· Web viewLIST OF PROCEDURES AND PROCEDURES COVERED UNDER THE WEST BENGAL HEALTH SCHEME (Current as on July 31, 2013) 01 – PROCEDURES Name of Procedure / Investigation Code Amount

LIST OF PROCEDURES AND PROCEDURES COVERED UNDER THE WEST BENGAL HEALTH SCHEME(Current as on July 31, 2013)

01 – PROCEDURES

Name of Procedure / Investigation CodeAmount Claimed

(in `)

Amount Admissible

(in `)GENERAL 001

Consultation by Medical Officer (OPD) 01001001 150/-Consultation by Specialist (OPD) 01001002 200/-Visit / Revisit /Consultation by Specialists (Indoor) (Maximum two visits per day admissible)

01001003 200/-

Consultation by Super Specialists (OPD) 01001004 250/-Visit / Revisit / Consultation by Super-Specialists (Indoor) (Maximum two visits per day admissible)

01001005 250/-

Pre-operative Anaesthetic Consultation 01001006 200/-Paramedical Consultation 01001007 75/-Special Nursing Charge (per shift of 12 hrs.) 01001008 150/-Aya / Attendant Charge (per shift 12 hrs.) 01001009 75/-Delayed primary suture 01001010 1,700/-Dressing Large 01001011 160/-Suturing without local anaesthesia 01001012 400/-Suturing of wounds with local anaesthesia 01001013 500/-Debridement of wounds 01001014 1,200/-Removal of Benign Tumor 01001015 1,100/-Aspiration Plural Effusion-Therapeutic 01001016 1,000/-Abdominal Aspiration – Therapeutic 01001017 1,300/-Removal of F.B. Superficial 01001018 1,200/-Bone Marrow Aspiration 01001019 1,500/-Joints Aspiration 01001020 1,500/-Strapping 01001021 100/-Removal of Stiches 01001022 60/-Venesection 01001023 300/-Phimosis under LA 01001024 1,500/-Lumbar puncture 01001025 700/-Sternal puncture 01001026 1,500/-Injection for Haemorrhoids 01001027 1,000/-Injection for Varicose Veins 01001028 1,300/-Catheterisation 01001029 120/-Dilatation of Urethra 01001030 1,100/-Incision & Drainage 01001031 600/-Intercostal Drainage 01001032 1,500/-Peritoneal dialysis 01001033 1,800/-Removal of soft tissue or regional block under general anaesthesia

01001034 2,400/-

Dressing Small 01001035 100/-Secondary suture of wounds 01001036 1,200/-Bone Marrow Transplantation (inclusive of all) 01001037 10,00,000/-

SKIN 002Excision of Moles 01002001 600/-Excision of Warts 01002002 600/-Excision of Molluscum contagiosum 01002003 600/-Excision of Veneral Warts 01002004 600/-Excision of Corns 01002005 550/-

Page 1 of 48

I / D Injection Keloid of Acne 01002006 300/-Chemical Cautery (per sittings) 01002007 120/-Excision of Sebaceous Cysts 01002008 1,700/-Excision of Superficial Liipoma 01002009 2,400/-Excision of Dermoid Cysts 01002010 2,450/-Surgery of infected corn (Day care) 01002011 2,800/-

E.N.T. 003Speech therapy per session of 30 – 40 minutes 01003001 200/-Removal of foreign body From Nose / Ear / Throat (Day care package)

01003002 1,500/-

Swallowing Therapy 01003003 250/-Syringing 01003004 300/-Polyp removal under LA 01003005 800/-Peritonsillar abscess drainage under LA 01003006 1,600/-Tinnitus Retraining Therapy 01003007 250/-Myringoplasty 01003008 10,700/-Staepedectomy 01003009 12,000/-Myringotomy with Grommet insertion 01003010 6,000/-Endoscopic Removal of Fish Bone 01003011 1,000/-Tympanotomy 01003012 8,000/-Paracentesis 01003013 4,300/-Tympanoplasty 01003014 14,000/-Mastoidectomy 01003015 15,600/-Otoplasty 01003016 16,500/-Labyrinthectomy 01003017 15,600/-Skull Base surgery 01003018 50,000/-Facial Nerve Decompression 01003019 20,000/-Septoplasty 01003020 10,200/-Submucous Resection 01003021 10,800/-Septo-rhinoplasty 01003022 15,000/-Rhinoplasty (non-cosmetic) 01003023 12,000/-Fracture Reduction 01003024 9,000/-Intra Nasal Diathermy 01003025 6,000/-Turbinectomy 01003026 9,600/-Endoscopic DCR 01003027 13,000/-Endoscopic Surgery 01003028 15,000/-Septal Perf. Repair 01003029 15,000/-Antrum Puncture 01003030 3,000/-Lateral Rhinotomy 01003031 1,350/-Cranio-facial resection 01003032 28,000/-Ethamoidectomy 01003033 17,600/-Caldwell Luc Surgery 01003034 12,000/-Angiofibroma Excision 01003035 18,000/-Endoscopic Hypophysectomy 01003036 25,000/-Endoscopic Optic Nerve Decompression 01003037 32,000/-Decompression of Orbit 01003038 30,000/-Ranula Excision 01003039 9,600/-Tongue Tie excision 01003040 8,100/-Sub Mandibular Duct Lithotomy 01003041 9,700/-Adenoidectomy 01003042 8,000/-Palatopharyngoplasty 01003043 15,100/-Cleft Palate repair 01003044 16,000/-Pharyngoplasty 01003045 18,000/-Styloidectomy 01003046 11,500/-Uvulo-palatoplasty 01003047 20,000/-

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Tympanomastoidectomy 01003048 15,600/-Dacunisation 01003049 7,000/-Tonsilklectomy 01003050 11,200/-Adenotonsillectomy 01003051 13,500/-Synichiolysis 01003052 4,200/-Submucosal Diathermy 01003053 4,000/-Nasal Mass Excision-Simple 01003054 11,200/-Nasal Mass Excision-Endoscopic Removal 01003055 13,500/-FESS 01003056 11,200/-Anterior Nasal Packing 01003057 4,000/-Post Nasal Packing 01003058 5,000/-Nasal Bone Reduction 01003059 6,000/-Excision of Lesion Base of Tongue-per Oral Approach 01003060 6,400/-Unilateral Pre-Auricular Sinus operation 01003061 23,400/-

Ophthalmology 004Cauterisation of ulcer/subconjuctival injection – One eye

01004001 200/-

Cauterisation of ulcer/subconjuctival injection – both eyes

01004002 300/-

Retrobular Injection – One eye 01004003 200/-Retrobular Injection – Both eyes 01004004 300/-Syringing of Lacrimal Sac- For one eye 01004005 200/-Syringing of Lacrimal Sac- For both eyes 01004006 300/-Paracentesis 01004007 800/-Foreign body removal 01004008 300/-Refraction / Fundoscopy 01004009 90/-Ortho-optic exercises 01004010 100/-Plepoptic Exercises 01004011 100/-Chalazion operation – One Eye 01004012 800/-Chalazion operation – Both Eyes 01004013 1,000/-Dressing (eye) 01004014 100/-Clinical Photography 01004015 100/-Pterygium 01004016 2,200/-Orbitotomy 01004017 9,000/-Ptosis correction 01004018 6,500/-Ectropion Correction 01004019 3,600/-Xenon Arc Laser 01004020 700/-DCR (Dacryo custorhinostomy) 01004021 5,700/-ECCE / ICCE 01004022 6,000/-Epicanthus correction 01004023 2,100/-Squint Correction (one eye) 01004024 4,000/-Squint Correction (both eyes) 01004025 6,000/-Keratoplasty 01004026 14,000/-Trabeculotimy 01004027 5,700/-Iridectomy 01004028 2,400/-Goniotomy 01004029 2,400/-Scleral Bukling (Retinal Detachment surgery) 01004030 14,000/-Syringing & Probing 01004031 1,100/-Vitrectomy 01004032 11,000/-Enucleation 01004033 4,000/-Eviseration 01004034 3,800/-Entropion correction 01004035 3,000/-Cataract with IOL (Cost of lens extra) 01004036 7,500/-Fistulectomy 01004037 5,700/-Glucoma surgery with Glucoma valves 01004037 5,000/-

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Caliculoplasty 01004039 3,000/-Dacryocystectomy 01004040 3,000/-Ptosis surgery with LPS resection 01004041 7,000/-Ptosis surgery with Sling surgery 01004042 7,000/-Extropion surgery – one lid 01004043 3,000/-Ectropion surgery – both lids 01004044 4,000/-Cheek rotation flap for lid tumors 01004045 8,000/-Telecanthus correction 01004046 4,000/-Fracture orbital repair 01004047 9,000/-Lasik 01004048 18,000/-TTT – Transpupillary thermal therapy 01004049 4,000/-PTK – Phototherapeutic keratectomy 01004050 9,000/-Iris cyst removal 01004051 1,000/-Lid Abscess incision and drainage 01004052 3,000/-Orbital Abscess incision and drainage 01004053 4,000/-Cyclodiathermy 01004054 2,000/-Perforating injury repair 01004055 4,000/-Phaco + IOL (inclusive of Foldable & Non-foldable lens) Package

01004056 14,500/-

YAG Laser Capsulotomy per sitting 01004057 600/-YAG Laser Iridectomy per sitting 01004058 600/-Argon Laser Trabeculoplasty (ALT) (per sitting) / Diod Laser

01004059 1,000/-

HVF 01004060 500/-Cryopexy 01004061 1,200/-ICG including Medicine 01004062 2,000/-ICG – Double including Medicine 01004063 3,600/-Electrolysis (Per sitting) 01004064 150/-Cyclocryo / Cyclodiathermy 01004065 500/-D.C.T. (OPD) 01004066 800/-Silicone Oil (1000) 01004067 4,000/-Silicone Oil (C5) 01004068 4,000/-Silicone Oil Removal 01004069 3,500/-Pneumo Retinopexy 01004070 2,400/-FGE / FAE 01004071 1,500/-Indirect Laser 01004072 1,000/-Endo Laser 01004073 2,400/-SF6 Gas 01004074 2,400/-C3F8 Gas 01004075 2,400/-PFCL 01004076 2,400/-Photodynamic Therapy procedure charges –(Single eye)

01004077 15,000/-

Photodynamic Therapy procedure charges – (both eyes)

01004078 25,000/-

Photodynamic Therapy (Single eye) 01004079 85,000/-Photodynamic Therapy (both eyes) 01004080 1,00,000/-Intravitreal Avastin (including cost of injection single) 01004081 6,000/-Intravitreal Lucentis (excluding cost of injection single)

01004082 4,000/-

Intravitreal Macugen (excluding cost of injection single)

01004083 4,000/-

Intravitreal injections of antibiotics (cost of medicines extra)

01004084 2,000/-

Retinal Foreign Body Removal 01004085 4,000/-PPV / Victerectomy 01004086 6,500/-

Page 4 of 48

Endo Diathermy 01004087 1,600/-Belt Buckle 01004088 3,200/-IVTCA 01004089 800/-Membrane Peeling 01004090 2,400/-Anterior Vitrectomy 01004091 5,000/-Lensectomy 01004092 7,500/-Orbitotomy (Multiple Wall) 01004093 16,000/-ERM (Epi Retinal Membrane) 01004094 3,600/-Reti Blue 01004095 2,400/-Corneal Collagen Cross – linking 01004096 15,000/-

Biopsies including Histopathological report (Package)

005

Biopsy procedure under Local Anaesthesia 01005001 4,000/-Biopsy procedure under General Anaesthesia 01005002 6,000/-Biopsy procedure under Endoscopy 01005003 8,000/-FNAC 01005004 3,500/-

Strapping (including Bandage & materials) 006Strapping of Finger 01006001 200/-Strapping of Toes 01006002 200/-Strapping of Wrist 01006003 360/-Strapping of Elbow 01006004 400/-Strapping of Knee 01006005 400/-Strapping of Ankle 01006006 400/-Strapping of Chest 01006007 500/-Strapping of Shoulder 01006008 450/-Nasal bone fracture 01006009 450/-Figure of 8 bandage 01006010 450/-Colar and cuff sling 01006011 450/-Ball bandage 01006012 450/-

Physiotherapy & Traction 007Ultrasonic therapy (per sitting) 01007001 70/-S.W. Diathermy (per sitting) 01007002 90/-Electrical stimulation (therapeutic) (per sitting) 01007003 70/-Infra red (per sitting) 01007004 90/-U.V. Therapeutic dose (per sitting) 01007005 90/-Electric vibrator (per sitting) 01007006 90/-Vibrator belt massage (per sitting) 01007007 90/-Intra Lumbar Traction (per sitting) 01007008 90/-Intermittent Cervical Traction (per sitting) 01007009 70/-Combined Lumbar & Cervical traction (per sitting) 01007010 70/-Wax bath 01007011 50/-Hot pack 01007012 70/-Whirlpool bath (per sitting) 01007013 90/-Obesity Exercises (per sitting) 01007014 60/-Breathing Exercises & Postural Drainage (per sitting) 01007015 70/-Cerebral Palsy – Massage (per sitting) 01007016 90/-Post – polio exercise (per sitting) 01007017 60/-Basic Gait Training (Per Session) 01007018 80/-Traction + IFT 01007019 150/-Traction + Stimulation 01007020 100/-Traction + SWD 01007021 100/-Traction + SWD +IFT 01007022 200/-Traction + US 01007023 140/-Traction + US + IFT 01007024 200/-Traction + US + IFT + SWD 01007025 260/-

Page 5 of 48

Traction + US + IFT + SWD 01007026 260/-IFT + PWB 01007027 150/-Exercise – per sitting 01007028 60/-PWB + Knee Joint Spad Fraction 01007029 100/-SWD + IFT 01007030 100/-US + IFT 01007031 100/-US + IFT + Stimulation 01007032 200/-US + Knee Joint + Spad Fraction 01007033 100/-US + PWB 01007034 100/-US + SW + Traction 01007035 200/-US + Tens 01007036 100/-US + Stimulation 01007037 100/-Knee Joints Spad Fraction 01007038 100/-Electronic Tilt Training – Per Session 01007039 100/-Interferential Therapy 01007040 100/-Laser Treatment – Per Session 01007041 150/-Microwave Diathermy – Per Session 01007042 150/-Quadriceps Chair Training (Per Session) 01007043 100/-Tens 01007044 80/-

Dental 008Extraction of tooth including L.A. 01008001 120/-Complicated Ext. per Tooth including L.A. 01008002 250/-Flap Operation per Tooth 01008003 500/-Gingivectomy per tooth 01008004 300/-Cyst under L.A. (Small) 01008005 300/-Cyst under L.A. (Large) 01008006 500/-Impacted Molar including LA 01008007 800/-Apisectomy including LA 01008008 1,000/-Fracture wiring including LA 01008009 80/-Reduction & immobilisation of fracture – Maxilla under LA

01008010 1,400/-

Reduction & immobilisation of fracture – Mandible under LA

01008011 3,000/-

Splints / Circum mandibular wiring under GA 01008012 2,000/-Internal wire fixation / plate fixation of Maxilla under LA

01008013 4,000/-

Internal wire fixation / plate fixation of Maxilla under GA

01008014 6,000/-

Internal wire fixation / plate fixation of Mandible under LA/GA

01008015 6,000/-

Cyst & Tumour of Maxilla mandible by enucleation / excision (package)

01008016 2,000/-

TM joint ankylosis – under GA (package) 01008017 11,000/-Hemi-mandibulectomy with graft (package) 01008018 7,000/-Hemi-mandibulectomy without graft (package) 01008019 4,000/-Segmental-mandibulectomy with graft (package) 01008020 6,000/-Segmental-mandibulectomy with graft (package) 01008021 2,000/-Maxillectomy – partial with graft (package) 01008022 5,000/-Maxillectomy – partial without graft (package) 01008023 4,000/-Maxillo-facial prosthesis (sal / auricular / orbital / facial lost part) (package)

01008024 5,000/-

Alvelolectomy, Frenectomy per Quadrant 01008025 1,150/-Alvelolectomy (minor) 01008026 380/-Amalgam Filling / tooth (compound) 01008027 450/-Amalgam Filling / tooth (regular) 01008028 380/-

Page 6 of 48

Apicoectomy Molar Tooth 01008029 2,250/-Arch Bar Removal 01008030 380/-Bite Plate / Retainers 01008031 1,150/-Cast Rpd (per tooth) 01008032 380/-Davis Crown / radicular Screw supported 01008033 1,900/-De Sensitising per sitting 01008034 200/-Dento Alveolar fracture Reduction & Splinting/l.a. 01008035 1,500/-Denture Repair (category 1) 01008036 230/-Dialation of Whartons Duct under L.A. 01008037 1,500/-Direct / indirect Pulp Capping 01008038 230/-Drain. of Dento Alveolar Absec (ex. Oral) 01008039 950/-Enucleation of Cyst of Oral Cavity 01008040 2,000/-Fibre Post Based Post & Core 01008041 1,900/-Floride Application (per sitting) 01008042 400/-Extraction of Impacted Tooth By Operation 01008043 400/-Extraction of MISP Tooth by Operation (Open Meth) 01008044 1,150/-GTR (Guided Tissue Regeneration) 01008045 1,900/-Gingivectomy per Quadrant 01008046 750/-Glass Ionomer Filling 01008047 400/-Glass Ionomes Filling 01008048 450/-Interdental Wiring 01008049 1,150/-Intra Articular Inj. Of Steroids in TMJ 01008050 900/-Jacket Crown Acrylic 01008051 1,500/-Minor Dento-alveolar Tracture Reduction & Splinting/la

01008052 950/-

Post Core/ tooth (cast Post) lab Metal Chgs. Extra 01008053 1,150/-Post Core/ tooth (pin Retain Comp. Core) 01008054 750/-Post Core/ tooth Screw/pin Retain. Amalgm. 01008055 550/-Preformed Carbonate Jacket Crown 01008056 750/-Preformed Steel Crown 01008057 1,150/-Pulpotomy 01008058 750/-Reduction of Dislocation of Tmj (Under LA.) 01008059 1,400/-Reimplantation (per Tooth) 01008060 3,400/-Removal Partial Denture (1st Tooth) 01008061 400/-Removal Partial Denture (Additional Tooth) 01008062 230/-Removal Partial Denture per Tooth (Palatal Bar) 01008063 750/-Repair of Facial Soft Tissue Laceration 01008064 1,150/-Repair of Facial Soft Tissue Laceration (minor) 01008065 750/-Root Canal Treatment (upto 4 sitting) 01008066 1,150/-Root Canal Treatment (extra sitting) 01008067 400/-Root Canal Treatment with Filling and Crown (package) (Lab. Charges extra)

01008068 3,600/-

Scaling per Sitting 01008069 400/-Sialolithotomy for Small Stones 01008070 115/-Surgical Extraction or Surgical Removal of Impact (package)

01008071 1,150/-

Surgical Removal of Benin Reoplasm of Oral (package)

01008072 1,500/-

Surgical Removal of Soft Tissue Lesion (package) 01008073 1,150/-Surgical Removal of Impact Mesiod. tuber (package) 01008074 1,150/-Disto – impact teeth (two) under G.A. 01008075 30,000/-ITU / CCU CHARGES (Special Care Cases) 009ICU/ITU/CCU/NICU/PICU (including – Oxygen; ECG/SPO2/NIBP/IBP monitoring; 1:2 Nursing c GNM Nursing; Round the clock Doctor (Resident on spot);

01009001 2,400/-

Page 7 of 48

Diet; Syringe Pump)Ventilator charge (including accessories)per day 01009002 1,000/-Pneupack Ventilator in Nursery (per day) 01009003 800/-High Definition Unit / Step Down (including Oxygen) 01009004 1,500/-Exchange Transfusion 01009005 1,200/-O.T. Charges for Exchange transfusion 01009006 400/-CRIB (Critical Ward Bed) 01009007 800/-

Oxygen Charges 010Private/ Semi-private/General Ward (per hour) 01010001 60/-

Burn Cases 011Upto 30% Burns 1st Dressing (excluding dressing materials and medicines)

01011001 700/-

Upto 30% Burns Subsequent Dressing (excluding dressing materials and medicines)

01011002 700/-

30% to 50% Burns 1st Dressing (excluding dressing materials and medicines)

01011003 700/-

30% to 50% Burns Subsequent Dressing (excluding materials and medicines)

01011004 700/-

Extensive Burn above 50% First Dressing (excluding dressing materials and medicines)

01011005 1,500/-

Extensive Burn above 50% Subsequent dressing (excluding dressing materials and medicines)

01011006 1,500/-

Burn Unit Bed (including Oxygen) 01011007 1,500/-Obstetric & Gynaecology Cases 012

Normal delivery or with Episiotomy & P. repair 01012001 12,000/-Low Forceps 01012002 12,000/-Low midcavity forceps 01012003 14,000/-Cesarean Section 01012004 20,000/-Cesarean Hysterectomy 01012005 22,000/-Rupture Uterus – closure & repair with Tubal Ligation

01012006 22,000/-

Perforation of Uterus after D/E Laparotomy & Closure

01012007 18,000/-

Laparotomy – peritonitis Lavage and Drainage 01012008 16,000/-Laparotomy-failed laparoscopy to explore 01012009 6,100/-Salphingectomy 01012010 14,000/-Salphingo-Oophorectomy 01012011 18,000/-Ovarean Cystectomy 01012012 18,000/-Oophorectomy 01012013 15,000/-Broad Ligment Haemotoma Drainage 01012014 12,000/-Exploration of perineal Haematoma & Resuturing of Episiotomy

01012015 12,000/-

Exploration of abdominal Haematoma (after laparotomy + LUCS)

01012016 12,000/-

Internal podalic version and extraction 01012017 12,000/-Manual Removal of Placenta 01012018 3,700/-3rd stage Complication MRP for outside delivery etc. 01012019 4,900/-Examination under anaesthesia 01012020 2,500/-Burst – abdomen Repair 01012021 3,300/-Gaping Pareneal Wound Secondary Suturing 01012022 2,500/-Gaping abdominal wound Secondary Suturing 01012023 3,700/-Complete perineal tear – repair 01012024 2,500/-Exploration of PPH-tear – repair 01012025 4,200/-Destructive Operation 01012026 12,000/-

Page 8 of 48

Suction evacuation vesicular mole, Missed abortion D/E

01012027 5,900/-

Colpotomy – drainage P/V needling EUA 01012028 4,200/-Repair of post – coital tear, perineal injury 01012029 4,200/-Excision of urethral carbuncle 01012030 4,000/-Laparoscopy (Gynae) 01012031 6,100/-Shirodkar, Mc. Donalds stich 01012032 3,700/-Laparotomy 01012033 20,000/-Abdominal Hysterectomy 01012034 22,000/-Vaginal Hysterectomy 01012035 22,000/-Myomectomy 01012036 22,000/-Vaginoplasty 01012037 22,000/-Vulvectomy (Simple / Radical) 01012038 25,000/-RVF Repair 01012039 25,000/-Other Major Operations 01012040 25,000/-Manchester Operations 01012041 20,000/-Perineorrhaphy 01012042 14,700/-Colporraphy 01012043 14,400/-Modified Gilliam 01012044 16,900/-Shirodkar’s Operation 01012045 10,200/-Diagnostic Curettage 01012046 2,700/-Fractional Curettage 01012047 3,400/-D & C and Cervical Biopsy 01012048 3,400/-Polypectomy 01012049 3,600/-Other – Minor Operation 01012050 3,600/-Excision Vaginal Cyst / Burtholin Cyst 01012051 3,900/-Excision Vaginal Septum 01012052 5,900/-Laparoscopy Diagnostic 01012053 6,000/-Laparoscopy Diagnostic 01012054 7,300/-Laparoscopy Operative 01012055 12,000/-Laparoscopy LAVH 01012056 25,000/-Drilling of Ovary 01012057 10,800/-Adhesiolysis 01012058 17,400/-Management of Ectopic pregnancy 01012059 20,000/-Hysteroscopy TCRE 01012060 11,500/-Hysteroscopy Removal of IUCD 01012061 5,500/-Hysteroscopy Removal of Septum 01012062 11,500/-Hysteroscopy Diagnostic 01012063 7,300/-Werthimas Hystrectomy for Cancer cervix 01012064 30,000/-Sterilisation Post Pertum 01012065 4,700/-Sterilisation Intravaginal 01012066 6,000/-Abortion – D & C 01012067 3,900/-Abortion – Evacuation 01012068 4,200/-MTP – 1st Trimester 01012069 3,200/-MTP – 2nd Trimester 01012070 4,800/-Extended Hysterectomy 01012071 28,000/-Hydrotubation 01012072 1,000/-

General Surgery 013Drainage of Abscess 01013001 2,000/-Dressing under G.A. 01013002 2,400/-Aspiration of cold Abscess of Lymphnode 01013003 3,100/-Aspiration of Empyema 01013004 2,400/-Aspiration of Liver Abscess 01013005 3,000/-Open Drainage of Liver Abscess 01013006 10,000/-Drainage of Pelvic Abscess 01013007 10,000/-

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Drainage of Ischiorectal Abscess 01013008 8,000/-Drainage of Subdiaphragmatic Abscess 01013009 14,000/-Open Drainage of Perinepheric Abscess 01013010 14,000/-Drainage of Perigastric Abscess 01013011 12,000/-Drainage of Perotid Abscess 01013012 8,000/-Drainage of Retropharyngeal Abscess 01013013 8,000/-Open Drainage of Psoras Abscess 01013014 8,000/-Open Drainage of Perivertebral Abscess 01013015 10,000/-Fissurectomy/Haemorroidectomy/Correction of Piles 01013016 16,000/-Haemorroidectomy / Correction of Piles with Stapler Gun (cost of Gun extra)

01013017 16,000/-

Excision of Superficial Neurofibroma 01013018 2,800/-Varicose Veins 01013019 25,000/-Excision of Carbuncle 01013020 4,000/-

Injury of Superficial Soft Tissues 014Interestical (Implant) 015

Head & Neck 01015001 9,700/-Breast 01015002 9,600/-Soft Tissue Sarcome 01015003 12,000/-

GASTROENTROLOGY 016Capsule Endoscopy 01016001 30,000/-Complete Double Baloon Enteroscopy 01016002 18,000/-Complete Small Bowel Evaluation 01016003 30,000/-Argan Plasma Coa (Major) 01016004 5,000/-Argan Plasma Coa (Major) (BS) 01016005 6,500/-Argan Plasma Coa (Minor) 01016006 2,200/-Argan Plasma Coa (Minor)(BS) 01016007 3,000/-Band Ligation 01016008 3,500/-Band Ligation (BS) 01016009 5,500/-Biliary Brushing 01016010 1,000/-Biliary Brushing (BS) 01016011 1,600/-Biliary Brushing (M) 01016012 16,000/-Biliary Brushing (M)(BS) 01016013 23,000/-Biliary Brushing (P) 01016014 13,300/-Biliary Brushing (P) (BS) 01016015 18,000/-Cre Balloon Dilatation (BS) 01016016 15,000/-Cre Balloon Dilatation 01016017 9,000/-Dilatation (Stricture) 01016018 3,000/-Dilatation (Stricture) (BS) 01016019 4,200/-EMG Charge (Large) 01016020 3,500/-EMG Charge (Small) 01016021 1,500/-Endoscopic Tube Place 01016022 3,000/-Endoscopic Tube Place (BS) 01016023 4,200/-Oesophageal Transit 01016024 1,200/-Gastrostomy (PEG) 01016025 7,000/-Gastrostomy (PEG) (BS) 01016026 11,000/-Glue Injection 01016027 4,500/-Glue Injection (BS) 01016028 7,000/-Hemosta by Glod Probe 01016029 7,000/-Hemostatic Clip 01016030 7,000/-Hemostatic Clip (BS) 01016031 10,000/-Hepatonorm 01016032 700/-Injection Hemostasis 01016033 4,000/-Inejction Hemostasis (BS) 01016034 6,000/-LGI Manometry 01016035 4,000/-

Page 10 of 48

LGI Manometry (BS) 01016036 6,000/-UGI Manometry 01016037 3,200/-UGI Manometry (BS) 01016038 4,500/-Nasobiliary Drainage 01016039 12,000/-Nasobiliary Drainage (BS) 01016040 18,000/-Nasojejunal Tube Plac 01016041 3,000/-Nasojejunal Tube Plac (BS) 01016042 4,200/-Papilla Cannu Minor 01016043 6,500/-Papilla Cannu Minor (BS) 01016044 8,200/-Pappu Stnt Spingt (M) 01016045 12,000/-Pappu Stnt Spingt (M) (BS) 01016046 17,500/-Polypectomy (Colonic) 01016047 3,200/-Polypectomy (Colonic) (BS) 01016048 4,800/-Polypectomy (Upper GI) 01016049 3,000/-Polypectomy (Upper GI) (BS) 01016050 4,500/-Pre Cutting 01016051 4,500/-Pre Cutting (BS) 01016052 7,500/-Pseudocyst Drainage 01016053 9,000/-Pseudocyst Drainage (BS) 01016054 16,000/-Sclerotherapy 01016055 3,000/-Sclerotherapy (BS) 01016056 3,800/-Small Bowel Enteroscp 01016057 14,000/-Sphincterotomy 01016058 10,500/-Sphincterotomy (BS) 01016059 16,000/-Stone Extraction 01016060 12,000/-Stone Extraction (BS) 01016061 17,000/-Gastric Emptying 01016062 2,500/-Mechanical Lithotripsy 01016063 25,000/-ERCP (Stenting) 01016064 10,000/-

Head & Neck 017Ear Lobe Repair one side 01017001 600/-Excision of Pinna for Growth (Squamous/Basal/ Injuries) Skin only

01017002 4,500/-

Excision of Pinna for Growth (Squamous/Basal/ Injuries) Skin and Cartilage

01017003 6,000/-

Partial Amputation of Pinna 01017004 6,000/-Total Amputation of Pinna 01017005 7,500/-Total Amputation & Excision of External Auditory Meatus

01017006 10,250/-

Excision of Cystic Hygroma Minor 01017007 5,500/-Excision of Cystic Hygroma Major 01017008 8,000/-Excision of Cystic Hygroma Extensive 01017009 12,300/-Excision of Branchial Cyst 01017010 11,000/-Excision of Branchial Sinus 01017011 11,000/-Excision of Pharyngeal Diverticulum 01017012 12,200/-Mandibulectomy 01017013 25,000/-Operation for Cervical Rib 01017014 30,000/-Pharyngectomy 01017015 35,000/-Stenosis Excisioin 01017016 17,000/-Commando Operation 01017017 27,000/-Block Dissection of Cervical Lymph Nodes 01017018 20,300/-Pharyngectomy & Reconstruction 01017019 40,000/-Operation for Carcinoma Lip – Wedge Excision 01017020 10,000/-Operation for Carcinoma Lip – Vermilionectomy 01017021 10,000/-Operation for Carcinoma Lip – Wedge Excision and 01017022 12,000/-

Page 11 of 48

VermilionectomyEstlander Operation 01017023 9,700/-Abbe Operation 01017024 12,000/-Cheek Advancement 01017025 10,200/-Excision of the Maxilla 01017026 23,300/-Excision of the Mandible – Segmental 01017027 18,100/-Hemimandibulectomy 01017028 27,200/-Partial Glossectomy 01017029 6,100/-Hemiglossectomy 01017030 13,500/-Total Glossectomy 01017031 25,000/-Parotidectomy – Superficial 01017032 24,000/-Parotidectomy – Conservative 01017033 19,700/-Parotidectomy – Radical 01017034 22,000/-Parotidectomy – Total 01017035 15,000/-Repair of Parotid Duct 01017036 20,400/-Removal of Submandibular Salivary gland 01017037 10,000/-Hemithyroidectomy 01017038 15,000/-Partial Thyroidectomy 01017039 16,000/-Subtotal Thyroidectomy (Toxic Goitre) 01017040 22,000/-Total Thyroidectomy 01017041 23,000/-Resectional Enucleation of Adenoma 01017042 12,500/-Isthmectomy 01017043 12,600/-Total Thyroidectomy and Block Dissection 01017044 31,400/-Excision of Lingual Thyroid 01017045 25,650/-Excision of Thyroglossal Cyst / Fistula 01017046 15,000/-Excision of Parathyroid Adenoma / Carcinoma 01017047 25,600/-Laryngectomy 01017048 37,150/-Laryngo Pharyngectomy 01017049 43,500/-Sinus & Fistula repair 01017050 14,000/-Lymph Node Excision 01017051 8,000/-Hyoid Suspension 01017052 12,000/-Genioplasty 01017053 12,000/-Direct Laryngoscopy 01017054 5,400/-Phonosurgery 01017055 15,400/-Fibroptic Laryngoscopy 01017056 3,000/-Microlaryngeal Surgery 01017057 11,000/-Laryngofissure 01017058 17,500/-

Head & Neck Cancer 018Benign Tumour Excisions 01018001 11,000/-Temporal Bone resection 01018002 27,600/-Radical Neck Dissection 01018003 28,500/-Carotid Body Excision (cost of Graft extra) 01018004 36,000/-Total Laryngectomy 01018005 39,050/-Flap Reconstructive Surgery 01018006 42,800/-Parapharyngeal Tumour Excision 01018007 32,000/-Total Thyroidectomy 01018008 30,000/-

Breast 019Drainage of Abscess 01019001 7,000/-Excision of Lumps 01019002 10,000/-Local Mastectomy (Simple) 01019003 13,500/-Radical Mastectomy (Formal or Modified) 01019004 28,000/-Excision of Mammary Fistula 01019005 16,000/-Segmental Rescection of Breast 01019006 18,300/-Breast Cancer (Tumour excision) 01019007 30,000/-

Cardio Respiratory Procedures 020

Page 12 of 48

Tracheostomy 01020001 3,700/-Thoracotomy (Penetrating Wounds) 01020002 17,500/-Intercostal Drainage of empyema 01020003 5,400/-Decortication (Pleurectomy) 01020004 37,000/-Thoracoplasty 01020005 37,000/-Pneumonectomy 01020006 37,000/-Lobectomy 01020007 37,000/-Segmental Resection 01020008 37,000/-Hydatid Cyst – Removal 01020009 37,000/-Video – assisted thoracoscopic lung Surgeries 01020010 37,000/-Lung volume reduction surgery (unilateral / Bilateral) 01020011 37,000/-Thoracoscopic Decortication 01020012 37,000/-Thoracoscopic Pneumonectomy 01020013 37,000/-Thoracoscopic Lobectomy 01020014 37,000/-Thoracoscopic Segmental Resection 01020015 37,000/-Thoracoscopic Cyst excision 01020016 37,000/-Thoracoscopic Sympathectomy 01020017 37,000/-Chest Wall Tumor Excision with Reconstruction 01020018 37,000/-Repair of Congenital Chest Wall Deformities 01020019 37,000/-Multiple Lobectomy 01020020 37,000/-Decortication + Thoracoplasty 01020021 37,000/-Decortication + Lung Resection + Thoracoplasty 01020022 37,000/-Open Lung Biopsy 01020023 18,000/-Medicistinoscopy (cervical) 01020024 15,000/-Video-assisted thoracoscopy (VATS) 01020025 36,960/-Thoracotomy for BPF 01020026 37,000/-Surgery for Destroyed Lung 01020027 37,000/-Sleeve Resection with Lobectomy 01020028 37,000/-Extrapleural Pneumonectomy 01020029 37,000/-Tracheal Stenosis Surgery 01020030 37,000/-Repair of Tracheo Innuminete Fistula 01020031 37,000/-Tracheal Resection for Tracheal Tumour 01020032 37,000/-Segmentectomy 01020033 37,000/-Wedge Resection 01020034 37,000/-Lung Resection with Paratracheal L. Node Resection 01020035 37,000/-Lung Resection with Chest Wall Invasion 01020036 37,000/-Lung Resection with Dissection of Lymph Node Stations

01020037 37,000/-

Surgery for Recurrent Pnemothoraxic 01020038 37,000/-Surgery for Aspergillosis (Lung Cavities) 01020039 37,000/-Bronchotomy 01020040 37,000/-Mediostonoscopy 01020041 15,000/-

Cardiac / Cardio Thoracic Procedures 021Coronary Bypass Surgery (including Pre-Surgery Profile)

01021001 1,50,000/-

Coronary Bypass Surgery – post Angioplasty (including Pre-Surgery Profile)

01021002 1,50,000/-

Coronary Balloon Angioplasty (Excluding Cost of Stents) (including Pre-Surgery Profile) (4 days’ package)

01021003 66,000/-

Balloon angioplasty with Valvotomy (including Pre-Surgery Profile)

01021004 90,000/-

Open Heart Procedures (including Pre-Surgery Profile)

01021005 1,50,000/-

Total correction of Tetralogy of Fallot 01021006 1,50,000/-

Page 13 of 48

(including Pre-Surgery Profile)RSUV correction (including Pre-Surgery Profile) 01021007 1,50,000/-TAPVC correction (including Pre-Surgery Profile) 01021008 1,50,000/-Open ASD VSD (including Pre-Surgery Profile)

01021009 1,50,000/-

Open Pulmonary Valvotomy (including Pre-Surgery Profile)

01021010 1,50,000/-

Open Aortic Valvotomy (including Pre-Surgery Profile)

01021011 1,50,000/-

Blalock Taussing Operation (including Pre-Surgery Profile)

01021012 72,000/-

Mitral Valvotomy (including Pre-Surgery Profile) 01021013 72,000/-Mitral Valve Replacement (Excluding Cost of Valve) (including Pre-Surgery Profile)

01021014 1,50,000/-

Arotic Valve Replacement (Excluding Cost of Valve) (including Pre-Surgery Profile)

01021015 1,50,000/-

Double Valve Replacement (Excluding Cost of Valves) (including Pre-Surgery Profile)

01021016 1,60,000/-

Thoraco-Abdomi Aorta Replacement (including Pre-Surgery Profile)

01021017 1,50,000/-

Coaractation – Aorta Repair of Block Taussing Shunt (including Pre-Surgery Profile)

01021018 96,000/-

Patent Ductus Arteriousus (including Pre-Surgery Profile)

01021019 72,000/-

Mitral Valvotomy (Open) (including Pre-Surgery Profile)

01021020 1,50,000/-

Pericardiostomy (including Pre-Surgery Profile) 01021021 54,000/-Pericardiectomy (including Pre-Surgery Profile) 01021022 72,000/-Pericardio Contesis 01021023 3,900/-Permanent Pacemaker Implantation (Excluding Cost of Pace-maker ) (4 days package)

01021024 19,400/-

Temporary Pacing Lead Implantation (including use of Temporary Pacemaker)

01021025 12,600/-

Embolectomy 01021026 19,800/-Aneurysm–Resection & Grafting (cost of Graft extra) 01021027 96,000/-Thoracocentesis 01021028 2,000/-Thorachostomy 01021029 5,400/-Exploratory Thorocotomy 01021030 37,000/-Unifocalization with Shunt (including Pre-Surgery Profile)

01021031 1,50,000/-

Removal of Foreign Body from Trachea or Oesophagus)

01021032 6,000/-

Rib Resection & Drainage 01021033 11,500/-Mediastinal Tumour 01021034 35,000/-Thymectomy 01021035 35,000/-ASD Device Closure (Excluding Cost of Device) 01021036 40,000/-PDA Device Closure (Excluding Cost of Device) 01021037 32,000/-DSA 01021038 5,400/-EPSTUDY 01021039 8,400/-3D RF Ablation 01021040 40,000/-Mini EP Study 01021041 5,000/-Coronary Angiography (1 day’s package) 01021042 11,700/-Fonten 01021043 1,70,000/-Gunshot injury 01021044 52,000/-Heart transplant 01021045 2,77,000/-Intra coronary stenting 01021046 58,000/-

Page 14 of 48

Directiol atherectomy 01021047 98,000/-Permanent Pacemaker Implantation (DDD) (Pacemaker cost extra) (4 days’ package)

01021048 25,000/-

Permanent Pacemaker Implantation (Biventricular) (Pacemaker cost extra) (4 days’ package)

01021049 30,000/-

Femoral Poplitial Bypass 01021050 75,000/-Iliacfemoral Bypass 01021051 75,000/-Aorto Bifemoral Bypass 01021052 75,000/-Carotid Subclavian Bypass 01021053 75,000/-PA Banding 01021054 55,000/-BD Glen 01021055 55,000/-Thoracic Aorta / Arch Replacement (including Pre-Surgery Profile)

01021056 1,50,000/-

AICD / ICD Implantation procedure charges (cost of implants extra)

01021057 60,000/-

C-PAP/Bi – PAP (per day) 01021058 500/-Note: CABG if done along with other Heart Surgeries like Valve Replacement etc. will attract the same rate as CABG.

Oesophagus 022Atresia of Oesophagus and Tracheo Oesophageal Fistula

01022001 29,700/-

Operations for Replacement of Oesophagus by Colon 01022002 38,000/-Oesophagectomy for Carcinoma Esophagus 01022003 38,000/-Oesophageal Intubation (Mausseau Barbin Tube) 01022004 15,500/-Achalasia Carida Transthoracic 01022005 29,700/-Achalasia Carida Abdominal 01022006 14,600/-Oesophago Gastrectomy for mid 1/3 lesion 01022007 38,000/-Oesophagus Dilatation of Stricture – per visit 01022008 1,500/-Colon–Inter position or Replacement of Oesophagus 01022009 38,000/-Oesophago Gastrectomy – Lower Corringers procedure

01022010 38,000/-

Esophageal Perforation Surgery 01022011 38,000/-Installation of Ryles Tube in Ca – Esophagus 01022012 5,000/-Esophageal Directiculum Surgery 01022013 38,000/-

Abdomen 023Gastroscopy 01023001 1,300/-Gastric & Duodenal Biopsy (Endoscopic) 01023002 1,700/-Pyleromyotomy 01023003 10,000/-Gastrostomy 01023004 12,000/-Simple Closure of Perforated peptic Ulcer 01023005 15,000/-Vagotomy Pyleroplasty / Gastro Jejunostomy 01023006 30,000/-Duodenojejunostomy 01023007 25,000/-Partial/Subtotal Gastrectomy for Carcinoma 01023008 30,000/-Partial/Subtotal Gastrectomy for Ulcer 01023009 30,000/-Operation for Bleeding Peptic Ulcer 01023010 25,000/-Gastrojejunostomy & Vagotomy 01023011 27,000/-Operation for Gastrojejunal Ulcer 01023012 25,000/-Total Gastrectomy for Cancer 01023013 35,000/-Highly Selective Vagotomy 01023014 25,000/-Selective Vagotomy & Drainage 01023015 25,000/-Congenital Diaphragmatic Hernia 01023016 30,000/-Hiatus Hernia Repair Abdominal 01023017 30,000/-Hiatus Hernia Repair Transthoracic 01023018 30,000/-Exploratory Laparotomy 01023019 12,900/-Epigastric Hernia Repair 01023020 15,000/-

Page 15 of 48

Umbilical Hernia Repair 01023021 15,000/-Ventral and Scar Hernia Repair 01023022 18,000/-Inguinal Hernia Herniorraphy – unilateral 01023023 15,000/-Inguinal Hernia – Hernioplasty-with mesh-unilateral 01023024 22,000/-Femoral Hernia Repair 01023025 22,000/-Rare Hernias – Repair (Spigalion, Obturator, Lumbar, Sciatic)

01023026 25,000/-

Splenectomy – For Trauma 01023027 25,000/-Splenectomy – For Hypersplenism 01023028 25,000/-Splenorenal Anastomosis 01023029 40,000/-Portocaval Anastomosis 01023030 40,000/-Direct Operation on Oesophagus for Portal Hypertension

01023031 30,000/-

Mesentericocaval Anastomosis 01023032 35,000/-Warren Shunt 01023033 35,000/-Pancerato Duodenectomy 01023034 36,000/-By Pass Procedure for Inoperable Carcinoma of Pancreas

01023035 30,000/-

Cystojejunostomy or Cystogastrostomy 01023036 30,000/-Cholecystectomy 01023037 18,000/-Cholecystectomy & Exploration of CBD 01023038 22,000/-Repair of Common Bile Duct 01023039 20,000/-Operation for Hydatid Cyst of Liver 01023040 25,000/-Cholecystostomy 01023041 14,200/-Hepatic Resections (Lobectomy Hepatectomy) 01023042 28,000/-Operation on Adrenal Glands – Bilateral 01023043 35,000/-Operation on Adrenal Glands–Unilateral for Tumour 01023044 20,000/-Appendicectomy for Acute Appendicitis 01023045 20,000/-Appendicectomy for Chronic Appendicitis 01023046 18,000/-Appendicular Abscess – Drainage 01023047 12,000/-Mesenteric Cyst – Excision 01023048 18,000/-Peritonioscopy / Laparoscopy 01023049 5,100/-Jejunostomy 01023050 18,000/-Ileostomy 01023051 18,000/-Congenital Atresia & Stenosis of Small Intestine 01023052 25,000/-Muconium ileus 01023053 20,000/-Mal – rotation & Volvulus of the Midgut 01023054 20,000/-Resection & Anastomosis of Small Intestine 01023055 22,000/-Excision of Meckle’s Diverticulum 01023056 22,000/-Duodenal Diverticulum 01023057 18,000/-Operation for Intestinal Obstruction 01023058 25,000/-Operation for Intestinal perforation 01023059 25,000/-Benign Tumours of Small Intestine 01023060 25,000/-Benign Tumours of Small Intestine 01023061 25,000/-Excision of Small Intestine Fistula 01023062 25,000/-Operations of the Duplication of Intestines 01023063 32,000/-Operations for Recurrent Intestinal Obstruction (Noble Plication & Other Operations for the Adhesions)

01023064 28,000/-

Ilieosigmoidostomy 01023065 22,000/-Ilieosigmoidostomy Colostomy 01023066 22,000/-Caecostomy 01023067 10,000/-Loop Colostomy Transverse Sigmoid 01023068 20,000/-Terminal Colostomy 01023069 24,000/-Closure of Colostomy 01023070 24,000/-

Page 16 of 48

Right Hemi-Colectomy 01023071 24,000/-Left Hemi – Colectomy 01023072 24,000/-Total Colectomy 01023073 39,000/-Operations for Volvulus of Large Bowel 01023074 25,200/-Operations for Sigmoid Diverticulitis 01023075 22,000/-Fissure in Ano - Dilatation 01023076 6,800/-Fissure in Ano – Fissurectomy 01023077 16,000/-Rectal Polyp – Excision 01023078 8,000/-Operation of Haemorrhoids – Lords procedure 01023079 10,000/-Fistula in Ano – High Fistulectomy 01023080 20,000/-Fistula in Ano – Low Fistulectomy 01023081 12,000/-Imperforat Anus – Colostomy 01023082 16,000/-Imperforate Anus – Pull Through Operation 01023083 22,000/-Prolapse Rectum – Theirch Wiring 01023084 15,000/-Prolapse Rectum – Rectopexy 01023085 10,000/-Prolapse Rectum – Grahams Operation 01023086 22,000/-Operations for Hirschsprungs Disease 01023087 22,000/-Excision of Pilonidal Sinus 01023088 12,300/-Abdomino – Perineal Excision of Rectum 01023089 26,700/-Anterior Resection of rectum 01023090 26,300/-Pull through Abdominal Resection 01023091 22,000/-Operations for Neuroblastomka 01023092 22,000/-Fistula / Fistulotomy 01023093 12,000/-Hernioctomy 01023094 21,000/-

Nephrology / Genitourinary 024Partial Nephrectomy 01024001 25,000/-Nephrolithotomy 01024002 25,000/-Pyelithotomy 01024003 25,000/-Operations for Hydrone – phrosis 01024004 25,000/-Open Drainage of Perinephric Abscess 01024005 15,000/-Cavernostomy 01024006 20,400/-Operations for Cyst of the Kidney 01024007 25,000/-Ureterolithotomy 01024008 20,000/-Nephroureterectomy 01024009 20,000/-Operations for Ureter for – Double Ureters 01024010 30,000/-Operations for Ureter – for Ectopia of Single Ureter 01024011 27,000/-Operations for Vesico-ureteric Reflux 01024012 28,000/-Ureterostomy – Cutaneous 01024013 20,000/-Uretero-Colic anastomosis 01024014 20,000/-Formation of an Ileal Conduit 01024015 22,000/-Ureteric Catheterisation 01024016 5,000/-Dormia Extraction of Calculus 01024017 6,000/-Biopsy of Bladder (Cystoscopic) 01024018 6,000/-Diathermy Destruction of Bladder Neoplasm 01024019 15,000/-Litholapexy 01024020 15,000/-Operations for Injuries of the Bladder 01024021 30,000/-Suprapubic Drainage (Cystostomy/Vesicostomy) 01024022 12,000/-Total Cystectomy 01024023 35,000/-Diverticulectomy 01024024 32,000/-Open Resection of the Bladder Neck 01024025 25,000/-Y-V Plasty of the Bladder Neck 01024026 25,000/-Cystoplasty 01024027 28,000/-Operations for Extrophy of the Bladder 01024028 40,000/-Repair of Ureterocoel 01024029 25,000/-Suprapubic Prostatectomy 01024030 25,000/-

Page 17 of 48

Restropubic Prostatectomy 01024031 25,000/-Transurethral Resection of Prostate (TURP)/ TUR Bladder Tumour

01024032 25,000/-

Intravesical BCG instillation (cost of BCG extra) 01024033 500/-Operations for Injury to Urethra 01024034 30,000/-Internal urethrotomy 01024035 15,000/-Urethral Reconstruction 01024036 32,000/-Operation for Congenital Valves of Urethra 01024037 16,000/-Operations for Incontinence of Urine – Male 01024038 25,000/-Operations for Incontinence of Urine – Female 01024039 25,000/-Reduction of Paraphimosis 01024040 2,450/-Circumcision (under General Anaesthesia) 01024041 6,000/-Meatotomy 01024042 3,500/-Meatoplasty 01024043 6,800/-Operations for Hypospadias – Chordee Correction 01024044 15,000/-Operations for Hypospadias – Second stage or one stage Repair

01024045 24,000/-

Operations for Epispadias 01024046 22,000/-Partial Amputation of the Penis 01024047 14,000/-Total amputation of the Penis 01024048 20,000/-Orchidectomy – Simple 01024049 14,000/-Orchidectomy – Radical 01024050 20,000/-Adreneclectomy Unilateral / Bilateral for Tumour / For Carcinoma

01024051 30,000/-

Operations for Hydrocele – Unilateral 01024052 8,000/-Operations for Hydrocele – Bilateral 01024053 12,000/-Operation for Torsion of Testis 01024054 15,000/-Vasovasostomy 01024055 18,000/-Operations for Varicocele 01024056 15,000/-Block Dissection of Inguinal Nodes – One Side 01024057 25,000/-Block Dissection of Inguinal Nodes – Both Sides 01024058 32,000/-Excision of Filarial Scrotum 01024059 16,000/-Emergency Dialysis Femoral Puncture 01024060 1,200/-Emergency Dialysis Subclavian Puncture 01024061 1,800/-Fistula / Shunt 01024062 8,000/-Dialysis Femoral Catheterisation Bilateral 01024063 1,500/-Haemo Dialysis (All inclusive) 01024064 1,500/-Double Lumen Sub Clavian Catheter 01024065 3,000/-Continuous Arterio Venus Haemofiltration (CAVH)/CAVD

01024066 17,000/-

Subclavian Access 01024067 1,850/-Femoral Access 01024068 1,750/-Plasma Exchange 01024069 2,500/-Donor Nephrectomy 01024070 50,000/-Renal Transplantation 01024071 2,50,000/-Ureteric Reimplant 01024072 4,200/-Lymphocoel 01024073 4,300/-Transplant Nephrectomy 01024074 35,000/-Nephrouretectomy 01024075 35,000/-Vascular Prosthetic Graft 01024076 35,000/-CAPD (insertion & removal)/Cystoscopic removal of D-J stent

01024077 8,000/-

PCNL – Unilateral 01024078 30,000/-PCNL – Bilateral / PCNL – III 01024079 46,000/-Palomo’s Unilateral 01024080 7,300/-

Page 18 of 48

Palomo’s Bilateral 01024081 12,600/-Endoscopic Teflon Inject 01024082 5,100/-Testicular Biopsy 01024083 4,350/-Gil-Verner’s Extended Pyelo-lithotomy 01024084 22,000/-Radical Nephrectomy Complicated Tumour or Adhesions

01024085 50,000/-

Anderson Hynes Pyeloroplasty 01024086 25,000/-Vasico Vaginal Fistula Repair 01024087 30,000/-Radical Cystectomy 01024088 44,000/-Caeco Cystoplasty 01024089 26,000/-Nephrectomy Simple 01024090 25,000/-Nephrostomy 01024091 22,000/-Ureteric Reimplant 01024092 25,000/-Partial Cystectomy 01024093 28,000/-Epididymectomy 01024094 12,000/-TURP Cystolithotripsy 01024095 30,000/-Open Prostatectomy 01024096 28,000/-Closure of Urethral Fistula 01024097 28,000/-Orchidopexy – Unilateral 01024098 15,000/-Orchidopexy – Bilateral 01024099 20,000/-Cystolithotomy – Suprapubic 01024100 15,000/-Endoscopic Removal of Stone in Bladder 01024101 18,000/-Resection Bladder Neck Endoscopic 01024102 18,000/-Ureteroscopic Removal – with LASER 01024103 40,000/-Ureteroscopic Removal – without LASER 01024104 18,000/-Urethroplasty 1st stage 01024105 14,000/-Optical Urethrotomy 01024106 18,000/-Exploratory Scrototomy 01024107 10,000/-Perineal Urethrostomy 01024108 15,000/-Dilation of Stricture Urethra under G.A. 01024109 4,000/-Dilatation of Stricture Urethra without Anesthesia 01024110 2,200/-Retroperitoneoscopy Nephrectomy 01024111 40,000/-Retroperitoneoscopy partial Nephrectomy 01024112 35,000/-Retroperitoneoscopic nephrolithotomy 01024113 35,000/-Retroperitoneoscopic pyelolithotomy 01024114 35,000/-Retroperitoneoscopic operation for Hyderonephrosis 01024115 35,000/-Retroperitoneoscopic surgery for Renal cyst 01024116 35,000/-Retroperitoneoscopic ureterolithotomy 01024117 35,000/-Retroperitoneoscopic Nephroureteroectomy 01024118 35,000/-Laparoscopy assisted orchidopexy 01024119 22,000/-Laparoscopic operation for varicocele 01024120 20,000/-Cystoscopic Basketing of Urethra 01024121 12,000/-Lithotripsy/ESWL (Complete) 01024122 30,000/-Lithotripsy – 1/SMSL (Day care) 01024123 18,000/-Lithotripsy – 2/3 /SMSL (Day care) 01024124 23,000/-Slow Efficienty Dialysis (SLED) 01024125 4,000/-Prosthetic Surgery for urinary incontinence 01024126 40,000/-Helium Laser Prostrate surgery / Optical Internal urethrotomy

01024127 30,000/-

High Intensity Focus Ultrasound (HIFU) Robotic for Carcinoma

01024128 1,50,000/-

CRRT Procedure 01024129 11,000/-TURP with LASER 01024130 32,000/-Lithoclast (Day care) 01024131 16,000/-

Plastic Surgery 025

Page 19 of 48

Primary Suture of Wound 01025001 3,200/-Injection of Keloids – Ganglion 01025002 2,700/-Injection of Keloids – Haemangioma 01025003 6,100/-Free Grafts – Wolfe Grafts 01025004 18,000/-Free Grafts – Theirech – Small Area 5% 01025005 18,500/-Free Grafts – Large area 10% 01025006 30,000/-Free Grafts – Very Large area 20% 01025007 32,400/-Skin Flaps – Rotation Flaps 01025008 28,750/-Skin Flaps – Advancement Flaps 01025009 31,650/-Skin Flaps – Direct-cross Leg Flaps-Cross Arm Flap 01025010 35,500/-Skin Flaps – Cross Finger 01025011 35,500/-Skin Flaps – Abdominal 01025012 35,500/-Skin Flaps – Thoracic 01025013 34,400/-Skin Flaps – Arm etc. 01025014 35,500/-Subcutaneous Pedicle Flaps Raising 01025015 28,500/-Subcutaneous Pedicle Flaps Delay 01025016 27,750/-Subcutaneous Pedicle Flaps Transfer 01025017 28,500/-Cartilage Grafting 01025018 29,700/-Reduction of Facial Fractures of Nose 01025019 9,000/-Reduction of Facial Fractures of Maxilla 01025020 13,800/-Reduction of Fractures of Mandible & Maxilla – Eye Let Splinting

01025021 27,000/-

Reduction of Fractures of Mandible & Maxilla – Cast Netal Splints

01025022 27,000/-

Reduction of Fractures of Mandible & Maxilla – Gumming Splints

01025023 27,000/-

Internal Wire Fixation of Mandible & Maxilla 01025024 32,000/-Cleft Lip – repair 01025025 32,400/-Cleft Palate Repair Severe Degree 01025026 33,800/-Primary Bone Grafting of Cleft Lip Palate 01025027 34,550/-Secondary Surgery for Cleft Lip Deformity 01025028 32,600/-Secondary Surgery for Cleft Palate 01025029 31,350/-Reconstruction of Eyelid Defects – Minor 01025030 17,550/-Reconstruction of Eyelid Defects – Major 01025031 30,000/-Plastic surgery of Different Regions of the Ear-Minor 01025032 10,000/-Plastic surgery of Different Regions of the Ear-Major 01025033 20,000/-Plastic surgery of the Nose – Minor 01025034 10,000/-Plastic surgery of the Nose – Major 01025035 20,000/-Plastic surgery for Facial Paralysis (Support with Reanimation)

01025036 32,000/-

Pendulous Breast – Mammoplasty 01025037 22,550/-Orthopaedic Surgery Procedure 026

Application of P.O.P Casts for Upper & Lower Limbs 01026001 7,500/-Application of Functional Cast Brace 01026002 7,500/-Application of Skin Traction 01026003 1,650/-Application of Skeletal Tractions 01026004 4,450/-Bandage & Strappings for Fractures 01026005 1,150/-Aspiration & Intra Articular Injections 01026006 950/-Application of P.O.P Spices & Jackets 01026007 6,000/-Close Reduction of Fractures of Limb & P.O.P 01026008 7,500/-Reduction of Compound Fractures 01026009 10,000/-Open Reduction & Internal Fixation of Fingers & Toes 01026010 18,000/-Open Reduction of fracture of Long Bones of Upper / Lower Limb-Nailing & External Fixation

01026011 28,000/-

Open Reduction of fracture of Long Bones of Upper / 01026012 27,000/-

Page 20 of 48

Lower Limb – AO ProceduresTension Band Wirings 01026013 6,000/-Bone Grafting 01026014 18,000/-Excision of Bone Tumours – Superficial 01026015 28,000/-Excision of Bone Tumours – Deep 01026016 40,000/-Excision of Ganglion 01026017 10,000/-Excision or other Operations for Scaphoid Fractures 01026018 25,000/-Sequestrectomy & Saucerizations-Superficial 01026019 20,000/-Sequestrectomy & Saucerizations – Deep 01026020 30,000/-Sequestrectomy & Saucerizations – Arthrotomy 01026021 35,000/-S.P. Nailing for Fracture Neck Femur 01026022 35,000/-Multiple Pinning Fracture Neck Femur 01026023 35,000/-Nail Plate Fixations for Fracture Neck Femur 01026024 35,000/-A.O. Compression Procedures for Fracture Neck Femur

01026025 35,000/-

Open Reduction of Fracture Neck Femur Muscle Pedicle Graft and Internal Fixations

01026026 35,000/-

Closed Reduction of Dislocations 01026027 10,000/-Open Reduction of Dislocations – Superficial 01026028 20,000/-Open Reduction of Dislocations – Deep 01026029 30,000/-Open Reduction of Fracture Dislocation & Internal Fixation

01026030 35,000/-

Neurolysis /Nerve Suture 01026031 25,000/-Nerve Repair with Grafting 01026032 32,000/-Tendon with Transplant or Graft 01026033 35,000/-Tendon Lengthening/Tendon Sutures 01026034 25,000/-Tendon Transfer 01026035 35,000/-Laminectomy, Excision Disc (Prosthesis extra) 01026036 40,000/-Laminectomy, Excision Disc and Tumours (Prosthesis extra)

01026037 60,000/-

Anterolateral Clearance for tuberculosis 01026038 32,000/-Anterolateral Decompression and Spinal Fusion 01026039 45,000/-Cost Transversectomy 01026040 30,000/-Corrective Ostectomy & Internal Fixation – Minor 01026041 15,000/-Corrective Ostectomy & Internal Fixation – Major 01026042 30,000/-Arthrodisis of – Minor Joints 01026043 15,000/-Arthrodisis of – Major Joints 01026044 30,400/-Soft Tissue Operations for C.T.E.V. 01026045 25,000/-Soft Tissue Operations for Polio (instrumentation extra)

01026046 25,000/-

Partial Hip Replacement (cost of Prosthesis extra) 01026047 40000/-Operations for Brachial Plexus & Cervical Rib 01026048 32,000/-Amputations – Below Knee 01026049 25,000/-Amputations – Below Elbow 01026050 25,000/-Amputations – Above Knee 01026051 35,000/-Amputations – Above Elbow 01026052 30,000/-Amputations – Forequarter 01026053 40,000/-Amputations – Hind Quarter and Hemipelvectomy 01026054 44,000/-Disarticulations – Major 01026055 30,000/-Disarticulations – Minor 01026056 20,000/-Arthrography & Osteomedullography 01026057 10,450/-Spinal Ostectomy and Internal Fixations 01026058 40,200/-Arthroscopy – Operative 01026059 24,250/-Soft Tissue Operation on Knee 01026060 24,000/-Myocutaneous and Fasciocutaneous Flat Procedures 01026061 24,000/-

Page 21 of 48

for LimbsRemoval of Nails, Wires & Screw 01026062 10,000/-Removal of Plates 01026063 15,000/-Total Hip Replacement–Unilateral (Excluding Implants)

01026064 60,000/-

Total Finger Joint Replacement–Unilateral (Excluding Implants)

01026065 23,000/-

Total Knee Joint Replacement–Unilateral (Excluding Implants)

01026066 55,000/-

Any other Joint Replacement (e.g. elbow, shoulder, etc.) – Unilateral (cost of Implants extra)

01026067 55,000/-

Multiple fractures repair (excluding peripheral limb injuries)-major (above three fractures) (cost of implants extra)

01026068 1,00,000/-

Multiple fractures repair (excluding peripheral limb injuries)-medium (above two fractures) (cost of implants extra)

01026069 60,000/-

Sternal Dehisences Repair 01026070 25,000/-Sternal Dehisences Reconstration 01026071 55,000/-Fingers (post, slab) 01026072 300/-Fingers full plaster 01026073 300/-Colles Fracture – Below elbow 01026074 1,200/-Colles Fracture – Full plaster 01026075 2,000/-Colles fracture Ant. Or post slab 01026076 1,000/-Above elbow full plaster 01026077 1,000/-Above knee post slab 01026078 700/-Below knee full plaster 01026079 1,000/-Below knee post slab 01026080 750/-Tube Plaster (or plaster cylinder) 01026081 1,450/-Above knee full plaster 01026082 2,400/-Above knee full slab 01026083 2,200/-Minerva Jacket 01026084 4000/-Plaster Jacket 01026085 3050/-Shoulder spica 01026086 3,350/-Single Hip spica 01026087 3,100/-Double Hip spica 01026088 3,800/-Resection of First Rib 01026089 45,000/-Resection of Cerical Rib 01026090 35,000/-Rib resection 01026091 12,500/-Ligament Reconstruction 01026092 22,000/-

Neuro – Surgery 027Craniotomy and Evacuation of Haematoma-Subdural 01027001 70,000/-Caraniotomy and Evacuation of Haematoma-Extradural

01027002 70,000/-

Evacuation of Brain Abscess 01027003 80,000/-Excision of Lobe (Frontal, Temporal, Cerebelium etc.) 01027004 80,000/-Excision of Brain Tumours – Supratentotial 01027005 80,000/-Excision of Brain Tumours – Subtentorial 01027006 80,000/-Surgery of Cord Tumours 01027007 60,000/-Ventriculoatrial / Ventriculoperitoneal Shunt 01027008 40,000/-Excision of Cervical Inter – Vertebral Discs. 01027009 50,000/-Sympathetectomy – Lumbar 01027010 18,000/-Sympathetectomy – Cervical 01027011 18,000/-Twist Drill Craniostomy 01027012 30,000/-

Page 22 of 48

Subdural Tapping 01027013 15,000/-Ventricular Tapping 01027014 12,000/-Abscess Tapping 01027015 15,000/-Placement of ICP Monitor 01027016 15,000/-Urokinase Therapy for ICH 01027017 15,000/-Skull Traction Application 01027018 3,400/-Lumber Pressure Monitoring 01027019 10,000/-Vascular Malformations 01027020 1,00,000/-Peritoneal Shunt 01027021 15,000/-Antrial Shunt 01027022 15,000/-Meningo Encephalocoel 01027023 52,000/-Meningomyelocoel 01027024 42,000/-C,S,F, Rhinorrhaea 01027025 55,000/-Cranioplasty 01027026 55,000/-Posterior Cervical Dissectomy 01027027 50,000/-Anterior Cervical Dissectomy 01027028 50,000/-Brachial Plexus Exploration Miscrosuturing 01027029 50,000/-Median Nerve Decompression 01027030 40,000/-Peripheral Neurectomy (Trigeminal) 01027031 45,000/-Trigeminal Rhiotomy 01027032 35,000/-Cranial Nerve Asstomosis 01027033 60,000/-Meningocoele Excision 01027034 45,000/-Peripheral Nerve Surgery – Major 01027035 50,000/-Peripheral Nerve Surgery – Minor 01027036 40,000/-Ventriculo – Atrial Shunt (Excluding Cost of valve) 01027037 1,00,000/-Nerve Biopsy (Procedure + Investigation) 01027038 15,000/-Brain Biopsy (Procedure + Investigation) 01027039 18,000/-Anterior Cervical Spine Surgery with fusion 01027040 60,000/-Anterior Lateral Decompression 01027041 60,000/-Brain Mapping 01027042 2,400/-Cervical or Dorsal Laminectomy 01027043 45,000/-Combined Trans-oral Surgery & CV Junction Fusion 01027044 1,10,000/-C.V. Junction Fusion 01027045 80,000/-Depressed Fracture 01027046 40,000/-Discectomy 01027047 45,000/-Endarterectomy 01027048 50,000/-R.F. Lesion for Trigeminal Neuralgia 01027049 30,000/-Spasticity Surgery 01027050 90,000/-Spinal Fusion Procedure 01027051 65,000/-Spinal Intra Medullary Tumours 01027052 65,000/-Spinal Bifida Surgery Major 01027053 65,000/-Spinal Bifida Surgery Minor 01027054 55,000/-Stereotaxic Procedures – biopsy / aspiration 01027055 22,000/-Trans Sphenoidal Surgery 01027056 65000/-Trans Oral Surgery 01027057 1,10,000/-Implantation of DBS – one Electrode 01027058 1,00,000/-Implantation of DBS – two Electrode 01027059 1,00,000/-Endoscopic Adueductoplasty 01027060 1,00,000/-Facial nerve reconstruction 01027061 50,000/-Recanelisation of venous sinuses 01027062 80,000/-Carotid stenting 01027063 75,000/-Cervical disc arthroplasty 01027064 35,000/-Lumber disc arthroplasty 01027065 30,000/-Corpus Callosectomy 01027066 60,000/-Hemishpherectomy 01027067 80,000/-

Page 23 of 48

Endoscopic CSF rhinorrhea repair 01027068 50,000/-Microsurgical excision of Acoustic tumour 01027069 60,000/-Microsurgical excision of meningomas 01027070 60,000/-Epilepsy surgery 01027071 80,000/-RF lesion for facet pain syndrome 01027072 40,000/-Cervical laminoplasty 01027073 40,000/-Lateral mass C1 – C2 screw fixation 01027074 60,000/-Microsurgical decompression for Trigemil nerve 01027075 60,000/-Cerebellar stimulation for hemifacial spasm 01027076 80,000/-Cerebellar stimulation for other cranial nerve neuralgia

01027077 80,000/-

IC EC bypass procedures 01027078 70,000/-Stereotactic guided craniotomy 01027079 70,000/-Baclofen pump implantation lesioning for movement disorder including Parkinsonism

01027080 60,000/-

Programmable shunt 01027081 40,000/-Endoscopic sympathectomy 01027082 18,000/-External ventricular drainage 01027083 12,000/-Image guided surgery Excision of tethered 01027084 60,000/-Endoscopic 3rd ventriculostomy 01027085 60,000/-Endoscopic cranial surgery / Biopsy / aspiration/ aneurysm coiling

01027086 60,000/-

Endoscopic discectomy 01027087 60,000/-Aneurysm coiling 01027088 80,000/-Endoscopic spil procedure – aneurysm coiling 01027089 80,000/-Surgery for grooving skull fractures–aneurysm coiling 01027090 80,000/-Carpel Tunnel decompression 01027091 40,000/-Clipping of intracranial aneurysm with use of clip 01027092 90,000/-Endoscopic aspiration of intracerebellar haematoma 01027093 60,000/-Stereotactic Radiosurgery for brain pathology (X knife / Gamma)

01027094 1,20,000/-

Foramen magnum decompression 01027095 60,000/-Foramen magnum decompression with syringo subarachnoid shunt

01027096 60,000/-

Dorsal column stimulation for backache in failed back syndrome

01027097 50,000/-

Surgery for recurrent disc prolapse / epidural fibrosis 01027098 60,000/-Surgery brain stem tumours 01027099 1,00,000/-Decompressive cranectomy for hemishpherical acute subdural

01027100 70,000/-

Intra arterial thrombolysis with RTPA for ischemic stroket RTPA – acute

01027101 1,00,000/-

Stereotactic aspiration of intracerebral haematoma 01027102 50,000/-Complex Brain Surgery 01027103 1,30,000/-Complex Spine Surgery 01027104 1,10,000/-Dorsal Sympathectomy 01027105 50,000/-Neuro rehabilitisation – package for 25 sittings (bed charges extra)

01027106 15,000/-

Vascular Surgery 028Patch Graft Angioplasty 01028001 50,000/-Operations for Stenosis of Renal Arteries 01028002 50,000/-Thrombendarterectomy 01028003 50,000/-Operations for Acquired Arteriovenous Fistula 01028004 50,000/-Congenital Arterio Venous Fistula 01028005 27,700/-Surgery for Arterial Aneurysm – Vertebral 01028006 80,000/-

Page 24 of 48

Surgery for Arterial Aneurysm – Carotid 01028007 42,500/-Surgery for Arterial Aneurysm – Main Arteries of the Limb

01028008 50,000/-

Dissecting Aneurysms + Implant 01028009 1,50,000/-Stripping of Short or Long Sephenous Veins 01028010 30,000/-Ligation of Ankle Perforators 01028011 17,400/-Excision and Sking Graft of Venous Ulcer 01028012 15,500/-Venous Thromoectomy 01028013 22,100/-Lymphatics Excision of Subcutaneous Tissues In Lymphoedema

01028014 30,000/-

Trendelenburg Operations 01028015 30,000/-Vascular Procedure – Minor 01028016 16,800/-Surgery for Arterial Aneurysm Spleen Artery 01028017 40,200/-Surgery for Arterial Aneurysm Renal Artery 01028018 40,200/-

Paediatric Surgery 029Excision of thyroglossal Duct / Cyst 01029001 30,000/-Diaphragmatic Hernia Repair (Thoracic or Abdominal Approach)

01029002 35,000/-

Tracheo Oesophageal Fistula (Correction Surgery) 01029003 40,000/-Colon Replacement of Oesophagus 01029004 40,000/-Omphalo Mesenteric Cyst Excision 01029005 30,000/-Omphalo Mesenteric Duct Excision 01029006 30,000/-Meckels Diverticulecomy 01029007 30,000/-Omphalocele 1st stage (Hernia Repair) 01029008 28,000/-Omphalocele 2nd stage (Hernia Repair) 01029009 30,000/-Gastrochisis Repair 01029010 24,000/-Inguinal Herniotomy 01029011 24,000/-Congenital Hydrocele 01029012 24,000/-Hydrocele of Cord 01029013 22,000/-Torsion Testis Operation 01029014 25,000/-Congenital Pyloric Stenosis – operation 01029015 27,000/-Duodenal – Atresia operation 01029016 35,000/-Pancreatic Ring Operation 01029017 45,000/-Meconium Ileus Operation 01029018 30,000/-Malrotation of Intestines operation 01029019 32,000/-Rectal Biopsy (Megacolon) 01029020 25,000/-Colostomy Transverse 01029021 28,000/-Colostomy Left Iliac 01029022 28,000/-Abdominal Perineal Pull Through (Hirschaprugis Disease)

01029023 35,000/-

Imperforate Anus Low Anomaly – Cut Back operation 01029024 22,000/-Imperforate Anus Low Anomaly – Cut Back operation 01029025 28,000/-Imperforate Anus High Anomaly – Sacroabdomino Perineal Pull Through

01029026 25,000/-

Imperforate Anus High Anomaly – closure of colostomy

01029027 21,000/-

Intususception Operation 01029028 35,000/-Choledochoduodenostomy for Atresia of Extra Hepatic Billiary Duct

01029029 35,000/-

Operation of Choledochal Cyst 01029030 35,000/-Nephrectomy for – Pyonephrosis 01029031 35,000/-Nephrectomy for – Hydronephrosis 01029032 35,000/-Nephrectomy for – Wilms Tumour 01029033 35,000/-Paraortic Lymphadenoctomy with Nephrectomy for Wilms Tumour

01029034 40,000/-

Page 25 of 48

Sacro – Coccygeal Teratoma Excision 01029035 30,000/-Neuroblastoma Debulking 01029036 32,000/-Neuroblastoma Total Excision 01029037 36,000/-Rhabdomyosarcoma wide Excision 01029038 40,000/-Colon Transplant / Conduit Management following Acid Structure oesophagus

01029039 65,000/-

Umbilical 01029040 500/-Peripheral Long Line 01029041 800/-LP 01029042 300/-Peritoneal Tapping 01029043 500/-Chest Drainage 01029044 800/-General Nursery Care (including Nursing Care etc.) 01029045 600/-Phototherapy per day 01029046 400/-Neonate Rooming in with mother per day (inclusive of Nursing Care)

01029047 600/-

SNCU (Sick New Born Care Unit) 01029048 1,600/-Operation of Trigger finger of children under G.A. 01029049 10,000/-

Laproscopic / Endoscopic Operations In Gen. Surgery / Gastrohepatic / Nephro -

030

Diagnostic Laproscopy 01030001 6,600/-Laproscopic Pyloromyotomy 01030002 18,000/-Laproscopic Gastorstomy 01030003 21,000/-Laproscopic Closure of Perforate peptic ulcer 01030004 25,000/-Laproscopic Vagotomy Pyleroplasty / gastro jejunostomy

01030005 24,000/-

Laproscopic umbilical hernia repair 01030006 20,000/-Laproscopic ventral hernia repair 01030007 25,000/-Laproscopic cystogastrostomy 01030008 30,000/-Lap. Cholecystectomy & CBD exploration 01030009 26,000/-Lap. Hydatid of liver surgery 01030010 28,000/-Lap. Hepatic resection 01030011 28,000/-Lap. Assisted small bowel resection 01030012 30,000/-Lap. For intestinal obstruction 01030013 30,000/-Lap. For intestinal perforation 01030014 28,000/-Lap. Assisted Right Hemicolectomy 01030015 32,000/-Lap. Assisted left Hemicolectomy 01030016 32,000/-Lap. Assisted Total Colectomy 01030017 37,000/-Laproscopic rectiokext 01030018 32,000/-Lap. Assisted Abdominoperineal Resection of rectum 01030019 37,000/-Lap. Assisted anterior resection 01030020 37,000/-Laproscopic Cholecystectomy 01030021 25,000/-Laproscopic Appendicectomy 01030022 21,000/-Laproscopic Hernia Repair 01030023 21,000/-Laproscopic Hiatus Hernia Repair 01030024 30,000/-Laproscopic Adhesiolysis 01030025 18,000/-Laproscopic Adrenalectomy 01030026 32,000/-Laproscopic Thyroidectomy 01030027 32,000/-Laproscopic Spleenectomy 01030028 32,000/-Laproscopic Colectomy 01030029 35,000/-Laproscopic Nephrectomy 01030030 40,000/-Inguinal Hernia (Laproscopic) 01030031 20,000/-Laproscopic Pyelolithotomy 01030032 30,000/-Ureterolithotomy 01030033 22,000/-Lap. Ovarian Cystectomy 01030034 22,000/-Laproscopic Hysterectomy 01030035 25,000/-

Page 26 of 48

Laproscopic Ectopic 01030036 22,000/-Foreign body removal 01030037 4,000/-Nephrolithotomy 01030038 35,000/-Operations for Hydronephrosis – Pyeloplasty 01030039 35,000/-Operations for Hydronephrosis – Endopyelotomy antegrade

01030040 35,000/-

Operations for Cyst of the Kidney 01030041 40,000/-URSL 01030042 25,000/-Nephroureterectomy 01030043 50,000/-Operations for Vesico – ureteric Reflux 01030044 40,000/-Diverticulectomy 01030045 22,000/-Repair of Ureterocoel 01030046 35,000/-Operations for Varicocele Palomo’s – Unilateral 01030047 20,000/-Operations for Varicocele Palomo’s – Bilateral 01030048 30,000/-Nephrostomy 01030049 16,000/-Orchidopexy – Unilateral 01030050 25,000/-Orchidopexy – Bilateral 01030051 30,000/-Prostratectomy 01030052 45,000/-Laproscopic Uro stone 01030053 30,000/-Incisional Hernioplasty 01030054 35,000/-

Radiotherapy & Chemotherapy (packages)Nuclear Medicines – Radio Isotope Therapy 031

131 – Iodine Therapy < 15mCi 01031001 5,200/-131 – Iodine Therapy 15 – 50mCi 01031002 16,900/-131 – Iodine Therapy 51 – 100mCi 01031003 16,900/-131 – Iodine Therapy > 100mCi 01031004 19,500/-Strontium therapy for metastatic bone pain palliation

01031005 7,200/-

Samarium – 153 therapy for metastatic bone paid palliation

01031006 10,700/-

Cobalt 60 Therapy 032Radical Therapy 01032001 70,000/-Adjustment Therapy – Immobilisation technique 01032002 16,000/-Palliative Therapy (less than 10 fractions) 01032003 15,000/-Palliative Therapy (10-25 fractions) 01032004 25,000/-Palliative Therapy (single fractions) 01032005 5,000/-

Linear Accelerators 0333 – D Planning (L. Acc. Or Cobalt – 60) 01033001 6,000/-2 – D Planning (L. Acc. Or Cobalt – 60) 01033002 5,000/-Intensity Modulated Radio Therapy 01033003 1,05,000/-Image Guided Radio Therapy (IGRT) 01033004 1,50,000/-IGRT Single Fraction 01033005 7,000/-3D – CRT (Confirmal Radio Therapy) 01033006 65,000/-3D – CRT with IGRT 01033007 75,000/-4D – CRT with IGRT 01033008 90,000/-Stereotactic Radio Surgery (SRS) 01033009 85,000/-Stereotactic Radio Therapy (SRT) 01033010 70,000/-Rapid Arc with IMRT rate 01033011 1,00,000Palliative Radiation Therapy upto 15 fractions 01033012 25,000/-Palliative Radiation Therapy upto 25 fractions 01033013 35,000/-Palliative Radiation single fractions 01033014 10,000/-Conventional Radiation Therapy CT 01033015 35,000/-Conventional Radiation Therapy CBCT 01033016 45,000/-SRS / SRT Neuro interventional charge / case 01033017 10,000/-Electron Beam (>10 Fractions) 01033018 40,500/-

Page 27 of 48

Electron Beam (<10 Fractions) 01033019 9,000/-Pre-radiation profile 01033020 2,500/-

Brachy Therapy 034Intra Cavitary Brachytherapy – 1st insertion 01034001 5,500/-Intra Cavitary / Inra Luminal Brachytherapy – 2nd and subsequent insertion

01034002 3,000/-

Intersititial Brach Therapy – 1st insertion 01034003 15,000/-Intersititial Brach Therapy – 2nd insertion 01034004 10,000/-

Chemotherapy 035Neoadjuvant 01035001 1,000/-Adjuvant 01035002 1,000/-Infusional Chemotherapy 01035003 1,000/-Chemotherapy wafers for malignant brain tumours 01035004 20,000/-Multiple drug therapy per day 01035005 900/-Targeted therapy Chemoport facility 01035006 1,000/-Chemoport facility 01035007 1,500/-PICC line (Peripherally Inserted Central Canulisation) 01035008 1,000/-

Room Rent (per day) 036General Ward 01036001 600/-Semi – Private Ward 01036002 1,200/-Private Ward 01036003 1,800/-Day Care / Minor (OPD) Surgeries (all categories) 01036004 600/-

Admissible Blood ChargesFor treatment in Government Hospitals 037

General Beds 01037001 50/-Paying Beds 01037002 100/-Cabin 01037003 140/-

For treatment in recognised Private Hospitals / Nursing Homes / Aided Institutions

038

Whole Blood 01038001 500/-F.F.P. 01038002 400/-Platelet Concentrate 01038003 400/-Platelet Rich Plasma 010358004 400/-Packed Cell 01038005 400/-Frozen Plasma 01038006 350/-Crypoprecipitate 01038007 300/-Washed RBC 01038008 400/-

RATES OF INVESTIGATIONS:

02 - INVESTIGATIONS

NAME OF INVESTIGATION CODEAmount Claimed

(in `)

Amount Admissible

(in `)GENERAL 001

Aspiration Plural Effusion – Diagnostic 02001001 750/-Abdominal Aspiration – Diagnostic 02001002 900/-Pericardial Aspiration 02001003 1,200/-Bone Marrow Aspiration 02001004 800/-Joints Aspiration 02001005 750/-E.C.G. 02001006 140/-E.E.G. 02001007 800/-Stress test (TMT) 02001008 850/-Lumber puncture 02001009 1,000/-

Page 28 of 48

Sternal puncture 02001010 800/-E.N.T. 002

Pure Tone Audiogram 02002001 300/-Impedence & other tests 02002002 300/-SISI, Tone Decay & Difference times 02002003 250/-Multiple hearing assessment test to Adults 02002004 450/-Hearing Aid Selection 02002005 100/-Hearing Aid Analysis 02002006 400/-Speech Discrimination Score 02002007 200/-Speech Assessment 02002008 200/-Cold Calorie Test for Vestibular function 02002009 180/-Audiometry (MHC) 02002010 250/-ABR (Threshold Est.) 02002011 650/-Acoustic Reflex Decay 02002012 100/-Eustachian Tube Func 02002013 100/-IMP Audiometry 02002014 300/-Otoacoustic Est. (OAE) 02002015 550/-PEAD Audio Assessment 02002016 200/-SRT & SDS 02002017 150/-Swallowing Assest 02002018 30/-Tympanometry 02002019 150/-Voice Assest 02002020 250/-Endo Laryngoscopy 02002021 850/-ENG 02002022 1,300/-Nasal Endoscopy 02002023 600/-Nasopharyngoscopy 02002024 600/-LV Dyssynchrony Study 02002025 1,400/-Stroboscopy 02002026 700/-

Eye 003Refraction / Fundoscopy 02003001 150/-Ortho-optic check up 02003002 150/-Perimetry / field test 02003003 400/-Clinical Photography 02003004 100/-Electrooculogram 02003005 500/-ERG 02003006 400/-Flourescein Angiography 02003007 800/-A – Scan 02003008 200/-Tono Graphy 02003009 450/-Ver 02003010 300/-Goldmen Perimetry 02003011 150/-Specular microscopy 02003012 200/-Indo cyaningreen Angiography of Retina 02003013 1,000/-Indo cyaningreen Angiography – IRIS 02003014 1,000/-Automated Perimetry 02003015 450/-Corneal endothelial cell count 02003016 200/-Corneal topography 02003017 200/-Corneal pachymetry 02003018 200/-Retinal nerve film analyser studies 02003019 100/-Auto Refrectemetry 02003020 60/-Biometry 02003021 180/-Ultrasound studies – A Scan 02003022 600/-Ultrasound studies – B Scan 02003023 600/-Retinal / Meter function studies 02003024 150/-PANACUTTY METER 02003025 200/-Laser interferometry 02003026 1,000/-

Page 29 of 48

EKGEOG 02003027 500/-Dacryocystography (DGC) 02003028 500/-Orbital Angio studies 02003029 500/-Digital Biometry Reading (Single) 02003030 180/-Biometry (Both eyes) 02003031 350/-Biometry – corp (Both) 02003032 400/-Biometry – corp – Single 02003033 300/-Pachymetry (Both Eyes) 02003034 400/-Pachymetry (Single) 02003035 200/-Multifocal ERG (One eye) 02003036 800/-NCT 02003037 160/-OCT – NFL Analyser 02003038 1,600/-Schiotz Tonometer 02003039 250/-TTT 02003040 2,500/-VEP 02003041 600/-Anterior Segment (Fundus) Photography 02003042 300/-USG 02003043 550/-

Physiotherapy 004Muscle testing and diagnostic 02004001 100/-

Dental 005Intra oral X – ray (Digital) 02005001 80/-Opg Cephalogram 02005002 210/-Opg Standard View 02005003 210/-Radio Visiograph (per Image) 02005004 110/-

Genetics 006Fragile X Decet & Karyo of Peri Bld Cell 02006001 3,500/-

X – Ray (Digital X Ray) 007Fluroscopy chest 02007001 120/-Occlusal 02007002 130/-Abdomen AP or Erect (one film) 02007003 130/-Abdomen Lateral View (one film) 02007004 130/-Abdomen for Pregnancy 02007005 130/-Chest PA view (one film) 02007006 130/-Chest Oblique or Lateral (one film) 02007007 130/-Mastoids (one film) 02007008 150/-Extremities, bones & joints (one film) 02007009 140/-Pelvis (one film) 02007010 140/-Paranasal sinuses (one film) 02007011 140/-T.M. Joints (one film) 02007012 140/-Abdomen & pelvis for K.U.B. 02007013 250/-Skull A.P. & Lateral 02007014 250/-Spine A.P. & Lateral 02007015 250/-Barium Swallow 02007016 700/-Sinography / Sialography 02007017 750/-Cystography / Urethrography 02007018 1,120/-Hystero – Salpaingography 02007019 1,110/-Arthrography 02007020 840/-Retrograde Pyelography 02007021 1,080/-Oral or I.V. Cholecystography 02007022 720/-Barium Enema 02007023 1,160/-Barium Meal Upper or Lower 02007024 960/-Bronchography 02007025 1,260/-I.V. Urography / I.V.P. 02007026 1,350/-Myelography 02007027 1,500/-Pneumo Encephalography 02007028 1,120/-

Page 30 of 48

Barium meal Complete 02007029 1,230/-Cerebral / Femoral Angiography 02007030 2,000/-Periapical X-Ray 02007031 100/-Barium Enema (Double Cont.) 02007032 1,300/-Barium IC Junction 02007033 750/-Gastro Contray Meal 02007034 750/-Intravenous Pyelogram 02007035 1,400/-T-Tube Cholangiogram 02007036 700/-PTBD Gram 02007037 700/-Micturating Cystourethrogram (MCU) 02007038 750/-VUR / Cystourethrography (MCU) 02007039 2600/-Small Bowel Enema 02007040 1150/-Any XRAY using portable machine – addl handing charge

02007041 300/-

Any other XRAY – single Film (Small) 02007042 130/-Any other XRAY – single Film (Large) 02007043 160/-

Conventional X-Ray (70% of Digital X-Ray rates) 008Fluroscopy chest 02008001 90/-Occlusal 02008002 90/-Abdomen AP or Erect (one film) 02008003 90/-Abdomen Lateral View (one film) 02008004 90/-Abdomen for Pregnancy 02008005 90/-Chest PA view (one film) 02008006 90/-Chest Oblique or Lateral (one film) 02008007 90/-Mastoids (one film) 02008008 100/-Extremities, bones & joints (one film) 02008009 90/-Pelvis (one film) 02008010 90/-Paranasal sinuses (one film) 02008011 90/-T.M. Joints (one film) 02008012 90/-Abdomen & pelvis for K.U.B. 02008013 170/-Skull A.P. & Lateral 02008014 160/-Spine A.P. & Lateral 02008015 170/-Barium Swallow 02008016 490/-Sinography / Sialography 02008017 520/-Cystography / Urethrography 02008018 780/-Hystero – Salpaingography 02008019 780/-Arthrography 02008020 590/-Retrograde Pyelography 02008021 760/-Oral or I.V. Cholecystography 02008022 510/-Barium Enema 02008023 810/-Barium Meal Upper or Lower 02008024 670/-Bronchography 02008025 880/-I.V. Urography / I.V.P. 02008026 950/-Myelography 02008027 1050/-Pneumo Encephalography 02008028 780/-Barium meal Complete 02008029 860/-Cerebral / Femoral Angiography 02008030 1180/-Periapical X-Ray 02008031 70/-Barium Enema (Double Cont.) 02008032 910/-Barium IC Junction 02008033 530/-Gastro Contray Meal 02008034 530/-Intravenous Pyelogram 02008035 980/-T-Tube Cholangiogram 02008036 490/-PTBD Gram 02008037 490/-Micturating Cystourethrogram (MCU) 02008038 530/-

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VUR / Cystourethrography (MCU) 02008039 1820/-Small Bowel Enema 02008040 810/-Any XRAY using portable machine – addl handing charge

02008041 300/-

Any other XRAY – single Film (Small) 02008042 90/-Any other XRAY – single Film (Large) 02008043 110/-

Ultrasound Investigations 009Obstetric First Scan / Follow up 02009001 500/-USG : Lower Abdomen / Pelvis 02009002 800/-Upper abdomen First Scan / Follow up 02009003 600/-Ultrasound – Neurosonogram 02009004 900/-USG – Neurosonogram - Screening 02009005 350/-Total Abdominal survey or Multiple organ study 02009006 950/-Special Procedure & Aspiration etc. 02009007 1,230/-Image Intensifiers 02009008 700/-USG : Neck 02009009 850/-USG : KUB 02009010 800/-USG : Whole Abdomen 02009011 950/-USG : Whole Abdomen + Transrectal 02009012 1,500/-USG : Scrotum 02009013 900/-USG : Testis 02009014 600/-Ultrasound Bladder 02009015 600/-Ultrasound Kidney / Renal 02009016 600/-USG : Pregnancy + Doppler 02009017 2,200/-USG : Joint (Unilateral) 02009018 900/-USG : Joint (Bilateral) 02009019 1,800/-USG : Musculoskeletal 02009020 800/-USG : Transrectal 02009021 800/-USG : Breast Unilateral 02009022 700/-USG : Breast Bilateral 02009023 1,050/-USG : Thyroid 02009024 800/-USG : Cgest 02009025 700/-USG : Prostate 02009026 550/-USG : Single Organ 02009027 550/-USG : Follicular Study 02009028 1,250/-USG : Guided Procedure 02009029 600/-USG : FNAC 02009030 900/-USG : Follow-up-Ovulation 02009031 600/-USG : For Congenital Anomaly 02009032 1,800/-Ultrasound Parotid 02009033 800/-Ultrasound Thigh 02009034 800/-Any USG using portable machine-handling charge 02009035 200/-Trans vaginal Sonography 02009036 800/-

Clinical Pathology 010Urine routine 02010001 60/-Quantitative Albumin / Sugar 02010002 50/-Urine Bile Pigment and Salt 02010003 50/-Urine Urobilinogen 02010004 50/-Urine Ketones 02010005 50/-Urine Occult Blood 02010006 50/-Urine total proteins 02010007 100/-Urine Sodium 02010008 100/-Urine Chloride 02010009 100/-Bence Jones protein 02010010 90/-Stool routine 02010011 60/-

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Stool occult blood 02010012 60/-Post coital smear examination 02010013 100/-Smear analysis 02010014 100/-Body fluid (CSF / Ascitic Fluid etc.) Chemistry, Sugar, Protein etc.

02010015 240/-

Body fluid for Malignant cells 02010016 200/-Urinary Porphobilinogen 02010017 110/-Urinary Myoglobin 02010018 400/-Urine for Immuno electrophoresis 02010019 3500/-Urine for Protein Electrophoresis 02010020 2800/-CRK ISO Enzyme Electrophoresis 02010021 5000/-Hb Electrophoresis 02010022 600/-Chyle Test 02010023 100/-Semen Analysis 02010024 280/-IVF Semen Analysis 02010025 250/-Stool Reducing Substance 02010026 60/-Stool for OVA, Parasite 02010027 70/-Stool for Parasite 02010028 60/-Stool Culture & Sensitivity 02010029 200/-Urine for Culture & Sensitivity 02010030 250/-Karyotype Chromosome Analysis 02010031 2400/-Genotyping 02010032 5000/-Glucotyping 02010033 5000/-Urine for Electrolytes 02010034 200/-Urine Amino – aciduria 02010035 150/-Urine for Phosphorus 02010036 220/-Urine for Z-N Stain 02010037 60/-Urine Protein / Creatinine Ratio 02010038 250/-Opiates Serum Random Urine 02010039 450/-Opiates Random Urine 02010040 450/-Urine Ammino Acid, Qualitative, 2 Dimensional 02010041 700/-Pre / Post-Dialysis Creatinine 02010042 100/-Pre / Post-Dialysis Potassium 02010043 100/-Pre / Post-Dialysis Sodium 02010044 100/-Pre / Post-Dialysis Urea 02010045 80/-

Haematology 011Haemoglobin (Hb) 02011001 50/-Total Leucocytic Count (TLC) 02011002 50/-Differential Leucocytic Count (DLC) 02011003 50/-E.S.R. 02011004 50/-Total Red Cell count 02011005 60/-Platelet count 02011006 80/-Reticulocyte count 02011007 70/-Absolute Eosinophil count 02011008 60/-Packed Cell Volume (PCV) 02011009 50/-Peripheral Smear Examination 02011010 70/-Smear for Malaria parasite 02011011 70/-Bleeding & Clotting Time 02011012 60/-Clot Retraction Time 02011013 50/-R.B.C. Fragility Test 02011014 100/-L.E. Cell 02011015 120/-Foetal Haemoglobin (Hb-F) 02011016 250/-Prothrombin Time (P.T.) 02011017 150/-Complete Haemogram 02011018 180/-Bone Marrow Smear Examination 02011019 400/-

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Partial Thromboplastin 02011020 200/-Glucose 6 Phosphate Dehydrogenase (G, 6PD) 02011021 220/-P.C.V. Haematocrit 02011022 50/-RBC Folate 02011023 1,350/-Whole Blood Folate 02011024 1,350/-Sickling Test 02011025 120/-Bleeding Time 02011026 40/-Clotting Time 02011027 40/-D-Dimer Semi Quantitative 02011028 900/-Sucrose Lysis Test 02011029 280/-Red Cell Osmotic Frag. With Incubato 02011030 280/-Heinz Body Test 02011031 120/-Fibrinogen 02011032 400/-FDP 02011033 150/-Plasma Haemoglobin 02011034 190/-Factor VIII Studies 02011035 1,000/-Factor IX Functional 02011036 1,200/-Factor V Functional 02011037 2,500/-Factor V Lieden Mutation Analysis 02011038 4,000/-TC, DC, ESR 02011039 120/-Absolute Lymphocytes Count 02011040 80/-HB, TC, DC 02011041 120/-Bone Marrow [Perls Stain] 02011042 750/-Cell Type & Cell Count 02011043 320/-Nasal Smear for Eosinophils 02011044 90/-CSF Cell Counts [TC / DC] 02011045 170/-Complete Blood Picture 02011046 180/-MCV MCH MCHC 02011047 180/-Investigation of ABO / RH 02011048 360/-Sinovial Fluid for Analysis 02011049 400/-Blood Parasites 02011050 70/-Malaria Parasite 02011051 70/-Malarial Antigen Detection 02011052 320/-Filaria Antigen W. Bancrofti 02011053 560/-Lap Score 02011054 400/-BAL Cell Count 02011055 100/-Cold Agglutination 02011056 150/-AT III 02011057 650/-AT III Anti Thrombin 02011058 650/-Absolute Neutrophil Count 02011059 50/-Osmotic Fragility 02011060 120/-HLA Typing 02011061 10,000/-T – Cell Cross Matching 02011062 5,000/-Karyotyping for Bone Marrow Cancer (REL) 02011063 6,000/-Sucrose Lysis Test 02011064 280/-APTT (50:50) 02011065 200/-Immunofixation Electroporesis 02011066 7,200/-Material Antigen Detection 02011067 450/-

Blood Bank 012Blood Group & RHO Type 02012001 140/-Cross match 02012002 50/-Packed Cells – Proc. Charges 02012003 450/-Saline Washed Packed Cells: Proc. Charges 02012004 450/-Coomb’s Test Direct / Indirect 02012005 200/-Australia Antigen 02012006 200/-

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RHO, Antibody titer 02012007 250/-Platelet rich Plasma – Proc. Charges 02012008 450/-Whole Human Blood –I.P. – Proc. Charges 02012009 450/-Fresh frozen Plasma: Proc. Charges 02012010 450/-Cryoprecipitate: Proc. Charges 02012011 450/-Platelet Concent - Proc. Charges 02012012 450/-Therapeutic Phlebotomy: Proc. Charges 02012013 450/-Granulocyte Conc. : Proc. Charges 02012014 450/-

Bio-Chemistry 013Glucose blood – Fasting / PP / Random 02013001 70/-Blood Urea Nitrogen / Blood Urea 02013002 80/-Serum Creatinine 02013003 100/-Serum Uric Acid 02013004 110/-Serum Bilirubin total / direct 02013005 130/-Serum Iron 02013006 220/-Serum Cholesterol 02013007 120/-Total Iron Binding Capacity 02013008 300/-CK MB 02013009 390/-Serum Calcium 02013010 120/-Serum Phosphorus 02013011 120/-Total Protein Alb / Glo Ration 02013012 140/-S.G.P.T. 02013013 120/-S.G.O.T. 02013014 120/-Serum amylase 02013015 250/-Serum Electrolyte 02013016 250/-Triglyceride 02013017 220/-Glucose Tolerance Test (GTT) 02013018 300/-C.P.K. 02013019 270/-L.D.H. 02013020 210/-L.D. – 1 02013021 320/-LDH & LD – 1 02013022 470/-T3 02013023 300/-T4 02013024 300/-TSH 02013025 300/-T3, T4, TSH 02013026 700/-FSH 02013027 420/-LH 02013028 410/-FSH & LH 02013029 670/-Prolactin 02013030 470/-Blood gas analysis 02013031 400/-Blood gas analysis with electrolytes 02013032 500/-Cortisol 02013033 650/-HDL Cholesterol 02013034 200/-VLDL Cholesterol 02013035 170/-ALDL / LDL Cholesterol 02013036 480/-Lipid Profile 02013037 700/-L.F.T. [Liver Function Test] 02013038 750/-Alkaline Phosphatase 02013039 150/-Acid Phosphatase 02013040 300/-Leucocyte Alkaline Phosphatase Score 02013041 600/-Serum Magnesium 02013042 170/-Serum Copper 02013043 500/-Serum Lithium 02013044 250/-Serum Lipase 02013045 250/-Serum Chloride 02013046 150/-

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Serum Inorganic Phosphorous 02013047 160/-Serum Ceruloplasmin 02013048 750/-Serum Carbamazepine / Tegretol 02013049 1,400/-Carbamazepine 02013050 600/-Serum Calcitonin 02013051 1400/-Calcitonin 02013052 1200/-Myoglobin Serum 02013053 2400/-Serum C Peptide 02013054 800/-Serum C Peptide (PP) 02013055 500/-Serum Eption /Phenytoin 02013057 700/-Albumin (Serum) 02013058 120/-Serum Eption / Phenytoin 02013059 720/-Albumin (Serum) 02013060 600/-Serum Sodium 02013061 240/-Serum Folate 02013062 720/-Folate & Vitamin 12 Serum 02013063 1,110/-Serum Aldolase 02013064 400/-Serum Acetaminophen 02013065 650/-Serum Growth Hormone 02013066 550/-Parathyroid Hormone (PTH), Intact 02013067 1,200/-Serum Osmolality 02013068 250/-Serum Potassium 02013069 150/-Serum TIBC 02013070 280/-Serum Parathormone Level 02013071 900/-Serum Homocystine / Homocystine/ Homocystine Level 02013072 750/-Serum Individual Phospolipids – TLC 02013073 450/-Serum / Plasma Bicarbonate 02013074 350/-Serum Haptoglobin 02013075 850/-Serum Testosterone 02013076 500/-Serum Thyroglobulin 02013077 1,360/-Lactate Plasma 02013078 550/-CA – 19-9 02013079 1,000/-CA – 125 02013080 800/-CA – 15.3 02013081 160/-CA – 72.4 Gastric Cancer Marker 02013082 1,050/-CSF Sugar 02013083 100/-CSF Protein 02013084 100/-Lactate (CSF) 02013085 400/-CSF – Protein Electropherisis 02013086 800/-CSF – Oligoclinal Band Analysis 02013087 2,000/-CSF for Biochemical Analysis 02013088 280/-CSF Chloride 02013089 150/-CSF Profile 02013090 3,200/-Sodium Bicarbonate 02013091 100/-Mucopolysaccharidoses (MPS) Screening U 02013092 500/-Renin Activity Plasma, PRA 02013093 4,000/-Plasma Ammonia 02013094 400/-Fructosamine 02013095 200/-GGT – Gamma Glutamy l Transaminase 02013096 320/-Globulin 02013097 120/-Estradiol 02013098 520/-Estradiol (E2) 02013099 420/-Glycosylated Haemoglobin [HBAIC] 02013100 520/-Alpha I Anti Trypsin Assay 02013101 1,200/-Insulin-P.P. / Fasting / Random 02013102 650/-

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Lactose Tolerance Test 02013103 550/-DHEA-S (Sulphate) 02013104 800/-Serum Digoxin / Serum Digoxin Level 02013105 700/-Serum Gastrin 02013106 900/-Progesterone 02013107 450/-Beta HCG (B – HCG) 02013108 650/-Beta HCG Quantitative Trophoblastic Cancer Marker 02013109 600/-Cardiac Enzymes 02013110 450/-LDH Heat Stable Fraction 02013111 640/-LDH Isoenzymes 02013112 1,430/-Antiphospolipid Antibody IGG & IGM 02013113 1,050/-Antiphospolipid Antibody IGM 02013114 750/-Anti – Sperm Antibody / ABS 02013115 550/-Alpha – Feto Protein (AFP) Cancer Marker 02013116 650/-Carcino Embryonic Antigen [CEA] 02013117 600/-Anti – Thyroid Antibodies 02013118 950/-Anti – Thyroid Antibodies – TG Ab 02013119 900/-Bicarbonate 02013120 150/-Anti Cardiolipin Antibody – Ig G / IgM 02013121 650/-Anti Cardiolipin Antibody Profile 02013122 1,700/-C _ Peptide Assay 02013123 350/-Cyst Fluid for Analysis 02013124 350/-Trop – T 02013125 820/-Troponin T – Qualitative 02013126 400/-Intracellular Calcium 02013127 120/-Pleural / Peritoneal Fluid for Sugar & Urea 02013128 80/-Peritoneal Dialysis Fluid for Sugar & Urea 02013129 220/-Apolipo Proteins 02013130 500/-Free testosterone 02013131 600/-Blood Acetone / Ketone 02013132 240/-Pleural Fluid for Protein 02013133 80/-Pleural Fluid for LDH 02013134 200/-Pleural Fluid for Amylase 02013135 180/-Fluid for LDH 02013136 160/-Fluid for Amylase 02013137 130/-Fluid for Creatinine 02013138 110/-Fluid for Lipase 02013139 130/-Fluid for Cholesterol 02013140 150/-Phenytoin Level 02013141 720/-24H Ketosteroid & Ketogenic Steroid 02013142 1,700/-Angio Tension Converting Enzyme (ACE) 02013143 780/-Phenobarbitone 02013144 720/-Anti Thyroid Antibodies TPO Ab 02013145 900/-Anti TG 02013146 550/-ACTH 02013147 960/-ACTH Plasma 02013148 960/-Intact PTH 02013149 700/-IGFI 02013150 350/-IGFI – I (Somatomedin – C) 02013151 2,800/-B – 2 Microglobulin 02013152 960/-Valporic Acid 02013153 520/-Valproate 02013154 520/-Sex Hormone Binding 02013155 1,200/-Vitamin B – 12 Level 02013156 800/-Vitamin D 25 Hydroxy 02013157 1,400/-

Page 37 of 48

17 Hydroxy Corticostiroids 02013158 580/-Lipoprotein (a) 02013159 400/-Synovial Fluid for Biochemistry 02013160 480/-Plasma Catecholamines 02013161 5,500/-Serum IgA 02013162 220/-Serum IgG 02013163 220/-Serum IgM 02013164 400/-Pericardial Fluid for Biochemistry 02013165 360/-Pericardial Fluid Test 02013166 100/-Peritoneal Fluid – Biochemistry 02013167 450/-Aldosterone 02013168 1,150/-Galactosemia Profile 02013169 1,800/-FISH (NH) 02013170 2,800/-FISH for BCR / ABL 02013171 3,200/-Fluid for TVPCR 02013172 1,400/-Serum Cortisone 02013173 380/-Transferrin 02013174 780/-Chromogranin A 02013175 5,000/-Cryo Globulin Screening 02013176 780/-Cocaine Metabolite Screen 02013177 500/-Cyclosporine CO 02013178 1,600/-Cytokeratin / Erythropoietin 02013179 1,200/-Protein C / S, Functional 02013180 2,800/-

Histopathology 014Pap Smear 02014001 240/-Histopathology exam per tissue type 02014002 250/-

Bacteriology & Serology 015Smear gram – stain examination 02015001 100/-Sputum smear A.F.B. stain 02015002 100/-Vaginal Smear Examination 02015003 100/-V.D.R.L. 02015004 120/-Widal test 02015005 180/-Rheumatoid Factor test 02015006 300/-Culture & Sensitivity (other specimens) 02015007 250/-Urine pregnancy test 02015008 200/-C.R.P. 02015009 220/-ASO Titer 02015010 250/-Quantitative H.C.G. 02015011 400/-Blood culture & sensitivity 02015012 250/-Vibro Cholera culture 02015013 250/-CAPD Fluid for Culture & Sensitivity 02015014 350/-CAPD Fluid for Fungal Stain / Gram Stain 02015015 100/-CAPD Fluid – Cytology 02015016 200/-Rapid Urease Test 02015017 250/-ASO (Antistreptoysin “O”) 02015018 360/-High Sensitivity – CRP 02015019 400/-PUS for Fungal Culture 02015020 250/-PUS for Fungal Stain 02015021 100/-PUS for Gram Stain 02015022 100/-PUS for Z – N Stain 02015023 100/-Culture & Sensitivity [PUS] 02015024 250/-Culture & Sensitivity [CSF] 02015025 250/-Culture & Sensitivity [Semen] 02015026 250/-Culture & Sensitivity [Fluid] 02015027 250/-Culture & Sensitivity [Sputum] 02015028 250/-

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Culture & Sensitivity [Throat Swab] 02015029 250/-Culture & Sensitivity for Vaginal Swab 02015030 250/-Culture & Sensitivity for Aspirated Fluid 02015031 250/-Culture & Sensitivity [Wound Swab] 02015032 250/-Wound Swab for Fungal Stain 02015033 100/-Wound Swab for Gram Stain 02015034 100/-Wound Swab for Z – N Stain 02015035 100/-Culture & Sensitivity [Rectal Swab] 02015036 250/-Nail for Fungal Culture 02015037 200/-Nail Clipping for KOH preparation 02015038 100/-Blood Culture & Sensitivity – Anaerobic 02015039 600/-Blood Culture & Sensitivity [Paediatric] 02015040 600/-Tissue for Culture & Sensitivity 02015041 250/-Mitral Valve Tissue for Culture & Sensitivity 02015042 250/-Aortic Valve Tissue for Culture & Sensitivity 02015043 250/-Arterial Line Tip for Culture & Sensitivity 02015044 250/-Ascitic Fluid for Culture & Sensitivity 02015045 600/-AC Tap for Culture & Sensitivity 02015046 250/-Sputum for AFB Culture 02015047 500/-Sputum for Fungal Culture 02015048 150/-Sputum for Fungal Stain 02015049 100/-Sputum for Z – N Stain 02015050 100/-Sputum for Grams Stain 02015051 100/-Esophageal Smear for Candida 02015052 150/-Urine for AFB Culture 02015053 500/-Pleural Fluid for AFB Culture 02015054 500/-Pleural Fluid – TBPCR 02015055 1,200/-Culture AFB Antibiotic Sensitivity – 5 Drug Panel 02015056 3,000/-Urine for Gram Stain 02015057 100/-Throat Swab for KLB 02015058 100/-Fungus Culture 02015059 150/-Clostridium Difficile Toxin A & B 02015060 1,200/-Yeast Identification and Susceptibility 02015061 350/-Non – Fermenter Identification 02015062 300/-Serology for Mumps IGM / IGG 02015063 1,000/-Torch Profile 02015064 1,500/-Serum Antigens Conv. Enzy. 02015065 400/-P – ANCA 02015066 800/-C – ANCA 02015067 800/-Aldehyde Serum Test 02015068 80/-Elisa Test for Ecinococcus Antibody Detec 02015069 600/-Ascitic Fluid Cell Count 02015070 200/-Anti HBS (Antibody to Australia – Antigen) 02015071 400/-Hepatitis B Surface Antibody 02015072 400/-Anti – HBC Core Antibody IgM 02015073 550/-Serum Immunoglobulin 02015074 600/-Immunoglobulin IGE 02015075 500/-IGE Allergy Individual 02015076 600/-Immunoglobulin - IGA 02015077 600/-Immunoglobulin – IGM 02015078 600/-Immunoglobulin – IGG 02015079 600/-Anti – HAV – IGM – Antibody 02015080 1,000/-Compliment C3 02015081 350/-Compliment C4 02015082 350/-Toxoplasma – IgG 02015083 370/-

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Toxoplasma – IgM 02015084 370/-Toxoplasma – IgG + IgM 02015085 700/-Cysticercosis Antibody / Antibody IgG 02015086 600/-Cytomegalovirus, PCR 02015087 2,000/-PCR for AFB 02015088 1,350/-Herpes I (IgG)(HSV Type I) 02015089 300/-Herpes I (IgM)(HSV Type I) 02015090 300/-Herpes I (IgG)(HSV Type II) 02015091 300/-Herpes I (IgM)(HSV Type I)I 02015092 300/-Herpes I + II (IgG) 02015093 300/-Herpes I + II (IgM) 02015094 300/-TPHA (Treponema Pallidum Haemagglutinat) 02015095 340/-HBsAG 02015096 420/-Hydatid Cyst for IgG Elisa 02015097 600/-Aspergillus Antibody (IGG / IGM) 02015098 1,000/-Anti HCV IgG / IgM 02015099 820/-Anti HEV IgG / IgM 02015100 840/-Allergy Screening – Adult 02015101 1,200/-Dengue Elisa 02015102 1,000/-Dengue Antibodies IgG + IgM 02015103 600/-Dengue NSI Ag Test 02015104 600/-Screening for C – Pylori [RUTI] 02015105 200/-Elisa for Tuberculosis [IGG / IGM / IGA] 02015106 350/-Febrile Agglutinis [Widal. Weli – FEI] 02015107 400/-HBe Antigen Detection (HBeAg) 02015108 550/-CMV (Cytomegalo Virus) Antibody [IGM] 02015109 350/-Brucella Antibody 02015110 420/-Breast Cancer ERPR and HER2 / NEU 02015111 2,400/-Anti HCV IIIrd Generation Elisa 02015112 350/-Epstein Bar Virus IGM [VCA Elisa] 02015113 600/-HEV IgM Elisa 02015114 700/-Legionella Pneumophila – Elisa 02015115 600/-Elisa for Pregnancy 02015116 630/-Elisa for Mumps (IgG Antibody) 02015117 450/-Elisa for Measles (IgG Antibody) 02015118 450/-Mumps Elisa (IgM Antibody) 02015119 520/-HIV P24Antigen 02015120 600/-Vivax Antigen 02015121 350/-Anti Smooth Muscle Antibody (ASMA) 02015122 500/-Anti-Mitochondrial Antibody – M2(AMA – M2) 02015123 750/-Anti – Nuclear Antibody / ANF / ANA 02015124 450/-ANAIFA (HEP – 2) Method 02015125 960/-Anti – Native Deoxyribonucleic Acid (Ds-DNA) 02015126 700/-Antismith Antibody 02015127 650/-Rubella IgG /IgM Antibody 02015128 360/-Rubella IgG & IgM 02015129 650/-Rubeola IgG /IgM Antibody 02015130 1,000/-Rubeola Antibodies IgG & IgM 02015131 1,400/-Leptospira Antibody IGM/IGG 02015132 840/-Leptospira Antibody IGG & IGM 02015133 1,650/-Cyptococcus Antigen – Latex Detection (CSF) 02015134 1,300/-Falciparum Antigen 02015135 360/-ADA (Adenosine Deaminase – Body Fluid) 02015136 450/-Mantoux Test 02015137 150/-Anti – HAV – Total (IGG & IGM) 02015138 720/-

Page 40 of 48

Cytomegalo Virus (CMV) Antibody [IGG] 02015139 320/-CMV IgM + IgG 02015140 600/-Chopra Aldehyde Test 02015141 100/-Amniotic Fluid – Lecithin Spingomyl 02015142 400/-Amoebiais Antibodies [IHA] Screening 02015143 280/-Amoebic Serology 02015144 800/-KOH Mount for Fungal Elements Detection 02015145 100/-Campylobacter Jejieni Antigen Detection I 02015146 360/-HIV Test ( 1 &2) 02015147 450/-Typhi DOT – M 02015148 160/-Hepatitis B-Core, total (HBC total, IGG + IGM) 02015149 720/-Anti HBC Antibody (IgM) 02015150 720/-Anti HBC Antibody (Total) 02015151 720/-Anti HBE 02015152 550/-Hepatitis Be Antibody 02015153 550/-Hepatitis D Virus Antibody 02015154 1,450/-HLAB27CHN 02015155 920/-HLA – B27, Disease Association Flow Cytometry 02015156 1,500/-HLA – ABC & DR Tissue Cross match 02015157 2,000/-HCV RNA PCR Qualitative 02015158 2,500/-Hepatitis C Viral RNA Genotype, LIPA 02015159 9,500/-Varicella – Zoster Virus IGG Titres 02015160 520/-Varicella Zoster IgM 02015161 720/-Varicella Zoster IgG & IgM 02015162 1,400/-Anti LKM-1 (Liver Kidney Microsomal – 1)Antibody 02015163 820/-Viable MTB Detection – PCR 02015164 1,500/-HIV Qualitative (Window Period Detection) 02015165 1,200/-Anti Sclero 70 / SCL 70 02015166 1,300/-Comprehensive CNS Panel – (Molecular Dia) 02015167 6,800/-HIV Proviral DNA Detector Qualitative 02015168 1,100/-Hepatitis B PCR Quantitative 02015169 1,900/-Hepatitis B Virus PCR Qualitative 02015170 3,000/-Anti GBM Antibody + 02015171 900/-HSV DNA PCR 02015172 1,500/-Anti RNP – Sm Antibody 02015173 1,000/-Antibody to Ribonucleo Protein IgG 02015174 1,100/-NBT Reduction Test 02015175 720/-Anti Jo Antibody 02015176 520/-Anti Jo – 1 Antibodies 02015177 840/-Antibody to SSA / SSB 02015178 2,000/-Antibody to SSA / LA 02015179 720/-Japanese Encephalitis Virus PCR (JE Virus P) 02015180 1,500/-HIV – 1 RNS Quantitative RT-PCR with CD-3, CD-4, CD 02015181 3,800/-RNS Study / Decrement 02015182 350/-HIV Viral Load CD4 & CD8 02015183 3,200/-Anti RNP – Sm IgG 02015184 1,100/-Anti Endomysial Antibody IgA 02015185 720/-CD – 4, CD – 8 02015186 700/-CD 10 02015187 1,200/-CD 20 02015188 920/-CD 3 02015189 920/-CD 30 02015190 920/-HCV RNA Quantitative / Viral Load 02015191 6,000/-HBV Quantitative 02015192 5,500/-HBV DNA Qualitative 02015193 1,900/-

Page 41 of 48

Mycobacterium IgA / IgG / IgM 02015194 600/-Mycobacterium IgG / IgM 02015195 500/-Mycobacterium Tuberculosis Serology EL 02015196 1,900/-TB PCR (Mycobacterium tuberculosis PCR) 02015197 850/-Treponema Pallidum Antibody Detection 02015198 300/-Treponemal Pallisum, FTPA – ABF 02015199 2,000/-Autoimmune Hepatitis Panel 02015200 900/-Antinuclear antibody Panel (14 antibody panel) 02015201 1,100/-Anti CCP Antibody 02015202 450/-Anti Centromere Antibody 02015203 800/-Serum Procalcitonin 02015204 2,000/-Serum Prealbumin 02015205 550/-HSV (1 + 2)IgG/IgM Antibodies 02015206 280/-HSV (1+2) IgG and HSV (1 + 2) IgM 02015207 550/-Chikungunya Test 02015208 500/-ANA / ANF in Dilution 02015209 1,000/-Bronchial Aspiration for Culture & Sensitivity 02015210 300/-Bronchial Aspiration for AFB Culture 02015211 500/-Bronchial Aspiration for Fungal Stain 02015212 100/-Bronchial Aspiration for Gram Stain 02015213 100/-Bronchial Aspiration for TBPCR 02015214 1,400/-CVP Tip for Culture & Sensitivity 02015215 300/-Dialysis Catheter Tip for C / S 02015216 300/-Ear / Eye / Nasal / Tongue Swab for Culture & Sensitivity 02015217 300/-Prostatic Secretion for Microscopy 02015218 150/-Prostrate Specific Antigen (PSA) 02015219 500/-BCR abl transcript quantification 02015220 4,000/-Aerobic by Bactec 02015221 900/-Dengue Serology lgG & lgM 02015222 1,200/-

Obstetric Cases 016Examination under anaesthesia 02016001 2,430/-Laparoscopy (Gynae) 02016002 6,060/-Lap. Dye Test with removal of adhesions 02016003 8,000/-

Biopsies (Specimen processing per tissue type) 017Biopsy [Large] 02017001 600/-Biopsy [Medium] 02017002 500/-Biopsy [Small] 02017003 350/-Biopsy [Extra Large] 02017004 800/-

Head & Neck Cancer 018Cardio Respiratory Procedures 019

Direct Laryngoscopy 02019001 4,380/-Bronchoscopy 02019002 2,400/-Mediastinoscopy 02019003 2,880/-Pleural Biopsy 02019004 3,630/-Thoracoscopy 02019005 6,600/-Pulmonary function test BMR 02019006 700/-Spirometry 02019007 700/-Spirometry with Helium Dilution 02019008 1,620/-Spirometry with Helium Dilution with diffusion capacity studies

02019009 1,620/-

Pulmonery exercise testing 02019010 940/-Punctal Cautery 02019011 100/-NT Pro BNP 02019012 1,000/-Cardioversion 02019013 1,400/-Cardiac Troponin I 02019014 400/-

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TEE with Anesthesia 02019015 2,500/-Testicular 02019016 800/-Flexible Bronchoscopy – Diagnostic – TBNA 02019017 10,000/-Flexible Bronchoscopy – Therapeutic 02019018 2,500/-Flexible Bronchoscopy – Glue 02019019 4,000/-Flexible Bronchoscopy – Baloon Tampete 02019020 4,000/-Flexible Bronchoscopy – Toileting 02019021 2,600/-Rigid Bronchoscopy – Diagnostic 02019022 5,000/-Rigid Bronchoscopy – Massive Haemoplysis 02019023 6,200/-Fibroptic bronchoscopy 02019024 2,100/-Fibroptic Bronchoscopy with Washing / Biopsy 02019025 2,500/-

Cardiac / Cardio Thoracic Procedures 020Test of Pacemaker 02020001 580/-Stress Myocardial Study (MBI / TR) 02020002 7,200/-Echo Screening 02020003 720/-Stress Echo / Dobutamine Echo 02020004 1,950/-Foetal Echocardiography 02020005 1,320/-Cardio Tocography 02020006 360/-2D Echo with colour Doppler/ 2D Echo Cardiography 02020007 1,320/-Trans Oesophaedral Echo (TEE) 02020008 840/-Holter Analysis & Holter Report (with Prd. Specification) / Tilt Table Test

02020009 1,470/-

Cardiac Cath Angiography (Without Coronary Angioplasty)

02020010 13,200/-

Aortogram 02020011 3,900/-Package charges for Cardiovascular investigation 02020012 410/-Stress Thallium 02020013 3,600/-Muga (Resting) 02020014 1,440/-Muga (Stress) 02020015 1,800/-Echo Colour Doppler 02020016 1,440/-Check Angio 02020017 7,000/-Doppler Carotid Artery 02020018 1,700/-Flow tron Excel (DVT) 02020019 500/-

Abdomen / Gastroenterology 021Gastroscopy 02021001 1,170/-Gastric & Duodenal Biopsy (Endoscopic) 02021002 1,560/-ERCP 02021003 4,000/-ERCP Fluroscopy 02021004 2,200/-Upper G.I. Endoscopy 02021005 1,100/-Upper G.I. Endoscopy with Biopsy 02021006 1,300/-Sigmoidoscopy (rigid) 02021007 1,400/-Sigmoidoscopy (flexible) 02021008 1,200/-Oesophagoscopy 02021009 1,100/-Colonoscopy 02021010 1,800/-Colonoscopy – Full (GAS-PKG) 02021011 2,000/-24 H PH Metry 02021012 4,000/-24 H PH Metry (BS) 02021013 5,500/-

Nephrology / Genitourinary 022Biopsy of Bladder (Cystoscopic) 02022001 8,000/-Urethroscopy 02022002 6,000/-Glomerular Filtration Rate 02022003 500/-Urethral dialatation – Diagnostics 02022004 1,000/-Visually Evoked Potential 02022005 500/-Uroflow Study (Micturometry) 02022006 600/-Urodynamic Study (Cystometry) 02022007 1,200/-

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Cystoscopy with Retrograde Catheter Unilateral 02022008 4,000/-Cystoscopy with Retrograde Catheter Bilateral 02022009 6,000/-Cystoscopy Diagnostic 02022010 5,000/-Cortisol – blood 02022011 240/-Voiding – cysto – urethrogram 02022012 360/-Renal Transplant Evaluation 02022013 1,500/-

Orthopaedic Surgery Procedure 023Arthrography & Osteomedullography 02023001 11,000/-Arthroscopy – Diagnostic 02023002 11,000/-

Neurology 024Placement of ICP Monitor – 02024001 6,000/-Lumber Pressure Monitoring 02024002 6,100/-Nerve Biopsy 02024003 8,500/-Brain Biopsy 02024004 8,500/-Brain Mapping 02024005 3,000/-Ambulatory Electro Ence 02024006 5,000/-Blink Reflex 02024007 500/-Decrement Test 02024008 650/-EMG Four Limbs 02024009 900/-EMG Two Limbs 02024010 480/-NCV Four Limbs 02024011 900/-NCV Two Limbs 02024012 500/-EMG – Facial 02024013 500/-NCV – Facial 02024014 500/-NCV + EMG – Facial 02024015 950/-Spincter – EMG 02024016 550/-H Reflex 02024017 500/-SSEP (Lower Limbs) 02024018 550/-SSEP (Upper Limbs) 02024019 550/-SSEP – UL / LL 02024020 1,000/-VEP (Flash) 02024021 550/-VEP (PR) 02024022 550/-Counsl of INH Patient 02024023 200/-Spl Edu Assessment 02024024 250/-Baer Study 02024025 550/-Baer / Threshold 02024026 1,000/-Councelling & Therapy 02024027 200/-IQ Assessment 02024028 300/-Neuro Psychological T 02024029 850/-Personality & IQ Child 02024030 450/-Personality Development T 02024031 650/-SSR 02024032 700/-Lumbar puncture with CSF Monitoring 02024033 1,500/-HER – 2 / NEU 02024034 1,200/-

Breast 025Mammography (Single side) 02025001 800/-Mammography (Both side) 02025002 1,500/-

Gynae, Operation Charges 026Diagnostic Curettage 02026001 3,000/-Fractional Curettage 02026002 3,400/-Hysteroscopy Diagnostic 02026003 7,500/-

Laproscopic Operations in Gen. Surgery / Gastrohepatic /Nephro –

027

Diagnostic Laproscopy 02027001 7,000/-Specialised Procedures / Investigations / C.T. Scan 028

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Cat Scan (C.T.) Head 02028001 1,600/-C.T. Head Scan Involv. Spl. Investigation 02028002 2,300/-C.T. Scan Brain 02028003 1,600/-HRCT Chest Thorax 02028004 6,000/-C.T. Chest (HRCT) 02028005 4,000/-C.T. Scan Chest 02028006 3,500/-C.T. Spine (Cervical, Dorsal, Lumber, Sacral) 02028007 3,500/-C.T. Angiogram of Cervical and Intra 02028008 7,200/-C.T. Cervical C.T. 3D Reconstruction only -- 02028009 1,200/-C.T. Guided Biopsy 02028010 2,000/-C.T. Guided percutaneous cath drainage 02028011 2,500/-C.T. Myelogram (Cervical Spine) 02028012 3,500/-C.T. Myelogram (Lumber Spine or D/S) 02028013 3,500/-CT Pelvis with Hip Joints 02028014 3,000/-CT KUB (Plain) 02028015 3,500/-CT Sacro Iliac Joint 02028016 2,500/-CT Pituitary / Sella 02028017 2,500/-CT Cisternography 02028018 1,600/-CTPetrous Temporal Bone 02028019 3,000/-CT Sacrum & Coccyx 02028020 3,500/-CT Scan Upper Abdomen 02028021 3,000/-CT Scan Lower Abdomen 02028022 3,000/-CT Scan Whole Abdomen 02028023 5,000/-CT Shoulder Joint / Knee Joint / Elbow Joint/ Any Other Joint (Plain)

02028024 3,500/-

CT Base of Neck 02028025 2,000/-CT Scan Neck (Thyroid Soft Tissue) 02028026 3,000/-CT Ankle with Foot 02028027 2,000/-C.T. Scan Orbits / Eye 02028028 3,000/-CT Arm / Humerus / Forearm / Radius –Ulna/ Leg / Tibia-Fibula/ Thigh / Femur (Single) Plain

02028029 4,500/-

C.T. Scan Limbs 02028030 2,500/-CT Both Thigh 02028031 2,000/-C.T. Scan Whole Body 02028032 10,000/-CT Extremities 02028033 2,000/-C.T. Scan of Para Nasal Sinus 02028034 3,000/-CT guided FNAC 02028035 2,500/-CT Angiography of Brain / Carotid / Thorax / Neck 02028036 5,400/-CT 64 Coronary Angiography 02028037 10,000/-CT Angiography of Brain / Carotid / Thorax / Neck / Abdomen / Extremities / Renal area/ Peripheral area/ Pulmonary area with Visipaque

02028038 6,500/-

CT Renal Angiography 02028039 5,000/-CT Angio Both Lower Limbs 02028040 10,000/-CT Angiography of Neck Vessels 02028041 5,000/-CT Angiography of Abdomen / Extremities / Renal area/ Peripheral area/ Pulmonary area

02028042 6,000/-

PET CT Scan (Whole Body) (including Flurodeoxy Glucose)

02028043 20,000/-

Therapeutic Aspiration – CT 02028044 3,000/-Diagnostic Aspiration – CT 02028045 1,600/-Ionic Contrast (20 C.C.) 02028046 270/-Ionic Contrast (50 C.C.) 02028047 675/-Non-Ionic Contrast (10 C.C.) 02028048 500/-Non-Ionic Contrast (25 C.C.) 02028049 750/-

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Non-Ionic Contrast (50 C.C.) 02028050 1,250/-Non-Ionic Contrast (100 C.C.) 02028051 2,100/-3D Reconstruction charge 02028052 1,200/-CT Dual Phase Study – Liver 02028053 5,000/-Fibroscan 02028054 3,500/-

MRI 029MRI Brain /Brain with Protocol / CSF Study / Internal Ear 02029001 6,000/-MRI Base of Skull 02029002 5,400/-MRI Orbits 02029003 6,000/-MRI Face 02029004 5,400/-MRI Nasopharynx and PNS 02029005 6,000/-MRI Pharynx 02029006 5,400/-MRI Neck 02029007 6,000/-MRI Pituitary 02029008 5,400/-MRI Thyroid / Cranio-Vertebral (C.V.) Junction / 02029009 5,000/-MRI Temporal Bones (Unilateral) 02029010 6,000/-MRI Venography / Angiography 02029011 5,400/-MRI Arm/ Fore Arm/ Thigh/ Femur/ Leg/ Foot 02029012 5,400/-MRI Arm (Humerus)(Left / Right) 02029013 5,400/-MRI – Single Joint 02029014 5,400/-MRI – Both Joints 02029015 9,000/-MRI Sacro Iliac Joints 02029016 5,400/-MRI Spine (Cervical/ Dorsal/ Lumber/ Cervico-Dorsal/ Dorso-Lumbar/ Lumbo-Sacral)

02029017 5,400/-

MRI Lumbar Spine & Sacroiliac Joint 02029018 6,000/-Double Region Plain (Brain & Spine) 02029019 9,000/-Tripple Region Plain (Brain & Spine) 02029020 13,000/-MRI CSF Flow Study 02029021 1,500/-MRI Spectroscopy 02029022 1,500/-MRI Diffusion Tensor Imaging (DTI) 02029023 1,500/-MRI SWI (Susceptibility Weighted Image) 02029024 1,500/-MRI Hip 02029025 6,000/-MRI Urogram 02029026 5,400/-MRI Pelvis 02029027 6,000/-MRCP 02029028 5,000/-MRI Extremities 02029029 6,000/-MRI Upper Abdomen with MRCP 02029030 6,000/-MRI Temporomandibular Single Joint 02029031 5,000/-MRI Temporomandibular Double Joints 02029032 6,000/-MRI Upper Abdomen 02029033 5,400/-MRI Upper Thigh & Lower Abdomen 02029034 7,000/-MRI Whole Abdomen 02029035 9,000/-MRI Lower Abdomen/ Pelvis 02029036 5,400/-MRI Breast 02029037 6,000/-MRI Thoracic Outlet 02029038 5,400/-MRI Spine Screening 02029039 5,400/-MRI Brachial Plexus 02029040 5,400/-MRI Chest 02029041 5,400/-MRI Brain with Spectroscopy 02029042 6,000/-MRI Brain with perfusion 02029043 7,300/-MRI Brain with Orbit/PNS/Angio/Neck Angio 02029044 6,500/-MRI Brain with DTI (Diffusion Tensor Imaging)/ SWI (susceptibility Weighted Image)/ Cranial Nerve Evaluation

02029045 6,000/-

MRI Perfusion Study 02029046 3,500/-

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MRI Screening 02029047 5,400/-Screening Single Area with Films 02029048 1,500/-Screening Double Area with Films 02029049 3,000/-MRI Small Part 02029050 4,000/-MRI Other Region 02029051 5,400/-Contrast (Ionic / Non-ionic) 02029052 2,500/-

Other Investigation 030Fluoroscopic Screening 02030001 120/-Oxygen Saturation 02030002 120/-Bone Densitometry Single site 02030003 800/-Bone Densitometry Two sites 02030004 1,200/-Bone Densitometry Three sites (Spine, Hip & one extremity)

02030005 1,600/-

Bone Densitometry Whole Body 02030006 2,200/-A.V. Fistula 02030007 3,000/-

Immunology 031Hepatitis B DNA 02031001 5,200/-HBV DNA Quantitative / Viral Load 02031002 6,000/-

Nuclear Medicines 032Isotope Venography 02032001 3,500/-Gallium – 67 Scan / Gallium Scan 02032002 8,500/-Thyroid Scan 02032003 1,800/-Iodine – 131 Thyroid Scan 02032004 2,500/-Thyroid (Tc99m) Scan 02032005 1,800/-Para Thyroid Scan 02032006 6,000/-Thallium Scan 02032007 9,000/-Spect Myocardial Perfusion Scan (Thalium/ Tetro) 02032008 11,000/-Spect Myo Perfusion Rest Scan (Thalium / Tero / Mie) 02032009 5,500/-Nuclear Blood Pool Scan 02032010 2,000/-Radio-Isotope Ureteric Reflux (Indirect) 02032011 3,000/-Whole Body Tc – V – DMSA Scan 02032012 3,500/-Brain Spect (Tumour Imaging) 02032013 2,500/-Tumour Immagery 02032014 5,000/-Bone Scan Spect (Single Region) 02032015 1,800/-Bone Scan – three phase (Single Region) 02032016 2,700/-Bone Scan Spect (whole body) 02032017 3,000/-Tc 99m DMSA Renal Scan 02032018 2,000/-

Profiles 033Lipid Profile 02033001 700/-Thyroid Profile 02033002 1,200/-Total Diabetic Profile 02033003 1,000/-Pre Cath Profile 02033004 850/-Coagulation Profile 02033005 550/-LFT [Liver Function Test] 02033006 750/-Pre Dialysis Serology 02033007 600/-Dialysis Profile 02033008 500/-Hepatitis B Profile 02033009 3,000/-Hepatitis Panel 02033010 1,800/-Neuro Profile 02033011 2,000/-Septic Profile 02033012 900/-Paediatric Septic Profile 02033013 1,800/-Basic Metabolic Panel (BMP) 02033014 320/-Comprehensive Metabolic Panel (CMP) 02033015 500/-Anaemia Screen (HAEMI) 02033016 2,800/-Thrombocytopenia Screen (HAEM2) 02033017 3,400/-

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Mycloma Screen (HAEM3) 02033018 2,700/-Lymphoma Screen (HAEM4) 02033019 2,000/-Polycythaemia (HAEM5) 02033020 1,800/-Thallasaemia Patient Screen (HAEM6) 02033021 3,000/-Thallasaemia Counselling Serum (HAEM7) 02033022 1,200/-CRBSI 02033023 550/-ACTH Stim 02033024 1,900/-Growth Hormone Stim 02033025 2,000/-Male GnRH Stim 02033026 3,500/-Female GnRH Stim 02033027 3,300/-Bone Marrow Profile 02033028 550/-EP Screening Profile 02033029 1,100/-Torch Profile 02033030 1,500/-Renal Profile 02033031 330/-Septic Profile (Hb, TC, DC, Platelets, ESR, P. Smear, Toxic Granules, Bad Cell, CRP)

02033032 780/

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Documents

· Web viewLIST OF PROCEDURES AND PROCEDURES COVERED UNDER THE WEST BENGAL HEALTH SCHEME (Current as on July 31, 2013) 01 – PROCEDURES Name of Procedure / Investigation Code Amount