR ELBOW/WRIST/SHOULDER BOTH SI 5600 5600 5600 CTL007 CT-LIMBS ONE PART FOR ELBOW/WRIST/SHOULDER EACH SI 5600 5600 5600 CTL009 CT-LIMBS ONE PART FOR KNEE/ANKLE/HIP BOTH SIDE PLA 5600 5600 5600 CTL011 CT-LIMBS ONE PART FOR KNEE/ANKLE/HIP EACH SIDE PLA 5600 5600 5600 CTL013 CT-LOWER ABDOMEN PLAIN 5880 5880 5880 CTL014 CT-LOWER ABDOMEN PLAIN AND CONTRAST 7280 7280 7280 CTM001 CT-MISC 5880 5880 5880 CTN001 CT-NECK/LARYNX SOFT TISSUE PLAIN AND CONTRAST 7000 7000 7000 CTN002 CT-NECK PLAIN 5560 5560 5560
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172 78581/2020/ESTT-NE_HRCTO001 CT-ORBIT/ FACE ETC PLAIN 5600 5600 5600 CTO002 CT-ORBIT/FACE ETC PLAIN & CONTRAST 7000 7000 7000 CTP001 CT-PARA NASAL SINUS + HEAD PLAIN 7000 7000 7000 CTP002 CT-PARA NASAL SINUS + HEAD- PLAIN & CONTRAST 8400 8400 8400 CTP003 CT-PELVIS PLAIN 5600 5600 5600 CTP004 CT-PELVIS PLAIN & CONTRAST 7700 7700 7700 CTP006 CT-PITUITARY GLAND/SELLA PLAIN & CONTRAST 5880 5880 5880 CTP007 CT-PNS AXIAL & CORONAL PLAIN 6580 6580 6580 CTS001 CT-SACRO-ILIAC JOINTS PLAIN 5600 5600 5600 CTS002 CT-SACRO-ILIAC JOINTS PLAIN AND CONTRAST 7000 7000 7000 CT-SPINE PLAIN & CONTRAST- CTS003 CERVICAL/DORSAL/LUMB/LS/SACR(EACH) 7980 7980 7980 CTS004 CT-SPINE PLAIN-CERVICAL/DORSAL/LUM/LS/SACR (EACH) 5600 5600 5600 CTS005 CT-STEREOTATIC SCANNING SURGICAL PROCEDURE 8400 8400 8400 CT-STEREOTATIC SCANNING WITHOUT SURGICAL CTS006 PROCEDURE 4200 4200 4200 CTS008 CT-SCANOGRAM 1850 1850 1850 CTT001 CT-THIGH PLAIN BOTH LIMB 7000 7000 7000 CTT002 CT-THIGH PLAIN AND CONTRAST BOTH LIMB 8400 8400 8400 CTT003 CT-THIGH PLAIN AND CONTRAST EACH LIMB 7000 7000 7000 CTT004 CT-THIGH PLAIN EACH LIMB 5600 5600 5600 CTT005 Triple rule out Angiography 28980 28980 28980 CTU001 CT-UPPER ABDOMEN- PLAIN 5600 5600 5600 CTU002 CT-UPPER ABDOMEN- PLAIN & CONTRAST 7000 7000 7000 CTU003 CT-UPPER ABDOMEN + CHEST - PLAIN 9100 9100 9100 CTU004 CT-UPPER ABDOMEN + CHEST - PLAIN & CONTRAST 11200 11200 11200 CTU006 CT-UPPER ARM PLAIN AND CONTRAST BOTH LIMB 8400 8400 8400 CTU007 CT-UPPER ARM PLAIN AND CONTRAST EACH LIMB 7000 7000 7000 CTU008 CT-UPPER ARM PLAIN 5600 5600 5600 CTV001 CT-VIRTUAL BRONCHOSCOPY (EXTRA) 3360 3360 3360 CTV002 CT-VIRTUAL COLONOSCOPY (EXTRA) 5600 5600 5600 CTW001 CT-WHOLE ABDOMEN (ABDOMEN AND PELVIS) PLAIN 8400 8400 8400 CT-WHOLE ABDOMEN (ABDOMEN AND PELVIS) PLAIN & CTW002 CONTRAST 10920 10920 10920 DXB001 BMD Forearm(Dexa Scan) 2430 2430 2430 DXB002 BMD Hip joint(Dexa Scan) 2430 2430 2430 DXB003 BMD prosthetic hip joint(Dexa Scan) 2430 2430 2430 DXB004 BMD Spine(Dexa Scan) 2430 2430 2430 DXB005 BMD whole body(Dexa Scan) 4190 4190 4190 MRA001 MRI-ANGIOGRAPHY ABDOMEN TRIPLE PHASE 20860 20860 20860 MRA002 MRI-ANGIOGRAPHY ARCH AORTOGRAM 20160 20160 20160 MRA003 MRI-ANGIOGRAPHY BRAIN (INTRACRANIAL) 11060 11060 11060 MRI-ANGIOGRAPHY BRAIN (INTRACRANIAL) WITH MRA004 CONTRAST 16800 16800 16800 MRA005 MRI-ANGIOGRAPHY BRAIN (VENOGRAPHY) 11060 11060 11060
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173 78581/2020/ESTT-NE_HRMRA006 MRI-ANGIOGRAPHY BRAIN (VENOGRAPHY) WITH CONTRAST 20860 20860 20860 MRA007 MRI-ANGIOGRAPHY BRAIN AND NECK VESSELS (PLAIN) 16800 16800 16800 MRA008 MRI-ANGIOGRAPHY BRAIN AND NECK VESSSELS (CONTRAST) 24080 24080 24080 MRA009 MRI-ANGIOGRAPHY CARDIAC 20160 20160 20160 MRA010 MRI-ANGIOGRAPHY LOWER ABDOMINAL AORTA AND ILIAC 20860 20860 20860 MRA011 MRI-ANGIOGRAPHY NECK VESSSELS (EXTRA CRANIAL) BOTH 9660 9660 9660 MRI-ANGIOGRAPHY NECK VESSSELS (EXTRA CRANIAL) BOTH MRA012 SIDE WITH CONTRAST 14000 14000 14000 MRA013 MRI-ANGIOGRAPHY PERIPH ARTERIAL BOTH LOWER LIMB 25200 25200 25200 MRA014 MRI-ANGIOGRAPHY PERIPH ARTERIAL BOTH UPPER LIMB 25200 25200 25200 MRA015 MRI-ANGIOGRAPHY PERIPH ARTERIAL EACH LOWER LIMB 23800 23800 23800 MRA016 MRI-ANGIOGRAPHY PERIPH ARTERIAL EACH UPPER LIMB 23800 23800 23800 MRI-ANGIOGRAPHY PERIPH VENOGRAPHY BOTH LOWER MRA017 LIMB 25200 25200 25200 MRI-ANGIOGRAPHY PERIPH VENOGRAPHY BOTH UPPER MRA018 LIMB 23800 23800 23800 MRI-ANGIOGRAPHY PERIPH VENOGRAPHY EACH LOWER MRA019 LIMB 23800 23800 23800 MRI-ANGIOGRAPHY PERIPH VENOGRAPHY EACH UPPER MRA020 LIMB 23800 23800 23800 MRA021 MRI-ANGIOGRAPHY PORTOVENOGRAPHY 16800 16800 16800 MRA022 MRI-ANGIOGRAPHY PULMONARY 20160 20160 20160 MRA023 MRI-ANGIOGRAPHY RENAL 20160 20160 20160 MRA024 MRI-ANGIOGRAPHY THORACIC AORTA 20160 20160 20160 MRA025 MRI-ANGIOGRAPHY UPPER ABDOMINAL AORTA 20160 20160 20160 MRA026 MRI-ANKLE BOTH PLAIN 19320 19320 19320 MRA027 MRI-ANKLE BOTH PLAIN AND CONTRAST 21560 21560 21560 MRA028 MRI-ANKLE SINGLE PLAIN 9660 9660 9660 MRA029 MRI-ANKLE SINGLE PLAIN AND CONTRAST 11060 11060 11060 MRA030 MRI-ARM/FOREARM PLAIN BOTH 19320 19320 19320 MRA031 MRI-ARM/FOREARM WITH CONTRAST BOTH 21560 21560 21560 MRA032 MRI-ARM/FOREARM PLAIN SINGLE 9660 9660 9660 MRA033 MRI-ARM/FOREARM PLAIN AND CONTRAST SINGLE 11900 11900 11900 MRA034 MRI-ARTHROGRAPHY 10920 10920 10920 MRB001 MRI-BOTH HIP PLAIN AND CONTRAST 12650 12650 12650 MRB002 MRI-BRACHIAL PLEXUS 9940 9940 9940 MRB003 MRI-BRAIN CONTRAST ONLY 6440 6440 6440 MRB004 MRI-BRAIN CSF FLOW STUDY 14490 14490 14490 MRB005 MRI-BRAIN DIFFUSION ONLY 9660 9660 9660 MRB006 MRI-BRAIN FOR CSF RHINORRHOEA 13440 13440 13440 MRB007 MRI-BRAIN FUNCTIONAL 9660 9660 9660 MRB008 MRI-BRAIN HIPPOCAMPUS VOLUME EXTRA 4200 4200 4200 MRB009 MRI-BRAIN PERFUSION 21000 21000 21000 MRB010 MRI-BRAIN PLAIN 10360 10360 10360 MRB011 MRI-BRAIN PLAIN & CONTRAST 14490 14490 14490
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174 78581/2020/ESTT-NE_HRMRB012 MRI-BRAIN SCREENING 3990 3990 3990 MRB013 MRI-BRAIN SPECTROSCOPY 14490 14490 14490 MRB014 MRI-BRAIN WITH DIFFUSION AND ADC MAP 14490 14490 14490 MRB015 MRI-BRAIN WITH EPILEPSY PROTOCOL 11480 11480 11480 MRB016 MRI-BRAIN WITH SCREENING SINGLE REGION 9800 9800 9800 MRB017 MRI-BREAST 9660 9660 9660 MRB018 MRI-BREAST PLAIN AND CONTRAST 12650 12650 12650 MRB019 MRI-BUCCAL REGION/CHEEK/FACE PLAIN 9660 9660 9660 MRB020 MRI-BUCCAL REGION/CHEEK/FACE WITH CONTRAST 12650 12650 12650 MRC001 MRI-CAVERNOUS SINUSES WITH CONTRAST 14280 14280 14280 MRC002 MRI-CHEST PLAIN 9660 9660 9660 MRC003 MRI-CHEST WITH CONTRAST 11760 11760 11760 MRC004 MRI-CONTRAST GADOLINIUM PER VIAL (10ml) 2520 2520 2520 MRC005 MRI-Contrast One Region 6440 6440 6440 MRD001 MRI-Duplicate Film(Per Film) 280 280 280 MRD002 MRI-Dynamic Study 8400 8400 8400 MRE001 MRI-ELBOW BOTH PLAIN 19320 19320 19320 MRE002 MRI-ELBOW BOTH PLAIN AND CONTRAST 21560 21560 21560 MRE003 MRI-ELBOW SINGLE PLAIN 9660 9660 9660 MRE004 MRI-ELBOW SINGLE PLAIN AND CONTRAST 11900 11900 11900 MRE005 MRI-EMERGENCY CHARGE HEAD 1400 1400 1400 MRE006 MRI-EMERGENCY CHARGE OTHER THAN HEAD 2100 2100 2100 MRE007 MRI-Emergency Charges 2100 2100 2100 MRF001 MRI-FOOT BOTH PLAIN 19320 19320 19320 MRF002 MRI-FOOT BOTH PLAIN AND CONTRAST 21560 21560 21560 MRF003 MRI-FOOT SINGLE PLAIN 9660 9660 9660 MRF004 MRI-FOOT SINGLE PLAIN AND CONTRAST 11760 11760 11760 MRH001 MRI-HAND BOTH PLAIN 19320 19320 19320 MRH002 MRI-HAND BOTH PLAIN AND CONTRAST 21560 21560 21560 MRH003 MRI-HAND SINGLE PLAIN 9660 9660 9660 MRH004 MRI-HAND SINGLE PLAIN AND CONTRAST 12650 12650 12650 MRH005 MRI-HIP PLAIN 9660 9660 9660 MRK001 MRI-KNEE BOTH PLAIN 19320 19320 19320 MRK002 MRI-KNEE BOTH PLAIN AND CONTRAST 21560 21560 21560 MRK003 MRI-KNEE SINGLE PLAIN 9660 9660 9660 MRK004 MRI-KNEE SINGLE PLAIN AND CONTRAST 11760 11760 11760 MRL001 MRI-LARYNX PLAIN 9660 9660 9660 MRL002 MRI-LARYNX PLAIN AND CONTRAST 11760 11760 11760 MRL003 MRI-LEG BOTH PLAIN 19320 19320 19320 MRL004 MRI-LEG BOTH PLAIN AND CONTRAST 21560 21560 21560 MRL005 MRI-LEG SINGLE PLAIN 9660 9660 9660 MRL006 MRI-LEG SINGLE PLAIN AND CONTRAST 11760 11760 11760 MRL007 MRI-LOWER ABDOMEN PLAIN 9660 9660 9660 MRL008 MRI-LOWER ABDOMEN PLAIN AND CONTRAST 12650 12650 12650
70| T a r i f f - AIMS
175 78581/2020/ESTT-NE_HRMRL009 MRI-LUMBOSACRAL PLEXUS 11060 11060 11060 MRM001 MRI-MISC 9240 9240 9240 MRN001 MRI-NECK PLAIN 9660 9660 9660 MRN002 MRI-NECK PLAIN AND CONTRAST 12650 12650 12650 MRO001 MRI-ORBIT PLAIN AND CONTRAST 12650 12650 12650 MRO002 MRI-ORBIT PLAIN 11270 11270 11270 MRP001 MRI-PAROTID / SUBMANDIBULAR PLAIN 9660 9660 9660 MRP002 MRI-PAROTID / SUBMANDIBULAR PLAIN AND CONTRAST 11760 11760 11760 MRP003 MRI-PELVIC FLOOR 9240 9240 9240 MRP004 MRI-PELVIS PLAIN 9660 9660 9660 MRP005 MRI-PELVIS PLAIN AND CONTRAST 12650 12650 12650 MRP006 MRI-PERIANAL 9660 9660 9660 MRP007 MRI-PNS PLAIN 9660 9660 9660 MRP008 MRI-PNS PLAIN AND CONTRAST 11900 11900 11900 MRS001 MRI-SCREENING SINGLE REGION 4030 4030 4030 MRS002 MRI-SELLA CONTRAST 11760 11760 11760 MRS003 MRI-SELLA PLAIN 9660 9660 9660 MRS004 MRI-SELLA PLAIN AND DYNAMIC CONTRAST 12650 12650 12650 MRS005 MRI-SHOULDER BOTH PLAIN 19320 19320 19320 MRS006 MRI-SHOULDER BOTH PLAIN AND CONTRAST 21560 21560 21560 MRS007 MRI-SHOULDER SINGLE PLAIN 9660 9660 9660 MRS008 MRI-SHOULDER SINGLE PLAIN AND CONTRAST 11760 11760 11760 MRS009 MRI-SI JOINTS PLAIN 9660 9660 9660 MRS010 MRI-SI JOINTS PLAIN AND CONTRAST 11760 11760 11760 MRI-SPINE EACH REGION CERVICAL/DORSAL/LUMB/LUMBO- MRS011 SACRAL PLAIN 11060 11060 11060 MRI-SPINE EACH REGION MRS012 CONTRASTCERVICAL/DORSAL/LUMB 12650 12650 12650 MRS013 MRI-SPINE EACH REGION MYELOGRAM EXTRA 1680 1680 1680 MRT001 MRI-TEMPORAL BONE PLAIN 9660 9660 9660 MRT002 MRI-TEMPORAL BONE PLAIN AND CONTRAST 11760 11760 11760 MRT003 MRI-THIGH BOTH PLAIN 19320 19320 19320 MRT004 MRI-THIGH BOTH PLAIN AND CONTRAST 21560 21560 21560 MRT005 MRI-THIGH SINGLE PLAIN 9660 9660 9660 MRT006 MRI-THIGH SINGLE PLAIN AND CONTRAST 11760 11760 11760 MRT007 MRI-TM JOINT PLAIN AND CONTRAST BOTH 11760 11760 11760 MRT008 MRI-TM JOINT PLAIN AND CONTRAST SINGLE 11760 11760 11760 MRT009 MRI-TM JOINT PLAIN BOTH 9660 9660 9660 MRT010 MRI-TM JOINT PLAIN SINGLE 9660 9660 9660 MRT011 MRI-TONGUE PLAIN 9660 9660 9660 MRT012 MRI-TONGUE PLAIN AND CONTRAST 11760 11760 11760 MRU001 MRI-UPPER ABDOMEN PLAIN 9660 9660 9660 MRU002 MRI-UPPER ABDOMEN PLAIN AND CONTRAST 12650 12650 12650 MRU003 MRI-UPPER ABDOMEN WITH MRCP 16640 16640 16640 MRU004 MRI-UROGRAPHY 9660 9660 9660 71| T a r i f f - AIMS
176 78581/2020/ESTT-NE_HRMRW001 MRI-WHOLE ABDOMEN FOR LOCALISATION OF TESTIS 9660 9660 9660 MRW002 MRI-WHOLE ABDOMEN PLAIN 17710 17710 17710 MRW003 MRI-WHOLE ABDOMEN PLAIN AND CONTRAST 25270 25270 25270 MRW004 MRI-WHOLE SPINE SCREENING 8860 8860 8860 MRW005 MRI-WITH CD EXTRA 1680 1680 1680 MRW006 MRI-WRIST BOTH PLAIN 19320 19320 19320 MRW007 MRI-WRIST BOTH PLAIN AND CONTRAST 21560 21560 21560 MRW008 MRI-WRIST SINGLE PLAIN 9660 9660 9660 MRW009 MRI-WRIST SINGLE PLAIN AND CONTRAST 11760 11760 11760 USA001 USG-ASPIRATION UNDER U.S. GUIDANCE 2400 2400 2400 USA002 Ultrasound AFI(Liquor) Twin Pregnancy 1540 1540 1540 USB001 USG-BIOPHYSICAL PROFILE (EXTRA) 1190 1190 1190 USB002 USG-BREAST BOTH 2800 2800 2800 USB003 USG-BREAST ELASTOGRAPHY 3500 3500 3500 USB004 USG-BREAST ONE SIDE 1500 1500 1500 USC001 USG-CHEST 1050 1050 1050 USC002 USG-CLINICAL 1050 1050 1050 USC003 USG-COLOR DOPPLER STUDY CAROTIDS (BOTH SIDES) 3840 3840 3840 USC004 USG-COLOR DOPPLER STUDY OBSTETRICAL 4900 4900 4900 USG-COLOR DOPPLER STUDY OBSTETRICAL TWIN USC005 PREGNANCY 7000 7000 7000 USC006 USG-COLOR DOPPLER STUDY PER. -ARTERIAL BOTH LIMB 5000 5000 5000 USC007 USG-COLOR DOPPLER STUDY PER. -ARTERIAL EACH LIMB 3780 3780 3780 USC008 USG-COLOR DOPPLER STUDY RENAL/ PORTAL SYSTEM 4200 4200 4200 USC009 USG-COLOR DOPPLER-PENILE 5600 5600 5600 USG-COLOR DOPPLERSTUDY PERIPHERAL VENOUS BOTH USC010 LIMB 5000 5000 5000 USG-COLOR DOPPLERSTUDY PERIPHERAL VENOUS EACH USC011 LIMB 3780 3780 3780 USC012 USG-COLOUR DOPPLER PER. (ART & VEN) BOTH LIMBS 8540 8540 8540 USC013 USG-COLOUR DOPPLER PER. (ART & VEN) EACH LIMBS 4340 4340 4340 USC014 USG-COLOUR DOPPLER STUDY SCROTUM 3000 3000 3000 USC015 USG-CRANIUM 2100 2100 2100 USC017 Ultrasound - cardiac Activity (CA) 700 700 700 USC018 USG COLOUR DOPPLER - PELVIC VESSELS 4200 4200 4200 USE001 USG-EARLY PREGNANCY 1120 1120 1120 USE004 USG-EYE 2420 2420 2420 USE005 USG-EXTRA FILM CHARGES 260 260 260 USE006 USG-Early Pregnancy NT.NB 1680 1680 1680 USE007 USG-Early pregnancy - twins 2430 2430 2430 USE008 USG-Early pregnancy - multiple 3220 3220 3220 USE009 USG-Early pregnancy NT NB - twins 3550 3550 3550 USE010 USG-Early pregnancy NT NB - multiple 4360 4360 4360 USF001 USG-FNAC WITH US GUIDANCE 2400 2400 2400 USF002 USG-FOR LOWER ABDOMEN/PELVIS/GYNAE 1200 1200 1200 72| T a r i f f - AIMS
177 78581/2020/ESTT-NE_HRUSF003 USG-FOR UPPER ABDOMEN 1200 1200 1200 USF004 USG-FOR WHOLE ABDOMEN 2100 2100 2100 USG001 Ultrasound-Guided Biopsy 3080 3080 3080 USG002 Ultrasound-Guided Procedure 5600 5600 5600 USH001 USG-HIP 2450 2450 2450 USK001 USG-KIDNEY/BLADDER & PROSTATE 1400 1400 1400 USK002 USG-KIDNEYS AND BLADDER 1100 1100 1100 USK003 USG-KIDNEYS ONLY 1000 1000 1000 USK004 Ultrasound Kidney Biopsy with USG Guidance 2100 2100 2100 USK005 Ultrasound KUB with Lower Abdomen(female) 2100 2100 2100 USK006 Ultrasound KUB with TVS Gynae(Female) 2380 2380 2380 USL001 USG-LIQUOR (AFI) 770 770 770 USM001 USG-MISC 1680 1680 1680 USM002 USG-MISC COLOUR DOPPLER 3500 3500 3500 USM003 USG MARKING 980 980 980 USM004 USG-US MSK - one site 2170 2170 2170 USM005 USG-US MSK - two sites 3550 3550 3550 USO001 USG-OBS ROUTINE (TWIN PREGNANCY) 3500 3500 3500 USO002 USG-OBSTETRICS 4D 3640 3640 3640 USO003 USG-OBSTETRICS 4D(TWIN PREGNANCY) 6050 6050 6050 USO004 USG-OBSTETRICS LEVEL 2 5180 5180 5180 USO005 USG-OBSTETRICS LEVEL 2 (TWIN PREGNANCY) 7000 7000 7000 USO006 USG-OBSTETRICS ROUTINE 2100 2100 2100 USO007 USG-OVULATION STUDY (Single Visit) 770 770 770 USO010 USG-Obstetrics Routine - multiple 7090 7090 7090 USP001 USG-PORTABLE (EXTRA) 1750 1750 1750 USR001 USG-RESIDUAL URINE 700 700 700 USS001 USG-SOFT TISSUE 1680 1680 1680 UST001 USG-T.V.S EARLY PREGNANCY 1680 1680 1680 UST002 USG-T.V.S. GYNAE 1680 1680 1680 UST003 USG-TESTICULAR LOCALISATION 2520 2520 2520 UST004 USG-TESTICULAR/SCROTUM 2400 2400 2400 UST005 USG-THYROID 2100 2100 2100 UST006 USG-TRANS RECTAL SCAN 2100 2100 2100 XRA001 XRAY-ABDOMEN ERECT 490 490 490 XRA002 XRAY-ABDOMEN ERECT AND SUPINE 980 980 980 XRA003 XRAY-ABDOMEN KUB 490 490 490 XRA004 XRAY-ABDOMEN RIGHT LATERAL DECUBITUS 490 490 490 XRA005 XRAY-ABDOMEN SUPINE 490 490 490 XRA006 XRAY-ANKLE A.P & LAT (LEFT) 980 980 980 XRA007 XRAY-ANKLE A.P & LAT (RIGHT) 980 980 980 XRA008 XRAY-ANKLE A.P (LEFT) 490 490 490 XRA009 XRAY-ANKLE A.P(RIGHT) 490 490 490 XRA010 XRAY-ANKLE A.P. & LAT. BOTH 1540 1540 1540
73| T a r i f f - AIMS
178 78581/2020/ESTT-NE_HRXRA011 XRAY-ANKLE LAT (LEFT) 490 490 490 XRA012 XRAY-ANKLE LAT (RIGHT) 490 490 490 XRA013 XRAY-APICOGRAM 490 490 490 XRB001 XRAY-BLADDER AREA AP 490 490 490 XRC001 XRAY-C.V.JUNCTION LAT. 490 490 490 XRC002 XRAY-CEPHALOGRAM 490 490 490 XRC003 XRAY-CERVICAL SPINE A.P. VIEW 490 490 490 XRC004 XRAY-CERVICAL SPINE AP & LAT 980 980 980 XRC005 XRAY-CERVICAL SPINE BOTH OBLIQUE VIEW 980 980 980 XRC006 XRAY-CERVICAL SPINE FOR ODONTOID PROCESS 490 490 490 XRC007 XRAY-CERVICAL SPINE LAT VIEW 490 490 490 XRC008 XRAY-CERVICAL SPINE LAT. FULL - EXT & FLEXION 980 980 980 XRC009 XRAY-CERVICAL SPINE OPEN MOUTH A.P. VIEW 490 490 490 XRC010 XRAY-CERVICO DORSAL SPINE A.P. & LAT 980 980 980 XRC011 XRAY-CERVICO DORSAL SPINE AP 490 490 490 XRC012 XRAY-CERVICO DORSAL SPINE LAT VIEW 490 490 490 XRC013 XRAY-CHEST A.P. 490 490 490 XRC014 XRAY-CHEST A.P. FOR RIBS 490 490 490 XRC015 XRAY-CHEST LT. LATERAL DECUBITUS 490 490 490 XRC016 XRAY-CHEST LT.LAT 490 490 490 XRC017 XRAY-CHEST OBLIQUE FOR RIBS (LEFT) 490 490 490 XRC018 XRAY-CHEST OBLIQUE FOR RIBS (RIGHT) 490 490 490 XRC019 XRAY-CHEST P.A. 490 490 490 XRC020 XRAY-CHEST P.A. & LEFT LAT. 980 980 980 XRC021 XRAY-CHEST P.A. & RIGHT LAT. 980 980 980 XRC022 XRAY-CHEST PORTABLE 980 980 980 XRC023 XRAY-CHEST RT. LAT. VIEW 490 490 490 XRC024 XRAY-CHEST RT. LATERAL DECUBITUS 490 490 490 XRC025 XRAY-CHEST(PA) WITH ABDOMEN SUPINE 980 980 980 XRC026 XRAY-CLAVICLE A.P LEFT 490 490 490 XRC027 XRAY-CLAVICLE A.P RIGHT 490 490 490 XRC028 XRAY-CLAVICLE P.A. BOTH 490 490 490 XRD001 XRAY-DORSAL SPINE A.P. 490 490 490 XRD002 XRAY-DORSAL SPINE AP & LAT 980 980 980 XRD003 XRAY-DORSAL SPINE LAT. 490 490 490 XRD004 XRAY-DORSO - LUMBAR SPINE A.P. STANDING 490 490 490 XRD005 XRAY-DORSO - LUMBAR SPINE LAT 490 490 490 XRD006 XRAY-DORSO-LUMBAR SPINE A.P. 490 490 490 XRD007 XRAY-DORSO-LUMBAR SPINE A.P. & LAT. 980 980 980 XRE001 XRAY-ELBOW A.P(LEFT) 490 490 490 XRE002 XRAY-ELBOW A.P(RIGHT) 490 490 490 XRE003 XRAY-ELBOW A.P. & LAT. BOTH 1540 1540 1540 XRE004 XRAY-ELBOW A.P. VIEW BOTH 490 490 490 XRE005 XRAY-ELBOW AP & LAT (LEFT) 980 980 980
74| T a r i f f - AIMS
179 78581/2020/ESTT-NE_HRXRE006 XRAY-ELBOW AP & LAT (RIGHT) 980 980 980 XRE007 XRAY-ELBOW LAT (LEFT) 490 490 490 XRE008 XRAY-ELBOW LAT (RIGHT) 490 490 490 XRF001 XRAY-FEET A.P. BOTH 490 490 490 XRF002 XRAY-FEET A.P.OBLIQUE/ LAT. BOTH 1540 1540 1540 XRF003 XRAY-FEMUR & HIP JOINT A.P. BOTH 980 980 980 XRF004 XRAY-FEMUR (THIGH) A.P. & LAT. RIGHT 980 980 980 XRF005 XRAY-FEMUR (THIGH) A.P. LEFT 490 490 490 XRF006 XRAY-FEMUR (THIGH) A.P. RIGHT 490 490 490 XRF007 XRAY-FEMUR (THIGH) AP & LATERAL LEFT 980 980 980 XRF008 XRAY-FEMUR (THIGH) LAT. LEFT 490 490 490 XRF009 XRAY-FEMUR WITH HIP JOINT AP (LEFT) 490 490 490 XRF010 XRAY-FEMUR WITH HIP JOINT AP (RIGHT) 490 490 490 XRF011 XRAY-FEMUR WITH KNEE JOINT AP & LAT. LEFT 980 980 980 XRF012 XRAY-FEMUR WITH KNEE JOINT AP & LAT. RIGHT 980 980 980 XRF013 XRAY-FEMUR(THIGH) LAT. RIGHT 490 490 490 XRF014 XRAY-FINGER AP AND LATERAL/OBLIQUE LEFT 980 980 980 XRF015 X-RAYFINGER AP AND LATERAL/OBLIQUE RIGHT 980 980 980 XRF016 XRAY-FOOT A.P. & OBLIQUE (LEFT) 980 980 980 XRF017 XRAY-FOOT A.P. & OBLIQUE (RIGHT) 980 980 980 XRF018 XRAY-FOOT AP LEFT 490 490 490 XRF019 XRAY-FOOT AP RIGHT 490 490 490 XRF020 XRAY-FOOT OBL. LEFT 490 490 490 XRF021 XRAY-FOOT OBL. RIGHT 490 490 490 XRF022 XRAY-FORE FOOT LEFT AP AND LATERAL 980 980 980 XRF023 XRAY-FORE FOOT RIGHT AP AND LATERAL 980 980 980 XRF024 XRAY-FOREARM A.P (LEFT) 490 490 490 XRF025 XRAY-FOREARM A.P (RIGHT) 490 490 490 XRF026 XRAY-FOREARM A.P. & LAT. BOTH 1540 1540 1540 XRF027 XRAY-FOREARM AP & LAT (LEFT) 980 980 980 XRF028 XRAY-FOREARM AP & LAT (RIGHT) 980 980 980 XRF029 XRAY-FOREARM LAT LEFT 490 490 490 XRF030 XRAY-FOREARM LAT RIGHT 490 490 490 XRF031 XRAY-FOREARM WITH WRIST AP & LAT. BOTH 1750 1750 1750 XRF032 XRAY-FOREARM WITH WRIST AP & LAT. LEFT 980 980 980 XRF033 XRAY-FOREARM WITH WRIST AP & LAT. RIGHT 980 980 980 XRH001 XRAY-HAND OBLIQUE LEFT 490 490 490 XRH002 XRAY-HAND OBLIQUE RIGHT 490 490 490 XRH003 XRAY-HAND P.A. & OBLIQUE BOTH 1540 1540 1540 XRH004 XRAY-HAND P.A. (LEFT) 490 490 490 XRH005 XRAY-HAND P.A. (RIGHT) 490 490 490 XRH006 XRAY-HAND P.A. VIEW (BOTH) 490 490 490 XRH007 XRAY-HAND PA & OBLIQUE (LEFT) 980 980 980 XRH008 XRAY-HAND PA & OBLIQUE (RIGHT) 980 980 980
75| T a r i f f - AIMS
180 78581/2020/ESTT-NE_HRXRH009 XRAY-HEEL AXIAL & LATERAL (BOTH) 1540 1540 1540 XRH010 XRAY-HEEL AXIAL & LATERAL (LEFT) 980 980 980 XRH011 XRAY-HEEL AXIAL & LATERAL (RIGHT) 980 980 980 XRH012 XRAY-HEEL AXIAL VIEW (LEFT) 490 490 490 XRH013 XRAY-HEEL AXIAL VIEW (RIGHT) 490 490 490 XRH014 XRAY-HEEL AXIAL VIEW BOTH 490 490 490 XRH015 XRAY-HEEL LAT BOTH 490 490 490 XRH016 XRAY-HIP JOINT A.P. & LAT. BOTH 1540 1540 1540 XRH017 XRAY-HIP JOINT A.P. (LEFT) 490 490 490 XRH018 XRAY-HIP JOINT AP & LAT VIEW (LEFT) 980 980 980 XRH019 XRAY-HIP JOINT AP & LAT VIEW (RIGHT) 980 980 980 XRH020 XRAY-HIP JOINT AP VIEW (RIGHT) 490 490 490 XRH021 XRAY-HIP JOINT LAT (RIGHT) 490 490 490 XRH022 XRAY-HIP JOINT LATERAL (LEFT) 490 490 490 XRH023 XRAY-HUMERUS ARM A.P. & LAT. BOTH 1540 1540 1540 XRH024 XRAY-HUMERUS ARM AP & LAT (LEFT) 980 980 980 XRH025 XRAY-HUMERUS ARM AP & LAT (RIGHT) 980 980 980 XRH026 XRAY-HUMERUS ARM AP LEFT 490 490 490 XRH027 XRAY-HUMERUS ARM AP RIGHT 490 490 490 XRH028 XRAY-HUMERUS ARM LAT LEFT 490 490 490 XRH029 XRAY-HUMERUS ARM LAT RIGHT 490 490 490 XRI001 XRAY-INFANTOGRAM 490 490 490 XRK001 XRAY-KNEE A.P. (LEFT) 490 490 490 XRK002 XRAY-KNEE A.P. (RIGHT) 490 490 490 XRK003 XRAY-KNEE A.P. STANDING BOTH 490 490 490 XRK004 XRAY-KNEE AP & LAT (LEFT) 980 980 980 XRK005 XRAY-KNEE AP & LAT (RIGHT) 980 980 980 XRK006 XRAY-KNEE AP & LAT. BOTH 1540 1540 1540 XRK007 XRAY-KNEE AP (BOTH) 490 490 490 XRK008 XRAY-KNEE AP& LAT STANDING (BOTH) 1540 1540 1540 XRK009 XRAY-KNEE AP&LAT STANDING LEFT 980 980 980 XRK010 XRAY-KNEE AP&LAT STANDING RIGHT 980 980 980 XRK011 X-RAY-KNEE INTERCONDYLAR NOTCH (BOTH) 980 980 980 XRK012 X-RAY-KNEE INTERCONDYLAR NOTCH (LEFT) 490 490 490 XRK013 X-RAY-KNEE INTERCONDYLAR NOTCH (RIGHT) 490 490 490 XRK014 XRAY-KNEE LAT (BOTH) 980 980 980 XRK015 XRAY-KNEE LAT (LEFT) 490 490 490 XRK016 XRAY-KNEE LAT (RIGHT) 490 490 490 XRK017 XRAY-KNEE SKYLINE VIEW (LEFT) 490 490 490 XRK018 XRAY-KNEE SKYLINE VIEW (RIGHT) 490 490 490 XRK019 XRAY-KNEE SKYLINE VIEW BOTH 490 490 490 XRL001 XRAY-L.S. SPINE A.P. VIEW 490 490 490 XRL002 XRAY-L.S. SPINE BOTH OBLIQUE VIEW 980 980 980 XRL003 XRAY-L.S. SPINE LAT 490 490 490
76| T a r i f f - AIMS
181 78581/2020/ESTT-NE_HRXRL004 XRAY-L.S.SPINE A.P. & LAT 980 980 980 XRL005 XRAY-L.S.SPINE LAT. FULL EXT. AND FULL FLEX. 980 980 980 XRL006 XRAY-LEG A.P. & LAT. BOTH 1750 1750 1750 XRL007 XRAY-LEG A.P. (LEFT) 490 490 490 XRL008 XRAY-LEG A.P. (RIGHT) 490 490 490 XRL009 XRAY-LEG A.P. BOTH 490 490 490 XRL010 XRAY-LEG AP & LAT (LEFT) 980 980 980 XRL011 XRAY-LEG AP & LAT (RIGHT) 980 980 980 XRL012 XRAY-LEG LAT LEFT 490 490 490 XRL013 XRAY-LEG LAT RIGHT 490 490 490 XRL014 XRAY-LEG WITH ANKLE AP & LATERAL (LEFT) 980 980 980 XRL015 XRAY-LEG WITH ANKLE AP & LATERAL (RIGHT) 980 980 980 XRL016 XRAY-LEG WITH KNEE AP & LATERAL (LEFT) 980 980 980 XRL017 XRAY-LEG WITH KNEE AP & LATERAL (RIGHT) 980 980 980 XRL018 XRAY-LUMBAR SPINE AP & LAT. 980 980 980 XRL019 XRAY-LUMBAR SPINE LAT. 490 490 490 XRM001 XRAY-MANDIBLE LAT. OBLIQUE BOTH 490 490 490 XRM002 XRAY-MANDIBLE LEFT LAT OBLIQUE 490 490 490 XRM003 XRAY-MANDIBLE P.A. VIEW 490 490 490 XRM004 XRAY-MANDIBLE RIGHT LAT. OBLIQUE 490 490 490 XRM005 XRAY-MASTOIDS LAT. OBLIQUE BOTH 980 980 980 XRM006 XRAY-MASTOIDS LEFT LAT OBLIQUE 490 490 490 XRM007 XRAY-MASTOIDS RIGHT LAT. OBLIQUE 490 490 490 XRM008 XRAY-MASTOIDS TOWNES VIEW 490 490 490 XRM009 XRAY-MISC. 490 490 490 XRN001 XRAY-NASAL BONE LAT. (BOTH) 980 980 980 XRO001 XRAY-OPTIC FORAMINA (BOTH) 980 980 980 XRO002 XRAY-ORBIT P.A. & LAT. 980 980 980 XRO003 XRAY-ORBIT P.A. VIEW 490 490 490 XRP001 XRAY-P.N.S. (CALDWELL VIEW) 490 490 490 XRP002 XRAY-P.N.S. (WATERS VIEW) 490 490 490 XRP003 XRAY- P-BARIUM MEAL 3500 3500 3500 XRP004 XRAY-P-BARIUM MEAL & SWALLOW 4900 4900 4900 XRP005 XRAY-P-BARIUM MEAL FOLLOW THROUGH 4900 4900 4900 XRP006 XRAY-P-BARIUM SWALLOW 2800 2800 2800 XRAY-P-BARIUM SWALLOW , BARIUM MEAL AND FOLLOW XRP007 THROUGH 5880 5880 5880 XRP008 XRAY-P-BARIUM SWALLOW FOR HITUS HERNIA/VARICES 2520 2520 2520 XRP009 XRAY-P-COLOGRAM 3500 3500 3500 XRP010 XRAY-P-CONTRAST FOR BARIUM 470 470 470 XRP011 XRAY-P-CONTRAST STUDY 4900 4900 4900 XRP012 XRAY-P-DEXABONE DENSITOMETERY (BOTH SIDE) 3500 3500 3500 XRP013 XRAY-P-DOUBLE CONTRAST BARIUM ENEMA 5600 5600 5600 XRP014 XRAY-P-DOUBLE CONTRAST BARIUM MEAL 3360 3360 3360
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182 78581/2020/ESTT-NE_HRXRP015 XRAY-P-DOUBLE CONTRAST BARIUM SWALLOW 2520 2520 2520 XRP016 XRAY-PELVIS FOR S.I JOINTS 490 490 490 XRP017 XRAY-PELVIS WITH BOTH HIP JOINT A.P. VIEW 490 490 490 XRP018 XRAY-PERORBITAL VIEW (FOR I.A.M.) 490 490 490 XRP020 XRAY-P-FISTULOGRAM 2800 2800 2800 XRP021 XRAY-P-FLUROSCOPY/SCREENING 490 490 490 XRP022 XRAY-P-H S G 2800 2800 2800 XRP023 XRAY-P-I V U 3010 3010 3010 XRP024 XRAY-P-I V U WITH M C U 4000 4000 4000 XRP025 XRAY-P-ILEOSTOGRAM 3500 3500 3500 XRP026 XRAY-P-IONIC CONTRAST UROGRAFIN-60% PER AMPOULE 700 700 700 XRP027 XRAY-P-IONIC CONTRAST UROGRAFIN-76% PER AMPOULE 840 840 840 XRP028 XRAY-P-M C U 2800 2800 2800 XRP029 XRAY-P-MAMMOGRAPHY-BOTH SIDE 2520 2520 2520 XRP030 XRAY-P-MAMMOGRAPHY-ONE SIDE 1680 1680 1680 XRP031 XRAY-P-MANIPULATION UNDER I.I 1680 1680 1680 XRP032 X-RAY-P-MISC 2800 2800 2800 XRP033 XRAY-P-NEPHROSTOGRAM 2100 2100 2100 XRAY-P-NON IONIC CONTRAST OMNIPAQUE PER VIAL(100 XRP034 ml) 2590 2590 2590 XRP036 XRAY-PORTABLE (EXTRA) 1400 1400 1400 XRP037 XRAY-P-PTC 2520 2520 2520 XRP038 XRAY-P-R.G.U 2520 2520 2520 XRP039 XRAY-P-RGP(ONE SIDE) 2020 2020 2020 XRP040 XRAY-P-RGU & MCU 4200 4200 4200 XRP041 XRAY-P-SIALOGRAM 1500 1500 1500 XRP042 XRAY-P-SINOGRAM 2520 2520 2520 XRP043 XRAY-P-T-TUBE CHOLANGIOGRAM 2520 2520 2520 XRS001 XRAY-S.I. JOINT OBLIQUE (LEFT) 490 490 490 XRS002 XRAY-S.I. JOINT OBLIQUE (RIGHT) 490 490 490 XRS003 XRAY-S.I. JOINT OBLIUQE BOTH 980 980 980 XRS004 XRAY-S.I. JOINT P.A. & LEFT OBLIQUE 980 980 980 XRS005 XRAY-S.I. JOINT P.A. & RIGHT OBLIQUE 980 980 980 XRS006 XRAY-S.I. JOINT PA & OBLIQUE (BOTH) 1540 1540 1540 XRS007 XRAY-S.T.N. LATERAL 490 490 490 XRS008 XRAY-SACRUM & COCCYX LAT 490 490 490 XRS009 XRAY-SACRUM & COCCYX P.A. & LAT. 980 980 980 XRS010 XRAY-SACRUM & COCCYX P.A. VIEW 490 490 490 XRS011 XRAY-SHOULDER JOINT A.P. BOTH 980 980 980 XRS012 XRAY-SHOULDER JOINT A.P. LEFT 490 490 490 XRS013 XRAY-SHOULDER JOINT A.P. RIGHT 490 490 490 XRS014 XRAY-SHOULDER JOINT AXIAL LEFT 490 490 490 XRS015 XRAY-SHOULDER JOINT AXIAL RIGHT 490 490 490 XRS016 XRAY-SKULL AP & LAT 980 980 980
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183 78581/2020/ESTT-NE_HRXRS017 XRAY-SKULL AP VIEW 490 490 490 XRS018 XRAY-SKULL FOR ORBITS 490 490 490 XRS019 XRAY-SKULL FOR STYLOID PROCESS 490 490 490 XRS020 XRAY-SKULL LAT. FOR SELLA (CONE VIEW) 490 490 490 XRS021 XRAY-SKULL LAT. VIEW 490 490 490 XRS022 XRAY-SKULL SUBMENTOVERTEX 490 490 490 XRS023 XRAY-SKULL TOWNES VIEW 490 490 490 XRS024 XRAY-STERNOCLAVICULAR JOINT LEFT OBLIQUE 490 490 490 XRS025 XRAY-STERNOCLAVICULAR JOINT RIGHT OBLIQUE 490 490 490 XRS026 XRAY-STERNUM LAT VIEW 490 490 490 XRS027 XRAY-SUB. MANDIBULAR REGION BOTH 490 490 490 XRS028 XRAY-SUB. MANDIBULAR REGION LEFT 490 490 490 XRS029 XRAY-SUB. MANDIBULAR REGION RIGHT 490 490 490 XRT001 XRAY-T.M. JOINTS LAT. OBL. OPEN & CLOSE MOUTH BOTH 1750 1750 1750 XRT002 XRAY-T.M. JOINTS LT LAT. OBL. OPEN & CLOSE MOUTH 980 980 980 XRT003 XRAY-T.M. JOINTS RT LAT. OBL. OPEN & CLOSE MOUTH 980 980 980 XRT004 XRAY-TOE AP AND OBLIQUE BOTH 1540 1540 1540 XRT005 XRAY-TOE AP AND OBLIQUE SINGLE 980 980 980 XRT006 XRAY-TILT STUDY 2500 2500 2500 XRW001 XRAY-WRIST AP LEFT 490 490 490 XRW002 XRAY-WRIST AP RIGHT 490 490 490 XRW003 XRAY-WRIST BALL CATCHER VIEW (BOTH) 490 490 490 XRW004 XRAY-WRIST JOINT FOR SCAPHOID LEFT 490 490 490 XRW005 XRAY-WRIST JOINT FOR SCAPHOID RIGHT 490 490 490 XRW006 XRAY-WRIST LAT LEFT 490 490 490 XRW007 XRAY-WRIST LAT RIGHT 490 490 490 XRW008 XRAY-WRIST P.A. & LAT. BOTH 980 980 980 XRW009 XRAY-WRIST P.A. VIEW (BOTH) 490 490 490 XRW010 XRAY-WRIST PA & LAT VIEW (LEFT) 980 980 980 XRW011 XRAY-WRIST PA & LAT VIEW (RIGHT) 980 980 980 CT3001 CT-3D RECONSTRUCTION (EXTRA) 8400 8400 8400 CTA001 CT-ANGIO GRAPHY WITH INTERVENTION PROCEDURE 23100 23100 23100 CTA002 CT-ANGIOGRAPHY ABDOMEN TRIPLE PHASE 21000 21000 21000 MRS014 CT-ANGIOGRAPHY ARCH AORTOGRAM 12730 12730 12730 MRS015 MRI-SPINE EACH REGION DORSAL 12730 12730 12730 MRS016 MRI-SPINE EACH REGION LUMBER SPINE 12730 12730 12730 MRS017 MRI-SPINE EACH REGION CONTRAST CERVICAL 14540 14540 14540 MRS018 MRI-SPINE EACH REGION CONTRAST DORSAL 14540 14540 14540 MRS019 MRI-SPINE EACH REGION CONTRAST LUMBER SPINE 14540 14540 14540 CTA004 CT-ANGIOGRAPHY BRAIN (INTRACRANIAL ARTERIES) 15120 15120 15120 CTA005 CT-ANGIOGRAPHY BRAIN(VENOGRAPHY) 15120 15120 15120 CTA006 CT-ANGIOGRAPHY CARDIAC 20160 20160 20160 CT-ANGIOGRAPHY LOWER ABDOMINAL AORTA AND ILIAC CTA007 ARTERIES. 28000 28000 28000
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184 78581/2020/ESTT-NE_HRCT-ANGIOGRAPHY NECK VESSSELS (EXTRA CRANIAL) BOTH CTA008 SIDE 16800 16800 16800 CTA009 CT-ANGIOGRAPHY NECK VESSSELS (EXTRA CRANIAL) ONE 15120 15120 15120 CTA010 CT-ANGIOGRAPHY PERIPH ARTERIAL BOTH LOWER LIMB 21000 21000 21000 CTA011 CT-ANGIOGRAPHY PERIPH ARTERIAL BOTH UPPER LIMB 21000 21000 21000 CTA012 CT-ANGIOGRAPHY PERIPH ARTERIAL EACH LOWER LIMB 17500 17500 17500 CTA013 CT-ANGIOGRAPHY PERIPH ARTERIAL EACH UPPER LIMB 17500 17500 17500 CTA014 CT-ANGIOGRAPHY PERIPH VENOGRAPHY BOTH LOWER LIMB 22400 22400 22400 CTA015 CT-ANGIOGRAPHY PERIPH VENOGRAPHY BOTH UPPER LIMB 22400 22400 22400 CTA016 CT-ANGIOGRAPHY PERIPH VENOGRAPHY EACH LOWER LIMB 18900 18900 18900 CTA017 CT-ANGIOGRAPHY PERIPH VENOGRAPHY EACH UPPER LIMB 18900 18900 18900
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185 78581/2020/ESTT-NE_HR
NON INVASIVE LAB ECHO PFT HOLTER TMT
Code Description Ward Semi Pvt Pvt NI2001 2D ECHO 2800 2800 2800 NI2003 2D Echo for LV function 1680 1680 1680 NIA001 ARTEIAL DOPPLER-1 LIMB 2800 2800 2800 NIA002 ARTEIAL DOPPLER-2 LIMB 3780 3780 3780 NIA003 ARTEIAL DOPPLER-All LIMB 5880 5880 5880 NIC001 CARITOID DOPPLER 4260 4260 4260 NIC002 Contrast Charges 1500 1500 1500 81| T a r i f f - AIMS
186 78581/2020/ESTT-NE_HRNID001 DODUTAMINE STRESS ECHO 4900 4900 4900 NIE001 ECG 310 310 310 NIE002 Emergency Echo 5650 5650 5650 NIF001 Fetal Echo 3500 3500 3500 NIH001 HOLTER MONITOR 2240 2240 2240 NII001 Intra operative Doppler 5550 5550 5550 NIP003 Portable Echo 3780 3780 3780 NIP007 Pead. Echo by CHA in OPD 2800 2800 2800 NIP008 Paed. Echo by CHA in IPD 4200 4200 4200 NIP009 Paed.Emergency Echo by CHA in IPD 4620 4620 4620 NIP010 Pead. Fetal Echo by CHA 2800 2800 2800 NIP011 Pead. Portable Echo by CHA 3780 3780 3780 NIR001 RENAL DOPPLER 4260 4260 4260 NIS001 STRESS ECHO 4900 4900 4900 NIT001 TEE 3500 3500 3500 NIT002 TMT 2380 2380 2380 NIV001 VENOUS DOPPLER ONE LIMB 3780 3780 3780 NIV003 VENOUS DOPPLER TWO LIMB 5160 5160 5160 NIV004 VENOUS DOPPLER FOR VARICOSE VEINS 6440 6440 6440 NI3001 2D ECHO WITH 3D MAPPING 3000 3000 3000 NI3002 2D ECHO WITH STRAIN IMAGING 3000 3000 3000 NI3003 2D ECHO WITH DYSSYNCHRONY STUDY 3000 3000 3000
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187 78581/2020/ESTT-NE_HR
ANAESTHESIA
Code Description Ward Semi Pvt Pvt ANA001 Anesthesia Charges-A 2800 3360 3920 ANA002 Anesthesia Charges-B 3500 4200 4900 ANA003 Anesthesia Charges-C 4200 5040 5880 ANA004 Anesthesia Charges-D 4900 5880 6860 ANA005 Anesthesia Charges-E 5600 6720 7840 ANC001 CAUDAL EPIDURAL Block 3500 4200 4900 ANC002 CONTINUOUS PLEXUS NERVE BLOCK 4900 5880 6860
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188 78581/2020/ESTT-NE_HRANF001 Fibreoptic bronchoscopy by Anaesthetist 4200 5040 5880 ANI001 IV CANNULATION 420 510 590 ANL001 LABOUR ANALGESIA 5600 6720 7840 ANL002 LUMBAR EPIDURAL Block 4200 5040 5880 ANL003 LUMBAR PUNCTURE by Anaesthetist 2000 2400 2800 ANS002 SINGLE SHOT NERVE BLOCK 3500 4200 4900 ANS003 SINGLE SHOT PLEXUS BLOCK 4200 5040 5880 ANT001 THORACIC EPIDURAL Block 4900 5880 6860 MONITERED ANESTHESIA CARE ANA006 CHARGES A 5000 6000 7000 MONITERED ANESTHESIA CARE ANA007 CHARGES B 10000 12000 14000 AND001 DISPOSABLE LASER FIBRE CHARGES II 5000 5000 5000 AND002 DISPOSABLE LASER FIBRE CHARGES I 20000 20000 20000 AND003 DISPOSABLE LASER FIBRE CHARGES 10000 10000 10000 AND004 DIODE LASER DELIVERY SYSTEM-II 24000 24000 24000 AND005 DIODE LASER DELIVERY SYSTEM 36000 36000 36000 ANR001 RFA CATHETER CHARGES 10000 10000 10000
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189 78581/2020/ESTT-NE_HR
CARDIOLOGY
CARDIAC SURGERY
CSC003 Coronary Angiography Package * – Daycare 10000
WARD S/C Single Suit P Suit CSC008 Coronary Angiography Package – Ward* 12000 Coronary Angiography Package - Semi. CSC006 14000 Pvt.* CSC005 Coronary Angiography Package - Pvt.* 16000 CSC004 Coronary Angiography Package - Suit* 18000 Coronary Angiography Package – CSC007 20000 Presidential Suit* 85| T a r i f f - AIMS
190 78581/2020/ESTT-NE_HRCSP005 Peripheral Angiography Package – Ward* 12000 Peripheral Angiography Package - Semi. CSP004 14000 Pvt.* CSP002 Peripheral Angiography Package - Pvt.* 16000 CSP001 Peripheral Angiography Package - Suit* 18000 Peripheral Angiography Package - CSP003 20000 Presidential Suit* CSA007 Angioplasty Coronary Package – Ward** 100000 Angioplasty Coronary Package - Semi. CSA005 110000 Pvt.** CSA004 Angioplasty Coronary Package - Pvt.** 120000 CSA003 Angioplasty Coronary Package – Suit** 130000 Angioplasty Coronary Package - CSA006 140000 Presidential Suit** Angioplasty Renal/Pheripheral/Caratoid CSA011 100000 Package – Ward** Angioplasty Renal/Pheripheral/Caratoid CSA010 110000 Package - Semi. Pvt.** Angioplasty Renal/Pheripheral/Caratoid CSA009 120000 Package - Pvt.** Angioplasty Renal/Pheripheral/Caratoid CSA008 130000 Package –Suit** Angioplasty Renal/Pheripheral/Caratoid CSA012 1400000 Package - Presidential Suit** Valvuloplasty/PTMC/BMV Package – CSV005 80000 Ward**** Open Heart Surg AVR/MVR/DVR & CABG CSO006 180000 210000 Package - War*** 240000 300000 350000 Abdominal aortic aneurysm CSA023 180000 210000 repair Package 240000 300000 350000 Aorto-femoral bypass CSA024 180000 210000 graft Package *** 240000 300000 350000 Peripheral Arterial Graft SurgeryPackage CSP012 80000 90000 100000 (excluding implant) *** 120000 140000 CSC036 Pericardiectomy Package*** 170000 190000 220000 240000 260000 Bentall’s/ Ascending aorta replacement CSC037 225000 265000 Package*** 300000 320000 350000 PNIE004 ECMO PACKAGE 390000 390000 390000 390000 390000 PNIE007 ECMO MAINTENANCE CHARGES_PACKAGE 118000 118000 118000 118000 118000 PCSC048 CABG PACKAGE 1 (OFF PUMP) 200000 230000 260000 320000 370000 PCSC050 CABG PACKAGE 1 (ON PUMP) 250000 280000 310000 370000 420000 PCSC049 CABG PACKAGE 2 (OFF PUMP) COMPLICATED 250000 280000 310000 370000 420000 PCSC051 CABG PACKAGE 2 (ON PUMP) COMPLICATED 250000 280000 310000 370000 420000 PCSO009 OPEN HEART SURGERY AVR PACKAGE 200000 230000 260000 320000 370000 PCSO004 OPEN HEART SURGERY DVR PACKAGE 200000 230000 260000 320000 370000 PCSO003 OPEN HEART SURGERY MVR PACKAGE 200000 230000 260000 320000 370000 PCSO006 OPEN HEART SURGERY TVR PACKAGE. 200000 230000 260000 320000 370000
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191 78581/2020/ESTT-NE_HR*Inclusions : Room Rent One day , Consultation Charges, Cath Lab Carges, Medcienes, Routine test Exclusions: Special Investingation, Non ionic Dye, CD charges (Rs1000/-)
**Inclusions: Room rent, consultation, Cath Lab, Medicines, Routine Test Exclusions: Special Investigations, Non lonic Dye (Visipac), Cost of special drug like IIB, IIIa inhibitor. In case of Primary PTCA Rs. 10000/- will be charged extra, visit charges of other than cardiologist.
*** Operation Theatre Charges Including Surgeon Fee+Anesthetist Fee+Cardiologist Fee Lab Investigation (Blood Group, Cross Matching, Kidney Profile, Liver Profile & Routine Hematology)
**** Inclusions: Room rent one day, consultation Charges, Cath Lab Charges, Medicines, Routine test Exclusions : Specil Investigations, Non ionic Dye, CD charges (Rs.1000/-)
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192 78581/2020/ESTT-NE_HR
CARDIOLOGY
Code Description Ward Semi Pvt Pvt CSV008 Vascular Reconstruction 100000 120000 140000 CST001 Temporary Pacemaker ( TPI) 14000 16800 19600 CSP007 Permanent Pacemaker(PPI) , Single Chamber 42000 50400 58800 CSP006 Permanent Pacemaker(PPI) , Double Chamber 56000 67200 78400 CSP008 Pericardial Tapping 7000 8400 9800 CSP010 Peripheral/Abdominal Vascular Embolisation 42000 50400 58800 CSP011 Peripheral Embolectomy Package 70000 84000 98000 CSA002 AICD(Single Chamber) 63000 75600 88200 CSA048 AICD(Double Chamber) 70000 84000 98000 88| T a r i f f - AIMS
193 78581/2020/ESTT-NE_HRCSB001 Biventricular 56000 67200 78400 CSC002 Combo Device 60000 72000 84000 CSS001 Swan GanzCatherization 4900 5880 6860 CSS002 Sternal wire insertion 2800 3360 3920 CSS003 Stem cell therapy 20010 20010 20010 CSC001 Check Angiography 11200 13440 15680 CSD001 Device Closure ** 70000 84000 98000 CSE002 ELECTROPHYSIOLOGY STUDY EP Minor 14000 16800 19600 CSE001 ELECTROPHYSIOLOGY STUDY EP Major 28000 33600 39200 CSE003 ELECTROPHYSIOLOGY STUDY RF Ablation 63000 75600 88200 CSE004 Emergency PTCA Charges 14000 16800 19600 CSE005 Endovascular Graft Implantation 70000 84000 98000 CSA014 Angioplasty with Intra Atrial STk Therapy 70000 84000 98000 CSL001 Lead Extraction 28000 33600 39200 CSH001 Head uptil test 3500 4200 4900 CSC009 CAG with simultaneous Angioplasty 12880 15456 18032 CSA013 AICD(Dual Chamber) 49000 58800 68600 CSA015 Device Closure ASD 42000 50400 58800 CSP013 Pleuro Pericardial Window 35420 42504 49588 CSC033 Cathlab charges for spinal angiogram 12710 15252 17794 CSA050 IVUS Associated Angioplasty 402500 483000 563500 CSA051 FFR Associated Angiplasty 322000 386400 450800
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194 78581/2020/ESTT-NE_HR
CRITICAL CARE SERVICES
Code Description Ward Semi Pvt Pvt CCA001 Arterial blood gas 1st ABG 1000 1000 1000 CCA002 Arterial blood gas subsequent ABG 630 630 630 CCA003 Arterial line radial 1750 1750 1750
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195 78581/2020/ESTT-NE_HRCCA004 Arterial line Femoral 2240 2240 2240 CCB002 BIPAP Connection per day 2100 2520 2940 CCB003 Bone marrow ASPIRATION 1680 2020 2360 CCB004 Bone marrow Biopsy 2240 2690 3140 CCB005 Bronchoscopy by Intensivist 8400 10080 11760 CCB006 BIPAP Connection per Hour 70 90 100 CCC001 Change of tracheostomy tube 310 370 440 CCC003 Code blue 4900 5880 6860 CCC004 Cricothyrotomy 3500 4200 4900 CCC005 CVP Insertion 2800 3360 3920 CCD001 Dialysis catheter 3080 3700 4320 CCF001 Foleys catheterisation 370 440 510 CCI001 ICTD insertion 6580 7900 9220 CCI002 Intranule insertion 770 930 1080 CCI003 Intubation & Ventilation 2800 3360 3920 CCN001 Neck cannula 420 510 590 CCP001 PA Catheter 3500 4200 4900 CCP002 Patient fluid warmer one time 770 930 1080 CCP003 Percutaneous Tracheostomy 3850 4620 5390 CCP004 PICC line insertion 1120 1350 1570 CCP007 Pulse oximeter room 280 340 400 CCR001 Ryles tube insertion 310 370 440 CCU001 USG charges 1140 1370 1590
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196 78581/2020/ESTT-NE_HR
BABY CARE
Code Description Ward Semi Pvt Pvt PEA001 Arterial Line insertion by pediatrician 3500 4200 4900 PEA003 Ascitic Tap ( pediatric) 3000 3600 4200 PEA004 Arterial Puncture Charges 1000 1200 1400 92| T a r i f f - AIMS
197 78581/2020/ESTT-NE_HRPEB001 Baby care charges 2100 2520 2940 PEB003 Bone Marrow Biopsy by pediatrician 3000 3600 4200 PEB004 Baby Observation charges Less than 8 hours 2100 2520 2940 PEB005 Baby Observation charges per day 3500 4200 4900 PEC001 Chest Tube insetion charges (neonatal) 5600 6720 7840 PEC002 Cisternal Puncture 2100 2520 2940 PEE001 Exchange transfusion 8400 10080 11760 PEF001 Femoral line catheterization by pediatrician 7000 8400 9800 PEH001 Hypothermia therapy in NICU 9660 11600 13530 PEI001 I.V. Medication 420 510 590 PEK001 Kidney Biopsy by pediatrician 3500 4200 4900 PEL001 Liver Biopsy(pediatric) 3500 4200 4900 PEL002 LP by pediatrician 2100 2520 2940 PEN001 NBBR LSCS Charges 4900 5880 6860 PEN002 NBBR Forceps 5390 6470 7550 PEN003 NBBR Normal high risk 5390 6470 7550 PEN004 NBBR Normal 4410 5300 6180 PEN005 NBBR Vaccum 5390 6470 7550 PEN006 NBBR Breech 6130 7350 8580 PEN007 Nebulization Charges 280 340 400 PEN008 NBBR LSCS High Risk 6470 7770 9060 PEP001 Partial Exchange 5600 6720 7840 PEP002 Peritoneal Dialysis by pediatrician 8400 10080 11760 PEP003 Phototherapy charges 1680 2020 2360 PEP004 Phototherapy charges Double surface 2520 3030 3530 PEP005 PICC insertion by pediatrician 5600 6720 7840 PEP006 Pleural tap Pediatric NICU/PICU 2100 2520 2940 PEP008 Pulse oxymeter room 700 840 980 PES001 Surfactant Administration 4900 5880 6860 Total parentral Nutrition administration PET001 charges 2800 3360 3920 PET002 Transcutaneous Bilirubin (Tc Bil) 200 240 280 PEU001 Umbilical arterial Canulation 7000 8400 9800 PEU002 Umbilical venous Canulation 5600 6720 7840 PEU003 UMBILICAL GRANULOMA CAUTERIZATION 280 340 400
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198 78581/2020/ESTT-NE_HR
COMMON PROCEDURES
Code Description Ward Semi Pvt Pvt COA001 Ankle Brachial Pressure Index 840 1010 1180 COB001 Biothesiometery 560 680 790
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199 78581/2020/ESTT-NE_HRCOB002 Blood Component Transfusion Charges 840 1010 1180 COD001 Doppler ABI 840 1010 1180 COI001 IV Infusion 280 340 400 COM001 Minor Dressing/ Suturing û I 280 340 400 COO001 Operating Microscope 2800 3360 3920 COP001 Podia-Scan 840 1010 1180 COP002 Plain Biothesiometry 840 1010 1180 COP003 Podiascan (Risk of diabetic foot) 560 680 790 COI002 Intraarticular Injection Simple joint 2430 2910 3400 COI003 Intraarticular Injection complex joint 3220 3870 4510 COS001 Skin biopsy for rhematology 3710 4460 5200
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200 78581/2020/ESTT-NE_HR
DENTAL
Code Description Ward Semi Pvt Pvt DN3004 3 UNIT BRIDGE 24150 24150 24150 DNA001 ABSCESS DRAINAGE PER TOOTH 700 700 700 96| T a r i f f - AIMS
201 78581/2020/ESTT-NE_HRDNA002 ADV.MEDICINE 280 280 280 DNA004 APICOECTOMY GRADE 1 -IPD 14000 14000 14000 DNA006 APICOECTOMY GRADE 2 -IPD 19600 19600 19600 DNA008 APEXIFICATION 3500 3500 3500 DNA009 APEXOGENESIS 4200 4200 4200 DNA010 APICOECTOMY SINGLE TOOTH 4900 4900 4900 DNA011 APICOECTOMY MULTIPLE TEETH 9100 9100 9100 DNB002 BLEACHING PER TOOTH 840 840 840 DNB004 BONE AUGMENTATION/EXPANSION 9800 9800 9800 DNB005 BONE GRAFT GRADE I 9800 9800 9800 DNB006 BONE GRAFT GRADE II 14000 14000 14000 DNB008 BRIDGE REPAIR 1120 1120 1120 DNB009 BLEACHING CHAIRSIDE 10500 10500 10500 DNB010 BLEACHING HOME 7000 7000 7000 DNB011 BLEACHING NON VITAL 2520 2520 2520 DNC001 CAST PARTIAL DENTURE ADDITIONAL TOOTH 1050 1050 1050 DNC002 CAST PARTIAL DENTURE BASE 8400 8400 8400 DNC003 CAUTERIZATION 840 840 840 DNC004 CERAMIC BRACES GRADE 1 47600 47600 47600 DNC005 CERAMIC BRACES GRADE 2 53200 53200 53200 DNC006 CERAMIC BRACES GRADE 3 58800 58800 58800 DNC008 CHECK UP 420 420 420 DNC009 CLEFT PALATE SURGERY-IPD 53200 53200 53200 DNC010 COMPLEX RETRAINER THERAPY 11200 11200 11200 DNC011 CONSULTATION 420 420 420 DNC012 CONSULTATION MAJOR -IPD 700 700 700 DNC015 CROWN METAL 2520 2520 2520 DNC016 CROWN PORCELAIN GRADE 1 4900 4900 4900 DNC017 CROWN PORCELAIN GRADE 2 LASER PFM 6300 6300 6300 DNC021 CROWN RECEMENTATION 700 700 700 DNC022 CROWN REPAIR 1120 1120 1120 DNC023 CROWN WITH FACING 2800 2800 2800 DNC027 CYST REMOVAL GRADE 1 -IPD 16800 16800 16800 DNC029 CYST REMOVAL GRADE 2 -IPD 22400 22400 22400 DNC031 CERAMIC BRACES SINGLE ARCH 30800 30800 30800 DNC032 CORE FILLING 1120 1120 1120 DNC033 CROWN METAL FREE GRADE 1 11200 11200 11200 DNC034 CROWN METAL FREE GRADE 2 14000 14000 14000 DNC035 CROWN METAL FREE GRADE 3 16800 16800 16800 DNC036 CURETTAGE QUADRANT 4200 4200 4200 DNC037 CURETTAGE SINGLE ARCH 5600 5600 5600 DNC038 CURETTAGE FULL MOUTH 11200 11200 11200 DNC039 CYST REMOVAL GRADE 1 9100 9100 9100 DNC040 CYST REMOVAL GRADE 2 9800 9800 9800
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202 78581/2020/ESTT-NE_HRDNC041 CERAMIC BRACES SELF LIGATING 80000 80000 80000 DNC042 Clear Aligners Part Payment 1 80500 80500 80500 DNC043 Clear Aligners Part Payment 2 40250 40250 40250 DND001 DENTURE (U/L) GRADE 1 14000 14000 14000 DND002 DENTURE (U/L) GRADE 2 16800 16800 16800 DND003 DENTURE REPAIR 700 700 700 DND004 DENTURE REPAIR +RELINE 2100 2100 2100 DND005 DENTURE SINGLE GRADE 1 7000 7000 7000 DND006 DENTURE SINGLE GRADE 2 8400 8400 8400 DND007 DEPIGMENTATION 4900 4900 4900 DND008 DESENSITIZING FULL MOUTH 3500 3500 3500 DND009 DESENSITIZING PER QUADRANT 1120 1120 1120 DND010 DESENSITIZING PER TOOTH 420 420 420 DND011 DIRECT SINUS LIFT 16800 16800 16800 DND012 DIRECT SINUS LIFT (GRADE2) 28000 28000 28000 DND013 DIRECT SINUS LIFT (GRADE3) 35000 35000 35000 DND014 Denture (U/L) Grade 3 28000 28000 28000 DNE001 EXTRACTION GRADE 1 420 420 420 DNE002 EXTRACTION GRADE 1 -IPD 7000 7000 7000 DNE003 EXTRACTION GRADE 2 840 840 840 DNE004 EXTRACTION GRADE 2 -IPD 11200 11200 11200 DNE005 EXTRACTION GRADE 3 1260 1260 1260 DNE006 EXTRACTION GRADE 3 -IPD 14000 14000 14000 DNE007 PROCEDURE (ENAP) 4900 4900 4900 DNF001 FILLING GRADE 1 800 800 800 DNF002 FILLING GRADE 2 1120 1120 1120 DNF003 FILLING GRADE 3 1400 1400 1400 DNF004 FILLING IPD 1680 1680 1680 DNF005 FLAP SURGERY FULL MOUTH 25200 25200 25200 DNF006 FLAP SURGERY GRADE 1 4900 4900 4900 DNF007 FLAP SURGERY GRADE 2 6300 6300 6300 DNF008 FLEXIBLE DENTURE ADDITIONAL TOOTH 700 700 700 DNF009 FLEXIBLE DENTURE BASE 6000 6000 6000 DNF010 FLUORIDE THERAPY ARCH 2800 2800 2800 DNF011 FLUORIDE THERAPY PER TOOTH 420 420 420 DNF012 FRACTURE REDUCTION GRADE 1 16800 16800 16800 DNF013 FRACTURE REDUCTION GRADE 1 -IPD 25200 25200 25200 DNF014 FRACTURE REDUCTION GRADE 2 21000 21000 21000 DNF015 FRACTURE REDUCTION GRADE 2 -IPD 30800 30800 30800 DNF016 FRACTURE REDUCTION GRADE 3 -IPD 39200 39200 39200 DNF017 FRENECTOMY 5600 5600 5600 DNF018 FRENOTOMY 3500 3500 3500 DNF023 Fixed Orthodontic Treatment 4040 4040 4040 DNG001 GINGIVECTOMY 4900 4900 4900
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203 78581/2020/ESTT-NE_HRDNG002 GINGIVECTOMY FULL ARCH 16800 16800 16800 DNG003 GINGIVECTOMY WITH BONE CUTTING 6300 6300 6300 DNG004 GUIDED TISSUE REGENERATION 10500 10500 10500 DNH001 HEMI SECTION 4900 4900 4900 DNI001 IMPLANT CROWN 7000 7000 7000 DNI002 IMPLANT GRADE I 28000 28000 28000 DNI003 IMPLANT GRADE II 39200 39200 39200 DNI004 INCISION & DRAINAGE PER TOOTH 700 700 700 DNI005 INDIRECT SINUS LIFT 7000 7000 7000 DNI006 INLAY GRADE 1 2100 2100 2100 DNI007 INLAY GRADE 2 3500 3500 3500 DNI008 IOPA 140 140 140 DNI009 IRRIGATION 280 280 280 DNI010 IMPLANT CROWN CUSTOM ABUTMENT 21000 21000 21000 DNI011 IMPLANT GRADE 3 63000 63000 63000 DNI012 Implant Hybrid Dentures 19320 19320 19320 DNL002 LOCAL CURRETTAGE PER TOOTH 700 700 700 DNL003 LINGUAL BRACES SINGLE ARCH 63000 63000 63000 DNL004 LINGUAL BRACES GRADE I 112000 112000 112000 DNL005 LINGUAL BRACES GRADE Ii 140000 140000 140000 DNLOO6 LOCAL DRUG DELIVERY/TOOTH 280 280 280 DNM001 MESIODENS REMOVAL 4900 4900 4900 DNM002 METAL BRACES GRADE 1 39200 39200 39200 DNM003 METAL BRACES GRADE 2 44800 44800 44800 DNM004 METAL BRACES GRADE 3 50400 50400 50400 DNM006 MINOR SURGICAL PROCEDURES GRADE 1 2800 2800 2800 DNM007 MINOR SURGICAL PROCEDURES GRADE 2 4200 4200 4200 DNM008 MINOR SURGICAL PROCEDURES GRADE 3 5600 5600 5600 DNM010 MTA 3500 3500 3500 DNM011 MUCOGINGIVAL SURGERY 6300 6300 6300 DNM012 MUTIPLE IOPA 700 700 700 DNM013 MYOFUNCTIONAL APPLIANCE 14000 14000 14000 DNM014 METAL BRACES SINGLE ARCH 25200 25200 25200 DNM015 METAL BRACES SELF LIGATING 63000 63000 63000 DNN003 NIGHT GUARD SINGLE ARCH 2100 2100 2100 DNN004 NIGHT GUARD DOUBLE ARCH 4200 4200 4200 DNN005 NATURAL PONTIC 6300 6300 6300 DNO002 OCCLUSAL EQUILIBRATION PER TOOTH 420 420 420 DNO003 OPERCULECTOMY 4200 4200 4200 DNO007 ORTHO TRAINER 14000 14000 14000 DNO009 OVER DENTURE 35000 35000 35000 DNO010 OPG 700 700 700 DNO011 OBTURATOR TEMP 11200 11200 11200 DNO012 OBTURATOR PERMANENT 35000 35000 35000
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204 78581/2020/ESTT-NE_HRDNO013 ORTHO ACTIVATION GRADE 1 2800 2800 2800 DNO014 ORTHO ACTIVATION GRADE 2 4200 4200 4200 DNO015 ORTHO ACTIVATION GRADE 3 7000 7000 7000 ORTHOGNONATHIC SURGERY SINGLE ARCH MAJOR - DNO016 IPD 42000 42000 42000 ORTHOGNONATHIC SURGERY BOTH ARCH MAJOR - DNO017 IPD 84000 84000 84000 DNO018 ORTHO MINI IMPLANT 4200 4200 4200 DNO019 Overdenture 8050 8050 8050 DNP004 PARTIAL DENTURE ADDITIONAL TOOTH 420 420 420 DNP008 PHASIC METAL BRACES TREATMENT 50400 50400 50400 DNP009 PIT & FISSUE SEALANT PER TOOTH 700 700 700 DNP014 PRECISION ATTACHMENT 6300 6300 6300 DNP015 PULPECTOMY 3500 3500 3500 DNP016 PULPOTOMY 2520 2520 2520 DNP017 PULPOTOMY MAJOR -IPD 5600 5600 5600 DNP018 PARTIAL DENTURE BASE ( TILL 3 TEETH ) 2100 2100 2100 DNP019 PEDO CROWNS PREFORMED 2520 2520 2520 DNP020 PEDO CROWNS CUSTOM MADE 3500 3500 3500 DNP021 POST METAL PREFABRICATED 1400 1400 1400 DNP022 POST FIBRE PREFABRICATED 3500 3500 3500 DNP023 POST CUSTOM MADE 2100 2100 2100 DNP024 PRECIOUS METAL CROWN 39200 39200 39200 DNP025 PULPECTOMY GRADE 2 4200 4200 4200 DNP026 PEDO CROWN CUSTOM MADE GRADE 2 4200 4200 4200 DNP027 PERIODONTAL MICROSURGERY 6300 6300 6300 DNR001 RCT GRADE 1 4200 4200 4200 DNR002 RCT GRADE 2 4900 4900 4900 DNR003 RE RCT GRADE 3 5600 5600 5600 DNR005 ROOT CANAL TREATMENT MAJOR -IPD 7000 7000 7000 DNR006 ROOT RESECTION 6300 6300 6300 DNS002 SCALING (Grade I) 1500 1500 1500 DNS003 SCALING (Grade II) 2100 2100 2100 DNS004 SCALING (Grade III) 2800 2800 2800 DNS006 SIMPLE RETAINER THERAPY 5600 5600 5600 DNS009 SOCKET PRESERVATION 7000 7000 7000 DNS010 SPACE MAINTAINER 4200 4200 4200 DNS013 SURGICAL EXPOSURE 5600 5600 5600 DNS014 SURGICAL EXTRACTION GRADE 1 4900 4900 4900 DNS015 SURGICAL EXTRACTION GRADE 2 6300 6300 6300 DNS016 SURGICAL EXTRACTION GRADE 3 7000 7000 7000 DNS017 SURGICAL IMPACTION GRADE 1 -IPD 11200 11200 11200 DNS018 SURGICAL IMPACTION GRADE 2 -IPD 16800 16800 16800 DNS019 SURGICAL IMPACTION GRADE 3 -IPD 22400 22400 22400 DNS020 SPLINTING PER TOOTH 840 840 840 100| T a r i f f - AIMS
205 78581/2020/ESTT-NE_HRDNS021 SPLINTING PER SEGMENT 5600 5600 5600 DNT001 TMJ SURGERY-IPD 84000 84000 84000 DNT002 TOOTH REIMPLANTATION 8400 8400 8400 DNT003 Two stage Implant 44800 44800 44800 DNV004 VENEER COMPOSITE 2100 2100 2100 DNV005 VENEER CERAMIC 8400 8400 8400 DNV006 VENEER ALL CERAMIC 11200 11200 11200 DNV007 Veneer Composite grade 2 3500 3500 3500 DNZ001 Zirconia Abutment 5600 5600 5600 DND015 DENTASCAN I 3000 3000 3000 DND016 DENTASCAN II 2500 2500 2500 LASER ASSISTED PERIODONTAL THERAPY / DNL007 QUADRANT 4000 4000 4000 LASER ASSISTED GINGIVECTOMY/CURETTAGE/CRW DNL008 LEN P/T 1000 1000 1000 DNL010 LASER ASSISTED PULPOTOMY 4000 4000 4000 DNL011 LASER ASSISTED RCT [PIPS] 6000 6000 6000 DNL012 LASER ASSISTED PERIODONTAL TREATMENT 4000 4000 4000 LASER ASSISTED DNL013 GINNGEVECTOMY/CURETTAGE/CROOLING 1000 1000 1000 DNL014 LASER ASSITED MINOR ORAL SURGERY 4000 4000 4000 DNL016 LASER ASSISTED RCT 6000 6000 6000
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206 78581/2020/ESTT-NE_HR
DERMATOLOGY
Code Description Ward Semi Pvt Pvt SKA001 ALLERGY TEST 3640 4370 5100
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207 78581/2020/ESTT-NE_HRSKB001 Botox 1 12320 14790 17250 SKB002 Botox 2 13860 16640 19410 SKB003 Bio Sculpting Treatment 66010 79220 92420 SKC001 CHEMICAL CAUTERY TYPE A 770 930 1080 SKC002 CHEMICAL CAUTERY TYPE B 980 1180 1380 SKC003 CO2 LASER TYPE A 6020 7230 8430 SKC004 CO2 LASER TYPE B 8120 9750 11370 SKC005 CO2 LASER TYPE C 10080 12100 14120 SKC006 COLLAGEN INDUCTION THERAPR BY DERMAROLLER A 16100 19320 22540 SKC007 COLLAGEN INDUCTION THERAPR BY DERMAROLLER B 20300 24360 28420 SKC008 COLLAGEN INDUCTION THERAPR BY DERMAROLLER C 24360 29240 34110 SKC009 CRYOTHERAPY-A 1400 1680 1960 SKC010 CRYOTHERAPY-B 2100 2520 2940 SKC011 CRYOTHERAPY-C 2380 2860 3340 SKC012 Collagen Induction Therapy by Dermaroller D 17640 21170 24700 SKC013 Cryo Sculpting 19320 23190 27050 SKE001 ELECTRIC CAUTERY TYPE A 980 1180 1380 SKE002 ELECTRIC CAUTERY TYPE B 1190 1430 1670 SKF001 Fractional Laser I 23100 27720 32340 SKF002 Fractional Laser II 38500 46200 53900 SKF003 Fractional Laser III 77000 92400 107800 SKF004 Filler 1 12320 14790 17250 SKF005 Filler 2 13860 16640 19410 SKF006 Full Body Firming Exercise(Therapy+Lipofit)5 Sessi 25760 30920 36070 SKF007 Full Body Firming Exercise(Therapy+Lipofit)10Sessi 48300 57960 67620 SKF008 Figure Correction Trims Treatment 3220 3870 4510 SKF009 Figure Correction Turbo Slim Treatment 4040 4840 5650 SKF010 Figure Correction Full Body Therapy 3550 4260 4960 SKF011 Figure Correction Premium Body Therapy 6290 7550 8810 SKF012 Figure Correction Treatment - CTS 11120 13340 15570 SKF013 Figure Correction Treatment - TEI 4040 4840 5650 SKG001 GENITAL WARTS- CRYOTHERAPY A 4060 4880 5690 SKG002 GENITAL WARTS-CRYOTHERAPY B 10220 12270 14310 I/L THERAPY (DEPENDING ON NUMBER/ TYPE OF SKI001 LESIONS)-A 980 1180 1380 I/L THERAPY (DEPENDING ON NUMBER / TYPE OF SKI002 LESIONS)-B 1190 1430 1670 I/L THERAPY (DEPENDING ON NUMBER / TYPE OF SKI003 LESIONS)-C 1540 1850 2160 I/L THERAPY (DEPENDING ON NUMBER / TYPE OF SKI004 LESIONS)-E 2940 3530 4120 I/L THERAPY (DEPENDING ON NUMBER / TYPE OF SKI005 LESIONS)-D 1960 2360 2750 SKL001 LARGE LESIONS -CRYOTHERAPY A 2800 3360 3920 SKL002 LARGE LESIONS- CRYOTHERAPY B 3920 4710 5490
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208 78581/2020/ESTT-NE_HRSKL003 Laser Hair Redn I 9240 11090 12940 SKL004 Laser Hair Redn II 16800 20160 23520 SKL005 Laser Hair Redn III 27720 33270 38810 SKL006 Laser Hair Redn IV 13860 16640 19410 SKL007 Laser Hair Redn V 36960 44360 51750 SKL008 Lipofit Per Session 3070 3680 4300 SKL009 Lipofit for 10 Session 25760 30920 36070 SKL010 Laser Hair Reduction Maintenance Sitting 1610 1940 2260 SKM001 MESOTHERAPY A 1960 2360 2750 SKM002 MESOTHERAPY B 2940 3530 4120 SKM003 MESOTHERAPY C 4060 4880 5690 SKM004 MISCELLANEOUS SMEARS 1120 1350 1570 SKN001 NBUVB - Phototherapy Type A per sitting 1120 1350 1570 SKN002 NBUVB - Phototherapy Type B per sitting 1540 1850 2160 SKN003 NBUVB - Phototherapy Type C per sitting 1960 2360 2750 SKN004 NBUVB - Phototherapy Type D per sitting 2240 2690 3140 SKN005 ND YAG LASER (PER SITTING) A 3920 4710 5490 SKN006 ND YAG LASER (PER SITTING) B 5040 6050 7060 SKN007 ND YAG LASER (PER SITTING) C 5880 7060 8240 SKN008 ND YAG LASER (PER SITTING) D 7840 9410 10980 SKN009 Narrow Band UVP Treatment(10 Sessions) 6300 7560 8820 SKP001 PATCH TEST TYPE A 2800 3360 3920 SKP002 PATCH TEST TYPE B 4060 4880 5690 SKP003 PUNCH/WEDGI SKIN ANALYSIS/HISTOPATH TYPE A 2800 3360 3920 SKP004 PUNCH/WEDGI SKIN ANALYSIS/HISTOPATH TYPE B 3220 3870 4510 SKP005 Pigmentation Reducer I 9240 11090 12940 SKP006 Pigmentation Reducer II 13440 16130 18820 SKP007 Pimple Free Package I 7280 8740 10200 SKP008 Pimple Free Package II 9240 11090 12940 SKP009 Puva Therapy/Targeted Therapy/Narrow Band-I 8050 9660 11270 SKP010 Puva Therapy/Targeted Therapy/Narrow Band-II 8870 10640 12410 SKQ001 Q SWITCHED LASER PER SITTING A 3780 4540 5300 SKQ002 Q SWITCHED LASER PER SITTING B 5320 6390 7450 SKQ003 Q SWITCHED LASER PER SITTING C 6160 7400 8630 SKR001 RADIO FREQUENCY CAUTERISAION A 1350 1620 1890 SKR002 RADIO FREQUENCY CAUTERISAION B 2240 2690 3140 SKR003 RADIO FREQUENCY CAUTERISAION C 2780 3330 3890 SKR004 RADIO FREQUENCY CAUTERISAION D 4060 4880 5690 SKR005 RADIO FREQUENCY CAUTERISAION E 5040 6050 7060 SKR006 RADIO FREQUENCY CAUTERISAION F 6020 7230 8430 SKS001 SKIN BIOPSY- TYPE A 2240 2690 3140 SKS002 SKIN BIOPSY- TYPE B 3220 3870 4510 SKS003 SKIN MINIGRAFTING A 2940 3530 4120 SKS004 SKIN RESURFACING BY CHEMICAL PEELS A 1540 1850 2160
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209 78581/2020/ESTT-NE_HRSKS005 SKIN RESURFACING BY CHEMICAL PEELS B 1960 2360 2750 SKS006 SKIN RESURFACING BY CHEMICAL PEELS C 3080 3700 4320 SKS007 SKIN RESURFACING BY COMBINATION PEELS D 3640 4370 5100 SKS008 SKIN RESURFACING BY COMBINATION PEELS E 3920 4710 5490 SKS009 SKIN RESURFACING BY DERMA BRASION A 1540 1850 2160 SKS010 SKIN RESURFACING BY DERMA BRASION B 1960 2360 2750 SKS011 SKIN RESURFACING BY DERMA BRASION C 2780 3330 3890 SKS012 SKIN RESURFACING BY DERMA BRASION D 4060 4880 5690 SKS013 SKIN RESURFACING BY DERMA BRASION E 5040 6050 7060 SKS014 SKIN SMEAR FOR AFB LEPRAE 2940 3530 4120 SKS016 SKIN TIGHTENING 21560 25880 30190 SKS017 Session Based Weight Loss 19170 23000 26840 SKT001 TZANCK SMEARS 1110 1330 1550 SKT002 Target Weight Loss 5KG 12560 15070 17590 SKG021 GLUTATHIONE INJ. 7000 8400 9800 SKG022 GLUTATHIONE INJ. (PACKAGE OF 15 INJ.) 90000 108000 126000
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210 78581/2020/ESTT-NE_HR
E N T
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211 78581/2020/ESTT-NE_HRCode Description Ward Semi Pvt Pvt ENA001 Adenoidectomy 14000 16800 19600 ENA002 Adenotonsillectomy 15400 18480 21560 ENA003 Anterior Ethemoidal Artery Ligation 7980 9580 11180 ENA004 Antral Wash Outs Bilateral 4000 4800 5600 ENA006 Audiology-Cochlear Implant-Pre op Evaulation Pack 7700 9240 10780 Audiology-Cochlear Implant- Mapping and Rehab ENA007 Packa 77000 92400 107800 ENA008 Audiology For Pure Tone With Special TESTS 770 930 1080 ENA009 Audiology-HEARING - AID TRIAL 1000 1200 1400 ENA010 Audiology-IMPEDENCE AUDIOMETRY 840 1010 1180 ENA011 Audiology-Neonatal ABR 2800 3360 3920 ENA012 Audiology-Speech Therapy (Assessment) 700 840 980 ENA013 Audiology-Speech Therapy (Package of 10 sessions) 6000 7200 8400 ENA014 Audiology-Speech Therapy (Per sitting) 700 840 980 ENA017 Aural Polypectomy 3220 3870 4510 ENA018 Audiology-OAE 980 1180 1380 ENA020 Antrostomy Intranasal Unilateral 3710 4460 5200 ENA021 Adenoidectomy Endoscopic 18200 21840 25480 ENA022 Adenotonsillectomy Coblation assisted 21000 25200 29400 ENB001 Bronchoscopy with foreign body Removal 20000 24000 28000 ENB003 Branchial Cyst Excision 20000 24000 28000 ENB004 Branchial Fistula Excision 20000 24000 28000 ENB005 Branchial Sinus Excision 20000 24000 28000 ENB006 Balloon sinuplasty-maxillary osteum-bilateral 19600 23520 27440 ENB007 Balloon sinuplasty-maxillary osteum-unilateral 14000 16800 19600 ENB008 Balloon sinuplasty Frontal Recess-bilateral 19600 23520 27440 ENB009 Balloon sinuplasty Frontal Recess-unilateral 14000 16800 19600 ENB010 Balloon sinuplasty Frontal+ maxillary combined 23800 28560 33320 ENB011 Balloon sinuplasty-Sphenoid osteum Bilateral 29400 35280 41160 ENB012 Balloon sinuplasty-Sphenoid osteum unilateral 23800 28560 33320 ENC001 Caldwell Lucs Surgery 10000 12000 14000 ENC003 Choanal Atresia 24000 28800 33600 ENC005 CSF Rhinorhorrea Leak Surgery 37100 44520 51940 ENC006 Cortical Mastoidectomy 20000 24000 28000 ENC007 Coblation Assisted uvulopalato plasty 30800 36960 43120 ENC008 Conchoplasty 16000 19200 22400 END001 Direct Laryngoscopy / FODL 3360 4040 4710 END002 Direct laryngoscopy/ FODL and biopsy 4620 5550 6470 END003 DCR Endoscopic 19600 23520 27440 ENE004 Ear Syringing 630 760 890 ENE005 Endo Lymphatic Sac Decompression 20000 24000 28000 ENE012 ENDOSCOTPY-THROAT/nose 2800 3360 3920 ENE013 Eustachian Catheterisation 280 340 400
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212 78581/2020/ESTT-NE_HRENE020 External Auditory Canal Growth Excision 5600 6720 7840 ENE028 External Ethmoidectomy 13020 15630 18230 ENE029 Examination under microscope in OT 4620 5550 6470 ENE030 Ear packing 500 600 700 ENE032 Examination under microscope 1540 1850 2160 ENE039 Ethemoidectomy Intra Nasal Bilateral 16380 19660 22940 ENE040 Ethemoidectomy Intranasal U/L 9800 11760 13720 ENE041 Ext. Carotid Artery Ligation 14000 16800 19600 ENE042 Ear Foreign Body Removal 1540 1850 2160 ENE043 Ethmoidectomy (Horgans) Transantral 28000 33600 39200 ENE044 Ethemoidal Surgery-Radical 28000 33600 39200 ENF001 Facial Nerve Decompression 27000 32400 37800 ENF005 Functional Endosc.Sinus Sur B/L Extended 25000 30000 35000 ENF006 Functional Endoscopic Sinus Surgery Limited 9800 11760 13720 ENF007 Functional Endoscopic Sinus Surgery U/L 14000 16800 19600 ENF008 Functional Endoscopic SinusSurg. B/L 22000 26400 30800 ENF009 Frontal Surgery-Radical 19600 23520 27440 ENG001 Glomus jugulare Tumor trans tymanic Approach 37800 45360 52920 Hematoma Pinna Ind with pressure ENH001 bandageUnilateral 2000 2400 2800 ENH002 HYPOPHARYNX Foreign Body Removal 12600 15120 17640 Hematoma Pinna Ind with pressure bandage ENH003 Bilateral 3080 3700 4320 ENI005 IMF wire Removal 1120 1350 1570 ENK001 Keloid ear excision 7000 8400 9800 ENL001 Laryngeal Web Excision 20000 24000 28000 ENL002 Laryngectomy Conservative 24000 28800 33600 ENL003 Laryngectomy Total 30000 36000 42000 ENL004 Laryngo Fissure 30000 36000 42000 ENL010 Laryngeal Stenosis Excision Cum Repair 30000 36000 42000 ENL011 Larynx Foreign Body Removal 12600 15120 17640 ENM001 Mastoid Cavity Obliteration 22000 26400 30800 ENM003 Mastoidectomy Modified 24000 28800 33600 ENM005 Maxillectomy 35000 42000 49000 ENM006 Microlaryngeal Surgery 20000 24000 28000 ENM007 Myringotomy Bilateral 9800 11760 13720 ENM008 Myringotomy Bilateral With Gromets 12600 15120 17640 ENM009 Myringotomy Unilateral 7000 8400 9800 ENM010 Myringotomy Unilateral with Gromet 8400 10080 11760 ENM011 Maxillectomy medial 27720 33270 38810 ENN001 Nasal Packing with Catherter balloons Bilateral 9800 11760 13720 ENN002 Nasal Packing-ANTERIOR 4200 5040 5880 ENN003 Nasal Packing-Anterior & Posterior 12600 15120 17640 ENN004 Nasal Packing-merocel 2800 3360 3920 ENN005 Nasal packing-unilateral ( Endoscopy Assisted) 7000 8400 9800 108| T a r i f f - AIMS
213 78581/2020/ESTT-NE_HRENN006 Nasal polypectomy bilateral 6930 8320 9710 ENN007 Nasal polypectomy unilateral 5600 6720 7840 ENN009 Nasal Endoscopy 3000 3600 4200 ENN010 Nasal Synaechae Excision ( Adhensions) Bilateral 8400 10080 11760 ENN011 Nasal Synaechae Excision ( Adhensions) Unilateral 7000 8400 9800 ENN012 Nasopharyngeal angiofibroma stage 1 excision 18480 22180 25880 ENN013 Nasopharyngeal angiofibroma stage 2 & 3 excision 33600 40320 47040 ENN014 Naso Ethmoidal complex Fracture reduction 15400 18480 21560 ENN015 Nsal Bones Reduction Manipulation of 11200 13440 15680 ENN016 Nose Foreign Body Removal 5600 6720 7840 ENO001 Oesophageal Strictures Dilatation 11200 13440 15680 ENO002 Oesophagoscopy with foreign removal 15000 18000 21000 ENO003 Ossiculoplasty 20000 24000 28000 ENO004 Oral Lesion Biopsy 4620 5550 6470 ENO005 ORO Antral Fistula Closure 15000 18000 21000 ENO006 Orbital Decompression Endoscopic 27720 33270 38810 ENO007 Oral lesion major excision benign 9240 11090 12940 ENO008 Oral lesion minor excision benign 6160 7400 8630 ENO009 Osteoma Paranasal Sinuses Excision 18480 22180 25880 ENP001 Pan endoscopy & Biopsy 14000 16800 19600 ENP002 Paracentesis 8000 9600 11200 ENP003 Parapharyngeal abscess incision & Drainage 14000 16800 19600 ENP004 Partial Turbinectomy 7000 8400 9800 ENP005 Peritonsillar Abscess incision & drainage 14000 16800 19600 ENP007 Pre Auricular sinus excision 11200 13440 15680 ENP008 Pharyngeal Diverticulum Excision 14000 16800 19600 ENP009 Pharyngeal Pounch Excision 14000 16800 19600 ENP010 Pharyngotomy Lateral 12600 15120 17640 ENP011 Palatal Fistula Repair 15000 18000 21000 ENP012 Parotidectomy Superficial 27720 33270 38810 ENP013 Parotidectomy Total 36960 44360 51750 ENR008 Removal of Nasal Pack 1400 1680 1960 ENR014 Retropharyngeal Abscess Incision & Drainage 14000 16800 19600 ENR015 Rhinoplasty Augmented 26180 31420 36660 ENR016 Rhinoplasty Tip and Ala job 36960 44360 51750 ENR017 Rhinoplasty augmentation 36960 44360 51750 ENR018 Rhinoplasty reduction including hump removal 36960 44360 51750 ENR019 Rhinotomy Lateral 30000 36000 42000 ENR020 Radical Mastoidectomy 20000 24000 28000 ENR021 Rhinoplasty Corrective 26180 31420 36660 ENS001 Septal Abscess incision & Drainage 14000 16800 19600 ENS002 Septal hematoma Incision & Drainage 14000 16800 19600 ENS003 Septoplasty 14000 16800 19600 ENS004 Stapedectomy 20000 24000 28000
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214 78581/2020/ESTT-NE_HRENS005 Styloidectomy 20000 24000 28000 ENS008 Suturing of small wounds neck 2800 3360 3920 ENS009 Suturing of small wounds nose 4200 5040 5880 ENS011 Sphenoethmoidectomy Endoscopic 23800 28560 33320 ENS012 Sphenoidectomy Endoscopic 23800 28560 33320 ENS013 Sinus Endoscopy 2450 2940 3430 ENS014 Sebaceous Cyst Neck Excision 5600 6720 7840 ENS015 Submandibular Gland Excision 14000 16800 19600 ENS016 Submandibular duct Calculus Intra oral Removal 10000 12000 14000 ENS017 Submandibular Abscess incision & drainage-ludwig 14000 16800 19600 ENS018 Spilt Ear lobules Repair Bilateral 5000 6000 7000 ENS019 Spilt Ear lobules Repair Unilateral 3000 3600 4200 ENS020 Sphenoid Surgery-Radical 17000 20400 23800 ENT001 Thyroglossal cyst Excision 20000 24000 28000 ENT002 Thyroglossal Sinus excision 20000 24000 28000 ENT003 Thyroidectomy 24000 28800 33600 ENT004 Tongue Tie release & suturing 5600 6720 7840 ENT005 Tonsillectomy 15000 18000 21000 ENT006 Tracheostomy 15000 18000 21000 ENT007 Transantral Ethmoidectomy (Horgans) 38000 45600 53200 ENT008 Tympanoplasty 16800 20160 23520 ENT009 Thyroidectomy total/near total 24000 28800 33600 ENT010 Thyroplasty 27720 33270 38810 ENT012 Tracheostomy tube change 2800 3360 3920 ENT013 Turbinectomy Partial b/l 7700 9240 10780 ENT014 Turbinectomy Partial u/l 4620 5550 6470 ENT015 Throat Endoscopy 2450 2940 3430 ENT016 Tracheal Stenosis Excision Cum Repair 12320 14790 17250 ENT017 Turbinates Submucosal Cauterization 7000 8400 9800 ENT018 Turbinates Submucosal Diathermy 7000 8400 9800 ENT019 Tracheal Reconstruction 61600 73920 86240 ENT020 TURBINOPLASTY 16000 19200 22400 ENU001 Uvulopalatopharyngoplasty (uppp) 27720 33270 38810 ENV001 Vidian Neurectomy 15400 18480 21560 ENW001 Wax Removal Of Ear Unilateral 1400 1680 1960 ENW002 Wax Removal Of Ears Bilateral 1400 1680 1960 ENF010 FODL 3970 4760 5550 ENF011 FODL& Biopsy 5420 6500 7590 ENC009 Cochlear Implant surgery(UIL) 71280 85540 99800 ENC010 Cochlear Implant surgery(BIL) 106920 128310 149690 ENC002 CALORIC TEST 500 500 500 ENE045 EXPLORATORY TYMPANOTOMY 24000 28800 33600
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GASTROENTEROLOGY
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216 78581/2020/ESTT-NE_HRCode Description Ward Semi Pvt Pvt GEA001 ACHALASIA CARDIA DILATATION 24010 28810 33610 GEA002 Argon plasma cogulation(APC)-single lesion 10010 12010 14010 GEA003 Argon plasma cogulation(APC)-multiple lesion 20010 24010 28010 GEB001 Bed Side Colonoscopy 20010 24010 28010 GEB002 BALLOON SPHINCTEROPLASTY 14000 16800 19600 GEB003 BILIARY/PANCREATIC STRICTURE DILATATION 16800 20160 23520 GEB004 Ballon Enteroscopy 32200 38640 45080 GEC001 Colonic decompression 20010 24010 28010 GEC002 Capsule Endoscopy 20010 24010 28010 GEC003 Colonic Dilatation 16010 19210 22410 GED001 Diagnostic Parocentesis 3010 3610 4210 GEE001 ENDOPROSTHESIS 20010 24010 28010 GEE002 ENDOSCOPIC MUCOSAL RESECTION 40000 48000 56000 GEE003 Endoscopic Ryles tube placement 9010 10810 12610 GEE006 ERCP 7700 9240 10780 GEE007 ESOPHAGEL DILATATION 24010 28810 33610 GEE009 Esophagoscopy 4000 4800 5600 ENDOSCOPIC MUCOSAL RESECTION ( FOLLOW GEE010 UP) 30010 36010 42010 GEE011 ESD 14000 16800 19600 GEF001 FOREIGN BODY REMOVAL 18000 21600 25200 GEF002 Fibroscan 6560 7870 9180 GEG001 GLUE INJECTION OF GASTRIC VARICES 21000 25200 29400 GEH001 Heator probe coagulation 28000 33600 39200 GEH002 HEMOCLIPPING OF BLEEDING VESSELS 28000 33600 39200 GEH003 H. pylori Testing 350 410 480 GEL001 LEFT SIDED COLONOSCOPY 8400 10080 11760 GEL002 LIVER BIOPSY - CAT IIMRS014 24010 28810 33610 GEL003 LIVER BIOPSY- CAT I 20010 24010 28010 GEL004 LIVER BIOPSY- CAT III 28000 33600 39200 GEM001 Mechanical Lithotripsy 14000 16800 19600 GEM002 Multiple Polyps-Polypectomy 16800 20160 23520 GEN001 NASO-JEJUNAL TUBE PLACEMENT 12600 15120 17640 GEP001 PAPILLOTOMY & STONE REMOVAL 11200 13440 15680 GEP002 PAPILLOTOMY + STENT INSERTION 11200 13440 15680 Papillotomy &/ or Stent insertion &/ or Stone GEP003 Removal 16800 20160 23520 GEP004 PEG 21000 25200 29400 GEP005 PILES INJ / BAND ( W/O CONSUMABLES) 11200 13440 15680 GEP006 POLYPECTOMY 11200 13440 15680 GEP008 Pseudo Cyst Drainage 28000 33600 39200 PTC ( Percutaneous Transhepatic GEP009 Cholangiography) 8400 10080 11760 GEP010 PTBD ( Percutaneous Transhepatic Biliary 14000 16800 19600 112| T a r i f f - AIMS
217 78581/2020/ESTT-NE_HRDrainage) GEP011 PEG Replacement 11200 13440 15680 GEP012 PEG Removal-Endoscopy 8400 10080 11760 GEP013 PEG Removal-Manual 2100 2520 2940 GEP014 GP-I DIAGNOSTIC 10010 12010 14010 GEP015 GP-II THERAPEUTIC 32000 38400 44800 GEP016 GP-III 20010 24010 28010 GES001 Sclerotherapy / Injection Therapy 11200 13440 15680 GES002 Side Viewing Endoscopy 7000 8400 9800 GES003 SIGMOIDOSCOPY 5600 6720 7840 GES004 Side Viewing Endoscopy with Stent Removal 5600 6720 7840 GET001 TOTAL COLONOSCOPY 12600 15120 17640 GET002 Therapeutic Parocentesis 4000 4800 5600 GEU001 UGI ENDOSCOPY 7000 8400 9800 GEE012 ERCP with X-Ray Film 17500 17500 17500 GEE013 Endoscopic ultrasound ( EUS ) 15000 18000 21000 ENDOSCOPIC CHOLEDOCHO GEE018 DUODENOSTOMY 40000 48000 56000 GEE021 ENDOSCOPIC HEPATICO GASTROSTOMY 40000 48000 56000 FECAL MICROBIOTA TRANSPLANTATION ( GEF003 FMT ) 25000 30000 35000 GEH004 Hydrogen Breath Test 5000 6000 7000 GEN002 NARROW BAND IMAGING ( NBI ) 5000 6000 7000 GEP017 POEM ( PER ORAL ENDOSCOPIC MYOTOMY ) 100000 120000 140000 GEV001 VARICEAL LIGATION EXCLUSIVE OF KIT 8000 9600 11200
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MAXILLO FACIAL SURGERY
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219 78581/2020/ESTT-NE_HRCode Description Ward Semi Pvt Pvt MFA001 ALVEOLECTOMY PERSEQMENT 5000 6000 7000 MFC002 CLORED REDUCTION ZYQOMATIC COMPLESE - MEDIUM 16800 20160 23520 MFC003 CLORED REDUCTION ZYQOMATIC COMPLESE - MINOR 10500 12600 14700 MFC004 CLORED REDUCTION FRACTURE MANDIBLS - MAJOR 25200 30240 35280 MFC005 CLORED REDUCTION FRACTURE MANDIBLS - MEDIUM 19600 23520 27440 MFC006 CLORED REDUCTION FRACTURE MANDIBLS - MINOR 14000 16800 19600 MFC007 CLORED REDUCTION FRACTURE MAXILLA - MAJOR 25200 30240 35280 MFC008 CLORED REDUCTION FRACTURE MAXILLA - MEDIUM 19600 23520 27440 MFC009 CLORED REDUCTION FRACTURE MAXILLA - MINOR 14000 16800 19600 MFC010 CLORED REDUCTION ZYQOMATIC COMPLESE - MAJOR 22400 26880 31360 MFC011 CLORED REDUCTION FRACTURE MAXILLA - OT Charges 5000 6000 7000 MFD001 DENTAL IMPLANT WITHOUT BONE DRAFTINGCHARGES 25200 30240 35280 DENTAL IMPLANT WITHOUT BONE DRAFTINGCHARGES- MFD002 MAJOR 45000 54000 63000 DENTAL IMPLANT WITHOUT BONE DRAFTINGCHARGES- MFD003 MEDIUM 35000 42000 49000 MFD004 DENTOALVCOLAN FRACTURE - MAJOR 14000 16800 19600 MFD005 DENTOALVCOLAN FRACTURE - MEDIUM 8400 10080 11760 MFD006 DENTOALVCOLAN FRACTURE - MINOR 5600 6720 7840 MFE001 ENUCLEATION OF CYST- MAJOR 18000 21600 25200 MFE002 ENUCLEATION OF CYST- MEDIUM 10000 12000 14000 MFE004 ENUCLEATION OF CYST- MINOR 6000 7200 8400 MFF001 FLAP SURGERY EXTENSIVE WITH BONE GRAFTING 15000 18000 21000 MFF002 FLAP SURGERY PER SEGMENT-MEDIUM 8400 10080 11760 MFF004 FLAP SURGERY PER SEGMENT-MINOR 5600 6720 7840 MFF005 FRACTURE WIRE REMOVAL 500 600 700 MFF006 FRACTURE WIRE TIGHTENING PER VISIT 500 600 700 GENIOPLASTY,SAGITTAL ASTRONOMY,LEFORT ASTRONOMY MFG001 COSMETIC SURGEY-MAJOR 50400 60480 70560 GENIOPLASTY,SAGITTAL ASTRONOMY,LEFORT ASTRONOMY MFG002 COSMETIC SURGEY-MEDIUM 42000 50400 58800 GENIOPLASTY,SAGITTAL ASTRONOMY,LEFORT ASTRONOMY MFG003 COSMETIC SURGEY-MINOR 33600 40320 47040 GINGIVCCTOMY PER SEGMENT EXTENSIVE WITH BONE MFG004 QRAFTING 12000 14400 16800 MFG005 GINGIVCCTOMY PER SEGMENT-MEDIUM 9000 10800 12600 MFG006 GINGIVCCTOMY PER SEGMENT-MINOR 5600 6720 7840 MFI001 IMF Major 28980 34780 40580 MFI002 IMF Medium 24150 28980 33810 MFI003 IMF Minor 16100 19320 22540 MFM001 MARSUPILIZATION OF CYST - MAJOR 25000 30000 35000 MFM002 MARSUPILIZATION OF CYST - MEDIUM 16800 20160 23520 MFM003 MARSUPILIZATION OF CYST - MINOR 14000 16800 19600 MFO001 OP FRACTURE MANDIBLE WITH BONE PLASTING-MINOR 10000 12000 14000
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220 78581/2020/ESTT-NE_HRMFO002 OPEN REDUCTION FRACTURE MAXILLA WITH BONE PLATING- 30800 36960 43120 OPEN REDUCTION FRACTURE MAXILLA BONE PLATING- MFO003 MEDIUM 22400 26880 31360 MFO004 OPEN REDUCTION FRACTURE MAXILLA BONE PLATING-MINOR 16800 20160 23520 OPEN REDUCTION ZYQOMATIC COMPLESE WITH BONES MFO005 PLANTING-MAJOR 30800 36960 43120 OPEN REDUCTION ZYQOMATIC COMPLESE WITH BONES MFO006 PLANTING-MEDIUM 25200 30240 35280 OPEN REDUCTION ZYQOMATIC COMPLESE WITH BONES MFO007 PLANTING-MINOR 15000 18000 21000 OPEN REDUCTION FRACTURE MANDIBLE WITH BONES MFO008 PLATING-MAJOR 35000 42000 49000 OPEN REDUCTION FRACTURE MANDIBLE WITH BONE MFO009 PLATING-MEDIUM 28000 33600 39200 OPEN REDUCTION FRACTURE MANDIBLE WITH BONE MFO010 PLATING-MINOR 20000 24000 28000 MFT001 TMJ SURGERY- MAJOR 42000 50400 58800 MFT002 TMJ SURGERY- MEDIUM 33600 40320 47040 MFT003 TMJ SURGERY- MINOR 25200 30240 35280
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NEPHROLOGY
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222 78581/2020/ESTT-NE_HRCode Description Ward Semi Pvt Pvt NPA001 A V Shunt 14000 16800 19600 NPA002 ACUTE PERITONEAL DIALYSIS - CATHERIZATION 4200 5040 5880 NPC001 CAPD INITIATION/TRAINING 8400 10080 11760 NPC002 CAPD exchange procedure only 700 840 980 NPC004 Charcoal hemoperfusion/Polymixin B(Proc only) 14000 16800 19600 NPC005 CRRT (PROCEDURE ONLY) 11200 13440 15680 NPD001 Double lumen femoral Access 4200 5040 5880 NPD002 DIALYSIS in Critically ill Patient 4830 5800 6770 NPE001 EMERG. ACUTE PERITONEAL DIALYSIS CATHERIZATION 7000 8400 9800 NPE003 EMERGENCY DIALYSIS (HAEMO) procedure only 5040 6050 7060 NPE008 EMERGENCY FEMORAL ACCESS procedure only 4900 5880 6860 NPE009 EMERGENCY SUB CLAVINE/IJ procedure only 6300 7560 8820 NPH001 HAEM WITH CON & FIL REUSE(MAINT) 3920 4710 5490 NPH002 HAEMODIALYSIS with CONSUMABLE without filter 3360 4040 4710 NPH010 HD Cath Insertion 3500 4200 4900 NPH011 Haemodialysis in pvtroom withoutfilter without mon 5040 6050 7060 NPH012 Haemodialysis in pvtroom withoutfilter with monito 5600 6720 7840 HAEMODIALYSIS FORSERO POSITIVE/ HEPATATIS / HIV NPH013 PAT 3920 4710 5490 NPI001 INTERMITTENT P.D (PER DAY) 5600 6720 7840 NPK001 KIDNEY BIOPSY PROCEDURE 4200 5040 5880 NPM001 MINOR PROCEDURE I (NEPHROLOGY) 700 840 980 NPM002 MINOR PROCEDURE II (Nephrology) 1400 1680 1960 NPM003 MINOR PROCEDURE III(Nephrology) 2430 2910 3400 NPP002 Peritoneal Equilibration test (procedure only) 700 840 980 NPP004 Permacath insertion charges 7000 8400 9800 NPP005 PLASMA PHERISIS BYFILTER METHOD 7000 8400 9800 NPP009 Renal/IMMUNOSUPPRESSIVE THERAPHY 1050 1260 1470 SLED (EXTENDED DURATION DIALYSIS WITH CONS & NPS001 FILTER) 6300 7560 8820 NPS002 SUB CLAVIAN ACCESS / IJ ACCESS procedure only 4900 5880 6860 NPS003 Single lumen femoral Access 3500 4200 4900 NPT001 TUNNELED DIALYSIS CATHETERIZATION(PROCEDURE) 16100 19320 22540
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NEURO DIAGNOSTIC LAB
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224 78581/2020/ESTT-NE_HRCode Description Ward Semi Pvt Pvt NDB001 BAER (Brainstem Auditory Evoked Response) 4200 4200 4200 NDB002 Blink Reflex Study 2800 2800 2800 NDB003 Botulinum toxin(Limited) 1400 1400 1400 NDB004 Botulinum toxin(Extensive) 3000 3000 3000 NDC001 Carpal tunnel syndrome injection 5320 5320 5320 NDE001 E.E.G(ROUTINE) 2100 2100 2100 NDE002 E.E.G (Bedside) 4340 4340 4340 NDE003 E.E.G (Sleep Deprived) 3150 3150 3150 NDE005 EMG (full study) 7000 7000 7000 NDE006 EMG (Limited) 3990 3990 3990 NDE007 EMG Needle guided botox injection 7970 7970 7970 NDE008 EEG (for 1 Hr.) 3500 3500 3500 NDE009 EEG (Limited Study) 2430 2430 2430 NDL001 L.P (Therapeatic) 2800 2800 2800 NDL002 L.P (Diagnostic) 2430 2430 2430 NDM001 Multiple Sleep Latency Test 8400 8400 8400 NDM002 Muscle Biopsy 4900 4900 4900 NDN001 NCV -Full study 6370 6370 6370 NDN002 NCV(Limited Study) 4970 4970 4970 NDN003 NCV + EMG (full study) 12600 12600 12600 NDN004 Nerve Biopsy 4900 4900 4900 NDN005 Neostigmine test 2100 2100 2100 NDN006 NCV(Three Limbs) 4200 4200 4200 Repetitive nerve stimulation (Decremental NDR001 Study) 5600 5600 5600 NDT001 Thrombolysis(Introvenous) 20000 20000 20000 NDV001 VEP (Visul Evoked Potential) 4900 4900 4900 NDV002 Video EEG (1Hr.) 6300 6300 6300 NDV003 Video EEG (2Hr.) 8000 8000 8000 NDN007 NCV(Brachial plexus study) 6420 6420 6420 NDN008 NCV(Carpel Tunnel study) 6420 6420 6420 NDS004 SSR(sympathetic skin response) 2140 2140 2140 NDS005 SSEP(Somatosensory Evoked potential) 5710 5710 5710 NDS003 SSR 2000 2000 2000
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Oncology Medical Onclolgy Bone Marrow Translant Nuclear Medicaine Raditherapy Surgical Procedures
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226 78581/2020/ESTT-NE_HRMOA002 Ascitic Fluid Tapping Therapeutic 6580 7900 9220 MOB001 Bone Marrow Transplant - Autologus 177100 212520 247940 MOB002 Bone Marrow Transplant - Allogenic 8710 10450 12200 MOC001 Cancer Bisphosphonates /day 700 840 980 MOC002 Cancer Immuntherapy /day 2800 3360 3920 MOC003 Chemoport Insertion 13160 15800 18430 MOC004 Chemoport Removal 2800 3360 3920 MOC005 Chemoport Access /Flush 700 840 980 MOC006 Chemotherapy-A 1400 1680 1960 MOC007 Chemotherapy-B 2800 3360 3920 MOC008 Chemotherapy-C 4200 5040 5880 MOC009 Core Biopsy 2100 2520 2940 MOC010 Chemoport Insertion Package 42000 50400 58800 MOC011 Cryopreservation 80500 96600 112700 MOE001 Emergency Tracheostomy 11900 14280 16660 MOH001 Hepatic Artery Infusion 5600 6720 7840 MOI001 I C D Removal 2100 2520 2940 MOI002 I C D Insertion 6580 7900 9220 MOI003 Incision Biopsy 5600 6720 7840 MOI004 Intra Arterial Head &Neck 5600 6720 7840 MOI005 Intra Arterial Limba Perfusion 5600 6720 7840 MOI006 Intra Peritoneal Chemotherapy 5600 6720 7840 MOI007 Intrapleural Chemotherapy 5600 6720 7840 MOI008 Intrathecal Chemotherapy 5600 6720 7840 MOI009 Intravesical Chemotherapy 4200 5040 5880 MOI010 IV Biphosphonate Therapy 700 840 980 MOP001 Punch Biopsy 2100 2520 2940 MOS001 Stem Cell Harvestation 178170 213800 249430 NMA001 ADRENAL MIBG -I 131MIBG 1 -131 35000 35000 35000 NMB001 BLOOD POOL SCAN - G.I BLEED 5880 5880 5880 NMB002 BLOOD POOL SCAN - VENOGRAM 4620 4620 4620 NMB003 BLOOD POOL SCAN - HEMANGIOMA 5320 5320 5320 NMB004 BONE MARROW SCAN 7700 7700 7700 NMB005 BONE -SPECT 5880 5880 5880 NMB006 BONE -WHOLE BODY/3 PHASE 5320 5320 5320 NMB007 BRAIN - BLOOD FLOW 2520 2520 2520 NMB008 BRAIN -HMPAO CORTICAL PERFUSION 16800 16800 16800 CARDIAC -THALLIUN (SPECT) WITH RE- NMC001 INJECTION( 14700 14700 14700 NMC002 CARDIAC - AVID INFARCT IMAGING (PYP) 3500 3500 3500 NMC003 CARDIAC - MUGA(RESTING) 4900 4900 4900 122| T a r i f f - AIMS
227 78581/2020/ESTT-NE_HRNMC005 Cardiac Scan (PET+Thallium) 39200 39200 39200 NME001 ESOPHAGEAL TRANSIT TIME 2800 2800 2800 NMG001 G. H .A BRAIN SPECT 7700 7700 7700 NMG002 GALLIUM SCAN FOR TUMOR IMAGING 30000 30000 30000 NMG003 GASTRIC EMPTYING (GER) 3500 3500 3500 NMG004 GALLIUM SCAN ( DEPENDS ON DOLLOR RATE) 42000 42000 42000 NMH001 HEPATO BILIARY SCAN 5880 5880 5880 NMH002 HYNICTATE whole body bone scan 28980 28980 28980 NMI001 I-131 TOXIC THERAPY PER 5 MCI 8400 8400 8400 NMI002 I-131 Therapy for Thyroid Sensor 32200 32200 32200 NML001 LIVER SACN (SPECT) 5600 5600 5600 NML002 LYMPHOSCINTIGRAPHY 7700 7700 7700 NMM001 MECKELS 3500 3500 3500 NMM002 MIBG SCAN(DEPENDS ON DOLLOR RATE) 77000 77000 77000 NMP001 PARATHYROIDSUBTRACTION SACN (MIBI) 9100 9100 9100 NMP002 PET-CT 32200 32200 32200 NMR001 RENAL - DMSA 5880 5880 5880 NMR002 RENAL -DRCG 3080 3080 3080 NMR003 DTPA Renal Scan 4900 4900 4900 NMR004 RENAL- DTPA(WITH CAPTOPRIL) 9800 9800 9800 NMR005 RESPIRATORY SYS.a PERFUSION SACN 4900 4900 4900 NMR006 RESPIRATORY SYS.b VENTILATION SCAN 4900 4900 4900 STRONTIUM-89CANCER THERAPY(DEPENDS ON NMS001 DOLLAR RATE) 81200 81200 81200 NMS002 SAMARIUM FOR METASTATIC BONE PAIN 84000 84000 84000 NMT001 Testicular scan 3920 3920 3920 NMT002 - TC 99m SCAN & UP TAKE 3220 3220 3220 NMT003 THYROID - I-131 THERAPY PER 5 MCI 8400 8400 8400 NMT004 THYROID - I-131 SCAN (WHOLE BODY) 9800 9800 9800 69000 RT-Palliative Single Site 65800 65800 65800 69000-A RT-Palliative Single Site-A 32900 32900 32900 69000-B RT-Palliative Single Site-B 32900 32900 32900 69001 RT-Palliative Multiple Site 84000 84000 84000 69001-A RT-Palliative Multiple Site-A 42000 42000 42000 69001-B RT-Palliative Multiple Site-B 42000 42000 42000 69004 RT-3D CRT 133000 133000 133000 69004-A RT-3D CRT-A 44800 44800 44800 69004-B RT-3D CRT-B 44800 44800 44800 69004-C RT-3D CRT-C 43400 43400 43400 69005 RT-IGRT 266000 266000 266000
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228 78581/2020/ESTT-NE_HR69005-A RT-IGRT-A 89600 89600 89600 69005-B RT-IGRT-B 88200 88200 88200 69005-C RT-IGRT-C 88200 88200 88200 69006 RT-Rapid Arc IMRT 280000 280000 280000 69006-A RT-Rapid Arc IMRT-A 93800 93800 93800 69006-B RT-Rapid Arc IMRT-B 93800 93800 93800 69006-C RT-Rapid Arc IMRT-C 92400 92400 92400 69007 RT-Rapid Arc IGRT 322000 322000 322000 69007-A RT-Rapid Arc IGRT-A 107800 107800 107800 69007-B RT-Rapid Arc IGRT-B 107800 107800 107800 69007-C RT-Rapid Arc IGRT-C 106400 106400 106400 69008 RT-IGRT & 4D Gating 329000 329000 329000 69008-A RT-IGRT & 4D Gating-A 110600 110600 110600 69008-B RT-IGRT & 4D Gating-B 109200 109200 109200 69008-C RT-IGRT & 4D Gating-C 109200 109200 109200 69009 RT-IMRT/SRT Boost 58800 58800 58800 69009-A RT-IMRT/SRT Boost-A 29400 29400 29400 69009-B RT-IMRT/SRT Boost-B 29400 29400 29400 69010 RT-IMRT/SRT Radical 196000 196000 196000 69010-A RT-IMRT/SRT Radical-A 65800 65800 65800 69010-B RT-IMRT/SRT Radical-B 65800 65800 65800 69010-C RT-IMRT/SRT Radical-C 64400 64400 64400 69011 RT-SRS/IMRS RADICAL 210000 210000 210000 69011-A RT-SRS/IMRS RADICAL-A 70000 70000 70000 69011-B RT-SRS/IMRS RADICAL-B 70000 70000 70000 69011-C RT-SRS/IMRS RADICAL-C 70000 70000 70000 69012 RT-SRS/IMRS Boost 140000 140000 140000 69013 RT-Electron Boost 30000 30000 30000 69014 RT-Single Fraction 9800 9800 9800 69015 RT-Total Skin Electron 154000 154000 154000 69015-A RT-Total Skin Electron-A 51800 51800 51800 69015-B RT-Total Skin Electron-B 51800 51800 51800 69015-C RT-Total Skin Electron-C 50400 50400 50400 69016 RT-Intra OP 28000 28000 28000 69017 RT-Blood Bag 7000 7000 7000 69018 RT-BrT:Intravaginal 28000 28000 28000 69019 RT-BrT:Intracavitary/Intraluminal 42000 42000 42000 69020 RT-BrT:Interstitial boost 56000 56000 56000 69021 RT-BrT:Interstitial Radical 154000 154000 154000 69021-A RT-BrT:Interstitial Radical-A 51360 51360 51360
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229 78581/2020/ESTT-NE_HR69021-B RT-BrT:Interstitial Radical-B 51330 51330 51330 69021-C RT-BrT:Interstitial Radical-C 51330 51330 51330 69022 RT-BrT:Mould 49000 49000 49000 69022-A RT-BrT:Mould-A 35000 35000 35000 69022-B RT-BrT:Mould-B 14000 14000 14000 69023 RT-BrT:Intraluminal 28000 28000 28000 69024 Surface Mould 8400 8400 8400 69051 RT-CT Planning (Plain) 4200 4200 4200 69052 RT-CT Planning (Contrast) 9800 9800 9800 69053 RT- MRI Planning (Plain) 7000 7000 7000 69054 RT- MRI Planning (Contrast) 11200 11200 11200 69055 RT-Planning PET-CT 25200 25200 25200 69056 Electron 115500 115500 115500 69056-A Electron-A 38500 38500 38500 69056-B Electron-B 38500 38500 38500 69056-C Electron-C 38500 38500 38500 69057-A 3DCRT Boost-A 44800 44800 44800 69058 Procedure for Brachytherapy 5600 5600 5600 69059 Package for Brachytherapy under anasthesia 40000 40000 40000 69060 HIFU for Uterine Fibroid 140000 140000 140000 69061 Emergency blood irradiation charges 12600 12600 12600 OSA001 Abbe- estlander flap 19600 19600 19600 OSA002 Abdominal Wall sarcoma excision 32200 38640 45080 OSA003 Abdominal wall tumour excision-Mesh repair 39200 47040 54880 OSA004 Abdominal wall tumour excision-Primary repair 29400 35280 41160 OSA005 Abdominoperineal Resection 58800 70560 82320 OSA006 Above Elbow amputation 33600 40320 47040 OSA007 Above Knee amputation 40600 48720 56840 OSA008 Adhesionolysis-- Laparoscopic 33600 40320 47040 OSA009 Adhesionolysis--Open 28000 33600 39200 OSA010 Adrenalectomy (B/L)--laparoscopic 56000 67200 78400 OSA011 Adrenalectomy (B/L)--open 47600 57120 66640 OSA012 Adrenalectomy (U/L)--laparoscopic 47600 57120 66640 OSA013 Adrenalectomy (U/L)--open 37800 45360 52920 OSA014 Advancement Flap 26180 31420 36660 OSA015 Anal dilatation 8400 10080 11760 OSA016 Ankle Disarticulation 33600 40320 47040 OSA017 Anorectal polyp excision 14000 16800 19600 OSA018 Anterior Exentration 54600 65520 76440 OSA019 Anterior mediastonotomy 33600 40320 47040
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230 78581/2020/ESTT-NE_HROSA020 Anterior Resection-- Laparoscopic 51100 61320 71540 OSA021 Anterior Resection--Open 44800 53760 62720 OSA022 Antrectomy-- Laparoscopic 35000 42000 49000 OSA023 Antrectomy --Open 29400 35280 41160 OSA024 Appendectomy-- Laparoscopic 29400 35280 41160 OSA025 Appendectomy--Open 25200 30240 35280 OSA026 Ascitic tapping (Paracentesis) 3920 4710 5490 OSA027 Axillary Dissection alone 36400 43680 50960 OSA029 Axillary lymph node biopsy 8400 10080 11760 OSB001 B/L Mastectomy 72800 87360 101920 OSB002 B/L Neck dissection 56000 67200 78400 OSB003 B/l Pelvic lymph node Dissection--laparoscopic 47600 57120 66640 OSB004 B/l Pelvic lymph node Dissection--open 42000 50400 58800 OSB005 B/l PLND-laparoscopic 50400 60480 70560 OSB006 B/l PLND-open 40600 48720 56840 OSB007 BCS with Axillary Dissection 54600 65520 76440 OSB008 Below Elbow amputation 32200 38640 45080 OSB009 Below Knee amputation 37800 45360 52920 OSB010 Bite Excision 25200 30240 35280 OSB011 Bladder wash 4200 5040 5880 OSB012 Bone Curettage 19600 23520 27440 OSB013 Bone grafting 18200 21840 25480 OSB014 Bone marrow Biopsy 7700 9240 10780 OSB015 Breast conservation surgery 44800 53760 62720 OSB016 Breast lumpectomy small 10500 12600 14700 OSB017 Breast lumpectomy Large 14000 16800 19600 OSB018 Bronchial Sleeve resection 49000 58800 68600 OSB019 Bronchopleural fistula repair 33600 40320 47040 OSB020 Burst abdomen suturing 29400 35280 41160 OSB021 Bilateral trismus 123970 148770 173560 OSB022 Bilobed flap small 44290 53140 62000 OSB023 Bilobed flap large 62000 74400 86790 OSC001 Caecostomy 23800 28560 33320 OSC002 Carotid body tumour excision 43400 52080 60760 OSC003 Central Arch resection of Mandible 39200 47040 54880 OSC004 Central line insertion 5040 6050 7060 OSC005 Cervical Biopsy 8400 10080 11760 OSC006 Cervical cauterization 14000 16800 19600 OSC007 Cervical esophagostomy 21000 25200 29400 OSC008 Cervical Lymph Node biopsy 8400 10080 11760
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231 78581/2020/ESTT-NE_HROSC009 Cervical Polypectomy 14000 16800 19600 OSC010 Chemoport insertion/ Permacath Insertion 19600 23520 27440 OSC011 Chest wall sarcoma excision 37800 45360 52920 OSC012 Chest wall sinus exploration 11200 13440 15680 OSC013 Chest wall tumour Excision 37800 45360 52920 Cholangiocarcinoma excision and liver OSC014 resection 61600 73920 86240 OSC015 Cholecystectomy-- Laparoscopic 33600 40320 47040 OSC016 Cholecystectomy--Open 28000 33600 39200 OSC017 Cholecystojejunostomy -- Laparoscopic 27300 32760 38220 OSC018 Cholecystojejunostomy--Open 23800 28560 33320 OSC019 Choledochoduodenostomy 39200 47040 54880 Choledochojejunostomy/Hepaticojejunostomy- OSC020 Lap 42700 51240 59780 Choledochojejunostomy/Hepaticojejunostomy- OSC021 Open 36400 43680 50960 OSC022 Circumcision 19600 23520 27440 OSC023 Clavicle resection 28000 33600 39200 OSC024 Closure of pharyngeal fistula 37100 44520 51940 OSC025 Colocolic Anastomosis-- Laparoscopic 41300 49560 57820 OSC026 Colocolic Anastomosis--Open 33600 40320 47040 OSC027 Colonic Transposition 39200 47040 54880 OSC028 Colostomy closure 29400 35280 41160 OSC029 Colostomy Revision 25200 30240 35280 OSC030 Colposcopy 14000 16800 19600 OSC031 Commando operation 68600 82320 96040 OSC032 Completion Total Thyroidectomy 40600 48720 56840 OSC033 Composite Resection 68600 82320 96040 OSC034 Conization of cervix 14000 16800 19600 OSC035 Craniofacial excision 70000 84000 98000 OSC036 Cryotherapy for cervical lesions 14000 16800 19600 OSC037 Cystogastrostomy 29400 35280 41160 OSC038 Cystoscopy 12600 15120 17640 OSC039 Cystoscopy and biopsy 14000 16800 19600 OSC040 Culd well luck 17710 21260 24800 OSD001 Decortication 51800 62160 72520 OSD002 Deltopectoral Flap Reconstruction 25200 30240 35280 OSD003 Diagnostic laparoscopy 29400 35280 41160 OSD004 Diagnostic laparotomy 29400 35280 41160 OSD005 Dilatation and Curettage 9800 11760 13720 OSD006 Direct Laryngoscopy 6300 7560 8820
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232 78581/2020/ESTT-NE_HROSD007 Distal pancreatectomy 40600 48720 56840 OSD008 Distal radical gastrectomy-- Laparoscopic 34300 41160 48020 OSD009 Distal radical gastrectomy --Open 29400 35280 41160 OSD010 Division of flap and insetting 15400 18480 21560 OSD011 Division of flap 11200 13440 15680 OSD012 Duodenum partial excision 26600 31920 37240 OSD013 DIEP free flap for breast 177100 212520 247940 OSD014 Diode laser raporisation and Prostatectomy 63760 76510 89260 OSD015 Diode Laser Visual internal urethrotomy 63760 76510 89260 OSE001 Elbow Disarticulation 37800 45360 52920 OSE002 Endometrial biopsy/aspiration 8400 10080 11760 OSE003 Endometrial curettage 11200 13440 15680 OSE004 Enucleation of eye 22680 27220 31760 OSE005 Ethmoidectomy 33600 40320 47040 OSE006 Evisceration of eyeball 26600 31920 37240 OSE007 Examination Under Anaesthesia 9800 11760 13720 OSE008 Examination Under Anaesthesia(Head&Neck) 7700 9240 10780 OSE009 Excional Biopsy- Small 6300 7560 8820 OSE010 Excional Biopsy- Large 8400 10080 11760 OSE011 Excision biopsy 11200 13440 15680 OSE012 Excision of Clivus tumors 54600 65520 76440 OSE013 Excision of Leukoplakia 11200 13440 15680 OSE014 Excision of Pinna 24360 29240 34110 OSE015 Excision of Skin Malignancy 22400 26880 31360 OSE016 Excision of Vocal Nodule 11200 13440 15680 OSE017 Excision of white patch 15400 18480 21560 OSE018 Exploration of Neck 16800 20160 23520 OSE019 Exploratory laparotomy 23800 28560 33320 OSE020 Exploratory laparotomy 21000 25200 29400 OSE021 Exploratory Thoracotomy 36400 43680 50960 OSE022 Extended left hemicolectomy-- Laparoscopic 53900 64680 75460 OSE023 Extended left hemicolectomy--Open 49000 58800 68600 OSE024 Extended Right hemicolectomy-- Laparoscopic 53900 64680 75460 OSE025 Extended Right hemicolectomy--Open 49000 58800 68600 OSE026 External carotid artery ligation 16800 20160 23520 OSE027 Extra compartmental Excision 40600 48720 56840 OSE028 Eye lid tumor excision 25900 31080 36260 OSE029 Eyeball Enucleation 22400 26880 31360 OSE030 Excision Co2 Lazer - Single 28340 34010 39680 OSE031 Excision Co2 Lazer - Multiple 44290 53140 62000
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233 78581/2020/ESTT-NE_HROSF001 Feeding gastrostomy 19600 23520 27440 OSF002 Feeding jejunostomy 19600 23520 27440 OSF003 Fibro adenoma Excision 12600 15120 17640 OSF004 Forehead flap 26600 31920 37240 OSF005 Forequarter amputation 47600 57120 66640 OSF006 Free fibula Reconstruction 63000 75600 88200 OSF007 Fulguration Co2 Lazer - Single 28340 34010 39680 OSF008 Fulguration Co2 Lazer - Multiple 44290 53140 62000 OSF009 Free radial flap grade 1 120430 144520 168600 OSF010 Free radial flap grade 2 126630 151960 177290 OSF011 Free ALT flap 126630 151960 177290 OSF012 Free ALT flap bipaddle 152310 182770 213230 OSF013 Free fibular flap 152310 182770 213230 OSF014 Free fibular flap bipaddle 164530 197440 230340 OSF015 Free fibular flap 3 osteotomies 177100 212520 247940 OSF016 Free jejanal flap for pharyngeal reconstruction 164530 197440 230340 OSF017 Flap division and insetting 26580 31890 37210 OSF018 Flap debulking and insetting 265650 318780 371910 OSF019 Fat injecion medium 62000 74400 86790 OSF020 Fat injection large 79710 95650 111590 OSG001 Gasric Pull up 25200 30240 35280 OSG002 Gastric bypass 25200 30240 35280 OSG003 Gastric pull up with cervical avastanosis 35000 42000 49000 OSG004 Gastric wedge resection-- Laparoscopic 34300 41160 48020 OSG005 Gastric wedge resection--Open 28000 33600 39200 OSG006 Gastroduodenostomy 28000 33600 39200 OSG007 Gastrojejunostomy -- Laparoscopic 32900 39480 46060 OSG008 Gastrojejunostomy--Open 28000 33600 39200 OSH001 HartmanÆ s procedure 43400 52080 60760 OSH002 Hemiglossectomy 29400 35280 41160 OSH003 Hemihepatectomy (Rt or Lt) 56000 67200 78400 OSH004 Hemimandibulectomy 32900 39480 46060 OSH005 Hemithyroidectomy 30800 36960 43120 OSH006 Hickman Catheter insertion 19600 23520 27440 OSH007 High Inguinal Orchidectomy--Alone 21000 25200 29400 OSH008 High Inguinal Orchidectomy--with scrotectomy 29400 35280 41160 OSH009 Hind Quarter Amputation 53200 63840 74480 OSH010 Hip Arthrodesis 47600 57120 66640 OSH011 Hip Disarticulation 54600 65520 76440 OSH012 Hysteroscopy 11200 13440 15680
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234 78581/2020/ESTT-NE_HROSI001 ICD insertion 3780 4540 5300 OSI002 Ileal Conduit/Ureterosigmoidostomy 36400 43680 50960 OSI003 Ileoanal Pouch Anastomosis 40600 48720 56840 OSI004 Ileocolic Anastomosis-- Laparoscopic 32900 39480 46060 OSI005 Ileocolic Anastomosis--Open 29400 35280 41160 OSI006 Ileosigmoidostomy 26600 31920 37240 OSI007 Ileostomy 25200 30240 35280 OSI008 Ileostomy closure 29400 35280 41160 OSI009 Ilioinguinal Block Dissection Bilateral 56000 67200 78400 OSI010 Ilioinguinal Block DissectionUnilateral 37800 45360 52920 OSI011 Implant reconstruction 41580 49900 58220 OSI012 Incisional Biopsy 8400 10080 11760 OSI013 Incisional hernia Repair- Mesh repair 38500 46200 53900 OSI014 Incisional hernia Repair- Primary closure 29400 35280 41160 OSI015 Infracoloic Omentectomy--laparoscopic 23800 28560 33320 OSI016 Infracoloic Omentectomy--open 18200 21840 25480 OSI017 Infratemporal Fossa Clearance 44800 53760 62720 OSI019 Inguinal lymph Node Biopsy 8400 10080 11760 OSI020 Inguinal node dissection bilateral 36400 43680 50960 OSI021 Inguinal node dissection unilateral 28000 33600 39200 OSI022 Interval Cytoreduction for CA ovary 54600 65520 76440 OSI023 Intracompartmental Excision 26600 31920 37240 OSI024 Ivor-Lewis Esophagectomy 54600 65520 76440 OSJ001 J- Needle biopsy 7700 9240 10780 OSJ002 Jaw cyst Enucleation 22960 27560 32150 OSJ003 Jaw Tumour Excision 38500 46200 53900 OSJ004 Jejunal Transposition 39200 47040 54880 OSJ005 Jejunojejunostomy-- Laparoscopic 25900 31080 36260 OSJ006 Jejunojejunostomy--Open 16800 20160 23520 OSK001 Knee Arthrodesis 28000 33600 39200 OSL001 Laryngopharyngoscopy 9800 11760 13720 OSL002 Laser Excision 12600 15120 17640 OSL003 LAVH 32200 38640 45080 OSL004 LD flap reconstruction 45500 54600 63700 OSL005 LEEP excision of cervix 14000 16800 19600 OSL006 left hemicolectomy-- Laparoscopic 51100 61320 71540 OSL007 left hemicolectomy--Open 44800 53760 62720 OSL008 Limb salvage Surgery 35000 42000 49000 OSL009 Liver cyst excision (benign) 29400 35280 41160 OSL010 Liver Mets Excision 44800 53760 62720
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235 78581/2020/ESTT-NE_HROSL011 Liver Mets RFA -- Laparoscopic 37800 45360 52920 OSL012 Liver Mets RFA --Open 29400 35280 41160 OSL013 Lobectomy 33600 40320 47040 OSL014 Local excision Rectum 29400 35280 41160 OSL015 Lymph Node biopsy 8400 10080 11760 OSL016 Lazer machine charges for Cancer patients 35420 42510 49590 OSL017 Lateral canthoplasty 17710 21260 24800 Mammographic needle localization and OSM001 excision 11200 13440 15680 OSM002 Mammopexy 25200 30240 35280 OSM003 Mammotome biopsy 10500 12600 14700 OSM004 Mandible/maxillary curettage 23100 27720 32340 OSM005 Mandibular Osteotomy 32200 38640 45080 OSM006 Marginal mandibulectomy 23800 28560 33320 OSM007 Mastopexy 29400 35280 41160 OSM008 Mckeown Esophagectomy 61600 73920 86240 OSM009 Meatoplasty 19600 23520 27440 OSM010 Meatotomy 4200 5040 5880 OSM011 Mediastinal Lymph node dissection 40600 48720 56840 OSM012 Mediastinal tumour Excision 42000 50400 58800 OSM013 Mediastinoscopic Biopsy 21000 25200 29400 OSM014 Mesenteric cyst excision 30800 36960 43120 OSM015 Metastatectomy B/L 47600 57120 66640 OSM016 Metastatectomy U/L 29400 35280 41160 OSM017 Microdochectomy 21000 25200 29400 OSM018 Mini laparotomy 14000 16800 19600 OSM019 Modified Radical mastectomy 52640 63170 73700 OSM020 MRND - I 39200 47040 54880 OSM021 MRND û III ( Functional Neck dissection) 36400 43680 50960 OSM022 MRND ûII 36400 43680 50960 OSN001 Nasal Polypectomy 7280 8740 10200 OSN002 Nasolabial flap 19600 23520 27440 OSN003 Neck exploration for hyperparathyroidism 42000 50400 58800 OSN004 Neobladder 39200 47040 54880 OSO001 Oncoplastic Breast Surgery 63000 75600 88200 OSO002 Oophorectomyá laparoscopic 21000 25200 29400 OSO003 Oophorectomyá open 16800 20160 23520 OSO004 Open Biliary stenting 18200 21840 25480 OSO005 Orchidectomy unilateral 14000 16800 19600 OSO006 Orchidectomyá bilateral 22400 26880 31360
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236 78581/2020/ESTT-NE_HROSO007 osteocutaneos radial flap grade 3 139560 167470 195380 OSP001 Pancreatic Fistula Closure 44800 53760 62720 OSP002 Para aortic lymph Node Dissection 28000 33600 39200 Para aortic lymph node dissection-- OSP003 laparoscopic 47600 57120 66640 OSP004 Para aortic lymph node dissection--open 42000 50400 58800 OSP005 Para pharyngeal tumour excision 53200 63840 74480 OSP006 Parathyroidectomy 35000 42000 49000 OSP007 Partial amputation of penis 29400 35280 41160 OSP008 Partial Cystectomy-- Laparoscopic 50400 60480 70560 OSP009 Partial Cystectomy--Open 40600 48720 56840 OSP010 Partial gastrectomy-- Laparoscopic 37800 45360 52920 OSP011 Partial gastrectomy--Open 29400 35280 41160 OSP012 Partial glossectomy 32060 38480 44890 OSP013 Partial laryngectomy 40600 48720 56840 OSP014 Partial Maxillectomy 33600 40320 47040 OSP015 Partial Nephrectomy Laparoscopic 49000 58800 68600 OSP016 Partial Nephrectomy Open 40600 48720 56840 OSP017 Partial Pharyngectomy 47600 57120 66640 OSP018 Partial Pneumonectomy 37800 45360 52920 OSP019 Partial/segmental mandibulectomy 29400 35280 41160 OSP020 Pelvic Resection Type I 40600 48720 56840 OSP021 Pelvic Resection Type II 46200 55440 64680 OSP022 Pelvic Resection Type III 53200 63840 74480 OSP023 Perianal abscess drainage 14000 16800 19600 OSP024 Perianal/Gluteal abscess drainage 15400 18480 21560 OSP025 Perineal Urethrostomy 40600 48720 56840 OSP026 Peritoneal Biopsies 11200 13440 15680 OSP027 Peritoneal toileting and drainage 16800 20160 23520 OSP028 Pleural tapping 6300 7560 8820 OSP029 Pleurectomy 40600 48720 56840 OSP030 Pleurodesis 6720 8070 9410 OSP031 PMMC flap Reconstruction 39200 47040 54880 OSP032 Pneumonectomy( Rt./ Lt) 51800 62160 72520 OSP033 Port site excision 14000 16800 19600 OSP034 Portocaval Shunt 54600 65520 76440 OSP035 Premaxillectomy 33300 39960 46610 OSP036 Primary Cytoreduction for CA ovary 54600 65520 76440 OSP037 Proctoscopy 3920 4710 5490 OSP038 Prostatic biopsy-Digital 6300 7560 8820
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237 78581/2020/ESTT-NE_HROSP039 Prostatic biopsy-TRUS 11200 13440 15680 OSP040 Proximal radical gastrectomy-- Laparoscopic 41300 49560 57820 OSP041 Proximal radical gastrectomy --Open 32060 38480 44890 OSP042 Puestow Operation 46200 55440 64680 OSP043 Punch/Wedge biopsy 6720 8070 9410 OSP044 Pyloromyotomy -- Laparoscopic 29400 35280 41160 OSP045 Pyloromyotomy--Open 23800 28560 33320 OSP046 Pyloroplasty -- Laparoscopic 29400 35280 41160 OSP047 Pyloroplasty --Open 23800 28560 33320 OSQ001 Quadrentectomy 26600 31920 37240 OSR001 Radial Artery free forearm flap 53200 63840 74480 OSR002 Radical cholecystectomy 42000 50400 58800 OSR003 Radical Cystectomy-- Laparoscopic 63000 75600 88200 OSR004 Radical Cystectomy--Open 50400 60480 70560 OSR005 Radical Hysterectomy Type III -laparoscopic 56000 67200 78400 OSR006 Radical Hysterectomy Type III -open 50400 60480 70560 OSR007 Radical Hysterectomy Type II-laparoscopic 50400 60480 70560 OSR008 Radical Hysterectomy Type II-open 44800 53760 62720 OSR009 Radical Hysterectomy Type I-laparoscopic 44800 53760 62720 OSR010 Radical Hysterectomy Type I-open 37800 45360 52920 OSR011 Radical Neck Dissection 43400 52080 60760 OSR012 Radical nephrectomy-- Laparoscopic 60200 72240 84280 OSR013 Radical nephrectomy --Open 53200 63840 74480 OSR014 Radical Nephrectomy with RPLND-Laparoscopic 71400 85680 99960 OSR015 Radical Nephrectomy with RPLND--Open 63000 75600 88200 OSR016 Radical nephroureterectomy-- Laparoscopic 61600 73920 86240 OSR017 Radical nephroureterectomy--Open 56000 67200 78400 OSR018 Radical Peritonectomy 54600 65520 76440 OSR019 Radical Prostatectomy Perineal 54600 65520 76440 OSR020 Radical Prostatectomy Retro pubic 54600 65520 76440 OSR021 Radical total Maxillectomy 44800 53760 62720 OSR022 Radical total parotidectomy 42000 50400 58800 OSR023 Radical Vaginectomy 40600 48720 56840 OSR024 Radical Vulvectomy 40600 48720 56840 OSR025 Ray Amputation 22400 26880 31360 OSR026 Re- Exploration 21000 25200 29400 OSR027 Renal Biopsy 6300 7560 8820 Retroperitoneal Lymph nodal dissection - OSR028 Laparosc 53900 64680 75460 OSR029 Retroperitoneal Lymph nodal dissection --Open 47600 57120 66640
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238 78581/2020/ESTT-NE_HROSR031 Retroperitoneal Sarcoma Excision 53200 63840 74480 OSR032 Rib resection 16100 19320 22540 OSR033 Right hemicolectomy-- Laparoscopic 48440 58130 67820 OSR034 Right hemicolectomy--Open 44800 53760 62720 OSR035 Rotationoplasty 50400 60480 70560 OSR036 RPLND 53200 63840 74480 OSR037 RT insertion 3500 4200 4900 OSR038 Removal of mandibular plates 35420 42510 49590 OSS001 Sacral Chordomas Excision 58800 70560 82320 OSS002 Salpingo-oophorectomy (B/L)-laparoscopic 29400 35280 41160 OSS003 Salpingo-oophorectomy (B/L)-open 25200 30240 35280 OSS004 Salpingo-oophorectomy (U/L)-laparoscopic 28000 33600 39200 OSS005 Salpingo-oophorectomy (U/L)-open 21000 25200 29400 OSS006 Scalene Lymph Node biopsy 8400 10080 11760 OSS007 Scalp tumor excision 26600 31920 37240 OSS008 Scapulectomy 40600 48720 56840 OSS009 Scrotectomy 19600 23520 27440 OSS010 Sebaceous cyst excision 9800 11760 13720 OSS011 Secondary Cytoreduction for CA ovary 54600 65520 76440 OSS012 Segmental Resection of Liver 43400 52080 60760 OSS013 Shoulder Disarticulation 47600 57120 66640 OSS014 Sigmoid Colectomy-- Laparoscopic 53900 64680 75460 OSS015 Sigmoid Colectomy --Open 46200 55440 64680 OSS016 Sigmoid end colostomy 23800 28560 33320 OSS017 Sigmoidoscopy 8400 10080 11760 OSS018 Simple mastectomy 42000 50400 58800 OSS019 Simple Ovarian Cystectomy (B/L)-laparoscopic 23800 28560 33320 OSS020 Simple Ovarian Cystectomy (B/L)-open 21000 25200 29400 OSS021 Simple Ovarian Cystectomy (U/L)-laparoscopic 21000 25200 29400 OSS022 Simple Ovarian Cystectomy (U/L)-open 16800 20160 23520 OSS023 Simple Vaginectomy 18200 21840 25480 OSS024 Simple Vulvectomy 18200 21840 25480 OSS025 Skin Graft reconstruction 14000 16800 19600 OSS026 Skull Base surgeries 70000 84000 98000 OSS027 Small bowel bypass-- Laparoscopic 27300 32760 38220 OSS028 Small bowel bypass --Open 23800 28560 33320 OSS029 Laparoscopic 38500 46200 53900 OSS030 Small Bowel resection anstomosis--Open 32200 38640 45080 OSS031 SOHND 30800 36960 43120 OSS032 Spleenectomy-- Laparoscopic 36400 43680 50960
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239 78581/2020/ESTT-NE_HROSS033 Spleenectomy--Open 30800 36960 43120 OSS034 Staging laparotomy with multiple biopsies 49000 58800 68600 OSS035 Staging laparotomy 21000 25200 29400 OSS036 Sternotomy 37800 45360 52920 OSS037 Sub mucosal cyst excision 16800 20160 23520 OSS039 Submandibular Gland Excision 26600 31920 37240 OSS040 Subtotal Gastrectomy-- Laparoscopic 41300 49560 57820 OSS041 Subtotal Gastrectomy--Open 32200 38640 45080 OSS042 Superficial parotidectomy 32200 38640 45080 OSS043 Supraclavicular Lymph Node biopsy 8400 10080 11760 OSS044 Supracolic Omentectomy--laparoscopic 26600 31920 37240 OSS045 Supracolic Omentectomy--open 21000 25200 29400 OSS046 Supraglottic laryngectomy 41300 49560 57820 OSS047 Suprapubic Cystostomy ( Trocar) 11200 13440 15680 OSS048 Suprapubic cystostomy( open) 14000 16800 19600 Surgical staging for Carcinoma Endometrium OSS049 laparo 56000 67200 78400 Surgical staging for Carcinoma Endometrium OSS050 open 47600 57120 66640 OSS051 Sweet Garloch Esophagectomy 53200 63840 74480 OSS052 SymeÆs amputation 28000 33600 39200 OST001 TAH & BSO 33600 40320 47040 OST002 Temporal Bone resection 51800 62160 72520 OST003 Temporalis fascia flap 19600 23520 27440 OST004 Testicular Biopsy 6300 7560 8820 OST005 Testicular Biopsy 11200 13440 15680 OST006 Thymectomy 39200 47040 54880 OST007 Thyroid Lobectomy 28000 33600 39200 OST008 TLH 42000 50400 58800 OST009 Toe/Finger Amputation 21000 25200 29400 OST010 Tongue Flap 19600 23520 27440 OST011 Tonsillectomy 23800 28560 33320 OST012 Total amputation of penis 39200 47040 54880 Total Colectomy/ Total Proctocolectomy- OST013 Laparosc 57400 68880 80360 OST014 Total Colectomy/ Total Proctocolectomy--Open 51800 62160 72520 OST015 Total Glossectomy 33600 40320 47040 OST016 Total laryngectomy 49000 58800 68600 OST017 Total laryngopharyngectomy 54600 65520 76440 OST018 Total pancreatectomy 51800 62160 72520 OST019 Total pelvic Exentration 71400 85680 99960
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240 78581/2020/ESTT-NE_HROST020 Total Pelvic Exentration (Anterior / Posterior) 64400 77280 90160 OST021 Total Pharyngectomy 52920 63510 74090 OST022 Total radical gastrectomy(D1) 42000 50400 58800 OST023 Total radical gastrectomy(D2) 45500 54600 63700 OST024 Total radical gastrectomy(D3) 49000 58800 68600 OST025 Total Thyroidectomy 40600 48720 56840 OST026 Tracheal Resection and repair 61600 73920 86240 OST027 Tracheal Resection 51800 62160 72520 OST028 Trachelectomy-laparoscopic 26600 31920 37240 OST029 Trachelectomy-open 22400 26880 31360 OST030 Tracheostomy 11200 13440 15680 OST031 TRAM flap 50400 60480 70560 OST032 Trans metatarsal amputation 28000 33600 39200 OST033 Transhiatal Esophagectomy 53200 63840 74480 OST034 Transverse Colectomy -- Laparoscopic 51100 61320 71540 OST035 Transverse Colectomy--Open 46200 55440 64680 OST036 Transverse loop Colostomy 23800 28560 33320 OST037 Triple Bypass -- Laparoscopic 48300 57960 67620 OST038 Triple Bypass --Open 40600 48720 56840 OST039 Trisegmentectomy (Rt or Lt) 64400 77280 90160 OST040 Trucut Biopsy 4200 5040 5880 OST042 TURBT 25200 30240 35280 OST043 TURP 21000 25200 29400 Undescended testicular tumour excision- OSU001 laparosco 47600 57120 66640 OSU002 Undescended testicular tumour excision--open 40600 48720 56840 OSU003 Upper Alveolectomy 22400 26880 31360 OSU004 Ureterectomy 22400 26880 31360 OSU005 Ureteric Reimplantation 39200 47040 54880 OSU006 Ureteric Stent removal 12600 15120 17640 OSU007 Ureteric Stenting 14000 16800 19600 OSU008 Ureterouretrostomy 32200 38640 45080 OSU009 Uretheral Catheterization 4200 5040 5880 OSU010 Uretheral stricture excision 14000 16800 19600 OSU011 Uretherectomy 23800 28560 33320 OSU012 Urethral dilatation 4900 5880 6860 OSU013 Unilateral trismus 70840 85010 99180 OSV001 VAD flushing 2100 2520 2940 VAD removal ( Chemoport, OSV002 Hickman/Es,Permacath) 8400 10080 11760 OSV003 Vaginal Hysterectomy 28000 33600 39200 136| T a r i f f - AIMS
241 78581/2020/ESTT-NE_HROSV004 Vagotomy 21000 25200 29400 OSV005 VATS 42000 50400 58800 OSV006 Vesicovaginal fistula repair 47600 57120 66640 OSV007 Vein grafting 35420 42510 49590 OSW001 Wedge excision of Liver-- Laparoscopic 36400 43680 50960 OSW002 Wedge excision of Liver--Open 29400 35280 41160 OSW003 Wedge resection Lung 25200 30240 35280 OSW004 WertheimÆs Hysterectomy 58800 70560 82320 OSW005 WhippleÆs procedure 63000 75600 88200 OSW006 Wide excision of soft tissue +SSG -- > 5cm 38500 46200 53900 OSW007 Wide excision of soft tissue +SSG --< 5cm 32200 38640 45080 OSW008 Wide excision of soft tissue wth local flap recon 57400 68880 80360 OSW009 WLE 19600 23520 27440 OSW010 WLE Buccal mucosa 18200 21840 25480 OSW011 WLE Floor Of Mouth 22400 26880 31360 OSW012 WLE Lip 25900 31080 36260 OSW013 WLE of DFSP 28000 33600 39200 OSW014 WLE Tongue 25200 30240 35280 OSW015 Wrist Disarticulation 30800 36960 43120 MOB003 BMT COORDINATION (GB) 25000 25000 25000 MOB004 BIOLOGICAL THERAPY 50000 50000 50000 MOB005 BONE MARROW 121000 121000 121000 MOB006 DATRI (MUD) 801000 801000 801000 MOC012 CHEMOTHERAPY-D 25000 25000 25000 MOC013 CHEMOTHERAPY-E 30000 30000 30000 MOC014 CHEMOTHERAPY-F 35000 35000 35000 TACE - TRANSARTERIAL MOC015 CHEMOEMBOLIZATION 63000 75600 88200 MOC016 TARGETED THERAPY 3450 4140 4830 MOC017 BONE MARROW ASPIRATION 1200 1440 1680 MOC018 BONE MARROW BIOPSY 1600 1920 2240 MOD001 DKMS (MUD) 1000000 1000000 1000000 MOP002 PLASMADEPLETION (CG) 40000 48000 56000 MOS002 STEM CELL ESTIMATION PROCEDURE (CG) 5000 6000 7000 MOS003 STEM CELL CRYOPRESERVATION (CG) 75000 90000 105000 MOT001 TUMOR ABLATION 21500 25800 30100
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242 78581/2020/ESTT-NE_HR
OPTHALMOLOGY
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243 78581/2020/ESTT-NE_HRCode Description Ward Semi Pvt Pvt OPA001 Automated perimetery/Comp field -One eye 1400 1400 1400 OPA002 A scan biometry 980 980 980 OPA003 Anterior Chamber wash 6300 7560 8820 OPA004 ANTERIOR VITRECTOMY 11200 13440 15680 OPA005 ARCUATE kERATOTOMY 6300 7560 8820 OPA006 Automated perimetery/Comp field Both eyes 2800 3360 3920 OPB001 Blepharoplasty Upper lid 19600 23520 27440 OPB002 Blepharoplasty Lower lid 19600 23520 27440 OPC001 CANTHOLYSIS 1960 2360 2750 OPC002 CAUTERIZATION CORNEAL ULCER 22400 26880 31360 OPC003 Chalazion Multiple 4900 5880 6860 OPC004 Chalazion single 2520 3030 3530 OPC005 Conjunctival flapping 5600 6720 7840 OPC006 CONJUNCTIVAL LACERATION REPAIR 12320 14790 17250 OPC007 Corneal foreign body removal deep under GA 7000 8400 9800 OPC008 Corneal foreign body removal deep under LA 5600 6720 7840 Corneal foreign body removal deep Superficial Under OPC009 GA 5320 6390 7450 Corneal foreign body removal deep Superficial Under OPC010 LA 2100 2520 2940 OPC011 Corneal Grafting 50000 60000 70000 OPC012 CHEMICAL INJURY EYE WASH 2100 2520 2940 OPC013 Corneal Perforating injuries 13300 15960 18620 OPC014 CORNEAL SCRAPPIN-OPD 1400 1680 1960 OPC015 Cyclocryopexy (EYE) 3500 4200 4900 OPC016 Economical 7000 8400 9800 OPC017 Cataract and IOL Ultrasmart 25200 30240 35280 OPC018 Cataract and IOL foldable 21000 25200 29400 OPC019 Cornea Scrapping under General Anestesia 3500 4200 4900 OPC021 Cataract surgery economical (Non Foldable Indian) 1120 1350 1570 OPC022 Cataract surgery (Non Foldable Indian) 4810 5770 6730 OPC023 Cataract surgery (Acry Fold) 5140 6170 7190 OPC024 Cataract surgery (Ultra Smart) 6610 7930 9250 OPC025 Cataract surgery (SP) 12370 14840 17310 OPC026 Cataract surgery (IQ) 14930 17910 20900 OPC027 Microincision cataract surgery(IQ) 17860 21440 25010 OPC028 Cataract surgery (Toric) 13100 15710 18330 OPC029 Cataract SurgeryPropac IOL 70000 84000 98000 OPC030 Cataract Surgery Toric IOL 77000 92400 107800 OPC031 Cataract Surgery Spveric 35000 42000 49000 OPC032 Cataract Surgery Multi Focal 91000 109200 127400 OPC033 Cataract Surgery Aspheric 37800 45360 52920 OPD001 Dacryocystectomy 11900 14280 16660 OPD002 Dacryocystorhinostomy 21000 25200 29400 139| T a r i f f - AIMS
244 78581/2020/ESTT-NE_HROPE002 Ectropion 9800 11760 13720 OPE003 ENDOPH VITRECTOMY 12600 15120 17640 OPE004 Entropion 8400 10080 11760 OPE005 Enucleation (EYE) 12600 15120 17640 OPE006 Enucleation (EYE) with implant 18900 22680 26460 OPE007 Epicanthus Repair 7700 9240 10780 OPE008 EPILATION 420 510 590 OPE009 Evisceration (EYE) 12600 15120 17640 OPE010 Evisceration (EYE) with implant 18900 22680 26460 OPE011 Exenteration (EYE) 17500 21000 24500 OPE012 Eye probing syringing Bilateral 6300 7560 8820 OPE013 Eye Probing Syringing Unilateral 4200 5040 5880 OPE014 EYE SHIELD 140 170 200 OPE015 Eyelid Abscess Drainage 9800 11760 13720 OPE016 Eyelid canliculi repair 9800 11760 13720 OPE017 Eyelid coloboma repair 12600 15120 17640 OPE018 Eyelid injuries repair 16800 20160 23520 OPE019 Eyelid tumors excision & Repair 3500 4200 4900 OPE020 Eye Exploration 1400 1680 1960 OPF001 F F ANGIOGRAPHY(OPD) 3500 4200 4900 OPF002 Fundus examination 560 680 790 OPF003 Fundus Examination Under GA 1400 1680 1960 OPF005 FUNDUS PHOTOGRAPHY 980 1180 1380 OPF006 FFA + OCT Combination 6300 7560 8820 OPF007 Focal Laser(Eye) 4200 5040 5880 OPG001 Glaucoma û Trabeculectomy 11200 13440 15680 OPG002 Glaucoma workup (OCT + VFA + AT) 5320 6390 7450 OPG003 GONIOSCOPY 560 680 790 OPG004 Goniotomy 6580 7900 9220 OPG005 GLAUCOMA PACKAGE(OCT+VFA+AT+PI) 12320 14790 17250 OPI001 INCISION & CAUTERY 3080 3700 4320 OPI002 Indirect opthalmoscopy 700 840 980 OPI003 INJ HEALON GV0.85ML 4480 5380 6280 OPI004 INJECTION FLUORESCEIN 70 90 100 OPI005 Intraocular Foreign body removal 16800 20160 23520 OPI006 INTRAVITREAL INJECTION 3500 4200 4900 OPI007 IOL EXPLANTATION 7000 8400 9800 OPI008 IOL REPOSITIONING 3500 4200 4900 OPI009 IRIDOPLASTY 9800 11760 13720 OPI010 Intra vitreal package with lucentis inj 105000 126000 147000 OPK001 Keratomertry 560 680 790 OPL001 Lacrimal Abscess drainage 8400 10080 11760 OPL002 LATTICE DELIMATION LASER 2800 3360 3920 OPL003 Lensectomy 21000 25200 29400
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245 78581/2020/ESTT-NE_HROPL004 LENSOMETRY 280 340 400 OPM001 Membranectomy 10920 13110 15290 OPM002 MICS package with IQ Lens 56000 67200 78400 OPM003 MIL Cataract 47600 57120 66640 OPO001 Orbitotomy 20300 24360 28420 OPO002 Orthoptic Exercises (2wks Package)or six sitting 1680 2020 2360 OPO003 Orthoptic Exercises (Single Sitting) 420 510 590 OPO004 OCT-Glaucoma 3220 3870 4510 OPO005 OCT-Retina 3500 4200 4900 OPP001 Paracentesis 1400 1680 1960 OPP002 Phacoemulsification package with IQ Lens 49000 58800 68600 OPP003 Phacoemulsification package with SP Lens 42000 50400 58800 Phacoemulsification package with Foldable imported OPP004 Lens 21000 25200 29400 OPP005 Cataract Surgery package (PMMA Lens) 14000 16800 19600 OPP006 Phaconit 7000 8400 9800 OPP007 Ptergium 6580 7900 9220 OPP008 Ptergium with conj graft 11900 14280 16660 OPP009 Pterygium with Amniotic membrane grafting 18200 21840 25480 OPP010 Ptosis 20300 24360 28420 OPP011 PUNCTAL OCCUTION 1050 1260 1470 OPP012 PUPILLOPLASTY 12600 15120 17640 OPP013 Prophylactic Laser In OPD (1 QD.) 5600 6720 7840 OPP014 Prophylactic Laser In OPD (2 QD.) 8400 10080 11760 OPP015 Prophylactic Laser In OPD (3 QD.) 10500 12600 14700 OPP016 Prophylactic Laser In OPD (4 QD.) 12600 15120 17640 OPP017 PRP Laser(Per eye Per sitting) 4200 5040 5880 OPP018 Phacoemulsification package with Toric Lens 77000 92400 107800 OPP022 Phacoemulsification package with Tecnis 1PC Lens 56350 67620 78890 OPP023 Phacoemulsification package with Sensar 1 PC Lens 48300 57960 67620 OPR001 REFRACTION CHARGES 420 510 590 OPR002 RETINA LASER PHOTOCOAGULATION- IPD 3780 4540 5300 OPR003 RETINA LASER PHOTOCOAGULATION- OPD 3500 4200 4900 OPR004 Retinal detachment Surgery 21000 25200 29400 OPR005 Retinocryopexy 4620 5550 6470 OPR007 ROP Screening 2800 3360 3920 OPR008 ROP Laser/Eye 7000 8400 9800 OPS001 Scleral perforation injuries repair 14000 16800 19600 OPS002 Secondary IOL Implantation ( Without IOL cost) 9800 11760 13720 OPS003 SPHINCTEROTOMY 3500 4200 4900 OPS004 Squint Horizontal Muscle 16520 19830 23130 OPS005 Squint Vertical muscle 20300 24360 28420 OPS007 Surgical Peripheral iridectomy 9800 11760 13720 OPS008 Symblepharon release with grafting 18200 21840 25480
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246 78581/2020/ESTT-NE_HROPS009 Syringing in OPD 700 840 980 OPS010 SCHIRMERS TEST 280 340 400 OPT001 Tarsorraphy 7000 8400 9800 OPT002 TEMPORARY TARSORRHAPHY 4200 5040 5880 OPT003 Tonometry Applanation 420 510 590 OPT004 Trabeculotomy 11200 13440 15680 OPU002 USG B Scan 1680 2020 2360 OPV001 VER 1680 2020 2360 OPV002 Vitrectomy 27300 32760 38220 OPY001 YAG LASER CAPSOLOTOMY PER EYE 3500 4200 4900 OPY002 YAG LASER IRIDOTOMY PER EYE 3920 4710 5490
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247 78581/2020/ESTT-NE_HR
ORTHOPAEDICS
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248 78581/2020/ESTT-NE_HR Semi Code Description Ward Pvt Pvt ORA001 Acetabular/Pelvic Fixation 30240 36290 42340 Acromioplasty-Sub Acromial Decompression & Excision of ORA002 Lateral end of Clavicle 13950 16740 19530 ORA003 Adductor Tenotomy & Obturator Neurectomy 13950 16740 19530 All open Reduction with Internal Fixation with bone Grafting ORA004 (Long bones) 23520 28230 32930 ORA005 All orif and bone grafting (Small) 8400 10080 11760 ORA006 Amputation -Fore Quarter 31920 38310 44690 ORA007 Amputation- Hind Quarter 37800 45360 52920 ORA008 Amputation of Digits-Multiple 11760 14120 16470 ORA009 Amputation of Digits-Single 55000 66000 77000 ORA010 Amputation-AE 18480 22180 25880 ORA011 Amputation-AK 20300 24360 28420 ORA012 Amputation-BE 13440 16130 18820 ORA013 Amputation-BK 16800 20160 23520 ORA014 Anterior Cervical Fusion 31920 38310 44690 ORA015 Anterior Spinal Fusion & Decmpression at multiple Levels 35000 42000 49000 ORA016 Anterior Spinal Fusion with Decmpression at SingleLevel 31080 37300 43520 ORA017 Arthodesis of Minor Joins 8400 10080 11760 ORA018 Arthotomy (Small joints) 6720 8070 9410 ORA019 Arthrodesis of Major Joints û Foot 10920 13110 15290 ORA020 Arthrodesis of Major Joints û Hand 11760 14120 16470 ORA021 Arthrodesis of Major Joints û HIP 31500 37800 44100 ORA022 Arthrodesis of Major Joints - Shoulder 25900 31080 36260 ORA023 Arthrodesis of Major Joints ûElbow 20160 24200 28230 ORA024 Arthrodesis of Major Joints ûKnee 21000 25200 29400 ORA025 Arthrodesis of Major Joints -Pan Talar 20160 24200 28230 ORA026 Arthroscopic ACL Reconstruction 25200 30240 35280 Aethroscopic Assisted Tibial Spine Fracture Reduction & ORA027 Fixation 21840 26210 30580 ORA028 Arthroscopic Joint Debridement 16800 20160 23520 ORA029 Arthroscopic Meniscal Repair 25200 30240 35280 ORA030 Arthroscopic Menisectomy 19600 23520 27440 ORA031 Arthroscopic PCL Reconstration 28000 33600 39200 ORA032 Arthroscopic Synovectomy Hip 21840 26210 30580 ORA033 Arthroscopic Synovectomy Knee 21840 26210 30580 ORA034 Arthroscopic Synovectomy Shoulder 21840 26210 30580 ORA035 Arthroscopic Synovectomy Wrist 21840 26210 30580 ORA036 Arthrotomy Ankle 13440 16130 18820 ORA037 Arthrotomy Hip 15120 18150 21170 ORA038 Arthrotomy Knee 15120 18150 21170 ORA039 Arthrotomy Wrist 11760 14120 16470 ORA040 Arthroscopic Capsular Release(Shoulder) 22400 26880 31360 144| T a r i f f - AIMS
249 78581/2020/ESTT-NE_HRORB001 Bilateral total Knee Replacement 84000 100800 117600 ORB002 Biopsy (Small Bones) 5040 6050 7060 ORB003 Biopsy Bone (Large) 10080 12100 14120 ORB004 Biopsy Muscle(Deep) 7560 9080 10590 ORB005 Bipolar Arthroplasty 19320 23190 27050 ORB006 BIPOLAR HEMIARTHO PLASTY 22680 27220 31760 ORB007 Biposy Muscle (Superficial) 2520 3030 3530 ORB008 Bone Graftiing for Frature non Union 14000 16800 19600 ORB009 Bone grafting 10920 13110 15290 ORB010 Biciptical Tendesis 19600 23520 27440 ORB011 Bilateral Hip Replacement 84000 100800 117600 ORC001 Carpal Tunnel Decompression (ORTHO) (B/L) 22400 26880 31360 ORC002 Carpal Tunnel Decompression (ORTHO) (Single) 12600 15120 17640 ORC003 Cervical Corpectomy 31920 38310 44690 ORC004 Cervical Rib Excision 26880 32260 37640 ORC005 Change of Tibal Articular Height( Change of ulena) 18480 22180 25880 ORC006 Closed Nailing of Long Bones- Femur 23800 28560 33320 ORC007 Closed Nailing of Long Bones ûHumerus 19660 23590 27520 ORC008 Closed Nailing of Long Bones ûTibia 22400 26880 31360 ORC009 Closed Reduction of Fractures & POP Application 3360 4040 4710 ORC010 Closed Reduction of joint Disclocation (hip/Shoulder/ Elbow) 5040 6050 7060 ORC011 Closed Reduction of Small Joints ûIP 2520 3030 3530 ORC012 Closed Reduction of Small Joints ûMP 2520 3030 3530 ORC013 Closed Reduction of Small Joints ûMTP 2520 3030 3530 ORC014 Colles fracture Closed Reduction & pop Cast 6000 7200 8400 ORC015 Combined Anterior & Posterior Spinal Surgery 94080 112900 131720 ORC016 Complex Knee Ligament Reconstruction & Stabilisation 33600 40320 47040 ORC017 Complex Spine Instrumentation 94080 112900 131720 ORC018 Complex Spine Resection & Reconstruction 94080 112900 131720 ORC019 Contracture Release (Small) 5040 6050 7060 ORC020 Contracture Release (Large) 11760 14120 16470 ORC021 Core Decompression 12000 14400 16800 ORC022 Corrective Lesser toe surgery 7560 9080 10590 ORC023 Corrective Spinal Osteotromy & Fusion 40000 48000 56000 ORC024 Costo- Transversectomy 25200 30240 35280 ORC025 Cross Finger Flaps 13440 16130 18820 ORC026 CTEV (Club Foot) Corrective Bone Surgery 20160 24200 28230 ORC027 CTEV- Manipulation & Corrective Cast 2520 3030 3530 ORC028 Curretage of Tumor & Bone Grafting (large) 18480 22180 25880 ORC029 Curretage of Tumor & Bone Grafting (Small) 6720 8070 9410 ORC031 Closed Reduction Of Complex Fractures and 6300 7560 8820 ORD001 DE Querveins Release 7060 8470 9880 ORD002 DHS 22400 26880 31360 ORD003 Diagnostic Arthroscopy- Ankle 10920 13110 15290
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250 78581/2020/ESTT-NE_HRORD004 Diagnostic Arthroscopy -Hip 13440 16130 18820 ORD005 Diagnostic Arthroscopy -Knee 11430 13710 16000 ORD006 Diagnostic Arthroscopy -Shoulder 17640 21170 24700 ORD007 Diagnostic Arthroscopy -Wrist 14280 17140 20000 ORD008 Difficult & Complex Fracture Fixation 26880 32260 37640 ORD009 Disarticulation Knee 20160 24200 28230 ORD010 Disarticulation-Ankle 17640 21170 24700 ORD011 Disarticulation-Elbow 14280 17140 20000 ORD012 Disarticulation-Hip 26880 32260 37640 ORD013 Disarticulation-Wrist 14280 17140 20000 ORD014 Drainage Abscess (Incision & Drainage) 2020 2420 2830 ORD015 Dressing I G A 1680 2020 2360 ORE001 Endoscopic Spine Biopsy 17640 21170 24700 ORE002 Endoscopic Spine Decompression 40320 48390 56450 ORE003 Excision Head of radius 11760 14120 16470 ORE004 Excision of Ganglion 3500 4200 4900 ORE005 Excision of Lower end Ulna 9580 11500 13410 ORE006 External Fixator for Fracture long Bones Lower Limb 11760 14120 16470 ORE007 External Fixator for Fracture Long Bones Upper Limb 14280 17140 20000 ORF001 Fasciotomy-Forearm 7560 9080 10590 ORF002 Fasciotomy-Leg 12600 15120 17640 ORF003 Fixation frac Hip-D.H.S/Jewett/Cannu screw 23800 28560 33320 ORF004 Fusion -Sacroiliac 25200 30240 35280 ORF005 Fusion -Sub Talar 16800 20160 23520 ORF006 Fusion -Tripple Arthrodesis 20160 24200 28230 ORF007 Fusion-Posterior Spinal 43680 52420 61160 ORG001 Girdlestone Arthroplasty 16800 20160 23520 ORH001 Hamstring Release 10920 13110 15290 ORI001 Ilizarov & Complex External Fixator 31920 38310 44690 ORI002 Infected TKA first Stage 31080 37300 43520 ORI003 Infected TKA Joint Debridement 17640 21170 24700 ORI004 Infected TKA Second Stage 65520 78630 91730 ORI005 Ingrowing toe Nail Excision 1680 2020 2360 ORI006 Joint Aspiration in OT 1680 2020 2360 ORK001 K Wire Fixation Small Bones (Single ) Hand 5600 6720 7840 ORK002 K Wire Fixation Small Bones (Single ) Foot 5600 6720 7840 ORK003 K-Wire Fixation of Small Bones-Foot (Multiple) 8400 10080 11760 ORK004 K-Wire Fixation of Small Bones-Hand (Multiple) 8400 10080 11760 ORK005 Kyphoplasty- single level 42000 50400 58800 ORL001 Laminectomy 34440 41330 48220 ORL002 Lateral Soft Tissue Release BK 10080 12100 14120 ORL003 Limb Salvage & Implantation of Mega Prosthesis 48720 58470 68210 ORL004 Local Flaps 10920 13110 15290 ORM001 Major Tendon Transfers 15120 18150 21170
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251 78581/2020/ESTT-NE_HRORM002 Manipulation of Joints 3360 4040 4710 ORM003 Manipulation of Joints -Elbow 3360 4040 4710 ORM004 Manipulation of Joints- Knee 5040 6050 7060 ORM005 Manipulation of Joints- Shoulder 6720 8070 9410 Medical Soft Tissue Tightening AK( for recurrent dislocation ORM006 Platella) 18480 22180 25880 ORM007 Microdisectomy 32760 39320 45870 ORM008 Microlumbar Disectomy 26040 31250 36460 ORM009 Mole Removal 1680 2020 2360 ORM010 Multiple hand Fracture & Tendon Injuries with skin loss 18480 22180 25880 ORM011 Multiple hand Fracture without skin loss 13440 16130 18820 ORM012 Minor Orthopaedic Procedure-I 1680 2020 2360 ORM013 Minor Orthopaedic Procedure-II 2520 3030 3530 ORM014 Minor Orthopaedic Procedure-III 3360 4040 4710 ORM015 Minor Orthopaedic Procedure-IV 2690 3230 3770 ORM016 Minor Orthopaedic Procedure-V 5040 6050 7060 ORM017 Major Orthopaedic procedure 1 8400 10080 11760 ORM018 Major Orthopaedic procedure 2 11200 13440 15680 ORM019 Major Orthopaedic procedure 3 14000 16800 19600 ORM020 Major Orthopaedic procedure 4 16800 20160 23520 ORM021 MCL repair 28000 33600 39200 ORO001 Open Synovectomy -Knee 15120 18150 21170 ORO002 Open Synovectomy -Wrist 12600 15120 17640 ORO003 Orif DCP (femur / Tibia) 21000 25200 29400 ORO004 Orif DCP (Humerus) 19320 23190 27050 ORO005 Orif DCP (Radius / Ulna) 18480 22180 25880 ORO006 Orif Bimalleolar 17640 21170 24700 ORO007 Orif Buttress Plate / Locking Plate ( Proximal Humerus) 19320 23190 27050 ORO008 Orif Fracture Claceneum 19600 23520 27440 ORO009 Orif Fracture Clavicle 14000 16800 19600 ORO010 Orif Fracture Radical Head 11760 14120 16470 ORO011 Orif Fracture Scaphoid 14280 17140 20000 ORO012 Orif Frature Lateral Maalleolus 10920 13110 15290 ORO013 Orif Frature Lower end Radius 10920 13110 15290 ORO014 Orif Frature Medial malleolus 10920 13110 15290 ORO016 Orif Frature Patella 14280 17140 20000 ORO017 Orif Frature supracondylar humerus 15120 18150 21170 ORO018 Orif Frature talus 16800 20160 23520 ORO019 Orif Intercondylar Humerus 21000 25200 29400 ORO020 Orif Lockingplate Suppacondylar Femur 21000 25200 29400 ORO021 Orif Long bone-Lower Limb 18480 22180 25880 ORO022 Orif Long Bones - Upper limbs 16800 20160 23520 ORO023 Orif Lower End Tibia (Locking Plate) 18480 22180 25880 ORO024 Orif of Complex Fratures 25200 30240 35280
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252 78581/2020/ESTT-NE_HRORO025 Orif of Complex Fratures -Lower limb 28560 34280 39990 ORO026 Orif of Complex frature-Upper Limb 25200 30240 35280 ORO027 Orif Plating (Metalarpl / Metatarsal) 10080 12100 14120 ORO028 ORIF-Periprosthetic Fractures 30240 36290 42340 ORO029 Osetotomy - French 14280 17140 20000 ORO030 Osteomyelitis-Surgical decompression 10920 13110 15290 ORO031 Osteotomy - Calcaneal 13440 16130 18820 ORO032 Osteotomy - High Tibial 15120 18150 21170 ORO033 Osteotomy -around Hip 20160 24200 28230 ORO034 ORIF Olucramon 10920 13110 15290 ORP001 Paediatric Hip Surgery - perthes/scfe/open reduction of CDH 26880 32260 37640 ORP002 Paediatric Hip Surgery-SCFE 21000 25200 29400 ORP003 Paedriatic Hip Surgery- open reduction of CDH 25200 30240 35280 ORP004 Patellar Realignment Procedure 18480 22180 25880 ORP005 Patellar Replacement 14280 17140 20000 ORP006 Patellectomy 15120 18150 21170 ORP007 Percutaneous K-wire Fixation 9240 11090 12940 ORP008 PFN 21000 25200 29400 ORP009 Ponseti Tenotomy 3360 4040 4710 ORP010 POP - I 930 1110 1300 ORP011 POP - II 1350 1620 1890 ORP012 POP - III 2020 2420 2830 ORP013 POP - IV 2860 3430 4000 ORP014 POP - V 4200 5040 5880 ORP015 POP - VI 5880 7060 8240 ORP016 POP - VII 6720 8070 9410 ORP017 POP Application -All Fratures 2000 2400 2800 Posterior lumbar Intervertebral Body fusion with ORP018 Instrumentation 40320 48390 56450 ORP019 Primary Nerve Repair 13440 16130 18820 ORP020 Primary Total joint Replacement - Unilateral -Elbow 42000 50400 58800 ORP021 Primary Total joint Replacement - Unilateral-Hip 42000 50400 58800 ORP022 Primary Total joint Replacement - Unilateral-Knee 42000 50400 58800 ORP023 Primary Total joint Replacement - Unilateral-shoulder 42000 50400 58800 ORP024 Primary Total joint Replacement- Unilateral-Ankle 42000 50400 58800 ORP025 Posterior decompression and fusion/intrumentation 280000 336000 392000 ORQ001 Quadriceps plasty without Arthroscopy 18480 22180 25880 ORR001 Re-adjustment of fixator 6000 7200 8400 ORR002 Recurrent Dislocation of patella stabilization (open method) 18480 22180 25880 Recurrent Dislocation stabilization -Shoulder ORR003 elbow(arthroscopic method) 18480 22180 25880 ORR004 Removal of exostosis 9240 11090 12940 ORR005 Removal of fixator 3030 3630 4240 ORR006 Removal of fracture fragment-Hip 16800 20160 23520 ORR007 Removal of Implants -long bones-lower limb 9750 11700 13650 148| T a r i f f - AIMS
253 78581/2020/ESTT-NE_HRORR008 Removal of Implants -long bones-upper limb 7060 8470 9880 ORR009 Repair of multiple tendons of hand 14280 17140 20000 ORR010 REVISION TKR ( ONE STAGE) 126000 151200 176400 ORR011 Rotation flaps 11760 14120 16470 ORR012 Rotator cuff repair û open 15120 18150 21170 ORR013 Revision THR 67200 80640 94080 ORR014 Recuurent disclocatn stabilization-Shoulder(ortho) 25200 30240 35280 ORR015 Reduction of Compound Fractures with POP 8400 10080 11760 ORS001 Secondry closure of wound 3700 4440 5180 ORS002 Shoulder arthroscopy, rotator cuff repair 30800 36960 43120 ORS003 Single nerve repair - major nerve 10920 13110 15290 ORS004 Single tendon grafting 10920 13110 15290 ORS005 Skeleton traction 2690 3230 3770 ORS006 Skin Grafting (Small) 5880 7060 8240 ORS007 Skin grafting (Large) 11760 14120 16470 ORS008 Skull traction 3360 4040 4710 ORS009 Small joint replacement 18480 22180 25880 ORS010 Standard spine instrumentation 35280 42340 49400 ORS011 SUPRACONDYLAR NAILING FEMUR 21000 25200 29400 ORS012 Shoulder hemiarthroplasty 25200 30240 35280 ORT001 Tendon repair-foot 10920 13110 15290 ORT002 Tendon Repair-Hand 10080 12100 14120 ORT003 Total Knee Joint Replacement U/L UNICONDYLAR 42000 50400 58800 Transforaminal lumber intervertebral body fusion with ORT004 instrumentation 40320 48390 56450 ORT005 Transthoracic anteriordecompression & fusion 36960 44360 51750 ORT006 Trigger Finger Release 6720 8070 9410 ORU001 Unicompartmental Knee Replacement -Unilateral 36960 44360 51750 ORV001 Venous Thrombectomy 29090 34900 40720 ORW001 Wound Debridment (Small) 6720 8070 9410 ORW002 Wound Deberidement (Ortho) (Large) 10920 13110 15290
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254 78581/2020/ESTT-NE_HR
OBS & Gynaecology
Code Description Ward Semi Pvt
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255 78581/2020/ESTT-NE_HR Pvt OBA001 Abdominal Hysterectomy 15400 18480 21560 OBA002 Abdominal Myomectomy (Multiple) 21560 25880 30190 OBA003 Abdominal/Vaginal Myomectomy (single) 15400 18480 21560 OBA004 Abdominal cervicoperxy for uv prolapse 21560 25880 30190 OBA005 Abortion second trimster 10500 12600 14700 OBA007 Amniocentersis 8260 9920 11570 OBA008 Anterior And Posterior Vaginal Repair 13860 16640 19410 OBA009 Anterior Colporrhaphy 7000 8400 9800 OBA010 Antenatal program(8 classes /month) 4200 5040 5880 OBB001 Bartholin abscess drainage 3500 4200 4900 OBB002 Bartholin cyst excision bilateral 10780 12940 15100 OBB003 Bartholin cyst excision unilateral 7500 9000 10500 OBB004 Bilateral Internal artery ligatum 13580 16300 19020 OBC001 Caesarian Hysterectomy 23100 27720 32340 OBC002 Cervical Cautry /Cervical Biopsy / cervical polypectomy 3850 4620 5390 OBC003 Cervical Cerclage 6160 7400 8630 OBC004 Colposcopy guided biopsy 6160 7400 8630 OBC005 Colpotomy and needling 2310 2780 3240 OBC006 Complex/ High Risk Hysterectomy 18480 22180 25880 OBC007 Cone/Leep Biopsy Of Cervix 11550 13860 16170 OBC009 CTG Monitoring - IPD 1540 1850 2160 OBC010 CTG Monitoring -One time 280 340 400 OBC011 Cervical Tear Repair 3500 4200 4900 OBD001 Delivery breech 17500 21000 24500 OBD002 Delivery forceps 15400 18480 21560 OBD003 Delivery normal 12600 15120 17640 OBD004 Delivery normal with high risk 15400 18480 21560 OBD005 Delivery twin 17500 21000 24500 OBD006 Delivery vaccum 15400 18480 21560 OBD007 Dilation & Curettage (D&C) 4200 5040 5880 OBD008 Drainage Of Abdominal Wall Haematoma 6930 8320 9710 OBD009 Drainage Of Vulval Hematome 7700 9240 10780 OBD010 Delivery twin vaccum 21410 25690 29970 OBE001 End to end tubal reanastomosis 22330 26800 31270 OBE002 Endometrial ablation 10780 12940 15100 OBE003 Endometrial biopsy 3080 3700 4320 OBE004 Episiotomy 4200 5040 5880 OBE006 Evacuation of retained product of conception/D&E 4620 5550 6470 OBE007 Evacuation Under Genreal Anaesthetic (Eua) 4000 4800 5600 OBE008 Excision of vaginal septum 6160 7400 8630 OBE009 Exploratory Laparotomy 12320 14790 17250 OBF001 FentonÆS Operation For Reconstruction Of vagina 22330 26800 31270 OBF002 First Trimester Mtp 5600 6720 7840
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256 78581/2020/ESTT-NE_HROBF003 First Trimester Mtp Plus Sterilisation 10780 12940 15100 OBF004 Foreign body removal fro vagina 3850 4620 5390 OBG001 GilliamÆS Ventrosupension 22330 26800 31270 OBH001 Hymenoplasty 11550 13860 16170 OBH002 Hysteroscopic Dissection Of uterine synaechiae mild 15400 18480 21560 OBH003 Hysteroscopic Myomectomy 19250 23100 26950 OBH004 Hysteroscopic Polypectomy 8470 10170 11860 OBH005 Hysteroscopic Removal Of Iucd 7700 9240 10780 OBH006 Hysteroscopic Resection Of Uterine Septum 15400 18480 21560 OBH007 Hysteroscopic tubal canulation 11710 14050 16390 OBH008 Hysteroscopy and D&C 6160 7400 8630 OBH009 Hysterotomy 10010 12020 14020 OBH010 Hysterotomy With Tubal Ligation 12320 14790 17250 OBI001 IUI 2100 2520 2940 OBI002 Iucd Insertion 1500 1800 2100 OBL001 Labiaplasty 13860 16640 19410 OBL002 Lap gyn staging 12320 14790 17250 OBL003 Lap sarcocolpopexy 32340 38810 45280 OBL004 Lap total hysterectomy 25410 30500 35580 OBL005 Lap. / Vaginal Adhesiolysis 12320 14790 17250 OBL006 Laparoscop Multiple Ovarian Puncture/Drilling 12320 14790 17250 OBL007 Laparoscop Ablation of Endometriotic Spots 12320 14790 17250 OBL008 Laparoscopic Adhesiolysis 15400 18480 21560 OBL009 Laparoscopic Aspiration Of Cyst 12320 14790 17250 OBL010 Laparoscopic Biopsy 12320 14790 17250 OBL011 Laparoscopic Enterocele Repair 18480 22180 25880 OBL012 Laparoscopic Fimbriolysis 15400 18480 21560 OBL013 Laparoscopic Myomectomy 25410 30500 35580 OBL014 Laparoscopic Oophorectomy 16170 19410 22640 OBL015 Laparoscopic Ovarian Cystectomy unilateral 16170 19410 22640 OBL016 Laparoscopic Ovarioplasty 19250 23100 26950 OBL017 Laparoscopic Procedure For Ectopic Pregnancy 16170 19410 22640 OBL018 Laparoscopic Removal Of Lost Iucd 13090 15710 18330 OBL019 Laparoscopic Salpyngostomy 16170 19410 22640 OBL020 Laparoscopic Salpynogo Oophorectomy 19250 23100 26950 OBL021 Laparoscopic tubal ligation 10010 12020 14020 OBL022 Laparoscopic Tuboplasty 30800 36960 43120 OBL023 Laparoscopic Vault Suspension 30800 36960 43120 OBL024 Laparoscopically Assisted VaginalHysterectomy-LAVH 24500 29400 34300 OBL025 Laparoscopically Assisted Vaginal Hysterectomy complex 30100 36120 42140 OBL026 Laparoscopy Diagnostic 11550 13860 16170 OBL027 Laparoscopy & Hysterocopy (diagnostic hystero lapro) 16170 19410 22640 OBL028 Laparoscorpic Burch repair 27720 33270 38810 OBL029 Laparotomy For Ectopic Pregnancy 13090 15710 18330
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257 78581/2020/ESTT-NE_HROBL030 Laproscopic ovarian cystectomy bilateral 21000 25200 29400 OBL031 Laprotomy for endometriosis 21560 25880 30190 OBL032 Le ForteÆS Operation For Genital Prolapse 15400 18480 21560 OBL033 Lscs 14000 16800 19600 OBL034 Lscs High Risk 18480 22180 25880 OBL035 Lscs repeat/twin pregnancy 15400 18480 21560 OBL036 Lscs with tubectomy 14000 16800 19600 OBL037 IUCD Removal 800 960 1120 OBL039 Laproscopic Myomectomy Multiple 29400 35280 41160 OBL040 Laproscopy for Endometriosis 23800 28560 33320 OBL041 Laproscopy for b/l Endometriosis 29800 35760 41710 OBM001 Manchester Repair (Fothergill Operation) 19250 23100 26950 OBM002 Manual Removal Of Placenta 6930 8320 9710 OBM003 Mc Indoe /Es Operation For Reconsteuction Of vagina 28490 34190 39890 OBM004 Mtp High Risk 8470 10170 11860 OBM006 MEDICAL ABORTION PACKAGE(COUNSELLING AFTER 15 DAYS 3220 3870 4510 OBN001 Non Descent Vag. Hyst. Simple 19250 23100 26950 OBO001 Other minor surgery 2310 2780 3240 OBO002 Ovarian Cystectomy 14630 17560 20490 OBO003 Ovariotomy (oophorectomy For benign ovarian tumour 13090 15710 18330 OBP001 Pan Hysterectomy For Endometriosis 28960 34750 40540 OBP002 PCT 770 930 1080 OBP003 Plastic Repair Of Uterus 19250 23100 26950 OBP004 Posterior Colpoperineorrhaphy 10010 12020 14020 OBR001 Redical Hysterectomy For carcinoma of Body Of Uterus 30800 36960 43120 OBR002 Redical Hysterectomy Plus Omentectomy for ca ovary 34650 41580 48510 OBR003 Radical Vulvectomy 34650 41580 48510 OBR004 Removal Of Simple Valval Tumour 7700 9240 10780 OBR005 Repair Of Perineal Tear, Old Second Degree 7000 8400 9800 OBR006 Repair Of Perineal Tear, Old Third Degree 13860 16640 19410 OBR007 Repair Of Perineal Tear, Post -Coital Or traumatic 12600 15120 17640 OBR008 Repair Of Vesico Vaginal Fistula 27720 33270 38810 OBR009 Removal of Mc Donald's Stich 1500 1800 2100 OBR010 Rupture Uterus Repair 33810 40580 47340 OBS001 Second Trimester Mtp complicated 13090 15710 18330 OBS002 Simple Vulvectomy 18480 22180 25880 OBS003 sling Operation For Urinary Stress Incontinence 19250 23100 26950 OBS004 Subtotal Hysterectomy 16170 19410 22640 OBT001 Three Swabs Test ( For Vaginal Fistulae) 770 930 1080 OBT002 Trachelorrhaphy 8470 10170 11860 OBT003 Trans - Cervical Resection Of endometrium 19250 23100 26950 OBT004 Tubal Ligation (Laperotomy) 8000 9600 11200 OBT005 Tuboplasty Micro Surgery 25410 30500 35580 OBT006 Tuboplasty, Macro Surgery 19250 23100 26950
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258 78581/2020/ESTT-NE_HROBT007 THIRD / FOURTH DEGREE PERINEAL TEAR 9660 11600 13530 OBV001 Vag. Hyst. With Cervical Descent Complex 22330 26800 31270 OBV002 Vag.Hyst.With Rectocystocele Repair 19250 23100 26950 OBV003 Vaginal Hysterectomy 16940 20330 23720 OBV004 Vaginoplasty 13860 16640 19410 OBV005 Vault Repair abdomen 21560 25880 30190 OBV006 Vault repair vaginal 16170 19410 22640 OBV007 Visual inspection of cervix 1540 1850 2160 OBV009 VULVAL BIOPSY 8050 9660 11270 OBW001 WertheimsÆS Hysterectomy 37730 45280 52830 OBW002 Willam/Es Operation For Reconstruction of vagina 30030 36040 42050 IOB00015 Laparoscopic Oophorectomy with Hysteroscopy 31370 37640 43910 OBE010 Exploration broad ligament haematoma 14260 17110 19960 OBV010 Vaginal exploration 12840 15400 17970 OBA016 Abdominal wall tumor - medium 9870 11830 13790 OBA017 Abdominal wall tumor - small 6560 7880 9190 OBL043 Laproscopic Myomectomy (single) 28520 34220 39920 IOB00001 Hysteroscopy and D&C 16100 19320 22540 IOB00002 Hysteroscopic Polypectomy 22540 27050 31560 IOB00003 Hysteroscopic Myomectomy Single 24150 28980 33810 IOB00004 Hysteroscopic Myomectomy Multiple 32200 38640 45080 IOB00005 Hysteroscopic Resection Of Uterine Septum 24150 28980 33810 IOB00006 Hysteroscopic Dissection of Uterine Synaechiae 20930 25120 29310 IOB00007 Hysteroscopic Adhesiolysis ( Asherman III/IV) 27370 32850 38320 IOB00008 Hysteroscopic Myomectomy Multiple 32200 38640 45080 IOB00009 Laparohysteroscopic Tubal Canulation 37590 45110 52630 IOB00010 Lap.Adhesiolysis Type I with Hysteroscopic 32200 38640 45080 IOB00011 Lap. Adhesiolysis Type II with hysteroscopy 37590 45110 52630 IOB00012 Lap.Multi Ovarian Punct/Drilling with Hysteroscopy 32200 38640 45080 IOB00013 Laproscopic Tubal Reconstruction Hysteroscopy 43070 51680 60290 IOB00014 Laparoscopic Myomectomy 43070 51680 60290 IOB00016 Lap Ovarian Cystectomy Unilateral with Hystroscopy 37850 45420 52980 IOB00017 Laparoscopic Ovarioplasty with Hysteroscopy 37850 45420 52980 IOB00018 Laparoscopic Salpyngostomy 37850 45420 52980 IOB00019 Lap. Salpynogo Oophorectomy with Hysteroscopy 37850 45420 52980 IOB00020 Laparoscopic Tuboplasty with Hysteroscopy 40250 48300 56350 IOB00021 Laparoscopy & Hysteroscopy (Diagnostic) 27370 32850 38320 IOB00022 Lap Ovarian Cystectomy Bilateral with Hysteroscopy 40250 48300 56350 IOB00023 Lap Endometriosis Extensive with Hysteroscopy 48300 57960 67620 IOB00024 Lap/Open Myomectomy Multiple 48300 57960 67620 IOB00025 Lap Cystesctomy multiple with Hysteroscopy 43070 51680 60290 IOB00026 Lap Cystesctomy Single with Hysteroscopy 40250 48300 56350
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259 78581/2020/ESTT-NE_HR
PHYSIOTHERAPY
PTA001 Arthroplasty Rehab Package-21days 11760 14120 16470 PTC011 CVA Rehab Package-21 Days 11760 14120 16470 155| T a r i f f - AIMS
260 78581/2020/ESTT-NE_HRPTC012 CONTINOUS PASSIVE MOTION( CPM KNEE ) 250 300 350 PTE007 Electortherapy+Exercise Therapy 700 840 980 PTE008 Electotherapy 490 590 690 PTE009 Exercise Therapy(20 Min) 420 510 590 PTE010 Exercise Therapy(45 Min) 700 840 980 PTE011 EXS. THERAPY 250 300 350 PTF001 Frozen Shoulder Package-21 Days 11760 14120 16470 PTH001 HOT PACK 240 290 340 PTI002 INTERFERENTIAL THERAPY 250 300 350 INTERMITTENT CERVICAL TRACTION +HOT PTI003 PACK 300 360 420 INTERMITTENT LUMBER TRACTION +HOT PTI004 PACK 300 360 420 PTI005 ICT+ILT+HOT PACK 560 680 790 PTL003 Lamaze Breathing Exercises 700 840 980 PTL004 LWD 410 490 570 PTM005 MICROWAVE DIATHERMY 250 300 350 PTM006 MUSCLE STIMULATION 410 490 570 PTO001 OBSTETRIC- POSTNATAL EXCERCISE 350 420 490 PTO002 OBSTETRIC-ANTENATAL EXCERCISE 350 420 490 PTO003 OA Knee Package-21 Days 11760 14120 16470 PTP001 Paraffin Wax bath 250 300 350 PTP002 PIVD Package-21 Days 11760 11760 11760 PTS001 SCI Rehab Package-21 Days 11760 11760 11760 PTS002 Sports Injury Rehab Package-21 Days 11760 11760 11760 PTS003 Strength Training Package-21 Days 11760 11760 11760 PTS004 SWD 410 490 570 PTT002 TENS 410 490 570 PTU001 US THERAPY 250 300 350
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261 78581/2020/ESTT-NE_HR
RESPIRATORY MEDICINE
157| T a r i f f - AIMS
262 78581/2020/ESTT-NE_HRCode Description Ward Semi Pvt Pvt RMB001 Bronchoscopy 8400 10080 11760 RMB002 Bronchoscopic guided intubation 4040 4840 5650 RMC001 Complete PFT including DLCo and FRC 2800 3360 3920 RMC002 Complete allergy test 7000 8400 9800 RMD001 D/L scopy 4200 5040 5880 RME001 EBUS Guided Bronchoscopy 40250 48300 56350 RMF001 Fibreoptic Brachytherapy catheter Insertion 9800 11760 13720 RMF002 Fibreoptic FB Removal 14000 16800 19600 RMI001 ICD insertion 6580 7900 9220 RMI002 ICD Removal 2100 2520 2940 RMM001 Medical thoracoscopy 7000 8400 9800 RMP001 Pleural aspiration/ Tapping 1120 1350 1570 Pulmonary function Test (Include Pre and RMP002 post Bronchodilation) 1400 1680 1960
RMP003 Partial allergy test 2800 3360 3920 Respiratory physiotheraphy by cough RMR001 assistPer cycle 1050 1260 1470 Resp. physiotheraphy by inspiratory muscle RMR002 training 840 1010 1180 RMS001 Sleep study Diagnostic & Titration (SNS) 11900 14280 16660 RMS002 Sleep study diagnostic or Titration 8400 10080 11760 RMS003 Six minute walk test 700 840 980 RMT001 Tracheal Stenting 14000 16800 19600
158| T a r i f f - AIMS
263 78581/2020/ESTT-NE_HR
GENERAL SURGERY
Code Description Ward Semi Pvt Pvt SU0001 Oesophageal repair 42000 50400 58800
159| T a r i f f - AIMS
264 78581/2020/ESTT-NE_HRSU0002 Oesophageal surgery for ca. oesophagus 56000 67200 78400 SU0003 Open Drainage Of Liver Abscess 25200 30240 35280 SU0004 Open Lung Biopsy 25200 30240 35280 SU0005 Orchidectomy bilateral 16800 20160 23520 SU0006 Orchidectomy unilateral 14000 16800 19600 SU0007 Orchidopexy bilateral 16800 20160 23520 SU0008 Orchidopexy unilateral 14000 16800 19600 SUA001 Abdominoperineal Resection 42000 50400 58800 Abscess Drainage ( Intra SUA002 Abdominal,Perinephric,Psoas,others) 25200 30240 35280 SUA003 Abscess Drainage ( single /small) 5600 6720 7840 SUA004 Abscess drainage(single /large) 11200 13440 15680 SUA005 Absses Drainage (Multiple, Perineal) 12600 15120 17640 SUA006 Adrenalectomy Total 42000 50400 58800 SUA007 Anal Dilatation under GA 7000 8400 9800 SUA008 Anal dilatation with lateral sphicterotomy under GA 11200 13440 15680 SUA009 Anal Sphincter Repair 42000 50400 58800 SUA010 Anal Sphincter Repair following Injury 42000 50400 58800 SUA011 Anterior Resection 44800 53760 62720 SUA012 Appendectomy 19600 23520 27440 SUA013 Ascitic/Pleural Fluid Tapping 2520 3030 3530 SUA014 Abscess Drainage (medium) 5600 6720 7840 SUB001 Biposy Lymph Node deep 7000 8400 9800 SUB002 Biposy Lymph Node superficial under local 4200 5040 5880 SUB003 Bleeding Peptic Ulcer 28000 33600 39200 SUB004 Block Dissection, (axilla,groin,retroperitoneal) 30800 36960 43120 SUB005 Brachial Cyst Excission/brachial fistula excision 25200 30240 35280 SUB006 Breast (MRM) B/L 42000 50400 58800 SUB007 Breast (MRM) U/L 28000 33600 39200 SUB008 Breast Conseravation Surgery 25200 30240 35280 SUB009 Breast lumpectomy Large 14000 16800 19600 SUB010 Breast lumpectomy Small 9800 11760 13720 SUB011 Burst Abdomen Repair 21000 25200 29400 SUB012 Bilateral Vasectomy 9800 11760 13720 SUC001 Carbuncle Large 16800 20160 23520 SUC002 Carbuncle small 7000 8400 9800 SUC003 Cervical Sympathectomy 35000 42000 49000 SUC004 Chest Drainage 6300 7560 8820 SUC005 Choedochojejunostomy 39200 47040 54880 SUC006 Cholecystectomy Open 23800 28560 33320 SUC007 Choledochoduodenostomy 39200 47040 54880 SUC008 Choledocholithotomy 28000 33600 39200 SUC009 Circumcision 9800 11760 13720 SUC010 Colectomy With illeorectal Anastomosis 49000 58800 68600
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265 78581/2020/ESTT-NE_HRSUC011 Colon Replacement 56000 67200 78400 SUC012 Colostomy /illeostomy alone 21000 25200 29400 SUC013 Colostomy/illeostomy closure 21000 25200 29400 SUC014 CAPD Insertion/Removal 11200 13440 15680 SUC015 Choledocoscopy 28000 33600 39200 SUD001 Decorticating Pleurectomy & Excision of Empyema 44800 53760 62720 SUD002 Dental Cyst , Excision And Jaw Reconstruction 44800 53760 62720 SUD003 Dental Cyst And Tumor Excision 16800 20160 23520 SUD004 Drainage Appendicular Abscess /complicated 25200 30240 35280 SUD005 Drainage Of Pseudopancreatic Cyst 30800 36960 43120 SUD006 Dressing under GA (large) 14000 16800 19600 SUD007 Dressing under GA (medium) 8400 10080 11760 SUD008 Dressing under GA (small) 5600 6720 7840 SUE001 Excision medium superficial tumour 8400 10080 11760 SUE002 Excision of Cyst And Benign Tumours Of oral cavity 9100 10920 12740 SUE003 Excision Of Multiple /infected Sabeaceous Cyst 7000 8400 9800 SUE004 Excision Of Pilonidal Sinus 12600 15120 17640 SUE005 Excision Of Sebaceous Cyst single 4200 5040 5880 SUE006 Excision Retroperitonal Tumor 35000 42000 49000 SUE007 Excision Small Superficial Tumour 5600 6720 7840 SUE008 Excision Thyroglossal Cyst/ Fistula 28000 33600 39200 SUE009 Exision Large Superficial Tumour 14000 16800 19600 SUE010 Exploration of neck injury 1 22400 26880 31360 SUE011 Exploration of neck injury 2 30800 36960 43120 SUE012 Exploratory laparotomy 18460 22160 25850 SUE013 Exploratory Laparotomy with resection anastomosis 28000 33600 39200 SUE014 Exploratory laprotomy for gunshot/stab injury 42000 50400 58800 SUE015 Ex.laparotomy/closure of perforation/bowel decomp. 25200 30240 35280 SUE016 Exploratory laprotomy with colostomy/illeostomy 33600 40320 47040 SUE017 Exploratory laprotomy with Complex liver injury repair1 28000 33600 39200 SUE018 Exploratory laprotomy with Complex liver injury repair2 42000 50400 58800 SUE019 Exploratory laprotomy with multi organ injury 56000 67200 78400 SUE020 Exploratory laprotomy with spleenectomy 28000 33600 39200 SUE021 Exploratory laprotomy wiyh diaphragmatic injury repair 35000 42000 49000 SUE022 Endovasular Surgery 30800 36960 43120 SUE023 Endovascular Surgery B/L 36400 43680 50960 SUE024 Excision of Pilonoidal Sinus with Flap cover 28000 33600 39200 SUE025 Excision of Pilonoidal Sinus with Primary Closure 15400 18480 21560 SUF001 Fistula In Ano high 16800 20160 23520 SUF002 Fistula In Ano low 8400 10080 11760 SUF003 Fouriniers gangrene 19600 23520 27440 SUF004 Foam Sclerotherapy Procedure 2800 3360 3920 SUF005 Fistula in ano (complex 28000 33600 39200 SUF006 Fistula in ano by MAFT 25200 30240 35280
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266 78581/2020/ESTT-NE_HRSUF007 Fissurectomy 11200 13440 15680 SUG001 Gastro Jejunostomy 28000 33600 39200 SUG002 Gastrostomy Or Jejunostomy 16800 20160 23520 SUG003 Flossectomy (partial) 25200 30240 35280 SUG004 Flossectomy (total) 35000 42000 49000 SUG005 GSO Omentectomy 12600 15120 17640 SUH001 Haemorrhoidectomy(open) 13300 15960 18620 SUH002 Haemorrhoidectomy(stapled) 15400 18480 21560 SUH003 Hernia any type obstructed 21000 25200 29400 SUH004 Hernia Epigastric/ Umbilical /other(open) 16800 20160 23520 SUH005 Hernia femoral 16800 20160 23520 SUH006 Hernia incisional small (open) 18200 21840 25480 SUH007 Hernia incisional large (open) 30800 36960 43120 SUH008 Hernia inguinal biilateral (open) 19600 23520 27440 SUH009 Hernia inguinal unilateral (open) 15400 18480 21560 SUH010 Hernia strangulated Incisional/inguinal Hernia any type 27300 32760 38220 SUH011 Herniotomy Ingunial 15400 18480 21560 SUH012 Highly Selective Vagotomy/TV+GJ 28000 33600 39200 SUH013 Hirschsprung Resection & Anastomosis 35000 42000 49000 SUH014 Hydatid Cyst Of Liver 35000 42000 49000 SUH015 Hydrocoele bilateral 11200 13440 15680 SUH016 Hydrocoele unilateral 8400 10080 11760 SUH019 Hernia Epigastric/ Umbilical /other(open) Large 25200 30240 35280 SUI001 Injection varicose vein 6300 7560 8820 SUI002 Intestinal Fistula 28000 33600 39200 SUI003 Intra operative cholangigram 5600 6720 7840 SUI004 Intussusception 25200 30240 35280 SUI005 Inguinal exploration for undescended testes 16800 20160 23520 SUL001 Lap/Open colonic resection 1 44800 53760 62720 SUL002 Lap/Open colonic resection 2 35000 42000 49000 SUL003 Lap achlasia cardia repair 39200 47040 54880 SUL004 Lap/Open adhesiolysis 19600 23520 27440 SUL005 Lap appendicectomy 19600 23520 27440 SUL006 Lap band surgery 58800 70560 82320 SUL007 Lap chole+lap adhesiolysis 25200 30240 35280 SUL008 Lap choledochoduodenostomy 42000 50400 58800 SUL009 Lap choledocholithotomy 36400 43680 50960 SUL010 Lap choleycystectomy 21000 25200 29400 SUL011 Lap closure of duodenal/gastric perforation 35000 42000 49000 SUL012 Lap diagnostic 11200 13440 15680 SUL013 Lap diaphragm repair 39200 47040 54880 SUL014 Lap epigastric/paraumbillical/incisional/othher(L) 32200 38640 45080 SUL015 Lap epigastric/paraumbillical/incisional/othher(M) 25200 30240 35280 SUL016 Lap epigastric/paraumbillical/incisional/othher(S) 19600 23520 27440
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267 78581/2020/ESTT-NE_HRSUL018 Lap gastric bypass 84000 100800 117600 SUL019 Lap hiatus hernia repair 35000 42000 49000 SUL020 Lap hydatid cyst excision 39200 47040 54880 SUL021 Lap illeostomy 25200 30240 35280 SUL022 Lap inguinal hernia (bilateral) 25200 30240 35280 SUL023 Lap inguinal hernia (unilateral) 21000 25200 29400 SUL024 Lap intra peritonea/parietal tumor excision 1 25200 30240 35280 SUL025 Lap intra peritoneal/parietal tumor excision 2 30800 36960 43120 SUL026 Lap ligation of varicocele 22400 26880 31360 SUL028 Lap lumbar sympathectomy 22400 26880 31360 SUL029 Lap orchidectomy 22400 26880 31360 SUL030 Lap orchidopexy 22400 26880 31360 SUL031 Lap pyeloplasty 35000 42000 49000 SUL032 Lap radical choleycystectomy 42000 50400 58800 SUL033 Lap rectopexy 35000 42000 49000 SUL034 Lap sleeve gastrectomy 59500 71400 83300 SUL035 Lap small bowel surgery 33600 40320 47040 SUL036 Lap spleenectomy 36400 43680 50960 SUL037 Lap/open surgery for pancreatic pseudocyst 39200 47040 54880 SUL038 Lap truncal vagotomy with GJ 42000 50400 58800 SUL039 Lap whiples 84000 100800 117600 SUL040 Laproscopic/Open biopsy 16800 20160 23520 SUL041 Laproscopic cystectomy partial 35000 42000 49000 SUL042 Laproscopic cystectomy total 49000 58800 68600 Laproscopic drainage of intra peritoneal abscess/liver SUL043 abscess 21000 25200 29400 SUL044 Laproscopic feeding jejunostomy 21000 25200 29400 SUL045 Laproscopic removal of infected mesh 21700 26040 30380 SUL046 Laproscopic surgery for acute abdomen 30800 36960 43120 SUL047 Left / Right Lobectomy Liver 56000 67200 78400 SUL048 Lap liver resection -I 35000 42000 49000 SUL049 Lap liver resection -II 49000 58800 68600 SUL050 Lap CAPD insersion 17500 21000 24500 SUM001 Mediastinoscopy 16800 20160 23520 SUM002 Mesenteric Cyst Excision 22400 26880 31360 SUN001 Nail bed excision 2800 3360 3920 SUN002 Necrosectomy & Open Drinage Of pancreatic abscess 42000 50400 58800 SUP001 Parathyroidectomy 39200 47040 54880 SUP002 parotidectomy(suprficial) 25200 30240 35280 SUP003 parotidectomy(total) 35000 42000 49000 SUP004 Partial Amputation Of Penis 25200 30240 35280 SUP005 Partial Gastrectomy 35000 42000 49000 SUP006 Partial Pancreatectomy 42000 50400 58800 SUP007 Partial Resection Of Liver / 44800 53760 62720
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268 78581/2020/ESTT-NE_HRSUP008 peripheral vascular procedure 1 21000 25200 29400 SUP009 peripheral vascular procedure 2 35000 42000 49000 SUP010 peripheral vascular procedure 3 42000 50400 58800 SUP011 Proctocolectomy 49000 58800 68600 SUP012 Pyloromyotomy 25200 30240 35280 SUP013 Peripheral pseudo aneurysmr repair 28000 33600 39200 SUP014 Peripheral Embolectomy 21000 25200 29400 SUR001 Radical Neck Dissection 28000 33600 39200 SUR002 Ranula Excision 9800 11760 13720 SUR003 Rare Hernias, Spigelian Obturator, Lumber (open) 25200 30240 35280 SUR004 Rectal Prolapse Repair (open) 35000 42000 49000 SUR005 Recurrent Inguinal Hernia/ Hernioplasty 22400 26880 31360 SUR006 Removal Of Submandibular Duct Calculus 9800 11760 13720 SUR007 Repair Of Diaphragmatic Hernia (open) 35000 42000 49000 SUR008 Repair Torn Ear Lobule Each 7000 8400 9800 SUR009 Retroperitoneal Drinage Of Abscess 22400 26880 31360 SUR010 Rib Resection & Drainage 21000 25200 29400 SUS001 Single incision lap appendix 21000 25200 29400 SUS002 Single incision lap bowel surgery 42000 50400 58800 SUS003 Single incision lap chole 22400 26880 31360 SUS004 Single incision lap hernia bilateral 25200 30240 35280 SUS005 Single incision lap hernia unilateral 22400 26880 31360 SUS006 Skin grafting(large) 28000 33600 39200 SUS007 Skin grafting(medium) 16800 20160 23520 SUS008 Skin grafting(small) 11200 13440 15680 SUS009 Splenectomy 22400 26880 31360 SUS010 Subcutaneous mastectomy(biilatral) 21700 26040 30380 SUS011 Subcutaneous mastectomy(unilatral) 16800 20160 23520 SUS012 Submandibular Sialadenectomy/Gland Excision 19600 23520 27440 SUS013 Submucous Cyst Excision 7700 9240 10780 SUS014 Subtotal Thyroidectomy 25200 30240 35280 SUS015 Suprapubic Drainage 8400 10080 11760 SUS016 Surgery For Hiatus Hernia (open) 36400 43680 50960 SUS017 Surgery For Portal Hypertension 42000 50400 58800 SUS018 Surgery For Recurrent Ulcer 28700 34440 40180 SUS019 Suture Of Large Laceration 16800 20160 23520 SUS020 Suture of medium laceration in ot 8400 10080 11760 SUS021 Suturing of massive lacerated facial wound 22400 26880 31360 SUS022 Simple mastectomy 21000 25200 29400 SUT001 Thiersch Operation 6300 7560 8820 SUT002 Thoracotomy for lungs/rib resection 49000 58800 68600 SUT003 Thoracotomy fordecortication 42000 50400 58800 SUT004 Total Amputation Of Penis 25200 30240 35280 SUT005 Total gastrectomy 42000 50400 58800
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269 78581/2020/ESTT-NE_HRSUT006 Total Thyroidectomy 29400 35280 41160 SUT007 Transverse Colectomy 25200 30240 35280 SUU001 Umbilectomy 14700 17640 20580 SUV001 Varicose vein surgery bilateral 29400 35280 41160 SUV002 Varicose vein surgery unilateral 22400 26880 31360 SUV003 Vats bullectomywith pleurodesis 39200 47040 54880 SUV004 Vats empyema drainage and decortication 36400 43680 50960 SUV005 Vats lobectomy 56000 67200 78400 SUV006 Vats pleural biopsy 22400 26880 31360 SUV007 Vats pleurodesis 22400 26880 31360 SUV008 Vatssegmentectomy/lungbipsy/transdiaphragmaticsurg 29400 35280 41160 SUV009 Vats sympathectomy 30800 36960 43120 SUV010 Vats thymectomy/mediasinal mass 42000 50400 58800 SUV012 Vaft major 28000 33600 39200 SUV013 vaft minor 16800 20160 23520 SUW001 Whipples surgery(open) 56000 67200 78400 SUW002 Wound debridement under GA(large) 22400 26880 31360 SUW003 Wound debridement under GA(medium) 16800 20160 23520 SUW004 Wound debridement under GA(small) 8400 10080 11760 SUW005 Wide excision 16800 20160 23520
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270 78581/2020/ESTT-NE_HR
PEDIATRIC SURGERY
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271 78581/2020/ESTT-NE_HRCode Description Ward Semi Pvt Pvt PSA001 Abdominoperineal Pull through (Duhanels) 30800 36960 43120 PSA002 Abscess insicion & Drainage (Pediatric) 2800 3360 3920 PSA003 Anal Transposition for ectopic anus (Pediatric) 19600 23520 27440 PSA004 Anterior Repair/Anteroid Palate With Bone Grafting 25200 30240 35280 PSA005 Antireflux surgery (Fundoplicaton) (Pediatric) 25200 30240 35280 PSA006 Appendicectomy (Pediatric) 15400 18480 21560 PSA007 Avulsion Injuries : Limbs - Large 22680 27220 31760 PSA008 Avulsion Injuries : Limbs -Medium 15960 19160 22350 PSA009 Avulsion Injuries : Limbs -Small 10640 12770 14900 PSA010 Avulsion Injuries : Scalp - Skin Grafting 13300 15960 18620 PSA011 Avulsion Injuries : Scalp -Replantation 49000 58800 68600 PSB001 Biliary Atresia (Kasais Portoenterostomy) 49000 58800 68600 PSB002 Biopsy rectal (Pediatric) 3500 4200 4900 PSB003 Bladder Exostrophy Repair (Biadder turn in ) (Pediatric) 30800 36960 43120 PSB004 Bladder Exostrophy comlete Repair (Pediatric) 49000 58800 68600 PSB005 Branchial Fistula (Pediatric) 16800 20160 23520 PSC001 Carpal Tunnel Syndrome (Per Side) 13300 15960 18620 PSC002 Choledochal Cyst excision (Pediatric) 30800 36960 43120 PSC003 Chordee Correction (Pediatric) 16800 20160 23520 PSC004 Circumcision (Pediatric) 6300 7560 8820 PSC005 Cleft Lip Repair (Unilateral) (Pediatric) 22400 26880 31360 PSC006 Cleft Lip: Bilateral : Complete 25200 30240 35280 PSC007 Cleft Lip: Bilateral : Incomplete 19600 23520 27440 PSC008 Cleft Lip: Unilateral : Complete 16800 20160 23520 PSC009 Cleft Lip: Unilateral : Incomplete 14000 16800 19600 PSC010 Cleft Palate - Complete 16800 20160 23520 PSC011 Cleft Palate Repair (Complete Cleft) (Pediatric) 22400 26880 31360 PSC012 Cleft Palate Repair (Incomplete Cleft) (Pediatric) 22400 26880 31360 PSC013 Cleft Palate -Soft Palate 14000 16800 19600 PSC014 Clitorovaginoplasty (Feminizing Genitoplasty) (Pediatric) 21000 25200 29400 PSC015 Colostomy & Multiple colonic biopsies (Pediatric) 16800 20160 23520 PSC016 Colostomy (Pediatric) 15400 18480 21560 PSC017 Colostomy closure(Pediatric) 17500 21000 24500 PSC018 Cystolithotomy (Pediatric) 14000 16800 19600 Cystoscopic Fulguration of Posterior urethral valves PSC019 (Pediatric) 12600 15120 17640 PSD001 Deep seated abscess drainage (Pediatric) 5600 6720 7840 PSD002 Diaphragm eventeration Repair (Pediatric) 35000 42000 49000 PSE001 Epispadias Repair (Pediatric) 25200 30240 35280 PSE002 esophageal Atresia with TEF (Primary Repair) 45640 54770 63900 Esophageal Replacement Surgery (Gastric Pull-UP) PSE003 (Pediatric) 49000 58800 68600 PSE004 Esophagostomy & Gastrostomy (Pediatric) 45640 54770 63900 PSE005 Excision Cyst / Tumour Benign Large (Pediatric) 19460 23360 27250 167| T a r i f f - AIMS
272 78581/2020/ESTT-NE_HRPSE006 Excision Cyst / Tumour Benign Small (Pediatric) 17080 20500 23920 PSE007 Excision of tumor (Pediatric) 15400 18480 21560 PSE008 Excision sacrococcygeal teratoma (Pediatric) 45640 54770 63900 PSE009 Exomphalos (Pediatric) 45640 54770 63900 PSF001 Foreign Body Removal From Wounds - Suberficial 5600 6720 7840 PSF002 Foreign Body removal from Wounds - Deep 11200 13440 15680 PSG001 Gastroschisis Repair (Pediatric) 45640 54770 63900 PSG002 Gastrostomy (Pediatric) 11200 13440 15680 PSH001 Haemangioma - A)Inj. Of Sclero 2800 3360 3920 PSH002 Haemangioma - B) Excision - Large 23940 28730 33520 PSH003 Haemangioma - B) Excision - Small 11200 13440 15680 PSH004 Haemangioma B) Excision - Medium 17500 21000 24500 PSH005 Hand Surgery Extra Digit Excision 11200 13440 15680 PSH006 Hemi-Nephroureterectomy (Pediatric) 25200 30240 35280 PSH007 Hernia Epigastric (Pediatric) 14000 16800 19600 PSH008 hernia Inguinal Bilateral (Pediatric) 21000 25200 29400 PSH009 Hernia Inguinal unilateral (Pediatric) 14000 16800 19600 PSH010 Hernia umbilical (Pediatric) 14000 16800 19600 PSH011 Hypospadias : Chordee Correction (1st Stage) 16800 20160 23520 PSH012 Hypospadias : Reconstruction Urethra (2nd Stage) 21000 25200 29400 PSI001 Incisional Hernia Repair 26600 31920 37240 PSI002 Injection Keloid - Large 1260 1520 1770 PSI003 Injection Keloid - Small 560 680 790 PSI004 Intussusception reduction (Pediatric) 45640 54770 63900 PSL001 Lacerated Wound With Skin Graft - Large 13300 15960 18620 PSL002 Lacerated Wound With Skin Graft - Medium 9240 11090 12940 PSL003 Lacerated Wound With Skin Graft - Small 5600 6720 7840 PSL004 Lacerations- Extensive (Forehead,Cheeks,Eyelid & Chin) 19880 23860 27840 PSL005 Laparotomy (Pediatric) 19600 23520 27440 PSL006 Lipoma Excion - Small 7000 8400 9800 PSL007 Lipoma Excision - Large 16800 20160 23520 PSL008 Liver Hydatid (Pediatric) 30660 36800 42930 PSL009 Lymph Node Biopsy (Pediatric) 5600 6720 7840 PSM001 Malrotation of intestine (Pediatric) 25200 30240 35280 PSM002 Meatal Stenosis/Tongue Tie 6300 7560 8820 PSM003 Meatotomy (Pediatric) 8400 10080 11760 PSM004 Meatus Reconstruction Meatoplasty 16800 20160 23520 PSM005 Meckels Diverticulectomy (Pediatric) 21000 25200 29400 PSN001 Neonatal Intestinal Atresia (Pediatric) 35000 42000 49000 PSN002 Nephrectomy / Nephroureterectomy (Pediatric) 25200 30240 35280 PSN003 Nephrostomy open (Pediatric) 19600 23520 27440 PSN004 Nephrostomy percutaneous (Pediatric) 14000 16800 19600 PSO001 OAE 420 510 590 PSO002 Orchidopexy bilateral (Pediatric) 21000 25200 29400
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273 78581/2020/ESTT-NE_HRPSO003 Orchidopexy unilateral (Pediatric) 14000 16800 19600 PSO004 Ovarian cystectomy (Pediatric) 19600 23520 27440 PSP001 Pulmonary hydatid (Pediatric) 30660 36800 42930 PSP002 Pyelolithotomy (Pediatric) 21700 26040 30380 PSP003 Pyeloplasty (Pediatric) 23800 28560 33320 PSP004 Pyloric stenosis (Pyloromyotomy) (Pediatric) 19600 23520 27440 PSP005 Port-Wine Stains-Excision And Repair-Small 9940 11930 13920 PSP006 Port-Wine Stains-Large 23940 28730 33520 PSP007 Posterior sagittal anorectoplasty (Pediatric) 30660 36800 42930 PSP008 Prepucial adhesions reduction 4200 5040 5880 PSR001 Rectal Polyp (Pediatric) 7140 8570 10000 PSR002 Resection & Anastamosis of intestine (Pediatric) 25200 30240 35280 PSR003 Revascularisation Of Digit(Per Digit) 33180 39820 46460 PSR004 Revascularisation Of Limb 33180 39820 46460 PSS001 Secondary Cleft Lip 16800 20160 23520 PSS002 Secondary Correction ( Lip) 16800 20160 23520 PSS003 Single Stage Reconstruction 19600 23520 27440 PSS004 Skin Grafting-Large (>20% Of Total Body Surface Area) 26600 31920 37240 Skin Grafting-Medium (8-20% Of Total Body Surface PSS005 Area) 18620 22350 26070 PSS006 Skin Grafting-Small(<8% Of Total Body Surface Area) 9240 11090 12940 PSS007 Spina bifida Repair (Large) (Pediatric) 30800 36960 43120 PSS008 Spina bifida Repair (Small) (Pediatric) 22400 26880 31360 PSS009 Splenectomy (Pediatric) 30660 36800 42930 PSS010 Suprapubic Cystostomy (Pediatric) 11200 13440 15680 PSS011 Surgical Toilet - Small 2660 3200 3730 PSS012 Surgical Toilet-Large 9240 11090 12940 PSS013 Surgical Toilet-Medium 5880 7060 8240 PSS014 Suture-Medium Lacerations 2660 3200 3730 PSS015 Suture-Small Lacerations/Minor Wounds 1680 2020 2360 PSS016 Syndactly-Multiple 11900 14280 16660 PSS017 Syndactly-Single 14000 16800 19600 PSS018 Syndactyly release (Pediatric) 17080 20500 23920 PST001 Temporo-Mandibular Joint Ankylosis 26600 31920 37240 PST002 Tendon/Nerve Repair 14000 16800 19600 PST003 Thoracotomy & Cyst Excision (Pediatric) 21000 25200 29400 PST004 Thoracotomy & Decortication (Pediatric) 45640 54770 63900 PST005 Thoracotomy Lobectomy (Pediatric) 45640 54770 63900 PST006 Thoracotomy Pneumonectomy (Pediatric) 45640 54770 63900 PST007 Thyroglossal Cyst (Pediatric) 16800 20160 23520 PST008 Torsion Testis (Pediatric) Contratual Fexatca 16800 20160 23520 PST009 Torticollis release (Pediatric) 14000 16800 19600 PSU001 Ureteric Reimplantation - Bilateral (Pediatric) 25200 30240 35280 PSU002 Ureteric Reimplantation - Unilateral (Pediatric) 19600 23520 27440
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274 78581/2020/ESTT-NE_HRPSU003 Ureterostomy Bilateral (Pediatric) 19600 23520 27440 PSU004 Ureterostomy unilateral(Pediatric) 16800 20160 23520 PSU005 Urethral dilatation (Pediatric) 5600 6720 7840 PSU006 urethral Fistula Repair (Pediatric) 16800 20160 23520 PSU007 Urethroplasty second stage correction (Pediatric) 16800 20160 23520 PSU008 Urethroplasty single stage distal hypospadias (Pediatric) 19600 23520 27440 Urethroplasty single stage MID/ PROX hypospadias PSU009 (Pediatric) 21000 25200 29400 PSV001 Ventriculo-peritoneal shunt placement (Pediatric) 35000 42000 49000 PSV002 Vesicostomy (Pediatric) 12600 15120 17640 PSV003 Vac Application 7000 8400 9800 PSV004 Vac wound therapy large PO dressing 4480 5380 6280 PSW001 Wound Debridement-Large 9240 11090 12940 PSW002 Wound Debridement-Medium 5880 7060 8240 PSW003 Wound Debridement-Small 2660 3200 3730 PSZ001 Z-Plasty-Large 13300 15960 18620 PSZ002 Z-Plasty-Medium 8540 10250 11960 PSZ003 Z-Plasty-Small 3920 4710 5490
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275 78581/2020/ESTT-NE_HR
PLASTIC SURGERY
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276 78581/2020/ESTT-NE_HR Semi Code Description Ward Pvt Pvt PLA001 ABBE Flap 21000 25200 29400 PLA002 Abdominoplasty+Liposuction (one region) 56000 67200 78400 PLA003 Abdominoplasty-Full 39200 47040 54880 PLA004 Abdominoplasty-Mini with Liposuction 33600 40320 47040 PLA005 Abdominoplasty-Mini with only Skin incision 25200 30240 35280 PLA006 Abdominoplasty-Small 29400 35280 41160 PLA007 Aesthetic Improvement of penis After Hypospadias (After Injury) 14000 16800 19600 PLA008 Alar Adjusment 14000 16800 19600 PLA009 Arch Bar Removal 2520 3030 3530 PLA010 Arch Bar Wiring (IMF) 6720 8070 9410 PLA011 Arma (Brachioplasty) (O.P.) 36400 43680 50960 PLA012 Arthrodesis of Joints (JR) (fuse of joints) 14000 16800 19600 PLA013 Arthrodesis of Joints (JR) (fuse of joints) 14000 16800 19600 PLA014 A-V Fistula Creation (Plastic Surgery) 17080 20500 23920 PLA015 A-V Malformation 28000 33600 39200 PLA016 Axillary Clearance 17420 20900 24390 PLB001 Blephroplasty-Upper and Lower 39510 47410 55320 PLB002 Bone Plating ( per fracture in Hand Bones) 9800 11760 13720 PLB003 Bony Fixation ( per fracture ) 9100 10920 12740 PLB004 Brachial Plexus - Exploration & Nerve Repair (JR) 49000 58800 68600 PLB005 Brachial Plexus - Exploration & Nerve Transfer (JR) 70000 84000 98000 PLB006 Breast Conserving Excision with axillary dissection 34300 41160 48020 PLB007 Breast Expender /Implant Reconstruction-EACH STAGE 21000 25200 29400 PLB008 Breast Reconstruction with implant 28000 33600 39200 PLB009 Browlift Through Upper Eyelid ( when done with Bleph) 25200 30240 35280 PLB010 Buccal Fat Pad Removal 23800 28560 33320 PLB011 BURN DRESSING IN OT (LARGE FOR MORE THAN 30% 8400 10080 11760 PLB012 BURN DRESSING IN OT (MEDIUM LESS MORE THAN 30% 5600 6720 7840 PLB013 BURN DRESSING IN OT (SMALL) 2800 3360 3920 PLB014 BURN DRESSING IN WARD (LARGE FOR MORE THAN 30%) 5600 6720 7840 PLB015 BURN DRESSING IN WARD (MEDIUM LESS THAN 30% 3500 4200 4900 PLB016 BURN DRESSING IN WARD (SMALL) 2100 2520 2940 PLB017 Burn escharotomy or fasciotomy - each 2240 2690 3140 PLB018 Burn Grafting Extensive 39200 47040 54880 PLB019 Burn Grafting Large 23800 28560 33320 PLB020 Burn Grafting Medium 18900 22680 26460 PLB021 Burn Grafting Small 11200 13440 15680 PLB022 Burn under GA dressing change 10500 12600 14700 PLB023 Buttock Lift 35000 42000 49000 PLC001 Canthopexy w/Orbicularis Suspension 33600 40320 47040 PLC002 Carcinoma Cheek Excision & Reconstruction 35000 42000 49000
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277 78581/2020/ESTT-NE_HRPLC003 Carpal Tunnel Syndrome 11200 13440 15680 PLC004 Cartilage Graft to Ear (UL) 21000 25200 29400 PLC005 Center BodyLift 84700 101640 118580 PLC006 Cheek Implant (Both Cheeks) 35000 42000 49000 PLC007 Cheek Implant(Per Side) 19600 23520 27440 PLC008 Chin Implant/Chin Augmentation 25200 30240 35280 PLC009 Circumferential Thigh 36400 43680 50960 PLC010 Circumferential Thigh and Buttock 49000 58800 68600 PLC011 CLEFT LIP plus CLEFT PALATE 25200 30240 35280 PLC012 Cleft Lip repair - bilateral ( Complete or Incomplete) 19600 23520 27440 PLC013 Cleft Lip repair - unilateral ( Complete or Incomplete) 19600 23520 27440 PLC014 Cleft Lip revision / SECONDARY CLEFT LIP REVISION (PLASTIC) 21000 25200 29400 PLC015 CLEFT PALATE (COMPLETE) 19600 23520 27440 PLC016 CLEFT PALATE (SOFT PALATE) 19600 23520 27440 PLC017 CLEFT PALATE FISTULA 22400 26880 31360 PLC018 Cleft Palate Repair 19600 23520 27440 PLC019 Close reduction of finger / hand fracture -fracture 5880 7060 8240 PLC020 Close reduction with K wire fixation hand fracture - per fracture 8680 10420 12160 PLC021 COMPLEX FINGER INJURY ( SINGLE ) 11200 13440 15680 PLC022 Composite Graft 22400 26880 31360 PLC023 Contracture - One Finger/Toe/Minor (JR) 8400 10080 11760 PLC024 Contracture Release Mild / Small 11200 13440 15680 PLC025 Contracture Release Moderate / Medium 19600 23520 27440 PLC026 Contracture Release Multiple Fingers/Extensive 21000 25200 29400 PLC027 Contracture Release Severe / Large 22400 26880 31360 PLC028 Coronal(open)Forehead and Browlift 33600 40320 47040 PLC029 Cosmetic Rhinoplasty 39200 47040 54880 PLC030 Cranial Bone Graftiing 25200 30240 35280 PLC031 LONG HAND RECONSTRUCTION(SIMPLE) 21000 25200 29400 PLC032 LONG HAND RECONSTRUCTION(COMPLEX) 35000 42000 49000 PLD001 Debridement-Extensive 12600 15120 17640 PLD002 Debridement-Large 9800 11760 13720 PLD003 Debridement-small 8400 10080 11760 PLD004 Debridement-Superficial 8400 10080 11760 PLD005 Dermabrasion rerioral , Periorbital or lip-small region 20300 24360 28420 PLD006 Dermabrasion-Part Face 23800 28560 33320 PLD007 Dermabrasopm Total Face 32200 38640 45080 PLD008 Desloughing - large 8400 10080 11760 PLD009 Desloughing - medium 5600 6720 7840 PLD010 Desloughing - small 2520 3030 3530 PLD011 Dressing Change - Large 1680 2020 2360 PLD012 Dressing Change - medium 1190 1430 1670 PLD013 Dressing Change - Small 980 1180 1380 PLD014 Dressing Change - X-Large 2520 3030 3530
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278 78581/2020/ESTT-NE_HRPLD015 DRESSING CHARGES BURNS MAJOR ( 10% TO 30%) (PLASTIC) 2100 2520 2940 PLD016 DRESSING CHARGES BURNS MAJOR ( 30% ABOVE) (PLASTIC) 2800 3360 3920 PLD017 DRESSING CHARGES BURNS MAJOR ( 5% TO 10%) (PLASTIC) 2100 2520 2940 PLD018 DRESSING CHARGES BURNS MAJOR ( UPTO 5%) (PLASTIC) 700 840 980 PLD019 Dressing in OT Large 7000 8400 9800 PLD020 Dressing in OT Medium 4200 5040 5880 PLD021 Dressing in OT Small 2520 3030 3530 PLD022 Dressing in OT X-Large 8400 10080 11760 PLD023 Dressing in Ward - X-Large 5180 6220 7260 PLD024 Dressing in Ward - Large 2520 3030 3530 PLD025 Dressing in Ward - Medium 1680 2020 2360 PLD026 Dressing in Ward - Small 1540 1850 2160 PLD027 Duptryens Contracture release per hand 16800 20160 23520 PLE001 ECTOPIC BLADDER RECONSTRUCTION 28000 33600 39200 PLE002 ECTROPION (BOTH) 19600 23520 27440 PLE003 ELEPHANTIASIS LIMB 28000 33600 39200 PLE004 ELEPHANTIASIS SCROTUM (PLASTIC) 21000 25200 29400 PLE005 Endoscopic Brow lift 33600 40320 47040 PLE006 Endoscopic Forhead Lift (O.P) 33600 40320 47040 PLE007 Epicanthus-both eyes 23800 28560 33320 PLE008 Epicanthus-one eye 12600 15120 17640 PLE009 EPISPADIAS (Urethra reconstruc) 14000 16800 19600 PLE010 Epispadias Genitalia Reconstruction 22400 26880 31360 PLE011 Reconstruction 35000 42000 49000 PLE012 Eversion of inverted nipples 17500 21000 24500 PLE013 Excision of Benign Lesion-1 / small 3780 4540 5300 PLE014 Excision of Benign Lesions-2 or 3 / one medium 7840 9410 10980 PLE015 Excision of Benign Lesions-4 to 6 /one large 11200 13440 15680 PLE016 extra large 14560 17480 20390 PLE017 EXCISION OF MOLE/CYST ( LARGE) 14000 16800 19600 PLE018 EXCISION OF MOLE/CYST ( MEDIUM) 12600 15120 17640 PLE019 EXCISION OF MOLE/CYST ( SMALL) 6300 7560 8820 PLE020 Excision of pharyngeal pouch & cricopharyngeal Myotomy 14000 16800 19600 PLE021 Expander Removal & Contouring Multiple 25200 30240 35280 PLE022 Expander Removal & Contouring Single 21000 25200 29400 PLE023 Extracrnial Osteotomy 39200 47040 54880 PLE024 EXTROPHY OF BLADDER ( CLOSURE) 18200 21840 25480 PLE025 Eye Bags 21000 25200 29400 PLE026 Eyebrow of Eyelash Graft (JR) 14000 16800 19600 PLE027 EYELID WEDGE RESECTION & RECONSTRUCTION ( PLASTIC) 16800 20160 23520 PLE028 EYELID RECONSTRUCTION TOTAL ( PLASTIC SURG) 28000 33600 39200 PLE029 EYELID RECONSTRUCTION PARTIAL ( PLASTIC SURG) 16800 20160 23520 PLE030 ENDOSCOPIC CYST REMOVAL 21000 25200 29400 PLF001 Face Lift SMAS ( Superficial Musculoaponeurotic System 38500 46200 53900
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279 78581/2020/ESTT-NE_HRPLF002 Face Lift-Lower Facelift 34300 41160 48020 PLF003 Face Lift-Mid Face Lift 34300 41160 48020 PLF004 FACIAL BONES FRONTAL BONE FRACTURE BILATERAL 16100 19320 22540 PLF005 FACIAL BONES FRONTAL BONE FRACTURE UNILATERAL 16100 19320 22540 PLF006 FACIAL BONES MANDIBILE FRACTURE OPEN REDUCTION (ORIF) 21000 25200 29400 FACIAL BONES MANDIBILE FRACTURE CLOSED REDUCTION ( PLASTIC PLF007 ) 14000 16800 19600 PLF008 FACIAL BONES MAXILLARY FRACTURE CLOSED REDUCTION 14000 16800 19600 PLF009 Facial Paralysis - Facial Nerve Repair 21000 25200 29400 PLF010 Facial Paralysis - cross Facial Nerve Graft 28000 33600 39200 PLF011 Facial Paralysis - facial Sling 28000 33600 39200 PLF012 Facial Paralysis - Functional Free Muscle Transfer 36400 43680 50960 PLF013 FACIAL PARALYSIS- MUSCLE FLAP 28000 33600 39200 PLF014 FACIAL PARALYSIS- NEUROTIZATION 22400 26880 31360 PLF015 FACIAL PARALYSIS SKIN CORRECTION ( PLASTIC ) 22400 26880 31360 PLF016 Facioculaneous Flap (LARGE) 26600 31920 37240 PLF017 FASCIOUTANEOUS FLAPS ( Medium) 22400 26880 31360 PLF018 FASCIOUTANEOUS FLAPS ( Small) 16800 20160 23520 PLF020 Finger tip injury - flap 21000 25200 29400 PLF021 Finger tip injury - graft 11200 13440 15680 PLF022 Flap Detachment & Final Inset 8400 10080 11760 PLF023 FLAP DETACHMENT/ DELAY / INSETTING 8400 10080 11760 PLF024 Flap Reconstruction 42000 50400 58800 PLF025 Forehead Reduction 22400 26880 31360 PLF026 Foreign body- Complex or Very Deep 12740 15290 17840 PLF027 Foreign Body removal from Wounds - Superficial 2800 3360 3920 PLF028 Full Thickness Graft - ( LARGE AREA ) 23800 28560 33320 PLF029 FULL THICKNESS SKIN GRAFT ( MEDIUM AREA ) 14000 16800 19600 PLF030 FULL THICKNESS SKIN GRAFT ( SMALL AREA ) (PLASTIC SURG) 9100 10920 12740 PLF031 FULL THICKNESS SKIN GRAFT ( SMALL AREA ) (PLASTIC SURG) 9100 10920 12740 PLF032 FULL THICKNESS SKIN GRAFT ( VERY LARGE AREA- HALF FACE) 33600 40320 47040 PLF033 Free fibula Reconstruction 63000 75600 88200 PLF034 FREE RADICAL FOREARM FLAP 49000 58800 68600 PLF035 FREE LD FLAP 49000 58800 68600 PLF036 Free ALT flap 49000 58800 68600 PLG001 Gynecomastia (excision and liposuction) Male Breast reduction 35000 42000 49000 PLG002 Gynecomastia (excision and liposuction)-Small 28000 33600 39200 PLG003 Gynecomastia (Liposuction) 25200 30240 35280 PLH001 HAIR TRANSPLANT-LARGE ( PER SITTING ) 75600 90720 105840 PLH002 HAIR TRANSPLANT-MEDIUM ( PER SITTING ) 53200 63840 74480 PLH003 Hair Transplant-Quote is per hair graft 90 110 120 PLH004 HAIR TRANSPLANT-SMALL( PER SITTING ) 28000 33600 39200 PLH005 HAND SURGERY REPAIR & GRAFT 16800 20160 23520 PLH006 HEMANGIOMA ( EXCISION LARGE ) 21000 25200 29400
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280 78581/2020/ESTT-NE_HRPLH007 HEMANGIOMA ( EXCISION MEDIUM ) 15820 18990 22150 PLH008 HEMANGIOMA ( EXCISION SMALL ) 12600 15120 17640 PLH009 HEMANGIOMA ( EXTENSIVE ) 28000 33600 39200 PLH010 HEMANGIOMA ( INJECTION SCRELOSING ) 2800 3360 3920 PLH011 HERNIA INCISIONAL ( PLASTIC ) 25200 30240 35280 PLH012 HYPOSPADIAS CHORDEE CORRECTION -( 1ST STAGE) 8820 10590 12350 PLH013 HYPOSPADIAS FISTULA CLOSURE 14000 16800 19600 PLH014 HYPOSPADIAS RECONSTRUCTION URETHRA (2 ND STAGE ) 16800 20160 23520 PLH015 HYPOSPADIAS SINGLE STAGE RECONSTRUCTION 21000 25200 29400 PLI001 ILIAC CREST BONE GRAFTING 14000 16800 19600 PLI002 INSETTING 12600 15120 17640 PLI003 Inter Maxillary Fixation 12600 15120 17640 PLK001 Keloid Injection - Large (multiple) 5180 6220 7260 PLK002 Keloid Injection - Large (single) 1260 1520 1770 PLK003 Keloid Injection - Small (multiple) 2800 3360 3920 PLK004 Keloid Injection - Small (single) 630 760 890 PLL001 LACERATED WOUND FINGER SINGLE ( PLASTIC )Very Small or simple 6300 7560 8820 PLL002 Laceration-Large 16800 20160 23520 PLL003 Laceration-Multiple 22400 26880 31360 PLL004 Laceration-Small 10360 12440 14510 LARGE MULTIPLE WOUNDS FACE SKINDEFFCT WITH FLAP( PLASTIC PLL005 SURG ) 23800 28560 33320 PLL006 Lip Reduction 15400 18480 21560 PLL007 Lip Rejuvenation 23800 28560 33320 PLL008 Lipoinjection - Major (JR) fat transplant 12600 15120 17640 PLL009 Lipoinjection - Minor (JR) fat transplant 7420 8910 10390 PLL010 Lipoma - Large 17500 21000 24500 PLL011 Lipoma - Medium 9800 11760 13720 PLL012 Lipoma - Small 14000 16800 19600 PLL013 Lipoma - X-Small 5600 6720 7840 PLL014 Liposculpture 2-3 Small region 23800 28560 33320 PLL015 Liposculpture Full Face 30800 36960 43120 PLL016 Liposculpture Small Region 14700 17640 20580 PLL017 LIPOSUCTION limited( MEDIUM) (PLASTIC SURG ) 14000 16800 19600 PLL018 LIPOSUCTION limited ( SMALL) ( PLASTIC SURG ) 11200 13440 15680 PLL019 Liposuction One region 24500 29400 34300 PLL020 liposuction Two Region 36400 43680 50960 PLL021 Liposuction-Three Region 49000 58800 68600 PLL022 Local Flap 14280 17140 20000 PLL023 Lower Blepheroplasty - bilateral 21000 25200 29400 PLL024 Lower Blepheroplasty with excessive heriated fat pad -bilateral 24500 29400 34300 PLL025 LUMP TUMOUR EXCISION WITH COVER (MEDIUM) 11270 13530 15780 PLL026 LUMP TUMOUR EXCISION WITH COVER(Large) 17500 21000 24500 PLL027 LUMP/ TUMOR EXCISION WITH COVER (SMALL) 8400 10080 11760
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281 78581/2020/ESTT-NE_HRPLL028 LYMPHATICOVENOUS SHUNT 11900 14280 16660 PLM001 MAJOR HAND INJURY 21000 25200 29400 PLM002 Major Revision (Nassal Tip and Osteotomies) 32200 38640 45080 PLM003 MAIL SEX TO FEMAIL SEX (ONLY VAGINAL PORTION) ( PLASTIC SURG) 49000 58800 68600 PLM004 Mammoplasty Augmentation ( with implantI )-BOTH 28000 33600 39200 PLM005 Mammoplasty Augmentation ( with implantI )-SINGLE 17500 21000 24500 PLM006 MANDIBLE RECONSTRUCTION BT PLATE 29400 35280 41160 PLM007 MANDIBLE RECONSTRUCTION BY BONE FLAP 46200 55440 64680 PLM008 MANDIBLE RECONSTRUCTION BY BONE GRAFT 35000 42000 49000 PLM009 Mandibular Osteotomy 39200 47040 54880 PLM010 Mastopexy 28700 34440 40180 PLM011 Mazillary Osteotomy 39200 47040 54880 PLM012 Microneural Repair 21000 25200 29400 PLM013 MICROTIA FIRST STAGE (PLASTIC SURG) 25900 31080 36260 PLM014 MICROTIA SECOND STAGE (PLASTIC SURG) 22400 26880 31360 PLM015 MICROTIA THIRD STAGE (PLASTIC SURG) 22400 26880 31360 PLM016 MICROTIA TOUCH UP SURGERY ( PLASTIC SURGERY) 11200 13440 15680 PLM017 MICROVASCULAR FREE FLAP (PLASTIC SURG) 49000 58800 68600 PLM018 MICROVASCULAR REPAIR (PLASTIC SURG) 28000 33600 39200 PLM019 MICROVASCULAR REPAIR (PLASTIC) 21280 25540 29800 PLM020 Modified Redical Mastectomy with Axillary clearance 43400 52080 60760 PLM021 Modified Radical Mastectomy(per side) 35000 42000 49000 PLM022 Myocutaneous Flap 28000 33600 39200 PLM023 MYOCUTANEOUS FLAP (LARGE) 22400 26880 31360 PLM024 MYOCUTANEOUS FLAPS ( SMALL) 18200 21840 25480 PLM025 Micro Needling RF 17250 20700 24150 PLN001 NAIL BED INJURY-MULTIPLE 14000 16800 19600 PLN002 NAIL BED INJURY-ONE FINGER 11200 13440 15680 Nasal Bone - Closed Reduction / FACIAL BONES-CLOSE FRACTURE PLN003 NOSE 11900 14280 16660 Nasal Bone - Open Reduction / FACIAL BONES-COMPOUND PLN004 FRACTURE NOSE 20300 24360 28420 PLN005 NASAL DEFORMITY WITH CLEFT LIP 22400 26880 31360 PLN006 Nasal Pack Removal 3080 3700 4320 PLN007 Necklift (extensive) when done wth fullSMAS Facelift 67200 80640 94080 PLN008 Necklift (extensive) without facelift 35000 42000 49000 PLN009 Nerve Graf Major (JR) 26600 31920 37240 PLN010 Nerve Graft Minor (JR) 23800 28560 33320 PLN011 Neurovascular Flap 26600 31920 37240 PLN012 Nipple correction per side 13860 16640 19410 PLN013 Nipple reduction 13860 16640 19410 PLN014 NAIL BED REPAIR 18200 21840 25480 PLO001 Open Capsulectomy per side 17500 21000 24500 Orbito Zygomatic Complex /FACIAL BONES MAXILLARY FRACTURE/ PLO002 ORBITAL FLOOR FRACTURE(ORIF) 22400 26880 31360 177| T a r i f f - AIMS
282 78581/2020/ESTT-NE_HRPLO003 Otoplasty-Protruding Ear ( both ear)/Bat ear correction 32200 38640 45080 PLO004 Otoplasty-Protruding Ear ( per ear)/Bat ear correction 19600 23520 27440 PLO005 Open Red Maxilla with Plating Major(R) 28000 33600 39200 PLO006 Open Red Maxilla with Plating Major(L) 28000 33600 39200 PLO007 Open Red Zygomatic Bone Complex with Plating(L) 21000 25200 29400 PLO008 OPPONENSPLASTY 35000 42000 49000 PLP001 Palate Fistula Closure 22400 26880 31360 PLP002 Pan Facial #s / COMPLEX FACIAL FRACTURE 38500 46200 53900 PLP003 panniculectomy-large 56000 67200 78400 PLP004 PENIL CURVATURE CORRECTION 51800 62160 72520 PLP005 PENIL EVULSION 21000 25200 29400 PLP006 PENIL RECONSTRUCTION WITH FLAP 56000 67200 78400 PLP007 PENIL SURGERY ( ERECTILE DYSFUNCTION-INFLATABLE ) 30800 36960 43120 PENIL SURGERY ( ERECTILE DYSFUNCTION- MALLEABLE) (PLASTIC PLP008 SURG) 29400 35280 41160 PLP009 PERIPHERAL VESSEL REPAIR SINGLE 20300 24360 28420 PLP010 PERIPHERAL VESSEL REPAIR WITH VEIN GRAFT 23800 28560 33320 PLP011 Periprosthetic capsulectomy per side 17500 21000 24500 PLP012 Pharyngoplasty 28000 33600 39200 PLP013 PHIMOSIS (PLASTIC SURG) 4200 5040 5880 PLP014 Polliazation and Island Flaps 22400 26880 31360 PLP015 Polydactyly - Single extra digit 11200 13440 15680 PLP016 Polydactyly (Complex) (JR) 16800 20160 23520 PLP017 Post Burn Contracture - Complex 22400 26880 31360 PLP018 Post Burn Contracture - Simple 11200 13440 15680 PLP019 PREAURICULAR SINUS EXCISION (PLASTIC SURG) 14000 16800 19600 PLP020 PREAURICULAR SKIN TAG (PLASTIC SURG) 7700 9240 10780 PLP021 Pressure Sore Flap / Bed Sore Flap (JR) - per flap 28000 33600 39200 PLP022 PTOSIS (PLASTIC) - single 16800 20160 23520 PLP023 PTOSIS frontalis sling - single 21000 25200 29400 PLP024 PULLLEY RECONSTRUCTION (PLASTIC SURG) 22400 26880 31360 PLP025 PULP INJURY WITH FLAP COVER 11200 13440 15680 PLP026 PULP INJURY WITH GRAFT 11200 13440 15680 PLP027 PULP NAIL BED AND BONE INJURY 14000 16800 19600 PLR001 RECANALIZATION OF VAS (ONE) 21700 26040 30380 PLR002 RECANALIZATION OF VAS BOTH 35000 42000 49000 PLR003 RECONSTRUCTION RHINOPLASTY - Limited 22400 26880 31360 PLR004 RECONSTRUCTION RHINOPLASTY - Partial 14700 17640 20580 PLR005 Reconstructive Rhinoplasty - FULL/Extensive 35000 42000 49000 PLR006 Reduction Mammoplasty 35000 42000 49000 PLR007 Removal of Benign Breast Mass-Large/Complex 28000 33600 39200 PLR008 Removal of Benign Breast Mass-Medium 21000 25200 29400 PLR009 Removal of Benign Breast Mass-Small 14000 16800 19600 PLR010 Removal of escharotomy (tangentil excision)-less than 8% 5600 6720 7840
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283 78581/2020/ESTT-NE_HRPLR011 Removal of escharotomy (tangentil excision)-8% - 20% 14000 16800 19600 PLR012 Removal of escharotomy (tangentil excision) greater than 20% 22400 26880 31360 PLR013 Removal of implant material per side 22400 26880 31360 PLR014 Removal of intact implant per side 21000 25200 29400 PLR015 REPLANTATION HAND (PLASTIC SURG) 42000 50400 58800 PLR016 REPLANTATION MULTIPLE FINGER (PLASTIC SURG) 49000 58800 68600 PLR017 REPLANTATION ONE FINGER (PLASTIC SURG) 35000 42000 49000 PLR018 REPLANTATION OTHER PARTS (PLASTIC SURG) 42000 50400 58800 PLR019 REPLANTATION SCALP (PLASTIC SURG) 49000 58800 68600 PLR020 Reduction Mammoplasty Bilateral 56000 67200 78400 PLS001 SAL head & neck 26600 31920 37240 PLS002 SAL Neck 28000 33600 39200 PLS003 Scar Revision Cosmetic - Large 21000 25200 29400 PLS004 Scar Revision Cosmetic - Medium 16800 20160 23520 PLS005 Scar Revision Cosmetic -Extra Large/Multiple 28000 33600 39200 PLS006 Scar Revision Cosmetic - Small 11200 13440 15680 PLS007 Secondary revision cleft lip nasal deformity 24500 29400 34300 PLS008 Secondary Rhinoplasty Minor Revision 24500 29400 34300 PLS009 Segmental Mastctomy with axillary clearacne 35000 42000 49000 PLS010 Septoplasty or Submucous Resection 24500 29400 34300 PLS011 Simple Scars - large 8400 10080 11760 PLS012 Simple Scars - medium 7000 8400 9800 PLS013 Simple mastectomy 35000 42000 49000 PLS014 Simple Scar-Extra Large 11900 14280 16660 PLS015 simple Scars - small 4620 5550 6470 PLS016 SPINE BIFIDA 21000 25200 29400 PLS017 Split ear lobule-One 5600 6720 7840 PLS018 Split ear lobule-Two 10500 12600 14700 PLS019 Subcranial Surgery 42000 50400 58800 PLS020 Submental Fat Pad removal 16800 20160 23520 PLS021 Surgical Toilet - Large 8400 10080 11760 PLS022 Surgical Toilet -Medium 5600 6720 7840 PLS023 Surgical Toilet -Small 2450 2940 3430 PLS024 Suture Removal - extra large 2800 3360 3920 PLS025 Suture Removal - lg 2100 2520 2940 PLS026 Suture Removal - medium 1400 1680 1960 PLS027 Suture Removal - sm 980 1180 1380 PLS028 Syndactly- SINGLE 11200 13440 15680 PLS029 Syndactyly - Complex (JR) 21000 25200 29400 PLT001 T.M.Joint Arthroplasty 35000 42000 49000 PLT002 T.M.Joint Release (Bilateral) 28000 33600 39200 PLT003 TENDON / NERVE REPAIR 16800 20160 23520 PLT004 TENDON GRAFT 23800 28560 33320 PLT005 TENDON GRAFTING WITH PROSTHESIS 16100 19320 22540
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284 78581/2020/ESTT-NE_HRPLT006 Tendon injury repair-EACH 18200 21840 25480 PLT007 Thigh Lift (medial or lateral) 35000 42000 49000 PLT008 Thigh lift+Buttock Lift 63000 75600 88200 PLT009 Thread Face Lift 23800 28560 33320 PLT010 Tip Rhinoplasty 24500 29400 34300 PLT011 TISSUE EXPANDER INSERTION - Single 15400 18480 21560 PLT012 TISSUE EXPANDER INSUFFLATION (PER SITTING) (PLASTIC SURG) 4200 5040 5880 PLT013 Tongue Flap 18060 21680 25290 PLT014 Tongue Flap 1st Stage 17500 21000 24500 PLT015 Tongue Flap 2nd Stage 15400 18480 21560 PLT016 TONGUE TIE (PLASTIC SURG) 3840 4610 5380 PLT017 TORTICOLLIS (SINGLE) (PLASTIC SURG) 24500 29400 34300 PLT018 Total Lower Body Lift (in patient) 105000 126000 147000 PLT019 Transcranial Surgery 47600 57120 66640 PLT020 TRAUMATIC EAR PARTIAL LOSS 21000 25200 29400 PLT021 TRAUMATIC EAR TOTAL LOSS 28000 33600 39200 PLT022 TUBOPLASTY 21000 25200 29400 PLT023 Tuck fatty skin in pubic area 23800 28560 33320 PLT024 TENDON REPAIR HAND 21000 25200 29400 PLT025 TENDON TRANSFER(SINGLE NERVE) 28000 33600 39200 PLT026 TENDON TRANSFER(MULTIPLE NERVE) 42000 50400 58800 PLT027 TOE TRANSFER 98000 117600 137200 PLU001 Under Chin/Submental Fat Pad Liposuction 17500 21000 24500 PLU002 Upper Blepheroplasty with excessive heriated fat pad - bilateral 25200 30240 35280 PLU003 Upper Blephroplasty - bilateral 21000 25200 29400 PLU004 Upper Body Lift 63000 75600 88200 PLV001 Vaginoplasty 28000 33600 39200 PLV002 Varicose Vein Stripping-major 28700 34440 40180 PLV003 Varocose Vein Stripping-Minor 25200 30240 35280 PLV004 VASCULAR PEDICLE LIGATION 6300 7560 8820 PLV005 Vermilion Adjustment, Z plasty of Lip 11900 14280 16660 Vaccum assisted closure per session WOUND COVER WITH SPLIT PLV006 THICKNESS SKIN 8400 10080 11760 WOUND COVER WITH SPLIT THICKNESS SKIN GRAFT (OTHER THAN PLW001 BURN) - MEDIUM 14700 17640 20580 WOUND COVER WITH SPLIT THICKNESS SKIN GRAFT (OTHER THAN PLW002 BURN) - SMALL 9100 10920 12740 WOUND COVER WITH SPUT THICKNESS SKIN GRAFT (OTHER THAN PLW003 BURN) - LARGE 21700 26040 30380 PLZ001 Z-Plasty Large 25200 30240 35280 PLZ002 Z-Plasty Medium 15400 18480 21560 PLZ003 Z-Plasty- Multiple or Extra large 29400 35280 41160 PLZ004 Z-Plasty Small 9800 11760 13720 PLB024 B/L BREAST DEBULKING –GRADE I 45000 54000 63000 PLC033 CHIN IMPLANT 22000 26400 30800
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285 78581/2020/ESTT-NE_HRPLC034 COMPLEX HAND INJURIES GRADE-3 37000 44400 51800 PLC035 COMPLEX HAND INJURIES GRADE-2 27000 32400 37800 PLC036 COMPLEX HAND INJURIES GRADE 1 25000 30000 35000 PLC037 COMPLEX FACIAL INJURIES GRADE 3 50000 60000 70000 PLC038 COMPLEX FACIAL INJURIES GRADE 2 45000 54000 63000 PLF037 FILLER INJ.(PER SYRINGE) 10000 12000 14000 PLI004 INJ.BOTOX(1/3 FACE) 20000 24000 28000 PLI005 INJ.BOTOX(2/3 FACE) 30000 36000 42000 PLI006 INJ.BOTOX(FULL FACE) 40000 48000 56000 PLI007 INJ.BOTOX(OTHER THAN FACE) 15000 18000 21000 PLJ001 JAW CONTOURING 25000 30000 35000 PLL029 LASER RESURFACING GRADE 1 10000 12000 14000 PLL030 LASER RESURFACING GRADE 2 20000 24000 28000 PLL031 LASER RESURFACING GRADE 3 30000 36000 42000 PLM026 MAXILLARY GROWTH EXCISION AND RECONTOURING 45000 54000 63000 PLV007 VASER LIPO SUCTION GRADE I 14290 17150 20010 PLV008 VASER LIPO SUCTION GRADE II 20000 24000 28000 PLV009 VASER LIPO SUCTION GRADE III 28580 34290 40000 PLV010 VASER LIPO SUCTION GRADE IV 35720 42860 50000 PLV011 VASER LIPO SUCTION GRADE V 42860 51430 60000 PLV012 VASER LIPO SUCTION GRADE VI 57150 68580 80010 PLV013 VASER LIPO SUCTION GRADE VII 64290 77150 90010 PLV014 VASER LIPO SUCTION GRADE II (A) 22860 27430 32000
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286 78581/2020/ESTT-NE_HR
NEURO SURGERY
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287 78581/2020/ESTT-NE_HR Code Description Ward Semi Pvt Pvt NSA001 ANTERIOR CERVICAL DYSTECTOMY AND FUSION 42000 50400 58800 NSB001 Brachial plexus surgery 70000 84000 98000 NSB002 Burrhole evacuation 25200 30240 35280 NSB003 BONE FLAP REPLACEMENT 21000 25200 29400 NSC001 Carpel tunnel syndrome 21000 25200 29400 NSC002 Cervical disc replacement 56000 67200 78400 NSC003 Cervical laminectomy 35000 42000 49000 NSC004 Cervical Microdiscectomy 56000 67200 78400 NSC005 Cervical plating 35000 42000 49000 NSC006 Combined anterior and posterior spinal surgery 70000 84000 98000 NSC007 Combined cranial and transnasal procedure 70000 84000 98000 NSC008 Cranioplasty 35000 42000 49000 NSC009 Craniotomy and decompression of hypertensive bleed 56000 67200 78400 Craniotomy and decompression of supratentorial NSC010 tumors 35000 42000 49000 Craniotomy and decompression of traumatic NSC011 hematoma 35000 42000 49000 NSC012 Craniotomy and evacuation of Intracranial hematoma 42000 50400 58800 NSC013 Craniotomy for ACF repair 56000 67200 78400 NSC014 Craniotomy for aneurysm/AVM 56000 67200 78400 NSC015 Craniotomy for brain abscess 42000 50400 58800 NSC016 Craniotomy for brain tumour 49000 58800 68600 NSC017 Craniotomy for complex aneurysm 63000 75600 88200 NSC018 Craniotomy for complex Tumor 70000 84000 98000 NSC019 Craniotomy for CP Angle SOL 56000 67200 78400 NSC020 Craniotomy for evacuation of extradural Hematoma 42000 50400 58800 NSC021 Craniotomy for Pineal Region SOL 70000 84000 98000 NSC022 Craniotomy for Posterior fossa SOL 56000 67200 78400 NSC023 Craniotomy for skull base tumors 70000 84000 98000 NSC024 Craniotomy for SOL 42000 50400 58800 NSC025 Craniotomy for supratentorial tumors 56000 67200 78400 NSC026 Craniotomy for trauma 49000 58800 68600 NSC027 Craniotomy for trauma exploration 28000 33600 39200 NSC028 CSF Diversionary procedure 28000 33600 39200 NSC029 CVJ Decompression 42000 50400 58800 NSC031 CRANIOPLASTY FOR ICH 35000 42000 49000 NSD001 Decompressive craniectomy 28000 33600 39200 NSD003 DIASTOMATOMYELIA 56000 67200 78400 NSD004 Deep brain stimulation 161000 193200 225400 NSE001 Endoscopic discectomy 63000 75600 88200 NSE002 Endoscopic third ventriculostomy 56000 67200 78400 NSE003 Excision of Scalp swelling 14000 16800 19600 NSE004 Excision of Sebacous Cyst 11200 13440 15680 183| T a r i f f - AIMS
288 78581/2020/ESTT-NE_HRNSF001 Foramen magnum decompression and duraplasty 56000 67200 78400 NSI001 Intra Coronal Chemical Angioplasty 63000 75600 88200 NSI002 Intra Arterial Thrombolysis 35000 42000 49000 NSI003 Intraspinal drug pump insertion 80500 96600 112700 NSK001 KYPHOPLASTY 42000 50400 58800 NSL001 Laminoplasty 56000 67200 78400 NSL002 lumbar microdiscectomy 56000 67200 78400 NSL003 Lumber drain 4200 5040 5880 NSL004 LOW LINE TETHERED CORD 35000 42000 49000 NSM001 Micro Surgery for CSF rhinnorhoea 63000 75600 88200 NSM002 MVD 56000 67200 78400 NSM003 MENINGOMYELOCELE 35000 42000 49000 NSM004 Median nerve decompression 12880 15460 18040 NSP001 Percutaneous vertebral biopsy 14000 16800 19600 NSP002 Peripheral nerve surgery 42000 50400 58800 NSP003 Posterior Spinal stabilization with pedicle screws 56000 67200 78400 NSP004 POSTERIOR CERVICAL INSTRUMENTATION 42000 50400 58800 NSR001 Re exploration craniotomy 35000 42000 49000 NSR002 Re-exploration craniotomy 35000 42000 49000 NSR003 Revision surgery for operated spine 63000 75600 88200 NSS001 Scalp evulsion suturing 4900 5880 6860 NSS002 Scalp laceration suturing large 2800 3360 3920 NSS003 Scalp laceration suturing medium 2100 2520 2940 NSS004 Scalp laceration suturing small 1400 1680 1960 NSS005 Shunt revision 14000 16800 19600 NSS006 Skull traction 4200 5040 5880 NSS007 Spinal dysraphism 42000 50400 58800 NSS008 Spinal instrumentation 70000 84000 98000 NSS009 Spinal tumour 49000 58800 68600 NSS010 Stereotactic surgery 56000 67200 78400 NSS011 Surgery for Cervical spine trauma 42000 50400 58800 NSS012 Surgery for chronic SDH 42000 50400 58800 NSS013 Surgery for PIVD/ Decompressive laminectomy 42000 50400 58800 NSS014 Surgery for spinal trauma/stabilization 56000 67200 78400 NSS015 SPINA BIFIDA 35000 42000 49000 NSS016 SPINAL INTRAMEDULLARY TUMOR 56000 67200 78400 NSS017 SURGERY FOR LOBECTOMY(FRONTALTEMPORAL) 35000 42000 49000 NSS018 Surgery for spinal dysraphism and detetheringof cord 64400 77280 90160 NSS019 SURGERY FOR IMPLANT DISPLACEMENT 8050 9660 11270 NST001 Thoracotomy for anterior spinal approach 63000 75600 88200 NST002 TP shunt 25200 30240 35280 NST003 Transnasal pituitary surgery 63000 75600 88200 NST004 Transoral surgery 56000 67200 78400 NST005 Transsphenoidal surgery for CSF leak 42000 50400 58800
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289 78581/2020/ESTT-NE_HRNST006 Transsphenoidal surgery for pituitary tumour 42000 50400 58800 NST007 Twist drill 4200 5040 5880 NSV001 Ventricular puncture/ EVD 4200 5040 5880 NSV002 Vertebroplasty 42000 50400 58800 NSV003 VP shunt 28000 33600 39200
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290 78581/2020/ESTT-NE_HR
UROLOGY
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291 78581/2020/ESTT-NE_HR Code Description Ward Semi Pvt Pvt URA002 Adrenalectomy Open 20000 24000 28000 URA003 Amputation Penis Partial 15000 18000 21000 URA004 Amputation Penis Total 20000 24000 28000 URA005 Artificial Sphincter Insertion 49000 58800 68600 URA006 Auto transplant 50000 60000 70000 URA008 AV Fistula aneurysm excision/ closure 20000 24000 28000 URA009 AV Fistula creation simple 11200 13440 15680 URA010 AV Fistula creation complicated 14000 16800 19600 URA011 AV Fistula creation with vein rotation 19600 23520 27440 URA012 AV GRAFT 40250 48300 56350 URB001 Bladder Perforation Repair Lap 15400 18480 21560 URB002 Bladder Perforation Repair Open 15000 18000 21000 URB003 Burch Colposuspension Lap 21700 26040 30380 URB004 Burch Colposuspension Open 18900 22680 26460 URC001 Chordee Correction 10000 12000 14000 URC002 Circumcision 10000 12000 14000 URC004 Cystectomy Partial Lap 22400 26880 31360 URC005 Cystectomy Partial Open 25000 30000 35000 URC006 Cystectomy Radical Lap 44800 53760 62720 URC008 CystoLithotomy Open 13000 15600 18200 URC009 Cystolithotripsy Trans Urethral 14000 16800 19600 URC010 Cystolithtripsy Percutaneous 16800 20160 23520 URC011 Cystoplasty Augmentation 32200 38640 45080 URC012 Cystoscopy Biopsy 9100 10920 12740 URC013 Cystoscopy BNI/TUIP 12600 15120 17640 URC014 Cystoscopy Botox Inj 14000 16800 19600 URC015 Cystoscopy Clot Evacuation 11200 13440 15680 URC016 Cystoscopy Deflux/ MACROPLASTIQUE Inj 12000 14400 16800 URC017 Cystoscopy Diagnostic 5600 6720 7840 URC018 Cystoscopy DJ Stent Removal U/L 2800 3360 3920 URC019 Cystoscopy Internal Urethrotomy/ VIU 12600 15120 17640 URC020 Cystoscopy TURBT Multiple 19600 23520 27440 URC021 Cystoscopy TURBT Single 14000 16800 19600 URC022 Caruncle Excision 8400 10080 11760 URC023 Cystectomy Radical with Ileal conduit 56000 67200 78400 URC024 Cystectomy Radical with Neobladder 70000 84000 98000 URC025 Cystoscopy Diagnostic GA 7000 8400 9800 URC026 Cystoscopy Fulguration 8400 10080 11760 URC027 Cystoscopy Deflux/ MACROPLASTIQUE Inj B/L 15000 18000 21000 URC028 Cystoscopy DJ Stent Removal B/L 4200 5040 5880 URD003 Dorsal Slit 4200 5040 5880 URE001 Ectopia Vesicae 35000 42000 49000
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292 78581/2020/ESTT-NE_HRURE002 Epidydectomy 10000 12000 14000 URE003 Epispadias Repair 42000 50400 58800 URE004 ESWL Unilateral Package 36400 43680 50960 URF001 Filarial Lymphatic Disconnection Lap 28000 33600 39200 URF002 Filarial Lymphatic Disconnection Open 28000 33600 39200 URF003 Filarial Scrotoplasty 9800 11760 13720 URF004 Foley Catheterisation 2000 2400 2800 URF005 Frenuloplasty 8000 9600 11200 URH001 Hydrocelectomy Unilateral 9800 11760 13720 URH002 Hydrocelectomy Bilateral 14000 16800 19600 URI001 Ileal Conduit 28000 33600 39200 URI002 Ileal Substitution of Ureter 35000 42000 49000 URI003 Inguinal Lymph Node Dissection Bilateral 18200 21840 25480 URI004 Inguinal Lymph Node Dissection Bilateral Lap (VEIL) 21000 25200 29400 URI005 Inguinal Lymph Node Dissection Unilateral 14000 16800 19600 URI006 Inguinal Lymph Node Dissection Unilateral Lap(VEIL) 16800 20160 23520 URI007 Inguino-Pelvic Block Dissection Bilateral Lap 23800 28560 33320 URI008 Inguino-Pelvic Block Dissection Bilateral Open 18200 21840 25480 URI009 Inguino-Pelvic Block Dissection Unilateral Lap 16800 20160 23520 URI010 Inguino-Pelvic Block Dissection Unilateral Open 14000 16800 19600 URI011 Intra Vesical BCG/Interferon/Mitomycin 2100 2520 2940 URI012 Isthmusectomy 25000 30000 35000 URI013 INJECTION THERAPY FOR ED 4830 5800 6770 URL006 Lymphocele Marsupialisation Lap 21000 25200 29400 URL007 Lymphocele Marsupialisation Open 18200 21840 25480 URL008 Lymph adenectomy pelvic 14000 16800 19600 URL009 Laser Prostatectomy 26600 31920 37240 URL010 Laser BNI 16800 20160 23520 URL011 Laser VIU 16800 20160 23520 URM001 Meatoplasty 8400 10080 11760 URM002 Meatotomy 5600 6720 7840 URM003 Mitrafanoff Procedure 28000 33600 39200 URN002 Nephrectomy Partial Open 30000 36000 42000 URN003 Nephrectomy Partial Laparoscopic 35000 42000 49000 URN004 Nephrectomy Radical Laparoscopic 35000 42000 49000 URN005 Nephrectomy Radical Open 25000 30000 35000 URN006 Nephrectomy Radical with IVC Thrombus 40000 48000 56000 URN007 Nephrectomy Simple Laparoscopic 25200 30240 35280 URN008 Nephrectomy Simple Open 21000 25200 29400 URN009 Nephrectomy with Adhesions Open 25200 30240 35280 URN010 Nephropexy Bilateral Lap 28000 33600 39200 URN011 Nephropexy Bilateral Open 21000 25200 29400 URN012 Nephropexy Unilateral Lap 18200 21840 25480 URN013 Nephropexy Unilateral Open 14000 16800 19600
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293 78581/2020/ESTT-NE_HRURN014 Nephroreterectomy Open 28000 33600 39200 URN015 Nephrostomy Change Bilateral 4620 5550 6470 URN016 Nephrostomy Change Unilateral 4200 5040 5880 URN017 Nephrostomy Imaging Guided Bilateral 21000 25200 29400 URN018 Nephrostomy Imaging Guided Unilateral 14000 16800 19600 URN019 Nephrostomy Open Bilateral 21000 25200 29400 URN020 Nephrostomy Open Unilateral 14000 16800 19600 URN021 Nephroureterectomy Laparoscopic 30800 36960 43120 URN022 NesbitÆs Plication 15000 18000 21000 URO001 Orchidectomy Bilateral 16800 20160 23520 URO002 Orchidectomy unilateral 11200 13440 15680 URO003 Orchidopexy Bilateral Lap 28000 33600 39200 URO004 Orchidopexy Bilateral Open 21000 25200 29400 URO005 Orchidopexy Unilateral Lap 25200 30240 35280 URO006 Orchidopexy Unilateral Open 16800 20160 23520 URP001 PCNL Bilateral 23100 27720 32340 URP002 PCNL Unilateral Stage 1 18900 22680 26460 URP004 PD Catheter Insertion 12600 15120 17640 URP005 PD Catheter Removal 4200 5040 5880 URP006 Penile Biopsy 4200 5040 5880 URP007 Penile Implant 21000 25200 29400 URP008 Penile Lengthening 21000 25200 29400 URP009 Perinephric abscess(Exploration for abscess perine 21000 25200 29400 URP010 Perinephric abscess drainage Unilateral 16800 20160 23520 URP011 PeyronieÆs Disease Surgery 28000 33600 39200 URP012 Prolift 21000 25200 29400 URP013 Prostate Biopsy Digital 5600 6720 7840 URP014 Prostate Biopsy TRUS Guided 5600 6720 7840 URP015 Prostatectomy Freyers/Millins Open 25900 31080 36260 URP016 Prostatectomy Radical Lap 49000 58800 68600 URP017 Prostatectomy Radical Open 42000 50400 58800 URP018 Prostatic Abscess Deroofing TransUrethral 14700 17640 20580 URP019 Prostatic Abscess Drainage Trans Rectal 7000 8400 9800 URP020 PU Valve Fulguration 14000 16800 19600 URP021 Pubovaginal Sling SURFLEX TVTO SLING 18900 22680 26460 URP022 Pyelolithotomy Laparoscopic 23800 28560 33320 URP023 Pyelolithotomy Open 18200 21840 25480 URP024 Pyeloplasty Laparoscopic 25200 30240 35280 URP025 Pyeloplasty Open 21000 25200 29400 URP026 PCNL Unilateral Pickup 15400 18480 21560 URP027 PCNL Partial Staghosn 23100 27720 32340 URP028 PCNL Complete Staghosn/Multiple Puncture 28000 33600 39200 URP029 Penile Implant Inflatable 35000 42000 49000 URP030 PIPE Test 4200 5040 5880
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294 78581/2020/ESTT-NE_HRURP031 Priapism Aspiration 7700 9240 10780 URP032 Priapism Distal Shunt 10500 12600 14700 URP033 Priapism Proximal Shunt 15000 18000 21000 URP034 Priapism Sapheno Corporeal Shunt 21000 25200 29400 URR002 Renal Cyst Decortication Lap 19600 23520 27440 URR003 Renal Cyst Decortication Open 16800 20160 23520 URR005 RPLND 49000 58800 68600 URR006 Radical Cystectomy with Uterosigmoidostomy 42000 50400 58800 URR010 Renal Arterial Reconstruction MINOR 24150 28980 33810 URR011 Renal Arterial Reconstruction MAJOR 32200 38640 45080 URR012 Renal Arterial Reconstruction SUPRAMAJOR 40250 48300 56350 URS001 Seminal Vesiculectomy Lap 35000 42000 49000 URS002 Seminal Vesiculectomy Open 30800 36960 43120 URS003 Seminal Vesiculogram 7000 8400 9800 URS004 SPC (Suprapubic Catheterisation)Trocar/Cannula 7000 8400 9800 URS005 SPC Change 2000 2400 2800 URS006 SPC Open Surgery 11200 13440 15680 URS007 Open Nephrectomy(Donor) 35420 42510 49590 URS008 Lap Nephrectomy(Donor) 0 0 0 URS009 Surgeon fee for RTP recipient 67620 81150 94670 URS010 Straightening of Penile 56350 67620 78890 URT001 Testicular Biopsy Unilateral 4200 5040 5880 URT002 Testicular Implant Bilateral 16800 20160 23520 URT003 Testicular Implant Unilateral 12600 15120 17640 URT004 TURED 15400 18480 21560 URT005 TURP Small less than 80gm 18900 22680 26460 URT008 TURP large more than 80gm 22400 26880 31360 URT009 Testicular Biopsy Bilateral 6300 7560 8820 URU001 UDM - CMG URODYNAMIC STUDY 5000 6000 7000 URU004 Ureter DJ Stenting Bilateral 12600 15120 17640 URU005 Ureter DJ Stenting Unilateral 8400 10080 11760 URU006 Ureter RGP Bilateral 10500 12600 14700 URU007 Ureter RGP Sclerotherapy Bilateral 12600 15120 17640 URU008 Ureter RGP Sclerotherapy Unilateral 9800 11760 13720 URU009 Ureter RGP Unilateral 7000 8400 9800 URU010 Uretero-Calycostomy 20000 24000 28000 URU011 Ureterocele Incision Bilateral 18200 21840 25480 URU012 Ureterocele Incision Unilateral 15400 18480 21560 URU013 Ureterolithotomy Lap 21700 26040 30380 URU015 Ureterolysis Bilateral Lap 26600 31920 37240 URU016 Ureterolysis Bilateral Open 22400 26880 31360 URU017 Ureterolysis Unilateral Open 19600 23520 27440 URU018 Ureterolysis Unilateral Lap 21000 25200 29400 URU019 Ureteroneocystostomy Unilateral Lap 25200 30240 35280
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295 78581/2020/ESTT-NE_HRURU020 Ureteroneocystostomy Unilateral Open 20000 24000 28000 URU021 Ureteroneocystostomy Bilateral Lap 30800 36960 43120 URU022 Ureteroneocystostomy Bilateral Open 32800 39360 45920 URU023 Ureteroneocystostomy Boari Flap Bilateral Lap 35000 42000 49000 URU024 Ureteroneocystostomy Boari Flap Bilateral Open 28000 33600 39200 URU025 Ureteroneocystostomy Boari Flap UnilateralLap 28000 33600 39200 URU026 Ureteroneocystostomy Boari Flap UnilateralOpen 25200 30240 35280 URU027 Ureteroscopy Diagnostic Bilateral Flexible 26600 31920 37240 URU028 Ureteroscopy Diagnostic Bilateral Rigid 16800 20160 23520 URU029 Ureteroscopy Diagnostic Unilateral Flexible 21000 25200 29400 URU030 Ureteroscopy Diagnostic Unilateral Rigid 12600 15120 17640 URU031 Ureteroscopy Stone Removal BilateralFlexible-RIRS 35000 42000 49000 URU032 Ureteroscopy Stone Removal Bilateral Rigid 22400 26880 31360 URU033 Ureteroscopy Stone Removal UnilaterlFlexible-RIRS 30800 36960 43120 URU034 Ureteroscopy Stone Removal Unilateral Rigid 15400 18480 21560 URU035 Ureteroscopy Tumor Fulguration Bilateral Flexible 35000 42000 49000 URU036 Ureteroscopy Tumor Fulguration BilateralRigid 21000 25200 29400 URU037 Ureteroscopy Tumor Fulguration Unilateral Flexible 26600 31920 37240 URU038 Ureteroscopy Tumor Fulguration UnilateralRigid 14700 17640 20580 URU039 Ureterostomy Cutaneous Bilateral 28000 33600 39200 URU040 Ureterostomy Cutaneous Unilateral 21000 25200 29400 URU041 Uretero-ureterostomy Lap 28000 33600 39200 URU042 Uretero-ureterostomy Open 21000 25200 29400 URU043 Uretherolithotomy 11200 13440 15680 URU044 Urethral dilatation 2800 3360 3920 URU045 Urethrocutaneous Fistula Closure 15000 18000 21000 URU048 Urethroplasty Hypospadias repair 1 Stage 21000 25200 29400 URU049 Urethroplasty Hypospadias repair 2nd Stage 21000 25200 29400 URU050 Urethroplasty Lay Open 16800 20160 23520 URU051 Urethroplasty Perineal 22400 26880 31360 URU052 Urethroplasty Stage 2 21000 25200 29400 URU053 Urethroplasty Transpubic 42000 50400 58800 URU054 Urethrostomy Perineal 16800 20160 23520 URU055 Urethrovaginal Fistula/ Diverticulum Closure 21000 25200 29400 URU056 Urinary Diversion 21000 25200 29400 URU057 Urinary Fistula 21000 25200 29400 URU058 Uroflowmetry UFR 840 1010 1180 Ureteroscopy Stone Removal Unilateral Rigid Large URU059 URS 18200 21840 25480 URU060 Ureteric Catheterization U/L 5600 6720 7840 URU061 Ueteric Catheterization B/L 8400 10080 11760 URU062 USG Guided aspiral of Perimephric Abseess 4200 5040 5880 URU063 Urethroplasty Buccal Mucosal Graft MINOR 32200 38640 45080 URU064 Urethroplasty Buccal Mucosal Graft MAJOR 40250 48300 56350
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296 78581/2020/ESTT-NE_HRURU065 Urethroplasty Buccal Mucosal Graft SUPRAMAJOR 48300 57960 67620 URU066 Urethroplasty Excision Primary Anastomosis MINOR 32200 38640 45080 URU067 Urethroplasty Exc. Primray Anastomosis MAJOR 40250 48300 56350 Urethroplasty Exc. Primray Anastomosis URU068 SUPRAMAJOR 48300 57960 67620 URV001 Varicocelectomy Bilateral Lap 22400 26880 31360 URV002 Varicocelectomy Bilateral Open Microscopic 18200 21840 25480 URV003 Varicocelectomy Unilateral Lap 18200 21840 25480 URV004 Varicocelectomy Unilateral Open Microscopic 14000 16800 19600 URV005 Vasectomy 9800 11760 13720 URV006 Vaso-Epididymostomy (VEA) 28000 33600 39200 URV007 Vesico Vaginal Fistula Closure Lap 35000 42000 49000 URV008 Vesico Vaginal Fistula Closure Open 28000 33600 39200
Renal Pacakage Inclusion 1. Pre Operative Dialysis of recipient 2. Recipient Surgery 3. 8 Day Stay for recipient 4. Donor Nephrectomy 5. 5 Day stay for Donor 6. Routine investigation and Medicine during hospital stay
Exclusion 1. DJ stenting removal 2. Higher Antibiotics 3. Plasma Pheresis 4. Medicine – Taesant, Meropenine, Inj. Imunonglobin 5. Immunosuppresant therapy such as simulect & ATG 6. CMVprophylaxis 7. Treatment of acute kidney rejection 8. Prolonged hospital stay because of some complication.
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297 78581/2020/ESTT-NE_HR
INTERVENTIONAL RADIOLOGY
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298 78581/2020/ESTT-NE_HR Code Description Ward Semi Pvt Pvt
IRA001 Arterio Portogram 14700 17640 20580 IRA002 Coiling of I.C Aneurysm 61600 73920 86240 IRB001 Balloon occlusion test 36680 44020 51360 IRB002 Bronchial Artery Embolization 29400 35280 41160 IRC001 Carotid Stenting/Angioplasty 44100 52920 61740 IRC002 CCF Embolization(Balloon)/Coil 52920 63510 74090 Cerebral AVM embolisation(ONYX)/Glue IRC003 Embolisation 58800 70560 82320 IRC004 Chemoembolization(Hepatic Tumours/Meets) 32200 38640 45080 CT Giuded IRC005 Biopsies(Liver/Kidney/Chest/Pancreas/Sp 7280 8740 10200 IRC006 CT/USG Guided Abscess/Pleural Aspiration/Drainag 5880 7060 8240 IRD001 Diagnostic Angiography(Specific Parts) 21700 26040 30380 IRD002 Diagnostic Venogram 5880 7060 8240 IRD003 Dialysis Catheter Insertions 5880 7060 8240 IRD004 DSA 8820 10590 12350 IRE001 Embolization of External carotid artery tumours 36680 44020 51360 IRE002 Embolization of Hemengioma(Face/Body) 29400 35280 41160 IRE003 Embolization spinal tumors (Hemangioma/Mets) 36680 44020 51360 IRF001 Fallopian Tube Catheterisation(For Blocked Tubes) 14700 17640 20580 IRG001 GI Bleed/Ischemia(Embolization) 21980 26380 30780 IRI001 Inferior vena cava filter 26460 31760 37050 IRI002 Intra-Arterial Thrombolysis(Stroke) 36680 44020 51360 IRI003 Intracranial Chemical Angioplasty(Nimodepepine) f 21980 26380 30780 IRI004 Intracranial Stenting 58800 70560 82320 IRI005 Intracranial Tumour Embolisation 29400 35280 41160 IRL001 Laser Ablation of varicose veins 29400 35280 41160 IRM001 Machine charges for Radiofrequency Ablation 36680 44020 51360 Pelvic,Lower Limb Angiography stenting & IRP001 thrombol 29400 35280 41160 IRP002 PTBD 29400 35280 41160 IRR001 Radiofrequency Ablation of Multiple metastasis 57680 69220 80760 IRR002 Renal Interventions 21980 26380 30780 IRR003 Radio frequency ablation of liver metastasis singl 44800 53760 62720 IRS001 Spinal angiogram 24220 29070 33910 IRS002 Spinal AVM/AVF embolization 49000 58800 68600 IRT001 TIPS 42000 50400 58800 IRT002 Transjugular Liver Biopsy 14000 16800 19600 Uterine Artery IRU001 Embolization(PPH,Fibroids,Adenomyo 42000 50400 58800 IRV001 Vericosal Embolization 21000 25200 29400 IRV002 Vertbroplastry 28000 33600 39200
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299 78581/2020/ESTT-NE_HR
INTERVENTIONAL PAIN MANAGEMENT
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300 78581/2020/ESTT-NE_HR Code Description Ward Semi Pvt Pvt IPA001 AO JOINT RFA 16100 19320 22540 IPB001 BURSA INJECTION 9660 11600 13530 IPC001 CAUDAL EPIDURAL STEROID INJ 12880 15460 18040 IPC002 CELIAC PLEXUS BLOCK 16100 19320 22540 IPC003 CELIAC PLEXUS NEUROLYSIS 19320 23190 27050 IPC004 CERVICAL DISC RADIOFREQUENCY 32200 38640 45080 IPC005 CERVICAL DRG BLOCK 12880 15460 18040 IPC006 CERVICAL DRG RFA 16100 19320 22540 IPC007 CERVICAL EPIDURAL STEROID INJ 19320 23190 27050 IPC008 CERVICAL FACET JT INJ/MBB-B/L 19320 23190 27050 IPC009 CERVICAL FACET JT INJ/MBB 12880 15460 18040 IPC010 CERVICAL MBB RFA (BOTH SIDE) 27370 32850 38320 IPC011 CERVICAL MBB RFA (ONE SIDE) 16100 19320 22540 IPG001 GANGLION IMPAR BLOCK 11270 13530 15780 IPG002 GANGLION IMPAR NEUROLYSIS 16100 19320 22540 IPG003 GANGLION IMPAR RFA 16100 19320 22540 IPG004 GASSERIAN GANGLION NEUROLYSIS 22540 27050 31560 IPG005 GASSERIAN GANGLION RFA 22540 27050 31560 IPG006 GENICULAR NERVE RFA 16100 19320 22540 IPG007 GLOSSOPHARYNGEAL NERVE BLOCK 6440 7730 9020 IPG008 GLOSSOPHARYNGEAL NERVE RFA 12880 15460 18040 IPG009 GREATER OCCIPITAL N(RFA ) 12880 15460 18040 IPG010 GREATER OCCIPITAL N(STROID INJ 6440 7730 9020 IPH001 HYPOGASTRIC PLEXUS BLOCK 11270 13530 15780 IPH002 HYPOGASTRIC PLEXUS NEUROLYSIS 16100 19320 22540 IPI001 IINTERCOSTAL NERVE RFA 12880 15460 18040 IPI002 ILLIO-INGUINAL NERVE BLOCK 6440 7730 9020 IPI003 ILLIO-INGUINAL NERVE RFA 12880 15460 18040 IPI004 INTERCOSTAL NERVE BLOCK 6440 7730 9020 IPI005 IV INFUSION 4830 5800 6770 IPK001 KNEE JOINT STEROID(ONE KNEE ) 6440 7730 9020 IPK002 KNEE JOINT STEROID(TWO KNEE ) 6440 7730 9020 IPK003 KNEE JT SYNVISC INJ(ONE KNEE ) 7260 8710 10160 IPK004 KNEE JT SYNVISC INJ(B/L ) 7260 8710 10160 IPL001 LATERAL CUTANEOUS NERVEBLOCK 8050 9660 11270 IPL002 LATERAL CUTANEOUS NERVE RFA 12880 15460 18040 IPL003 LUMBAR DISC RADIOFREQUENCY 24150 28980 33810 IPL004 LUMBAR DRG BLOCK 11270 13530 15780 IPL005 LUMBAR DRG RFA 16100 19320 22540 IPL006 LUMBAR FACET JT INJ/MBB (B/L) 11270 13530 15780 IPL007 LUMBAR FACET JT INJ/MBB 8050 9660 11270 IPL008 LUMBAR EPIDURAL INJ 8050 9660 11270
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301 78581/2020/ESTT-NE_HRIPL009 LUMBAR MEDIAN BRANCH RFA(B/L) 24150 28980 33810 IPL010 LUMBAR MEDIAN BRANCH RFA 16100 19320 22540 IPL011 LUMBAR SYMPATHECTOMY BLOCK 11270 13530 15780 IPL012 LUMBAR SYMPATHETIC RFA 16100 19320 22540 IPL013 LUMBAR SYMPATHETIC NEUROLYSIS 16100 19320 22540 IPO001 OZONE DISCOLYSIS 16100 19320 22540 IPP001 PAIN PROCEDURE - A 6440 7730 9020 IPP002 PAIN PROCEDURE - B 9660 11600 13530 IPP003 PAIN PROCEDURE - C 12880 15460 18040 IPP004 PAIN PROCEDURE - D 19320 23190 27050 IPP005 PAIN PROCEDURE - E 25760 30920 36070 IPP006 PAIN PROCEDURE - F 32200 38640 45080 IPP007 PERIPHERAL NERVE BLOCKS 9660 11600 13530 IPP008 PERIPHERAL NERVE RFA 12880 15460 18040 IPP009 PIRIFORMIS MUSCLE INJECTION 12880 15460 18040 IPS001 SACRO-ILLIAC JOINT INJECTION 9660 11600 13530 IPS002 SACRO-ILLIAC JOINT RFA 16100 19320 22540 IPS003 SHOULDER JOINT INJECTON 6440 7730 9020 IPS004 SPHENOPALATINE GANG. BLOCK 19320 23190 27050 IPS005 SPHENOPALATINE GANGLION RFA 12880 15460 18040 IPS006 SPLANCHNIC NERVE BLOCK + RFA 16100 19320 22540 IPS007 SPLANCHNIC N. DIAGNOSTIC BLOCK 12090 14500 16920 IPS008 SPLANCHNIC NERVE NEUROLYSIS 16100 19320 22540 IPS009 STELLATE GANGLION RFA 16100 19320 22540 IPS010 STELLATE GANGLION BLOCK 9660 11600 13530 IPS011 SUPRASCAPULAR NERVE BLOCK 8050 9660 11270 IPS012 SUPRASCAPULAR NERVE RFA 11270 13530 15780 IPT001 THORACIC EPIDURAL STEROID INJ 14490 17390 20290 IPT002 TRIGGER POINT INJECTION 6440 7730 9020
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302 78581/2020/ESTT-NE_HR
PAEDIATRIC CARDIAC SURGERY
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303 78581/2020/ESTT-NE_HR Semi Code Description Ward Pvt Pvt PCS0001 Pediatric CS Open Level 1 (ASD)-Package 241500 289800 338100 Pediatric CS Open Level 1(ASD)-Procedure Pediatrcic CS PCS0002 Open Level 60390 72460 84540 PCS0003 Pediatrcic CS Open Level 2(VSD,TOF,PAPVC)-Package 281750 338100 394450 Pediatric CS Closed Level 1(BT shunt,PA PCS0004 2(VSD,TOF,PAPVC)-Procedur 80500 96600 112700 PCS0005 Pediatric CS Closed Level 1(BT shunt,PAband)-Pack 241500 289800 338100 PCS0006 Pediatric CS Closed Level 1(BT shunt, PA band)-Proc 70440 84530 98610 PCS0007 Ped CS closed L2(CoarctationRepair,C.BTshunt)Pack 281750 338100 394450 PCS0008 Ped CS closed L2(CoarctationRepair,C.BTshunt)Proc 80500 96600 112700 PCS0009 open Heart surg L3(TAPVC,Truncus,TGA,DORV)-Proc 140890 169060 197240 PCS0010 Ped CS Bedside PDA Ligation - Proc 100640 120760 140890 PCS0011 Ped CS Device Closure of PDA - Proc 30190 36230 42260 PCS0012 Ped CS Device Closure ASD - Proc 30190 36230 42260 PCS0013 Ped CS Balloon Valvuloplasty - Proc 28980 34780 40580 PCS0014 Ped CS Pericardiocenteiss - Proc 20140 24160 28190 Ped CS Redo Sternotomy/mini sternotomy PCS0015 charges+B4899 40250 48300 56350 PCS0016 Ped CS Pediatric Perfusion Charges 10070 12080 14100 PCS0017 Ped CS Foreign body retrieval 48300 57960 67620 PCS0018 Ped CS Vascular cut down 16100 19320 22540 PCS0019 Ped CSChest wall repair 48300 57960 67620 PCS0020 Ped CS Off pump charges 40250 48300 56350 PCS0021 Ped CS Specialist OT nurses 6440 7730 9020 PCS0022 Ped CS OT Technicians 4830 5800 6770 PCS0023 Ped CS - ECHO 3550 4260 4960 PEA002 ASD - PAEDS PROCEDURE 13000 15000 17000 PEB006 BT SHUNT PROCEDURE(7 DAYS IN ICU) 0 0 22630 PEB007 BT SHUNT ON PUMP PROCEDURE(7 DAYS IN ICU) 0 0 33750 PEB008 BAV - PAEDS PROCEDURE 16000 19200 22400 PEB009 BPV - PAEDS PROCEDURE 16000 19200 22400 PEB010 BMV - PAEDS PROCEDURE 16000 19200 22400 PEB011 BAS - PAEDS PROCEDURE 16000 19200 22400 PED001 DSO PROCEDURE(7 DAYS IN ICU) 0 0 49000 EBSTEIN/TRUNCUS REPAIR + COST OF CONDUIT PEE002 (SEPARATE)PROCEDURE(7 DAYS IN ICU) 0 0 45950 PEN010 NORWOOD SURGERY PROCEDURE(7 DAYS IN ICU) 0 0 49000 PAEDIATRIC ASD CLOSURE PROCEDURE(7 DAYS PEP010 IN ICU) 0 0 41480 PEP011 PAEDIATRIC ASO PROCEDURE(7 DAYS IN ICU) 0 0 47000 PEP012 PAEDIATRIC CAVSD PROCEDURE(7 DAYS IN ICU) 0 0 47000 PEP013 PAEDIATRIC BDG PROCEDURE(7 DAYS IN ICU) 0 0 34130 PEP014 PAEDIATRIC COA PROCEDURE(7 DAYS IN ICU) 0 0 20000 PEP015 PAEDIATRIC CONDUIT REPAIR PROCEDURE(7 0 0 47000 199| T a r i f f - AIMS
304 78581/2020/ESTT-NE_HRDAYS IN ICU) PAEDIATRIC DORV /RASTELLI/REV + COST OF PEP016 CONDUIT (SEPARATE)PROCEDURE(7 DAYS IN ICU) 0 0 46500 PAEDIATRIC FONTAN + COST OF CONDUIT PEP017 (SEPARATE)PROCEDURE(7 DAYS IN ICU) 0 0 45000 PAEDIATRIC KAWASHIMA PROCEDURE(7 DAYS IN PEP018 ICU) 0 0 43330 PEDIATRIC VALVE REPAIR PROCEDURE(7 DAYS IN PEP019 ICU) 0 0 45950 PEP020 PAEDIATRIC PA BAND PROCEDURE(7 DAYS IN ICU) 0 0 22050 PEP021 PAEDIATRIC SENNING PROCEDURE(7 DAYS IN ICU) 0 0 49100 PEP022 PAEDIATRIC TAPVC PROCEDURE(7 DAYS IN ICU) 0 0 46730 PAEDIATRIC TOF/ TOTAL CORRECTION PEP023 PROCEDURE(7 DAYS IN ICU) 0 0 42000 PEP024 PDA LIGATION PROCEDURE(7 DAYS IN ICU) 0 0 20000 PEP025 PA PLASTY ON PUMP PROCEDURE (7 DAYS IN ICU) 0 0 39250 PEP026 PDA - PAEDS PROCEDURE 0 0 17000 PES002 SAM RESECTION PROCEDURE(7 DAYS IN ICU) 0 0 41500 PEV001 VSD CLOSURE PROCEDURE(7 DAYS IN ICU) 0 0 41250 PEV002 VSD - PAEDS PROCEDURE 0 0 17000 PEV003 VASCULAR PLUG -PAEDS PROCEDURE 0 0 17000 PCS0001 Pediatric CS Open Level 1 (ASD)-Package 241500 289800 338100 Pediatric CS Open Level 1(ASD)-Procedure Pediatrcic CS PCS0002 Open Level 60390 72460 84540 PCS0003 Pediatrcic CS Open Level 2(VSD,TOF,PAPVC)-Package 281750 338100 394450 Pediatric CS Closed Level 1(BT shunt,PA PCS0004 2(VSD,TOF,PAPVC)-Procedur 80500 96600 112700
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305 78581/2020/ESTT-NE_HR
BED SIDE SERVICE CHARGES
Code Description Ward Semi Pvt Pvt BDA001 Airmatress/Ripple alphabed (Per day) 490 490 490 BDA005 Ambu scope usage for intubation 2900 3480 4060
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306 78581/2020/ESTT-NE_HRBDB001 B-Type Oxygen Cylinder Charges 330 390 460 BDB002 Bed Preparation Services 820 820 820 BDB006 Bedside echo by intensivist 820 980 1140 BDC001 Cusa Machine Charges Minor 8050 8050 8050 BDC002 Cusa Machine Charges Major 16100 16100 16100 BDC003 C.Arm Charges 1/2 hour 2430 2430 2430 BDC004 C.Arm Charges 1 Hour 4040 4040 4040 BDH001 House Keeping Service (Suites/P.Suites) 1210 1450 1690 BDM007 Machine Charges 24150 28980 33810 BDN001 Noklot (Per day) 730 880 1020 BDN002 Nursing Services (Suites/P.Suites) 4040 4840 5650 BDO001 Oxygen Charges(Per hour) 90 110 120 BDS001 Stand by Ventilator 1610 1940 2260 BDV001 Ventilator Charges less than 4 hours 3630 3630 3630 BDV002 Ventilators per day 4040 4040 4040 BDW001 Wardboy Charges (Suites/P.Suites) 1210 1450 1690 BDA006 ALBUMIN THERAPY CHARGES 1500 1500 1500 BDA007 ARTHRO SCOPIC SHAVER SYSTEM 8000 8000 8000 BDC005 COBLATOR BAND (PROCISE MAX) 20000 20000 20000 BDC006 COBLATOR CHARGES 10000 10000 10000 DIODE LASER MACHINE CHARGES BDD002 (SINGLE LIMB) 26550 26550 26550 DIODE LASER MACHINE CHARGES BDD003 (DOUBLE LIMB) 47200 47200 47200 BDD005 LASER MACHINE 20000 20000 20000 BDE001 ENSEAL CHARGES MAJOR 20000 20000 20000 BDE002 ENSEAL CHARGES MINOR 10000 10000 10000 BDE003 ECG (BED SIDE) 220 220 220 EASYNAV BRAIN & SPINE NAVIGATION BDE004 SYSTEM CHARGES 31250 31250 31250 BDH002 HARMONIC CHARGES MAJOR 11700 11700 11700 BDH003 HARMONIC CHARGES MINOR 5850 5850 5850 SONICBEAT 5MM,35CM FRONT- BDH004 ACTUATED GRIP MAJOR 11700 11700 11700 SONICBEAT 5MM,35CM FRONT- BDH005 ACTUATED GRIP MINOR 5850 5850 5850 BDH006 HIPIC CYTOREDUTIVE 200000 200000 200000 BDI001 IABP MACHINE CHARGES 30000 30000 30000 BDL001 LINA TRIPOL MAJOR 6800 6800 6800 BDL002 LINA TRIPOL MINOR 3900 3900 3900 LAPROSCOPIC ONCOSURGICAL UNIT BDL003 CHARGES(LOSU) 10000 10000 10000 BDL004 LIGASURE MAJOR (O) (VALLEY LAB) 6000 6000 6000 BDL005 LIGASURE MINOR (O) (VALLEY LAB) 3000 0 0 MOULD ROOM CHARGES FOR RAPID BDM001 ARC/IGRT/IMRT 7000 7000 7000 MOULD ROOM CHARGES FOR RAPID BDM002 ARC/IGRT/IMRT 3000 3000 3000 202| T a r i f f - AIMS
307 78581/2020/ESTT-NE_HRBDM003 Mould Room Cons. Charges for 3DCRT 5250 5250 5250 BDM004 Mould Room Cons. Charges for 3DCRT 2250 2250 2250 BDM005 Mould Room Cons. Charges for Palliative 10000 10000 10000 BDM006 Mould Room Cons. Charges for Palliative 1800 1800 1800 BDM008 Miscellaneous Charges 10000 10000 10000 BDN003 NEURO DRILL CHARGES 5000 5000 5000 BDN005 NURSING SUPERVISION 50000 50000 50000 PERFORATOR CUTTER ACRA UT ADULT BDP001 DISPOSABLE(200-271 8000 8000 8000 PATIENT UNDER OBSERVATION - LONG BDP002 STAY 1000 1000 1000 PATIENT UNDER OBSERVATION - SHORT BDP003 STAY 500 500 500 BDP004 Emergency Observation Charges 1000 1000 1000 BDR001 RFA MACHINE CHARGE FOR ONCOLOGY 30700 30700 30700 BDS002 SYRINGE PUMP 300 300 300 SINGLE USE PATIENT PROBE (O) BDS003 (PHOENIX) 200 200 200 BDS004 BED SHEET CHARGES 200 200 200 BDS005 PATIENT DRESS 500 500 500 BDS006 COMMANDO DRILL 2500 2500 2500 ZD STEREOTACTIC FRAME COMPLETE BDS007 SYSTEM 52000 52000 52000 BDS027 LASER MACHINE CHARGES 0 0 22130 BDT003 TRACHEAL RECONSTRUCTION T-TUBE 5000 5000 5000 BDU001 STRUCTURE LOCATOR CHARGES 500 500 500 BDU002 STRUCTURE LOCATOR CHARGES 500 500 500 BDU003 STRUCTURE LOCATOR CHARGES 500 500 500 BDU004 STRUCTURE LOCATOR CHARGES 500 500 500 BDU005 USG GUIDANCE FOR O.T. PROCEDURE 500 500 500 BDV004 VASER MACHINE CHARGES GRADE I 7500 7500 7500 BDV005 VASER MACHINE CHARGES GRADE II 10000 10000 10000 BDV006 VASER MACHINE CHARGES GRADEIII 15000 15000 15000 BDV007 VASER MACHINE CHARGES GRADE IV 20000 20000 20000 BDV009 VASER LIPO MACHINE CHARGES 5000 5000 5000 CC004 Consumable charges for Palliative 4200 4200 4200 CONSUMABLE CHARGES FOR RAPID CC005 ARC/IGRT/IMRT 7000 7000 7000 VENTILATOR CHARGES LESS THAN 4 CCV001 HOURS 2250 2250 2250 CMC001 BALLOON MINI TREK 17010 17010 17010 CMC002 BALLOON ACROSS HP 23000 23000 23000 COM002 MINOR DRESSING/ SUTURING II 300 300 300 COM003 MINOR DRESSING/ SUTURING III 500 500 500 COM004 MINOR DRESSING/ SUTURING IV 700 700 700 COM010 ENEMA - CHARGES 200 200 200 COT001 TYPHIM 310 310 310 BDN006 Nursing Charges/per day 400 400 400 203| T a r i f f - AIMS
308 78581/2020/ESTT-NE_HR100099 RMO charges /per day 500 500 500
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