2017-18 BILLING POLICY GUIDELINES AND SCHEDULE OF CHARGES
BILLING GUIDELINES
Bed charges
1. Bed charges include room rent / nursing care and dietary services for the patient 2. Doctor’s visit shall be billed extra as per applicable tariff 3. Bed charges shall be billed for the full day on the day of admission irrespective of the time and admission (room charges are from 12 noon to 12 noon) 4. Any stay in the room or ICU upto 8 hours shall be billed at half day rent of the category
Labour room
1. Labour room is considered as an intensive care area for Obs & Gynae patients and hence patient staying in labour room will be billed as per labour room charges. 2. In case the patient physically stays in the labour room during the hospitalization the patient shall be billed for all charges including surgery and procedure as per labour room category. 3. If the patient is admitted in a desired category and during hospitalization transferred to labour room after the procedure the patient shall be levied charges on pro rata basis.
BED TRANSFERS
Bed transfer during hospitalization
All bed transfers shall be preferably done between 11.00 AM to 2.00 PM, however in case of emergency the patient can be transferred at any point of time.
Patient transfer from one bed category to another bed category
In case a patient is transferred from higher category to lower category the patient shall be billed as per actual tariff and procedure charges of the stay during hopitalization
However if during hospitalization patient is shifted from lower category to a higher category the room charges applicable will be of higher category from the day of admission
OTHER SERVICES
1. The intensive care room charges includes charges for oxygen and infusion pump including ICU monitors 2. However, the patient shall be billed for infusion pump, oxygen and monitor if used in wards as per applicable tariffs. 3. In case of ventilator, DVT pumps, air mattress, phototherapy, BIPAP or any other equipment used the patient shall be billed for the same in ICU separately. 4. Any procedure performed shall be billed as per applicable tariff
OT BILLING GUIDLELINES
Economy ward 100% (Rack rate) Twin Sharing 120% Single Room 140% Suite 170% ICU/CCU/HDU As per single room NICU/PCIU As per single room
Information regarding OT procedures and billing
Surgery / Procedure performed on patients directly admitted to the ICU shall be billed according to the tariff rate applicable to single room occupancy.
However at the time of transfer from ICU if the patient opted for a higher category then the single room, the cost of the procedure / surgery shall be billed according to the applicable tariff of the respective higher category.
In case of transfer from ICU - if the patient opts for a lower category the cost of surgery / procedure shall remain the same. OT Charges
OT Charges 55% Anaesthesia Gases 25% Anaesthesiologist 35% Assistant Surgeon Charges 30%
Day care surgery and procedure
The surgical procedure charges for daycare shall be billed as per twin sharing basis
Protocol for multiple surgery and emergency surgeries
In case of multiple surgeries the procedure with higher surgeon fee shall always be considered as the first / principal procedure and further calculations shall be based on the same.
Multiple surgeries performed by the same surgical team
If the same surgical team performs multiple procedure / surgery on a patient then the first surgery shall be billed at 100% and the second as 50% and third surgery onwards 25% of the surgeon charges. All the other charges i.e. OT charges, anesthesiologists charges, assistant surgeon charges, OT anesthesia gases shall be billed proportionately.
In case the surgery is carried out by two different regions or different areas of the body both the surgeries shall be charged at 100%
Multiple surgical team for a single surgery
In case more than one team is required to perform surgical procedure the surgeon fees shall be splited between teams after mutual understanding of the surgeon and no additional charges will be levied to the patient.
Multiple surgeon for multiple surgery
In case multiple teams of different specialties are performing different surgeries on a same patient the patient will be billed at 100% for both the surgeons as per applicable tariff. The subsequent procedure shall be billed similarly as mentioned earlier.
In case of re-exploration within 48 hours the patient shall be billed only for consumables
Assistant surgeon charges
The assistant surgeon charges shall be levied in cases wherein another surgeon assisted the primary consultant in a major case in the OT. And it shall need approval from Medical adiminstration however if more than two assistant surgeons are used only one assistant surgeon shall be billed.
Surgery on Sunday or holiday
Any surgery performed on a Sunday or holiday will be considered as an emergency and charged 25% extra of the opted category
Emergency Surgery
If a surgery performed during emergency category i.e. from 10 pm to 7 am additional 25% emergency charges shall be levied.
Post procedure visits
For non ICU patients up to 24 hours after the surgery no IPD consultant of the primary surgical team shall be charged. CONTENT BED CHARGES...... 2 CTVS...... 3 INTERVENTIONAL CARDIOLOGY...... 4 PEDIATRICS AND NEONATOLOGY...... 5 LABORATORY DIAGNOSTICS...... 6 X-RAY...... 23 ULTRASOUND...... 28 RADIO-MRI...... 31 RADIO-CT...... 35 EAR,NOSE,THROAT...... 38 AUDIOLOGY & SPEECH THERAPY...... 39 NEURO & SPINE SURGERY...... 40 NEUROSURGERY...... 44 OPTHALMOLOGY...... 48 DENTISTRY ...... 51 GASTROENTEROLOGY...... 71 ANAESTHESIA...... 72 UROLOGY...... 73 ICU- EQUIPMENT CHARGES...... 75 NEPHROLOGY...... 76 MAMMOGRAPHY...... 76 PEDIATRICS AND NEONATOLOGY...... 77 INTERVENTIONAL RADIOLOGY...... 80 RESPIRATORY MEDICINE...... 81 OBSTETRICS AND GYNAECOLOGY...... 82 GENERAL SURGERY...... 87 SURGICAL ONCOLOGY...... 106 NON-INVASIVE CARDIOLOGY...... 108 TRANSFUSION MEDICINE...... 109 NEUROLOGY...... 109 MEDICAL ONCOLOGY...... 110 AMBULANCE AND EMERGENCY...... 110 ORTHOPAEDICS ...... 111 BED CHARGES S.NO. CATEGORY CHARGES 1 SUITE 9500 2 SINGLE ROOM 7200 3 DOUBLE ROOM 4700 4 GENERAL WARD 3000 5 CRADLE SUITE/LDR 1500 6 CRADLE charges 1000 7 ICU 8000 8 CCU 8000 9 CTVS 8000 10 DAY CARE 1600 11 NICU LEVEL 1 6000 12 NICU LEVEL 2 7000 13 PICU 7000 14 SICU 7000 15 HDU 6800 16 ISOLATION ICU 9000 17 ISOLATION ROOM 7200 18 LABOR ROOM 7200
2 CTVS S.NO. PACKAGES GW TWIN SINGLE SUITE 1 CABG 218750 251600 306300 382800 2 CABG+ASD 218750 251600 306300 382800 3 CABG+AVR 243750 280300 341300 426600 4 CABG+DVR 243750 280300 341300 426600 5 CABG+CAROTID ENDARTERECTOMY 281250 323400 393800 492200 6 CABG+MVR/REPAIR 243750 280300 341300 426600 7 CABG+VSR REPAIR 281250 323400 393800 492200 8 CAROTID ENDARTERECTOMY 122500 140900 171500 214400 9 CABG + LV ANEURYSMORRHAPHY 281250 323400 393800 492200 10 CABG REDO/HIGH RISK 250000 287500 350000 437500 11 AVR/MVR/SINGLE VALVE REPLACEMENT 218750 251600 306300 382800 12 AVR/MVR + TV REPAIR 231250 265900 323800 404700 13 DVR 231250 265900 323800 404700 14 DVR+ TV REPAIR 237500 273100 332500 415600 15 VALVE REPLACEMENT AORTIC MINIMAL ACCESS 281250 323400 393800 492200 16 VALVE REPLACEMENT MITRAL MINIMAL ACCESS 281250 323400 393800 492200 17 BENTALL CONDUIT AVR 281250 323400 393800 492200 18 ASD 218750 251600 306300 382800 19 VSD 218750 251600 306300 382800 20 TOF REPAIR 218750 251600 306300 382800 21 GLENN SHUNT 218750 251600 306300 382800 22 BT SHUNT 218750 251600 306300 382800 23 PERICARDECTOMY 148750 171100 208300 260300 24 COARCTATION REPAIR 218750 251600 306300 382800 25 INTRA AORTIC BALLON PUMP (IABP) PACKAGE 87500 100600 122500 153100 26 ABDOMINAL AORTIC ANEURYSM REPAIR 218750 251600 306300 382800 27 FEMORAL BYPASS LOWER LIMB 156250 179700 218800 273400 28 ILEO-POPLITEAL BYPASS 156250 179700 218800 273400 29 PERIPHERAL VASCULAR SURGERY PACKAGE 140000 161000 196000 245000 30 POPLITEAL BYPASS 156250 179700 218800 273400 31 AORTO-FEMORAL BYPASS 187500 215600 262500 328100 32 AORTOBIFEMORAL BYPASS 187500 215600 262500 328100 33 ARTERIAL VENO GRAFTING (AV FISTULA) 31250 35900 43800 54700
3 INTERVENTIONAL CARDIOLOGY S.NO. SERVICE NAME Ward TWIN SINGLE SUIT 1 CARDIOVERSION 750 860 1050 1310 2 CAROTID ANGIOPLASTY Package 168750 194060 236250 295310 CHECK CORONARY ANGIOGRAPHY 3 10630 12220 14870 18590 Package 4 COMBOS DEVICE/BIV PACING PACKAGE 93750 107810 131250 164060 CORONARY ANGIOGRAPHY (CAG) 5 12500 14370 17500 21880 Package CORONARY ANGIOPLASTY (PTCA) 6 168750 194060 236250 295310 Package 7 DAY CARE ANGIOGRAM Package 11880 13660 16630 20780 DEVICE CLOSURE(ASD/VSD/PDA) 8 155000 178250 217000 271250 Package 9 EP STUDY Package 31250 35940 43750 54690 10 AICD / BV PACING CHARGES Package 75000 86250 105000 131250 11 PACEMAKER SINGLE CHAMBER PACKAGE 43750 50310 61250 76560 12 PERICARDIAL TAPPING 7880 9060 11030 13780 PERIPHERAL ANGIOGRAPHY / DSA 13 12500 14370 17500 21880 Package 14 PERIPHERAL ANGIOPLASTY Package 168750 194060 236250 295310 15 Radio frequency ablation with EP study 123750 142310 173250 216560 16 Radio Frequency Ablation(RFA) Package 100000 115000 140000 175000 17 RENAL ANGIOGRAPHY PACKAGE 13750 15810 19250 24060 18 RENAL ANGIOPLASTY Package 155000 178250 217000 271250 19 SWAN GANZ CATHETERIZATION 9380 10780 13130 16410 20 TEMPORARY PACEMAKER WITH MATERIAL 18130 20840 25380 31720
4 PEDIATRICS AND NEONATOLOGY S.No. Service Name opd NICU 1 CATHETERIZATION 500 2 CVP LINE WITHOUT MATERIAL 3125 3 DRESSING LARGE 1250 4 DRESSING MEDIUM 750 5 DRESSING EXTRA LARGE 2250 6 DRESSING SMALL 500 7 EXCHANGE BLOOD TRANSFUSION 8000 8 ENDOTRACHEAL INTUBATION 1250 9 HYDROSTATIC PROCEDURE 10125 10 INTERCOSTAL DRAINAGE 3000 11 LUMBAR PUNCTURE 1250 12 NEBULISER/PER DAY 375 NEONATAL RESUSSCITATION-NORMAL 13 2125 DELIVERY NEONATAL RESUSCITATION 14 3000 (CAESAREAN) 15 PARTIAL EXCHANGE 3000 16 PERIPHERAL ARTERIAL LINE 1000 17 PERIPHERAL CVP LINE 2125 PHOTOTHERAPY SINGLE SURFACE 18 1000 (PER DAY) PHOTOTHERAPY DOUBLE SURFACE 19 1875 (PER DAY) 20 PLEURAL TAP 2250 21 SURFACTANT PROCEDURE 4000 22 UMBILICAL CANNULATION 1000 23 Neonatal Sepsis Screen -1 1115.5 24 Neonatal Sepsis Screen -2 2300 25 Neonatal Growth Profile -1 690 26 Neonatal Growth Profile -2 1725 27 Neonatal Jaundice -1 1955 28 Neonatal Jaundice -2 3105
5 LABORATORY DIAGNOSTICS S.NO. SERVICE NAME “OPD” GW TWIN SINGLE SUITE 1 Total iron binding capacity (TIBC) 490 590 680 830 1030 05 - DRUG SUSCEPTIBILITY, BACTEC 2 8020 9580 11020 13410 16770 AFB 10 - DRUG SUSCEPTIBILITY, BACTEC 3 12020 14370 16530 20120 25150 AFB 4 10 DRUG SENSITIVITY AFB 15560 18600 21390 26040 32550 5 12 DRUG SENSITIVITY AFB 15020 17960 20650 25140 31430 6 24 Hrs. Urinary calcium 380 450 520 630 790 7 4 DRUG SENSITIVITY FOR FUNGUS 5620 6720 7730 9410 11760 8 4 Drugs Panel Mycobactrium 3890 4650 5350 6510 8140 9 5 DRUG SENSITIVITY AFB 7590 9080 10440 12710 15890 5-HYDROXYINDOLEACETIC ACID, 10 4040 4830 5550 6760 8450 5-HIAA, RANDOM URINE 11 A/G RATIO 400 480 550 670 840 12 Absolute Eosinophil Count 170 210 240 290 370 ACETYLCHOLINE RECEPTOR 13 4430 5290 6080 7410 9260 AUTOANTIBODIES 14 ACID PHOSPHATASE, PROSTATIC 520 620 710 870 1090 15 ACID PHOSPHATASE, TOTAL 290 340 390 480 600 ACTH STIMULATION TEST FOR 16 750 890 1020 1250 1560 CORTISOL ACTH STIMULATION TEST FOR DHEA 17 3170 3800 4370 5320 6650 SULPHATE 18 ACTH, PLASMA 2390 2860 3290 4000 5010 Activated Partial Thromboplastin Time 19 390 470 540 660 820 (APTT) 20 ADENOSINE DEAMINASE, ADA 680 810 930 1130 1420 21 AFB CULTURE 1150 1380 1590 1930 2420 AFB IDENTIFICATION, RAPID, NAP 22 2210 2640 3040 3700 4620 TEST 23 AFB Stain (Z N) / Smear Exam 350 410 470 570 720 AFB Stain (Z N) / Smear Exam.- 24 350 410 470 570 720 Sputum 25 Albumin 210 250 290 350 440 26 ALBUMIN CREATININE RATIO (URINE) 630 760 870 1060 1330 27 ALCOHOL SCREEN, BLOOD 3040 3630 4170 5080 6350 28 ALCOHOL SCREEN, RANDOM URINE 3040 3630 4170 5080 6350 29 ALDOLASE 1520 1820 2090 2550 3190 30 ALDOSTERONE 3330 3990 4590 5590 6980 31 Alkaline Phosphatase (ALP) 230 280 320 390 490 32 ALKAPTONURIA, URINE 370 440 510 620 770 33 ALLERGY COMPREHENSIVE PROFILE 9430 11280 12970 15790 19740 Allergy Wheeze/Rhinitis Comprehensive 34 14950 17880 20560 25030 31290 Panel Adult 35 Allergy, Phadiatop 1140 1360 1560 1900 2380 36 Alpha Fetoprotein 1150 1380 1590 1930 2420 ALPHA-1-ANTITRYPSIN 37 2880 3440 3960 4820 6020 QUANTITATION
6 S.NO. SERVICE NAME “OPD” GW TWIN SINGLE SUITE ALPHA-FETOPROTEIN, AFP,AMNIOTIC 38 1350 1610 1850 2250 2820 FLUID 39 AMINO ACID, QUALITATIVE, PLASMA 10710 12800 14720 17920 22400 40 AMINO ACID, QUALITATIVE, URINE 10710 12800 14720 17920 22400 41 Ammonia 1610 1930 2220 2700 3380 42 AMOEBIC SEROLOGY 2070 2480 2850 3470 4340 43 ANA Profile 5180 6190 7120 8670 10830 44 ANA WITH ELISA* 1320 1580 1820 2210 2770 45 ANCA 2890 3450 3970 4830 6040 ANCA-MPO ANTIMYELOPEROXIDASE 46 2530 3030 3480 4240 5300 Ab( P-ANCA ) ANCA-PR3, SERIN PROTEINASE 3 Ab, 47 2530 3030 3480 4240 5300 ELISA ( C- ANCA ) 48 ANDROSTENEDIONE 2590 3090 3550 4330 5410 ANGIOTENSIN CONVERTING 49 1660 1980 2280 2770 3470 ENZYME, (ACE) 50 ANGIOTENSIN II 10750 12860 14790 18000 22510 ANTI - DS DNA AB, DOUBLE 51 4160 4980 5730 6970 8720 STRANDED IN DILUTION ANTI - DS DNA ANTIBODY, DOUBLE 52 2590 3090 3550 4330 5410 STRANDED ANTI - SS DNA ANTIBODY, SINGLE 53 3900 4660 5360 6520 8160 STRANDED 54 ANTI - T3 AUTOANTIBODY 21770 26030 29930 36440 45550 55 ANTI - T4 AUTOANTIBODY 21770 26030 29930 36440 45550 ANTI CARDIOLIPIN Ab PANEL, 56 3900 4660 5360 6520 8160 IGG+IGA+IGM 57 ANTI CARDIOLIPIN Ab, IGA 1350 1610 1850 2250 2820 58 ANTI CARDIOLIPIN Ab, IGG 1350 1610 1850 2250 2820 59 ANTI CARDIOLIPIN Ab, IGM 1350 1610 1850 2250 2820 ANTI CYCLIC CITRULLINATED 60 1950 2340 2690 3280 4100 PEPTIDE;ANTI CCP ANTI ECHINOCOCCUS Ab, HYDATID 61 1950 2340 2690 3280 4100 SEROLOGY, IGG ANTI ERYTHROPOIETIN ANTIBODY 62 2510 3000 3450 4200 5250 (EPO) 63 ANTI HBSAG 1140 1360 1560 1900 2380 64 Anti HEV IgG 2590 3090 3550 4330 5410 65 ANTI LKM ANTIBODY 2590 3090 3550 4330 5410 66 ANTI MULLERIAN HORMONE, AMH 3010 3600 4140 5040 6300 Anti NMDA Receptor/Anti Glutamate 67 7240 8660 9960 12120 15160 Antibody ANTI NUCLEAR Ab / FACTOR IFA 68 2130 2540 2920 3560 4450 (HEP-2) ANTI SACCHAROMYCES CEREVISIAE 69 3220 3850 4430 5390 6740 (ASCA) IgA ANTIBODIES ANTI SACCHAROMYCES CEREVISIAE 70 3220 3850 4430 5390 6740 (ASCA) IgG ANTIBODIES ANTI TAENIA SOLIUM, 71 1830 2190 2520 3070 3830 CYSTICERCOSIS, IGG ANTI THROMBIN III 72 5320 6370 7330 8920 11150 ACTIVITY(FUNCTIONAL)
7 S.NO. SERVICE NAME “OPD” GW TWIN SINGLE SUITE 73 ANTI-DNASE B 1700 2040 2350 2860 3570 74 Anti-HCV 660 780 900 1090 1370 ANTINEUTROPHIL CYTOPLASMIC Ab, 75 2820 3370 3880 4720 5900 ANCA ANTIPHOSPHOLIPID Ab PANEL, IGG 76 5380 6440 7410 9020 11270 + IGM 77 ANTIPHOSPHOLIPID Ab, IGG 1610 1930 2220 2700 3380 78 ANTIPHOSPHOLIPID Ab, IGM 1610 1930 2220 2700 3380 ANTIPHOSPHOLIPID SYNDROME 79 6440 7700 8860 10780 13480 PANEL 80 ANTISPERM Ab, SERUM 1520 1820 2090 2550 3190 81 Antistreptolysin O (ASO) 630 760 870 1060 1330 82 ANTITHROMBIN FUNCTIONAL 5320 6370 7330 8920 11150 ANTITHYROGLOBULIN ANTIBODY; 83 2890 3450 3970 4830 6040 ANTI Tg ANTITHYROID Ab PANEL 84 (ANTITHYROGLOBULIN 4160 4980 5730 6970 8720 +ANTITHYROIDPEROXIDASE) ANTITHYROID PEROXIDASE 85 2070 2480 2850 3470 4340 ANTIBODY, ANTI TPO 86 ANTI-TSH AUTOANTIBODY 21770 26030 29930 36440 45550 87 APTT - PACKAGE 520 620 710 870 1090 88 ARSENIC LEVEL 4750 5680 6530 7950 9940 89 Arterial Blood Gas (ABG) 760 910 1050 1270 1590 90 ARYL SULPHATASE A 2850 3410 3920 4770 5970 91 ASPERGILLUS ANTIBODY IGG 3160 3780 4350 5290 6620 92 ASPERGILLUS ANTIBODY IGM 3160 3780 4350 5290 6620 93 Auramine-AFB 380 450 520 630 790 94 AUTOIMMUNE HEPATITIS PANEL - I 5470 6550 7530 9170 11460 95 B12 vitamin 1610 1930 2220 2700 3380 96 BACTERIAL MENINGITS SCREEN 4140 4950 5690 6930 8660 BACTERIAL VAGINOSIS AND 97 380 450 520 630 790 CANDIDA (NUGENTS SCORING) 98 BCR - ABL PCR, QUANTITATIVE 7500 8970 10320 12560 15700 99 Bence jones protein 380 450 520 630 790 BETA 2 MICROGLOBULIN, RANDOM 100 2440 2920 3360 4090 5110 URINE 101 BETA 2 MICROGLOBULIN, SERUM 2440 2920 3360 4090 5110 102 BETA -2 TRANSFERRIN 5180 6190 7120 8670 10830 103 BIle Pigments 170 210 240 290 370 104 Bile Salts 170 210 240 290 370 105 Bilirubin Indirect 230 280 320 390 490 106 Bilirubin Total 230 280 320 390 490 107 BILIRUBIN, TOTAL, DIRECT & INDIRECT 290 340 390 480 600 108 Biotinidate Quantitative Blood 4650 5560 6390 7780 9730 109 BLEEDING TIME (BT) 400 480 550 670 840 110 BLOOD GROUPING 230 280 320 390 490 BLOOD CULTURE AND SENSITIVITY 111 1440 1720 1980 2410 3010 AEROBIC 112 BLOOD SUGAR, FASTING & PP 230 280 320 390 490
8 S.NO. SERVICE NAME “OPD” GW TWIN SINGLE SUITE 113 BLOOD SUGAR, REFLO 90 110 130 150 190 114 BLOOD SUGAR, REFLO,PP 90 110 130 150 190 115 Blood Urea 230 280 320 390 490 116 Body Fluid Amylase 460 550 630 770 960 117 BODY FLUIDS, ROUTINE 630 760 870 1060 1330 118 BONE BIOPSY 13340 15950 18340 22330 27910 119 Bone Marrow Aspiration 1150 1380 1590 1930 2420 120 Bone Marrow Biopsy 6090 7290 8380 10210 12760 121 BONE MARROW, IRON STAIN 630 760 870 1060 1330 122 BONE MARROW, PAS 400 480 550 670 840 123 BONE MARROW, SMEAR 400 480 550 670 840 BONE MARROW+PERIPHERAL SMEAR, 124 3280 3920 4510 5490 6860 CPROC BONE MARROW+PERIPHERAL SMEAR, 125 1440 1720 1980 2410 3010 REPORTING BRONCHO ALVEOLAR SPECIMEN FOR 126 PNEUMOCYSTIS SPECIES IMMUNO 2590 3090 3550 4330 5410 FLUORESCENCE 127 Brucella Ab 3040 3630 4170 5080 6350 128 B-TYPE NATRIURETIC PEPTIDE, BNP 3010 3600 4140 5040 6300 129 BUFFY COAT FOR LD BODIES 400 480 550 670 840 C1 ESTERASE INHIBITOR,PROTEIN 130 3680 4400 5060 6160 7700 QUANTITATION 131 C3 COMPLEMENT COMPONENT 1070 1280 1470 1790 2240 132 C4 COMPLEMENT COMPONENT 1010 1210 1390 1690 2120 133 CA 125, OVARIAN CANCER MARKER 1950 2340 2690 3280 4100 134 CA 15.3, BREAST CANCER MARKER 2170 2600 2990 3640 4550 CA 19.9, PANCREATIC CANCER 135 2300 2750 3160 3850 4810 MARKER CA 27.29 & CA 15.3, BREAST CANCER 136 13350 15960 18350 22340 27930 MARKERS PANEL 137 CA 27.29, BREAST CANCER MARKER 11530 13790 15860 19310 24130 138 CALCITONIN 3470 4150 4770 5810 7260 139 Calcium (Serum) 230 280 320 390 490 140 Calcium Ionized 1010 1210 1390 1690 2120 141 CALCIUM, 24-HOUR URINE* 400 480 550 670 840 142 CANDIDA ALBICANS ANTIBODY 4160 4980 5730 6970 8720 143 CAPILLARY FRAGILITY TEST 350 410 470 570 720 144 CARBAMAZEPINE 1490 1790 2060 2510 3130 145 CARCINO EMBRYONIC ANTIGEN,CEA 1090 1310 1510 1830 2290 146 CARDIAC ENZYME 1550 1860 2140 2600 3260 CATECHOLAMINES + VMA, 24-HOUR 147 13190 15770 18140 22080 27600 URINE 148 CATECHOLAMINES PLASMA 10630 12710 14620 17790 22240 149 CATECHOLAMINES, 24-HOUR URINE 6440 7700 8860 10780 13480 150 CATECHOLAMINES, RANDOM URINE 7490 8950 10290 12530 15660 151 CD4 COUNTS 2510 3000 3450 4200 5250 152 C-ERB B2/ HER-2 NEU 2350 2810 3230 3930 4920 153 CERULOPLASMIN, SERUM 1750 2090 2400 2930 3660
9 S.NO. SERVICE NAME “OPD” GW TWIN SINGLE SUITE 154 CERVICAL BIOPSY 800 960 1100 1340 1680 155 CH50 COMPLEMENT TOTAL SERUM 3910 4680 5380 6550 8190 156 Chikungunya Detection PCR 5750 6880 7910 9630 12040 157 Chikungunya IgM 1550 1860 2140 2600 3260 CHLAMYDIA TRACHOMATIS, PCR 158 2690 3220 3700 4510 5640 (QUALITATIVE) 159 Chloride 210 250 290 350 440 160 CHLORIDE, 24 HOUR URINE* 400 480 550 670 840 161 CHOLINESTERASE SERUM 760 910 1050 1270 1590 162 CHROMOGRANIN A : CGA 10290 12310 14160 17230 21540 CHROMOSOME ANALYSIS 163 5000 5980 6880 8370 10470 (KARYOTYPE) BLOOD CHROMOSOME ANALYSIS FOR 164 5320 6370 7330 8920 11150 HEMATOLOGIC MALIGNANCY CHROMOSOME ANALYSIS, PRODUCT 165 6990 8360 9610 11700 14630 OF CONCEPTION 166 CHYLE EXAMINATION 790 950 1090 1330 1660 167 CHYLE EXAMINATION 800 960 1100 1340 1680 168 CITRATE 24-HOUR URINE 1210 1440 1660 2020 2520 169 CKMB 750 890 1020 1250 1560 CLINICAL TOXICOLOGY SCREEN 170 12520 14970 17220 20960 26200 URINE 171 Clot retraction test 380 450 520 630 790 172 CLOTTING TIME (CT) 400 480 550 670 840 173 CMV DNA Qualitative, Rt-PCR 10410 12440 14310 17420 21770 174 COAGULATION PROFILE 2 4960 5930 6820 8300 10380 175 COMPLEMENT PROFILE 15260 18250 20990 25550 31940 Complete Blood Count(CBC), EDTA 176 400 480 550 670 840 Whole Blood 177 Comprehensive Metabolic Panel 3140 3750 4310 5250 6560 COMPREHENSIVE METABOLIC 178 2170 2600 2990 3640 4550 SCREEN, URINE 179 COOMBS TEST, DIRECT 800 960 1100 1340 1680 180 COOMBS TEST, INDIRECT 800 960 1100 1340 1680 COPPER, 24-HOUR URINE, ATOMIC 181 3020 3620 4160 5070 6340 ABSORPTION COPPER, RANDOM URINE, ATOMIC 182 3020 3620 4160 5070 6340 ABSORPTION COPPER, SERUM, ATOMIC 183 2590 3090 3550 4330 5410 ABSORPTION COPPER, SERUM, 184 1100 1320 1520 1850 2310 SPECTROPHOTOMETRY 185 Cortisol (Evening) 920 1100 1270 1540 1930 186 Cortisol (Morning) 920 1100 1270 1540 1930 187 CORTISOL, FREE, 24 HOURS URINE 920 1100 1270 1540 1930 188 CORTISOL, FREE, 24-HOUR URINE 920 1100 1270 1540 1930 189 C-PEPTIDE 1440 1720 1980 2410 3010 CPK ISOENZYME ELECTROPHORESIS, 190 12780 15280 17570 21390 26740 CK ISOENZYMES 191 C-Reactive Protein (CRP) 630 760 870 1060 1330 192 Creatine phosphokinase (CPK) 460 550 630 770 960 10 S.NO. SERVICE NAME “OPD” GW TWIN SINGLE SUITE 193 Creatinine Clearance 630 760 870 1060 1330 194 CREATININE, 24-HOUR URINE* 380 450 520 630 790 CRYOGLOBULINS SCREEN 195 1510 1800 2070 2520 3150 QUALITATIVE 196 CRYPTOCOCCUS ANTIGEN, CSF 3230 3860 4440 5400 6760 197 CRYPTOCOCCUS ANTIGEN, SERUM 3230 3860 4440 5400 6760 CRYPTOSPORIDIUM ANTIGEN 198 1670 1990 2290 2790 3480 DETECTION FROM STOOL CSF AND SERUM PROTEIN 199 5890 7040 8100 9860 12320 ELECTROPHORESIS 200 CSF EXAMINATION 690 830 950 1160 1450 CSF PROTEIN ELECTROPHORESIS / 201 6440 7700 8860 10780 13480 OLOGOCLONAC BANDS CSF PROTEIN ELECTROPHORESIS, 202 5510 6590 7580 9230 11530 OLIGOCLONAL BANDS, CSF 203 CULTURE BODY FLUIDS AEROBIC 1750 2090 2400 2930 3660 CULTURE AEROBIC BACTRIA 204 1890 2260 2600 3160 3960 SENSITIVITY CULTURE AND SENSITIVITY 205 1010 1210 1390 1690 2120 MISCELLANEOUS 206 CULTURE, AEROBIC, EYE SWAB 1010 1210 1390 1690 2120 207 CULTURE, AEROBIC, NASAL SWAB 1010 1210 1390 1690 2120 208 CULTURE, AEROBIC, PUS 1010 1210 1390 1690 2120 209 CULTURE, AEROBIC, THROAT SWAB 1010 1210 1390 1690 2120 210 CULTURE, AEROBIC, VAGINAL SWAB 1010 1210 1390 1690 2120 211 CULTURE, ANAEROBIC 1750 2090 2400 2930 3660 212 CULTURE, ANAEROBIC, BLOOD RAPID 1440 1720 1980 2410 3010 CULTURE, ANAEROBIC, BODY FLUIDS, 213 1440 1720 1980 2410 3010 RAPID 214 CULTURE, CHOLERA 1010 1210 1390 1690 2120 215 CULTURE, DIPHTHERIA 1750 2090 2400 2930 3660 216 CULTURE, FUNGUS, BLOOD, RAPID 1380 1650 1900 2310 2890 CULTURED AEROBIC BACTERIA 217 1490 1790 2060 2510 3130 IDENTIFICATION CULTURED AFB MOTT DROG 218 10930 13060 15020 18280 22860 SENSITIVITY FOR SLOW GROWERS CULTURED ANAEROBIC BACTERIA 219 1720 2060 2370 2880 3610 IDENTIFICATION 220 Cystatin C 2010 2410 2770 3370 4220 221 CYSTIC FIBROSIS, NEONATAL SCREEN 750 890 1020 1250 1560 222 CYTOLOGY OF FLUID 400 480 550 670 840 CYTOLOGY, CELL BLOCK 223 740 880 1010 1230 1540 PREPARATION CYTOLOGY, CONSULTATION - 224 690 830 950 1160 1450 SECOND OPINION 225 CYTOMEGALOVIRUS ,CMV, IGM 1070 1280 1470 1790 2240 CYTOMEGALOVIRUS(CMV) 226 1510 1800 2070 2520 3150 ANTIBODIES PANEL-IGG & IGM CYTOMEGALOVIRUS, CMV, Ab PANEL 227 1560 1870 2150 2620 3270 (IGG + IGM) 228 CYTOMEGALOVIRUS, CMV, IGG 1070 1280 1470 1790 2240
11 S.NO. SERVICE NAME “OPD” GW TWIN SINGLE SUITE 229 CYTOMEGALOVIRUS, CMV, PCR 6440 7700 8860 10780 13480 230 D-dimers 1780 2130 2450 2980 3730 231 DENGUE ANTIGEN NSI 690 830 950 1160 1450 232 DENGUE RNA PCR 5510 6590 7580 9230 11530 233 Dengue Virus IgG/IgM, Dengue combo 1380 1650 1900 2310 2890 234 DEOXYCORTICOSTERONE 17710 21180 24360 29650 37070 235 DEXAMETHASONE 10930 13060 15020 18280 22860 236 DHEA 3900 4660 5360 6520 8160 237 DHEAS 1670 1990 2290 2790 3480 238 DIALYSIS FLUID EXAMINATION 920 1100 1270 1540 1930 239 DIAZEPAM, SERUM 18350 21950 25240 30730 38410 240 Differential Count (DLC) 290 340 390 480 600 241 Digoxin 1510 1800 2070 2520 3150 Direct Immunofluorescence (Skin & 242 2390 2860 3290 4000 5010 Kidney) 243 DNA HISTOGRAM 5060 6050 6960 8470 10590 244 DOPAMINE PLASMA 5060 6050 6960 8470 10590 245 Dust Panel 3140 3750 4310 5250 6560 EAR SWAB CULTURE AND SENSTIVITY 246 1010 1210 1390 1690 2120 AEROBIC ECHINOCOCCUS(HYDATED) 247 2740 3270 3760 4580 5720 SEROLOGY 1GG 248 Eczema Panel for Non-Vegetarians 5750 6880 7910 9630 12040 249 Eczema Panel for Vegetarians 4260 5090 5850 7130 8910 250 EGFR 290 340 390 480 600 251 ENDOMYSIAL ANTIBODY IGA, IFA 2220 2650 3050 3710 4640 252 EPSTEIN BARR VIRUS Ab, IGG 2510 3000 3450 4200 5250 253 EPSTEIN BARR VIRUS Ab, IGG & IGM 4700 5620 6460 7870 9840 254 EPSTEIN BARR VIRUS Ab, IGM 2510 3000 3450 4200 5250 255 Erythrocyte Sedimentation Rate (ESR) 170 210 240 290 370 256 ERYTHROPOIETIN (EPO) 3230 3860 4440 5400 6760 257 Estradiol 890 1060 1220 1480 1860 258 ESTRIOL (E3) TOTAL, SERUM 1830 2190 2520 3070 3830 ESTRIOL, UNCONJUGATED (UE3) 259 1970 2350 2700 3290 4110 SERUM 260 ESTROGEN RECEPTOR, ER 1830 2190 2520 3070 3830 261 Excision Biopsy 7900 9450 10870 13230 16540 262 EXTRA SLIDE 400 480 550 670 840 263 FACTOR IX, FUNCTIONAL 2890 3450 3970 4830 6040 264 FACTOR V FUNCTIONAL 4260 5090 5850 7130 8910 265 FACTOR V LEIDEN 7500 8970 10320 12560 15700 266 FACTOR VIII STUDIES 2890 3450 3970 4830 6040 267 FACTOR X, FUNCTIONAL 6460 7730 8890 10820 13530 268 FAST PLAQUE TB ASSAY 1100 1320 1520 1850 2310 FAST PLAQUE TB ASSAY + RAPID AFB 269 1670 1990 2290 2790 3480 CULTURE 270 FEBRILE AGGLUTININS PANEL 1660 1980 2280 2770 3470 271 Fecal Calprotectin 4020 4810 5530 6730 8420 272 Ferritin,Serum 920 1100 1270 1540 1930
12 S.NO. SERVICE NAME “OPD” GW TWIN SINGLE SUITE 273 Fibrinogen( FDP) 1630 1950 2240 2730 3410 274 FIBRINOGEN, CLOTTING ACTIVITY 760 910 1050 1270 1590 FILARIA, WUCHERIA BANCROFTI, 275 1100 1320 1520 1850 2310 ANTIGEN FLUID FOR CYTOLOGY/MALIGNANT 276 920 1100 1270 1540 1930 CELL 277 FNAC - For Reporting 1040 1240 1430 1740 2170 278 FNAC, PROCEDURE 290 340 390 480 600 279 FOLATE 1670 1990 2290 2790 3480 280 Folate, RBC 2300 2750 3160 3850 4810 281 Follicle-stimulating hormone (FSH) 980 1170 1350 1640 2050 FREE PROSTATE SPECIFIC ANTIGEN, 282 1550 1860 2140 2600 3260 (PSA) 283 Free T3 510 610 700 850 1070 284 Free T4 510 610 700 850 1070 285 FT3 + FT4 + TSH 1150 1380 1590 1930 2420 286 FUNGUS CULTURE 1440 1720 1980 2410 3010 FUNGUS EXAMINATION, ROUTINE, 287 400 480 550 670 840 KOH PREPARATION FUNGUS EXAMINATION,INDIA INK 288 400 480 550 670 840 PREPARATION 289 G6PD Qualitative 1140 1360 1560 1900 2380 290 GALL STONE ANALYSIS 1830 2190 2520 3070 3830 291 Gamma GT 350 410 470 570 720 292 GBM AB 2820 3370 3880 4720 5900 293 GENE XPERT 3330 3990 4590 5590 6980 294 GLIADIN ANTIBODY, IGA 4400 5270 6060 7380 9220 295 GLIDIAN ANTIBODY IgA & IgG 4310 5160 5930 7220 9030 296 GLIDIAN ANTIBODY IGG 2010 2410 2770 3370 4220 297 Globulin 130 150 170 210 260 GLU-6-PHOSPHATE DEHYDROGE 298 1520 1820 2090 2550 3190 (G-6-PD) QUANT 299 Glucagon 6090 7290 8380 10210 12760 300 Glucose (PP) 120 140 160 200 250 301 Glucose (Fasting) 120 140 160 200 250 302 Glucose Challenge Test (GCT) 240 290 330 410 510 303 GLUCOSE OF BODY FLUID 120 140 160 200 250 304 Glucose Random (RBS) 120 140 160 200 250 GLUCOSE TOLERANCE TEST, GTT, 305 630 760 870 1060 1330 (FOUR SPECIMENS) GLUTAMIC ACID 306 8840 10570 12160 14800 18500 DECARBOXYLASE,GAD,IGG 307 Glycocylated Hemoglobin (HbA1C) 690 830 950 1160 1450 308 Gram Stain - Sputum 230 280 320 390 490 309 GRAMS STAIN 230 280 320 390 490 310 GROWTH HORMONE STIMULATION 5000 5980 6880 8370 10470 311 H1N1 INFLUENZA 5650 6750 7760 9450 11810 312 Haemogram , Blood 560 670 770 940 1170 313 HANGING DROP FOR CHOLERA 230 280 320 390 490 314 HAPTOGLOBIN,SERUM 5470 6550 7530 9170 11460
13 S.NO. SERVICE NAME “OPD” GW TWIN SINGLE SUITE 315 HB ELECTROPHORESIS (HPLC) 1610 1930 2220 2700 3380 316 HbsAg 720 870 1000 1220 1520 317 HBSAG, ELISA 890 1060 1220 1480 1860 HCG, BETA SUBUNIT, QUANTITATIVE, 318 920 1100 1270 1540 1930 RANDOM URINE 319 HCV ELISA 1090 1310 1510 1830 2290 320 HCV RNA GENOTYPE LIPA 10020 11980 13780 16770 20970 321 HCV RNA QUALITATIVE 5180 6190 7120 8670 10830 322 HCV RNA QUANTITATIVE 13350 15960 18350 22340 27930 323 HDL - Cholesterol 380 450 520 630 790 324 HELICOBACTER PYLORI PANEL 4960 5930 6820 8300 10380 325 HELICOBACTER PYLORI, IGA 3500 4180 4810 5850 7320 326 HELICOBACTER PYLORI, IGG 3500 4180 4810 5850 7320 327 Hematocrit 120 140 160 200 250 328 Hemoglobin (HB) 120 140 160 200 250 329 HEMOGLOBIN FREE URINE 330 400 460 560 700 330 HEPATITIS A Ab, IGM 1900 2270 2610 3180 3970 331 HEPATITIS A Ab, TOTAL 1660 1980 2280 2770 3470 HEPATITIS A DIAGNOSTIC PANEL, 332 3690 4410 5070 6170 7720 TOTAL+IGM 333 HEPATITIS ACUTE DIAGNOSTIC PANEL 3900 4660 5360 6520 8160 HEPATITIS B CHRONIC PANEL 334 2590 3090 3550 4330 5410 (HBSAG+ HBEAG+ HBEAb) 335 HEPATITIS B CORE Ab, HBcAb, IGM 1520 1820 2090 2550 3190 336 HEPATITIS B CORE Ab, HBcAb, TOTAL 1510 1800 2070 2520 3150 337 HEPATITIS B SURFACE Ab, HBsAb 1010 1210 1390 1690 2120 HEPATITIS B VIRAL DRUG RESISTANCE 338 11390 13610 15650 19050 23820 & GENOTYPING 339 HEPATITIS B VIRUS, PCR (QUALITATIVE) 7060 8440 9710 11820 14770 HEPATITIS B VIRUS,PCR(QUAN), VIRAL 340 8770 10490 12060 14690 18360 LOAD ESTIMATION ( HBV PCR ) 341 HEPATITIS BE Ab, HBeAb 1300 1550 1780 2170 2710 342 HEPATITIS BE ANTIGEN, HBeAG 1370 1640 1890 2300 2870 343 HEPATITIS BE PANEL (HBeAb+ HBeAG) 2120 2530 2910 3540 4430 344 HEPATITIS C Ab, HCV Ab, IGG 2210 2640 3040 3700 4620 345 HEPATITIS C VIRUS, PCR (QUALITATIVE) 5770 6900 7930 9660 12080 HEPATITIS C VIRUS,PCR(QUAN)-VIRAL 346 10630 12710 14620 17790 22240 LOAD ESTIMATION 347 HEPATITIS DELTA ANTIBODIES (HDV) 3270 3910 4500 5470 6840 348 HEPATITIS E ANTIBODY, HEV Ab, IGM 2530 3030 3480 4240 5300 349 HERPES SIMPLEX I, IGG 1070 1280 1470 1790 2240 350 HERPES SIMPLEX I, IGM 1070 1280 1470 1790 2240 351 HERPES SIMPLEX II, IGG 1070 1280 1470 1790 2240 352 HERPES SIMPLEX II, IGM 1070 1280 1470 1790 2240 Herpes Simplex Virus (HSV) Type 1, 353 7240 8660 9960 12120 15160 PCR, Qualitative Herpes Simplex Virus (HSV) Type 2, 354 7240 8660 9960 12120 15160 PCR, Qualitative HERPES SIMPLEX VIRUS 1 & 2, PCR 355 10650 12730 14640 17820 22280 (QUALITATIVE)
14 S.NO. SERVICE NAME “OPD” GW TWIN SINGLE SUITE High Sensitivity C-Reactive Protein 356 1010 1210 1390 1690 2120 (Hscrp) 357 HISTO SLIDES 290 340 390 480 600 358 HISTONE ANTIBODIES 1710 2050 2360 2870 3590 359 HISTOP, LARGE BIOPSIES 2190 2610 3000 3650 4570 360 HISTOP, MEDIUM BIOPSIES 1610 1930 2220 2700 3380 361 HISTOP, RADICAL BIOPSIES 4140 4950 5690 6930 8660 362 HISTOP, SMALL BIOPSIES 860 1030 1180 1440 1800 HISTOPATHOLOGY KIDNEY BIOPSY 363 4700 5620 6460 7870 9840 PANEL 1 364 Histopathology,Kidney Biopsy Panel 3 10350 12380 14240 17330 21670 365 HISTOPATOLOGY LIVER BIOPSY PANEL 2130 2540 2920 3560 4450 366 HIV ELISA 760 910 1050 1270 1590 367 HIV I & II 630 760 870 1060 1330 368 HIV MONITOR(CD4/CD8/VIRAL LOAD) 10020 11980 13780 16770 20970 369 HIV1 &2 ANTIBODIES, WESTERN BLOT 4770 5710 6570 7990 9990 HIV1 RNA QUANTITATIVE REAL TIME 370 6040 7220 8300 10110 12640 PCR 371 HLA-B 27 PCR 4600 5500 6320 7700 9630 372 HLA-B27, FLOW CYTOMETRY 3040 3630 4170 5080 6350 373 HLA-B5, SEROLOGY 6440 7700 8860 10780 13480 HOMOCYSTEINE, QUANTITATIVE, 374 1210 1440 1660 2020 2520 SERUM HOMOVANILLIC ACID, HVA,RANDOM 375 11030 13190 15170 18470 23080 URINE HPV DNA CERVICAL SPECIMEN OR 376 3330 3990 4590 5590 6980 BIOPSIES 377 HUMAN GROWTH HORMONE 1210 1440 1660 2020 2520 HUMAN PAPILLOMAVIRUS, (HYBRID 378 2760 3300 3790 4620 5780 CAPTURE ASSAY-2) 379 HYDROXY PROGESTERONE (17-OHP) 2010 2410 2770 3370 4220 380 IBD SCREENING PANEL 5470 6550 7530 9170 11460 IGF (I & GROWTH HORMONE 381 5840 6990 8040 9790 12230 FACTOR) 382 IHC Marker-1 1840 2200 2530 3080 3850 383 IHC, LYMPHOMA PANEL 9660 11550 13280 16170 20210 IMMUNE DEFICIENCY PANEL CD4/ 384 3080 3690 4240 5170 6460 CD8 COUNTS IMMUNOFIXATION 385 ELECTROPHORESIS (IFE) 24 HOURS 10100 12070 13880 16900 21120 URINE IMMUNOFIXATION 386 10650 12730 14640 17820 22280 ELECTROPHORESIS, SERUM 387 IMMUNOGLOBULIN IGA,SERUM 1070 1280 1470 1790 2240 388 IMMUNOGLOBULIN IGE,SERUM 1220 1460 1680 2040 2560 Immunoglobulin IgG Synthesis Index & 389 2880 3440 3960 4820 6020 Rate IMMUNOGLOBULIN IGG, 390 21690 25930 29820 36300 45380 SUBCLASSES 391 IMMUNOGLOBULIN lGG, SERUM 1150 1380 1590 1930 2420 392 IMMUNOGLOBULIN lGM, SERUM 670 800 920 1120 1400
15 S.NO. SERVICE NAME “OPD” GW TWIN SINGLE SUITE 393 INDIA INK STAIN 400 480 550 670 840 INDIVIDUAL DRUG SENSITIVITY 394 1480 1770 2040 2480 3100 EXCEPT PZA (16 DRUGS) 395 INFLUENZA ANTIGEN A & B 2360 2820 3240 3950 4940 396 INSULIN, FASTING 1090 1310 1510 1830 2290 397 INSULIN, PP 1090 1310 1510 1830 2290 398 INSULIN, RANDOM 1090 1310 1510 1830 2290 399 INTERLEUKIN-6, IL-6 3330 3990 4590 5590 6980 400 INTRINSIC FACTOR, IGG 3010 3600 4140 5040 6300 401 IONISED CALCIUM 800 960 1100 1340 1680 IRON+ TOTAL IRON BINDING 402 600 720 830 1010 1260 CAPACITY+ TRANSFERRIN SAT 403 Issue of Slides ( Non returnable) 100 120 140 170 210 404 ISLET CELL ANTIBODY 3330 3990 4590 5590 6980 JAK2 Mutation Detection Qualitative 405 5750 6880 7910 9630 12040 PCR 406 KALA AZAR ANTIGEN TEST 1610 1930 2220 2700 3380 KAPPA/LAMBDA LIGHT 407 8510 10180 11710 14250 17820 CHAINS,FREE,SERUM 408 Ketone bodies, Urine 150 180 210 250 320 KIDNEY STONE ANALYSIS WITH 409 1830 2190 2520 3070 3830 PICTURE KIDNEY STONE ANALYSIS WITH 410 1840 2200 2530 3080 3850 PICTURE 411 LACTATE PLASMA 1630 1950 2240 2730 3410 412 LACTATE DEHYDROGENASE, LDH 400 480 550 670 840 413 LDL - Cholesterol 350 410 470 570 720 414 LE CELL 400 480 550 670 840 415 LEAD LEVEL 2510 3000 3450 4200 5250 416 Legionella Antigen EIA,Urine 6410 7660 8810 10720 13410 417 LEISHMANIA (KALA AZAR) Ab, IGG 2510 3000 3450 4200 5250 LEISHMANIA (KALA AZAR) ANTIBODY 418 2050 2450 2820 3430 4290 IGG 419 LEPTIN 4600 5500 6320 7700 9630 420 LEPTOSPIRA Ab, IGG 2170 2600 2990 3640 4550 421 LEPTOSPIRA Ab, IGM 2130 2540 2920 3560 4450 422 LEPTOSPIRA Ab, lGG + lGM 4270 5100 5870 7140 8930 423 LEPTOSPIRA DARKFIELD & CULTURE 1370 1640 1890 2300 2870 LEUCOCYTE ALKALINE PHOSPHATASE 424 1980 2370 2730 3320 4150 SCORE ( LAP SCORE) Leukemia Diagnostic Comprehensive 425 17250 20630 23720 28880 36100 Profile 7 LEUKEMIA DIAGNOSTIC PANAL CLL/ 426 10700 12790 14710 17910 22380 HCL/SLL(BASIC) LEUKEMIA DIAGNOSTIC PANEL 427 20850 24930 28670 34900 43630 ACUTE LEUKEMIAS LEUKEMIA DIAGNOSTIC PANEL AML 428 15860 18960 21800 26540 33180 CHARACTERIZATION 429 Leutinizing Hormone 890 1060 1220 1480 1860 430 LEUTINIZING HORMONE (LH) 520 620 710 870 1090 431 Lipase 690 830 950 1160 1450 16 S.NO. SERVICE NAME “OPD” GW TWIN SINGLE SUITE 432 LIPID ELECTROPHORESIS 6070 7260 8350 10160 12710 433 Lipid Profile,Serum 980 1170 1350 1640 2050 434 Lipid Profile-Extended 3650 4360 5010 6100 7630 435 LIPOPROTIEN A, LP A 1670 1990 2290 2790 3480 436 LITHIUM 520 620 710 870 1090 437 Liver Biopsy with Special Stains 12660 15140 17410 21200 26500 438 Liver Function Test (LFT),Serum 860 1030 1180 1440 1800 439 LUPUS ANTICOAGULANT 2740 3270 3760 4580 5720 440 Lyme Discase Ab IgG&IgM 4010 4800 5520 6720 8400 441 LYMPHOMA DIAGNOSTICS PANEL 23360 27930 32120 39100 48880 442 LYMPHOMA PANEL-3 10840 12970 14920 18160 22700 443 Magnesium (Serum) 630 760 870 1060 1330 444 Magnesium(Urine) 630 760 870 1060 1330 445 Malarial Parasite 180 220 250 310 390 MATERNAL SERUM SCREEN 2 446 2890 3450 3970 4830 6040 (DOUBLE MARKER) MATERNAL SERUM SCREEN 3, TRIPLE 447 4020 4810 5530 6730 8420 TEST 448 MCV 250 300 350 420 530 449 MERCURY LEVEL 4400 5270 6060 7380 9220 450 METANEPHRINES URINE 13880 16600 19090 23240 29050 451 METHAEMOGLOBIN 1350 1610 1850 2250 2820 452 MICRO PROTEIN OF BODY FLUID 800 960 1100 1340 1680 453 Microalbumin,Urine 640 770 890 1080 1350 454 MITOCHONDRIAL Ab, AMA, IFA 2680 3200 3680 4480 5600 455 Mold Panel 4140 4950 5690 6930 8660 MONO TEST (INFECTIOUS 456 1380 1650 1900 2310 2890 MONONUCLEOSIS) MUCOPOLYSACCHARIDOSIS SCREEN 457 #VALUE! 0 0 0 0 , URINE 458 MULTIPLE PROSTATE BIOPSIES 6150 7360 8460 10300 12880 459 MUMPS VIRUS AB PANEL 4350 5200 5980 7280 9100 460 Myasthenia Gravis Panel 5680 6790 7810 9510 11880 461 MYCO PLASMIN PNEUMONIA IgG 3010 3600 4140 5040 6300 462 MYCO PLASMIN PNEUMONIA IgM 3170 3800 4370 5320 6650 MYCOBACTERIUM TUBERCULOSIS, 463 3280 3920 4510 5490 6860 PCR ( TB PCR ) 464 MYCOPLASMIN PNUMONIAE (IGG) 3010 3600 4140 5040 6300 465 MYCOPLASMIN PNUMONIAE (IGM) 3170 3800 4370 5320 6650 466 MYOGLOBIN, URINE 8350 9980 11480 13970 17470 467 MYOGLOBIN,SERUM 6770 8100 9320 11340 14180 468 NASAL SMEARS FOR EOSINOPHILS 400 480 550 670 840 NEISSERIA GONORRHOEAE, PCR 469 3330 3990 4590 5590 6980 (QUALITATIVE) 470 Neuron Specific Enolase (NSE) Serum 3560 4260 4900 5960 7460 471 OPIATES SCREEN, RANDOM URINE 830 990 1140 1390 1730 472 OSMOLALITY, RANDOM URINE 1140 1360 1560 1900 2380 473 OSMOLALITY, SERUM 1220 1460 1680 2040 2560 474 OSMOTIC FRAGILITY 610 730 840 1020 1280
17 S.NO. SERVICE NAME “OPD” GW TWIN SINGLE SUITE OSTEOCALCIN, BONE GLA PROTEIN, 475 2740 3270 3760 4580 5720 BGP, SERUM 476 OXALATE 24-HOUR URINE 2610 3120 3590 4370 5460 477 PAP Smear 1150 1380 1590 1930 2420 478 PAP SMEAR, REVIEW OF SLIDES 920 1100 1270 1540 1930 479 PARATHYROID HORMONE PTH 2710 3250 3740 4550 5690 PARATHYROID HORMONE, PTH, 480 1950 2340 2690 3280 4100 INTACT 481 Parietal Cell Antibody 1760 2100 2420 2940 3680 PAROXYSMAL NOCTURNAL 482 HEMOGLOBINURIA (PNH) 8510 10180 11710 14250 17820 CONFIRMATIRY TEST;CD55 & CD59 PARVOVIRUS B-19 AB PANEL IGG & 483 8350 9980 11480 13970 17470 IGM 484 PCR FOR TB 3010 3600 4140 5040 6300 485 PERIPHERAL SMEAR 230 280 320 390 490 486 PERIPHERAL SMEAR FOR FILARIA 290 340 390 480 600 487 PHENOBARBITONE 1530 1830 2100 2560 3200 488 Phenytoin 1630 1950 2240 2730 3410 489 Phosphorous(Urine) 380 450 520 630 790 490 Phosphorus (Serum) 230 280 320 390 490 491 PLASMA RENIN ACTIVITY 6070 7260 8350 10160 12710 492 Platelet Count 170 210 240 290 370 493 PNEUMOCYSTIS SPECIES, IFA 3130 3740 4300 5240 6550 494 PNEUMOSLIDE IGM 3750 4480 5150 6270 7840 495 PNH SCREENING TEST 1510 1800 2070 2520 3150 PORPHOBILINOGEN,QUANTITATIVE 496 5150 6160 7080 8620 10780 URINE PORPHYRINS TOTAL,QUANTITATIVE 24 497 5290 6330 7280 8860 11080 HOUR URINE 498 Potassium (Serum) 210 250 290 350 440 499 PROCALCITONIN 4020 4810 5530 6730 8420 500 Progesterone 890 1060 1220 1480 1860 501 PROGESTERONE RECEPTOR, PR 1830 2190 2520 3070 3830 502 Prolactin 690 830 950 1160 1450 503 Prostatic Specific Antigen( PSA ) 1270 1510 1740 2110 2640 504 PROTEIN C, FUNCTIONAL 5510 6590 7580 9230 11530 505 Protein Electorpharesis & IFE, Serum 7360 8800 10120 12320 15400 506 Protein Electrophoresis 980 1170 1350 1640 2050 507 PROTEIN ELECTROPHORESIS URINE 5890 7040 8100 9860 12320 PROTEIN ELECTROPHORESIS,SERUM 508 1150 1380 1590 1930 2420 (DOESNT INCL IFE) 509 PROTEIN S, FUNCTIONAL 5320 6370 7330 8920 11150 510 PROTEIN TOTAL, 24-HOUR URINE 290 340 390 480 600 511 Prothrombin Time (PT INR) , Plasma 380 450 520 630 790 512 PRP THERAPEUTIC 1720 2060 2370 2880 3610 513 PSA (FREE) 1070 1280 1470 1790 2240 514 PSA (PROFILE) T/F RATIO 2510 3000 3450 4200 5250 515 PYRUVATE PYRUVIC ACID 5150 6160 7080 8620 10780 516 PZA SENSITIVITY 3040 3630 4170 5080 6350
18 S.NO. SERVICE NAME “OPD” GW TWIN SINGLE SUITE 517 Quadrapule Marker 4010 4800 5520 6720 8400 518 RAPID AFB CULTURE ONLY 1610 1930 2220 2700 3380 RAPID AFB CULTURE PLUS 519 1830 2190 2520 3070 3830 DIFFERENTIATION 520 RAPID MALARIAL ANTIGEN (R.M.C.T) 630 760 870 1060 1330 521 RBS(BY GLUCOMETER )IN WARD 90 110 130 150 190 522 Reducing Substances in Stool 250 300 350 420 530 523 Renal Function Test (KFT/RFT) Serum 860 1030 1180 1440 1800 524 Respiratory Panel 6 (PCR) 3760 4500 5180 6300 7880 525 Reticulocyte count (Retic count) 290 340 390 480 600 526 Review of Outside Slide > 10 760 910 1050 1270 1590 527 RH ANTIBODY TITER 1040 1240 1430 1740 2170 528 Rheumatoid Factor ( RA) 580 690 790 970 1210 529 Rotavirus Antigen 1380 1650 1900 2310 2890 530 RUBELLA, IGG 1140 1360 1560 1900 2380 531 RUBELLA, IGM 1070 1280 1470 1790 2240 532 SCL-70 (SCLERODERMA) AB 1270 1510 1740 2110 2640 533 Semen Analysis 690 830 950 1160 1450 534 SEMEN FRUCTOSE QUALITATIVE 460 550 630 770 960 535 SEMEN FRUCTOSE,QUANTITATIVE 330 400 460 560 700 536 SEMEN WASH 3450 4130 4750 5780 7230 SEROLOGY FOR HISTOPLASMA 537 8770 10490 12060 14690 18360 ANTIBODIES 538 Serum Amylase 400 480 550 670 840 Serum Ascities Albumin 539 290 340 390 480 600 Gradiant(SAAG) 540 Serum Creatinine 210 250 290 350 440 541 Serum Electrolytes 520 620 710 870 1090 542 SERUM FRUCTOSAMINE 1300 1550 1780 2170 2710 543 Serum Galactomannan 5870 7010 8060 9810 12270 544 SERUM GASTRIN LEVELS 2130 2540 2920 3560 4450 545 SGOT (AST) 230 280 320 390 490 546 SGPT (ALT) 230 280 320 390 490 547 Sickling Test 380 450 520 630 790 548 Single Drug Sensitivity 2880 3440 3960 4820 6020 549 Skin Biopsy 1610 1930 2220 2700 3380 SKIN / NAIL SCRAPINGS FOR 550 290 340 390 480 600 FUNGUS 551 SLIDE FOR SECOND OPINION 580 690 790 970 1210 552 Smear for Cytology 920 1100 1270 1540 1930 553 SMEAR FOR FUNGUS 290 340 390 480 600 554 Smear for Grams Stain 220 260 300 360 460 555 SMEAR FOR MALIGNANT CELLS 920 1100 1270 1540 1930 556 SMITH Ab, IGG 3330 3990 4590 5590 6980 557 SMOOTH MUSCLE Ab, IFA 2820 3370 3880 4720 5900 558 Sodium (Serum) 210 250 290 350 440 559 Sodium(Urine)24 Hour 290 340 390 480 600 560 Sodium(Urine)Random 290 340 390 480 600 561 SOMATOMEDIN - C (IGF - I) 5670 6780 7800 9490 11870
19 S.NO. SERVICE NAME “OPD” GW TWIN SINGLE SUITE SPECIAL STAINING (AFB, Gram, 562 230 280 320 390 490 Fungal) SPUTUM CULTURE AND SENSITIVITY 563 1010 1210 1390 1690 2120 AEROBIC 564 SPUTUM FOR FUNGUS 290 340 390 480 600 565 SPUTUM FOR MALIGNANT CELLS 920 1100 1270 1540 1930 566 SPUTUM, EOSINOPHIL COUNT 170 210 240 290 370 567 SS - A/RO ANTIBODY 1610 1930 2220 2700 3380 568 Stool Analysis 170 210 240 290 370 569 STOOL CULTURE & SENSITIVITY 1010 1210 1390 1690 2120 Stool Examination Hanging drop 570 230 280 320 390 490 Preparation 571 STOOL FOR DIFFICILE TOXIN 3330 3990 4590 5590 6980 572 STOOL OCCULT BLOOD 170 210 240 290 370 573 SUCROSELYSIS TEST 760 910 1050 1270 1590 574 SYNOVIAL CYTOLOGY 630 760 870 1060 1330 575 TACROLIMUS 6070 7260 8350 10160 12710 576 TB FERON GOLD 3430 4100 4720 5740 7180 577 Testosterone 1440 1720 1980 2410 3010 578 TESTOSTERONE, FREE 3040 3630 4170 5080 6350 579 THALASSEMIA PROFILE 2020 2420 2780 3390 4240 580 THROAT SWAB FOR ALBERT STAIN 350 410 470 570 720 581 Thyroglobulin TG 1840 2200 2530 3080 3850 582 Thyroid Stimulating Hormone (TSH) 580 690 790 970 1210 583 TTG 1890 2260 2600 3160 3960 584 Titration Study 8740 10450 12020 14630 18290 585 TLC 290 340 390 480 600 586 TMA/rRNA 3140 3750 4310 5250 6560 587 TMS(METABOLIC SURVEY) 6190 7400 8510 10360 12950 588 TORCH PANEL, IGG + IGM 3500 4180 4810 5850 7320 589 TORCH, IGG 2170 2600 2990 3640 4550 590 TORCH, IGM 2170 2600 2990 3640 4550 591 Total Beta HCG 1170 1400 1610 1960 2450 592 Total Cholesterol 250 300 350 420 530 593 Total Protein 290 340 390 480 600 594 TOTAL SERUM IRON, FEMALE 400 480 550 670 840 595 TOTAL SERUM IRON, MALE 400 480 550 670 840 596 TOTAL SERUM IRON, NEONATE 400 480 550 670 840 TOXICOLOGY SCEREEN, BLOOD 597 11390 13610 15650 19050 23820 DRUG SCREEN 598 TOXOPLASMA, IGG 1140 1360 1560 1900 2380 599 TOXOPLASMA, IGM 1070 1280 1470 1790 2240 600 TRANSFERRIN SATURATION 1670 1990 2290 2790 3480 TREPONEMA PALLIDUM 601 750 890 1020 1250 1560 HAEMAGGLUTINATION,TPHA TRICHOMONAS VAGINALIS, PCR 602 2760 3300 3790 4620 5780 (QUALITATIVE) 603 TRIGLYCERIDE FLUID 400 480 550 670 840 604 Triglycerides 400 480 550 670 840
20 S.NO. SERVICE NAME “OPD” GW TWIN SINGLE SUITE 605 TROPONIN-I 1290 1540 1770 2160 2700 606 TROPONIN-T 1070 1280 1470 1790 2240 607 TRYPTASE 4950 5910 6800 8270 10340 608 Tuberculosis Screening ( Mantoux test) 170 210 240 290 370 TUMOR NECROSIS FACTOR,TNF, 609 5470 6550 7530 9170 11460 ALPHA 610 Typhidot IgM 720 870 1000 1220 1520 611 U1 SNRNP ANTIBODIES 3330 3990 4590 5590 6980 612 UREA 170 210 240 290 370 613 Uric Acid (Serum) 210 250 290 350 440 614 URIC ACID, 24-HOUR URINE 410 500 580 700 880 615 URINARY AMYLASE 800 960 1100 1340 1680 URINARY CALCIUM/CREATININE 616 800 960 1100 1340 1680 RATIO(SPOT TEST) 617 Urinary Potassium - 24 hrs 350 410 470 570 720 618 Urinary Potassium - Random 350 410 470 570 720 619 Urinary Uric Acid - 24 hrs 350 410 470 570 720 620 URINE ACIDIFICATION TEST 1670 1990 2290 2790 3480 621 URINE ALBUMIN / SUGAR 170 210 240 290 370 622 URINE ALBUMIN ACETONE RATIO 920 1100 1270 1540 1930 623 URINE ANION GAP 750 890 1020 1250 1560 624 URINE CALCIUM 290 340 390 480 600 625 Urine creatinine random 380 450 520 630 790 626 URINE CULTURE 1010 1210 1390 1690 2120 627 URINE FOR AFB 380 450 520 630 790 628 Urine for Bile Salts 130 150 170 210 260 629 URINE FOR CHYLE 400 480 550 670 840 630 URINE FOR DYSMORPHIC RBC 350 410 470 570 720 631 Urine for Pregnancy (UPT) 290 340 390 480 600 632 URINE FOR UROBILINOGEN 170 210 240 290 370 633 URINE MAGNESIUM 24HRS* 800 960 1100 1340 1680 634 URINE MICRO PROTEIN 800 960 1100 1340 1680 635 URINE PHOSPHORUS 24 HRS* 400 480 550 670 840 636 Urine Routine 160 190 220 270 330 637 URINE ROUTINE EXAMINATION 150 180 210 250 320 638 Valproic Acid 1380 1650 1900 2310 2890 VANILMANDELIC ACID,VMA, 24 639 5080 6080 6990 8510 10640 HOUR URINE VARICELLA ZOSTER VIRUS Ab PANEL, 640 4700 5620 6460 7870 9840 IGG & IGM 641 VARICELLA ZOSTER VIRUS Ab, IGG 2350 2810 3230 3930 4920 642 VARICELLA ZOSTER VIRUS Ab, IGM 2350 2810 3230 3930 4920 643 VDRL, RPR 290 340 390 480 600 VGKC(Voltage Gated Potassium 644 8050 9630 11070 13480 16850 Channel) Antibody 645 VITAMIN - E 7690 9200 10580 12880 16100 646 VITAMIN A, RETINOL, SERUM 3960 4730 5440 6620 8280 647 VITAMIN D, 25- HYDROXY 2420 2890 3320 4050 5060 648 VITAMIN D,1,25- DIHYDROXY 4260 5090 5850 7130 8910
21 S.NO. SERVICE NAME “OPD” GW TWIN SINGLE SUITE 649 VLDL - Cholesterol 510 610 700 850 1070 650 VON WILLEBRAND FACTOR , VWF, AG 12520 14970 17220 20960 26200 651 WEIL FELIX 1010 1210 1390 1690 2120 Wheeze/Rhinitis Comprehensive Panel 652 11500 13750 15810 19250 24060 Paediatric 653 Widal Test ,Serum 290 340 390 480 600 654 ZINC, SERUM/PLASMA 2190 2610 3000 3650 4570 655 ZN STAINING + RAPID AFB CULTURE 1100 1320 1520 1850 2310 ZN STAINING + RAPID AFB CULTURE 656 6440 7700 8860 10780 13480 + PCR ZN STAINING+RAPID AFB 657 4400 5270 6060 7380 9220 CULTURE+DIFFERENTIATION+PCR
22 X-RAY S.NO. SERVICE NAME “OPD” GW TWIN SINGLE SUITE 1 Bone Densitometry 2880 3440 3960 4820 6020 2 DEXA SPINE 3450 4130 4750 5780 7230 3 DEXA SPINE & FEMUR 2880 3440 3960 4820 6020 4 DEXA WHOLE BODY SCAN 4140 4950 5690 6930 8660 5 BARIUM ENEMA SINGLE CONTRAST 3450 4130 4750 5780 7230 6 BARIUM ENEMA DOUBLE CONTRAST 4600 5500 6320 7700 9630 BARIUM MEAL FOLLOW THROUGH 7 4600 5500 6320 7700 9630 (BMFT) 8 BARIUM SWALLOW 2300 2750 3160 3850 4810 BARIUM UPPER GI STUDY SINGLE 9 7820 9350 10750 13090 16360 CONTRAST BARIUM UPPER GI STUDY DOUBLE 10 5750 6880 7910 9630 12040 CONTRAST 11 BARIUM STUDY 3450 4130 4750 5780 7230 12 NEPHROSTOGRAM 1380 1650 1900 2310 2890 DYE STUDY SINOGRAM/ 13 2070 2480 2850 3470 4340 FISTULOGRAM 14 FLUOROSCOPY SCREENING ONLY 750 890 1020 1250 1560 15 HYSTEROSALPINGOGRAM (HSG) 3450 4130 4750 5780 7230 MICTURATING CYSTOURETHROGRAM 16 2880 3440 3960 4820 6020 (MCU) 17 MCU & RGU 4600 5500 6320 7700 9630 RETROGRADE GENITOURETHROGRAM 18 2650 3160 3630 4420 5530 (RGU) 19 XRAY ABDOMEN AP/PA 400 480 550 670 840 XRAY ACROMIO-CLAVICULAR JOINT 20 400 480 550 670 840 BOTH XRAY ACROMIO-CLAVICULAR JOINT 21 800 960 1100 1340 1680 SINGLE 22 XRAY FOOT OBLIQUE 400 480 550 670 840 23 ATLANTA AXIAL JOINT AP 400 480 550 670 840 24 XRAY ATLANTA AXIAL JOINT LAT 400 480 550 670 840 25 XRAY ABDOMEN ERECT 400 480 550 670 840 26 BM SWALLOW + UGI + FT 3450 4130 4750 5780 7230 27 BM UGI + FT 5750 6880 7910 9630 12040 28 XRAY CHEST LATERAL (RIGHT OR LEFT) 400 480 550 670 840 XRAY CHEST OBLIQUE (RIGHT OR 29 400 480 550 670 840 LEFT) 30 XRAY CHEST PA 400 480 550 670 840 31 COLOGRAM 2880 3440 3960 4820 6020 32 XRAY SPINE CERVICAL LAT 400 480 550 670 840 33 EMERGENCY CHARGES(ADDITIONAL) 580 690 790 970 1210 34 GASTROGRAFIN STUDY 3450 4130 4750 5780 7230 35 GASTROGRAFIN SWALLOW 2880 3440 3960 4820 6020 36 XRAY HAND PA / AP 400 480 550 670 840 37 XRAY HEEL AXIAL VIEW 400 480 550 670 840 38 XRAY HEEL LATERAL 400 480 550 670 840 39 IVP WITH MCU 4600 5500 6320 7700 9630 40 XRAY KNEE SKYLINE VIEW 400 480 550 670 840
23 S.NO. SERVICE NAME “OPD” GW TWIN SINGLE SUITE 41 NON - IONIC CONTRAST PER 50 CC 2190 2610 3000 3650 4570 42 PER OPERATIVE CHOLANGIOGRAM 1380 1650 1900 2310 2890 43 XRAY EACH EXPOSURE 400 480 550 670 840 44 RGP ONE SIDE IN OT 3100 3710 4270 5190 6490 45 XRAY SHOULDER JOINTS LAT 400 480 550 670 840 46 SIALOGRAM 1720 2060 2370 2880 3610 47 XRAY S I JOINTS LEFT 400 480 550 670 840 48 XRAY S I JOINTS PA 400 480 550 670 840 49 XRAY S I JOINTS RIGHT 400 480 550 670 840 50 SINOGRAM 2070 2480 2850 3470 4340 51 XRAY TOWNES VIEW 400 480 550 670 840 52 T-TUBE CHOLANGIOGRAM 1380 1650 1900 2310 2890 53 VENTRICULOGRAM 5750 6880 7910 9630 12040 54 XRAY WRIST OBLIQUE 400 480 550 670 840 55 XRAY PORTABLE BEDSIDE 690 830 950 1160 1450 56 XRAY ANKLE LAT 400 480 550 670 840 57 X-RAY PLAIN EACH EXPOSURE 460 550 630 770 960 58 XRAY IVP 3450 4130 4750 5780 7230 59 XRAY CHEST AP 400 480 550 670 840 60 XRAY SPINE CERVICO DORSAL AP 400 480 550 670 840 61 XRAY COCCYX AP 400 480 550 670 840 62 XRAY SPINE DORSO LUMBAR AP 400 480 550 670 840 63 XRAY DORSAL SPINE LAT 400 480 550 670 840 64 XRAY ELBOW LAT 400 480 550 670 840 65 XRAY FEMUR (THIGH) LAT 400 480 550 670 840 66 XRAY FOREARM LAT 400 480 550 670 840 67 XRAY HIP LAT 400 480 550 670 840 68 XRAY KNEE LAT 400 480 550 670 840 69 XRAY LEG SINGLE LAT 400 480 550 670 840 70 XRAY SPINE LUMBOSACRAL LAT 400 480 550 670 840 71 XRAY SHOULDER AXIAL VIEW 400 480 550 670 840 72 XRAY SKULL LAT 400 480 550 670 840 73 XRAY WRIST SINGLE LAT 400 480 550 670 840 74 xray Cervical Spine flexion 400 480 550 670 840 75 xray cervical spine extension 400 480 550 670 840 76 xray L.S.Spine Flexion 400 480 550 670 840 77 xray L.S.Spine extension 400 480 550 670 840 78 xray dorsal Spine extension 400 480 550 670 840 79 xray dorsal Spine flexion 400 480 550 670 840 80 XRAY ANKLE AP 400 480 550 670 840 81 XRAY ARM BOTH 800 960 1100 1340 1680 82 XRAY ARM SINGLE 400 480 550 670 840 83 XRAY CALCANEUM BOTH 400 480 550 670 840 84 XRAY CALCANEUM SINGLE 400 480 550 670 840 85 XRAY CHEST OBLIQUE 400 480 550 670 840 86 XRAY CHEST FOR RIBS 400 480 550 670 840 87 XRAY CHEST PENETRATED 400 480 550 670 840 88 XRAY CLAVICLE BOTH- AP 800 960 1100 1340 1680
24 S.NO. SERVICE NAME “OPD” GW TWIN SINGLE SUITE 89 XRAY CLAVICLE SINGLE 400 480 550 670 840 90 XRAY COCCYX LAT 400 480 550 670 840 91 XRAY ELBOW BOTH 1150 1380 1590 1930 2420 92 XRAY ELBOW AP 400 480 550 670 840 93 XRAY NASAL BONE ( R+L) 860 1030 1180 1440 1800 94 XRAY FACE ORBITS 400 480 550 670 840 95 XRAY FACE PARANASAL SINUSES 400 480 550 670 840 96 XRAY FACE ZYGOMATIC ARCH 400 480 550 670 840 97 XRAY FEMUR BOTH 1150 1380 1590 1930 2420 98 XRAY FEMUR SINGLE AP 400 480 550 670 840 99 XRAY FINGERS 800 960 1100 1340 1680 100 XRAY FOOT BOTH 1150 1380 1590 1930 2420 101 XRAY FOOT LAT 400 480 550 670 840 102 XRAY FOREARM AP 400 480 550 670 840 103 XRAY HANDS BOTH 400 480 550 670 840 104 XRAY HANDS LAT/OBLIQUE 400 480 550 670 840 105 XRAY HIP AP 400 480 550 670 840 106 XRAY HUMERUS BOTH 800 960 1100 1340 1680 107 XRAY HUMERUS SINGLE 400 480 550 670 840 108 XRAY KNEE SINGLE AP 400 480 550 670 840 109 XRAY KUB 400 480 550 670 840 110 XRAY LEG SINGLE AP 400 480 550 670 840 111 XRAY MANDIBLE BOTH 800 960 1100 1340 1680 112 XRAY MANDIBLE SINGLE 400 480 550 670 840 XRAY NEUROLOGY CERVICAL 113 400 480 550 670 840 MYELOGRAM XRAY NEUROLOGY LUMBAR 114 800 960 1100 1340 1680 MYELOGRAM XRAY NEUROLOGY THORACIC 115 800 960 1100 1340 1680 MYELOGRAM 116 XRAY PARANASAL SINUSES (PNS) 400 480 550 670 840 117 XRAY PATELLA BOTH- AP 800 960 1100 1340 1680 118 XRAY PATELLA SINGLE 400 480 550 670 840 119 XRAY PELVIS WITH B/L HIP 400 480 550 670 840 120 XRAY SI JOINTS BOTH 800 960 1100 1340 1680 121 XRAY SI JOINT SINGLE 800 960 1100 1340 1680 122 XRAY SACRUM AP/PA 400 480 550 670 840 123 XRAY SCAPULA BOTH 800 960 1100 1340 1680 124 XRAY SCAPULA SINGLE 400 480 550 670 840 125 XRAY SHOULDER BOTH 800 960 1100 1340 1680 126 XRAY SHOULDER AP 400 480 550 670 840 127 XRAY SKULL AP 400 480 550 670 840 128 XRAY SKULL BASE 400 480 550 670 840 129 XRAY SKULL CONED VIEWD OF SELLA 400 480 550 670 840 XRAY MASTOIDS OBLIQUE (RIGHT 130 860 1030 1180 1440 1800 +LEFT) 131 XRAY SKULL MASTOIDS SINGLE 400 480 550 670 840 132 XRAY SKULL OPTIC FORAMEN BOTH 800 960 1100 1340 1680
25 S.NO. SERVICE NAME “OPD” GW TWIN SINGLE SUITE XRAY ORBITAL VIEW / OPTIC 133 400 480 550 670 840 FORAMEN 134 XRAY SPINE CV JUNCTION 400 480 550 670 840 135 XRAY SPINE CERVICAL AP 400 480 550 670 840 136 XRAY SPINE CERVICODORSAL LAT 400 480 550 670 840 137 XRAY SPINE DORSAL AP 400 480 550 670 840 138 XRAY SPINE DORSOLUMBAR LAT 400 480 550 670 840 139 XRAY SPINE LUMBOSACRAL AP 400 480 550 670 840 XRAY SPINE SACRUM & COCCYX 140 400 480 550 670 840 (ONE PART) 141 XRAY STERNUM 400 480 550 670 840 XRAY STERNO CLAVICULAR JOINT 142 400 480 550 670 840 BOTH - AP XRAY STERNOCLAVICULAR JOINT 143 800 960 1100 1340 1680 SINGLE 144 XRAY THIGH SINGLE 400 480 550 670 840 XRAY TMJ (TEMPORO MANDIBULAR 145 1150 1380 1590 1930 2420 JOINT) BOTH XRAY TMJ (TEMPORO MANDIBULAR 146 800 960 1100 1340 1680 JOINT) SINGLE 147 XRAY TOES 400 480 550 670 840 148 XRAY WRIST SINGLE AP 400 480 550 670 840 149 XRAY STYLOID PROCESS 400 480 550 670 840 150 X-RAY ABDOMEN - ERECT & SUPINE 800 960 1100 1340 1680 151 X-RAY ANKLE BOTH - AP & LATERAL 1150 1380 1590 1930 2420 152 X-RAY ANKLE SINGLE - AP & LATERAL 800 960 1100 1340 1680 153 XRAY ARM BOTH - AP & LATERAL 400 480 550 670 840 154 XRAY CHEST - PA & LATERAL 800 960 1100 1340 1680 155 XRAY CHEST - AP & LATERAL 800 960 1100 1340 1680 156 XRAY COCCYX - AP & LATERAL 800 960 1100 1340 1680 157 XRAY ELBOW BOTH - AP & LATERAL 1150 1380 1590 1930 2420 158 XRAY FACIAL BONE - AP & LATERAL 800 960 1100 1340 1680 159 XRAY FEMUR SINGLE - AP & LATERAL 400 480 550 670 840 160 XRAY FOOT SINGLE - AP /PA 400 480 550 670 840 161 XRAY FOOT BOTH - AP & LATERAL 400 480 550 670 840 162 XRAY FOOT SINGLE - LATERAL 400 480 550 670 840 163 XRAY FOREARM BOTH - AP & LATERAL 1150 1380 1590 1930 2420 XRAY FOREARM SINGLE - AP & 164 800 960 1100 1340 1680 LATERAL 165 XRAY HANDS BOTH - AP & LATERAL 1150 1380 1590 1930 2420 166 XRAY HANDS SINGLE - AP /PA 400 480 550 670 840 167 XRAY HIP BOTH - AP & LATERAL 1150 1380 1590 1930 2420 168 XRAY HIP SINGLE - AP & LATERAL 800 960 1100 1340 1680 XRAY HIP SINGLE - JUDET’S LATERAL & 169 400 480 550 670 840 MEDIAL 170 XRAY HUMERUS BOTH - AP & LATERAL 1150 1380 1590 1930 2420 XRAY HUMERUS SINGLE - AP & 171 800 960 1100 1340 1680 LATERAL 172 XRAY KNEE BOTH - AP & LATERAL 1040 1240 1430 1740 2170 173 XRAY KNEE SINGLE - AP & LATERAL 800 960 1100 1340 1680
26 S.NO. SERVICE NAME “OPD” GW TWIN SINGLE SUITE XRAY KNEE BOTH - AP, LATERAL & 174 800 960 1100 1340 1680 AXIAL XRAY KNEE SINGLE - AP, LATERAL & 175 1150 1380 1590 1930 2420 AXIAL 176 XRAY KUB - AP & LATERAL 400 480 550 670 840 177 XRAY LEG BOTH - AP & LATERAL 1150 1380 1590 1930 2420 178 XRAY LEG SINGLE - AP & LATERAL 800 960 1100 1340 1680 XRAY MANDIBLE SINGLE - AP & 179 800 960 1100 1340 1680 OBLIQUE 180 XRAY PATELLA SINGLE - AP & AXIAL 400 480 550 670 840 181 XRAY SACRUM - LATERAL 400 480 550 670 840 XRAY SHOULDER SINGLE - AXILLARY 182 400 480 550 670 840 VIEW 183 XRAY SKULL - AP & LATERAL 800 960 1100 1340 1680 XRAY SPINE CV JUNCTION - AP & 184 800 960 1100 1340 1680 LATERAL XRAY SPINE CV JUNCTION - OPEN 185 800 960 1100 1340 1680 MOUTH, LAT IN FLEX & EXTN 186 XRAY SPINE CERVICAL - AP & LATERAL 800 960 1100 1340 1680 XRAY SPINE CERVICODORSAL - BOTH 187 800 960 1100 1340 1680 OBLIQUES XRAY SPINE DORSAL - BOTH 188 800 960 1100 1340 1680 OBLIQUES XRAY SPINE DORSOLUMBAR - BOTH 189 800 960 1100 1340 1680 OBLIQUES XRAY SPINE LUMBOSACRAL - BOTH 190 800 960 1100 1340 1680 OBLIQUES XRAY SPINE SACRUM & COCCYX - AP 191 800 960 1100 1340 1680 & LATERAL XRAY STERNOCLAVICULAR JOINT 192 1150 1380 1590 1930 2420 BOTH - AP & OBLIQUE XRAY STERNOCLAVICULAR JOINT 193 800 960 1100 1340 1680 SINGLE - AP & OBLIQUE XRAY TMJOINT BOTH - OPEN & 194 1380 1650 1900 2310 2890 CLOSED MOUTH XRAY TMJOINT SINGLE - OPEN & 195 920 1100 1270 1540 1930 CLOSED MOUTH 196 XRAY WRIST BOTH - AP & LATERAL 1150 1380 1590 1930 2420 XRAY WRIST BOTH - AP, LATERAL & 197 2070 2480 2850 3470 4340 ULNAR DEVIATION XRAY WRIST SINGLE - AP, LATERAL & 198 1150 1380 1590 1930 2420 ULNAR DEVIATION 199 X-RAY SOFT TISSUE NECK LATERAL 400 480 550 670 840 200 X-RAY NASOPHARYNX LATERAL 460 550 630 770 960 201 Extra X-ray film charges (per film) 120 140 160 200 250 202 XRAY ANKLE BOTH- AP 400 480 550 670 840 203 XRAY FOREARM BOTH- AP 800 960 1100 1340 1680 204 XRAY HIP BOTH- AP 400 480 550 670 840 205 XRAY KNEE BOTH- AP 400 480 550 670 840 206 XRAY WRIST BOTH- AP 400 480 550 670 840
27 ULTRASOUND S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE ULTRASOUND ARTERIAL DOPPLER 1 5180 6190 7120 8670 10830 LOWER LIMB(USG) ULTRASOUND ARTERIAL DOPPLER 2 5180 6190 7120 8670 10830 UPPER LIMB(USG) ULTRASOUND VENOUS DOPPLER 3 5180 6190 7120 8670 10830 LOWER LIMB(USG) COLOUR DOPPLER OBSTETRICS 4 2070 2480 2850 3470 4340 FOLLOW UP COLOUR DOPPLER OBSTETRICS 5 4600 5500 6320 7700 9630 (WITH AFI & BPS) ULTRASOUND VENOUS DOPPLER 6 4140 4950 5690 6930 8660 UPPER LIMB(USG) ULTRASOUND VENOUS DOPPLER 7 5180 6190 7120 8670 10830 VARICOSE VEINS(USG) 8 COLOUR DOPPLER PORTAL SYSTEM 4020 4810 5530 6730 8420 DIAGNOSTIC ASPIRATION UNDER U/S 9 1720 2060 2370 2880 3610 GUIDE 10 EMERGENCY CHARGES (ADDITIONAL) 1380 1650 1900 2310 2890 EMERGENCY OBSTETRICS 11 3680 4400 5060 6160 7700 ULTRASOUND 12 EMERGENCY ULTRASOUND 2760 3300 3790 4620 5780 OVULATION STUDY TVS FOLLOW UP 13 920 1100 1270 1540 1930 (PER VISIT) 14 OVULATION STUDY TVS (FIVE VISITS) 2650 3160 3630 4420 5530 15 PORTABLE BEDSIDE CHARGES 1950 2340 2690 3280 4100 ULTRASOUND GUIDED TRU-CUT 16 5410 6460 7430 9040 11310 BIOPSY ULTRASOUND GUIDE HYDROSTATIC / 17 4540 5430 6240 7600 9500 PNEUMATIC REDUCTION 18 ULTRASOUND IN OT 1780 2130 2450 2980 3730 ULTRASOUND KUB & PROSTATE WITH 19 1840 2200 2530 3080 3850 PVR 20 ULTRASOUND FOR AFI 630 760 870 1060 1330 21 ULTRASOUND FOLLOW UP 920 1100 1270 1540 1930 ULTRASOUND GUIDED PROCEDURE 22 1670 1990 2290 2790 3480 SIMPLE ULTRASOUND GUIDED PROCEDURE 23 3050 3640 4190 5100 6370 COMPLEX ULTRASOUND GUIDED PROCEDURE 24 4950 5910 6800 8270 10340 MAJOR 25 ULTRASOUND LEVEL - II SCAN (4D) 3680 4400 5060 6160 7700 26 ULTRASOUND OBSTETRICS BPS 2190 2610 3000 3650 4570 27 ULTRASOUND OBSTETRICS LEVEL - II 2010 2410 2770 3370 4220 ULTRASOUND OBSTETRICS TWIN 28 2010 2410 2770 3370 4220 PREGNANCY 29 ULTRASOUND PROSTATE TA+TR 2010 2410 2770 3370 4220 30 ULTRASOUND SALIVARY GLANDS 1780 2130 2450 2980 3730 31 ULTRASOUND GUIDED D&C 3280 3920 4510 5490 6860 32 ULTRASOUND SMALL PARTS 1210 1440 1660 2020 2520 33 ULTRASOUND FOR PVR 520 620 710 870 1090
28 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE ULTRASOUND REVIEW/ 34 980 1170 1350 1640 2050 SCREENING(WITHOUT FILM) ULTRASOUND GUIDED 35 9030 10790 12410 15110 18880 PERCUTANEOUS DRAINAGE 36 ULTRASOUND GUIDED TRUS BIOPSY 13050 15610 17950 21850 27320 37 ULTRASOUND GUIDED FNAC 2530 3030 3480 4240 5300 ULTRASOUND OBSTETRICS (WITH 38 1440 1720 1980 2410 3010 FILM) 39 ULTRASOUND BREAST (USG) 1670 1990 2290 2790 3480 40 ULTRASOUND KUB 1040 1240 1430 1740 2170 41 Fetal Echocardiography (Radiology) 3330 3990 4590 5590 6980 42 ULTRASOUND CHEST 860 1030 1180 1440 1800 43 ULTRASOUND DOPPLER CAROTIDS 2930 3510 4040 4910 6140 ULTRASOUND DOPPLER EXTREMITY 44 7420 8870 10200 12420 15520 (BOTH) ARTERIAL 45 ULTRASOUND DOPPLER PENILE 3280 3920 4510 5490 6860 46 ULTRASOUND DOPPLER RENALS 3680 4400 5060 6160 7700 47 ULTRASOUND DOPPLER SCROTUM 1780 2130 2450 2980 3730 48 USG DOPPLER SPLENOPORTAL 4020 4810 5530 6730 8420 49 USG EXTREMITY 2300 2750 3160 3850 4810 ULTRASOUND LOWER ABDOMEN/ 50 1610 1930 2220 2700 3380 PELVIS 51 ULTRASOUND NECK 1780 2130 2450 2980 3730 52 ULTRASOUND ORBITS 1780 2130 2450 2980 3730 53 ULTRASOUND PREGNANCY DOPPLER 4020 4810 5530 6730 8420 USG PREGNANCY BIOPHYSICAL 54 1270 1510 1740 2110 2640 PROFILE 55 USG PREGNANCY 3D/4D 4140 4950 5690 6930 8660 56 ULTRASOUND THYROID GLAND 1780 2130 2450 2980 3730 57 ULTRASOUND TRANSRECTAL (TRUS) 2010 2410 2770 3370 4220 58 ULTRASOUND TRANSVAGINAL (TVS) 1270 1510 1740 2110 2640 59 ULTRASOUND UPPER ABDOMEN 920 1100 1270 1540 1930 60 ULTRASOUND WHOLE ABDOMEN 1610 1930 2220 2700 3380 61 ULTRASOUND CRANIUM (USG) 2070 2480 2850 3470 4340 ULTRASOUND SOFT TISSUE WITH 62 1900 2270 2610 3180 3970 DOPPLER ULTRASOUND FOR LIVER 63 2650 3160 3630 4420 5530 ELASTOGRAPHY ULTRASOUND GUIDED BREAST 64 4540 5430 6240 7600 9500 FNAC/ASPIRATION 65 ULTRASOUND FOR Early pregnancy 1550 1860 2140 2600 3260 USG First Trimester Screening(USG + 66 3390 4060 4670 5680 7110 CERVIX) ULTRASOUND -First Trimester 67 4260 5090 5850 7130 8910 Screening (Twins) -USG +CERVIX 68 Anomaly scan(INCLUDING 3D/4D) 4260 5090 5850 7130 8910 69 USG -Cervical Screening (TVS) 1380 1650 1900 2310 2890 USG FOR Fetal Well being (Growth & 70 4020 4810 5530 6730 8420 Dopplers) ULTRASOUND Multiple 71 5640 6740 7750 9440 11800 pregnancy(TWINS)
29 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE 72 USG -Higher order multiple pregnancy 6320 7560 8690 10580 13230 73 USG -Follow up multiple pregnancy 5350 6390 7350 8950 11180 74 MRI fetal screening 4020 4810 5530 6730 8420 75 Amniocentesis 11270 13480 15500 18870 23590 76 CVS 11270 13480 15500 18870 23590 77 Fetal Reduction 13800 16500 18980 23100 28880 78 Follow up scan 1490 1790 2060 2510 3130
30 RADIO-MRI S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE MR ANGIOGRAPHY CONTRAST 1 15520 18560 21340 25980 32480 ABDOMEN 2 MR ANGIOGRAPHY CONTRAST BRAIN 11960 14300 16450 20020 25030 3 MR ANGIOGRAPHY CONTRAST CHEST 15520 18560 21340 25980 32480 MR ANGIOGRAPHY CONTRAST 4 20130 24060 27670 33680 42110 EXTREMITY 5 MR ANGIOGRAPHY CONTRAST NECK 11960 14300 16450 20020 25030 MR ANGIOGRAPHY CONTRAST 6 15520 18560 21340 25980 32480 PULMONARY 7 MR ANGIOGRAPHY CONTRAST RENAL 10930 13060 15020 18280 22860 MR ANGIOGRAPHY CONTRAST NECK & 8 20130 24060 27670 33680 42110 BRAIN MR ANGIOGRAPHY CONTRAST AORTIC 9 15520 18560 21340 25980 32480 ARCH & NECK 10 MR ANGIOGRAPHY PLAIN ABDOMEN 13800 16500 18980 23100 28880 11 MR ANGIOGRAPHY PLAIN BRAIN 9660 11550 13280 16170 20210 12 MR ANGIOGRAPHY PLAIN EXTREMITIES 16680 19940 22930 27920 34900 13 MR ANGIOGRAPHY PLAIN NECK 8740 10450 12020 14630 18290 14 MR ANGIOGRAPHY PLAIN BRAIN & NECK 13800 16500 18980 23100 28880 15 MRI BRACHIAL PLEXUS SINGLE 9200 11000 12650 15400 19250 16 MRI BRAIN CONTRAST 10350 12380 14240 17330 21670 17 MRI BRAIN PLAIN 6900 8250 9490 11550 14440 18 MRI BRAIN WITH CSF FLOW STUDY 12070 14440 16610 20220 25270 19 MRI BRAIN WITH EPILEPSY PROTOCOL 10350 12380 14240 17330 21670 20 MRI BREAST BOTH CONTRAST 14370 17190 19770 24070 30080 21 MRI CARDIAC CONTRAST 18400 22000 25300 30800 38500 22 MRI CARDIAC PLAIN 13800 16500 18980 23100 28880 23 MRI CHEST CONTRAST 10350 12380 14240 17330 21670 24 MRI CHEST PLAIN 8630 10310 11860 14430 18040 MR CHOLANGIOPANCREATICOGRAPHY 25 9660 11550 13280 16170 20210 (MRCP)(ONLY) 26 MRI CISTERNOGRAPHY/MYELOGRAPHY 8860 10590 12180 14830 18530 27 MRI DYNAMIC STUDY KIDNEYS 5290 6330 7280 8860 11080 28 MRI DYNAMIC STUDY OTHER (PER PART) 6900 8250 9490 11550 14440 29 MR ENTEROCLYSIS PLAIN 8400 10040 11550 14060 17570 MRI EXTRA CONTRAST CHARGES - PER 30 4720 5640 6490 7900 9870 10CC 31 MRI EXTRA FILM CHARGES - PER FILM 210 250 290 350 440 MRI EXTREMITIES SINGLE LEG 32 9430 11280 12970 15790 19740 (CONTRAST) MRI EXTREMITIES SINGLE THIGH 33 9430 11280 12970 15790 19740 (CONTRAST) MRI EXTREMITIES SINGLE FOREARM 34 9430 11280 12970 15790 19740 (CONTRAST) MRI EXTREMITIES SINGLE ARM 35 9430 11280 12970 15790 19740 (CONTRAST) 36 MRI EXTREMITIES SINGLE LEG (PLAIN) 7820 9350 10750 13090 16360 37 MRI EXTREMITIES SINGLE THIGH (PLAIN) 7820 9350 10750 13090 16360
31 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE MRI EXTREMITIES SINGLE FOREARM 38 7820 9350 10750 13090 16360 (PLAIN) 39 MRI EXTREMITIES SINGLE ARM (PLAIN) 7820 9350 10750 13090 16360 40 MRI FETAL STUDY 7820 9350 10750 13090 16360 41 MR FISTULOGRAM CONTRAST 10470 12510 14390 17510 21890 42 MR FISTULOGRAM PLAIN 8280 9900 11390 13860 17330 43 MRI INNER EAR (PLAIN) 8400 10040 11550 14060 17570 44 MRI JOINT SINGLE CONTRAST FOOT 9430 11280 12970 15790 19740 45 MRI JOINT SINGLE CONTRAST ANKLE 9430 11280 12970 15790 19740 46 MRI JOINT SINGLE CONTRAST KNEE 9430 11280 12970 15790 19740 MRI JOINT SINGLE CONTRAST 47 9430 11280 12970 15790 19740 SHOULDER 48 MRI JOINT SINGLE CONTRAST ELBOW 9430 11280 12970 15790 19740 49 MRI JOINT SINGLE CONTRAST WRIST 9430 11280 12970 15790 19740 50 MRI JOINT SINGLE CONTRAST HAND 9430 11280 12970 15790 19740 51 MRI JOINT SINGLE PLAIN SHOULDER 7820 9350 10750 13090 16360 52 MRI JOINT SINGLE PLAIN ELBOW 7820 9350 10750 13090 16360 53 MRI JOINT SINGLE PLAIN WRIST 7820 9350 10750 13090 16360 54 MRI JOINT SINGLE PLAIN HAND 7820 9350 10750 13090 16360 MRI JOINT BOTH (R & L) CONTRAST 55 17250 20630 23720 28880 36100 FOOT MRI JOINT BOTH (R & L) CONTRAST 56 17250 20630 23720 28880 36100 ANKLE 57 MRI JOINT BOTH (R & L) CONTRAST KNEE 17250 20630 23720 28880 36100 MRI JOINT BOTH (R & L) CONTRAST SI 58 9430 11280 12970 15790 19740 JOINTS 59 MRI JOINT BOTH (R & L) PLAIN SI JOINTS 9200 11000 12650 15400 19250 MRI JOINT BOTH (R & L) PLAIN 60 7820 9350 10750 13090 16360 STERNOCLAVICULAR MRI LOWER ABDOMEN/PELVIS 61 11500 13750 15810 19250 24060 CONTRAST 62 MRI LOWER ABDOMEN/PELVIS PLAIN 8630 10310 11860 14430 18040 63 MRI NASOPHARYNX/PNS CONTRAST 10930 13060 15020 18280 22860 64 MRI NASOPHARYNX/PNS PLAIN 8630 10310 11860 14430 18040 MRI NECK/ THYROID/ LARYNX 65 11500 13750 15810 19250 24060 CONTRAST 66 MRI NECK/THYROID/LARYNX PLAIN 8630 10310 11860 14430 18040 67 MRI ORBITS CONTRAST 11500 13750 15810 19250 24060 68 MRI ORBITS PLAIN 8630 10310 11860 14430 18040 69 MRI PROSTATE CONTRAST 10470 12510 14390 17510 21890 70 MRI PROSTATE PLAIN 7820 9350 10750 13090 16360 MRI RECTUM (HIGH RESOLUTION) 71 24150 28880 33210 40430 50540 CONTRAST 72 MRI SELLA (PITUITARY FOSSA) CONTRAST 10470 12510 14390 17510 21890 73 MR SINOGRAM CONTRAST 10470 12510 14390 17510 21890 74 MR SINOGRAM PLAIN 7820 9350 10750 13090 16360 75 MR SPECTROSCOPY EXTRA 8400 10040 11550 14060 17570 76 MRI SPINE CONTRAST CV JUNCTION 10470 12510 14390 17510 21890 77 MRI SPINE CONTRAST CERVICAL 10350 12380 14240 17330 21670 78 MRI SPINE CONTRAST CERVICODORSAL 10350 12380 14240 17330 21670
32 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE 79 MRI SPINE CONTRAST DORSAL 10350 12380 14240 17330 21670 80 MRI SPINE CONTRAST DORSOLUMBAR 10350 12380 14240 17330 21670 81 MRI SPINE CONTRAST LUMBOSACRAL 10350 12380 14240 17330 21670 MRI SPINE CONTRAST SACRUM & 82 10350 12380 14240 17330 21670 COCCYX 83 MRI SPINE PLAIN CV JUNCTION 8400 10040 11550 14060 17570 84 MRI SPINE PLAIN CERVICAL 8400 10040 11550 14060 17570 85 MRI SPINE PLAIN CERVICODORSAL 8400 10040 11550 14060 17570 86 MRI SPINE PLAIN DORSAL 8400 10040 11550 14060 17570 87 MRI SPINE PLAIN DORSOLUMBAR 8400 10040 11550 14060 17570 88 MRI SPINE PLAIN LUMBOSACRAL 8400 10040 11550 14060 17570 89 MRI SPINE PLAIN SACRUM & COCCYX 8400 10040 11550 14060 17570 90 MRI UPPER ABDOMEN CONTRAST 11500 13750 15810 19250 24060 91 MRI UPPER ABDOMEN PLAIN 8630 10310 11860 14430 18040 92 MR UROGRAPHY (MRU) CONTRAST 10350 12380 14240 17330 21670 93 MR UROGRAPHY (MRU) PLAIN 7820 9350 10750 13090 16360 94 MR VENOGRAPHY CONTRAST 12650 15130 17400 21180 26480 95 MR VENOGRAPHY PLAIN 8400 10040 11550 14060 17570 96 MRI WHOLE ABDOMEN CONTRAST 20700 24750 28460 34650 43310 97 MRI WHOLE ABDOMEN PLAIN 16100 19250 22140 26950 33690 98 MRI GUIDED (FNAC) 4600 5500 6320 7700 9630 99 MRI SCREENING WHOLE SPINE 6900 8250 9490 11550 14440 MRI BRAIN ADDITIONAL PERFUSION 100 17250 20630 23720 28880 36100 STUDY 101 MRI BRAIN ADDITIONAL TRACTOGRAPHY 8860 10590 12180 14830 18530 MRI SCREENING PACKAGE - LS SPINE & 102 4600 5500 6320 7700 9630 SI JOINTS 103 MRI PORTOGRAPHY (CONTRAST) 12650 15130 17400 21180 26480 104 MRI per part (unspecified) plain 7820 9350 10750 13090 16360 105 MRI per part (unspecified) with Contrast 10470 12510 14390 17510 21890 MRI BRAIN ADDITIONAL FUNCTIONAL 106 11500 13750 15810 19250 24060 EXAM (per activity) 107 MRI SCREENING PER PART (OTHERS) 3450 4130 4750 5780 7230 108 MRI FACE (PLAIN) 7820 9350 10750 13090 16360 109 MRI FACE (CONTRAST) 10470 12510 14390 17510 21890 110 MRI SKULL BASE PLAIN 7820 9350 10750 13090 16360 111 MRI SKULL BASE CONTRAST 10470 12510 14390 17510 21890 112 MRI GLUTEAL REGION PLAIN 7820 9350 10750 13090 16360 113 MRI GLUTEAL REGION CONTRAST 10470 12510 14390 17510 21890 114 MR CISTERNOGRAPHY CONTRAST 11500 13750 15810 19250 24060 115 MRCP with contrast-Donor 13800 16500 18980 23100 28880 116 MRI Temporal Bone - Plain 7820 9350 10750 13090 16360 117 MRI Temporal Bone - Contrast 10350 12380 14240 17330 21670 118 MRI Pituitary 7820 9350 10750 13090 16360 119 MRI Whole body PLAIN 14370 17190 19770 24070 30080 120 MRI Brain With Diffusion Studies 12070 14440 16610 20220 25270 121 MRI Whole Body PET Like Screening 12650 15130 17400 21180 26480 122 MRI Joint with Arthrography 16680 19940 22930 27920 34900 123 MRI Joints (single) 7820 9350 10750 13090 16360
33 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE 124 MRI Musculoskeletal 9430 11280 12970 15790 19740 125 MRI LOWER-LIMB 7820 9350 10750 13090 16360 126 MRI UPPER-LIMB 7820 9350 10750 13090 16360 127 MRI WHOLE ABDOMEN CONTRAST. 20700 24750 28460 34650 43310 128 MRI Diffusion Studies with ADC MAP 7820 9350 10750 13090 16360 129 MRI B/L ANKLE PLAIN 14370 17190 19770 24070 30080 130 MRI B/L ELBOW CONTRAST 17250 20630 23720 28880 36100 131 MRI B/L ELBOW PLAIN 14370 17190 19770 24070 30080 132 MRI B/L FOOT PLAIN 14370 17190 19770 24070 30080 133 MRI B/L KNEE PLAIN 14370 17190 19770 24070 30080 134 MRI B/L SHOULDER CONTRAST 17250 20630 23720 28880 36100 135 MRI B/L SHOULDER PLAIN 1440 1720 1980 2410 3010 136 MRI B/L WRIST CONTRAST 17250 20630 23720 28880 36100 137 MRI B/L WRIST PLAIN 14370 17190 19770 24070 30080 138 MRI EMERGENCY CHARGES 1720 2060 2370 2880 3610 139 MRI JOINT SINGLE CONTRAST HIP 9430 11280 12970 15790 19740 140 MRI JOINT SINGLE PLAIN ANKLE 7820 9350 10750 13090 16360 141 MRI JOINT SINGLE PLAIN FOOT 7820 9350 10750 13090 16360 142 MRI JOINT SINGLE PLAIN HIP 7820 9350 10750 13090 16360 143 MRI JOINT SINGLE PLAIN KNEE 7820 9350 10750 13090 16360 144 MRI LUMBOSACRAL PLEXUS 8830 10560 12140 14780 18480 145 MRI PAROTID REGION CONTRAST 10470 12510 14390 17510 21890 146 MRI PAROTID REGION PLAIN 7820 9350 10750 13090 16360 147 MRI PLAIN BREAST 7820 9350 10750 13090 16360 148 MRI SCREENING BRAIN 2300 2750 3160 3850 4810 149 MRI SCREENING SPINE SINGLE AREA 2300 2750 3160 3850 4810 150 MRI SPINE CONTRAST SACURM/COCCYX 10350 12380 14240 17330 21670 151 MRI SPINE PLAIN SACURM/COCCYX 8400 10040 11550 14060 17570 MRI STERNOCLAVICULAR JOINT 152 9430 11280 12970 15790 19740 CONTRAST 153 MRI T M JOINT CONTRAST 9430 11280 12970 15790 19740 154 MRI T M JOINT PLAIN 7820 9350 10750 13090 16360 155 MRI TRIPLE PHASE ABDOMEN 17080 20420 23480 28590 35740
34 RADIO-CT S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE 1 CT ANGIOGRAPHY BRAIN 12650 15130 17400 21180 26480 2 CT ANGIOGRAPHY NECK 12650 15130 17400 21180 26480 3 CT CHEST & UPPER ABDOMEN PLAIN 10810 12930 14870 18100 22630 CT CHEST & UPPER ABDOMEN 4 13800 16500 18980 23100 28880 CONTRAST(NON IONIC) 5 CT GUIDED BIOPSY / INTERVENTION 6900 8250 9490 11550 14440 6 CT GUIDED FNAC 3740 4470 5140 6260 7820 CT HEAD PLAIN & CONTRAST (NON 7 5920 7080 8140 9910 12390 IONIC) CT HEAD & PNS CONTRAST 8 8860 10590 12180 14830 18530 (NON IONIC) 9 CT HEAD & PNS PLAIN 6900 8250 9490 11550 14440 10 CT INTERNAL EAR 7300 8730 10040 12220 15280 11 CT JOINTS 8570 10240 11780 14340 17920 CT LIMBS OR NECK SOFT TISSUE 12 9030 10790 12410 15110 18880 CONTRAST (NON IONIC) 13 CT LIMBS OR NECK SOFT TISSUE PLAIN 6670 7980 9180 11170 13970 CT NOSE & PNS CORONAL AND AXIAL 14 5350 6390 7350 8950 11180 VIEW CT NOSE & PNS CORONAL AND AXIAL 15 8280 9900 11390 13860 17330 VIEW CONTRAST CT NOSE & PNS CORONAL VIEW 16 7360 8800 10120 12320 15400 CONTRAST CT ORBIT/PNS/PITUITARY FOSSA 17 6210 7430 8540 10400 13000 CONTRAST(CORONAL) CT ORBIT/PNS/PITUITARY FOSSA PLAIN 18 4600 5500 6320 7700 9630 (AXIAL & CORONAL) CT ORBIT/PNS/PITUITARY FOSSA PLAIN & 19 6900 8250 9490 11550 14440 CONTRAST CT SCAN GUIDED PROCEDURES 20 3280 3920 4510 5490 6860 COMPLEX 21 CT CRANIO-VERTIBULAR (CV) JUNCTION 5750 6880 7910 9630 12040 22 CT MAXILLARY/ FACE REGION 4310 5160 5930 7220 9030 23 CT THYROID (WITH CONTRAST) 6900 8250 9490 11550 14440 CT SPINE WITH INTRATHECAL CONTRAST 24 7650 9140 10510 12800 16000 - 3LEVELS 25 DENTAL CT 11500 13750 15810 19250 24060 26 EMERGENCY CHARGES(ADDITIONAL) 1670 1990 2290 2790 3480 27 HRCT CHEST CONTRAST (NON IONIC) 6210 7430 8540 10400 13000 28 CT PNS/FACE/ORBITS (CONTRAST). 6900 8250 9490 11550 14440 29 CT PNS/ORBITS (PLAIN). 3280 3920 4510 5490 6860 30 CT EXTREMITIES (PLAIN) 5180 6190 7120 8670 10830 31 CT ANESTESIA CHARGES 1670 1990 2290 2790 3480 32 CT ANGIOGRAPHY CHEST 13800 16500 18980 23100 28880 33 CT ANGIOGRAPHY PULMONARY 16100 19250 22140 26950 33690 34 CT ANGIOGRAPHY ABDOMEN 19550 23380 26890 32730 40920 35 CT ANGIOGRAPHY RENAL 16100 19250 22140 26950 33690 36 CT HEAD (CONTRAST) 3680 4400 5060 6160 7700 37 CT HEAD (PLAIN) 2300 2750 3160 3850 4810
35 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE CT ORBIT / PNS/ PITUITARY FOSSA 38 5750 6880 7910 9630 12040 CONTRAST (AXIAL&CORONAL) CT ORBIT/PNS/PITUITARY FOSSA PLAIN 39 4140 4950 5690 6930 8660 (ONE PLANE ONLY),, 40 CT CHEST (CONTRAST) 5750 6880 7910 9630 12040 41 CT CHEST (PLAIN) 4020 4810 5530 6730 8420 42 CT CISTERNOGRAPHY / MYELOGRAPHY 7360 8800 10120 12320 15400 43 CT DYNAMIC STUDY - OTHER (PER PART) 11500 13750 15810 19250 24060 44 CECT Abdomen With Enteroclysis 11500 13750 15810 19250 24060 CT CONTRAST CHARGES - VISIPAQUE ( 45 2880 3440 3960 4820 6020 100 ML) CT CONTRAST CHARGES - OMNIPAQUE 46 2420 2890 3320 4050 5060 (100ML) 47 CT EXTRA FILM CHARGES (PER FILM) 230 280 320 390 490 CT EXTREMITIES (CONTRAST) UPPER 48 6320 7560 8690 10580 13230 PROXIMAL (ARM) CT EXTREMITIES (CONTRAST) UPPER 49 6320 7560 8690 10580 13230 DISTAL (FOREARM) CT EXTREMITIES (CONTRAST) LOWER 50 6320 7560 8690 10580 13230 PROXIMAL (THIGH) CT EXTREMITIES (CONTRAST) LOWER 51 6320 7560 8690 10580 13230 DISTAL (LEG) CT EXTREMITIES (PLAIN) UPPER PROXIMAL 52 4720 5640 6490 7900 9870 (ARM) CT EXTREMITIES (PLAIN) UPPER DISTAL 53 4720 5640 6490 7900 9870 (FOREARM) CT EXTREMITIES (PLAIN) LOWER PROXIMAL 54 4720 5640 6490 7900 9870 (THIGH) CT EXTREMITIES (PLAIN) LOWER DISTAL 55 4720 5640 6490 7900 9870 (LEG) 56 CT JOINTS SINGLE (PLAIN) SHOULDER 4720 5640 6490 7900 9870 57 CT JOINTS SINGLE (PLAIN) ELBOW 4720 5640 6490 7900 9870 58 CT JOINTS SINGLE (PLAIN) WRIST 4720 5640 6490 7900 9870 59 CT JOINTS SINGLE (PLAIN) HAND 4720 5640 6490 7900 9870 60 CT JOINTS SINGLE (PLAIN) KNEE 4720 5640 6490 7900 9870 61 CT JOINTS SINGLE (PLAIN) ANKLE 4720 5640 6490 7900 9870 62 CT JOINTS SINGLE (PLAIN) FOOT 4720 5640 6490 7900 9870 CT JOINTS BOTH (PLAIN) TEMPORO- 63 6320 7560 8690 10580 13230 MANDIBULAR 64 CT JOINTS BOTH (PLAIN) SHOULDER 6320 7560 8690 10580 13230 CT JOINTS BOTH (PLAIN) STERNUM/ 65 6320 7560 8690 10580 13230 STERNO-CLAVICULAR 66 CT JOINTS BOTH (PLAIN) ELBOW 6320 7560 8690 10580 13230 67 CT JOINTS BOTH (PLAIN) WRIST 6320 7560 8690 10580 13230 68 CT JOINTS BOTH (PLAIN) HAND 6320 7560 8690 10580 13230 69 CT JOINTS BOTH (PLAIN) SACROILIAC (SI) 6320 7560 8690 10580 13230 70 CT JOINTS BOTH (PLAIN) HIP 6320 7560 8690 10580 13230 71 CT JOINTS BOTH (PLAIN) KNEE 6320 7560 8690 10580 13230 72 CT JOINTS BOTH (PLAIN) ANKLE 6320 7560 8690 10580 13230 73 CT JOINTS BOTH (PLAIN) FOOT 6320 7560 8690 10580 13230 74 CT KUB WITH CONTRAST. 5920 7080 8140 9910 12390
36 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE 75 CT KUB (PLAIN) 4310 5160 5930 7220 9030 76 CT NECK/PHARYNX/LARYNX (CONTRAST) 5750 6880 7910 9630 12040 77 CT NECK/PHARYNX/LARYNX (PLAIN) 4140 4950 5690 6930 8660 78 CT HEAD AND ORBITS (CONTRAST) 8800 10520 12100 14730 18410 79 CT HEAD AND ORBIT PLAIN.. 6900 8250 9490 11550 14440 80 CT SCAN GUIDED PROCEDURES MAJOR 5180 6190 7120 8670 10830 81 CT SCAN GUIDED PROCEDURES SIMPLE 1670 1990 2290 2790 3480 82 CT SINOGRAM 5180 6190 7120 8670 10830 CT UPPER OR LOWER ABDOMEN 83 6900 8250 9490 11550 14440 CONTRAST (NON IONIC).. 84 CT UPPER OR LOWER ABDOMEN PLAIN.. 5520 6600 7590 9240 11550 85 CT UROGRAPHY 8050 9630 11070 13480 16850 86 CT WHOLE ABDOMEN (CONTRAST) 8630 10310 11860 14430 18040 87 CT WHOLE ABDOMEN (PLAIN) 6440 7700 8860 10780 13480 88 CT COLONOSCOPY / BRONCHOSCOPY 5180 6190 7120 8670 10830 CT CHOLANGIOPANCREATICO-GRAPHY 89 9430 11280 12970 15790 19740 3D-VIRTUAL 90 HRCT CHEST 5350 6390 7350 8950 11180 91 HRCT TEMPORAL BONES 5520 6600 7590 9240 11550 92 CT PERFUSION STUDY 15520 18560 21340 25980 32480 93 CT ANGIOGRAPHY ENTIRE AORTA 19550 23380 26890 32730 40920 94 CT ANGIO PERIPHERAL 17250 20630 23720 28880 36100 95 CT PARANSAL SINUSES (CORONAL ONLY) 3280 3920 4510 5490 6860 96 CT CORONARY CALCIUM SCORING 6320 7560 8690 10580 13230 CT Triple Phase (Liver) + Volumetry + Liver 97 16680 19940 22930 27920 34900 Angio 98 CT CD charges (CT) 230 280 320 390 490 99 CT TOPOGRAM/SCNOGRAM 1380 1650 1900 2310 2890 CT SPINE CERVICAL/DORSAL/ 100 7300 8730 10040 12220 15280 LUMBOSACRAL (EACH)-3LEVEL. 101 CT SPINE PLAIN & CONTRAST 3 LEVELS.. 8800 10520 12100 14730 18410 CT CHEST+WHOLE ABDOMEN 102 14370 17190 19770 24070 30080 (CONTRAST) 103 CT CHEST+WHOLE ABDOMEN (PLAIN) 12650 15130 17400 21180 26480 104 3D CT reconstruction only 3280 3920 4510 5490 6860 105 CT angiography - Neck and brain 18980 22690 26090 31770 39710 106 CT angiography - Neck and chest 18980 22690 26090 31770 39710 107 CT ANGIOGRAPHY CORONARY 16680 19940 22930 27920 34900 CT angiography - Pulmonary and lower 108 23000 27500 31620 38500 48130 limbs (DVT protocol) 109 CECT abdomen with enterography 11500 13750 15810 19250 24060 110 CT angiography -Head, neck and chest 23000 27500 31620 38500 48130 CT angiography - Chest, abdomen and 111 23000 27500 31620 38500 48130 lower limbs
37 EAR,NOSE,THROAT S.NO. SERVICE NAME GW TWIN SINGLE SUITE 1 BALOON SINOPLASTY(LIMITED) 18750 21563 26250 32813 2 CAUDAL DISLOCATION OF SEPTUM CORRECTION 6250 7188 8750 10938 3 ADENOTONSILLECTOMY 12500 14375 17500 21875 4 CAUTRIZATION AURAL / NASAL / ORAL 1875 2156 2625 3281 5 AURAL SUCtion 500 575 700 875 6 ENDOSCOPIC ARTERIAL LIGATION FOR EPISTAXIS 18750 21563 26250 32813 ENDOSCOPIC ADENOIDECTOMY / 7 10000 11500 14000 17500 TONSILLECTOMY 8 EAR SUCTION U/L 250 288 350 438 9 EAR SUCTION B/L 500 575 700 875 10 EAR GRANULATIONS REMOVAL 2500 2875 3500 4375 11 COBALATOR SURGERY (MEDIUM) 25000 28750 35000 43750 12 COBALATOR SURGERY (SMALL) 18750 21563 26250 32813 13 90* LARYNGOSCOPY 17500 20125 24500 30625 14 ENDOSCOPIC SEPTOPLASTY 12500 14375 17500 21875 15 DCR 15000 17250 21000 26250 16 ENDOSCOPY NOSE / THROAT 2500 2875 3500 4375 17 COBALATOR / LASER TONSILLECTOMY 18750 21563 26250 32813 18 COBALATOR / LASER ADENOTONSILLECTOMY 21250 24438 29750 37188 19 ESOPHAGEAL FOREIGN BODY REMOVAL 8625 9919 12075 15094 20 FOREIGN BODY REMOVAL EAR / NOSE 875 1006 1225 1531 21 FRACTURE NASAL BONE WITH SEPTUM 12500 14375 17500 21875 22 ENDOSCOPIC CSF LEAK REPAIR 25000 28750 35000 43750 23 ENDOSCOPIC CONCHABULLECTOMY 10000 11500 14000 17500 24 FOREIGN BODY REMOVAL MINOR 1875 2156 2625 3281 25 FESS ANTERIOR 9375 10781 13125 16406 26 FESS POSTERIOR 11250 12938 15750 19688 27 FLEXIBLE LARYNGOSCOPY 3750 4313 5250 6563 28 INTERLAY TYMPANOPLASTY 15000 17250 21000 26250 29 CARTILAGE TYMPANOPLASTY 17500 20125 24500 30625 30 CANAL WALL RECONSTRUCTION 12500 14375 17500 21875 31 MLS LASER / COBALATOR 15000 17250 21000 26250 32 MLS BIOPSY 10000 11500 14000 17500 33 LASER RESECTION OF LARYNX MASS 25000 28750 35000 43750 MICRODEBRIDER TONSILLECTOMY / 34 16250 18688 22750 28438 ADENOIDECTOMY 35 LASER SURGERY - SMALL 12500 14375 17500 21875 36 LASER SURGERY - MEDIUM 18750 21563 26250 32813 37 LASER SURGERY - LARGE 31250 35938 43750 54688 38 LASER SURGERY - ENDOSCOPIC 43750 50313 61250 76563 39 COBALATOR TURBINECTOMY 15000 17250 21000 26250 40 NASAL PACKING (LIGHT) 1875 2156 2625 3281 41 ONLAY TYMPANOPLASTY 8375 9631 11725 14656 42 INLAY TYMPANOPLASTY 12500 14375 17500 21875 43 ENDOSCOPIC TYMPANOPLASTY 13750 15813 19250 24063 COMBINED APPROACH TYMPANOPLASTY / 44 22500 25875 31500 39375 MASTOIDECTOMY
38 S.NO. SERVICE NAME GW TWIN SINGLE SUITE 45 NASAL ENDSCOPY SCREENING 1125 1294 1575 1969 46 REVISION SEPTOPLASTY 10000 11500 14000 17500 47 REMOVAL OF GRANULATIONS EAR / NOSE 3750 4313 5250 6563 48 PUNCH BIOPSY 1875 2156 2625 3281 49 SYRINGING EAR 625 719 875 1094 50 REMOVAL OF MAGGOTS NOSE 1875 2156 2625 3281 51 SETTING NASAL BONE 6250 7188 8750 10938 52 SPLIT EAR LOBULE STITCHING 5625 6469 7875 9844 53 SPLIT EAR LOBULE MICRO - STITCHING 11250 12938 15750 19688 54 STRABOSCOPY 6250 7188 8750 10938 55 SINUS TRACT EXCISION SMALL 6250 7188 8750 10938 56 SINUS TRACT EXCISION LARGE 9375 10781 13125 16406 57 TYMPANOPLASTY WITH ANTROTOMY 13750 15813 19250 24063 58 STRABOSCOPY SCREENING 4375 5031 6125 7656 59 TOTAL THYROIDECTOMY 22500 25875 31500 39375 60 HEMITHYROIDECTOMY 18750 21563 26250 32813 61 VOCAL CARD INJECTION 11250 12938 15750 19688 62 VOCAL CARD PALSY SURGERY 18750 21563 26250 32813 63 VIDIAN NERVE RESECTION 22500 25875 31500 39375
AUDIOLOGY & SPEECH THERAPY S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE 1 PTA 860 1130 1300 1580 1980 2 PTA with special Test 1150 1500 1720 2100 2630 3 PTA with HAT 1720 2250 2590 3150 3940 4 Free Field Audiometry 580 750 860 1050 1310 5 Impedence/Tympanogram 1150 1500 1720 2100 2630 6 Impedence with ETF 1380 1800 2070 2520 3150 7 Impedence with Reflax Test 1950 2550 2930 3570 4460 8 OAE 1040 1350 1550 1890 2360 9 BERA 3450 4500 5180 6300 7880 10 ASSR 3450 4500 5180 6300 7880 11 ECO-G 4020 5250 6040 7350 9190 12 Speech Consultation 920 1200 1380 1680 2100 13 Speech Therapy per sitting 920 1200 1380 1680 2100 Speech Therapy per Month (Three Days 14 8630 11250 12940 15750 19690 per Week) 15 Hearing Aid Trial 460 600 690 840 1050 16 Speech Audiometery 750 980 1130 1370 1720 17 Speech Discrimination Score(SDS) 800 1050 1210 1470 1840 18 ECO-G VESTIBULAR TESTING 4020 5030 5780 7040 8800
39 NEURO & SPINE SURGERY S.NO. SERVICE NAME GW TWIN SINGLE SUITE 1 ANTERIOR APPROACH - C2 37500 43130 52500 65630 2 ANTERIOR APPROACH - C2 WITH FUSION 40000 46000 56000 70000 ANTERIOR CERVICAL DECOMPRESSION SINGLE 3 26250 30190 36750 45940 LEVEL ANTERIOR CERVICAL DECOMPRESSION MULTIPLE 4 31250 35940 43750 54690 LEVEL ANTERIOR CERVICAL DECOMPRESSION WITH 5 37500 43130 52500 65630 FUSION SINGLE LEVEL ANTERIOR CERVICAL DECOMPRESSION WITH 6 43750 50310 61250 76560 FUSION MULTIPLE LEVEL 7 ANTERIOR CERVICAL DISSECTOMY 25000 28750 35000 43750 EXCISION OF CERVICAL OPLL AND FUSION 8 37500 43130 52500 65630 SINGLE LEVEL EXCISION OF CERVICAL OPLL AND FUSION 9 43750 50310 61250 76560 -MULTIPLE LEVEL ANTERIOR CERVICAL DISSECTOMY WITH FUSION - 10 28750 33060 40250 50310 SINGLE LEVEL ANTERIOR CERVICAL DISSECTOMY WITH FUSION - 11 35000 40250 49000 61250 MULTIPLE LEVEL ANTEROLATERAL SPINAL DECOMPRESSION AND 12 37500 43130 52500 65630 FIXATION CREVICAL CARPECTOMY SINGLE LEVEL WITH 13 31250 35940 43750 54690 FUSION CREVICAL CARPECTOMY MULTIPLE LEVEL WITH 14 37500 43130 52500 65630 FUSION POSTERIOR CERVICAL DECOMPRESSION AND 15 37500 43130 52500 65630 FUSION, MULTI LEVEL POSTERIOR CERVICAL DECOMPRESSION, MULTI 16 37500 43130 52500 65630 LEVEL 17 CERVICAL DISC ARTHROPLASTY 37500 43130 52500 65630 CERVICAL LAMINECTOMY POSTERIOR SINGLE 18 25000 28750 35000 43750 LEVEL 19 CERVICAL LATERAL MASS FIXATION 28750 33060 40250 50310 CERVICAL LAMINECTOMY AND LATERAL MASS 20 40000 46000 56000 70000 FIXATATION MULTIPLE LEVEL 21 CERVICAL LAMINOPLASTY-SINGLE LEVEL 27500 31620 38500 48130 22 CERVICAL LAMINOPLASTY MULTIPLE 32500 37380 45500 56880 23 CERVICAL SPINE TUMOUR-EXTRADURAL 35000 40250 49000 61250 24 CERVICAL SPINE TUMOUR- IDEM 27500 31620 38500 48130 CERVICAL SPINE TUMOUR - IDEM WITH NERVE 25 31250 35940 43750 54690 ROOTS INVOLVEMENT 26 CERVICAL SPINE TUMOUR - INTRAMEDULLARY 55000 63250 77000 96250 27 CERVICAL SPINE TUMOUR - INTRADURAL 43750 50310 61250 76560 28 CERVICAL SPINE TUMOUR - COMPLEX/MULTILEVEL 55000 63250 77000 96250 29 TRANS ORAL EXCISION ODONTOID 43750 50310 61250 76560 30 TRANS ORAL BIOPSY 15000 17250 21000 26250 31 PRECUTENOUS ODONTOID SCREW FIXATATION 31250 35940 43750 54690 32 CV JUNCTION SURGERY 46250 53190 64750 80940 33 ANTERIOR CERVICAL DISC REPLACEMENT 40000 46000 56000 70000 34 ANTERIOR AND POST SURGERY FOR CVJ 56250 64690 78750 98440
40 S.NO. SERVICE NAME GW TWIN SINGLE SUITE FORAMEN MAGNUM, C1- C2 COMPLEX 35 66250 76190 92750 115940 RECONSTRUCTION & FUSION 36 POSTERIOR FIXATATION - BONY CVJ ANOMALY 36250 41690 50750 63440 37 C1 - C2 TRANSARTICULAR FIXATATION 42500 48870 59500 74380 38 SURGERY FOR CERVICAL SPINE TRAUMA 37500 43130 52500 65630 39 SURGERY FOR COMPLEX CERVICAL SPINE TRAUMA 62500 71880 87500 109380 40 DORSAL/LUMBAR SPINE TUMOUR - EXTRADURAL 31250 35940 43750 54690 41 DORSAL/LUMBAR SPINE TUMOUR - IDEM 25000 28750 35000 43750 DORSAL/LUMBAR SPINE TUMOUR - IDEM WITH 42 28750 33060 40250 50310 NERVE ROOT INVOLVENT DORSAL/LUMBAR SPINE TUMOUR - 43 55000 63250 77000 96250 INTRAMEDULLARY 44 DORSAL/LUMBAR SPINE TUMOUR - INTRADURAL 41250 47440 57750 72190 DORSAL/LUMBAR SPINE TUMOUR COMPLEX / 45 50000 57500 70000 87500 MULTILEVEL 46 DORSAL /LUMBAR LAMINECTOMY - SINGLE LEVEL 20000 23000 28000 35000 47 DORSAL /LUMBAR LAMINECTOMY- < LEVEL 25000 28750 35000 43750 48 DORSAL /LUMBAR LAMINECTOMY MULTIPLE LEVEL 30000 34500 42000 52500 DORSAL/LUMBAR LAMINECTOMY MULTIPLE LEVEL 49 33750 38810 47250 59060 WITH FACECTECTOMY DORSAL/LUMBAR LAMINECTOMY MULTIPLE LEVEL 50 40000 46000 56000 70000 WITH FACECTECTOMY & FORAMINOTOMY 51 DORSAL/ LUMBAR LAMINECTOMY WITH FIXATION 31250 35940 43750 54690 DORSAL/ LUMBAR LAMINECTOMY -MULTILEVEL 52 37500 43130 52500 65630 WITH FIXATION DORSAL /LUMBAR LAMINECTOMY WITH 53 56250 64690 78750 98440 FACETECTOMY WITH FIXATION DORSAL /LUMBAR LAMINECTOMY WITH 54 65000 74750 91000 113750 FACETECTOMY WITH FIXATION --MULTILEVEL 55 DORSAL /LUMBAR LAMINOPLASTY -UP TO 2 LEVEL 37500 43130 52500 65630 DORSAL /LUMBAR LAMINOPLASTY - MORE THEN 2 56 46250 53190 64750 80940 LEVEL DORSAL /LUMBAR LAMINECTOMY WITH 57 31250 35940 43750 54690 INTERBODY FUSION - POSTERIOR DORSAL/LUMBAR LAMINECTOMY WITH 58 37500 43130 52500 65630 INTERBODY FUSION -POSTERIOR (MULTI LEVEL) DORSAL/ LUMBAR INTERBODY FUSION - 59 37500 43130 52500 65630 POSTEROLATERAL APPROACH DORSAL /LUMBAR INTERBODY FUSION - 60 POSTEROLATERAL APPROACH WITH MULTILEVEL 50000 57500 70000 87500 FIXATATION - POSTERIOR DORSAL / LUMBAR INTERBODY FUSION - 61 31250 35940 43750 54690 ANTERIOR APPROACH DORSAL / LUMBAR INTERBODY FUSION - 62 43750 50310 61250 76560 ANTERIOR APPROACH - MULTILEVEL 63 LUMBAR SPINE RETROPERITONEAL APPROACH 43750 50310 61250 76560 DORSAL /LUMBAR LAMINECTOMY - EXCISION OF 64 20000 23000 28000 35000 OYLL / HYPERTROPHIC LIGAMENTS 65 SURGERY FOR DORSAL / LUMBAR SPINE TRAUMA 25000 28750 35000 43750 SURGERY FOR COMPLEX DORSAL / LUMBAR SPINE 66 62500 71880 87500 109380 TRAUMA
41 S.NO. SERVICE NAME GW TWIN SINGLE SUITE DORSAL /LUMBAR LAMINECTOMY - EXCISION OF 67 25000 28750 35000 43750 OYLL/HYPERTROPHIC LIGAMENTS - MULTILEVEL 68 LUMBAR DISCOIDECTOMY -OPEN SINGLE LEVEL 20000 23000 28000 35000 69 LUMBAR- DISCOIDECTOMY -OPEN UP TO 2 LEVEL 26250 30190 36750 45940 70 LUMBAR DISCOIDECTOMY - OPEN MULTIPLE LEVEL 28750 33060 40250 50310 71 MICRODISCOIDECTOMY - SINGLE LEVEL 25000 28750 35000 43750 72 MICRODISCOIDECTOMY - MULTIPLE LEVEL 31250 35940 43750 54690 ENDOSCOPIC LUMBAR DISCOIDECTOMY - SINGLE 73 26250 30190 36750 45940 LEVEL ENDOSCOPIC LUMBAR DISCOIDECTOMY- 74 33750 38810 47250 59060 MULTIPLE LEVEL 75 VERTEBRAL BIOPSY 8750 10060 12250 15310 76 VERTEBROPLASTY -SINGLE LEVEL 20000 23000 28000 35000 77 VERTEBROPLASTY -MULTIPLE LEVEL 25000 28750 35000 43750 78 KYPHOPLASTY - MULTIPLE LEVEL 37500 43130 52500 65630 79 KYPHOPLASTY - SINGLE LEVEL 25000 28750 35000 43750 80 KYPHOPLASTY DOUBLE BALLOON 28750 33060 40250 50310 81 KYPHOPLASTY DOUBLE BALLOON -MULTIPLE LEVEL 37500 43130 52500 65630 82 SPINAL DYSRAPHISM SURGERY - SIMPLE 43750 50310 61250 76560 83 SPINAL DYSRAPHISM SURGERY - COMPLEX 62500 71880 87500 109380 84 MENINGOCOELE REPAIR- SIMPLE 22500 25870 31500 39380 85 MENINGOMYELOYELOCOELE REPAIR - SIMPLE 31250 35940 43750 54690 86 MENINGOMYELOCOELE REPAIR- COMPLEX 43750 50310 61250 76560 87 LIPOMENINGOMYELOCOELE - COMPLEX 56250 64690 78750 98440 88 ASPIRATION OF ABSCESS / HAEMATOMA IN SPINE 8750 10060 12250 15310 89 HALO JACKET APPLICATION 8750 10060 12250 15310 90 HALO JACKET REMOVAL 4375 5030 6130 7660 91 LUMBAR DRAIN PLACEMENT 5000 5750 7000 8750 92 LUMBAR PRESSURE MONITORING 10000 11500 14000 17500 93 ANTERO LATERAL DECOMPRESSION SPINE 26250 30190 36750 45940 94 ANTERO LATERAL DECOMPRESSION WITH FUSION 35000 40250 49000 61250 ANTEROLATERAL SPINAL DECOMPRESSION AND 95 50000 57500 70000 87500 RECONSTRUCTION 96 ENDOSCOPIC SPINE DECOMPRESSION 37500 43130 52500 65630 ENDOSCOPIC SPINE DECOMPRESSION WITH 97 50000 57500 70000 87500 FUSION 98 BONE GRAFTING 11250 12940 15750 19690 99 LAMINECTOMY FOR CANAL STENOSIS 31250 35940 43750 54690 100 LARGE INTRA SPINAL TUMOUR 75000 86250 105000 131250 101 LUMBER PUNCTURE/CSF DRAINAGE 3125 3590 4380 5470 102 MULTIPLE INTERCOSTAL BLOCK 5000 5750 7000 8750 103 MULTIPLE NERVE BLOCK 7125 8190 9980 12470 104 SINGLE FORAMINAL BLOCK 7500 8630 10500 13130 105 MULTIPLE FORAMINAL BLOCK 10000 11500 14000 17500 106 SINGLE NERVE ROOT BLOCK 6250 7190 8750 10940 107 MULTIPLE NERVE ROOT BLOCK 8750 10060 12250 15310 108 CARPEL TUNNEL BLOCK 3750 4310 5250 6560 109 SINGLE EPIDURAL BLOCK 3125 3590 4380 5470 110 MULTIPLE EPIDURAL BLOCK 5625 6470 7870 9840
42 S.NO. SERVICE NAME GW TWIN SINGLE SUITE PERCUTANEOUS NEUCLEOPLASTY CERVICAL - 111 12500 14370 17500 21880 SINGLE LEVEL PERCUTANEOUS NEUCLEOPLASTY CERVICAL 112 17500 20130 24500 30630 MULTIPLE PERCUTANEOUS NEUCLEOPLASTY LUMBAR SINGLE 113 15000 17250 21000 26250 LEVEL PERCUTANEOUS NEUCLEOPLASTY LUMBAR 114 18750 21560 26250 32810 MULTIPLE LEVEL 115 OZONE THERAPY - SINGLE LEVEL 18750 21560 26250 32810 116 OZONE THERAPY - MULTIPLE LEVEL 25000 28750 35000 43750 117 NEUROLYSIS/NERVE DECOMPRESSION 18750 21560 26250 32810 118 SPINAL CORD TUMOUR 87500 100620 122500 153130 119 COMPLEX SPINAL INSTRUMENTATION 5000 5750 7000 8750 120 STANDARD SPINE INSTRUMENTATION 22500 25870 31500 39380 TRANSFORAMINAL LUMBAR INTERVERTEBRAL BODY 121 27500 31620 38500 48130 FUSION WITH INSTRUMENTATION TRANSTHORACIC ANTERIOR DECOMPRESSION & 122 32500 37380 45500 56880 FUSION POSTERIOR LUMBAR INTERVERTEBRAL BODY 123 27500 31620 38500 48130 FUSION 124 ANTERIOR CERVICAL FUSION 27500 31620 38500 48130 ANTERIOR SPINAL FUSION & DECOMPRESSION AT 125 33750 38810 47250 59060 MULTIPLE LEVELS ANTERIOR SPINAL FUSION WITH DECOMPRESSION 126 27500 31620 38500 48130 AT SINGLE LEVEL Decompression Spine Posterior Approach/ 127 25000 28750 35000 43750 laminectomy 1level Decompression Spine Posterior Approach/ 128 300000 345000 420000 525000 laminectomy 2 -3 levels-Spine Decompression Spine Posterior Approach/ 129 33750 38810 47250 59060 laminectomy >3 levels 130 Discectomy Microdiscectomy-Spine 26250 30190 36750 45940 131 Cervical disc replacement 1 level revision 50000 57500 70000 87500 132 C1-C2 Closed reduction 10000 11500 14000 17500
43 NEUROSURGERY S.NO. SERVICE NAME GW TWIN SINGLE SUITE 1 ANEURYSM (BRAIN) 52500 60400 73500 91900 2 ANGIOMAS (BRAIN) 52500 60400 73500 91900 3 BRACHIAL PLEXUS SURGERY 45000 51700 63000 78800 4 BRAIN ABSCESS 35000 40300 49000 61300 5 BRAIN BIOPSY 14375 16500 20100 25200 6 V.P. Shunt 28750 33100 40300 50300 7 BRAIN STEM SURGERY 52500 60400 73500 91900 8 BRAIN TUMOUR (GLIOMA) 43750 50300 61200 76600 9 CSF RHINORRHOEA 45000 51700 63000 78800 10 CHRONIC SUBDURAL HAEMATOMA (BURR HOLES) 27500 31600 38500 48100 11 CARPEL TUNNEL SYNDROME 12875 14800 18000 22500 12 ENDOSCOPIC BRAIN SURGERY 43750 50300 61200 76600 13 EPIDURAL INJECTION 9625 11100 13500 16800 14 EXTERNAL VENTRICULAR DRAINAGE VENTRE TAP. 13500 15500 18900 23600 15 FACETECTOMY 18750 21600 26300 32800 16 FORAMEN MAGNUM SURGERY 52500 60400 73500 91900 17 FACIAL NERVE RECONSTRUCTION 32500 37400 45500 56900 18 INTRA CRANIAL HAEMATOMA 40000 46000 56000 70000 19 MENINGIOMA 52500 60400 73500 91900 MICRO VASCULAR DECOMPRESSION OF 20 52500 60400 73500 91900 TRIGEMINAL NEURALGIA 21 NERVE BIOPSY 14375 16500 20100 25200 22 ANEURYSM WITH NECK CONTROL 43750 50300 61200 76600 23 ANEURYSM WITH NECK CONTRAL 52500 60400 73500 91900 24 ANEURYSM WITH TEMPORARY CLIPPING 57500 66100 80500 100600 25 FMD (FORAMEN MAGNUM DECOMPRESSION) 26250 30200 36800 45900 26 FMD DURAPLASTY 28750 33100 40300 50300 27 FMD DURAPLASTY - FASCIA LATA GRAFT 40000 46000 56000 70000 28 FMD AND POST FUSION 32500 37400 45500 56900 29 FDM DURAPLASTY AND POST FUSION 52500 60400 73500 91900 FMD, BONY RECONSTRUCTION, DURAPLASTY, 30 57500 66100 80500 100600 AND FUSION 31 DRIP DRY LP 4375 5000 6100 7700 32 EPIDURAL CATHER PLACEMENT 11625 13400 16300 20300 33 BURR HOLE - MULTIPLE 17375 20000 24300 30400 34 BURE HOLE WITH AIR EVACUATION 11625 13400 16300 20300 35 EVACUATION OF CHRONIC SDH 42500 48900 59500 74400 36 EVECUATION OF SUBACUTE SDH 28750 33100 40300 50300 37 TWIST DRILL - EVD PLACEMENT 22500 25900 31500 39400 38 VENTRICULAR TAPPING 7125 8200 10000 12500 39 BURR HOLE EVD PLACEMENT 26250 30200 36800 45900 40 CONVERSION OF EVD TO VP SHUNT 20000 23000 28000 35000 41 REVISION OF V P SHUNT 17375 20000 24300 30400 42 SHUNT REMOVAL 14500 16700 20300 25400 43 REPOSITI0NING OF VP SHUNT 7125 8200 10000 12500 44 THECOPERITONEAL SHUNT (TP SHUNT) 22500 25900 31500 39400 45 SYRINGOSTOMY 14500 16700 20300 25400
44 S.NO. SERVICE NAME GW TWIN SINGLE SUITE 46 CSF IVERSION PROCEDURE 37500 43100 52500 65600 47 CRANIOPLASTY WITH REMODELLING OF BONE 35000 40300 49000 61300 CRANIOPLASTY, RECONSTRUCTION OF BONY 48 46250 53200 64700 80900 DEFECT WITH DURAPLASTY 49 MIDLINE SUBOCCIPITAL CRANIECTOMY 26250 30200 36800 45900 50 SUBOCCIPITAL CARNIOTOMY 32500 37400 45500 56900 51 CRANIOTOMY FOR SUPERTIFICIAL ICH 28750 33100 40300 50300 52 CRANIOTOMY FOR DEEP ICH 43750 50300 61200 76600 53 CRANIOTOMY FOR COMPLEX AVM 57500 66100 80500 100600 CRANIOTOMY - DECOMPRESSION 54 26250 30200 36800 45900 SUPRATENTORIAL TUMOUR CRANIOTOMY - TOTAL EXCISION SUPRATENTORIAL 55 32500 37400 45500 56900 TUMOUR 56 CRANIOTOMY- BIOPSY SUPRATENTORIAL TUMOUR 22500 25900 31500 39400 57 CRANIOTOMY FOR INTRAPARENCHYMAL TUMOUR 35000 40300 49000 61300 58 CRANIOTOMY FOR EXTRAAXIAL BRAIN TUMOUR 28750 33100 40300 50300 CRANIOTOMY FOR ANTERIOR SKULL BASE 59 43750 50300 61200 76600 TUMOUR CRANIOTOMY FOR MIDDLE CRANIAL FOSSA 60 52500 60400 73500 91900 TUMOURS 61 CRANIOTOMY FOR POSTERIOR FOSSA TUMOUR 28750 33100 40300 50300 62 CRANIOTOMY FOR POSTERIOR SKULL BASE LESION 57500 66100 80500 100600 63 CRANIOTOMY FOR CP ANGLE LESIONS 37500 43100 52500 65600 64 CRANIOTOMY -MVD 46250 53200 64700 80900 65 CRANIOTOMY FOR ACOUSTIC SCHNOMNA 55000 63200 77000 96300 66 SKULL BASE TUMOUR - SIMPLE 32500 37400 45500 56900 67 SKULL BASE TUMOUR - COMPLEX 37500 43100 52500 65600 68 CRANIOTOMY - PINEAL TUMOURS 61250 70400 85800 107200 69 EXCISION OF SCALP TUMOUR 14500 16700 20300 25400 70 SUPRATENTORIAL COMPLEX BRAIN TUMOURS 57500 66100 80500 100600 71 CRANIOTOMY FOR CP ANGLE MENINGIOMA 48750 56100 68300 85300 72 RETROMASTOID SUBOCCIPITAL CRANIOTOMY 28750 33100 40300 50300 MICROSCOPIC TRANSNASAL 73 26250 30200 36800 45900 TRANSSPHENOIDALSURGERY (TNTS) MICROSCOPIC EXTENDED TRANSPHENOIDAL 74 35000 40300 49000 61300 SURGERY MICROSCOPIC EXTENDED TRANSPHENOIDAL 75 48750 56100 68300 85300 SURGERY WITH SELLAR FLOOR RECONSTRUCTION 76 ENDOSCOPIC CSF DIVERSION 35000 40300 49000 61300 77 ETV FOR VENTRICULITIS 37500 43100 52500 65600 78 VENTRICULAR ENDOSCOPY DIAGNOSTIC 22500 25900 31500 39400 79 ENDOSCOPIC ASPIRATION OF CYSTIC LESIONS 26250 30200 36800 45900 80 ENDOSCOPIC EXCISION VENTRICULAR LESIONS 55000 63200 77000 96300 81 ENDOSCOPIC TNTS 32500 37400 45500 56900 82 ENDOSCOPIC EXTENDED TNTS 35000 40300 49000 61300 83 ENDOSCOPIC SELLAR FLOOR RECONSTRUCTION 40000 46000 56000 70000 84 ENDOSCOPIC EXCISION OF COMPLEX LESIONS 57500 66100 80500 100600 ENDOSCOPIC EVACUTION OF VENTRICULAR 85 20000 23000 28000 35000 BLEED 86 COMBINED CRANIAL & ENDOSCOPIC PROCEDURE 70000 80500 98000 122500
45 S.NO. SERVICE NAME GW TWIN SINGLE SUITE 87 CARPAL TUNNEL DECOMPRESSION BILATERAL 18750 21600 26300 32800 88 PERIPHERAL NEVER SURGERY MINOR 26250 30200 36800 45900 89 PERIPHERAL NERVE SURGERY MAJOR 33750 38800 47300 59100 90 DEBRIDEMENT AND SUTURING 14500 16700 20300 25400 91 REPAIR OF SCALP AVULSION 22500 25900 31500 39400 92 PERCUTANEOUS TRACHEOUS 14500 16700 20300 25400 93 OPEN TRACCHEOSTOMY DECANULATION 8625 9900 12100 15100 94 CEREBRAL DSA AND COILING 28750 33100 40300 50300 95 PITUITARY TUMOUR 45000 51700 63000 78800 96 PERIPHERAL NERVE SURGERY 18750 21600 26300 32800 97 POST. FOSSA SURGERY 52500 60400 73500 91900 98 REPAIR OF DURAL REAL WITH GLUE 28750 33100 40300 50300 99 RF CESION FOR FARCET JOINT 12875 14800 18000 22500 100 SUB DURAL HAEMATOMA 35000 40300 49000 61300 101 SPINAL EPIDURAL FIBROSIS 35000 40300 49000 61300 102 SUBPIAL RESECTION 38750 44600 54300 67800 103 THECO PERITONEAL SHUNT 28750 33100 40300 50300 104 THROMBOLYSIS WITH r TPA 13500 15500 18900 23600 105 V-P SHUNT 28750 33100 40300 50300 106 Syringo Subarachnoid Shunt 20000 23000 28000 35000 107 Burr Hole Single 14500 16700 20300 25400 108 Cranioplasty 36250 41700 50800 63400 109 Carpal Tunnel Syndrome 11625 13400 16300 20300 110 Neurolysis external/ internal 14500 16700 20300 25400 111 Brachial plexus injury 37500 43100 52500 65600 112 Decompressive craniotomy 37500 43100 52500 65600 113 Decompressive craniotomy and duroplasty 65000 74800 91000 113800 114 ICP Monitoring 15875 18300 22200 27800 115 Skull Traction 4375 5000 6100 7700 116 Lipomeningomyelocele 26250 30200 36800 45900 117 Endoscopic ventriculostomy 28750 33100 40300 50300 118 Endoscopic CSF Rhinorrhoea 32500 37400 45500 56900 119 Endoscopic endonasal odointoid removal 6375 7300 8900 11200 120 Aneurysm simple 28750 33100 40300 50300 121 Aneurysm Complex 35000 40300 49000 61300 122 Artero venous fistula 12250 14100 17200 21400 123 Artero venous malformation complex 52500 60400 73500 91900 124 Carotid ligation and repair 35000 40300 49000 61300 125 Lumbar puncture (neurosurgery) 3250 3700 4600 5700 126 Subdural tap 4375 5000 6100 7700 127 Biopsy/Nerve/Muscle 4250 4900 6000 7400 128 Neurofibroma excision 11375 13100 15900 19900 129 SKULL BASE SURGERY 52500 60400 73500 91900 130 CRANIOTOMY 30000 34500 42000 52500 131 DEPRESSED FRACTURE 20000 23000 28000 35000 132 LOBECTOMY 35000 40300 49000 61300 133 CRANIOTOMY FOR DEPRESSED FRACTURE 27500 31600 38500 48100
46 S.NO. SERVICE NAME GW TWIN SINGLE SUITE CRANIOTOMY FOR DEPRESSED FRACTURE WITH 134 37500 43100 52500 65600 DURAPLASTY 135 DURAL REPAIR WITH GLUE 11625 13400 16300 20300 136 REMOVAL / ELEVATION OF BONE FRAMENTS 14500 16700 20300 25400 CRANIOTOMY FOR ANTERIOR CRANIAL FOSSA 137 37500 43100 52500 65600 (ACF) FRACTURES 138 CRANIOTOMY WITH ACF REPAIR 57500 66100 80500 100600 CRANIOTOMY, ACF REPAIR WITH FASCIA LATA 139 65000 74800 91000 113800 GRAFT 140 CRANIOTOMY FOR EDH UNILATERAL 43750 50300 61200 76600 141 CRANIOTOMY FOR BILATERAL EDH 56250 64700 78800 98400 142 CRANIOTOMY FOR EDH & SDH 68750 79100 96300 120300 143 CARNIOTOMY FOR SDH 50000 57500 70000 87500 144 CRANIOTOMY- EVACUATION OF CONTUSION 36250 41700 50800 63400 145 CRANIOTOMY - LOBECTOMY 52500 60400 73500 91900 CRANIOTOMY EVACUATON OF CONTUSION WITH 146 72500 83400 101500 126900 LOBECTOMY 147 SURGERY FOR COMPLEX HEAD INJURY 87500 100600 122500 153100 148 BIFRONTAL CRANIOTOMY 50000 57500 70000 87500 149 CARNIECTOMY - POSTERIOR FOSSA EDH 43750 50300 61200 76600 150 Extra dural haematoma 25000 28700 35000 43800 151 Cerebral contusion 38750 44600 54300 67800 152 Subdural haematoma 32500 37400 45500 56900 153 GROWING FRACTURE SKULL 43750 50300 61200 76600
47 OPTHALMOLOGY S.NO. SERVICE OPD GW TWIN SINGLE SUITE DESCMENT MEMBRANE ENDOTHELIAL 1 115000 137500 158125 192500 240625 KERATOPLASTY DMEK (P) 2 BOTULINUM TOXIN PER SIDE 17250 20630 23720 28880 36100 3 LASER LIO FOR ROP (P) 6900 8250 9488 11550 14438 4 COMPLETE GLAUCOMA WORK-UP 4600 5500 6320 7700 9630 5 COMPLETE RETINA WORK-UP 4600 5500 6320 7700 9630 FUNDUS FLUORESCIEN 6 4025 4810 5530 6730 8420 ANGIOGRAPHY F.F.A RETINA GREEN LASER (PRP) PER 7 4025 4810 5530 6730 8420 SITTING RETINA GREEN LASER (MACULAR) PER 8 4025 4810 5530 6730 8420 SITTING 9 POSTERIOR SUBTENON TRICORT 4025 4810 5530 6730 8420 10 YAG IRIDOTOMY 3450 4130 4750 5780 7230 11 YAG CAPSULOTOMY 2875 3440 3960 4820 6020 RETINA GREEN LASER (FOCAL) PER 12 2875 3440 3960 4820 6020 SITTING 13 POSTERIOR SUBTENON TRICORT 2875 3440 3960 4820 6020 RETINOPATHY OF PREMATURITY 14 2875 3440 3960 4820 6020 SCREENING 15 3D OCT (RETINA) 2645 3160 3630 4420 5530 16 3D OCT (GLAUCOMA) 2645 3160 3630 4420 5530 AUTOMATED PERIMETRY/ VISUAL 17 2300 2750 3160 3850 4810 FIELDS 18 COMPLETE SQUINT WORK-UP 2070 2480 2850 3470 4340 19 OCT ( RETINA) ONE EYE 1380 1650 1900 2310 2890 20 ANTERIOR SEGMENT OCT 1265 1510 1740 2110 2640 21 B-SCAN BIOMETRY 1150 1380 1590 1930 2420 22 EYE WASH 1150 1380 1590 1930 2420 23 EMERGENCY CONSULTATION 1150 1380 1590 1930 2420 24 A-SCAN BIOMETRY 805 960 1100 1340 1680 25 CONJUCTIVAL SUTURE REMOVAL 805 960 1100 1340 1680 SUBCONJUNCTIVAL INJECTION OF 26 805 960 1100 1340 1680 MYDRICAINE/ ANTIBIOTICS 27 CONCRETION REMOVAL OPD 805 960 1100 1340 1680 28 DEEP FB REMOVAL (CORNEA) 575 690 790 970 1210 29 DIURINAL NCT 575 690 790 970 1210 30 FUNDUS PHOTO 575 690 790 970 1210 31 SYRINGING OPD 575 690 790 970 1210 32 PARACENTESIS 575 690 790 970 1210 33 SUPERFICAL FB REMOVAL.(CORNEA) 345 410 470 570 720 34 PATCH CILIA REMOVAL 345 410 470 570 720 35 DILATED REFRACTION 230 280 320 390 490 36 SCHIRMER’S TEST 230 280 320 390 490 37 EYE DRESSING 230 280 320 390 490 38 INDIRECT OPHTHALMOSCOPY 230 280 320 390 490 PHACO + HYDROPHILIC FOLDABLE 39 16500 18975 23100 28875 IOL ACRIFOLD (P)
48 S.NO. SERVICE OPD GW TWIN SINGLE SUITE PHACO + HYDROPHOBIC FOLDABLE 40 27500 31625 38500 48125 IOL EYECRYL/AUROVUE (P) MICS+ FOREIGN FOLDABLE IOL 41 35000 40250 49000 61250 (ACRYSOF SP) (P) MICS+ FOREIGN FOLDABLE IOL 42 41250 47438 57750 72188 (ACRYSOF IQ) (P) MICS+ FOREIGN PRELOADED 43 FOLDABLE IOL(ULTRASERT+ACRTSOF 47500 54625 66500 83125 IQ) (P) MICS +FOREIGN TORIC FOLDABLE 44 62500 71875 87500 109375 IOL (ACRYSOF IQ TORIC) (P) MICS + MULTIFOCAL FOLDABAL IOL 45 75000 86250 105000 131250 (ACRYSOF IQ RESTOR) (P) MICS+ MULTIFOCAL+TORIC 46 FOLADABLE IOL(ACRYSOF IQ RESTOR 112500 129375 157500 196875 TORIC) (P) EXTRA CHARGES IN COMPLICATED 47 12500 14375 17500 21875 CATARACT SURGERY 48 SECONDARY IOL IMPLANTATION 25000 28750 35000 43750 49 INTRAVITREAL TRICORT (P) 10000 11500 14000 17500 50 INTRAVITREAL LUCENTIS (P) 43750 50313 61250 76563 51 OT FB REMOVAL (P) 12500 14375 17500 21875 52 WOUND CLOSURE (PERFORATING) (P) 25000 28750 35000 43750 WOUND CLOSURE (PERFORATING) 53 31250 35938 43750 54688 UNDER GA (P) 54 KERATOPLASTY SURGERY (P) 75000 86250 105000 131250 55 PTERYGIUM EXCISION (SIMPLE) (P) 7500 8625 10500 13125 PTERYGIUM EXCISION (AUTOGRAFT) 56 27500 31625 38500 48125 (P) PTERYGIUM EXCISION 57 37500 43125 52500 65625 (AUTOGRAFT+GLUE) (P) CORNEAL PERFORATION REPAIR WITH 58 18750 21563 26250 32813 GLUE WITH BCL (P) TRABECULECTOMY WITH MITOMYCIN 59 35000 40250 49000 61250 C (P) 60 TRAB +IMPLANT (OLOGEN) (P) 43750 50313 61250 76563 61 GLAUCOMA SHUNT SURGERY (P) 62500 71875 87500 109375 62 ECTROPION SURGERY (P) 18750 21563 26250 32813 63 ENTROPION SURGERY (P) 18750 21563 26250 32813 64 PTOSIS SURGERY (P) 18750 21563 26250 32813 65 DCR ENDOSCOPIC SURGERY (P) 37500 43125 52500 65625 66 DCR EXTERNAL SURGERY (P) 37500 43130 52500 65630 67 BLEPHAROPLASTY (P) 18750 21563 26250 32813 GOLD WEIGHT FOR 68 LAGOPHTHALMOS (less than 1.2gm) 43750 50313 61250 76563 (P) GOLD WEIGHT FOR 69 62500 71875 87500 109375 LAGOPHTHALMOS (UPTO 2gm) (P) 70 BALLOON DACROPLASTY (P) 50000 57500 70000 87500 71 LID LACERATION REPAIR (P) 18750 21563 26250 32813 72 LID CHALAZION I & C SINGLE (P) 5000 5750 7000 8750 73 LID CHALAZION I & C MULTIPLE (P) 8750 10063 12250 15313
49 S.NO. SERVICE OPD GW TWIN SINGLE SUITE 74 LID MASS EXCISION AND BIOPSY (P) 18750 21563 26250 32813 CANALICULAR REPAIR / CANTHAL 75 18750 21563 26250 32813 REPAIR (P) 76 LID ABSCESS DRAINAGE (P) 6250 7188 8750 10938 HORIZONTAL MUSCLE SURGERY IN 77 25000 28750 35000 43750 LA (P) HORIZONTAL MUSCLE SURGEY BOTH 78 62500 71875 87500 109375 EYE IN GA (P) 79 VERTICAL MUSCLE SURGERY IN LA (P) 25000 28750 35000 43750 80 INTRA CAMERAL GAS INJECTION (P) 12500 14375 17500 21875 SYRINGING AND PROBING UNDER 81 18750 21563 26250 32813 GA (P) PEDIATRIC CATARACT SURGERY 82 62500 71875 87500 109375 UNDER GA WITH ACRYSOF IQ IOL (P) 83 EVISCERATION SUREGERY (P) 18750 21563 26250 32813 84 ENUCLEATION SURGERY (P) 25000 28750 35000 43750 85 PUNCTAL PLUGS FOR DRY EYES (P) 15000 17250 21000 26250 86 HYPHEMA DRAINAGE (P) 12500 14375 17500 21875 87 CORNEAL C3R CROSSLINKING (P) 18750 21563 26250 32813 88 SURGICAL PUPILLOPLASTY (P) 18750 21563 26250 32813 89 SURGICAL MEMBRANECTOMY (P) 18750 21563 26250 32813 EXAMINATION UNDER ANESTHESIA 90 12500 14375 17500 21875 (P) EDTA CHELATION FOR BAND SHAPE 91 18750 21563 26250 32813 KERATOPATHY (P) 92 AMNIOTIC MEMBRANE GRAFTING (P) 18750 21563 26250 32813 93 SYMBLEPHARON RELEASE (P) 12500 14375 17500 21875 94 TARSORRHAPHY (P) 18750 21563 26250 32813 95 LID MARGIN TUMOR BIOPSY (P) 12500 14375 17500 21875 96 LID RECONSTRUCTION MINOR (P) 12500 14375 17500 21875 97 LID RECONSTRUCTION MAJOR (P) 31250 35938 43750 54688 98 RECANNULISATION OF PUNCTUM (P) 21250 24438 29750 37188 GUNDERSON FLAP FOR CORNEAL 99 18750 21563 26250 32813 MELTING (P) DEEP ANTERIOR LAMELLAR 100 87500 100625 122500 153125 KERATOPLASTY DALK (P) ICL IMPLANTATION COLLAMER 101 156250 179688 218750 273438 PHAKIC IOL (P) 102 CYCLO CRYOPEXY (P) 18750 21563 26250 32813 103 ORBITOTOMY (P) 37500 43125 52500 65625 104 ORBITOTOMY WITH IMPLANT (P) 62500 71875 87500 109375 LID RUMOR EXCISION WITH REPAIR BY 105 37500 43125 52500 65625 FLAPS (P) 106 XANTHELESMA EXCISION (P) 18750 21563 26250 32813 107 VIRAL WARTS EXCISION (P) 8750 10063 12250 15313 EXPLANTATION OF DISLOCATED IOL 108 41250 47438 57750 72188 AND ANTERIOR VITRECTOMY (P) 109 RUPTURE GLOBE PRIMARY REPAIR (P) 62500 71875 87500 109375 110 CORNEAL WOUND REPAIR (P) 43750 50313 61250 76563
50 DENTISTRY S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE 1 Bleaching_Additional Bleach Tube 1720 2060 2369 2884 3605 2 Bleaching_Bleaching Office Grade 1 4600 5500 6325 7700 9625 Bleaching_Bleaching Office Grade 1 3 2300 2750 3163 3850 4813 (Initial) Bleaching_Bleaching Office Grade 1 4 2300 2750 3163 3850 4813 (Final) 5 Bleaching_Bleaching Office Grade 2 5750 6880 7912 9632 12040 Bleaching_Bleaching Office Grade 2 6 2880 3440 3956 4816 6020 (Initial) Bleaching_Bleaching Office Grade 2 7 2880 3440 3956 4816 6020 (Final) 8 Bleaching_Bleaching Office Grade 3 11500 13750 15813 19250 24063 Bleaching_Bleaching Office Grade 3 9 5750 6880 7912 9632 12040 (Initial) Bleaching_Bleaching Office Grade 3 10 5750 6880 7912 9632 12040 (Final) 11 Bleaching_Bleaching Office Grade 4 17250 20630 23725 28882 36103 Bleaching_Bleaching Office Grade 4 12 8630 10310 11857 14434 18043 (Initial) Bleaching_Bleaching Office Grade 4 13 8630 10310 11857 14434 18043 (Final) 14 Bleaching_Bleaching Trays 2530 3030 3485 4242 5303 15 Bleaching_Walking Bleach 2300 2750 3163 3850 4813 16 Bone Grafting Grade I 2300 2750 3163 3850 4813 17 Bone Grafting Grade I (Initial) 1150 1380 1587 1932 2415 18 Bone Grafting Grade I (Final) 1150 1380 1587 1932 2415 19 Bone Grafting Grade II 2880 3440 3956 4816 6020 20 Bone Grafting Grade II (Initial) 1440 1720 1978 2408 3010 21 Bone Grafting Grade II (Final) 1440 1720 1978 2408 3010 22 Bone Grafting Grade III 5750 6880 7912 9632 12040 23 Bone Grafting Grade III (Initial) 2880 3440 3956 4816 6020 24 Bone Grafting Grade III (Final) 2880 3440 3956 4816 6020 25 Dental Implant Grade 1 23000 27500 31625 38500 48125 26 Dental Implant Grade 1 (Initial) 11500 13750 15813 19250 24063 27 Dental Implant Grade 1 (Final) 11500 13750 15813 19250 24063 28 Dental Implant Grade 2 34500 41250 47438 57750 72188 29 Dental Implant Grade 2 (Initial) 17250 20630 23725 28882 36103 30 Dental Implant Grade 2 (Final) 17250 20630 23725 28882 36103 31 Dental Implant Grade 3 32200 38500 44275 53900 67375 32 Dental Implant Grade 3 (Initial) 16100 19250 22138 26950 33688 33 Dental Implant Grade 3 (Final) 16100 19250 22138 26950 33688 34 Dental Implant Grade 4 51750 61880 71162 86632 108290 35 Dental Implant Grade 4 (Initial) 25870 30940 35581 43316 54145 36 Dental Implant Grade 4 (Final) 25870 30940 35581 43316 54145 Extractions_Dental Surgical Removal Of 37 3450 4130 4750 5782 7228 Tooth Grade 1 Extractions_Dental Surgical Removal Of 38 4600 5500 6325 7700 9625 Tooth Grade 2
51 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE Extractions_Dental Surgical Removal Of 39 5750 6880 7912 9632 12040 Tooth Grade 3 40 Extractions_Impaction Grade 1 6900 8250 9488 11550 14438 41 Extractions_Impaction Grade 2 9200 11000 12650 15400 19250 42 Extractions_Impaction Grade 3 13800 16500 18975 23100 28875 Extractions_Removal Of Decayed Root 43 2300 2750 3163 3850 4813 Grade 1 Extractions_Removal Of Decayed Root 44 3450 4130 4750 5782 7228 Grade 2 Extractions_Removal Of Decayed/Over 45 800 960 1104 1344 1680 Retained Tooth 1 Extractions_Removal Of Decayed/Over 46 1040 1240 1426 1736 2170 Retained Tooth 2 Extractions_Removal Of Decayed/Over 47 1270 1510 1737 2114 2643 Retained Tooth 3 Extractions_Removal Of Decayed/Over 48 1720 2060 2369 2884 3605 Retained Tooth 4 Extractions_Removal Of Fractured 49 2070 2480 2852 3472 4340 Tooth F A Therapy_Ceramic Braces 50 40250 48130 55350 67382 84228 Treatmentgrade 1 F A Therapy_Ceramic Braces 51 23000 27500 31625 38500 48125 Treatmentgrade 1 Installment 1 F A Therapy_Ceramic Braces 52 17250 20630 23725 28882 36103 Treatmentgrade 1 Installment 2 F A Therapy_Ceramic Braces 53 46000 55000 63250 77000 96250 Treatmentgrade 2 F A Therapy_Ceramic Braces 54 23000 27500 31625 38500 48125 Treatmentgrade 2 installment 1 F A Therapy_Ceramic Braces 55 11500 13750 15813 19250 24063 Treatmentgrade 2 installment 2 F A Therapy_Ceramic Braces 56 11500 13750 15813 19250 24063 Treatmentgrade 2 installment 3 F A Therapy_Fixed Orthodontic 57 109250 130630 150225 182882 228603 Treatment Without Braces F A Therapy_Fixed Orthodontic 58 54620 65310 75107 91434 114293 Treatment Without Braces (Initial) F A Therapy_Fixed Orthodontic 59 54620 65310 75107 91434 114293 Treatment Without Braces (Final) F A Therapy_Growth Modification 60 11500 13750 15813 19250 24063 Grade 1 F A Therapy_Growth Modification 61 5750 6880 7912 9632 12040 Grade 1 (Initial) F A Therapy_Growth Modification 62 5750 6880 7912 9632 12040 Grade 1 (Final) F A Therapy_Growth Modification 63 17250 20630 23725 28882 36103 Grade 2 F A Therapy_Growth Modification 64 8630 10310 11857 14434 18043 Grade 2 (Initial) F A Therapy_Growth Modification 65 8630 10310 11857 14434 18043 Grade 2 (Final) F A Therapy_Growth Modification 66 23000 27500 31625 38500 48125 Grade 3
52 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE F A Therapy_Growth Modification 67 11500 13750 15813 19250 24063 Grade 3 (Initial) F A Therapy_Growth Modification 68 11500 13750 15813 19250 24063 Grade 3 (Final) F A Therapy_Lingual Treatment Grade 69 40250 48130 55350 67382 84228 1 F A Therapy_Lingual Treatment Grade 70 20130 24060 27669 33684 42105 1 (Initial) F A Therapy_Lingual Treatment Grade 71 20130 24060 27669 33684 42105 1 (Final) F A Therapy_Lingual Treatment Grade 72 32200 38500 44275 53900 67375 2 F A Therapy_Lingual Treatment Grade 73 16100 19250 22138 26950 33688 2 (Initial) F A Therapy_Lingual Treatment Grade 74 16100 19250 22138 26950 33688 2 (Final) 75 F A Therapy_Ortho Breakage Charges 1150 1380 1587 1932 2415 F A Therapy_Ortho Breakage Charges 76 580 690 794 966 1208 (Initial) F A Therapy_Ortho Breakage Charges 77 580 690 794 966 1208 (Final) 78 F A Therapy_Self Ligating Metal 28750 34380 39537 48132 60165 79 F A Therapy_Self Ligating Metal (Initial) 14370 17190 19769 24066 30083 80 F A Therapy_Self Ligating Metal (Final) 14370 17190 19769 24066 30083 F A Therapy_Self Ligating Metal 81 17250 20630 23725 28882 36103 Brackets intallment 1 F A Therapy_Self Ligating Metal 82 5750 6880 7912 9632 12040 Brackets intallment 2 F A Therapy_Self Ligating Metal 83 5750 6880 7912 9632 12040 Brackets intallment 3 84 F A Therapy_Space Maintainer 1 2300 2750 3163 3850 4813 F A Therapy_Space Maintainer 1 85 1150 1380 1587 1932 2415 (Initial) 86 F A Therapy_Space Maintainer 1 (Final) 1150 1380 1587 1932 2415 87 F A Therapy_Space Maintainer 2 3450 4130 4750 5782 7228 F A Therapy_Space Maintainer 2 88 1720 2060 2369 2884 3605 (Initial) 89 F A Therapy_Space Maintainer 2 (Final) 1720 2060 2369 2884 3605 F A Therapy_Ss Braces Treatment 90 32200 38500 44275 53900 67375 Grade 1 F A Therapy_Ss Braces Treatment 91 16100 19250 22138 26950 33688 Grade 1 (Initial) F A Therapy_Ss Braces Treatment 92 16100 19250 22138 26950 33688 Grade 1 (Final) 93 Miscellaneous_Polishing 580 690 794 966 1208 94 Miscellaneous_Pulp Capping Dycal 690 830 955 1162 1453 Miscellaneous_Pulp Capping Dycal 95 350 410 472 574 718 (Initial) Miscellaneous_Pulp Capping Dycal 96 350 410 472 574 718 (Final) 97 Miscellaneous_Splint Grade 1 2300 2750 3163 3850 4813 98 Miscellaneous_Splint Grade 2 4020 4810 5532 6734 8418
53 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE 99 Miscellaneous_Splint Grade 3 6320 7560 8694 10584 13230 100 Miscellaneous_Splint Grade 3 (Initial) 3160 3780 4347 5292 6615 101 Miscellaneous_Splint Grade 3 (Final) 3160 3780 4347 5292 6615 102 Miscellaneous_Study Model 460 550 633 770 963 Oral Surgical Procedures_Alveolectomy 103 2880 3440 3956 4816 6020 Grade 1 Oral Surgical Procedures_Alveolectomy 104 1440 1720 1978 2408 3010 Grade 1 (Initial) Oral Surgical Procedures_Alveolectomy 105 1440 1720 1978 2408 3010 Grade 1 (Final) Oral Surgical Procedures_Alveolectomy 106 4020 4810 5532 6734 8418 Grade 2 Oral Surgical Procedures_Alveolectomy 107 2010 2410 2772 3374 4218 Grade 2 (Initial) Oral Surgical Procedures_Alveolectomy 108 2010 2410 2772 3374 4218 Grade 2 (Final) Oral Surgical Procedures_Alveoloplasty 109 1720 2060 2369 2884 3605 Grade 1 Oral Surgical Procedures_Alveoloplasty 110 2880 3440 3956 4816 6020 Grade 2 Oral Surgical Procedures_Alveoloplasty 111 1440 1720 1978 2408 3010 Grade 2 (Initail) Oral Surgical Procedures_Alveoloplasty 112 1440 1720 1978 2408 3010 Grade 2 (Final) 113 Apexification Grade 1 3450 4130 4750 5782 7228 114 Apexification Grade 1 (Initial) 1720 2060 2369 2884 3605 115 Apexification Grade 1 (Final) 1720 2060 2369 2884 3605 116 Apexification Grade 2 5750 6880 7912 9632 12040 117 Apexification Grade 2 (Initail) 2880 3440 3956 4816 6020 118 Apexification Grade 2 (Final) 2880 3440 3956 4816 6020 Oral Surgical Procedures_Apexogenesis 119 3450 4130 4750 5782 7228 Grade 1 Oral Surgical Procedures_Apexogenesis 120 1720 2060 2369 2884 3605 Grade 1 (Initail) Oral Surgical Procedures_Apexogenesis 121 1720 2060 2369 2884 3605 Grade 1 (Final) Oral Surgical Procedures_Apexogenesis 122 5750 6880 7912 9632 12040 Grade 2 Oral Surgical Procedures_Apexogenesis 123 2880 3440 3956 4816 6020 Grade 2 (Initail) Oral Surgical Procedures_Apexogenesis 124 2880 3440 3956 4816 6020 Grade 2 (Final) Oral Surgical Procedures_Apicoectomy 125 3450 4130 4750 5782 7228 Grade 1 Oral Surgical Procedures_Apicoectomy 126 1720 2060 2369 2884 3605 Grade 1 (Initial) Oral Surgical Procedures_Apicoectomy 127 1720 2060 2369 2884 3605 Grade 1 (Final) Oral Surgical Procedures_Apicoectomy 128 5750 6880 7912 9632 12040 Grade 2 Oral Surgical Procedures_Apicoectomy 129 2880 3440 3956 4816 6020 Grade 2 (Initial)
54 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE Oral Surgical Procedures_Apicoectomy 130 2880 3440 3956 4816 6020 Grade 2 (Final) Oral Surgical Procedures_Apicoectomy 131 9200 11000 12650 15400 19250 Grade 3 Oral Surgical Procedures_Apicoectomy 132 4600 5500 6325 7700 9625 Grade 3 (Initial) Oral Surgical Procedures_Apicoectomy 133 4600 5500 6325 7700 9625 Grade 3 (Final) Oral Surgical Procedures_Biopsy 134 1150 1380 1587 1932 2415 (Small) Oral Surgical Procedures_Bone Graft 135 11500 13750 15813 19250 24063 Grade 1 Oral Surgical Procedures_Bone Graft 136 5750 6880 7912 9632 12040 Grade 1 (Initial) Oral Surgical Procedures_Bone Graft 137 5750 6880 7912 9632 12040 Grade 1 (Final) Oral Surgical Procedures_Bone Graft 138 16100 19250 22138 26950 33688 Grade 2 Oral Surgical Procedures_Bone Graft 139 8050 9630 11075 13482 16853 Grade 2 (Initial) Oral Surgical Procedures_Bone Graft 140 8050 9630 11075 13482 16853 Grade 2 (Final) Oral Surgical Procedures_Bone Graft 141 20700 24750 28463 34650 43313 Grade 3 Oral Surgical Procedures_Bone Graft 142 10350 12380 14237 17332 21665 Grade 3 (Initial) Oral Surgical Procedures_Bone Graft 143 10350 12380 14237 17332 21665 Grade 3 (Final) Oral Surgical Procedures_Canine 144 5750 6880 7912 9632 12040 Exposure Oral Surgical Procedures_Canine 145 2880 3440 3956 4816 6020 Exposure (Initial) Oral Surgical Procedures_Canine 146 2880 3440 3956 4816 6020 Exposure (Final) Oral Surgical Procedures_Canine 147 9200 11000 12650 15400 19250 Exposure Oral Surgical Procedures_Canine 148 4600 5500 6325 7700 9625 Exposure (Initial) Oral Surgical Procedures_Canine 149 4600 5500 6325 7700 9625 Exposure (Final) Oral Surgical Procedures_Closure Of 150 5750 6880 7912 9632 12040 Oro Antral Fistual (Oaf) Grade 1 Oral Surgical Procedures_Closure 151 Of Oro Antral Fistual (Oaf) Grade 1 2880 3440 3956 4816 6020 (Initial) Oral Surgical Procedures_Closure Of 152 2880 3440 3956 4816 6020 Oro Antral Fistual (Oaf) Grade 1 (Final) Oral Surgical Procedures_Cyst 153 7470 8940 10281 12516 15645 Enucleation Medium Oral Surgical Procedures_Cyst 154 3740 4470 5141 6258 7823 Enucleation Medium (Initial) Oral Surgical Procedures_Cyst 155 3740 4470 5141 6258 7823 Enucleation Medium (Final)
55 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE Oral Surgical Procedures_Cyst 156 5750 6880 7912 9632 12040 Enucleation Small Oral Surgical Procedures_Cyst 157 2880 3440 3956 4816 6020 Enucleation Small (Initial) Oral Surgical Procedures_Cyst 158 2880 3440 3956 4816 6020 Enucleation Small (Final) Oral Surgical Procedures_Cyst 159 6900 8250 9488 11550 14438 Marsupilization Grade 1 Oral Surgical Procedures_Cyst 160 3450 4130 4750 5782 7228 Marsupilization Grade 1 (Initial) Oral Surgical Procedures_Cyst 161 3450 4130 4750 5782 7228 Marsupilization Grade 1 (Final) Oral Surgical Procedures_Cyst 162 9200 11000 12650 15400 19250 Marsupilization Grade 2 Oral Surgical Procedures_Cyst 163 4600 5500 6325 7700 9625 Marsupilization Grade 2 (Initial) Oral Surgical Procedures_Cyst 164 4600 5500 6325 7700 9625 Marsupilization Grade 2 (Final) Oral Surgical Procedures_Dental 165 1150 1380 1587 1932 2415 Suturing Grade 1 Oral Surgical Procedures_Dental 166 580 690 794 966 1208 Suturing Grade 1 (Initial) Oral Surgical Procedures_Dental 167 580 690 794 966 1208 Suturing Grade 1 (Final) Oral Surgical Procedures_Dental 168 1720 2060 2369 2884 3605 Suturing Grade 2 Oral Surgical Procedures_Dental 169 860 1030 1185 1442 1803 Suturing Grade 2 (Initial) Oral Surgical Procedures_Dental 170 860 1030 1185 1442 1803 Suturing Grade 2 (Final) Oral Surgical Procedures_Dental 171 2300 2750 3163 3850 4813 Suturing Grade 3 Oral Surgical Procedures_Dental 172 1150 1380 1587 1932 2415 Suturing Grade 3 (Initial) Oral Surgical Procedures_Dental 173 1150 1380 1587 1932 2415 Suturing Grade 3 (Final) Oral Surgical Procedures_Dental 174 580 690 794 966 1208 Suturing Removal Oral Surgical Procedures_Drainage Of 175 3450 4130 4750 5782 7228 E.O Abscess Grade 1 Oral Surgical Procedures_Drainage Of 176 1720 2060 2369 2884 3605 E.O Abscess Grade 1 (Initial) Oral Surgical Procedures_Drainage Of 177 1720 2060 2369 2884 3605 E.O Abscess Grade 1 (Final) Oral Surgical Procedures_Drainage Of 178 5750 6880 7912 9632 12040 E.O Abscess Grade 2 Oral Surgical Procedures_Drainage Of 179 2880 3440 3956 4816 6020 E.O Abscess Grade 2 (Initail) Oral Surgical Procedures_Drainage Of 180 2880 3440 3956 4816 6020 E.O Abscess Grade 2 (Final) Oral Surgical Procedures_Drainage Of 181 8050 9630 11075 13482 16853 E.O Abscess Grade 3 Oral Surgical Procedures_Drainage Of 182 4020 4810 5532 6734 8418 E.O Abscess Grade 3 (Initial)
56 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE Oral Surgical Procedures_Drainage Of 183 4020 4810 5532 6734 8418 E.O Abscess Grade 3 (Final) Oral Surgical Procedures_Drainage Of 184 5750 6880 7912 9632 12040 I.0 Abscess Grade 2 Oral Surgical Procedures_Drainage Of 185 2880 3440 3956 4816 6020 I.0 Abscess Grade 2 (Initial) Oral Surgical Procedures_Drainage Of 186 2880 3440 3956 4816 6020 I.0 Abscess Grade 2 (Final) Oral Surgical Procedures_Drainage Of 187 2880 3440 3956 4816 6020 I.O Abscess Grade 1 Oral Surgical Procedures_Drainage Of 188 1440 1720 1978 2408 3010 I.O Abscess Grade 1 (Initial) Oral Surgical Procedures_Drainage Of 189 1440 1720 1978 2408 3010 I.O Abscess Grade 1 (Final) Oral Surgical Procedures_Drainage Of 190 8050 9630 11075 13482 16853 I.O Abscess Grade 3 Oral Surgical Procedures_Drainage Of 191 4020 4810 5532 6734 8418 I.O Abscess Grade 3 (Initial) Oral Surgical Procedures_Drainage Of 192 4020 4810 5532 6734 8418 I.O Abscess Grade 3 (Final) 193 Oral Surgical Procedures_Frenectomy 2300 2750 3163 3850 4813 Oral Surgical Procedures_Frenectomy 194 1150 1380 1587 1932 2415 (Initial) Oral Surgical Procedures_Frenectomy 195 1150 1380 1587 1932 2415 (Final) 196 Oral Surgical Procedures_Imf Grade 1 17250 20630 23725 28882 36103 Oral Surgical Procedures_Imf Grade 1 197 8630 10310 11857 14434 18043 (Initial) Oral Surgical Procedures_Imf Grade 1 198 8630 10310 11857 14434 18043 (Final) Oral Surgical Procedures_Ridge 199 11500 13750 15813 19250 24063 Splitting 1 Oral Surgical Procedures_Ridge 200 5750 6880 7912 9632 12040 Splitting 1 (Initial) Oral Surgical Procedures_Ridge 201 5750 6880 7912 9632 12040 Splitting 1 (Final) Oral Surgical Procedures_Ridge 202 17250 20630 23725 28882 36103 Splitting 2 Oral Surgical Procedures_Ridge 203 8630 10310 11857 14434 18043 Splitting 2 (Initial) Oral Surgical Procedures_Ridge 204 8630 10310 11857 14434 18043 Splitting 2 (Final) Oral Surgical Procedures_Sinus Lift 205 17250 20630 23725 28882 36103 Direct (Per Side) Grade 1 Oral Surgical Procedures_Sinus Lift 206 8630 10310 11857 14434 18043 Direct (Per Side) Grade 1 (Initial) Oral Surgical Procedures_Sinus Lift 207 8630 10310 11857 14434 18043 Direct (Per Side) Grade 1 (Final) Oral Surgical Procedures_Sinus Lift 208 23000 27500 31625 38500 48125 Direct (Per Side) Grade 2 Oral Surgical Procedures_Sinus Lift 209 11500 13750 15813 19250 24063 Direct (Per Side) Grade 2 (Initial) Oral Surgical Procedures_Sinus Lift 210 11500 13750 15813 19250 24063 Direct (Per Side) Grade 2 (Final)
57 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE Oral Surgical Procedures_Sinus Lift 211 5750 6880 7912 9632 12040 Indirect Grade 1 Oral Surgical Procedures_Sinus Lift 212 2880 3440 3956 4816 6020 Indirect Grade 1 (Initial) Oral Surgical Procedures_Sinus Lift 213 2880 3440 3956 4816 6020 Indirect Grade 1 (Final) Oral Surgical Procedures_Sinus Lift 214 9200 11000 12650 15400 19250 Indirect Grade 2 Oral Surgical Procedures_Sinus Lift 215 4600 5500 6325 7700 9625 Indirect Grade 2 (Initial) Oral Surgical Procedures_Sinus Lift 216 4600 5500 6325 7700 9625 Indirect Grade 2 (Final) Oral Surgical Procedures_Socket 217 1150 1380 1587 1932 2415 Currettage Oral Surgical Procedures_Socket 218 580 690 794 966 1208 Currettage (Initial) Oral Surgical Procedures_Socket 219 580 690 794 966 1208 Currettage (Final) Oral Surgical Procedures_Suturing 220 2880 3440 3956 4816 6020 Laceration Oral Surgical Procedures_Suturing 221 1440 1720 1978 2408 3010 Laceration (Initial) Oral Surgical Procedures_Suturing 222 1440 1720 1978 2408 3010 Laceration (Final) Oral Surgical Procedures_Tmj 223 2300 2750 3163 3850 4813 Dislocation Oral Surgical Procedures_Tmj 224 1150 1380 1587 1932 2415 Dislocation (Initial) Oral Surgical Procedures_Tmj 225 1150 1380 1587 1932 2415 Dislocation (Final) Oral Surgical Procedures_Tooth Re 226 5750 6880 7912 9632 12040 Implantation With Splinting Oral Surgical Procedures_Tooth Re 227 2880 3440 3956 4816 6020 Implantation With Splinting (Initial) Oral Surgical Procedures_Tooth Re 228 2880 3440 3956 4816 6020 Implantation With Splinting (Final) Oral Surgical Procedures_Tumour 229 11500 13750 15813 19250 24063 Excision Grade 1 Oral Surgical Procedures_Tumour 230 5750 6880 7912 9632 12040 Excision Grade 1 (Initial) Oral Surgical Procedures_Tumour 231 5750 6880 7912 9632 12040 Excision Grade 1 (Final) Oral Surgical Procedures_ 232 9200 11000 12650 15400 19250 Vestibuloplasty Oral Surgical Procedures_ 233 4600 5500 6325 7700 9625 Vestibuloplasty (Initial) Oral Surgical Procedures_ 234 4600 5500 6325 7700 9625 Vestibuloplasty (Final) Rehabilitation_All CeraMIC 235 11500 13750 15813 19250 24063 ZIRCONIAGrade 1 Rehabilitation_All CeraMIC 236 5750 6880 7912 9632 12040 ZIRCONIAGrade 1 (Initial) Rehabilitation_All CeraMIC 237 5750 6880 7912 9632 12040 ZIRCONIAGrade 1 (Final)
58 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE Rehabilitation_All Ceramic ZIRCONIA 238 13800 16500 18975 23100 28875 Grade 2 Rehabilitation_All Ceramic ZIRCONIA 239 6900 8250 9488 11550 14438 Grade 2 (Initial) Rehabilitation_All Ceramic ZIRCONIA 240 6900 8250 9488 11550 14438 Grade 2 (Final) Rehabilitation_All Ceramic ZIRCONIA 241 17250 20630 23725 28882 36103 Grade 3 Rehabilitation_All Ceramic ZIRCONIA 242 8630 10310 11857 14434 18043 Grade 3 (Initial) Rehabilitation_All Ceramic ZIRCONIA 243 8630 10310 11857 14434 18043 Grade 3 (Final) Rehabilitation_Band & Loop Space 244 3450 4130 4750 5782 7228 Maintainer Rehabilitation_Band & Loop Space 245 1720 2060 2369 2884 3605 Maintainer (Initial) Rehabilitation_Band & Loop Space 246 1720 2060 2369 2884 3605 Maintainer (Final) Rehabilitation_Cast Partial Denture 247 12650 15130 17400 21182 26478 Grade 1 Rehabilitation_Cast Partial Denture 248 6320 7560 8694 10584 13230 Grade 1 (Initial) Rehabilitation_Cast Partial Denture 249 6320 7560 8694 10584 13230 Grade 1 (Final) Rehabilitation_Cast Partial Denture 250 17250 20630 23725 28882 36103 Grade 2 Rehabilitation_Cast Partial Denture 251 8630 10310 11857 14434 18043 Grade 2 (Initial) Rehabilitation_Cast Partial Denture 252 8630 10310 11857 14434 18043 Grade 2 (Final) Rehabilitation_Cast Partial Denture 253 23000 27500 31625 38500 48125 Grade 3 Rehabilitation_Cast Partial Denture 254 11500 13750 15813 19250 24063 Grade 3 (Initial) Rehabilitation_Cast Partial Denture 255 11500 13750 15813 19250 24063 Grade 3 (Final) Rehabilitation_Complete Denture 256 23000 27500 31625 38500 48125 Grade 1 Rehabilitation_Complete Denture 257 11500 13750 15813 19250 24063 Grade 1 (Initial) Rehabilitation_Complete Denture 258 11500 13750 15813 19250 24063 Grade 1 (Final) Rehabilitation_Complete Denture 259 28750 34380 39537 48132 60165 Grade 2 Rehabilitation_Complete Denture 260 14370 17190 19769 24066 30083 Grade 2 (Initial) Rehabilitation_Complete Denture 261 14370 17190 19769 24066 30083 Grade 2 (Final) Rehabilitation_Complete Denture 262 34500 41250 47438 57750 72188 Grade 3 Rehabilitation_Complete Denture 263 17250 20630 23725 28882 36103 Grade 3 (Initial) Rehabilitation_Complete Denture 264 17250 20630 23725 28882 36103 Grade 3 (Final)
59 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE Rehabilitation_Crown & Loop Space 265 4600 5500 6325 7700 9625 Maintainer Rehabilitation_Crown & Loop Space 266 2300 2750 3163 3850 4813 Maintainer (Initial) Rehabilitation_Crown & Loop Space 267 2300 2750 3163 3850 4813 Maintainer (Final) Rehabilitation_Crown Removal (Per 268 800 960 1104 1344 1680 Tooth) 269 Rehabilitation_Dental Rpd Flexible Plate 5750 6880 7912 9632 12040 Rehabilitation_Dental Rpd Flexible Plate 270 2880 3440 3956 4816 6020 (Initial) Rehabilitation_Dental Rpd Flexible Plate 271 2880 3440 3956 4816 6020 (Final) 272 Diastema Closure 9200 11000 12650 15400 19250 273 Diastema Closure (Initial) 4600 5500 6325 7700 9625 274 Diastema Closure (Final) 4600 5500 6325 7700 9625 Rehabilitation_Flexible Denture Grade 275 23000 27500 31625 38500 48125 1 Rehabilitation_Flexible Denture Grade 276 11500 13750 15813 19250 24063 1 (Initial) Rehabilitation_Flexible Denture Grade 277 11500 13750 15813 19250 24063 1 (Final) Rehabilitation_Flexible Denture Grade 278 28750 34380 39537 48132 60165 2 Rehabilitation_Flexible Denture Grade 279 14370 17190 19769 24066 30083 2 (Initial) Rehabilitation_Flexible Denture Grade 280 14370 17190 19769 24066 30083 2 (Final) 281 Rehabilitation_Metal Bridge Per Unit 3450 4130 4750 5782 7228 Rehabilitation_Metal Bridge Per Unit 282 1720 2060 2369 2884 3605 (Initial) Rehabilitation_Metal Bridge Per Unit 283 1720 2060 2369 2884 3605 (Final) 284 Rehabilitation_Metal Crown 2880 3440 3956 4816 6020 285 Rehabilitation_Metal Crown (Initial) 1440 1720 1978 2408 3010 286 Rehabilitation_Metal Crown (Final) 1440 1720 1978 2408 3010 287 Rehabilitation_Night Guard 2880 3440 3956 4816 6020 288 Rehabilitation_Night Guard (Initial) 1440 1720 1978 2408 3010 289 Rehabilitation_Night Guard (Final) 1440 1720 1978 2408 3010 290 Rehabilitation_Obturators 17250 20630 23725 28882 36103 291 Rehabilitation_Obturators (Initial) 8630 10310 11857 14434 18043 292 Rehabilitation_Obturators (Final) 8630 10310 11857 14434 18043 Rehabilitation_Porcelain Crown Grade 293 4600 5500 6325 7700 9625 1 (Pfm) Rehabilitation_Porcelain Crown Grade 294 2300 2750 3163 3850 4813 1 (Pfm) (Initial) Rehabilitation_Porcelain Crown Grade 295 2300 2750 3163 3850 4813 1 (Pfm) (Final) Rehabilitation_Porcelain Crown Grade 296 5180 6190 7119 8666 10833 2 (Pfm) Rehabilitation_Porcelain Crown Grade 297 2590 3090 3554 4326 5408 2 (Pfm) (Initial)
60 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE Rehabilitation_Porcelain Crown Grade 298 2590 3090 3554 4326 5408 2 (Pfm) (Final) Rehabilitation_Porcelain Crown Grade 299 5750 6880 7912 9632 12040 3 (Pfm) Rehabilitation_Porcelain Crown Grade 300 2880 3440 3956 4816 6020 3 (Pfm) (Initial) Rehabilitation_Porcelain Crown Grade 301 2880 3440 3956 4816 6020 3 (Pfm) (Final) Rehabilitation_Porcelain Veneers Grade 302 10350 12380 14237 17332 21665 1 Rehabilitation_Porcelain Veneers Grade 303 5180 6190 7119 8666 10833 1 (Initial) Rehabilitation_Porcelain Veneers Grade 304 5180 6190 7119 8666 10833 1 (Final) Rehabilitation_Porcelain Veneers Grade 305 13800 16500 18975 23100 28875 2 Rehabilitation_Porcelain Veneers Grade 306 6900 8250 9488 11550 14438 2 (Initial) Rehabilitation_Porcelain Veneers Grade 307 6900 8250 9488 11550 14438 2 (Final) Rehabilitation_Porcelain Veneers Grade 308 17250 20630 23725 28882 36103 3 Rehabilitation_Porcelain Veneers Grade 309 8630 10310 11857 14434 18043 3 (Initial) Rehabilitation_Porcelain Veneers Grade 310 8630 10310 11857 14434 18043 3 (Final) 311 Rehabilitation_Post And Core Grade 1 2300 2750 3163 3850 4813 Rehabilitation_Post And Core Grade 1 312 1150 1380 1587 1932 2415 (Initial) Rehabilitation_Post And Core Grade 1 313 1150 1380 1587 1932 2415 (Final) 314 Rehabilitation_Post And Core Grade 2 3450 4130 4750 5782 7228 Rehabilitation_Post And Core Grade 2 315 1720 2060 2369 2884 3605 (Initial) Rehabilitation_Post And Core Grade 2 316 1720 2060 2369 2884 3605 (Final) 317 Rehabilitation_Post And Core Grade 3 4600 5500 6325 7700 9625 Rehabilitation_Post And Core Grade 3 318 2300 2750 3163 3850 4813 (Initial) Rehabilitation_Post And Core Grade 3 319 2300 2750 3163 3850 4813 (Final) 320 Rehabilitation_Relining Grade 1 2300 2750 3163 3850 4813 321 Rehabilitation_Relining Grade 1 (Initial) 1150 1380 1587 1932 2415 322 Rehabilitation_Relining Grade 1 (Final) 1150 1380 1587 1932 2415 323 Rehabilitation_Relining Grade 2 3450 4130 4750 5782 7228 324 Rehabilitation_Relining Grade 2 (Initial) 1720 2060 2369 2884 3605 325 Rehabilitation_Relining Grade 2 (Final) 1720 2060 2369 2884 3605 326 Rehabilitation_Relining Grade 3 4600 5500 6325 7700 9625 327 Rehabilitation_Relining Grade 3 (Initial) 2300 2750 3163 3850 4813 328 Rehabilitation_Relining Grade 3 (Final) 2300 2750 3163 3850 4813 Rehabilitation_Removable Space 329 2300 2750 3163 3850 4813 Maintainer
61 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE Rehabilitation_Removable Space 330 1150 1380 1587 1932 2415 Maintainer (Initial) Rehabilitation_Removable Space 331 1150 1380 1587 1932 2415 Maintainer (Final) Rehabilitation_Repair Work Of 332 1150 1380 1587 1932 2415 Fractured Denture Grade 1 Rehabilitation_Repair Work Of 333 580 690 794 966 1208 Fractured Denture Grade 1 (Initial) Rehabilitation_Repair Work Of 334 580 690 794 966 1208 Fractured Denture Grade 1 (Final) Rehabilitation_Repair Work Of 335 1720 2060 2369 2884 3605 Fractured Denture Grade 2 Rehabilitation_Repair Work Of 336 860 1030 1185 1442 1803 Fractured Denture Grade 2 (Initial) Rehabilitation_Repair Work Of 337 860 1030 1185 1442 1803 Fractured Denture Grade 2 (Final) 338 Rehabilitation_Rpd Additional Tooth 580 690 794 966 1208 339 Rehabilitation_Rpd Single Tooth Type 1 1150 1380 1587 1932 2415 340 Rehabilitation_Rpd Single Tooth Type 2 1720 2060 2369 2884 3605 Rehabilitation_Single Complete 341 8050 9630 11075 13482 16853 Denture Grade 1 Rehabilitation_Single Complete 342 4020 4810 5532 6734 8418 Denture Grade 1 (Initial) Rehabilitation_Single Complete 343 4020 4810 5532 6734 8418 Denture Grade 1 (Final) Rehabilitation_Single Complete 344 11500 13750 15813 19250 24063 Denture Grade 2 Rehabilitation_Single Complete 345 5750 6880 7912 9632 12040 Denture Grade 2 (Initial) Rehabilitation_Single Complete 346 5750 6880 7912 9632 12040 Denture Grade 2 (Final) 347 Rehabilitation_Sleep Guard 3450 4130 4750 5782 7228 348 Rehabilitation_Sleep Guard (Initial) 1720 2060 2369 2884 3605 349 Rehabilitation_Sleep Guard 2 (Final) 1720 2060 2369 2884 3605 Rehabilitation_Smile Design Lower 350 17250 20630 23725 28882 36103 Grade 1/ Arch Anteriors Rehabilitation_Smile Design Lower 351 8630 10310 11857 14434 18043 Grade 1/ Arch Anteriors (Initial) Rehabilitation_Smile Design Lower 352 8630 10310 11857 14434 18043 Grade 1/ Arch Anteriors 2 (Final) Rehabilitation_Smile Design Lower 353 23000 27500 31625 38500 48125 Grade 2 Rehabilitation_Smile Design Lower 354 11500 13750 15813 19250 24063 Grade 2 (Initial) Rehabilitation_Smile Design Lower 355 11500 13750 15813 19250 24063 Grade 2 (Final) Rehabilitation_Smile Design Upper 356 17250 20630 23725 28882 36103 Grade 1 Rehabilitation_Smile Design Upper 357 8630 10310 11857 14434 18043 Grade 1 (Initial) Rehabilitation_Smile Design Upper 358 8630 10310 11857 14434 18043 Grade 1 (Final)
62 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE Rehabilitation_Smile Design Upper 359 23000 27500 31625 38500 48125 Grade 2 Rehabilitation_Smile Design Upper 360 11500 13750 15813 19250 24063 Grade 2 (Initial) Rehabilitation_Smile Design Upper 361 11500 13750 15813 19250 24063 Grade 2 (Final) Rehabilitation_Space Maintainer Grade 362 3450 4130 4750 5782 7228 1 Rehabilitation_Space Maintainer Grade 363 1720 2060 2369 2884 3605 1 (Initial) Rehabilitation_Space Maintainer Grade 364 1720 2060 2369 2884 3605 1 (Final) Rehabilitation_Space Maintainer Grade 365 5750 6880 7912 9632 12040 2 Rehabilitation_Space Maintainer Grade 366 2880 3440 3956 4816 6020 2 (Initial) Rehabilitation_Space Maintainer Grade 367 2880 3440 3956 4816 6020 2 (Final) Rehabilitation_Stainless Steel Crown 368 3450 4130 4750 5782 7228 Grade 1 Rehabilitation_Stainless Steel Crown 369 1720 2060 2369 2884 3605 Grade 1 (Initial) Rehabilitation_Stainless Steel Crown 370 1720 2060 2369 2884 3605 Grade 1 (Final) Rehabilitation_Stainless Steel Crown 371 2300 2750 3163 3850 4813 Grade 2 Rehabilitation_Stainless Steel Crown 372 1150 1380 1587 1932 2415 Grade 2 (Initial) Rehabilitation_Stainless Steel Crown 373 1150 1380 1587 1932 2415 Grade 2 (Final) 374 Rehabilitation_Temporary Crown 520 620 713 868 1085 375 Rehabilitation_Thinners 23000 27500 31625 38500 48125 376 Rehabilitation_Thinners (Initial) 11500 13750 15813 19250 24063 377 Rehabilitation_Thinners (Final) 11500 13750 15813 19250 24063 378 R A Therapy_Bite Plate 4600 5500 6325 7700 9625 379 R A Therapy_Bite Plate (Initial) 2300 2750 3163 3850 4813 380 R A Therapy_Bite Plate (Final) 2300 2750 3163 3850 4813 R A Therapy_Habit Breaking Appliance 381 4020 4810 5532 6734 8418 1 R A Therapy_Habit Breaking Appliance 382 2010 2410 2772 3374 4218 1 (Initial) R A Therapy_Habit Breaking Appliance 383 2010 2410 2772 3374 4218 1 (Final) R A Therapy_Habit Breaking Appliance 384 5750 6880 7912 9632 12040 2 R A Therapy_Habit Breaking Appliance 385 2880 3440 3956 4816 6020 2 (Initial) R A Therapy_Habit Breaking Appliance 386 2880 3440 3956 4816 6020 2 (Final) 387 R A Therapy_Mouthguards 3450 4130 4750 5782 7228 388 R A Therapy_Mouthguards (Initial) 1720 2060 2369 2884 3605 389 R A Therapy_Mouthguards (Final) 1720 2060 2369 2884 3605 390 R A Therapy_Oral Screen 3450 4130 4750 5782 7228
63 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE 391 R A Therapy_Oral Screen (Initial) 1720 2060 2369 2884 3605 392 R A Therapy_Oral Screen (Final) 1720 2060 2369 2884 3605 393 R A Therapy_Pediatric Obturator 5750 6880 7912 9632 12040 394 R A Therapy_Pediatric Obturator (Initial) 2880 3440 3956 4816 6020 395 R A Therapy_Pediatric Obturator (Final) 2880 3440 3956 4816 6020 R A Therapy_Remova Ble Appliance 396 6320 7560 8694 10584 13230 Grade 1 (Retainer U/L) R A Therapy_Remova Ble Appliance 397 3160 3780 4347 5292 6615 Grade 1 (Retainer U/L) (Initial) R A Therapy_Remova Ble Appliance 398 3160 3780 4347 5292 6615 Grade 1 (Retainer U/L) (Final) R A Therapy_R A Grade 2 (Screw 399 10350 12380 14237 17332 21665 Appliance) R A Therapy_R A Grade 2 (Screw 400 5180 6190 7119 8666 10833 Appliance) (Initial) R A Therapy_R A Grade 2 (Screw 401 5180 6190 7119 8666 10833 Appliance) (Final) R A Therapy_R A Grade 3 (Screw 402 14370 17190 19769 24066 30083 Appliance) R A Therapy_R A Grade 3 (Screw 403 7190 8590 9879 12026 15033 Appliance) (Initial) R A Therapy_R A Grade 3 (Screw 404 7190 8590 9879 12026 15033 Appliance) (Final) R A Therapy_Retainer Remaking Grade 405 1720 2060 2369 2884 3605 1 R A Therapy_Retainer Remaking Grade 406 2880 3440 3956 4816 6020 2 R A Therapy_Retainer Remaking Grade 407 1440 1720 1978 2408 3010 2 (Initial) R A Therapy_Retainer Remaking Grade 408 1440 1720 1978 2408 3010 2 (Final) 409 R A Therapy_Simple Removable Ortho 6320 7560 8694 10584 13230 R A Therapy_Simple Removable Ortho 410 3160 3780 4347 5292 6615 (Initial) R A Therapy_Simple Removable Ortho 411 3160 3780 4347 5292 6615 (Final) 412 R A Therapy_Thumbsucking Grade 1 7470 8940 10281 12516 15645 R A Therapy_Thumbsucking Grade 1 413 3740 4470 5141 6258 7823 (Initial) R A Therapy_Thumbsucking Grade 1 414 3740 4470 5141 6258 7823 (Final) 415 R A Therapy_Thumbsucking Grade 2 8630 10310 11857 14434 18043 R A Therapy_Thumbsucking Grade 2 416 4310 5160 5934 7224 9030 (Initial) R A Therapy_Thumbsucking Grade 2 417 4310 5160 5934 7224 9030 (Final) 418 R A Therapy_Trainer Therapy 11500 13750 15813 19250 24063 419 R A Therapy_Trainer Therapy (Initial) 5750 6880 7912 9632 12040 420 R A Therapy_Trainer Therapy (Final) 5750 6880 7912 9632 12040 421 R A Therapy_Z Spring Appliance 5750 6880 7912 9632 12040 422 R A Therapy_Z Spring Appliance (Initial) 2880 3440 3956 4816 6020 423 R A Therapy_Z Spring Appliance (Final) 2880 3440 3956 4816 6020
64 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE 424 Restorations_Cementation Of Bridge 1150 1380 1587 1932 2415 425 Restorations_Cementation Of Crown 690 830 955 1162 1453 426 Restorations_Ceramic Inlays 5750 6880 7912 9632 12040 427 Restorations_Ceramic Inlays (Initial) 2880 3440 3956 4816 6020 428 Restorations_Ceramic Inlays (Final) 2880 3440 3956 4816 6020 Restorations_Composite Filling Cervical 429 1720 2060 2369 2884 3605 Abrasion/Class 5 Grade 2 Restorations_Composite Filling Cervical 430 1150 1380 1587 1932 2415 Abrasion/Class 5 Grade 1 Restorations_Composite Filling 431 4020 4810 5532 6734 8418 Extensive Restorations_Composite Filling 432 2010 2410 2772 3374 4218 Extensive (Initial) Restorations_Composite Filling 433 2010 2410 2772 3374 4218 Extensive (Final) Restorations_Composite Filling Grade 434 920 1100 1265 1540 1925 1 Restorations_Composite Filling Grade 435 1380 1650 1898 2310 2888 2 Restorations_Composite Filling Grade 436 2300 2750 3163 3850 4813 3 Restorations_Composite Filling Grade 437 1150 1380 1587 1932 2415 3 (Initial) Restorations_Composite Filling Grade 438 1150 1380 1587 1932 2415 3 (Final) Restorations_Composite Filling Grade 439 2880 3440 3956 4816 6020 4 Restorations_Composite Filling Grade 440 1440 1720 1978 2408 3010 4 (Initial) Restorations_Composite Filling Grade 441 1440 1720 1978 2408 3010 4 (Final) 442 Restorations_Composite Inlay Direct 4600 5500 6325 7700 9625 Restorations_Composite Inlay Direct 443 2300 2750 3163 3850 4813 (Initial) Restorations_Composite Inlay Direct 444 2300 2750 3163 3850 4813 (Final) 445 Restorations_Composite Veneer 2880 3440 3956 4816 6020 446 Restorations_Composite Veneer (Initial) 1440 1720 1978 2408 3010 447 Restorations_Composite Veneer (Final) 1440 1720 1978 2408 3010 448 Restorations_Core Build Up Grade 1 1720 2060 2369 2884 3605 449 Restorations_Core Build Up Grade 2 2880 3440 3956 4816 6020 Restorations_Core Build Up Grade 2 450 1440 1720 1978 2408 3010 (Initial) Restorations_Core Build Up Grade 2 451 1440 1720 1978 2408 3010 (Final) Restorations_Desensitivity Treatment 452 920 1100 1265 1540 1925 (Per Visit) 453 Restorations_G. I Filling 580 690 794 966 1208 454 Restorations_Gi (Light Cure) 1150 1380 1587 1932 2415 455 Restorations_Irm Filling 800 960 1104 1344 1680 Restorations_Pit & Fissure Sealant (Per 456 580 690 794 966 1208 Tooth)
65 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE 457 Restorations_Silver Amalgam (Mod) 2880 3440 3956 4816 6020 Restorations_Silver Amalgam (Mod) 458 1440 1720 1978 2408 3010 (Initial) Restorations_Silver Amalgam (Mod) 459 1440 1720 1978 2408 3010 (Final) 460 Restorations_Silver Amalgam Grade 1 920 1100 1265 1540 1925 461 Restorations_Silver Amalgam Grade 2 1150 1380 1587 1932 2415 462 Restorations_Temporary Filling 230 280 322 392 490 463 R C TreatmentPulp Therapy 1 3560 4260 4899 5964 7455 464 R C TreatmentPulp Therapy 1 (Initial) 1780 2130 2450 2982 3728 465 R C TreatmentPulp Therapy 1 (Final) 1780 2130 2450 2982 3728 466 R C TreatmentPulp Therapy 2 4830 5780 6647 8092 10115 467 R C TreatmentPulp Therapy 2 (Initial) 2420 2890 3324 4046 5058 468 R C TreatmentPulp Therapy 2 (Final) 2420 2890 3324 4046 5058 469 R C TreatmentPulp Therapy 3 5750 6880 7912 9632 12040 470 R C TreatmentPulp Therapy 3 (Initial) 2880 3440 3956 4816 6020 471 R C TreatmentPulp Therapy 3 (Final) 2880 3440 3956 4816 6020 472 R C TreatmentPulpotomy 2880 3440 3956 4816 6020 473 R C TreatmentPulpotomy (Initial) 1440 1720 1978 2408 3010 474 R C TreatmentPulpotomy (Final) 1440 1720 1978 2408 3010 R C TreatmentRct ( Re Treatment)- 475 4600 5500 6325 7700 9625 Grade 1 R C TreatmentRct ( Re Treatment)- 476 2300 2750 3163 3850 4813 Grade 1 (Initial) R C TreatmentRct ( Re Treatment)- 477 2300 2750 3163 3850 4813 Grade 1 (Final) R C TreatmentRct ( Re Treatment)- 478 6900 8250 9488 11550 14438 Grade 2 R C TreatmentRct ( Re Treatment)- 479 3450 4130 4750 5782 7228 Grade 2 (Initial) R C TreatmentRct ( Re Treatment)- 480 3450 4130 4750 5782 7228 Grade 2 (Final) R C TreatmentRct ( Re Treatment)- 481 9200 11000 12650 15400 19250 Grade 3 R C TreatmentRct ( Re Treatment)- 482 4600 5500 6325 7700 9625 Grade 3 (Initial) R C TreatmentRct ( Re Treatment)- 483 4600 5500 6325 7700 9625 Grade 3 (Final) 484 R C TreatmentRct Grade 1 7010 8390 9649 11746 14683 485 R C TreatmentRct Grade 1 (Initial) 3510 4190 4819 5866 7333 486 R C TreatmentRct Grade 1 (Final) 3510 4190 4819 5866 7333 487 R C TreatmentRct Grade 2 8050 9630 11075 13482 16853 488 R C TreatmentRct Grade 2 (Initial) 4020 4810 5532 6734 8418 489 R C TreatmentRct Grade 2 (Final) 4020 4810 5532 6734 8418 R C TreatmentRoot Canal Perforation 490 2300 2750 3163 3850 4813 Repair R C TreatmentRoot Canal Perforation 491 1150 1380 1587 1932 2415 Repair (Initial) R C TreatmentRoot Canal Perforation 492 1150 1380 1587 1932 2415 Repair (Final) 493 Sensitive Teeth Treatment (Per Tooth) 580 690 794 966 1208
66 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE 494 Soft Tissue Curettage ( Per Tooth) 690 830 955 1162 1453 Soft Tissue Flap Surgery ( Per 495 5750 6880 7912 9632 12040 Quardrant ) Grade 1 Soft Tissue Flap Surgery ( Per 496 2880 3440 3956 4816 6020 Quardrant ) Grade 1 (Initial) Soft Tissue Flap Surgery ( Per 497 2880 3440 3956 4816 6020 Quardrant ) Grade 1 (Final) Soft Tissue Flap Surgery ( Per 498 6900 8250 9488 11550 14438 Quardrant ) Grade 2 Soft Tissue Flap Surgery ( Per 499 3450 4130 4750 5782 7228 Quardrant ) Grade 2 (Initial) Soft Tissue Flap Surgery ( Per 500 3450 4130 4750 5782 7228 Quardrant ) Grade 2 (Final) Soft Tissue Flap Surgery ( Per 501 8050 9630 11075 13482 16853 Quardrant ) Grade 3 Soft Tissue Flap Surgery ( Per 502 4020 4810 5532 6734 8418 Quardrant ) Grade 3 (Initial) Soft Tissue Flap Surgery ( Per 503 4020 4810 5532 6734 8418 Quardrant ) Grade 3 (Final) Soft Tissue Flap Surgery ( Per 504 9200 11000 12650 15400 19250 Quardrant ) Grade 4 Soft Tissue Flap Surgery ( Per 505 4600 5500 6325 7700 9625 Quardrant ) Grade 4 (Initial) Soft Tissue Flap Surgery ( Per 506 4600 5500 6325 7700 9625 Quardrant ) Grade 4 (Final) Soft Tissue Flap Surgery Plus Bone 507 13800 16500 18975 23100 28875 Graft Grade 1 Soft Tissue Flap Surgery Plus Bone 508 6900 8250 9488 11550 14438 Graft Grade 1 (Initial) Soft Tissue Flap Surgery Plus Bone 509 6900 8250 9488 11550 14438 Graft Grade 1 (Final) Soft Tissue Flap Surgery Plus Bone 510 17250 20630 23725 28882 36103 Graft Grade 2 Soft Tissue Flap Surgery Plus Bone 511 8630 10310 11857 14434 18043 Graft Grade 2 (Initial) Soft Tissue Flap Surgery Plus Bone 512 8630 10310 11857 14434 18043 Graft Grade 2 (Final) Soft Tissue Flap Surgery With Bone 513 8630 10310 11857 14434 18043 Graft Grade 1 Soft Tissue Flap Surgery With Bone 514 4310 5160 5934 7224 9030 Graft Grade 1 (Initial) Soft Tissue Flap Surgery With Bone 515 4310 5160 5934 7224 9030 Graft Grade 1 (Final) Soft Tissue Flap Surgery With Bone 516 9780 11690 13444 16366 20458 Graft Grade 2 Soft Tissue Flap Surgery With Bone 517 4890 5840 6716 8176 10220 Graft Grade 2 (Initial) Soft Tissue Flap Surgery With Bone 518 4890 5840 6716 8176 10220 Graft Grade 2 (Final) Soft Tissue Flap Surgery With Bone 519 10930 13060 15019 18284 22855 Graft Grade 3 Soft Tissue Flap Surgery With Bone 520 5460 6530 7510 9142 11428 Graft Grade 3 (Initial)
67 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE Soft Tissue Flap Surgery With Bone 521 5460 6530 7510 9142 11428 Graft Grade 3 (Final) 522 Soft Tissue Flap Surgey Grade 2 (Initial) 6900 8250 9488 11550 14438 523 Soft Tissue Flap Surgey Grade 2 (Final) 3450 4130 4750 5782 7228 524 Soft Tissue Flap Surgey Grade 2 3450 4130 4750 5782 7228 525 Soft Tissue Full Mouth Flap Surgery 25300 30250 34788 42350 52938 Soft Tissue Full Mouth Flap Surgery 526 12650 15130 17400 21182 26478 (Initial) Soft Tissue Full Mouth Flap Surgery 527 12650 15130 17400 21182 26478 (Final) 528 Soft Tissue Full Mouth Scaling Grade 1 1040 1240 1426 1736 2170 529 Soft Tissue Full Mouth Scaling Grade 2 1380 1650 1898 2310 2888 530 Soft Tissue Full Mouth Scaling Grade 3 1150 1380 1587 1932 2415 531 Soft Tissue Full Mouth Scaling Grade 4 2300 2750 3163 3850 4813 Soft Tissue Full Mouth Scaling Grade 4 532 1150 1380 1587 1932 2415 (Initial) Soft Tissue Full Mouth Scaling Grade 4 533 1150 1380 1587 1932 2415 (Final) Soft Tissue Gingival Curettage (Per 534 1150 1380 1587 1932 2415 Tooth) 535 Soft Tissue Gingivectomy (Per Tooth) 920 1100 1265 1540 1925 Soft Tissue Mucogingival Surgery Per 536 2880 3440 3956 4816 6020 Tooth Grade 1 Soft Tissue Mucogingival Surgery Per 537 1440 1720 1978 2408 3010 Tooth Grade 1 (Initial) Soft Tissue Mucogingival Surgery Per 538 1440 1720 1978 2408 3010 Tooth Grade 1 (Final) Soft Tissue Mucogingival Surgery Per 539 4600 5500 6325 7700 9625 Tooth Grade 2 Soft Tissue Mucogingival Surgery Per 540 2300 2750 3163 3850 4813 Tooth Grade 2 (Initial) Soft Tissue Mucogingival Surgery Per 541 2300 2750 3163 3850 4813 Tooth Grade 2 (Final) Soft Tissue Mucogingival Surgery Per 542 9200 11000 12650 15400 19250 Tooth Grade 3 Soft Tissue Mucogingival Surgery Per 543 4600 5500 6325 7700 9625 Tooth Grade 3 (Initial) Soft Tissue Mucogingival Surgery Per 544 4600 5500 6325 7700 9625 Tooth Grade 3 (Final) Soft Tissue Subgingival Scaling& Root 545 1150 1380 1587 1932 2415 Planing Grade 1 (Per Quadrant) Soft Tissue Subgingival Scaling& Root 546 2300 2750 3163 3850 4813 Planing Grade 2 (Per Quadrant) Soft Tissue Subgingival Scaling& Root 547 1150 1380 1587 1932 2415 Planing Grade 2 (Per Quadrant) (Initial) Soft Tissue Subgingival Scaling& Root 548 1150 1380 1587 1932 2415 Planing Grade 2 (Per Quadrant) (Final) Treating Peri Implantitis And Implant 549 1720 2060 2369 2884 3605 Exposure 550 Treatment Of Non Healing Ulcer 1380 1650 1898 2310 2888 551 Pedo Ss Crowns 2300 2750 3163 3850 4813 552 Pedo Ss Crowns (Initial) 1150 1380 1587 1932 2415
68 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE 553 Pedo Ss Crowns (Final) 1150 1380 1587 1932 2415 554 Strip Crown 2300 2750 3163 3850 4813 555 Strip Crown (Initial) 1150 1380 1587 1932 2415 556 Strip Crown (Final) 1150 1380 1587 1932 2415 557 F Application Grade 1 4600 5500 6325 7700 9625 558 F Application Grade 1 (Initial) 2300 2750 3163 3850 4813 559 F Application Grade 1 (Final) 2300 2750 3163 3850 4813 560 F Application Grade 2 5750 6880 7912 9632 12040 561 F Application Grade 2 (Initial) 2880 3440 3956 4816 6020 562 F Application Grade 2 (Final) 2880 3440 3956 4816 6020 563 O.S Fracture Reduction Grade 1 17250 20630 23725 28882 36103 564 O.S Fracture Reduction Grade 1 (Initial) 8630 10310 11857 14434 18043 565 O.S Fracture Reduction Grade 1 (Final) 8630 10310 11857 14434 18043 566 O.S Fracture Reduction Grade 2 23000 27500 31625 38500 48125 567 O.S Fracture Reduction Grade 2 (Initial) 11500 13750 15813 19250 24063 568 O.S Fracture Reduction Grade 2 (Final) 11500 13750 15813 19250 24063 569 O.S Fracture Reduction Grade 3 28750 34380 39537 48132 60165 570 O.S Fracture Reduction Grade 3 (Initial) 14370 17190 19769 24066 30083 571 O.S Fracture Reduction Grade 3 (Final) 14370 17190 19769 24066 30083 572 Cyst Enucleation 17080 20420 23483 28588 35735 573 Cyst Enucleation (Initial) 8540 10210 11742 14294 17868 574 Cyst Enucleation (Final) 8540 10210 11742 14294 17868 575 Dento Aloevlar -Isolated Fracture 9940 11880 13662 16632 20790 Dento Aloevlar -Isolated Fracture 576 4970 5940 6831 8316 10395 (Initial) 577 Dento Aloevlar -Isolated Fracture (Final) 4970 5940 6831 8316 10395 578 Excision Of Bony Tumour Or Cyst 38810 46410 53372 64974 81218 Excision Of Bony Tumour Or Cyst 579 19410 23200 26680 32480 40600 (Initial) Excision Of Bony Tumour Or Cyst 580 19410 23200 26680 32480 40600 (Final) 581 Horizontal Grade - I 6730 8040 9246 11256 14070 582 Horizontal Grade - I (Initial) 3360 4020 4623 5628 7035 583 Horizontal Grade - I (Final) 3360 4020 4623 5628 7035 584 Incision & Drainage Of Abscess 4350 5200 5980 7280 9100 585 Incision & Drainage Of Abscess (Initial) 2170 2600 2990 3640 4550 586 Incision & Drainage Of Abscess (Final) 2170 2600 2990 3640 4550 587 Incisional Biopsy 3000 3590 4129 5026 6283 588 Incisional Biopsy (Initial) 1500 1790 2059 2506 3133 589 Incisional Biopsy (Final) 1500 1790 2059 2506 3133 590 Mesioangular Impacton 5590 6680 7682 9352 11690 591 Mesioangular Impacton (Initial) 2790 3340 3841 4676 5845 592 Mesioangular Impacton (Final) 2790 3340 3841 4676 5845 593 Repair Lacerated Wound One Lip 3000 3590 4129 5026 6283 Repair Lacerated Wound One Lip 594 1500 1790 2059 2506 3133 (Initial) Repair Lacerated Wound One Lip 595 1500 1790 2059 2506 3133 (Final) 596 Repair Lacerated Wounds Both Lips 6730 8040 9246 11256 14070
69 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE Repair Lacerated Wounds Both Lips 597 3360 4020 4623 5628 7035 (Initial) Repair Lacerated Wounds Both Lips 598 3360 4020 4623 5628 7035 (Final) 599 Repair Of Multiple Lacerated Wounds 6210 7430 8545 10402 13003 Repair Of Multiple Lacerated Wounds 600 3100 3710 4267 5194 6493 (Initial) Repair Of Multiple Lacerated Wounds 601 3100 3710 4267 5194 6493 (Final) 602 Total Extraction Single Jaw 6730 8040 9246 11256 14070 603 Total Extraction Single Jaw (Initial) 3360 4020 4623 5628 7035 604 Total Extraction Single Jaw (Final) 3360 4020 4623 5628 7035 605 Vertical Impacted Teeth 4350 5200 5980 7280 9100 606 Vertical Impacted Teeth (Initial) 2170 2600 2990 3640 4550 607 Vertical Impacted Teeth (Final) 2170 2600 2990 3640 4550
70 GASTROENTEROLOGY S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE injection sclerotherapy in bleeding 1 11500 12500 14370 17500 21880 varices 2 injection sclerotherapy in bleeding piles 6900 7000 8050 9800 12250 3 Naso-jejunal tube placement 8630 8000 9200 11200 14000 4 S B tube placement 0 5000 5750 7000 8750 5 Naso-biliary tube insertion 9200 9500 10930 13300 16630 6 Pre-cut sphincterotomy 9780 9500 10930 13300 16630 7 Biliary stent removal 4020 4000 4600 5600 7000 8 Narrow band imaging (upper GI) 4020 4000 4600 5600 7000 9 Narrow band imaging (Lower GI) 4600 4500 5180 6300 7880 10 CBD stricture dilatation 10930 10500 12070 14700 18380 11 Balloon dilatation of papilla 10930 10500 12070 14700 18380 12 Biliary brush cytology 7470 7500 8630 10500 13130 13 Enteral stent placement 14370 15000 17250 21000 26250 14 Helicobacter Pylori (RUT) 460 500 580 700 880 15 EUS Mediastinal (simple) 5750 6500 7470 9100 11380 16 EUS mediastinal (complex) 7470 7500 8630 10500 13130 17 EUS Pancreas 7470 7500 8630 10500 13130 18 EUS Biliary 9780 10000 11500 14000 17500 19 EUS Pancreato-biliary (Simple) 12070 12500 14370 17500 21880 20 EUS Pancreato-biliary (complex) 14370 15000 17250 21000 26250 21 EUS Screening Procedure 5180 5500 6320 7700 9630 22 EUS Guided FNAC 12070 12500 14370 17500 21880 EUS Guided Mediastinal L/N FNAC 23 14370 15000 17250 21000 26250 (Simple) EUS Guided Mediastinal L/N FNAC 24 20700 20000 23000 28000 35000 (Complex) EUS FNAC Pancreatic Mass lesion 25 20700 20000 23000 28000 35000 (Simple) EUS FNAC Pancreatic Mass lesion 26 23000 25000 28750 35000 43750 (Complex)) 27 EUS Guided Cysto-Gastrostomy 23000 25000 28750 35000 43750 28 EUS Guided Celiac Plexus Block 18000 20000 23000 28000 35000 29 UGI Video Endoscopy (I) 4200 5200 5980 7280 9100 30 Capsule Endoscopy 17000 19000 21850 26600 33250 31 PEG Replacement 5500 6500 7470 9100 11380 32 ERCP consumables charges 3500 4000 4600 5600 7000 33 Enteroscopy consumables Charges 10000 12000 13800 16800 21000 34 Fibroscan 4300 4700 5410 6580 8230 35 EUS Consumables charges 7500 9500 10930 13300 16630 36 Argon Plasma Coagulation (APC) 16000 20000 23000 28000 35000 37 Endoscopic intra-gastric Balloon 28000 35000 40250 49000 61250 38 Equipment Charges 4000 5000 5750 7000 8750 39 Breath test 3000 3500 4020 4900 6130 40 ERCP 10500 12500 14370 17500 21880 41 Sphincterotomy 6500 7500 8630 10500 13130 42 Ascitic Taping (Diagnostic) 2500 3500 4020 4900 6130 43 Endoscopic Mucosal resection 18000 20000 23000 28000 35000
71 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE 44 Endoprosthesis 16500 18000 20700 25200 31500 45 Esophageal dilatation 9500 12500 14370 17500 21880 46 EVL 9500 12000 13800 16800 21000 47 Forieign Body removal 8500 10000 11500 14000 17500 48 Hemoclipping of Bleeding vessels 15000 18000 20700 25200 31500 49 Papillotomy and stone removal 8500 10500 12070 14700 18380 50 PEG 15000 17000 19550 23800 29750 51 Piles Injection 4000 5000 5750 7000 8750 52 Polypectomy 8500 10000 11500 14000 17500 53 Total Video Colonoscopy 7000 8500 9780 11900 14880 54 Side Viewing Endoscopy 4500 5500 6320 7700 9630 55 Biopsy Procedure Charges 1000 1500 1720 2100 2630 56 Bed side procedure charges 10000 11500 14000 17500 57 Emergency Charges 4000 5000 5750 7000 8750 58 Glue injection of gastric Varices 16500 18000 20700 25200 31500 59 UGI Video Endoscopy (II) 5200 5700 6550 7980 9980 Endoscopic injection therapy for 60 12500 15000 17250 21000 26250 hemostasis in peptic ulcer 61 Band ligation for vascular lesion 10000 12500 14370 17500 21880 62 Ileoscopy 6000 8000 9200 11200 14000 63 Upper GI Endoscopy with Biopsy 5500 6000 6900 8400 10500 64 Hemorrhoid Banding 4000 5000 5750 7000 8750 65 UGI Video endoscopy (III) 7000 7500 8630 10500 13130 66 Biliary stenting (Plastic and Metallic) 8000 10000 11500 14000 17500 67 Colonoscopy Left Sided 5000 6000 6900 8400 10500 68 CRE Balloon Dilatation 12500 15000 17250 21000 26250 69 Mechanical Lithotrypsy 16500 20000 23000 28000 35000 70 Liver Biopsy 8000 10000 11500 14000 17500 71 Sigmoidoscopy 4900 5500 6320 7700 9630 72 Enteroscopy 15000 16000 18400 22400 28000 73 Endo loop Procedure 5500 6500 7470 9100 11380 74 Papillotomy and stent insertion 8500 10500 12070 14700 18380 75 Achalasia Cardia Pneumatic Dilatation 15000 16500 18980 23100 28880 76 ERCP Package Day Care I 18000 77 ERCP Package Day Care II 24000
ANAESTHESIA S.NO. SERVICE NAME Department OPD GW TWIN SINGLE SUITE Pre Anaesthesia PREANAES Check Up/ Anaesthesiology 500 500 500 500 500 CONSULTATION
72 UROLOGY S.NO. SERVICE NAME GW TWIN SINGLE SUITE 1 bladder diverticulectomy -open 15600 17940 21840 27300 2 Bladder Neck Incision / TUIP 13100 15060 18340 22930 3 BOARI FLAP 22500 25870 31500 39380 4 BUCAL MUCOSA CYSTO URETHROPLASTY 25000 28750 35000 43750 5 CAPD Catheter Insertion 9600 11040 13440 16800 6 CAPD Catheter removal 7500 8630 10500 13130 7 Catheterization (with ordinary Foleys) 3100 3560 4340 5430 8 CIRCUMCISION 5300 6090 7420 9280 9 Circumcision/ Meatoplasty 5300 6090 7420 9280 10 CONGENITAL PU VALVES 14600 16790 20440 25550 11 Cystectomy (partial) 15000 17250 21000 26250 12 CYSTO DIATHERMY 10000 11500 14000 17500 13 CYSTOSCOPY CLOT EVACUATION 8100 9320 11340 14180 14 Cystoscopy with biopsy 8100 9320 11340 14180 15 D.J Stenting/ stent insertion ( Unilateral ) 9500 10930 13300 16630 16 DJ stent removal 3100 3560 4340 5430 17 DJ Stent Removal (Bilateral) 4400 5060 6160 7700 18 ENDOSCOPIC CYSTO LITHOTOMY 11300 12990 15820 19780 19 EREC AID SYSTEM - PER DAY 1100 1270 1540 1930 20 EXTOPIC SINGLE URETER 22500 25870 31500 39380 21 Hydrocele - Bilateral 11100 12760 15540 19430 22 Hydrocele - Unilateral 7100 8160 9940 12430 23 IMMUNOTHERAPY 1100 1270 1540 1930 24 Incontinence surgery (AUS) 18800 21620 26320 32900 25 INGUINAL VARICOCELECTOMY 11900 13680 16660 20830 26 INTRA CORPOREAL LITHOTRIPSY 5800 6670 8120 10150 27 INTRAVESICAL INJ. OF BOTULINUM 10600 12190 14840 18550 28 LAP URETEROLITHOTOMY 21300 24490 29820 37280 29 Lap. Pyeloplasty 22500 25870 31500 39380 30 Laser Prostatectomy 25000 28750 35000 43750 31 LITHOTRIPSY 42500 48870 59500 74380 32 Lithotripsy - Post PCNL residual stone 9600 11040 13440 16800 Microsurgical Vasoepididymal /Vasovasal 33 20000 23000 28000 35000 Anastomosis (Unilateral) 34 NEPHRECTOMY 22500 25870 31500 39380 35 Nephrectomy (Radical) -open 25000 28750 35000 43750 36 Nephrectomy (Simple) -open 22500 25870 31500 39380 37 Nephrectomy Nephroureterectomy (Radical ) 20000 23000 28000 35000 38 Nephrostomy - Open 12500 14370 17500 21880 39 NESBITS OPERATION 7900 9090 11060 13830 40 OPEN CYSTO LITHOTOMY 11300 12990 15820 19780 41 Open prostatectomy 14500 16680 20300 25380 42 OPERATION FOR BLADDER INJURY 14500 16680 20300 25380 43 OPERATION FOR DOUBLE URETER 22500 25870 31500 39380 44 OPERATION FOR KIDNEY CYST -- LAP 18400 21160 25760 32200 45 Optical Internal Urethrotomy(OIU) 9400 10810 13160 16450 46 P C N L < 3CM 15000 17250 21000 26250
73 S.NO. SERVICE NAME GW TWIN SINGLE SUITE 47 P C N L >3CM 18800 21620 26320 32900 48 Penile Implant 23100 26560 32340 40430 49 PROSTATE BIOPSY 6400 7360 8960 11200 50 PUV Fulguration 15000 17250 21000 26250 51 Pyelolithotomy -Open 15000 17250 21000 26250 52 PYELOPLASTY 17500 20130 24500 30630 53 RENAL AUTOTRANSPLANTATION 87500 100620 122500 153130 54 REPAIR OF URETEROCELE 14600 16790 20440 25550 55 RETROGRADE INTRARENAL SURGERY 22500 25870 31500 39380 56 Suprabubic Cystostomy 5800 6670 8120 10150 57 SUPRAPUBIC CATHETERISATION 2100 2420 2940 3680 58 TOTAL CYSTECTOMY 26300 30240 36820 46030 59 TRANS OBTINOTIOR TAPE 18800 21620 26320 32900 TRANSURETHRAL DRAINAGE OF PROSTATIC 60 14100 16210 19740 24680 ABSCESS TRANSURETHRAL RESECTION OF EJACULATORY 61 14100 16210 19740 24680 DUCT 62 TURBT < 1 cm 15000 17250 21000 26250 63 TURBT >1 cm 20000 23000 28000 35000 64 TURP < 80 gms (Bipolar) 22500 25870 31500 39380 65 TURP < 80 gms (Monopolar) 18800 21620 26320 32900 66 TURP > 80 gms (Bipolar) 18800 21620 26320 32900 67 TURP > 80 gms (Monopolar) 15000 17250 21000 26250 68 Ureteric Reimplantation ( Unilateral ) 15800 18170 22120 27650 Ureteric Reimplantation with Boari flap Bilateral- 69 26300 30240 36820 46030 Open 70 Ureterolithotomy (Lap/Open) 15000 17250 21000 26250 71 Ureteroscopy ( Diagnostic ) 10000 11500 14000 17500 72 Ureteroureterostomy - Laproscopic 22500 25870 31500 39380 73 URETHRAL BULBAR OR ANTERIOR STRICTURE 14600 16790 20440 25550 74 URETHRAL DILATION 3800 4370 5320 6650 75 URETHRAL RECONSTRUCTION MEMBRANOUS 15000 17250 21000 26250 76 Urethroplasty ( Single Stage ) 15000 17250 21000 26250 77 Urethroplasty (Two Staged-Second Stage) 15000 17250 21000 26250 78 Urinary diversion without cystectomy (conduit) 22500 25870 31500 39380 79 Uro retrograde pyelogram (RGP) 3900 4490 5460 6830 80 Uroflowmetry 900 1040 1260 1580 81 URSL LOWER/MID 17400 20010 24360 30450 82 URSL UPPER 20000 23000 28000 35000 83 Vasectomy 11000 12650 15400 19250 84 VESICOURETERIC REFLUX (VUR) 22500 25870 31500 39380 85 York Masson Recto Urinary Fistula Repair 20000 23000 28000 35000 86 TESA(BILATERAL) - PACKAGE 22500 25870 31500 39380
74 ICU- EQUIPMENT CHARGES S.NO. SERVICE NAME IPD 1 INFUSION PUMP CHARGES 375 2 AIR MATRESS CHARGES 625 3 DVT PUMP PER DAY 500 4 Nebulization per sitting 63 5 Nubulization per day 375 6 Ultrasonic nebulizer per sitting 125 7 Ultrasonic nebulizer per day 625 8 BIPAP UPTO 4HR 1000 9 BIAPA UPTO 12 HRS 1750 10 BIPAP UPTO 24 HRS 3125 11 MECH VENTILATION UPTO 8HR 1875 12 MECH VENTILATION UPTO 24 HR 3750 13 Laser charges 6250 14 Harmonic 8750 15 Laser (Urology) 5500 16 I Gel 125 17 LMA 250 18 Proseal LMA 438 19 Plasma Filter 22250 20 EP Lab Diagnostic Charge 17375 21 EP Lab Charge 50625 22 oxygen therapy upto 4 hrs 313 23 Oxygen therapy upto 12 hrs 750 24 Oxygen therapy UPTO 24 hrs 1375 25 IV CANNULATION CHARGES 375 26 RT INSERTION 313 27 BED SIDE PROCEDURE (ICU SURCHARGE) 2500 28 ARTERIAL LINE 3125 29 CVP INSERTION 3125 30 TRACHEOSTOMY 13750 31 FOLEYS CATHETERIZATION 625 32 LUMBAR PUNCTURE 2250 33 MICROSCOPE 2500 34 NEURODRILL (CRANIAL-MINOR) 4375 35 NEURODRILL (CRANIAL-MAJOR) 6250 36 NEURODRILL (SPINAL-MINOR) 3125 37 NEURODRILL (SPINAL-MAJOR) 5000 38 CUSA MACHINE 2500 39 HARMONIC + LIGA SURE 10000 40 ENSEAL 10000 41 LINA TRIPOL 6250 42 ARTHROSCOPIC SHAVER SYSTEM 1250 43 DVD CHARGES 625 44 ORTHOPILOT CHARGES 1250 45 BIS STRIP 375 46 WARMER BLANKET 250 47 FLUID WARMER 250 75 S.NO. SERVICE NAME IPD 48 Nerve locator charges 625 49 C -ARM 2500 50 HOLEP 18750 51 PCA Pump upto 24 hrs 625 52 FIBREOPTIC INTUBATION 625 53 CAUDAL BLOCK 1250 54 THORACIC EPIDURAL 5625 55 LUMBAR EPIDURAL 3750 56 LABOUR EPIDURAL 10000 57 INTERCOASTAL BLOCK 1500 58 Monitored Anaesthesia Care A 2500 59 Monitored Anaesthesia Care B 3750 60 Monitored Anaesthesia Care C 5000
NEPHROLOGY S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE DOUBLE LUMEN CATHERTHER 1 INSERTION FOR DIALYSIS (JUGULAR/ 8625 9400 10810 13160 16450 SUBCLAVIAN/FEMAORAL) CRRT KIT+ initiation + monitoring + 2 56300 64745 78820 98525 fluid (Day 1) 3 CRRT monitoring 13800 15870 19320 24150 PERCUTANEOUS TENCHOFF 4 10500 12075 14700 18375 CATHETERIZATION SLOW EXTENDED DURATION DIALYSIS 5 5405 6500 7475 9100 11375 (SLED) EMERGENCY 6 CAPD Training 10500 12075 14700 18375 7 EMERGENCY DIALYSIS 6210 7500 8625 10500 13125 8 Haemodialysis First Use 3335 4400 5060 6160 7700 9 REUSE DIALYSIS 2070 3100 3565 4340 5425 10 Haemodiafilteration 4000
MAMMOGRAPHY S.NO. SERVICE NAME OPD GW TWIN SINGLE SUIT 1 DIGITAL MAMMOGRAPHY ONE SIDE 1550 1800 2070 2520 3150 DIGITAL MAMMOGRAPHY BOTH 2 2180 2600 2990 3640 4550 SIDES
76 PEDIATRICS AND NEONATOLOGY S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE 1 Cleft lip repair B/L complete (pead) 18750 21600 26300 32800 2 HYDROSTATIC PROCEDURE 9380 10800 13100 16400 ANAL TRANSPOSITION FOR ECTOPIC 3 10000 11500 14000 17500 ANUS (PEDIATRIC) ANTIREFLUX SURGERY 4 18130 20800 25400 31700 (FUNDOPLICATION) (PEDIATRIC) BILIARY ATRESIA (KASAIS 5 47500 54600 66500 83100 PORTOENTEROSTOMY) BLADDER EXOSTROPHY REPAIR 6 22500 25900 31500 39400 (BLADDER TURN IN) (PEDIATRIC) BLADDER EXOSTROPHY REPAIR 7 43750 50300 61200 76600 COMPLETE REPAIR (PEDIATRIC) DIAPHRAGM EVENTERATION REPAIR 8 47500 54600 66500 83100 (PEDIATRIC) EXCISION CYST/TUMOUR BENIGN 9 20000 23000 28000 35000 LARGE (PEDIATRIC) 10 EXCISION OF TUMOR (PEDIATRIC) 168750 194100 236200 295300 EXCISION WIDE 11 47500 54600 66500 83100 RHABDOMYOSARCOMA (PEDIATRIC) 12 GASTROSTOMY (PEDIATRIC) 7500 8600 10500 13100 HEMI-NEPHROURETERECTOMY 13 22500 25900 31500 39400 (PEDIATRIC) 14 HERNIA EPIGASTRIC (PEDIATRIC) 11250 12900 15700 19700 HERNIA INGUINAL BILATERAL 15 20000 23000 28000 35000 (PEDIATRIC) HERNIA INGUINAL UNILATERAL 16 11880 13700 16600 20800 (PEDIATRIC) 17 HERNIA UMBILICAL (PEDIATRIC) 15000 17300 21000 26300 INTUSSUSCEPTION REDUCTION 18 31250 35900 43800 54700 (PEDIATRIC) 19 LAPAROTOMY (PEDIATRIC) 15000 17300 21000 26300 20 LIVER HYDATID (PEDIATRIC) 27500 31600 38500 48100 21 LYMPH NODE BIOPSY (PEDIATRIC) 3130 3600 4400 5500 MALROTATION OF INTESTINE 22 25000 28700 35000 43800 (PEDIATRIC) MECKELS DIVERTICULECTOMY 23 21250 24400 29700 37200 (PEDIATRIC) NEONATAL INTESTINAL ATRESIA 24 27500 31600 38500 48100 (PEDIATRIC) 25 OVARIAN CYSTECTOMY (PEDIATRIC) 13750 15800 19300 24100 POSTERIOR SAGITTAL 26 27500 31600 38500 48100 ANORECTOPLASTY (PEDIATRIC) 27 PREPUCIAL ADHESIONS REDUCTION 5250 6000 7300 9200 28 PULMONARY HYDATID (PEDIATRIC) 27500 31600 38500 48100 RESECTION & ANASTAMOSIS OF 29 21250 24400 29700 37200 INTESTINE (PEDIATRIC) SPINA BIFIDA REPAIR (LARGE) 30 31250 35900 43800 54700 (PEDIATRIC) SPINA BIFIDA REPAIR (SMALL) 31 22500 25900 31500 39400 (PEDIATRIC) 32 SPLENECTOMY (PEDIATRIC) 22500 25900 31500 39400
77 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE SUPRAPUBIC CYSTOSTOMY 33 11250 12900 15700 19700 (PEDIATRIC) THORACOTOMY & CYST EXCISION 34 15000 17300 21000 26300 (PEDIATRIC) THORACOTOMY & DECORTICATION 35 25000 28700 35000 43800 (PEDIATRIC) URETEROSTOMY BILATERAL 36 15000 17300 21000 26300 (PEDIATRIC) URETHROPLASTY SINGLE STAGE 37 11880 13700 16600 20800 DISTAL HYPOSPADIAS (PEDIATRIC) VENTRICULO-PERITONEAL SHUNT 38 18750 21600 26300 32800 PLACEMENT (PEDIATRIC) WILMS TUMOUR/NEUROBLASTOMA 39 37500 43100 52500 65600 EXCISION (PEDIATRIC) ULTRASOUND GUIDED PNEUMATIC 40 4380 5000 6100 7700 REDUCTION OF INTUSSUSCEPTION 41 VENOUS CUT DOWN 3750 4300 5300 6600 FIBRINOLYTIC AGENT INSTALLATION 42 1250 1500 1700 2100 2600 IN PLEURAL CAVITY 43 Cleft lip repair u/l complete (pead) 15630 18000 21900 27400 1st stage Hypospadias repair - staged 44 15000 17300 21000 26300 (pead) 2nd stage Hypospadias repair -staged 45 11250 12900 15700 19700 (pead) Abdominoperineal Resection of Rectum 46 15630 18000 21900 27400 (pead) 47 Anal Dilatation (pead) 1880 2200 2600 3300 Anal Fissure (Sphincterotomy/ 48 10630 12200 14900 18600 Fissurectomy) (pead) 49 Ano-rectal Fistula-High Level (pead) 13750 15800 19300 24100 50 Ano-rectal Fistula-Low Level (pead) 8750 10100 12300 15300 51 Ascitic Tap (pead) 1880 2200 2600 3300 Branchial Cyst or Fistula/Sinus 52 10630 12200 14900 18600 (Unilateral) (pead) 53 Choledochal cyst (Roux-en-Y) (pead) 15630 18000 21900 27400 54 Chordee correction (pead) 10000 11500 14000 17500 55 ClitoroVaginoplasty for CAH (pead) 16250 18700 22800 28400 56 Colostomy & Colonic Biopsy (pead) 11880 13700 16600 20800 57 Colostomy (pead) 10630 12200 14900 18600 58 Colostomy Closure (pead) 10630 12200 14900 18600 Cystolithotomy/Trocar SPC/Suprapubic 59 8750 10100 12300 15300 Cystostomy (pead) 60 Cystoscopic stent removal (pead) 3130 3600 4400 5500 Cystoscopy and valves fulguration/ 61 8130 9300 11400 14200 Neonatal (pead) Diaphragmatic Hernia/Eventration of 62 31250 35900 43800 54700 Diaphragm Lap/Open (pead) Dilatation of Urethral Stricture/ 63 10630 12200 14900 18600 Calibration (pead) 64 Epigastric/ UMB Hernia (pead) 11880 13700 16600 20800 65 Epispadis Repair (pead) 18130 20800 25400 31700 66 Exc of cyst / mole (pead) 15000 17300 21000 26300
78 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE 67 Exploratory Laparotomy (pead) 22500 25900 31500 39400 68 Femoral Hernia/Herniorraphy (pead) 13130 15100 18400 23000 69 Gastroschisis repair (pead) 40000 46000 56000 70000 Incision and Drainage of deep abscess 70 2250 2600 3200 3900 (pead) Incisional Hernia Repair without Marlex 71 15630 18000 21900 27400 Mesh (pead) Inguinal Hernia Repair (Herniorraphy) 72 10630 12200 14900 18600 (Paed) 73 Intercostal Block (pead) 2500 2900 3500 4400 74 Intercostal chest Drainage (pead) 3750 4300 5300 6600 75 Intestine Perforation closure (pead) 20000 23000 28000 35000 Intussusception-Simple Reduction in 76 11880 13700 16600 20800 fluro or OT (pead) 77 Ischorectal Abscess Drainage (pead) 10630 12200 14900 18600 78 Laceration large (pead) 8750 10100 12300 15300 79 Laceration medium (pead) 6880 7900 9600 12000 80 Laceration small (pead) 3750 4300 5300 6600 Lacerations- facial Large multiple 81 15000 17300 21000 26300 (pead) 82 Lap/Open Appendicectomy (pead) 8750 10100 12300 15300 83 Left Hemicolectomy (pead) 22500 25900 31500 39400 84 Left liver lobectomy (pead) 27500 31600 38500 48100 85 Meatotomy (pead) 9380 10800 13100 16400 86 Myelomeningocele (pead) 15630 18000 21900 27400 87 Nephrostogram (pead) 15000 17300 21000 26300 88 Nephrostomy-Open (pead) 13130 15100 18400 23000 89 Nephrostomy-Percutaneous (pead) 8750 10100 12300 15300 90 Obstructed Hernia (Any Type) (pead) 14380 16500 20100 25200 Oesophageal Atresia and tracheo- 91 42500 48900 59500 74400 oesophageal fistula (pead) Open Drainage Perinephric Abscess 92 11250 12900 15700 19700 (pead) 93 Orchidopexy (Bilateral) (pead) 12500 14400 17500 21900 94 Orchidopexy (Unilateral) (pead) 8130 9300 11400 14200 Partial liver resection (lateral 95 31250 35900 43800 54700 segmentectomy) (pead) Partial Nephrectomy/Nephrolithotomy 96 15630 18000 21900 27400 (pead) 97 Perianal Abscess Drainage (pead) 11880 13700 16600 20800 98 Pyelolithotomy (pead) 18130 20800 25400 31700 99 Pyeloplasty Lap/open (pead) 15000 17300 21000 26300 100 Radical Nephroureterectomy (pead) 18750 21600 26300 32800 101 Rare Hernia-Spigelian (pead) 11880 13700 16600 20800 102 Rectal Biopsy (pead) 1880 2200 2600 3300 103 Rectal Polyp Excision (pead) 8750 10100 12300 15300 104 Reduction of Paraphimosis (pead) 2130 2400 3000 3700 Release of Sternocleidomastoid- 105 10000 11500 14000 17500 Torticollis (pead) 106 Right Hemicolectomy (pead) 22500 25900 31500 39400
79 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUITE 107 Sacrococcygeal Teratoma (pead) 40000 46000 56000 70000 Single stage proximal Hypospadias 108 repair / chordee without hypospadias 7500 8600 10500 13100 (pead) 109 Superficial Parotidectomy (pead) 16250 18700 22800 28400 110 Thoracotomy & Lobectomy (pead) 35000 40300 49000 61300 Thoracotomy & segmental resection of 111 25000 28700 35000 43800 Lung (Paed) 112 Thyroglossal Cyst/Sinus/Fistula (pead) 15000 17300 21000 26300 113 Torsion Testis (pead) 11880 13700 16600 20800 114 Umbilical Hernia with mesh (pead) 12500 14400 17500 21900 115 Ureterolithotomy (pead) 14380 16500 20100 25200 116 Ureterostomy (Unilateral) (pead) 11880 13700 16600 20800 117 urethral fistula Repair (pead) 13130 15100 18400 23000 118 Urethral Injury Repair (pead) 8750 10100 12300 15300 119 Urethroscopy Diagnostic (pead) 3750 4300 5300 6600 120 Vaginoplasty (pead) 18750 21600 26300 32800 121 Varicocoel (pead) 11880 13700 16600 20800 VATS / Thoracoscopic Thymectomy 122 35000 40300 49000 61300 (pead) 123 VATS/ Thoracoscopic Lobectomy (pead) 35000 40300 49000 61300 VATS/ Thoracoscopic Pleural biopsy 124 20000 23000 28000 35000 (pead) 125 Ventral hernia with mesh (pead) 17500 20100 24500 30600 126 Ventricular Puncture (pead) 1750 2000 2500 3100 127 Vesicostomy (pead) 11880 13700 16600 20800
INTERVENTIONAL RADIOLOGY S.NO. SERVICE NAME GW TWIN SINGLE SUIT 1 LASER ABLATION OF VARICOSE VEINS 40000 46000 56000 70000 Image Guided Interventional Procedure Charges 2 9875 11400 13825 17300 Minor Image Guided Intervantional Procedures Charges 3 13250 15200 18550 23200 Major 4 Interventional Radiology Procedure -1 25000 28700 35000 43800 5 Interventional Radiology Procedure -2 35000 40300 49000 61300 6 Interventional Radiology Procedure -3 48750 56100 68250 85300 7 Interventional Radiology Procedure -4 68750 79100 96250 120300 8 Interventional Radiology Procedure -5 82500 94900 115500 144400 UTERINE ARTERY EMBOLIZATION 9 45000 51700 63000 78800 (PPH,FIBROIDS,ADENOMYOSIS,PRE OPERATIVE) 10 BRONCHIAL ARTERY EMBOLIZATION (PROCEDURE) 43750 50300 61250 76600 11 RFA PROCEDURE 17250 19800 24150 30200 12 BRONCHIAL ARTERY EMBOLIZATION 42500 48900 59500 74400
80 RESPIRATORY MEDICINE S.NO. SERVICE NAME OPD GW TWIN SINGLE SUIT 1 BAL 2300 2750 3160 3850 4810 2 Bronchoscopy 12420 14850 17080 20790 25990 3 Bronchoscopy for Foreign Body 18400 22000 25300 30800 38500 Bronchoscopy for Foreign Body 4 18400 22000 25300 30800 38500 under GA 5 Brushing 575 690 790 966 1210 6 Complete PFT 7475 8940 10280 12516 15650 7 Endobronchial biopsy 2300 2750 3160 3850 4810 8 EBUS 20700 24750 28460 34650 43310 9 EBUS under GA 20700 24750 28460 34650 43310 10 Follow up Bronchoscopy 8625 10310 11860 14434 18040 11 ICD 5750 6880 7910 9632 12040 12 Lung volume with diffusion 5750 6880 7910 9632 12040 13 Pleurodesis via ICD 2875 3440 3960 4816 6020 14 Radial EBUS(Fluroscopic) 20700 24750 28460 34650 43310 15 Six minute walk test 690 830 950 1162 1450 16 Sleep Study (Diagnostic) 13225 15810 18180 22134 27670 17 Sleep Study (split Nights) 16675 19940 22930 27916 34900 18 Spirometry 1725 2060 2370 2884 3610 19 Spirometry with Lung volume 4485 5360 6160 7504 9380 20 Spirometry with reversibility 2185 2610 3000 3654 4570 21 Stenting under Fluroscopy 18400 22000 25300 30800 38500 22 STK (Single session) 3565 4260 4900 5964 7460 23 STK (Subsequent) 1725 2060 2370 2884 3610 24 TBLB 2300 2750 3160 3850 4810 25 TBNA 3450 4130 4750 5782 7230 26 Thoracoscopy( Diagnostic with Biopsy) 17250 20630 23720 28882 36100 27 Thoracoscopy( Theurapatic) 20700 24750 28460 34650 43310
81 OBSTETRICS AND GYNAECOLOGY S.NO. SERVICE NAME OPD GW TWIN SINGLE SUIT 1 ABD MYOMECTOMY-SIMPLE 13500 15500 18900 23600 ABDOMINAL CERVICOPEXY FOR 2 26300 30200 36800 46000 UTEROVAGINAL PROLAPSE ABDOMINAL OPERATION FOR STRESS 3 26300 30200 36800 46000 INCONTINENCE 4 ABDOMINAL STERILIZATION 5600 6400 7800 9800 5 ABORTION SECOND TRIMESTER 8800 10100 12300 15400 6 ADHESIOLYSIS 9600 11000 13400 16800 7 AMINOINFUSION 2100 2400 2900 3700 8 AMNIOCENTESIS 2100 2400 2900 3700 9 AMNIOTIC MEMBRANE PERFORATION 300 300 400 500 BARTHOLIN CYST EXCISION 10 7400 8500 10400 13000 BILATERAL & MARSUPIALISATION BARTHOLIN CYST EXCISION 11 5000 5800 7000 8800 UNILATERAL & MARSUPIALISATION 12 CAESAREAN HYSTERECTOMY 20000 23000 28000 35000 13 Caesarian Section(PKS) 48100 55300 67300 84200 14 CERVICAL BIOPSY 3800 4400 5300 6700 15 CERVICAL CAUTERY 3800 4400 5300 6700 16 CERVICAL CAUTERY & BIOPSY 6300 7200 8800 11000 17 CERVICAL CRYOTHERAPY 3800 4400 5300 6700 18 CERVICAL POLYPECTOMY 2100 2400 2900 3700 19 COLPORRHAPHY ANTERIOR 7400 8500 10400 13000 20 COLPORRHAPHY POSTERIOR 3900 4500 5500 6800 21 COLPOSCOPY 3800 4400 5300 6700 22 COLPOSCOPY + CERVICAL BIOPSY 9900 11400 13900 17300 23 COLPOSCOPY DIRECTED BIOPSY 5600 6400 7800 9800 24 COLPOTOMY & NEEDLING 2100 2400 2900 3700 COMPLEX & HIGH RISK 25 31300 36000 43800 54800 HYSTERECTOMY 26 CONE BIOPSY OF CERVIX 7900 9100 11100 13800 27 CRYOTHERAPY 1200 1100 1300 1500 1900 28 CTG MONITORING PER GRAPH 500 600 700 900 29 CTG MONITORING 1500 1700 2100 2600 30 D & E (UNDER SEDATION) 3800 4400 5300 6700 31 DELIVERY BREECH 17300 19900 24200 30300 32 DELIVERY TWIN 21300 24500 29800 37300 33 DELIVERY VACCUUM 17300 19900 24200 30300 DIAGNOSTIC LAPAROSCOPY 34 43800 50400 61300 76700 (PACKAGE) DIAGNOSTIC 35 12500 14400 17500 21900 LAPROSCOPY(PROCEDURE) DILATATION & CURETTAGE (D & C) - 36 3800 4400 5300 6700 PROCEDURE DILATATION & CURETTAGE (D & C) 37 13800 15900 19300 24200 PACKAGE DRAINAGE OF ABDOMINAL WALL 38 7100 8200 9900 12400 HEMATOMA
82 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUIT DRAINAGE OF VULVAL 39 3900 4500 5500 6800 HEMATOMA(SIMPLE) DRAINAGE OF VULVAL 40 6400 7400 9000 11200 HEMATOMA(COMPLEX) DRESSING EXTRA LARGE (GYNAE 41 2600 3000 3600 4600 OPD) 42 DRESSING LARGE (GYNAE OPD) 1400 1600 2000 2500 43 DRESSING MEDIUM (GYNAE OPD) 900 1000 1300 1600 44 DRESSING SMALL (GYNAE OPD) 500 600 700 900 45 EB UNDER LA IN LR 1000 1200 1400 1800 END TO END ANASTOMOSIS 46 17600 20200 24600 30800 BILATERAL (TUBAL ANASTOMOSIS) 47 ENDOMETRIAL ABLATION 9600 11000 13400 16800 48 ENDOMETRIAL BIOPSY 3600 4100 5000 6300 49 ENTEROCELE REPAIR-VAGINAL 3900 4500 5500 6800 50 EPISIOTOMY 3900 4500 5500 6800 51 EUA & NEEDLING Procedure 2300 2600 3200 4000 EVACUATION OF HYDATI FORM 52 8900 10200 12500 15600 MOLE 53 EVACUATION OF RETAINED POC 3900 4500 5500 6800 54 EVACUATION OF UTERUS 2900 3300 4100 5100 55 EXCISION OF LABIAL CYST 3900 4500 5500 6800 56 EXCISION OF URETHRAL CARUNCLE 3900 4500 5500 6800 57 EXCISION OF VAGINAL SEPTUM 6400 7400 9000 11200 58 EXPLORATORY LAPAROTOMY 27500 31600 38500 48100 FENTONS OPERATION FOR 59 25000 28700 35000 43800 RECONSTRUCTION OF VAGINA FOREIGN BODY REMOVAL FROM 60 3900 4500 5500 6800 VAGINA 61 GILLIAMS VENTROSUSPENSION 20000 23000 28000 35000 62 GYNAE PAP PROCEDURE 800 900 1100 1400 63 HEMATOCOLPOS EXCISION SEPTUM 3900 4500 5500 6800 64 HSG PROCEDURE 1300 1500 1800 2300 65 HYMENECTOMY 2500 2900 3500 4400 HYSTERECTOMY (ABDOMINAL) HIGH 66 17600 20200 24600 30800 RISK 67 HYSTERECTOMY VAGINAL & REPAIR 20600 23700 28800 36100 68 HYSTERECTOMY VAGINAL 17500 20100 24500 30600 HYSTERO FOREIGN BODY REMOVAL 69 7400 8500 10400 13000 / IUCD HYSTEROSCOPIC ENDOMETRIAL 70 5000 5800 7000 8800 BIOPSY 71 HYSTEROSCOPIC POLYPECTOMY 5000 5800 7000 8800 HYSTEROSCOPIC POLYPECTOMY 72 7500 8600 10500 13100 WITH RESECTION HYSTEROSCOPIC TUBAL 73 7500 8600 10500 13100 CANNULATION HYSTEROSCOPIC WITH TUBAL 74 11400 13100 16000 20000 LIGATION HYSTEROSCOPY DIAGNOSTIC 75 22500 25900 31500 39400 (PACKAGE)
83 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUIT HYSTEROSCOPY DIAGNOSTIC 76 5000 5800 7000 8800 (PROCEDURE) 77 HYSTEROTOMY 12300 14100 17200 21500 78 I&D BARTHOLINS ABSCESS 3500 4000 4900 6100 79 I&D PERINEAL ABSCESS 8000 9200 11200 14000 80 INTRA UTERINE INSEMINATION 1300 1500 1800 2300 81 IUCD INSERTION 1300 1500 1800 2300 82 IUCD REMOVAL 600 700 800 1100 83 LAP ADHESIOLYSIS-SIMPLE 12500 14400 17500 21900 84 LAP MYOMECTOMY -SIMPLE /small 18800 21600 26300 32900 LAP MYOMECTOMY-COMPLEX/large/ 85 25000 28700 35000 43800 multiple 86 LAP- OOPHRECTOMY 12500 14400 17500 21900 87 LAP- OOPHRECTOMY BILATERAL 21300 24500 29800 37300 LAP OVARIAN CYSTECTOMY- 88 21300 24500 29800 37300 COMPLEX (large) LAP OVARIAN CYSTECTOMY-SIMPLE 89 13800 15900 19300 24200 (small) 90 LAP OVARIAN DRILLING 6300 7200 8800 11000 91 LAP- SALPINGO -OOPHRECTOMY 11400 13100 16000 20000 LAP SURGERY FOR ECTOPIC- 92 17600 20200 24600 30800 COMPLEX 93 LAP SURGERY FOR ECTOPIC-SIMPLE 15900 18300 22300 27800 LAP. ASSISTED VAGINAL 94 HYSTERECTOMY (LAVH) WITH 20000 23000 28000 35000 ADHESIOLYSIS LAP. ASSISTED VAGINAL 95 16300 18700 22800 28500 HYSTERECTOMY(SIMPLE) LAP. GYN OVARIAN CYSTECTOMY 96 13500 15500 18900 23600 UNILATERAL 97 LAP. GYN OVARIOTOMY 13500 15500 18900 23600 98 LAP. GYN RUPTURED OVARIAN CYST 11400 13100 16000 20000 LAP. GYN SALPINGO 99 13500 15500 18900 23600 OOPHERECTOMY BILATERAL 100 LAP. GYN STAGING 13500 15500 18900 23600 101 LAP. GYN TWISTED OVARIAN CYST 11400 13100 16000 20000 102 LAP. LIGATION 6300 7200 8800 11000 LAPAROSCOPIC GYN ECTOPIC 103 11400 13100 16000 20000 PREGNANCY 104 LAPAROSCOPIC SACROCOLPOPEXY 37500 43100 52500 65600 LAPAROSCOPIC TOTAL ABDOMINAL 105 25000 28700 35000 43800 HYSTERECTOMY 106 LAPAROTOMY GYN ENDOMETRIOSIS 13500 15500 18900 23600 LAPAROTOMY GYN EXTENSIVE 107 20000 23000 28000 35000 ENDOMETRIOSIS(FROZEN PELVIS) LAPAROTOMY GYN OOPHERECTOMY 108 13500 15500 18900 23600 BILATERAL LAPAROTOMY GYN OOPHERECTOMY 109 11400 13100 16000 20000 UNILATERAL 110 LAPAROTOMY GYN OVARIAN BIOPSY 9600 11000 13400 16800 LAPAROTOMY GYN OVARIAN 111 17600 20200 24600 30800 CYSTECTOMY BILATERAL 84 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUIT LAPROTOMY FOR ECTOPIC 112 12500 14400 17500 21900 PREGNANCY 113 LEFORDS OPERATION 7400 8500 10400 13000 114 LSCS 11900 13700 16700 20800 115 LSCS COMPLICATED 15000 17300 21000 26300 116 LSCS REPEAT 15000 17300 21000 26300 117 LSCS TWIN PREGNANCY 15000 17300 21000 26300 118 LSCS WITH TUBECTOMY 15000 17300 21000 26300 MANCHESTER / FOTHERGIL 119 14100 16200 19700 24700 PROCEDURE 120 MCDONALD STITCHING 5000 5800 7000 8800 121 MIRENA INSERTION 2100 2400 2900 3700 MRP (MANNUAL REMOVAL OF 122 3900 4500 5500 6800 PLACENTA) 123 MTP 5000 5800 7000 8800 124 MTP BY DRUGS 3800 4400 5300 6700 125 MTP WITH TUBECTOMY 9600 11000 13400 16800 126 MULTILOAD INSERTION (3 YRS) 1300 1500 1800 2300 127 MULTILOAD INSERTION (5 YRS) 1300 1500 1800 2300 128 OBS TOTAL HYSTERECTOMY 18600 21400 26000 32600 129 OPERATIVE HYSTEROSCOPY 12500 14400 17500 21900 OPERATIVE HYSTEROSCOPY SEPTUM 130 17600 20200 24600 30800 DIVISION OPERATIVE HYSTEROSCOPY 131 9600 11000 13400 16800 SYNAECHAE REMOVAL PANHYSTERECTOMY FOR 132 20000 23000 28000 35000 ENDOMETRIOSIS 133 PLASTIC REPAIR OF UTERUS 26300 30200 36800 46000 PYOMETRA / HEMATOMETRA 134 3900 4500 5500 6800 DRAINAGE RADICAL ABDOMINAL 135 20000 23000 28000 35000 HYSTERECTOMY RADICAL HYSTERECTOMY PLUS 136 OMENTECTOMY FOR OVARIAN 26300 30200 36800 46000 MALIGNANCY RECTOVAGINAL FISTULAS REPAIR 137 9600 11000 13400 16800 THIRD DEGREE 138 REMOVAL OF MISSED IUCD 3900 4500 5500 6800 139 REMOVAL OF SIMPLE VULVAL TUMOR 2100 2400 2900 3700 REMOVAL OF SIMPLE VULVAL TUMOR 140 3900 4500 5500 6800 (B/L) 141 REMOVAL OF VAGINALCYST 11400 13100 16000 20000 142 REPAIR OF CERVICAL TEAR 3900 4500 5500 6800 143 REPAIR PERINEAL TEAR TRAUMATIC 3900 4500 5500 6800 RESUSPENSION OF POST 144 17600 20200 24600 30800 HYSTERECTOMY VAULT PROLAPSE 145 RESUTURING - BURST ABDOMEN 15900 18300 22300 27800 146 RICHARDSON SLING OPERATION 20000 23000 28000 35000 SALPINGO OOPHORECTOMY 147 13500 15500 18900 23600 BILATERAL
85 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUIT SALPINGO OOPHORECTOMY 148 11400 13100 16000 20000 UNILATERAL 149 SHIRODKARS STITCHING 7400 8500 10400 13000 150 SIMPLE VULVECTOMY 10600 12200 14800 18600 SLING OPERATION FOR URINARY 151 20000 23000 28000 35000 STRESS INCONTINENCE 152 SUBTOTAL HYSTERECTOMY 21300 24500 29800 37300 153 SUTURING PERINEAL TEARS II DEGREE 1900 2200 2700 3300 SUTURING PERINEAL TEARS III 154 3800 4400 5300 6700 DEGREE 155 THERMAL ABLATION 9600 11000 13400 16800 156 THREE SWAB TEST FOR VVF 2100 2400 2900 3700 157 TOTAL LAP HYSTERECTOMY 18800 21600 26300 32900 TOTAL VULVECTOMY WITH 158 20000 23000 28000 35000 DISSECTION OF NODES 159 TRACHELORRHAPY 11400 13100 16000 20000 TRANSCERVICAL RESECTION OF 160 9600 11000 13400 16800 ENDOMETRIUM 161 TUBAL INSUFFLATION 2100 2400 2900 3700 162 TUBAL LIGATION 7400 8500 10400 13000 TUBAL RECANALISATION/TUBOPLASY 163 26300 30200 36800 46000 (microsurgery) 164 Tubectomy 5500 6300 7700 9600 TUBOPLASTY (OPER. MICROSCOPE) 165 31300 36000 43800 54800 BILATERAL TUBOPLASTY (OPER. MICROSCOPE) 166 26300 30200 36800 46000 UNILATERAL 167 TUBOPLASTY BILATERAL 31300 36000 43800 54800 168 VAGINAL DELIVERY-HIGH RISK 18000 20700 25200 31500 VAGINAL OPERATION FOR STRESS 169 16500 19000 23100 28900 INCONTINENCE 170 VAGINOPLASTY WITHOUT GRAFT 17600 20200 24600 30800 171 VAULT REPAIR 13500 15500 18900 23600 VISUAL INSPECTION OF ACETOWHITE 172 1400 1600 2000 2500 AREA 173 VISUAL INSPECTION OF THE CERVIX 1400 1600 2000 2500 174 VULVAL BIOPSY-SINGLE 2100 2400 2900 3700 175 VVF REPAIR- VESICOVAGINAL 26300 30200 36800 46000 176 WERTHEIMS HYSTERECTOMY 37500 43100 52500 65600
86 GENERAL SURGERY S.NO. SERVICE NAME OPD GW TWIN SINGLE SUIT 1 VARICOSE VEINS OF LIMBS EXCISION 15880 18260 22200 27800 2 A-V FISTULA WRIST 8000 9200 11200 14000 3 A-V FISTULA ELBOW 11130 12800 15600 19500 Superior Mesenteric Artery Repair (Surgeon 4 30000 34500 42000 52500 Charge) 5 CAROTID BODY TUMOR EXCISION 16000 18400 22400 28000 6 EXTERNAL CAROTID ARTERY LIGATION 5500 6320 7700 9600 7 INJECTION VARICOSE VEINS 4025 4750 5460 6700 8300 8 Subfacial ligation of perforators - unilateral 10000 11500 14000 17500 9 Subfacial ligation of perforators - Bilateral 16250 18690 22800 28400 Trendlenburg,s procedure with stripping of 10 12500 14370 17500 21900 LSV - U/L Trendlenburg,s procedure with stripping of 11 20000 23000 28000 35000 LSV - B/L Trendlenburg,s procedure with stripping of 12 8750 10060 12300 15300 SSV- U/L Trendlenburg,s procedure with stripping of 13 13750 15810 19300 24100 SSV- B/L Subfacial endoscopic perforator surgery 14 13750 15810 19300 24100 (SEPS) - U/L Subfacial endoscopic perforator surgery 15 22500 25870 31500 39400 (SEPS) - B/L 16 Hemangioma Excision - small 10000 11500 14000 17500 17 Hemangioma Excision - medium 15000 17250 21000 26300 Hemangioma Excision - large / deep 18 31250 35940 43800 54700 intramuscular open repair of diphrag hernia (Surgeon 19 18750 21560 26300 32800 Charges) VATS EMPYEMA DRAINAGE & 20 15000 17250 21000 26300 DECORTICATION 21 VATS BULLECTOMY WITH PLEURODESIS 27500 31620 38500 48100 22 open repair of diphrag hernia 47500 54620 66500 83100 23 Tolet Thoracotomy (Surgeon Charge) 21250 24440 29700 37200 METASTATECTOMY CLAMSHELL(BILATERAL 24 27500 31620 38500 48100 THORACOTOMY FOR SARCOMA METS 25 METASTATECTOMY UNILATERAL 20000 23000 28000 35000 26 MEDIASTINAL LYMPH NODE DISSECTION 30000 34500 42000 52500 27 MEDIASTINAL TUMOR EXCISION 30000 34500 42000 52500 28 PLEURODESIS EACH SITTING 3750 4310 5300 6600 29 PLEURAL BIOPSY 6130 7050 8600 10700 PNEUMONECTOMY/LOBECTOMY WITH 30 18130 20850 25400 31700 OR WITHOUT HILAR NODE DISSECTION 31 SEGMENTAL RESECTION 16880 19410 23600 29500 32 SLEEVE RESECTION BRONCHUS 21250 24440 29700 37200 CHEST WALL TUMOR EXC. WITH PRIMARY 33 20000 23000 28000 35000 CLOSURE/WITH REPAIR OF CHEST WALL 34 EXPLORATORY THORACOTOMY 16000 18400 22400 28000 INTERNAL MAMMARY NODE 35 6750 7760 9500 11800 SAMPLING(WHEN DONE ALONE)
87 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUIT Lap repair of diphrag hernia (Surgeon 36 35000 40250 49000 61300 Charges) 37 LAP DIAPHRAGM REPAIR 40000 46000 56000 70000 38 LAP DIAPHRAGM REPAIR WITH MESH 30000 34500 42000 52500 THORACOTOMY FOR REMOVAL OF 39 27500 31620 38500 48100 OESOPHAGEAL FOREIGN BODY INTERCOSTAL DRAINAGE FOR 40 5500 6320 7700 9600 PNEUMOTHORAX VATS decortication for adhesive pleuritis - 41 27500 31620 38500 48100 stage III 42 VATS Mediastenal lymph node biopsy 10000 11500 14000 17500 43 VATS wedge resection of lung 18750 21560 26300 32800 44 VATS lobectomy 31250 35940 43800 54700 45 VATS cervical sympathectomy 15000 17250 21000 26300 46 VATS pericardial window 20000 23000 28000 35000 47 Thoracotomy for decortication 22500 25870 31500 39400 Thoracotomy for lobectomy / 48 25000 28750 35000 43800 pneumonectomy open lobectomy / pneumonectomy with 49 27500 31620 38500 48100 mediastinal L N dissection 50 VATS esophagectomy 42500 48870 59500 74400 51 Diagnostic thoracoscopy 12500 14370 17500 21900 52 CHOLANGIOGRAM INTRA OPERATIVE 4750 5460 6700 8300 53 CHOLECYSTOSTOMY 31250 35940 43800 54700 54 COMPLEX LIVER INJURY REPAIR II 47500 54620 66500 83100 55 LAP. CHOLEDOCHODUDENOSTOMY 32500 37380 45500 56900 LAP. CHOLEDOCHOLITHOTOMY WITH 56 CHOLEDOCHODUODENOSTOMY (GEN. 47500 54620 66500 83100 SURGERY) LAP SURGERY FOR PANCREATIC 57 32500 37380 45500 56900 PSEUDOCYST (CYSTOGASTROSTOMY) 58 LIVER RIGHT LOBECTOMY 40000 46000 56000 70000 59 LIVER TRISEGMENTECTOMY 32500 37380 45500 56900 60 OPEN DRAINAGE OF LIVER ABSCESS 18750 21560 26300 32800 PANCREAS HEAD CA TRIPLE BYPASS 61 40000 46000 56000 70000 SURGERY 62 PANCREATECTOMY PARTIAL 43750 50310 61200 76600 63 PANCREATECTOMY TOTAL 47500 54620 66500 83100 64 PANCREATIC TUMORS 47500 54620 66500 83100 65 PANCREATICOJEJUNOSTOMY 27500 31620 38500 48100 66 REPAIR OF BILE DUCT STRICTURE 47500 54620 66500 83100 RESECTION OF GROWTH OF COMMON 67 47500 54620 66500 83100 HEPATIC DUCTAND REPAIR 68 SPLENECTOMY 11000 12650 15400 19300 SUBCARDIAC PORTO AZYGOS DISCONNECTION AND 69 40000 46000 56000 70000 DEVASCULARISATION OF LOWER OESOPHAGUS AND PROXIMAL STOMACH 70 WHIPPLES PANCREATO-DUODENECTOMY 63750 73310 89300 111600 71 COMPLEX LIVER INJURY REPAIR I 47500 54620 66500 83100
88 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUIT RESECTION OF LIVER CYST WITH 72 25000 28750 35000 43800 REMOVAL 73 SPLEENECTOMY 23750 27310 33300 41600 74 CHOLEDOCHOLITHOTOMY 18750 21560 26300 32800 75 Cholecystectomy 31250 35940 43800 54700 76 cholecystomy + choledochoduodenostomy 32500 37380 45500 56900 cholecystomy and 77 31250 35940 43800 54700 choledocholithotomy(open) Lap cholecystom&choledocholithotomy(CBD 78 40000 46000 56000 70000 exploration) 79 Lap deroofing of non- hydatid liv cyst 40000 46000 56000 70000 80 Lap splenectomy 32500 37380 45500 56900 Necrosectomy and drainage of pancreatic 81 40000 46000 56000 70000 abscess 82 SEGMENT III BYPASS 15750 18110 22100 27600 83 TRISEGMENTECTOMY 21250 24440 29700 37200 84 DISTAL PANCREAT ECTOMY 15750 18110 22100 27600 PANCREATICO DUODENECTOMY 85 23750 27310 33300 41600 (WHIPPLES) 86 SPLENECTOMY 26250 30190 36800 45900 87 CHOLECYSTOJEJUNOSTOMY 13250 15240 18600 23200 88 CHOLANGIOCARCINOMA RESECTION 20000 23000 28000 35000 89 HEPATIC ARTERY PORT PLACEMENT 11000 12650 15400 19300 90 HEPATICO JEJUNOSTOMY 20000 23000 28000 35000 LEFT LATERAL 91 14630 16820 20500 25600 SEGMENTECTOMY(SEGMENT2 AND 3) LABECTOMY RIGHT (SEGMENTS5,6,7,8)/ 92 20000 23000 28000 35000 LEFT(SEGMENTS1,2,3,4) 93 METASTECTOMY 13250 15240 18600 23200 RADICAL CHOLECYSTECTOMY(WITH 94 20000 23000 28000 35000 SEGMENT 4 &5) HEPATIC RESECTIONS ( LOBECTOMY 95 30000 34500 42000 52500 HEPATECTOMY) 96 Pancreatic Repair (Surgeon Charge) 8250 9490 11600 14400 97 Cholecystectomy (Surgeon Charges) 31250 35940 43800 54700 cholecystomy + choledochoduodenostomy 98 32500 37380 45500 56900 (Surgeon Charges) cholecystomy and 99 choledocholithotomy(open) (Surgeon 31250 35940 43800 54700 Charges) Lap cholecystom&choledocholithotomy(CBD 100 35000 40250 49000 61300 exploration) (Surgeon Charges) Lap deroofing of non- hydatid liv cyst 101 40000 46000 56000 70000 (Surgeon Charges) 102 Lap splenectomy (Surgeon Charges) 32500 37380 45500 56900 Necrosectomy and drainage of pancreatic 103 40000 46000 56000 70000 abscess (Surgeon Charges) Open Cholecystectomy Simple Surgeon 104 116250 133690 162800 203400 Charge Open Cholecystectomy Complex Surgeon 105 140000 161000 196000 245000 Charge
89 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUIT Lap Cholecystectomy Simple Surgeon 106 132500 152380 185500 231900 Charge Lap Cholecystectomy Complex Surgeon 107 140000 161000 196000 245000 Charge Laparoscopic DRAINAGE OF LIVER 108 20000 23000 28000 35000 ABSCESS Lap Necrosectomy and drainage of 109 40000 46000 56000 70000 pancreatic abscess (Surgeon Charges) PANCREATICO DUODENECTOMY pylorus 110 52500 60370 73500 91900 preserving 111 Splenoraphy 27500 31620 38500 48100 112 Excision of single Hydatid cyst of liver 26250 30190 36800 45900 113 Excision of multiple Hydatid cysts of liver 40000 46000 56000 70000 114 Resection of CBD with reconstruction 30000 34500 42000 52500 115 T Tube insertion 6250 7190 8800 10900 116 Intraop choledocoscopy 7500 8630 10500 13100 117 Puestow Procedure 31250 35940 43800 54700 Drainage of psoas abscess (Surgeon 118 14000 16100 19600 24500 Charges) 119 open / lap adhesiolysis (Surgeon Charges) 13500 15520 18900 23600 120 ABSCESS DRAINAGE PERINEPHRIC 14000 16100 19600 24500 121 ABSCESS DRAINAGE SUBDIAPRAGMATIC 14000 16100 19600 24500 122 ADRENAL GLAND NEOPLASM EXCISION 40000 46000 56000 70000 123 ADRENALECTOMY SUB TOTAL BILATERIAL 56250 64690 78800 98400 124 ADRENALECTOMY SUB TOTAL UNILATERAL 40000 46000 56000 70000 125 ADRENALECTOMY TOTAL BILATERAL 56250 64690 78800 98400 LAPAROTOMY WITH REMOVAL OF 126 18750 21560 26300 32800 INFECTED MESH 127 MESENTERIC CYST EXCISION 15880 18260 22200 27800 128 OMENTOPEXY 23750 27310 33300 41600 129 PELVIC LYMPHADENECTOMY 12750 14660 17900 22300 EXPLORATION & EXCISION OF SINUS & 130 15880 18260 22200 27800 DEBRIDMENT CLOSUE 131 Drainage of psoas abscess 14000 16100 19600 24500 132 Mesentric Lymph Node Excision With Biopsy 14500 16680 20300 25400 133 Peritoneal Lavage (Surgeon Charges) 6880 7910 9600 12000 Abdominal Wall Repair 134 6880 7910 9600 12000 Reconstruction(Surgeon Charge) 135 Omentectomy (Surgeon Charges) 7500 8630 10500 13100 136 Mesentric Tear Repair (Surgeon Charges) 8250 9490 11600 14400 SECONDARY SUTURING FOR BURST 137 9630 11070 13500 16900 ABDOMEN 138 ADRENALECTOMY ( BILATERAL) 53750 61810 75300 94100 139 ADRENALECTOMY ( UNILATERAL) 42500 48870 59500 74400 140 HIGH / RADICAL ORCHIDECTOMY 9380 10790 13100 16400 141 NEPHROBLASTOMA 20000 23000 28000 35000 RETROPERITONEAL LYMPH NODE 142 18630 21420 26100 32600 DISSECTION FOR TESTICULAR TUMOURS 143 URETERIC DIVERSION IN NEOBLADDER 16000 18400 22400 28000 URETERIC DIVERSION IN TO AN IIEAL 144 14630 16820 20500 25600 LOOP 90 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUIT 145 URETEROSIGMOID DIVERSION 14630 16820 20500 25600 146 RETROPERITONEAL SARCOMA EXCISION 17380 19990 24300 30400 MODIFIED RADICAL HYSTERECTOMY(CA. 147 26250 30190 36800 45900 ENDOMETRIUM ETC) 148 RADICAL HYSTERECTOMY ( CA. CERVIX) 26250 30190 36800 45900 149 RADICAL VULVECTOMY 16630 19120 23300 29100 150 SIMPLE VULVECTOMY 11630 13370 16300 20400 CYTOREDUTION FOR ADVANCED 151 16250 18690 22800 28400 DISEASE PRIMARY SURGERY FOR OVARIAN 152 26250 30190 36800 45900 MALIGNANCY,INCL. TAH 153 SECOND LOOK LAPAROTOMY 16250 18690 22800 28400 154 ANTERIOR PELVIC EXENTERATION 23750 27310 33300 41600 155 POSTERIOR PELVIC EXENTERATION 23750 27310 33300 41600 156 TOTAL PELVIC EXENTERATION 30000 34500 42000 52500 EXPLORATORY LAPAROTRY FOR 157 10630 12220 14900 18600 MALIGNANT OBSTRUCTION 158 LAP. LUMBAR SYMPATHECTOMY 23750 27310 33300 41600 LAP URETEROLITHOTOMY / 159 25000 28750 35000 43800 PYELOLITHOTOMY 160 ORCHIDECTOMY (UNILATERAL) 11250 12940 15700 19700 161 open / lap adhesiolysis 13500 15520 18900 23600 ABDOMINAL WALL TUMOR RESECTION 162 18750 21560 26300 32800 WITH MESH REPAIR ABDOMINAL WALL TUMOR RESECTION 163 12130 13950 17000 21200 WITH PRIMARY CLOSURE Gastro-jejunostomy(without vagotomy) 164 15000 17250 21000 26300 (Surgeon Charges) 165 Gastrostomy (Surgeon Charges) 12500 14370 17500 21900 Highly selected vagotomy (Surgeon 166 23750 27310 33300 41600 Charges) 167 Oesophagostomy (Surgeon Charges) 12500 14370 17500 21900 Gastrectomy - Partial or Subtotal (Surgeon 168 23750 27310 33300 41600 Charges) 169 Gastrectomy - Total or Near total 28750 33060 40300 50300 Gastrectomy - total or partial with D2 170 37500 43130 52500 65600 lymph node dissection/ redical gastrectomy Pyloromotomy for pyloric stenosis/ 171 21250 24440 29700 37200 pyloroplasty (Surgeon Charges) ACHALASIA CARDIA DILATATION Surgeon 172 17380 19990 24300 30400 Charges Open Cardiomyotomy for Achalasia 173 20000 23000 28000 35000 Cardia 174 OESOPHAGEAL TEAR REPAIR 22500 25870 31500 39400 175 PERFORATED GASTRIC ULCER SIMPLE 15880 18260 22200 27800 176 PERFORATED ULCER COMPLICATED 23750 27310 33300 41600 RESECTION & TRANSPLANT OF COLON 177 40000 46000 56000 70000 FOR CANCER OESOPHAGUS SUBCARDIAC PORTO AZYGOS DISCONNECTION AND 178 40000 46000 56000 70000 DEVASCULARISATION OF LOWER OESOPHAGUS AND PROXIMAL STOMACH
91 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUIT THORACOTOMY FOR REMOVAL OF 179 40000 46000 56000 70000 OESOPHAGEAL FOREIGN BODY TRANSECTION OESOPHAGUS USING EEA 180 40000 46000 56000 70000 STAPLER ZOLLINGER ELLISON SYNDROME TOTAL 181 GASTRECTOMY & MANAGEMENT OF 28750 33060 40300 50300 PRIMARY LESION 182 Gastro-jejunostomy(without vagotomy) 15000 17250 21000 26300 183 Gastrostomy 12500 14370 17500 21900 184 Highly selected vagotomy 23750 27310 33300 41600 185 Oesophagostomy 12500 14370 17500 21900 186 Partial or Subtotal Gastrectomy 23750 27310 33300 41600 Pyloromotomy for pyloric stenosis/ 187 12500 14370 17500 21900 pyloroplasty 188 CERVICAL OESOPHAGOSTOMY 9630 11070 13500 16900 EXCISION OF LEIOMYOMA 189 18750 21560 26300 32800 OESOPHAGUS 190 IVOR - LEWIS PROCEDURE 47500 54620 66500 83100 191 OESOPHAGOGASTRECTOMY (SWEET’S) 47500 54620 66500 83100 192 RETROSTERNAL GASTRIC BYPASS 35000 40250 49000 61300 THREE STAGE OESOPHAGECTOMY 193 21250 24440 29700 37200 (MCKEWON’S) TOTAL OESOPHAGOGASTRECTOMY WITH 194 47500 54620 66500 83100 COLONIC/JEJUNAL PULL UP TRANSHIATAL OESOPHAGECTOMY WITH 195 43750 50310 61200 76600 GASTRIC PULL UP DISTAL RADICAL GASTRECTOMY (D2 196 37500 43130 52500 65600 GASTRECTOMY) 197 PALLIATIVE GASTERCTOMY 28750 33060 40300 50300 TOTAL RADICAL GASTRECTOMY WITH OR 198 37500 43130 52500 65600 WITHOUT LYMPHNODE DISSECTION 199 GASTRO - JEJUNOSTOMY 15000 17250 21000 26300 200 GASTROSTOMY OR JEJUNOSTOMY 7380 8490 10300 12900 201 Lap gastrostomy (Surgeon Charges) 15250 17540 21400 26700 202 LAP Cardiomyotomy for Achalasia Cardia 25000 28750 35000 43800 203 LAP HIATUS HERNIA 32500 37380 45500 56900 204 LAP GASTROJEJUNOSTOMY 32500 37380 45500 56900 205 Lap gastrostomy 15250 17540 21400 26700 206 Lap Open Gastropexy (Surgeon Charges) 30000 34500 42000 52500 207 Thoracolaparoscopic esophagectomy 56250 64690 78800 98400 208 Lateral gastroduodenostomy 17500 20130 24500 30600 209 Appendicectomy (Surgeon Charges) 12750 14660 17900 22300 Appendicular absecess drainage (Surgeon 210 12250 14090 17200 21400 Charges) 211 Closure of colostomy (Surgeon Charges) 7380 8490 10300 12900 212 Ileostomy (Surgeon Charges) 15000 17250 21000 26300 213 Proctocolectomy(open) (Surgeon Charges) 40000 46000 56000 70000 Single intestinal resc and anastomosis 214 18750 21560 26300 32800 (Surgeon Charges) 215 COLOSTOMY 15880 18260 22200 27800 216 COLOSTOMY CLOSURE 15880 18260 22200 27800
92 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUIT 217 INTESTINAL FISTULA 32500 37380 45500 56900 218 PERFORATED DUODENAL ULCER SIMPLE 18750 21560 26300 32800 TOTAL COLECTOMY & ILEORECTAL 219 47500 54620 66500 83100 ANASTOMOSIS 220 TRANSVERSE COLECTOMY 32500 37380 45500 56900 221 TUBE CEACOSTOMY 12750 14660 17900 22300 222 Appendicectomy 12750 14660 17900 22300 223 Appendicular absecess drainage 12250 14090 17200 21400 224 Closure of colostomy 7380 8490 10300 12900 225 Ileostomy 28750 33060 40300 50300 226 Proctocolectomy(open) 40000 46000 56000 70000 227 Single intestinal resc and anastomosis 18750 21560 26300 32800 228 Jejunostomy 12750 14660 17900 22300 229 Caecal Repair (Surgeon Charge) 6880 7910 9600 12000 Intestine Perforation Repair (Surgeon 230 23750 27310 33300 41600 Charge) 231 ILCOSTOMY CLOSURE (Surgeon Charges) 15880 18260 22200 27800 232 Stricturoplasty (Surgeon Charge) 15880 18260 22200 27800 233 Open Appendicectomy Simple 48750 56060 68300 85300 Open Appendicectomy Complex Surgeon 234 57500 66130 80500 100600 Charge RESECTION ANASTOMOSIS BOWEL - 235 18750 21560 26300 32800 SINGLE COLECTOMY (RIGHT/LEFT/TRANSVERSE/ 236 18750 21560 26300 32800 SIGMOID) EXTENDED HEMICOLECTOMY FOR CA 237 26250 30190 36800 45900 COLON 238 SIGMOID COLECTOMY 14630 16820 20500 25600 TOTAL COLECTOMY WITH ILEORECTAL 239 ANASTOMOSIS/HARTMANNS/MUCUS 23750 27310 33300 41600 FISTULA 240 ILEOSTOMY / COLOSTOMY 15880 18260 22200 27800 ILEOTRANSVERSE COLOSTOMY 241 10500 12070 14700 18400 ANASTOMOSIS ILEO - SIGMOID COLOSTOMY 242 9630 11070 13500 16900 ANASTOMOSIS RESECTION ANASTOMOSIS BOWEL 243 25000 28750 35000 43800 -MULTIPLE Lap closure of intestinal perforation 244 23750 27310 33300 41600 (Surgeon Charges) LAP ASSISTED / LAPAROSCOPIC BOWEL 245 32500 37380 45500 56900 RESECTION 246 LAP COLONIC SURGERY 40000 46000 56000 70000 247 PERFORATED ULCER COMPLICATED 23750 27310 33300 41600 248 Removal of Feeding Jejunostomy Tube 6670 1500 1720 2100 2600 249 Lap appendicectomy 18750 21560 26300 32800 250 Lap closure of intestinal perforation 23750 27310 33300 41600 251 Lap hemicolectomy 32500 37380 45500 56900 252 Lap feeding jejunostomy 15630 17970 21900 27400 253 Ladd’s procedure 23750 27310 33300 41600
93 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUIT volvulous - sigmoid / ileocaecal - 254 22500 25870 31500 39400 derotation and fixation 255 intussusception reduction 18750 21560 26300 32800 256 Adhesionolysis for intestinal obstruction 20000 23000 28000 35000 257 Limited right colectomy 15000 17250 21000 26300 258 Exploratory laparotomy for acute abdomen 10000 11500 14000 17500 Exploratory Laparoscopy with 259 18750 21560 26300 32800 Adhesionolysis and biopsy Haemorrhoidectomy (Stappler) (Surgeon 260 15130 17400 21200 26500 Charges) ABDOMINOPERINEAL PULL THROUGH 261 RESECTION WITH COLORECTAL 26250 30190 36800 45900 ANASTOMOSIS ABDOMINOPERINEAL RESECTION 262 26250 30190 36800 45900 RECTUM WITH COLOSTOMY ANAL DILATATION (UNDER GA) LORDS 263 6750 7760 9500 11800 PROCEDURE ANAL SPHINCTER REPAIR FOLLOWING 264 50000 57500 70000 87500 INJURY 265 ANTERIOR RESECTION OF RECTUM 18750 21560 26300 32800 266 Low ANTERIOR RESECTION OF RECTUM 21250 24440 29700 37200 Ultra low ANTERIOR RESECTION OF 267 26250 30190 36800 45900 RECTUM 268 RECTAL PROLAPSE REPAIR 22500 25870 31500 39400 THIERSCH OPERATION / WIRING FOR 269 15880 18260 22200 27800 RECTAL PROLAPSE 270 Haemorrhoidectomy (Stappler) 15130 17400 21200 26500 271 Haemorrhoidectomy (Surgeon Charges) 15130 17400 21200 26500 Lateral sphincterotomy or fissurectomy 272 9630 11070 13500 16900 (Surgeon Charges) Open Haemorrhoidectomy Simple Surgeon 273 15000 17250 21000 26300 Charge Open Haemorrhoidectomy Complex 274 18750 21560 26300 32800 Surgeon Charge Fistula in ANO Low Level (Single) Surgeon 275 11250 12940 15700 19700 Charge Fistula in ANO Low Level (Multiple) Surgeon 276 17500 20130 24500 30600 Charge 277 Fistula in ANO High Level Surgeon Charge 17500 20130 24500 30600 Fistula in ANO Complex High Level 278 20000 23000 28000 35000 Surgeon Charge 279 ANTERIOR RESECTION OF RECTUM 17130 19700 24000 30000 ABDOMINO-PERINEAL RESECTION OF 280 18130 20850 25400 31700 RECTUM 281 WIDE EXCISION PER RECTUM 9630 11070 13500 16900 282 LAP RECTOPEXY 28750 33060 40300 50300 283 STAR procedure 20000 23000 28000 35000 External ANAL SPHINCTER REPAIR 284 6750 7760 9500 11800 FOLLOWING INJURY Anorectal SPHINCTER REPAIR 285 50000 57500 70000 87500 FOLLOWING INJURY 286 Resection Rectopexy 23750 27310 33300 41600
94 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUIT 287 seton application 7500 8630 10500 13100 288 Seton tightening 6250 7190 8800 10900 289 Excision / cauterisation of genital warts 10000 11500 14000 17500 290 Rectal polypectomy 9630 11070 13500 16900 291 Rectal Biopsy 6250 7190 8800 10900 Rectal prolapse - repair by perineal 292 18750 21560 26300 32800 approach HERNIA INGUINAL REPAIR BILATERAL 293 20000 23000 28000 35000 (WITH MESH) 294 Inguinal mesh hernioplasty U/L 12500 14370 17500 21900 295 HERNIA LUMBAR 15880 18260 22200 27800 296 HERNIA STRANGULATED (ANY TYPE) 22500 25870 31500 39400 297 HERNIASUPRAUMBLICAL 15880 18260 22200 27800 298 HIATUS HERNIA REPAIR 32500 37380 45500 56900 HIATUS HERNIA REPAIR THROUGH THE 299 40000 46000 56000 70000 CHEST HIATUS HERNIA REPAIR THROUGH THE 300 32500 37380 45500 56900 ABDOMEN 301 HYDROCELE (B/L) EVISCERATION OF SAC 11250 12940 15700 19700 302 HYDROCELE (U/L) EVERSION OF SAC 8750 10060 12300 15300 303 EPIDIDYMAL CYST EXCISION 8750 10060 12300 15300 OPEN EPIGASTRIC/INCISIONAL/RARE 304 15880 18260 22200 27800 HERNIA(SMALL) Large ventral/ incisional hernia - mesh 305 21250 24440 29700 37200 repair 306 Inguainal Hernia (B/L) Surgeon Charge 82500 94870 115500 144400 307 Inguinal Hernia (U/L) Surgeon Charge 67500 77630 94500 118100 308 Incisional Hernia Small Surgeon Charge 67500 77630 94500 118100 309 Incisional Hernia Large Surgeon Charge 82500 94870 115500 144400 310 Incisional Hernia Multiple Surgeon Charge 140000 161000 196000 245000 311 Umblical Hernia Surgeon Charge 130000 149500 182000 227500 312 ORCHIDECTOMY ( BILATERAL) 15000 17250 21000 26300 313 ORCHIDECTOMY ( UNILATERAL) 11250 12940 15700 19700 Lap Rep of INGUINAL hernia U/L (Surgeon 314 15000 17250 21000 26300 Charges) Lap Repair of INGUINAL hernia B/L 315 22500 25870 31500 39400 (Surgeon Charges) 316 Lap ventral hernia (Surgeon Charges) 23750 27310 33300 41600 317 LAP HERNIA (LAP REPAIR) IN CHILDERN 18750 21560 26300 32800 LAP EPIGASTRIC/INCISIONAL/RARE 318 18750 21560 26300 32800 HERNIA(SMALL) 319 Lap Rep of INGUINAL hernia UL 18750 21560 26300 32800 320 Lap ventral hernia 23750 27310 33300 41600 321 open repair of diphragmatic hernia 47500 54620 66500 83100 322 Lap cholecystectomy (Surgeon Charges) 37500 43130 52500 65600 323 Lap repair of obturator hernia 18750 21560 26300 32800 324 Open repair of obturator hernia 17500 20130 24500 30600 325 Large hydrocele U/L- Excision of sac 11250 12940 15700 19700 326 Hernia with hydrocele U/L 17500 20130 24500 30600
95 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUIT High inguinal ORCHIDECTOMY U/L for 327 15000 17250 21000 26300 testicular tumor 328 Orchidopexy for tortion of testis 15000 17250 21000 26300 ABSCESS DRAINAGE (MULTIPLE ABSCESS 329 8000 9200 11200 14000 NECK) 330 ANTERIOR CRANIAL FOSSA 22500 25870 31500 39400 B/L Radical Neck dissection with 331 62500 71880 87500 109400 Mandibulectomy(Surgeon Charge) 332 BRANCHIAL CYST EXCISION 12500 14370 17500 21900 333 BREAST CONSERVATION SURGERY 23750 27310 33300 41600 BUCCAL MUCOSA TUMOR (WIDE 334 10000 11500 14000 17500 EXCISION) COMPOSITE RESECTION OF 335 ORAL CARCINOMA (WIDE EX 17500 20130 24500 30600 ,MANDIBULECTOMY,NECK DISSECTION) COMPOSITE RESECTION POST 336 26250 30190 36800 45900 RADIOTHERAPY 337 CONSERVATION LARYNGECTOMY 46250 53190 64700 80900 338 EXCISION OF LEUCOPLAKIA - LARGE 8130 9350 11400 14200 339 EXCISION OF LEUCOPLAKIA - SMALL 4380 5040 6100 7700 340 HEMI MANDIBULECTOMY 27500 31620 38500 48100 HEMITHYROIDECTOMY/COMPLETE 341 35000 40250 49000 61300 THYROIDECTOMY LARYNGECTOMY WITH PARTIAL 342 PHARYNGECTOMY/LARYNGO 18630 21420 26100 32600 PHARYNGECTOMY LARYNGO PHARYNGO 343 26250 30190 36800 45900 OESOPHAGASTOMY 344 LIP TUMOR: WEDGE EXCISION 8750 10060 12300 15300 345 lobuloplasty for split ear lobule U/L 5000 5750 7000 8800 346 MASTECTOMY BILATERAL 40000 46000 56000 70000 MODIFIED NECK DISSECTION/ 347 20000 23000 28000 35000 FUNCTIONAL NECK DISSECTION MODIFIED RADICAL MASTECTOMY/ 348 60000 69000 84000 105000 HALSTED RADICAL MASTECTOMY PARAPHARYNGEAL SPACE TUMOR 349 30000 34500 42000 52500 EXCISION 350 PARATHYROIDECTOMY 17380 19990 24300 30400 PARTIAL GLOSSECTOMY/HEMI 351 12500 14370 17500 21900 GLOSSECTOMY PARTIAL MAXILLECTOMY/UPPER 352 ALVEOLECTOMY,MEDICAL MAXILECTOMY/ 37500 43130 52500 65600 HARD PALATE EXCISION 353 PROVOX PROSTHESIS 6130 7050 8600 10700 RECONSTRUCTION OF EAR DEFORMITY 354 15880 18260 22200 27800 - STAGE SEGMENTAL/MARGINAL 355 16250 18690 22800 28400 MANDIBULECTOMY SIMPLE MASTECTOMY / TOILET 356 20000 23000 28000 35000 MASTECTOMY SUBMANDIBULAR SALIVARY GLAND 357 8000 9200 11200 14000 EXCISION
96 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUIT SUPRA-OMOHYOID NECK DISSECTION/ 358 POSTERO LATERAL/CENTRAL NECK 17500 20130 24500 30600 DISSECTION 359 TEMPORAL BONE EXCISION 22500 25870 31500 39400 THYROGLOSSAL CYST OR FISTULA 360 15880 18260 22200 27800 EXCISION THYROIDECTOMY-SUB TOTAL 361 23750 27310 33300 41600 (MALIGNANT DISEASE) 362 TOTAL GLOSSECTOMY 20000 23000 28000 35000 363 TOTAL LARYNGECTOMY 16000 18400 22400 28000 364 TOTAL MAXILLECTOMY 16000 18400 22400 28000 TOTAL MAXILLECTOMY WITH ORBITAL 365 18630 21420 26100 32600 EXENTERATION TOTAL THYROIDECTOMY WITH TRACHEAL 366 20000 23000 28000 35000 RESECTION TOTAL THYROIDECTOMY/SUBTOTAL 367 46250 53190 64700 80900 THYROIDECTOMY WITH /WITHOUT CND 368 TOTAL/RADICAL PAROTIDECTOMY 20000 23000 28000 35000 369 TRACHEOSTOMY - BED SIDE EMERGENCY 10000 11500 14000 17500 370 TRACHEOSTOMY - ELECTIVE 7500 8630 10500 13100 WIDE EXCISION - BASE OF TONGUE 371 20000 23000 28000 35000 TUMOUR WIDE LOCAL EXCISION & AXILLARY 372 17880 20560 25000 31300 DISSECTION PAROTID GLAND - SUPERFICIAL 373 17500 20130 24500 30600 PAROTIDECTOMY PAROTID GLAND - TOTAL 374 23750 27310 33300 41600 PAROTIDECTOMY 375 THYROID - Hemi thyroidectomy 15000 17250 21000 26300 376 THYROID - Subtotal thyroidectomy 20000 23000 28000 35000 377 THYROID - Total/ near total thyroidectomy 22500 25870 31500 39400 THYROID - Thyroidectomy with central 378 28750 33060 40300 50300 neck dissection 379 THYROID - completion thyroidectomy 10000 11500 14000 17500 380 THYROID - Isthemectomy 10000 11500 14000 17500 THYROID - thyroidectomy for retrostrenal 381 27500 31620 38500 48100 goitre PARATHYROID - PARATHYROIDECTOMY 382 37500 43130 52500 65600 for parathyroid hyperplasia PARATHYROID - PARATHYROIDECTOMY 383 22500 25870 31500 39400 for parathyroid adenoma 384 BREAST - Fibroadenoma excision - Single 6250 7190 8800 10900 385 BREAST - Fibroadenoma excision - multiple 10000 11500 14000 17500 386 BREAST - Gaint Fibroadenoma excision 10000 11500 14000 17500 387 BREAST - Simple Mastectomy U/L 20000 23000 28000 35000 388 BREAST - Simple Mastectomy B/L 35000 40250 49000 61300 389 BREAST - MRM U/L 23750 27310 33300 41600 390 BREAST - MRM B/L 42500 48870 59500 74400 391 BREAST - lumpectomy 11250 12940 15700 19700 392 BREAST - Skin sparing mastectomy 21250 24440 29700 37200 393 BREAST - Reduction mamoplasty 25000 28750 35000 43800
97 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUIT 394 BREAST - Augmentation mamoplasty 25000 28750 35000 43800 395 BREAST -Wide excision of lump 12500 14370 17500 21900 BREAST - Gynacomastia - Webster’s 396 11250 12940 15700 19700 procedure U/L BREAST - Gynacomastia - Webster’s 397 16250 18690 22800 28400 procedure B/L 398 BREAST - Microdochectomy 10000 11500 14000 17500 399 BREAST - Nipple reconstruction 6880 7910 9600 12000 400 BREAST - Reconstruction 27500 31620 38500 48100 401 BREAST - axillary L N Dissection 15000 17250 21000 26300 402 BREAST - axillary L N sampling 10000 11500 14000 17500 403 BREAST - Implant insertion 27500 31620 38500 48100 BREAST - Excision of axillary tail of breast 404 10000 11500 14000 17500 U/L BREAST -Wide local excision with axillay 405 22500 25870 31500 39400 dissection 406 BREAST - Toitet mastectomy 21250 24440 29700 37200 407 CIRCUMCISION (Surgeon Charges) 8750 10060 12300 15300 408 Exc of pilonidal sinus (Surgeon Charges) 11130 12800 15600 19500 Exc of pilonidal sinus with flap closure 409 13630 15670 19100 23900 (Surgeon Charges) 410 ABSCESS INCISION & DRAINAGE IN OT 3630 4170 5100 6400 411 BIOPSY LYMPH NODE INGUINAL 6380 7340 8900 11200 412 BIOPSY LYMPH NODE CERVICAL/AXILLARY 7500 8630 10500 13100 413 CARBUNCLE (LARGE) 10000 11500 14000 17500 414 CARBUNCLE (SMALL) 6250 7190 8800 10900 415 CYST REMOVAL (SKIN) 3335 5630 6470 7900 9900 416 DIABETIC GANGRENE (MAJOR) 15880 18260 22200 27800 417 DIABETIC GANGRENE (MINOR) 11130 12800 15600 19500 418 ISCHIORECTAL ABSCESS 10000 11500 14000 17500 419 SKIN GRAFTING SPLIT 15880 18260 22200 27800 420 SKIN GRAFTING SPLIT - small 10000 11500 14000 17500 421 SKIN GRAFTING SPLIT - large 20000 23000 28000 35000 422 SUPERFICIAL CYST LARGE 8000 9200 11200 14000 423 SUPERFICIAL TUMOR LARGE 11130 12800 15600 19500 424 SUPERFICIAL TUMOR SMALL (MULTIPLE) 9630 11070 13500 16900 425 SUPERFICIAL TUMOR SMALL 8000 9200 11200 14000 426 ORCHIDECTOMY (UNILATERAL) 11250 12940 15700 19700 427 BURNS DRESSING 6380 7340 8900 11200 UMBILICAL SINUS EXCISION AND 428 11130 12800 15600 19500 PRIMARY CLOSURE ABD. WALL REPAIR AFTER TUMOR 429 15880 18260 22200 27800 EXCISION 430 EXCISSION BIOPSY 11630 13370 16300 20400 431 Wound Exploration Major 10500 12070 14700 18400 432 Wound Exploration Minor 7500 8630 10500 13100 433 Circumcision 6500 7470 9100 11400 434 Exc of pilonidal sinus 11130 12800 15600 19500 435 LYMPH NODE BIOPSY 10880 12510 15200 19000
98 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUIT ABSCESS INCISION & DRAINAGE IN OT 436 3630 4170 5100 6400 (Surgeon Charges) WOUND DELAYED PRIMARY SUTURING 437 8000 9200 11200 14000 (SECONDARY) (Surgeon Charges) Evacution of Hematoma(Scrotal) U/L 438 23750 27310 33300 41600 (Surgeon Charges) 439 evacution of scrotal abcess U/L 11250 12940 15700 19700 440 evacution of scrotal abcess B/L 14380 16540 20100 25200 441 evacution of (scrotal )hematoma B/L 31250 35940 43800 54700 442 Excision of Sinus (Surgeon Charge) 5500 6320 7700 9600 443 Excision of Invloved Skin (Surgeon Charges) 5500 6320 7700 9600 Testicular Biopsy Unilateral (Surgeon 444 7130 8200 10000 12500 Charges) TestIcular Biopsy Bilateral (Surgeon 445 12380 14240 17300 21700 Charges) PREPUTIAL DILATATION (SURGEON 446 1035 1250 1440 1800 2200 CHARGES) Gluteal Sinus With Primary Closure Case to 447 10500 12070 14700 18400 Pilonidal Sinus (Surgeon Charges) Wound Exploration Major (Surgeon 448 10500 12070 14700 18400 Charge) Wound Exploration Minor (Surgeon 449 7500 8630 10500 13100 Charge) 450 LYMPH NODE BIOPSY (Surgeon Charges) 10880 12510 15200 19000 451 AMPUTATION DIGITS / TOES 12880 14810 18000 22500 452 PENILE AMPUTATION - PARTIAL 10630 12220 14900 18600 453 PENILE AMPUTATION - TOTAL 13250 15240 18600 23200 454 AMPUTATION FEET / HAND 16250 18690 22800 28400 RADICAL GROIN DISSECTION ALONE- 455 18750 21560 26300 32800 BILATERAL RADICAL GROIN DISSECTION ALONE- 456 13130 15100 18400 23000 UNILATERAL TOTAL PENILE AMPUTATION WITH 457 25000 28750 35000 43800 BILATERAL RADICAL GROIN DISSECTION TOTAL PENILE AMPUTATION WITH 458 UNILATERAL RADICAL GROIN 20000 23000 28000 35000 DISSECTION 459 AMPUTATION LEG / FOREARM 17500 20130 24500 30600 460 AMPUTATION THIGH / ARM 23750 27310 33300 41600 461 DISARTICULATION HIP/SHOULDER 13250 15240 18600 23200 462 FOREQUARTER AMPUTATION 53750 61810 75300 94100 GAINT CELL TUMOUR BONE CURETTAGE 463 13250 15240 18600 23200 RESECTION GAINT CELL TUMOUR CURETTAGE & 464 16250 18690 22800 28400 BONE CEMENT 465 HINDQUARTER AMPUTATION 20000 23000 28000 35000 466 COMPARTMENTECTOMY 23750 27310 33300 41600 467 WIDE EXCISION 13250 15240 18600 23200 EXCISIONAL BIOPSY/EXCISION OF LUMP/ 468 7380 8490 10300 12900 FIBROADENOMA/WEDGE BIOPSY ABDOMINAL WALL TUMOR RESECTION 469 18750 21560 26300 32800 WITH MESH REPAIR
99 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUIT ABDOMINAL WALL TUMOR RESECTION 470 12130 13950 17000 21200 WITH PRIMARY CLOSURE 471 EXCISION SEBACEOUS CYST (SMALL) 3130 3600 4400 5500 472 LAP ORCHIDECTOMY 22500 25870 31500 39400 WOUND DELAYED PRIMARY SUTURING 473 8000 9200 11200 14000 (PRIMARY) WOUND DELAYED PRIMARY SUTURING 474 8000 9200 11200 14000 (SECONDARY) WOUND GUNSHOT DEBRIDEMENT 475 12750 14660 17900 22300 (MINOR) WOUND GUNSHOT DEBRIDEMENT AND 476 15880 18260 22200 27800 PRIMARY CLOSURE/REMOVAL OF BULLET ABSCESS DRAINAGE (MULTIPLE ABSCESS 477 8000 9200 11200 14000 NECK) 478 MULTIPLE SINUS EXCISION U/L 12750 14660 17900 22300 479 Secondary wound closure(suturing) 3220 3880 4460 5400 6800 Necrotising soft tissue infection - 480 11880 13660 16600 20800 Debridement 481 Fornier’s gangrene - Debridement 11880 13660 16600 20800 482 Skin cancer -wide excision 10000 11500 14000 17500 483 Desmiod tumor Wide local excision 15630 17970 21900 27400 484 Diagnostic Laproscopy 10250 11790 14300 17900 485 Lap Rep of INGUINAL hernia UL 15000 17250 21000 26300 486 Lap Repair of INGUINAL hernia B/L (Surg 22500 25870 31500 39400 Lap cholecystom&choledocholithotomy(CBD 487 35000 40250 49000 61300 exploration) (Surgeon Charges) Lap closure of intestinal perforation 488 23750 27310 33300 41600 (Surgeon Charges) Lap deroofing of non- hydatid liv cyst 489 40000 46000 56000 70000 (Surgeon Charges) 490 Lap gastrostomy (Surgeon Charges) 15250 17540 21400 26700 491 Lap splenectomy (Surgeon Charges) 32500 37380 45500 56900 492 Lap ventral hernia (Surgeon Charges) 23750 27310 33300 41600 Lap repair of diphrag hernia (Surgeon 493 35000 40250 49000 61300 Charges) 494 LAP Cardiomyotomy for Achalasia Cardia 35000 40250 49000 61300 LAP ASSISTED / LAPAROSCOPIC BOWEL 495 32500 37380 45500 56900 RESECTION 496 LAP. CHOLEDOCHODUDENOSTOMY 32500 37380 45500 56900 LAP. CHOLEDOCHOLITHOTOMY WITH 497 CHOLEDOCHODUODENOSTOMY (GEN. 47500 54620 66500 83100 SURGERY) 498 LAP COLONIC SURGERY 40000 46000 56000 70000 499 LAP DIAPHRAGM REPAIR 40000 46000 56000 70000 500 LAP DIAPHRAGM REPAIR WITH MESH 47500 54620 66500 83100 LAP FOREIGN BODY REMOVAL (GEN 501 14380 16540 20100 25200 SURGERY) 502 LAP HERNIA (LAP REPAIR) IN CHILDERN 23750 27310 33300 41600 503 LAP HIATUS HERNIA 32500 37380 45500 56900 504 LAP LIGATION OF VARICOCELE 15880 18260 22200 27800 505 LAP. LUMBAR SYMPATHECTOMY 23750 27310 33300 41600
100 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUIT 506 LAP ORCHIDECTOMY 22500 25870 31500 39400 507 LAP RECTOPEXY 28750 33060 40300 50300 LAP SURGERY FOR PANCREATIC 508 32500 37380 45500 56900 PSEUDOCYST (CYSTOGASTROSTOMY) LAP URETEROLITHOTOMY / 509 25000 28750 35000 43800 PYELOLITHOTOMY 510 LAP GASTROJEJUNOSTOMY 32500 37380 45500 56900 LAP EPIGASTRIC/INCISIONAL/RARE 511 18750 21560 26300 32800 HERNIA(SMALL) 512 SLEEV GASTRACTOMY 45000 51750 63000 78800 513 Diagnostic Laproscopy 10250 11790 14300 17900 514 Lap Rep of INGUINAL hernia UL 18750 21560 26300 32800 515 Lap appendicectomy 23750 27310 33300 41600 Lap cholecystom&choledocholithotomy(CBD 516 40000 46000 56000 70000 exploration) 517 Lap closure of intestinal perforation 23750 27310 33300 41600 518 Lap deroofing of non- hydatid liv cyst 40000 46000 56000 70000 519 Lap gastrostomy 15250 17540 21400 26700 520 Lap splenectomy 32500 37380 45500 56900 521 Lap ventral hernia 23750 27310 33300 41600 522 open / lap adhesiolysis 13500 15520 18900 23600 Laparoscopy Peritoneal Biopsy (Surgeon 523 9880 11360 13800 17300 Charges) Lap Cholecystectomy Level 1(Surgeon 524 25000 28750 35000 43800 Charges) Lap Cholecystectomy Level 2(Surgeon 525 30000 34500 42000 52500 Charges) DIAGNOSTIC LAPAROSCOPY LEVEL 1 526 7500 8630 10500 13100 (Surgeon Charges) DIAGNOSTIC LAPAROSCOPY LEVEL 2 527 8750 10060 12300 15300 (Surgeon Charges) 528 Lap appendicectomy (Surgeon Charges) 23750 27310 33300 41600 529 Lap cholecystectomy (Surgeon Charges) 37500 43130 52500 65600 Lap Partial Nephrectomy U/L (Surgeon 530 31250 35940 43800 54700 Charges) 531 Lap Open Gastropexy (Surgeon Charges) 30000 34500 42000 52500 Lap Cholecystectomy Simple Surgeon 532 132500 152380 185500 231900 Charge Lap Cholecystectomy Complex Surgeon 533 140000 161000 196000 245000 Charge 534 ADRENAL GLAND NEOPLASM EXCISION 40000 46000 56000 70000 535 ADRENALECTOMY SUB TOTAL BILATERIAL 56250 64690 78800 98400 536 ADRENALECTOMY SUB TOTAL UNILATERAL 40000 46000 56000 70000 537 ADRENALECTOMY TOTAL BILATERAL 56250 64690 78800 98400 VATS EMPYEMA DRAINAGE & 538 40000 46000 56000 70000 DECORTICATION 539 VATS BULLECTOMY WITH PLEURODESIS 40000 46000 56000 70000 Laparoscopic DRAINAGE OF LIVER 540 20000 23000 28000 35000 ABSCESS Lap Necrosectomy and drainage of 541 40000 46000 56000 70000 pancreatic abscess (Surgeon Charges)
101 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUIT VATS decortication for adhesive pleuritis - 542 27500 31620 38500 48100 stage III 543 VATS Mediastenal lymph node biopsy 10000 11500 14000 17500 544 VATS wedge resection of lung 18750 21560 26300 32800 545 VATS lobectomy 31250 35940 43800 54700 546 VATS cervical sympathectomy 15000 17250 21000 26300 547 VATS pericardial window 20000 23000 28000 35000 548 Thoracotomy for decortication 22500 25870 31500 39400 Thoracotomy for lobectomy / 549 25000 28750 35000 43800 pneumonectomy open lobectomy / pneumonectomy with 550 27500 31620 38500 48100 mediastinal L N dissection 551 VATS esophagectomy 42500 48870 59500 74400 Secondary wound closure(suturing) 552 3220 3880 4460 5400 6800 (Surgeon Charges) 553 DRESSING IN OT 4000 4600 5600 7000 554 SUPRAPUBIC DRAINAGE (CYSTOSTOMY) 8000 9200 11200 14000 WOUND GUNSHOT DEBRIDEMENT AND 555 15880 18260 22200 27800 PRIMARY CLOSURE/REMOVAL OF BULLET U/S GUIDED DRAINAGE OF LIVER 556 4000 4600 5600 7000 ABSCESS 557 STITCHING LARGE LACERATION 14380 16540 20100 25200 558 MULTIPLE SINUS EXCISION U/L 12750 14660 17900 22300 559 B/L VASSECTOMY 6380 7340 8900 11200 560 CURVETAGE 4630 5320 6500 8100 561 EXAMINATION UNDER ANESTHESIA 2880 3310 4000 5000 562 P D Cath Removal (Surgeon Charges) 4130 4750 5800 7200 563 Cueratage (Surgeon Charge) 4630 5320 6500 8100 Evacuation of Hematoma (Surgeon 564 12130 13950 17000 21200 Charge) RADICAL CYSTECTOMY WITH IIEAL 565 26250 30190 36800 45900 COLONIC CONDUIT RADICAL CYSTECTOMY WITH URETERO- 566 SIGMOIDOSTOMY/CUTANEOUS 23750 27310 33300 41600 URETEROSTOMY 567 BIOPSY - AXIAL SKELETON - NEEDLE 4000 4600 5600 7000 568 BONE BIOPSY OPEN - LONG BONES 7380 8490 10300 12900 569 BONE BIOPSY OPEN - SMALL BONES 5500 6320 7700 9600 BIOPSY - NON-AXIAL SKELETAL BONES- 570 3750 4310 5300 6600 NEEDLE 571 INTERNAL HEMIPELVECTOMY 22500 25870 31500 39400 REGIONAL RESECTION OF LARGE BONE 572 20000 23000 28000 35000 TUMOR 573 Bone Marrow Aspiration (Procedure) 3880 4460 5400 6800 574 Continuous Infusion Chaemotherapy 2530 3000 3450 4200 5300 575 Intravericle Chemotherapy 6130 7050 8600 10700 576 Intraperitoneal Chemotherapy 6130 7050 8600 10700 577 Bone Marrow Aspiration With Biopsy 6130 7050 8600 10700 578 Lumbar Puncture (Onco Procedure) 2250 2590 3200 3900 579 Intrathecal Chemotherapy 3880 4460 5400 6800 580 IV Bolus Chemotherapy Per Injection 632.5 750 860 1100 1300 102 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUIT Major Chemotherapy Multi Drug or More 581 3880 4460 5400 6800 Than 4 Hrs. Minor Chemotherapy Single Drug or Less 582 2250 2590 3200 3900 Than 4 Hrs. 583 Chemoport Flushing Charges 632.5 750 860 1100 1300 584 PICC Line Insertion 4630 5320 6500 8100 CO2 LASER FULGURATION (Surgeon 585 41130 47300 57600 72000 Charges) 586 Chemoport Removal (Surgeon Charges) 3250 3740 4600 5700 BIOPSY - AXIAL SKELETON - NEEDLE 587 4000 4600 5600 7000 (Surgeon Charges) BIOPSY - NON-AXIAL SKELETAL BONES- 588 3750 4310 5300 6600 NEEDLE (Surgeon Charges) ABSCESS DRAINAGE UNDER 589 1725 2130 2450 3000 3700 ULTRASOUND (PROCEDURE) 590 DRESSING EXTRA LARGE (GEN SUR OPD) 2185 2630 3020 3700 4600 591 DEBRIDEMENT OF WOUND 3130 3600 4400 5500 592 DRESSING LARGE (GEN SUR OPD) 1150 1380 1590 1900 2400 593 DRESSING MEDIUM (GEN SUR OPD) 862.5 1000 1150 1400 1800 594 DRESSING SMALL (GEN SUR OPD) 632.5 750 860 1100 1300 595 SUTURE OF LARGE WOUND 6210 7380 8490 10300 12900 596 SUTURE OF MEDIUM WOUND 4485 5380 6190 7500 9400 597 SUTURE OF SMALL WOUND 2645 3130 3600 4400 5500 598 NAIL BED WEDGE EXCISION IN OT 4000 4600 5600 7000 EXPLORATION & EXCISION OF SINUS & 599 15880 18260 22200 27800 DEBRIDMENT CLOSUE 600 Excision of Sinus (Surgeon Charge) 5500 6320 7700 9600 601 INTRAVENOUS CHEMOTHERAPY PER DAY 14380 16540 20100 25200 INTRAPLEURAL/INTRAPERITONEAL 602 4380 5040 6100 7700 CHEMOTHERAPY 603 INTRAHEPATIC CHEMOTHERAPY 5630 6470 7900 9900 USG GUIDED INTRAPLEURAL 604 4630 5320 6500 8100 CHEMOTHERAPY 605 Palmer abscess/ web space abcess I & D 6250 7190 8800 10900 ABSCESS DRAINAGE UNDER 606 1725 2130 2450 3000 3700 ULTRASOUND (PROCEDURE) 607 DRESSING EXTRA LARGE (GEN SUR OPD) 2185 2630 3020 3700 4600 608 DEBRIDEMENT OF WOUND 3130 3600 4400 5500 609 DRESSING LARGE (GEN SUR OPD) 1150 1380 1590 1900 2400 610 DRESSING MEDIUM (GEN SUR OPD) 862.5 1000 1150 1400 1800 611 DRESSING SMALL (GEN SUR OPD) 632.5 750 860 1100 1300 612 SUTURE OF LARGE WOUND 6210 7380 8490 10300 12900 613 SUTURE OF MEDIUM WOUND 4485 5380 6190 7500 9400 614 SUTURE OF SMALL WOUND 2645 3130 3600 4400 5500 615 EXCISION SEBACEOUS CYST (SMALL) 2130 2450 3000 3700 FOREIGN BODY REMOVAL UNDER LA 616 6670 8000 9200 11200 14000 (SUPERFICIAL) 617 INJECTION VARICOSE VEINS 4025 4750 5460 6700 8300 618 NAIL BED WEDGE EXCISION IN OT 4000 4600 5600 7000 WOUND DELAYED PRIMARY SUTURING 619 8000 9200 11200 14000 (PRIMARY) 103 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUIT WOUND DELAYED PRIMARY SUTURING 620 8000 9200 11200 14000 (SECONDARY) WOUND GUNSHOT DEBRIDEMENT 621 12750 14660 17900 22300 (MINOR) 622 Removal of Feeding Jejunostomy Tube 6670 8000 9200 11200 14000 623 Corn Excision 6325 7630 8770 10700 13400 624 Secondary wound closure(suturing) 3220 3880 4460 5400 6800 625 Proctoscopy (Surgeon Charge) 1265 1500 1720 2100 2600 626 PLEURAL ASPIRATION 1725 2130 2450 3000 3700 INTERCOSTAL DRAINAGE FOR 627 5500 6320 7700 9600 PNEUMOTHORAX 628 PUNCH BIOPSY 2500 2880 3500 4400 629 WEDGE BIOPSY 7630 8770 10700 13400 630 INTRAVENOUS CHEMOTHERAPY PER DAY 14380 16540 20100 25200 INTRAPLEURAL/INTRAPERITONEAL 631 4380 5040 6100 7700 CHEMOTHERAPY 632 INTRAHEPATIC CHEMOTHERAPY 5630 6470 7900 9900 USG GUIDED INTRAPLEURAL 633 4630 5320 6500 8100 CHEMOTHERAPY Secondary wound closure(suturing) 634 3220 3880 4460 5400 6800 (Surgeon Charges) 635 CARBUNCLE (SMALL) 5500 6320 7700 9600 636 CYST REMOVAL (SKIN) 3335 4000 4600 5600 7000 637 DIABETIC GANGRENE (MINOR) 11130 12800 15600 19500 638 SUPERFICIAL CYST LARGE 8000 9200 11200 14000 639 SUPERFICIAL TUMOR LARGE 11130 12800 15600 19500 640 SUPERFICIAL TUMOR SMALL (MULTIPLE) 9630 11070 13500 16900 641 SUPERFICIAL TUMOR SMALL 8000 9200 11200 14000 642 SUPRAPUBIC DRAINAGE (CYSTOSTOMY) 8000 9200 11200 14000 643 STITCHING LARGE LACERATION 14380 16540 20100 25200 644 BURNS DRESSING 6380 7340 8900 11200 645 EXCISSION BIOPSY 11630 13370 16300 20400 646 Wound Exploration Major 10500 12070 14700 18400 647 Wound Exploration Minor 7500 8630 10500 13100 648 LYMPH NODE BIOPSY 10880 12510 15200 19000 ABSCESS INCISION & DRAINAGE IN OT 649 3630 4170 5100 6400 (Surgeon Charges) WOUND DELAYED PRIMARY SUTURING 650 8000 9200 11200 14000 (SECONDARY) (Surgeon Charges) Wound Exploration Major (Surgeon 651 10500 12070 14700 18400 Charge) Wound Exploration Minor (Surgeon 652 7500 8630 10500 13100 Charge) 653 LYMPH NODE BIOPSY (Surgeon Charges) 10880 12510 15200 19000 654 PLEURODESIS EACH SITTING 3750 4310 5300 6600 655 PLEURAL BIOPSY 6130 7050 8600 10700 656 Bone Marrow Aspiration (Procedure) 3880 4460 5400 6800 657 Continuous Infusion Chaemotherapy 2530 3000 3450 4200 5300 658 Intravericle Chemotherapy 6130 7050 8600 10700 659 Intraperitoneal Chemotherapy 6130 7050 8600 10700
104 S.NO. SERVICE NAME OPD GW TWIN SINGLE SUIT 660 Bone Marrow Aspiration With Biopsy 6130 7050 8600 10700 661 Lumbar Puncture (Onco Procedure) 2250 2590 3200 3900 662 Intrathecal Chemotherapy 3880 4460 5400 6800 663 IV Bolus Chemotherapy Per Injection 632.5 750 860 1100 1300 Major Chemotherapy Multi Drug or More 664 3880 4460 5400 6800 Than 4 Hrs. Minor Chemotherapy Single Drug or Less 665 2250 2590 3200 3900 Than 4 Hrs. 666 Chemoport Flushing Charges 632.5 750 860 1100 1300 667 PICC Line Insertion 4630 5320 6500 8100 668 Chemoport Removal (Surgeon Charges) 3250 3740 4600 5700 BIOPSY - AXIAL SKELETON - NEEDLE 669 4000 4600 5600 7000 (Surgeon Charges) BIOPSY - NON-AXIAL SKELETAL BONES- 670 3750 4310 5300 6600 NEEDLE (Surgeon Charges) 671 ingrowing toe nail excision 3500 4020 4900 6100
105 SURGICAL ONCOLOGY S.NO. SERVICE NAME GW SEMI SINGLE SUITE ABDOMINAL WALL TUMOR RESECTION WITH 1 18750 21600 26300 32800 MESH REPAIR ABDOMINAL WALL TUMOR RESECTION WITH 2 18750 21600 26300 32800 MESH REPAIR ABDOMINOPERINEAL PULL THROUGH RESECTION 3 26250 30200 36800 45900 WITH COLORECTAL ANASTOMOSIS ABDOMINOPERINEAL RESECTION RECTUM WITH 4 26250 30200 36800 45900 COLOSTOMY 5 AMPUTATION FEET / HAND 16250 18700 22800 28400 6 AMPUTATION LEG / FOREARM 15000 17300 21000 26300 7 AMPUTATION THIGH / ARM 15000 17300 21000 26300 8 ANTERIOR RESECTION OF RECTUM 18750 21600 26300 32800 9 BRANCHIAL CYST EXCISION 12500 14400 17500 21900 10 BUCCAL MUCOSA TUMOR (WIDE EXCISION) 10000 11500 14000 17500 11 COLECTOMY (RIGHT/LEFT/TRANSVERSE/SIGMOID) 18750 21600 26300 32800 12 COMPARTMENTECTOMY 21250 24400 29700 37200 COMPOSITE RESECTION OF ORAL CARCINOMA 13 17500 20100 24500 30600 (WIDE EX ,MANDIBULECTOMY,NECK DISSECTION) 14 Desmiod tumor Wide local excision 15625 18000 21900 27300 DISTAL RADICAL GASTRECTOMY (D2 15 37500 43100 52500 65600 GASTRECTOMY) 16 EXCISION OF LEIOMYOMA OESOPHAGUS 18750 21600 26300 32800 17 EXCISION OF LEUCOPLAKIA - LARGE 8125 9300 11400 14200 18 EXCISION OF LEUCOPLAKIA - SMALL 4375 5000 6100 7700 19 EXTENDED HEMICOLECTOMY FOR CA COLON 26250 30200 36800 45900 20 Hemangioma Excision - large / deep intramuscular 31250 35900 43800 54700 21 Hemangioma Excision - medium 15000 17300 21000 26300 22 Hemangioma Excision - small 10000 11500 14000 17500 23 HEMI MANDIBULECTOMY 27500 31600 38500 48100 24 LIP TUMOR: WEDGE EXCISION 8750 10100 12300 15300 25 Low ANTERIOR RESECTION OF RECTUM 21250 24400 29700 37200 26 MEDIASTINAL LYMPH NODE DISSECTION 30000 34500 42000 52500 27 MEDIASTINAL TUMOR EXCISION 30000 34500 42000 52500 METASTATECTOMY CLAMSHELL(BILATERAL 28 27500 31600 38500 48100 THORACOTOMY FOR SARCOMA METS 29 METASTATECTOMY UNILATERAL 20000 23000 28000 35000 MODIFIED NECK DISSECTION/FUNCTIONAL NECK 30 20000 23000 28000 35000 DISSECTION 31 OESOPHAGOGASTRECTOMY (SWEET’S) 47500 54600 66500 83100 32 ORCHIDECTOMY ( BILATERAL) 15000 17300 21000 26300 33 ORCHIDECTOMY ( UNILATERAL) 11250 12900 15700 19700 34 PALLIATIVE GASTERCTOMY 28750 33100 40300 50300 35 PARAPHARYNGEAL SPACE TUMOR EXCISION 30000 34500 42000 52500 36 PARTIAL GLOSSECTOMY/HEMI GLOSSECTOMY 12500 14400 17500 21900 37 RADICAL GROIN DISSECTION ALONE- UNILATERAL 13125 15100 18400 23000 38 RADICAL GROIN DISSECTION ALONE-BILATERAL 18750 21600 26300 32800 39 RESECTION ANASTOMOSIS BOWEL - SINGLE 18750 21600 26300 32800 40 RESECTION ANASTOMOSIS BOWEL -MULTIPLE 25000 28700 35000 43800
106 S.NO. SERVICE NAME GW SEMI SINGLE SUITE 41 RETROSTERNAL GASTRIC BYPASS 26250 30200 36800 45900 42 SEGMENTAL/MARGINAL MANDIBULECTOMY 16250 18700 22800 28400 43 SIMPLE MASTECTOMY / TOILET MASTECTOMY 20000 23000 28000 35000 44 Skin cancer -wide excision 10000 11500 14000 17500 SUPRA-OMOHYOID NECK DISSECTION/POSTERO 45 17500 20100 24500 30600 LATERAL/CENTRAL NECK DISSECTION TOTAL COLECTOMY WITH ILEORECTAL 46 23750 27300 33300 41600 ANASTOMOSIS/HARTMANNS/MUCUS FISTULA TOTAL PENILE AMPUTATION WITH BILATERAL 47 25000 28700 35000 43800 RADICAL GROIN DISSECTION TOTAL PENILE AMPUTATION WITH UNILATERAL 48 20000 23000 28000 35000 RADICAL GROIN DISSECTION TOTAL RADICAL GASTRECTOMY WITH OR 49 37500 43100 52500 65600 WITHOUT LYMPHNODE DISSECTION 50 TRACHEOSTOMY - BED SIDE EMERGENCY 10000 11500 14000 17500 51 TRACHEOSTOMY - ELECTIVE 7500 8600 10500 13100 TRANSHIATAL OESOPHAGECTOMY WITH GASTRIC 52 43750 50300 61200 76600 PULL UP 53 Ultra low ANTERIOR RESECTION OF RECTUM 26250 30200 36800 45900 54 WIDE EXCISION - BASE OF TONGUE TUMOUR 20000 23000 28000 35000
107 NON-INVASIVE CARDIOLOGY S.NO. SERVICE NAME OPD GW TWIN SINGLE SUIT 1 2D Echo for LV Function 2070 2480 2850 3470 4340 2 AMBULATORY B.P. MONITORING 750 890 1020 1250 1560 3 Arterial Doppler - All Limbs 5640 6740 7750 9440 11800 4 DOBUTAMINE STRESS ECHO 4720 5640 6490 7900 9870 ECHO SCREENING FOR LV 5 1610 1930 2220 2700 3380 FUNCTION 6 FOLLOW UP SPIROMETRY 1380 1650 1900 2310 2890 7 HOLTER - 48 HRS 3910 4680 5380 6550 8190 8 RENAL DOPPLER 4260 5090 5850 7130 8910 9 VENOUS DOPPLER VARICOSE VEINS 5520 6600 7590 9240 11550 COLOUR DOPPLER BEDSIDE 10 1150 1380 1590 1930 2420 CHARGES COLOUR DOPPLER EMERGENCY 11 860 1030 1180 1440 1800 CHARGES 12 VENOUS DOPPLER UPPER LIMB 3910 4680 5380 6550 8190 OUTSIDE ANGIOGRAM CD REVIEW / 13 1150 1380 1590 1930 2420 OPINION 14 PRE AV FISTULA STUDY 860 1030 1180 1440 1800 15 Arterial Doppler 1 Limb 2880 3440 3960 4820 6020 16 Arterial Doppler 2 Limbs 3680 4400 5060 6160 7700 17 Carotid Doppler 3910 4680 5380 6550 8190 CAROTID INTIMA MEDIA THICKNESS 18 1490 1790 2060 2510 3130 ASSESMENT 19 ECG 290 340 390 480 600 20 Echo Dobutamine Stres 4020 4810 5530 6730 8420 21 Echo Dobutamine Stress with contrast 11390 13610 15650 19050 23820 22 EXERCISE STRESS ECG (TMT) 2070 2480 2850 3470 4340 23 Fetal Echocardiography 4490 5360 6160 7500 9380 24 HEAD-UP TILT TEST 5520 6600 7590 9240 11550 25 PEDIATRIC ECHO 3330 3990 4590 5590 6980 26 Portable Echo 3450 4130 4750 5780 7230 27 Stress Echocardiography with contrast 9200 11000 12650 15400 19250 28 TRANS ESOPHAGEAL ECHO/2D 4370 5230 6010 7320 9150 29 Transthoracic echo 5520 6600 7590 9240 11550 30 Venous Doppler 3910 4680 5380 6550 8190 31 Echo Screening / TMT 1840 2200 2530 3080 3850
108 TRANSFUSION MEDICINE S.NO. Service Name OPD GW TWIN SINGLE SUIT 1 Cross Match 460 500 580 700 880 2 Packed Red Cell (Leuco reduced) 2300 2500 2880 3500 4380 3 Fresh Frozen Plasma (FFP) 1380 1500 1720 2100 2630 4 Platelet Concentrate (RDP) 1380 1500 1720 2100 2630 5 Platelet Apheresis (SDP) 12650 13750 15810 19250 24060 6 Donor Screening Charge 1720 1880 2160 2630 3290 7 Whole Human Blood 2070 2250 2590 3150 3940 8 Cryoprecipitate 2070 2250 2590 3150 3940 9 Therapeutic Phlebotomy (Blood Letting) 350 380 440 530 670 10 Transfer Bag 290 310 360 430 540 11 Washed Red Cells 3160 3440 3960 4820 6020 12 Therapeutic Plasma Exchange (TPE) 18400 20000 23000 28000 35000 13 Thermacol Box (Refundable) 120 130 150 180 230 14 Blood Group 230 250 290 350 440 15 Rh(D) Antibody Titre 800 880 1010 1230 1540 16 PRP Injection (Therapeutic) 2070 2250 2590 3150 3940 17 PRF (Therapeutic) 1720 1880 2160 2630 3290
NEUROLOGY S.NO. SERVICE NAME OPD GW TWIN SINGLE SUIT BAER (BRAINSTEM AUDITORY EVOKED 1 4600 5500 6300 7700 9600 RESPONSE) 2 CARPEL TUNNEL STUDY 5180 6200 7100 8700 10900 3 EMG (BOTH LOWER LIMBS) 4600 5500 6300 7700 9600 4 EMG (BOTH UPPER LIMBS) 4600 5500 6300 7700 9600 5 NCV (BOTH UPPER LIMBS) 4020 4800 5500 6700 8400 6 NCV (BOTH LOWER LIMBS) 4020 4800 5500 6700 8400 7 NCV (FULL STUDY) 5180 6200 7100 8700 10900 SSEP (SOMATOSENSORY EVOKED 8 4600 5500 6300 7700 9600 POTENTIAL) 9 V.E.P 4600 5500 6300 7700 9600 10 VIDEO EEG (ONE HOUR) 4720 5600 6400 7800 9800 11 H-Reflex 4020 4800 5500 6700 8400 12 Repititive Nerve Stimulation 4020 4800 5500 6700 8400 13 Mobile EEG 5750 6900 7900 9700 12100 14 EEG-Routine 2300 2800 3200 3900 4900 15 EEG Sleep 3450 4100 4700 5700 7200 16 Video EEG Routine 3450 4100 4700 5700 7200 17 Sympathetic Skin Response (SSR) 2880 3400 3900 4800 6000 18 R R Interval Variation 2880 3400 3900 4800 6000 19 Facial NCV 4020 4800 5500 6700 8400 20 EMG (Full Study) 6900 8300 9500 11600 14500 21 EMG (Limited) 4600 5500 6300 7700 9600 22 Brachial Plexus Study 9200 11000 12600 15400 19300 23 Blink Reflex 4020 4800 5500 6700 8400
109 MEDICAL ONCOLOGY S.NO. SERVICE NAME GW TWIN SINGLE SUIT 1 Chemotherapy (Single drug) 1900 2190 2700 3300 2 Chemotherapy (Combination) 3000 3450 4200 5300 3 Chemotherapy (Infusion therapy) 3800 4370 5300 6700 4 Target chemotherapy 5000 5750 7000 8800 5 Chemotherapy (Short stay) 950 1090 1300 1700
AMBULANCE AND EMERGENCY S.NO. Accident & Emergency (A & E) PRICE 1 Paramedical/Nursing Aid Charges(Faridabad) 300 2 Paramedical/Nursing Aid Charge(Delhi NCR) 800 3 Assistance in Ambulane (GDA) 200 4 ALS AMBULANCE PER KM 40 5 MEDICAL SUPERVISION (SPECIALIST) IN AMBULANCE OUTSTATION-PER DAY 6000 6 MEDICAL SUPERVISION (SUPER SPECIALIST) IN AMBULANCE OUTSTATION- PER DAY 10000 7 MEDICAL SUPERVISION IN AMBULANCE OUTSTATION- PER DAY 4000 8 ALS Ambulance – ALS(upto 5KM) 1000 9 MEDICAL SUPERVISION IN AMBULANCE ABOVE 40KM UPTO 12HRS 2500 10 ENDOTRACHEAL INTUBATION 1500 11 ENEMA 300 12 GASTRIC LAVAGE 600 13 INFUSION CHARGES 150 14 I/M INJECTION 100 15 I/V INJECTION 150 16 MLC CHARGES 750 17 RESUSCITATION CHARGES(CASUALTY) 2000 18 CLW suturing (more than 5 inches) 500 19 STITCH REMOVAL(CASUALTY) 200 20 STEAM INHALATION(CASUALTY) 50 21 CATHETERIZATION(CASUALTY) 500
110 ORTHOPAEDICS S.NO. SERVICE NAME GW TWIN SINGLE SUIT 1 K Wire 6300 7200 8800 11000 2 CHEST STRAPPING 1300 1500 1800 2300 3 DRESSING EXTRA LARGE ( OPD/casualty) 2400 2800 3400 4200 4 DRESSING LARGE (OPD/casualty) 1500 1700 2100 2600 5 DRESSING MEDIUM (OPD/casualty) 1000 1200 1400 1800 6 DRESSING SMALL (OPD/casualty) 500 600 700 900 7 INJ. ACLASTA(PROCEDURE ) 4600 5300 6400 8100 8 KNEE ASPIRATION 1300 1500 1800 2300 9 POP I (ORTHO OPD) 1900 2200 2700 3300 10 POP II (ORTHO OPD) 3100 3600 4300 5400 11 POP III (ORTHO OPD) 4400 5100 6200 7700 12 INJ. SYNVISC(PROCEDURE) 2500 2900 3500 4400 13 ACL / PCL avulsion - fixator (arthroscopic open) 18800 21600 26300 32900 14 Arthoscopic Bankart repair 25000 28700 35000 43800 15 Biopsy Bone and soft tissue 10000 11500 14000 17500 16 Bipolar hemiarthroplasty 20000 23000 28000 35000 17 Cannulated screw fixation (Closed) 12500 14400 17500 21900 18 Closed reduction and interlocked nailing of femur 20000 23000 28000 35000 19 Closed reduction and interlocking nailing of tibia 20000 23000 28000 35000 20 Closed reduction and plaster application for fracture 5000 5800 7000 8800 21 Complex ORIF Hand 12500 14400 17500 21900 22 Core decompression U/L 11400 13100 16000 20000 23 CTEV - Manipulation 2100 2400 2900 3700 24 CTEV - surgery 20000 23000 28000 35000 25 DHS/DCS (Complex) 18800 21600 26300 32900 26 External fixator foot & ankle 13100 15100 18300 22900 27 Fasciotomy 7400 8500 10400 13000 28 Finger Reconstruction simple 18800 21600 26300 32900 29 Girdle Stone Arthroplasty 17500 20100 24500 30600 30 Hip arthrotomy 13500 15500 18900 23600 31 Joint Aspiration(Proc) 2100 2400 2900 3700 32 Open rotator cuff repair for small-medium tears 14100 16200 19700 24700 33 ORIF # both bone of forearm LCDCP/ nail 13500 15500 18900 23600 34 ORIF # both bone of forearm locking plate 13500 15500 18900 23600 35 ORIF # olecranon with locking plate 13100 15100 18300 22900 36 ORIF # patella 13100 15100 18300 22900 37 ORIF acetabulum 25000 28700 35000 43800 38 ORIF CALCANEUM with k wires 13100 15100 18300 22900 39 ORIF clavicle 13100 15100 18300 22900 40 ORIF inter/intra condylar region of humerus 18800 21600 26300 32900 41 ORIF radial head 13100 15100 18300 22900 42 ORIF scaphoid 13100 15100 18300 22900 43 ORIF talus 13100 15100 18300 22900 44 osteotomy tibia 13100 15100 18300 22900 45 Periprosthetic fracture 20000 23000 28000 35000 46 Quadriceps Plasty / Repair 17600 20200 24600 30800 47 Revision TKR/UL Single Stage 46300 53200 64800 81000 111 S.NO. SERVICE NAME GW TWIN SINGLE SUIT 48 Skeletal traction application 2900 3300 4100 5100 49 Tendon transfer 13500 15500 18900 23600 50 U/L TKR + U/L UKA 25000 28700 35000 43800 51 Unilateral-Total Elbow Joint Replacement 25000 28700 35000 43800 52 ARTHROSCOPIC SYNOVECTOMY WRIST 20000 23000 28000 35000 ARTHROSCOPIC ASSISTED TIBIAL SPINE FRACTURE 53 20000 23000 28000 35000 REDUCTION & FIXATION 54 ARTHROTOMY ANKLE 13500 15500 18900 23600 55 ARTHROTOMY KNEE 13500 15500 18900 23600 56 ARTHROTOMY WRIST 11400 13100 16000 20000 57 BILATERAL TOTAL KNEE REPLACEMENT (P) 388000 446000 543000 678000 58 UNILATERAL TOTAL KNEE REPLACEMENT (P) 238000 273000 333000 416000 59 Partial Knee replacement (unilateral) 288000 331000 403000 503000 60 Partial Knee replacement (bilateral) 413000 474000 578000 722000 61 BIOPSY MUSCLE (DEEP) 7400 8500 10400 13000 62 BONE GRAFTING 10300 11800 14400 18000 CARPAL TUNNEL DECOMPRESSION (ORTHO) 63 9600 11000 13400 16800 (SINGLE) 64 CARPAL TUNNEL DECOMPRESSION (ORTHO) (B/L) 17600 20200 24600 30800 65 CHANGE OF TIBAL ARTICULAR HEIGHT 17600 20200 24600 30800 66 CLOSED NAILING OF LONG BONES - HUMERUS 20000 23000 28000 35000 67 CLOSED REDUCTION OF JOINT DISCLOCATION 2900 3300 4100 5100 68 CLOSED REDUCTION OF SMALL JOINTS - IP 3100 3600 4300 5400 69 CLOSED REDUCTION OF SMALL JOINTS - MTP 3100 3600 4300 5400 70 CLOSED REDUCTION OF SMALL JOINTS - MP 3100 3600 4300 5400 COLLES FRACTURE CLOSED REDUCTION & POP 71 3100 3600 4300 5400 CAST COMPLEX KNEE LIGAMENT RECONSTRUCTION & 72 31300 36000 43800 54800 STABILISATION 73 CONTRACTURE RELEASE 11400 13100 16000 20000 74 CORRECTIVE LESSER TOE SURGERY 7400 8500 10400 13000 75 CURETTAGE OF TUMOR & BONE GRAFTING 17600 20200 24600 30800 76 DIAGNOSTIC ARTHROSCOPY - ANKLE 11400 13100 16000 20000 77 DIAGNOSTIC ARTHROSCOPY - HIP 13500 15500 18900 23600 78 DIAGNOSTIC ARTHROSCOPY - KNEE 11400 13100 16000 20000 79 DIAGNOSTIC ARTHROSCOPY - SHOULDER 17600 20200 24600 30800 80 DIAGNOSTIC ARTHROSCOPY - WRIST 13500 15500 18900 23600 81 DIFFICULT & MULTIPLE FRACTURE FIXATION 31300 36000 43800 54800 82 DISARTICULATION - ANKLE 13500 15500 18900 23600 83 DISARTICULATION -ELBOW 13500 15500 18900 23600 84 DISARTICULATION - HIP 26300 30200 36800 46000 85 DISARTICULATION - WRIST 13500 15500 18900 23600 86 DRAINAGE ABSCESS (INCISION & DRAINAGE) 3100 3600 4300 5400 87 EXCISION HEAD OF RADIUS 11400 13100 16000 20000 88 EXCISION OF LOWER END ULNA 9600 11000 13400 16800 89 FASCIOTOMY - LEG 10000 11500 14000 17500 90 FUSION - SUB TALAR 18800 21600 26300 32900 91 FUSION - TRIPPLE ARTHRODESIS 20000 23000 28000 35000 92 HAMSTRING RELEASE 10900 12500 15300 19100
112 S.NO. SERVICE NAME GW TWIN SINGLE SUIT 93 ILIZAROV & COMPLEX EXTERNAL FIXATOR 25000 28700 35000 43800 94 INFECTED TKA FIRST STAGE 18800 21600 26300 32900 95 INFECTED TKA JOINT DEBRIDEMENT 13500 15500 18900 23600 96 INFECTED TKA SECOND STAGE 37500 43100 52500 65600 97 K - WIRE FIXATION OF SMALL BONES - FOOT 7400 8500 10400 13000 98 K - WIRE FIXATION OF SMALL BONES - HAND 7400 8500 10400 13000 99 LATERAL SOFT TISSUE RELEASE BK 9600 11000 13400 16800 LIMB SALVAGE & IMPLANTATION OF MEGA 100 37500 43100 52500 65600 PROSTHESIS 101 MANIPULATION OF JOINTS 3900 4500 5500 6800 102 MANIPULATION OF JOINTS - ELBOW 3900 4500 5500 6800 103 MANIPULATION OF JOINTS - KNEE 3900 4500 5500 6800 104 MANIPULATION OF JOINTS - SHOULDER 3900 4500 5500 6800 105 MEDICAL SOFT TISSUE TIGHTENING AK 17600 20200 24600 30800 106 MEDICAL SOFT TISSUE TIGHTENING BK 17600 20200 24600 30800 MULTIPLE HAND FRACTURE & TENDON INJURIES 107 17400 20000 24400 30500 WITH SKIN LOSS 108 MULTIPLE HAND FRACTURE WITHOUT SKIN LOSS 13500 15500 18900 23600 109 OPEN SYNOVECTOMY - KNEE 17600 20200 24600 30800 110 OPEN SYNOVECTOMY - WRIST 13500 15500 18900 23600 PRIMARY TOTAL JOINT REPLACEMENT - UNILATERAL 111 25000 28700 35000 43800 - ANKLE PRIMARY TOTAL JOINT REPLACEMENT - UNILATERAL - 112 25000 28700 35000 43800 SHOULDER 113 RE - ADJUSTMENT OF FIXATOR 2900 3300 4100 5100 RECURRENT DISLOCATION - STABLIZATION - 114 25000 28700 35000 43800 SHOULDER - ELBOW (ARTHROSCOPIC METHOD) RECURRENT DISLOCATION OF PATELLA 115 18800 21600 26300 32900 STABILIZATION (OPEN METHOD) 116 REMOVAL OF EXOSTOSIS 10000 11500 14000 17500 117 REMOVAL OF FIXATOR 2900 3300 4100 5100 118 REMOVAL OF FRACTURE FRAGMENT - HIP 17500 20100 24500 30600 119 REMOVAL OF IMPLANTS - LARGE 12500 14400 17500 21900 120 REMOVAL OF IMPLANTS - SMALL 7500 8600 10500 13100 121 REPAIR OF MULTIPLE TENDONS OF HAND 13500 15500 18900 23600 122 RESURFACE HIP ARTHOPLASTY UNILATERAL 31300 36000 43800 54800 123 ROTATION FLAPS 11400 13100 16000 20000 124 SHOULDER ARTHROSCOPY, ROTATOR CUFF REPAIR 21300 24500 29800 37300 125 SINGLE NERVE REPAIR - MAJOR NERVE 11400 13100 16000 20000 126 SINGLE TENDON GRAFTING 11400 13100 16000 20000 127 Skull Traction 3400 3900 4800 6000 128 SMALL JOINT REPLACEMENT 15800 18200 22100 27700 129 TENDON REPAIR - FOOT 9600 11000 13400 16800 130 TENDON REPAIR - HAND 9600 11000 13400 16800 131 SUPRACONDYLAR NAILING FEMUR 20000 23000 28000 35000 132 WOUND DEBRIDEMENT (ORTHO) 2900 3300 4100 5100 133 TENSION BAND WIRING 10600 12200 14800 18600 134 PRIMARY NERVE REPAIR 13500 15500 18900 23600 135 PLATING FIXATION 13500 15500 18900 23600
113 S.NO. SERVICE NAME GW TWIN SINGLE SUIT 136 LOCKING COMPRESSION PLATING ( LCP ) 25000 28700 35000 43800 137 MONTEGGIA FRACTURE WITH DISLOCATION 18800 21600 26300 32900 138 GALEAZZS FRACTURE WITH DISLOCATION 18800 21600 26300 32900 139 FIBULECTOMY 9600 11000 13400 16800 140 JESS DISTRACTOR L/E RADIUS +/- K -WIRE FIXATION 13500 15500 18900 23600 141 CLOSED REDUCTION OF SHOULDER DISLOCATION 6300 7200 8800 11000 142 JESS FIXATOR MAJOR 9600 11000 13400 16800 143 JESS FIXATOR MINOR 5800 6700 8100 10200 144 CRUSH INJURY MAJOR 17600 20200 24600 30800 145 CRUSH INJURY MINOR 9600 11000 13400 16800 146 ORIF FRACTURE LATERAL MALLEOLUS 13100 15100 18300 22900 147 ORIF FRACTURE LOWER END RADIUS 13100 15100 18300 22900 148 ORIF FRACTURE MEDIAL MALLEOLUS 13100 15100 18300 22900 149 ORIF LONG BONE - LOWER LIMB 17500 20100 24500 30600 150 ORIF LONG BONES - UPPER LIMBS 17500 20100 24500 30600 151 ORIF OF COMPLEX FRACTURES - LOWER LIMB 25000 28700 35000 43800 152 ORIF OF COMPLEX FRACTURES - UPPER LIMB 25000 28700 35000 43800 153 OSTEOMYELITIS - SURGICAL DECOMPRESSION 9600 11000 13400 16800 154 OSTEOTOMY - AROUND HIP 17500 20100 24500 30600 155 OSTEOTOMY CALCANEAL 13100 15100 18300 22900 156 OSTEOTOMY - FRENCH 13100 15100 18300 22900 PAEDIATRIC HIP SURGERY - OPEN REDUCTION OF 157 20000 23000 28000 35000 CDH PAEDIATRIC HIP SURGERY - PERTHES/SCFE/OPEN 158 20000 23000 28000 35000 REDUCTION OF CDH 159 PAEDIATRIC HIP SURGERY - SCFE 20000 23000 28000 35000 160 PATELLAR REALIGNMENT PROCEDURE 17500 20100 24500 30600 161 PATELLAR REPLACEMENT 13500 15500 18900 23600 162 PATELLECTOMY 13500 15500 18900 23600 163 PERCUTANEOUS K - WIRE FIXATION UNDER C - ARM 9400 10800 13200 16500 164 STEROID INJECTION 2500 2900 3500 4400 165 CANCELLOUS SCREW FIXATION FEMUR LOWER END 6300 7200 8800 11000 166 EXTERNAL FIXATION PELVIS 13500 15500 18900 23600 CURRETAGE OF OSTEOMYLITIS CAVITY & 167 11600 13300 16200 20300 SINOVECTOMY OPEN REDUCTION OF JOINT + DRAINAGE OF 168 11600 13300 16200 20300 HEMATOMA + NEURO - MASCULAR - REPAIR CANCELLOUS SCREW FIXATION FRACTURE NECK 169 18800 21600 26300 32900 FEMUR 170 FIBULA GRAFTING 6300 7200 8800 11000 171 INTERNAL FIXATION PELVIS 18800 21600 26300 32900 172 ADHESIOLYSIS / MOBLIZATION OF JOINT 3800 4400 5300 6700 173 REMOVAL OF FOREIGN BODY 8400 9700 11800 14700 174 BONE TUMOUR WITH MULTIPLE GRAFTING 35000 40300 49000 61300 ARTHROSCOPIC DECOMPROMENT TENDON REPAIR 175 35000 40300 49000 61300 OF SHOULDER(ADS) 176 SHOULDER REPLACEMENT 25000 28700 35000 43800 ORTHOSCOPIC MENISECTOMY LATERAL WEDGE 177 25000 28700 35000 43800 OSTEOTOMY TIBIA
114 S.NO. SERVICE NAME GW TWIN SINGLE SUIT DEBRIDEMENT WITH SAUCERIZATION WITH IMP OF 178 20000 23000 28000 35000 GENTA BEEDS CLOSE REDUCTION AND UPPER TIBIAL SKELETAL 179 9600 11000 13400 16800 TRACTION 180 RECONSTRUCTION PLATING HUMERUS LOWER END 22500 25900 31500 39400 INTERLOCKING NAILING FEMUR WITH BONE 181 22500 25900 31500 39400 GRAFTING 182 MANIPULATION WITH I/A INJ. DEPO-MEDROL 9600 11000 13400 16800 183 CAUDAL EPIDURAL INJ. 5800 6700 8100 10200 184 GASTRONEMIUS CYST EXCISION 17500 20100 24500 30600 185 EXCISION OF TUMOUR MASS 18800 21600 26300 32900 186 S/C FRENCH OSTEOTOMY 18800 21600 26300 32900 187 TENDOACHILLES REPAIR 17500 20100 24500 30600 ASPIRATION KNEE WITH DEBRIDEMENT WITH A/K 188 12300 14100 17200 21500 POP SLAB DEBRIDEMENT WITH LARGE AREA FULL THICKNESS 189 17500 20100 24500 30600 SKIN GRAFTING 190 RELEASE OF ECRB FOR TENNIS ELBOW 9600 11000 13400 16800 191 REVISION THR 37500 43100 52500 65600 192 TROCHANTERIC HOOK 5800 6700 8100 10200 ACROMIOPLASTY-SUB ACROMIAL DECOMPRESSION 193 18800 21600 26300 32900 & EXCISION OF LATERAL END OF CLAVICLE ADDUCTOR TENOTOMY & OBTURATOR 194 13500 15500 18900 23600 NEURECTOMY 195 AMPUTATION- FORE/HIND QUARTER 25000 28700 35000 43800 196 AMPUTATION-AE 15000 17300 21000 26300 197 AMPUTATION-AK 18800 21600 26300 32900 198 AMPUTATION-BE 13800 15900 19300 24200 199 AMPUTATION-BK 15000 17300 21000 26300 200 AMPUTATION OF DIGITS-MULTIPLE 11400 13100 16000 20000 201 AMPUTATION OF DIGITS-SINGLE 7400 8500 10400 13000 202 ARTHRODESIS OF LARGE JOINTS 25000 28700 35000 43800 203 ARTHRODESIS OF MEDIUM JOINTS 18800 21600 26300 32900 204 ARTHRODESIS OF SMALL JOINTS 12500 14400 17500 21900 205 ARTHROSCOPIC ACL RECONSTRUCTION 26300 30200 36800 46000 206 ARTHROSCOPIC JOINT DEBRIDEMENT 17400 20000 24400 30500 207 ARTHROSCOPIC MENISCAL REPAIR 26300 30200 36800 46000 208 ARTHROSCOPIC MENISECTOMY 20000 23000 28000 35000 209 ARTHROSCOPIC PCL RECONSTRUCTION 20000 23000 28000 35000 210 ARTHROSCOPIC SYNOVECTOMY HIP 20000 23000 28000 35000 211 ARTHROSCOPIC SYNOVECTOMY KNEE 20000 23000 28000 35000 212 ARTHROSCOPIC SYNOVECTOMY SHOULDER 20000 23000 28000 35000 213 Dequervians Release-Wrist/Hand 10000 11500 14000 17500 EXTERNAL FIXATOR FOR FRACTURE LONG BONES 214 13100 15100 18300 22900 LOWER LIMB EXTERNAL FIXATOR FOR FRACTURE LONG BONES 215 16800 19300 23500 29400 UPPER LIMB 216 Figure of 8 Bandage 2500 2900 3500 4400
115 l of al World-Class Infrastructure in QRG Health City ane l Ma n P jo O r
• 350 beds
H TPA, GIPSA 9
o for Cashless m
• 100 critical care beds (with Isolation beds) 7 8 e Treatment
3 s • 10 modular OT, with an Integrated Emergency OT 0 a m 0 5 p 3 • Neonatal ICU - 16 Beds le 8 7 c : ol n • Pediatrics ICU - 9 Beds lec y o tion facilit • 13 bedded Emergency Care with dedicated resuscitation room & triage area • International Patient Lounge • Advanced Cardiac Life Support Ambulances • IT enabled hospital at all levels • Food Courts
World-Class Technology in QRG Health city • 3 Tesla MRI • Sleep Study • 128 Slice CT Scan • Bronchoscopy • Dexascan • Endoscopy • Mammography • TMT, ECHO • Fibroscan • Holter • EBUS • Computerised Navigation for TKR • EEG, EMG, NCV • Audiology & Speech therapy • Urodynamics • Holmium Laser
Our Institutes • Cardiology and Cardiothoracic Surgery • Gastroenterology • Orthopaedics and Joint Replacement • Respiratory & Sleep Medicine • Neurology and Neurosurgery • Nephrology & Kidney Transplant • Obstetrics and Gynaecology • Diabetes and Metabolic Disorders • General and Minimal Invasive Surgery • Critical Care and Anaesthesiology
Our Departments • Ear, Nose & Throat (ENT) • Ophthalmology • Urology • Dentistry and Maxillofacial Surgery • Internal Medicine • Physiotherapy and Rehabilitation • Plastic & Reconstructive Surgery • Clinical Psychology and Psychiatry • Skin and Cosmetology • Preventive Health and Wellness • Paediatric Surgery and Congenital • Dietetics and Nutrition Disorders • Laboratory and Transfusion Medicine • Paediatrics and Neonatology • Radio diagnosis and Imaging
116