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Billing policy & Guidelines

BILLING POLICY AND


GUIDELINES

MAX HOSPITAL - SAKET

FY 17-18
As on 01.10.2017

Max Super Specialty Hospital - Saket Page 1


Billing policy & Guidelines

GENERAL INSTRUCTIONS

1. Out Patient Consultation

a) During the day if a Stat report for any investigation (Pathology) is required 20 % extra
shall be charged. In the night between 22:00 hrs and 8:00 hrs 20% extra as Emergency
charges would be levied on all Investigations/Diagnostics/ Diagnostic procedures.
b) On call: Between 22:00 hrs and 8:00 hrs an Emergency call to a Specialist doctor (On
call), an Additional Fee of 100% of Normal Tariff will be charged.
c) For administering an injection, a supportive Prescription is mandatory. In case Patient is
not carrying a prescription then he needs to consult the EMO/SR by paying the consult
first and get a Prescription then only will the injection be administered.
d) Admission following OP consultation in the Specialty Doctor who offered OP consult,
then only one IP visit shall be booked for the same Specialty Doctor during first 24 hrs of
OP Consult for the same Patient.
e) All OPD/Post Discharge Reports, if not collected by the patient within a month of
investigation will be destroyed.

2. Registration Charges

Onetime OPD registration charges of INR.200/- shall be charged to all new patients
coming to Max Hospital for the first time.

3. Follow-up Visit policy for IPD patients

One follow-up OPD Consultation with 100% discount within 7 days of a surgical case or
within 5 days of a Medical case shall be billed as "First free follow-up consult after
discharge" and Post Discharge Suture & Staple removal will be complimentary but
consumables will be charged on actual

4. Equipment Charges

a) Any specific equipment hired from outside the Max Hospital would be charged
additionally on actual.
b) Any special equipment utilized for the procedure will be charged additionally, over &
above the normal tariff rates at the rate of 25% of Surgeon’s fee.

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Billing policy & Guidelines

5. Triage Billing Policy

a) Triage Bed Charges: Triage stay (Emergency) charges @ 500/- per hour (First Hour
Free) up to a maximum of Eight hours. Beyond 8 hrs if the patient stays in the hospital,
charges will be applicable as per opted room category.
b) Resuscitation charges: Rs. 2,500/-
c) Patient is admitted as inpatient from Emergency, Triage bed charges shall not be levied
d) Patient is admitted as inpatient from Emergency, EMO charges shall be levied.
e) Procedure charges shall be charged as per economy room tariff.
f) Triage tariff do not include EMO/ SR/ Specialty doctor Visit/ Investigation / Procedure/
Consumables / Medicines, which will be billed additionally.
g) Visit charges of in house EMO will be INR. 300/-. If a Consultant visits Triage, the
charges are as per the Pricing Policy and only one consultation visit either EMO/SR or
Consultant shall be charged.
h) Day Emergency / Triage Visit i.e. between 08:00 & 22:00 hours will be charged as per
OPD rates. Night emergency visit in the triage area (On call consultants) will be charged
at twice the normal OPD rates.
i) If the Specialist Doctor is present in the OPD, no extra charge for Emergency reference
except for normal tariff will be levied.

6. MLC Charges

In MLC cases an additional charge of INR. 1,000 shall be levied to cover extra cost
incurred by hospitals. This shall only be applicable for MLC cases where patient gets
admitted to our hospital and also applicable for Outside registered MLC cases. This shall
not be applicable for cases where there is direct discharge from Triage/ER and
CGHS/PSU patients.

7. Daycare Billing Policy

a) Day Care room rent is applicable for 12 hrs and if stay exceeds for more than 12 hrs
then then the charges of economy room will be charged.
b) In case of Day Care surgical procedures, Primary Surgeon shall not charge IPD
Consultation but one visit of a different specialty doctor is allowed. In Medical Day Care
cases, however, the primary treating doctor shall charge one IPD Consultation.
c) In day Care-Surgeon fee, Doctor Visit and other charges will be charged equal to double
room category.

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Billing policy & Guidelines

d) If patient gets admitted as inpatient from Day Care to Double or higher than double, all
charges will be applicable as per occupied Room Type. But if patient gets admitted to
category lower than double, room rent will be applicable as per occupied room type &
charges for surgery will be applicable as per Double room.

8. IPD Billing Policy

a) Billing Cycle

1. Billing cycle will start from time of admission and is from 11:00 am to 11:00 am.
Therefore 11:00 am is the checkout time for discharge. This policy however is not
applicable in case of Day Care.
2. Minimum half day charge is applicable for any admission. Up to 8 hours of Stay
will be billed as Half Day Stay and beyond Eight (8) hours shall be billed as Full
Day.
3. 12 hour Billing cycle shall be followed for Private Nursing/GDA. Even if the
service is availed for less than 12 hours, full charges shall be levied.
4. At the time of discharge, a grace period of Two (2) hours will be given and shall
not attract additional charges. Grace period of 2 hours is only applicable beyond
Eight (8) hours of stay.

b) Room Policy

1. Room tariff includes standard fittings in the room according to the type of
Occupancy / Laundry Services / House-keeping services.
2. Room rent charges do not includes any professional fees like RMO Fess, Diet
Charges, Dietician Visit, MRD charge and Equipment charges etc.
3. Any additional Food & Beverage for anybody (Patient/Attendants) will be charged
on MRP Basis.
4. If the Patient’s Attendant retains the room while the Patient is in HDU / ICU /
Nursery, additional charges for the Room and Food & Beverage would be levied
separately.
5. In such cases Room would be provided subject to availability & approval from
Unit Operations Head.
6. ICU tariff includes Room rent, RMO charges and Pulse Oxymeter etc.
7. ICU Tariff does not include Specialty Doctors Visit / Ventilator / Investigations /
Procedures / Consumables and Medicines.

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Billing policy & Guidelines

8. NICU Level I tariff Includes Bed charges, SPo2 monitoring, Cardio Respiratory
monitoring and Warmer.
9. NICU Level II tariff Includes Level I and Infusion pump, Pulse Oxymeter,
Phototherapy & Oxygen.
10. NICU Level III tariff Includes services of Level I and Level II.
11. The Room charges do not include any Therapeutic procedure / Ventilator or
Ventilator Initiation charges and Oxygen charges.
12. In IPD, nursing Charges up to 10% of Net Bill shall be applicable for all
admissions except day care
13. When a patient is admitted through Emergency and the desired type of room is
not available, then whichever type of room is available will be offered to Patient
and charges will be applicable as per offered room type.

c) Medical History Assessment Charges

One time charges of INR.1500 to be charged from all IP admissions except those who
are admitted in Triage (Non admissions) and Pre-ADT (Non admission).

d) Medical Evaluation for TPA

One time charges of INR.300 to be charged as Medical Evaluation for TPA charges from
all IP admissions routed through TPA and for Day-Care Sitting (Dialysis / Chemotherapy)
INR. 50 shall be charged.

e) R.M.O Fees

RMO Fees of INR. 600 will be applicable once in a day during patient Stay in the hospital
from each Inpatient.

f) Complexity/High Risk policy

Hospital shall levy additional charges of up to 30% of Net Bill for High Risk or complex
for package, surgeries and procedures.

g) Diet Charge

Diet charges of INR. 450 will be applicable once in every day during patient Stay in the
hospital from each Inpatient.

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Billing policy & Guidelines

h) Dietician’s Charge

Dietician charges of INR. 500 will be applicable once in every four days during patient
Stay in the hospital from each Inpatient.

i) Nursing Charges

Nursing charges will be applicable once in a day during patient Stay in the hospital from
each Inpatient.

j) IP Consultation Policy

a) In the IPD the admitting doctor (Primary Consultant) will be entitled to maximum of
two IP visits per day and One (each) emergency consult in a day is allowed for both
Primary and Secondary doctor (if required per patient in between 10:00 Pm to 8:00
Am). Apart from this Primary Consultation, one visit of RMO for INR. 600/- will be
applicable per day for Non ICU Stay.
b) In ICU two visits for the admitting doctor and two visits for intensivist per day will be
charged.
c) In HUD two visits for the admitting doctor and one visit for intensivist per day shall be
charged.
d) In case of surgery, up to first 24 hrs of surgery, no IPD consult of primary surgeon or
unit will be charged to patient. Thereafter, he may charge up to two visits per day.
e) Intensivist Charges are applicable for all Critical Care beds except in case of
Transplant ICU and CCU where charges will be applicable as a when required.
f) Cross Referral: For those cases that are referred by the treating doctor for an
opinion, only one visit per day will be charged as per recorded instructions in the
case sheet. The referral could be for
 Single Consult
 Continuous care

k) Bed Transfer policy

a) In the event of Bed Transfer during course of treatment, the higher category of bed
charges will be charged from the billing cycle applicable at the time of transfer.
b) In case the Patient is transferred from Lower to Higher category of Room following
the Surgery/ Procedure, the surgical procedure charge would be revised according to

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Billing policy & Guidelines

higher bed category. The bed charges and the doctor’s visit charges would be
charged as per the higher room category from the day & time of transfer
c) In case the Patient is transferred from Higher to lower category of room following
surgery / procedure, the surgery / procedure would be charged as per Higher Bed
category. The bed charges and the doctor’s visit charges would be charged as per
the higher room category from the day & time of transfer
d) In case of room transfer, consultant’s fee will be charged according to room where
consultant takes the visit physically.
e) If the patient is transferred to ICU during the course of IP stay, then the surgery /
procedure charges shall remain same as per original Bed occupied charges.
However, ICU charges will be levied during actual duration of stay in the ICU.
f) In case, due to non-availability of room if patient is shifted to higher category in that
case also charges will be applicable as per desired category and when the desired
category becomes available, patient gets shifted there.
g) If more than one procedure are carried out and the patient decides to opt for the
lower category before the procedure and accordingly lower category rates should be
charged.

9. Policy Related to Surgery/Package/Procedure

a) In case of multiple surgeries, the surgery with the higher surgeon fee will be
considered as Primary surgery and all other charge related calculations will be based
on this Primary Surgery.
b) If two or more surgeons perform two or more different surgeries / procedures, they
shall be entitled to their individual full surgeon’s fee for their respective procedures.
The Procedure charges shall be levied separately for each procedure
c) If the same surgeon performs more than one surgery at the same time on the same
area of body then the Surgery costing the maximum shall be billed 100% followed by
the surgery costing lesser as 75% of the listed tariff and followed by the surgery
costing still lesser as 60% of the listed tariff but if surgeries are carried out on
different body areas then all surgeries will be charged 100%.
d) In case different Specialty Surgeons perform different surgeries then all surgeries will
be charged at 100% of surgeon fee as specified in tariff table.
e) If package is available for particular surgery/procedure in Tariff shall be billed to
patient irrespective of Cash/TPA.
f) Limits defined in tariffs for packages have to be strictly followed until and unless
authorized by GM Ops of Unit.

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Billing policy & Guidelines

g) In case of multiple packages in same sitting and different body site, both packages
shall be billed @100%.
h) In cases of multiple packages in same sitting and same body site, the highest priced
package shall be billed @100%, second packages @75% and third onwards @60%.
i) In case of multiple packages in different sitting (irrespective of body site) both
packages shall be billed at 100%.
j) If for any Clinical reason an attempted Laparoscopic Surgery fails and Open Surgery
is performed in the same sitting, then the Surgery performed is to be billed according
to the Open Surgery Tariff with additional charges of laparoscopic equipment.
k) When a patient is admitted to ICU directly, the charges for Surgery shall be according
to the tariff rates applicable to Double Room Category. However, at the time of
transfer from ICU, if the patient opts for a room, which is higher than the Double
Occupancy, the cost of surgery shall be charged according to the tariff applicable to
respective higher occupancy level and the bed charges shall be that of ICU for the
same day but from next day onwards bed charges will be applicable as per higher
occupancy level. If the patient opts for a category lower than the double room
occupancy the cost of surgery shall remain the same as charged while the patient
was in ICU.
l) However, for procedure done in ICU, cost of procedure will be charged as per Single
room category if the patient is in ICU. And, at the time of transfer from ICU, the cost
of procedure shall remain same as per Single room category.
m) Surgeon fee for ICU will be charged as per the Double room charges.
n) For REDO Surgery within 48 hrs, only consumables shall be charged (no extra cost
for Surgeon Fee, OT or Anaesthesia) with prior written approval from Director/ Head
of Department/Departmental Coordinator.
o) For Redo surgeries after 48 hrs-72 hrs, 50% of surgeon fee and percentage shall be
applicable on all subsequent areas i.e. (OT Charges, Anaesthesia Charges).
However, consumables & pharmacy will be charged as per actuals.
p) For Redo surgeries after 72 hrs, all charges shall be charged as per actual.
q) Twin Delivery/Triplet onwards will be charged 50% of first Delivery.
r) In case of packages, No refund will be made to the patient even if patient leaves
early.
s) Service Tax will be charged extra as applicable on all cosmetic procedures as
prescribed by Government notification.

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Billing policy & Guidelines

10. Assistant Surgeon Policy

a) In cases where surgery is of category above 20, an additional charge may be levied
for the Assistant Surgeon’s Fee. However, in special cases and with concurrence of
Medical Superintendent, the same can be levied on surgeries of category 20 &
below. This will be 30% of Primary Surgeon’s fee in case Assistant Surgeon is of
same specialty as Primary Surgeon. Patients in such cases should be informed
beforehand about this additional charge during surgery. Assistant Surgeon is
someone who is the level of Attending Consultant and above and Assistant
Surgeon’s Fee shall be applicable for all surgeries of same surgeon or same
specialty done in one sitting.
b) In special cases where the Surgeon feels that it is in the best interest of Patient to
have presence of a Second Surgeon or Assistant Surgeon (above Attending
Consultant) of a different specialty, then the Second Surgeon or Assistant Surgeon of
different Specialty will be entitled to an additional 50% of the Primary Surgeon’s fee.
Patients in such cases should be informed beforehand about need of Second
Surgeon or Assistant Surgeon during surgery and Assistant Surgeon’s Fee shall be
applicable for all surgeries of same surgeon or same specialty done in one sitting.

11. Procedure and Anaesthesia Charges

a) Hospital policy recommends presence of Anaesthetists, even on topical application


procedure, within the Operating Room (OR).
b) Any minor procedure performed whether planned or as an emergency would be
charged over & above the consultation charges except the Dental procedure where
either the procedure charge or consultation whichever is higher would be charged.
c) In Cardiology Bedside procedures (Echo) will be charged 25% extra and Radiology
Bedside Procedures at 50% extra of OPD charges
d) Standby Anaesthesia Charges for all surgery/procedures will be charged at 25% of
the Surgeon Fee.
e) OT Billing Principles
Description % of Surgeon fee
OT Charges 95%
Anesthesia Charges 35% in case of GA/SA/RA/MAC
OT under LA 85%
Treatment Room Charges 25%

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Billing policy & Guidelines

12. Advance Policy

a) For Planned procedures 100% of the estimate amount to be collected as advanced.


If 100% of the estimated amount has not been cleared / deposited then surgery
clearance shall not be given. Surgery clearance shall be issued post the deposit of
requisite advance.
b) For Emergencies and non-procedure observation patients following advances to be
taken, (Unless the consultant fills an estimate in this case 80% of estimate):

Room Type Advance Amount slab


Suite INR. 55,000/-
Classic Deluxe INR. 45,000/-
Single INR. 35,000/-
Double INR. 30,000/-
Economy INR. 25,000/-
ICU INR. 75,000/-
NICU/PICU INR. 25,000/-

c) (TPA) Retail Customers/ Individual policy Holders: Advance to be taken (as per
policies / Protocols set up by units) where in patients walks in without authorization
letter. Even in case of authorization letter nominal deposits can be asked to recover
non-medical items.
d) The advance should be refunded (on the basis of authorization / after deducting for
the items which are not covered by the TPA’s) to the customer at the time of
discharge by cash or cheque.
e) For TPA or Corporate patients, hospital may ask Patient to deposit advance money
as per policy of the patient; or INR. 5000/- for Corporate patients and INR.10000/- for
Individual policy holders to cover cost of non-medical / admissible items, which are
not paid by TPAs. Unutilized amount should be refunded at the time of discharge.
The Patient needs to sign a consent letter promising that in case TPA denies the
payment of treatment, the entire payment will be made by the patient and the issues
with TPA will be sorted by Patient.
f) Interim bill to be informed to the patient whenever the balance advance amount is
less than INR.10,000/-. At any given time we should have a credit of INR.10,000/-.
For ICU patient’s available balance must be INR. 50, 000/- .
g) Face sheet is to be signed by the patient only. In case of minor or Unconscious
Patient attendant or guardian has to sign the face sheet.

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Billing policy & Guidelines

13. Mode of payment and Refund Policy

a) We accept payment by cash, credit cards and drafts.


b) All cash refunds of INR. 10000 & above and Payment made through Credit card for
INR. 5000 & above will be refunded through cheque/RTGS within 7 working days.
c) RTGS will be transferred within 24 hours or next working day of discharge of the
patient. The detail of RTGS will be sent via email to the patient/attendant.
d) In usual circumstances admission cannot be cancelled unless until patient is unfit for
surgery. In such circumstances refund will be given only with the prior written
approval of Director/ HOD / GM-Ops.
e) All refunds (OPD/ IPD) should be countersigned by the Duty Manager / Head–FO.
f) No individual credit is allowed. In exceptional cases a credit is extended up to 30
days.

14. OT Bookings

a) According to the Surgery Non Refundable OT Booking Advance is to be made by the


Patient.
b) At any given point of time OT Booking amount shall not be refunded except on
medical ground / non availability of OT/ surgeon/ Equipment’s. While refunding the
amount a written approval from the Primary consultant and the GM-Ops is
mandatory.

15. Financial Clearance for Surgery

a) Full advance (100%) of Estimate or as per protocol for TPA/ Corporate patients.
b) Undertaking should be given before the surgery from the operating surgeon.
c) Emergency surgery should be certified by the surgeon and recorded in the patient’s
file, due approval should be taken from DMS/ GM-Ops before giving the financial
clearance.
d) Any emergency surgery clearance should be escalated by the Duty Manager on shift
through email to GM-Ops/ Dy Medical Superintendent/ Head- Front office.

16. Tax Instruction

If any tax is introduced by Government regarding GST or any other tax related
concern same shall be borne by the patient and our customers.

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Billing policy & Guidelines

Note - This policy is applicable only for prevailing Financial Year and Schedule of
charges is liable to change without prior notice.

Max Super Specialty Hospital - Saket Page 12


Packages Tariff
Updated as on
October 1, 2017

Max Super Speciality Hospital


2, Press Enclave Marg
Saket-110017

Page 1 of 29
S. No. Policy Remarks for All Packages

Packages have been designed for the convenience of patient billing at a discounted rate and hence certain limits have been defined
1
for the consumption included in each package.
1.a Pharmacy Consumption and investigation beyond the limits, shall be charged extra and as per actual.

The Max Hospital Management has the right to discontinue a package and to change terms and conditions, without giving any prior
2
information or notice.

3 A fixed length of stay is defined for each package, including exact no. of days in ICU beds.
3.a If a Patient stays longer in ICU bed than defined in package, room differential shall be charged wrt Non ICU bed.
3.b If a Patient stays longer than total length of stay, then full rent of room occupied shall be charged for extra stay.

4 Doctor Consultation, other than Primary Admitting Doctor or other than as defined in package shall be charged extra.

5 Implants will be charged extra and on MRP until and unless specified in package definition.

6 All services shall be charged extra and on actual basis if Patient's stay exceeds than total length of stay defined in package.

7 Any additional Procedure or Surgery, if not defined in package definition, shall be charged extra

8 The management reserve right to change terms and conditions depending on the availability of services.

1st April 2017 - Max Hospital Saket

Page 2 of 29
PACKAGE TARIFF & BILLING

ANGIOPLASTY
Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit Investigation Limit
45226 Angioplasty (Non Complex) 1+1 150,000 170,000 195,000 230,000 260,000 44,800 17,100
45227 Angioplasty (Complex) 1+1 170,000 190,000 220,000 255,000 290,000 44,800 17,100
45228 Angioplasty (Complex and Primary) 1+1 180,000 205,000 235,000 270,000 310,000 44,800 17,100
45706 Angioplasty (Non Complex) with Angiography 1+1 160,000 180,000 205,000 240,000 275,000 47,500 19,500

Inclusions
1 Investigations and pharmacy up to defined limits. Anything beyond limits shall be charged extra as per actual price.
2 Cath Lab charges, procedure charges and surgeon fee shall be included in package.
3 Cardiologist visit and Intensvisit consult during defined ICU stay shall be included in package.
Exclusions
1 Stents are not part of package and shall be billed as per actuals.
2 If two or more stents are used Rs 20,000 shall be charged for each stent used beyond first stent.
3 Integrilin, Reopro, Eptiflo, Streptokinase, Coromaxe, Aggramed, Urokinase or any other Blood Thinner will be charged on actual.
4 Antibiotics, if used, will be charged extra as per actual price.
5 CD charges will be charged extra to package cost if patient request for same.
6 High Risk, Complex, Primary or Emergency PTCA cases shall be billed higher than normal rates as per hospital policy.
7 In case patient undergoes repeat PTCA within a week or during same admission then Re-Do / Re-Procedures
charges shall be applicable as per hospital policy.
8 Billing beyond package days shall be as per actuals and open billing.

OTHER ANGIOPLASTY
Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit Investigation Limit
19461 Balloon Mitral Valvuloplasty 1+1 73,100 81,200 101,500 121,800 142,100 22,000 17,100
25282 Carotid Angioplasty 1+1 154,300 171,400 214,300 257,100 300,000 32,000 17,100
33215 Directional Artherectomy/Rotablator Atherectomy 1+1 166,500 185,000 231,300 277,500 323,800 59,900 17,100
20808 Renal Angioplasty 1+1 116,800 129,800 162,300 194,700 227,200 44,800 17,100
20553 Peripheral Angioplasty(PTA) 1+1 113,000 125,500 156,900 188,300 219,600 16,000 17,100
29259 Peripheral Arterial Embolization/Thrombolysis 1+1 63,300 70,300 87,900 105,500 123,000 22,800 17,100

Inclusions
1 Investigations and pharmacy up to above defined limit.
2 Cath Lab charges, procedure charges and surgeon fee shall be included in package.
3 Cardiologist visit and Intensvisit consult during defined ICU stay shall be included in package.
Exclusions
1 Cost of stent(s) will be charged extra to package cost on actual.
2 Integrilin, Reopro, Eptiflo, Streptokinase, Coromaxe, Aggramed, Urokinase or any other Blood Thinner will be charged on actual
3 Antibiotics, if used, will be charged extra to package cost at applicable rates.
4 Rotaburr, Advancer, Rota Wiire, Directional Artherectomy Equipment when used will be charged extra.

Page 3 of 29
Note
** PTCA - Complex Reprocedure/ Non-Complex Reprocedure are procedure charges ONLY. Other services will be charged on actual.

PACEMAKER IMPLANTATION
Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit Investigation Limit
19457 Single Chamber Pacemaker 1+2 63,700 70,800 88,500 106,200 123,900 8,000 11,400
19458 Double Chamber Pacemaker 1+2 69,200 76,900 96,100 115,400 134,600 13,000 11,400
19459 Bi-Ventricular Pacemaker Implantation 1+2 92,700 103,000 128,800 154,500 180,300 15,000 11,400
40952 TAVI (Trans Catheter Aortic Valve Implantation) 1+2 181,800 202,000 252,500 303,000 353,500 66,000 11,400
43572 Leadless Pacemaker 0+2 114,500 127,200 159,000 190,800 222,600 12,900 11,900

Inclusions
1 Investigations and pharmacy up to above defined limit.
2 Cath Lab charges, procedure charges and surgeon fee shall be included in package.
3 Cardiologist visit and Intensvisit consult during defined ICU stay shall be included in package.
Exclusions
1 All Pacemakers / Device / Filters charges will be extra on actual.
2 Antibiotics, if used, will be charged extra to package cost at applicable rates.

ICD PROCEDURE / COMBO DEVICE


Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit Investigation Limit
32791 AICD 1+3 88,700 98,500 123,100 147,800 172,400 13,000 11,400
20844 ICD Procedure charges 1+3 88,700 98,500 123,100 147,800 172,400 13,000 11,400
42480 Combo device 1+3 95,400 106,000 132,500 159,000 185,500 13,000 11,400

Inclusions
1 Investigations and pharmacy up to above defined limit.
2 Cath Lab charges, procedure charges and surgeon fee shall be included in package.
3 Cardiologist visit and Intensvisit consult during defined ICU stay shall be included in package.
Exclusions
1 The package does not include the cost of combo device (s) / Filters
2 Antibiotics, if used, will be charged extra to package cost at applicable rates.

Page 4 of 29
AORTIC STENT GRAFT INSERTION
Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit Investigation Limit
21392 Aortic Stent Graft Insertion 2+4 120,700 134,100 167,600 201,200 234,700 43,400 17,100

Inclusions
1 Investigations and pharmacy up to above defined limit.
2 Cath Lab charges, procedure charges and surgeon fee shall be included in package.
3 Cardiologist visit and Intensvisit consult during defined ICU stay shall be included in package.
Exclusions
1 Cost of Stent Graft/ Implant (s)
2 Integrilin, Reopro, Eptiflo, Streptokinase, Coromaxe, Aggramed, Urokinase or any other Blood Thinner will be charged extra on actual .
3 Rotaburr, Advancer, Rota Wiire, Directional Artherectomy Equipment if used will be charged extra.
4 Antibiotics if used, will be charged extra at applicable rates.

Page 5 of 29
PULSE GENERATOR REPLACEMENT
Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit Investigation Limit
30385 Pulse Generator Replacement 1+1 68,600 76,200 95,300 114,300 133,400 20,000 17,100

Inclusions
1 Investigations and pharmacy up to above defined limit.
2 Cath Lab charges, procedure charges and surgeon fee shall be included in package.
3 Cardiologist visit and Intensvisit consult during defined ICU stay shall be included in package.
Exclusions
1 Implantation/consumable Charges, cost of device will be charged extra on actual.
2 Antibiotics if used, will be charged extra at applicable rates.

PEDIATRIC CARDIAC SURGERY


Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit Investigation Limit
42617 DSO (Non Complex) 3+6 186,900 217,400 298,200 348,600 391,700 78,000 62,000
42618 DSO (Complex) 3+6 196,400 221,700 264,600 311,900 348,600 78,000 62,000
42619 Ebstein/Truncus Repair+Cost of Conduit(Extra) 3+6 183,800 210,100 273,000 320,300 357,000 78,000 62,000
42620 Norwood Surgery 3+6 196,400 222,700 264,600 311,900 348,600 78,000 62,000
42621 PA Plasty on Pump 3+6 157,500 185,900 219,450 259,400 305,600 78,000 49,100
42622 Pediatric Bidirectional Glenn Off Pump 3+6 136,500 159,600 214,200 254,100 286,700 78,000 49,100
42623 Pediatric Fontan(Complex) 3+6 196,400 221,800 264,600 311,900 348,600 78,000 62,000
42625 Pediatric MV Repair(Complex) 3+6 183,800 211,400 273,000 320,300 357,000 78,000 62,000
42626 Pediatric TOF/Total Correction(Complex) 3+6 178,500 205,700 265,650 311,900 347,600 78,000 62,000
42627 Rastelli+cost of conduit(charged seperately) 3+6 186,900 217,400 298,200 348,600 391,700 78,000 62,000
42628 Rev Surgery 3+6 186,900 217,400 298,200 348,600 391,700 78,000 62,000
42629 Subaortic Membrane Resection(Non Complex) 3+6 165,900 193,200 259,350 308,700 347,600 78,000 49,100
42630 Subaortic Membrane Resection(Complex) 3+6 178,500 204,800 273,000 315,000 351,800 78,000 62,000
19523 Pediatric ASD Repair 3+6 165,900 193,200 259,350 308,700 347,600 70,000 49,100
25298 Pediatric ASO 3+6 188,000 215,300 259,350 308,700 347,600 78,000 62,000
25299 Pediatric AV Canal Repair (Non Complex) 3+6 188,000 215,300 259,350 308,700 347,600 68,300 62,000
25296 Pediatric Bidirectional Glenn On Pump 3+6 165,900 193,200 259,350 308,700 347,600 70,000 49,100
23137 Pediatric Coarctation Repair 3+6 88,200 110,300 143,850 154,400 176,400 40,000 27,800
20650 Pediatric Conduit Repair 3+6 188,000 215,300 259,350 308,700 347,600 78,000 62,000
25301 Pediatric Fontan (Non Complex) 3+6 188,000 215,300 259,350 308,700 347,600 78,000 62,000
25293 Pediatric MV Repair (Non Complex) 3+6 168,000 192,200 249,900 293,000 326,600 70,000 49,100
25302 Pediatric PA Banding 3+6 88,200 110,300 143,850 154,400 176,400 40,000 27,800
25291 Pediatric TOF (Non Complex) 3+6 168,000 192,200 249,900 293,000 326,600 70,000 49,100
38886 Pediatric Valve Repair (Complex) 3+6 191,100 221,600 298,200 354,900 393,800 80,400 62,000
25290 Pediatric VSD Repair 3+6 165,900 193,200 259,350 308,700 347,600 70,000 49,100
25294 Pediatric TAPVC (Non Complex) 3+6 178,500 204,800 273,000 315,000 351,800 70,000 62,000
29620 PDA Ligation On Pump 3+6 113,400 125,000 136,500 158,600 176,400 40,000 27,800
20042 PDA Ligation Off Pump 3+6 77,700 88,200 99,750 127,100 137,600 28,000 27,800
20043 BT Shunt 3+6 93,500 118,700 140,700 156,500 173,300 44,000 27,800
38872 Pediatric AV Repair (Complex) 3+6 186,900 217,500 291,900 348,600 386,400 80,400 62,000
38873 Pediatric DORV 3+6 186,900 217,400 291,900 348,600 386,400 80,400 62,000
39682 Pediatric Kawashima 3+6 173,300 202,700 270,900 324,500 362,300 74,800 62,000

Page 6 of 29
38874 Pediatric Senning 3+6 196,400 225,800 304,500 352,800 394,800 80,400 62,000
38875 Pediatric TAPVC (Complex) 3+6 186,900 217,100 298,200 348,600 391,700 80,400 62,000

Inclusions
1 Investigations and pharmacy up to above defined limit.
2 Psychological counseling and Physiotherapy sitting will be part of package within package stay.
3 CTVS OT charges, procedure changes and surgeon fee shall be included in package.
4 Pediatric Cardiac surgeon visit and Intensvisit consult during defined ICU days shall be included in package.
Exclusions
1 All Prosthetics & Implants ( Patch, Valve , Shunt , Graft , Conduit ) will be charges extra on actual.
2 Aortic Balloon, Cell Saver Kit & Femoral CPB Kit will be charged extra on actual.
3 Antibiotics if used, will be charged extra at applicable rates.

THORACIC SURGERIES
Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit Investigation Limit
27756 Lobectomy 3+4 224,500 249,400 311,800 374,100 436,500 82,300 32,900
27758 Maximal Thymectomy 3+4 127,000 141,100 176,400 211,700 246,900 35,000 32,900
27761 Pleurectomy/Decortication 3+4 200,500 222,800 278,500 334,200 389,900 73,500 32,900
27762 Pneumonectomy 3+4 234,000 260,000 325,000 390,000 455,000 85,800 32,900
27764 Thoracotomy and Pericardial window construction 3+4 146,400 162,700 203,400 244,100 284,700 52,500 32,900

Inclusions
1 Investigations and pharmacy up to above defined limit.
2 Psychological counseling and Physiotherapy sitting will be part of package within package stay.
3 Consult(s) of Microbiological doctor and Pulmonogist will be included in cost of package.
4 CTVS OT charges, procedure changes and surgeon fee shall be included in package.
5 Cardiac Surgeon visit and Intensvisit consult during defined ICU days shall be included in package.
Exclusions
1 Vascular Stapler/Refill Consumables will be charged as per actual

CONGINETAL HEART DISEASE INTERVENTION


Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit Investigation Limit
22965 ASD Device closure 1+2 82,000 102,800 128,500 154,200 179,900 32,200 11,400
33452 VSD Device Closure 1+2 80,500 99,900 124,900 149,900 170,800 32,200 11,400

Page 7 of 29
21249 PDA Device Closure 1+2 74,000 94,800 118,500 142,200 165,900 32,000 11,400
23171 Valvuloplasty / Others 1+2 80,600 89,600 112,000 134,400 156,800 29,100 11,400
23172 Infant Valvuloplasty / Others (Off Pump) 1+2 103,000 114,400 143,000 171,600 200,200 35,000 11,400

Inclusions
1 Investigations and pharmacy up to above defined limit.
2 Psychological counseling and Physiotherapy sitting will be part of package within package stay.
3 Cath Lab charges, procedure charges and surgeon fee shall be included in package.
4 Cardiologist visit and Intensvisit consult during defined ICU stay shall be included in package.
Exclusions
1 Cost of devices (s), Swan GANZ & IABP (Intra Aortic Balloon Pump) will be charged extra to package cost on actual.
2 Antibiotics if used, will be charged extra at applicable rates.

ADULT CARDIAC SURGERY


Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit Investigation Limit
25697 CABG (By pass surgery) 3+4 241,000 267,800 334,800 401,700 468,700 100,000 74,800
28739 CABG (By pass surgery) - High Risk 5+4 300,000 340,000 400,000 560,000 620,000 105,000 74,800
19522 CABG - REDO 3+4 305,900 339,900 424,900 509,900 594,800 120,000 74,800
20847 CABG + Carotid Endarterectomy 3+4 305,900 339,900 424,900 509,900 594,800 110,000 74,800
31617 CABG + LV Aneurysm Repair 3+4 255,000 283,300 354,100 425,000 495,800 110,000 74,800
23025 CABG with any Valve Repair/Replacement 3+4 305,900 339,900 424,900 509,900 594,800 110,000 74,800
31618 CABG + AVR 3+4 305,900 339,900 424,900 509,900 594,800 110,000 74,800
27813 CABG With DVR 3+4 319,900 355,400 444,300 533,100 622,000 120,000 74,800
31619 CABG + Ring Annuloplasty 3+4 273,500 303,900 379,900 455,900 531,800 110,000 74,800
31630 CABG + VSD Closure 3+4 287,400 319,300 399,100 479,000 558,800 110,000 74,800
31631 CABG + ASD Closure 3+4 264,200 293,600 367,000 440,400 513,800 110,000 74,800
31615 CABG - Ministernotomy 3+4 203,900 226,600 283,300 339,900 396,600 100,000 74,800
31634 CABG + MVR + TV Repair / Aneurysm Repair 3+4 315,200 350,200 437,800 525,300 612,900 120,000 74,800

Inclusions
1 Investigations and pharmacy up to above defined limit.
2 Psychological counseling and Physiotherapy sitting will be part of package within package stay.
3 Blood Bank - Cross Matching, Whole Blood, Fresh Frozen Plasma and Random Donor Platelet Concentrate processing charges up to 4 units.
4 Ventilator Equipment charges during defined ICU stay(s).
5 Physiotherapy - Exercise/Therapy up to 12 sittings.
6 CTVS OT charges, procedure changes and surgeon fee shall be included in package.
7 Cardiac Surgeon visit and Intensvisit consult during defined ICU days shall be included in package.
Exclusions
1 All Prosthetics & Implants ( Patch, Valve , Shunt , Graft , Conduit ) will be charges extra on actual.
2 Aortic Balloon, Cell Saver Kit & Femoral CPB Kit will be charged extra on actual.
3 Reopening / Re-Exploration during the package stay will be charges on actual.
4 Antibiotics/Expensive Drugs will be charged extra to package cost.

Page 8 of 29
VALVE SURGERY
Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit Investigation Limit
25161 Mitral Valve Replacement 3+4 244,800 272,000 340,000 408,000 476,000 110,000 83,100
31637 Mitral Valve Repair 3+4 244,800 272,000 340,000 408,000 476,000 100,000 83,100
25289 Aortic Valve Replacement 3+4 244,800 272,000 340,000 408,000 476,000 100,000 83,100
31640 Tricuspid V Repair 3+4 248,600 276,200 345,300 414,300 483,400 100,000 83,100
19530 Double Valve Replacement 3+4 264,600 294,000 367,500 441,000 514,500 100,000 83,100
31643 MVR + LA Clot Removal 3+4 258,000 286,700 358,400 430,100 501,700 110,000 83,100
31645 Mitral Valve Replacement + TV Repair 3+4 293,000 325,500 406,900 488,300 569,600 110,000 83,100
31651 DVR + TV Repair 3+4 297,700 330,800 413,500 496,200 578,900 110,000 83,100
31653 MVR/AVR - Redo 3+4 311,900 346,500 433,100 519,800 606,400 120,000 83,100
31654 AVR/MVR + TVR - Redo 3+4 316,600 351,800 439,800 527,700 615,700 120,000 83,100

Inclusions
1 Investigations and pharmacy up to above defined limit.
2 Psychological counseling and Physiotherapy sitting will be part of package within package stay.
3 Blood Bank - Cross Matching, Whole Blood, Fresh Frozen Plasma and Random Donor Platelet Concentrate processing charges up to 4 units.
4 Ventilator Equipment charges during defined ICU stay(s).
5 Physiotherapy - Exercise/Therapy up to 12 sittings.
6 CTVS OT charges, procedure changes and surgeon fee shall be included in package.
7 Cardiac Surgeon visit and Intensvisit consult during defined ICU days shall be included in package.
Exclusions
1 All Prosthetics & Implants ( Patch, Valve , Shunt , Graft , Conduit ) will be charges extra on actual.
2 Aortic Balloon, Cell Saver Kit & Femoral CPB Kit will be charged extra on actual.
3 Reopening / Re-Exploration during the package stay will be charges on actual.
4 Antibiotics/Expensive Drugs will be charged extra to package cost.

OTHER CARDIAC SURGERY


Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit Investigation Limit
28752 Thoraco Abdominal Aneurysm Repair 3+4 261,000 290,000 362,500 435,000 507,500 85,800 74,800
31661 Bentall Procedure 3+4 305,900 339,900 424,900 509,900 594,800 110,000 74,800
31663 Ascending Aorta Replacement 3+4 305,500 339,400 424,300 509,100 594,000 110,000 74,800
25160 ASD Repair/Closure 3+4 214,100 237,900 297,400 356,900 416,300 100,000 74,800
31665 VSD Closure/Repair 3+4 218,300 242,600 303,300 363,900 424,600 100,000 74,800
25532 Myxoma LA/RA 3+4 238,200 264,700 330,900 397,100 463,200 90,000 74,800
25288 Aneurysmectomy 3+4 248,100 275,700 344,600 413,600 482,500 85,800 74,800
27760 Pericardiectomy 3+4 175,200 194,700 243,400 292,100 340,700 80,000 48,400
37732 Carotid Endartectomy 3+4 127,000 141,100 176,400 211,700 246,900 60,000 48,400

Page 9 of 29
31669 Repair Ruptured Aneurysm Sinus of Valsava on CPB 3+4 341,100 379,000 473,800 568,500 663,300 110,000 74,800
38107 Pulmonary Endarterectomy 3+4 281,800 313,100 391,400 469,700 547,900 100,000 74,800
23140 Aortic Aneurysm repair (Aneusymoraphy) 3+4 248,100 275,700 344,600 413,600 482,500 100,000 83,100

Inclusions
1 Investigations and pharmacy up to above defined limit.
2 Psychological counseling and Physiotherapy sitting will be part of package within package stay.
3 Blood Bank - Cross Matching, Whole Blood, Fresh Frozen Plasma and Random Donor Platelet Concentrate processing charges up to 4 units.
4 Ventilator Equipment charges during defined ICU stay(s).
5 Physiotherapy - Exercise/Therapy up to 12 sittings.
6 CTVS OT charges, procedure changes and surgeon fee shall be included in package.
7 Cardiac Surgeon visit and Intensvisit consult during defined ICU days shall be included in package.
Exclusions
1 All Prosthetics & Implants ( Patch, Valve , Shunt , Graft , Conduit ) will be charges extra on actual.
2 Aortic Balloon, Cell Saver Kit & Femoral CPB Kit will be charged extra on actual.
3 Reopening / Re-Exploration during the package stay will be charges on actual.
4 Antibiotics/Expensive Drugs will be charged extra to package cost.

MINIMALLY INVASIVE CARDIAC SURGERY


Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit Investigation Limit
34143 CABG (Minimally Invasive) 3+4 306,600 340,700 425,900 511,100 596,200 116,000 74,800
34147 MITRAL VALVE REPLACEMENT (Minimally Invasive) 3+4 283,500 315,000 393,800 472,500 551,300 105,000 83,100
34149 AORTIC V REPLACEMENT (Minimally Invasive) 3+4 288,300 320,300 400,400 480,500 560,500 105,000 83,100
34158 ASD CLOSURE / REPAIR (Minimally Invasive) 3+4 258,700 287,400 359,300 431,100 503,000 94,900 74,800

Inclusions
1 Investigations and pharmacy up to above defined limit.
2 Psychological counseling and Physiotherapy sitting will be part of package within package stay.
3 Blood Bank - Cross Matching, Whole Blood, Fresh Frozen Plasma and Random Donor Platelet Concentrate processing charges up to 4 units.
4 Ventilator Equipment charges during defined ICU stay(s).
5 Physiotherapy - Exercise/Therapy up to 12 sittings.
6 CTVS OT charges, procedure changes and surgeon fee shall be included in package.
7 Cardiac Surgeon visit and Intensvisit consult during defined ICU days shall be included in package.
Exclusions
1 All Prosthetics & Implants ( Patch, Valve , Shunt , Graft , Conduit ) will be charges extra on actual.
2 Aortic Balloon, Cell Saver Kit & Femoral CPB Kit will be charged extra on actual.
3 Reopening / Re-Exploration during the package stay will be charges on actual.
4 Antibiotics/Expensive Drugs will be charged extra to package cost.

LIST OF DRUGS NOT INCLUDED IN CARDIAC PACKAGE


S.No. GENERIC NAMES OF ANTIBIOTICS
1 ALBUMIN
2 AMPHOTERICIN B LIPID COMPLEX (ampholip)
3 AZITHROMYCIN (azee, azithral)
4 AZTREO 1GM INJECTION
5 AZTREONAM (ajenam)

Page 10 of 29
6 CEFETAMET PIVOXIL (altamet)
7 CEFTAZIDIME (fortum)
8 CEFTIZOXIME (cefizox)
9 CEFTRIAXONE + TAZOBACTUM (xone)
10 CELEMIX
11 CLARITHROMYCIN (claribid, klacid, crixan, synclar)
12 CLINDAMYCIN (dalacin, dalcinex)
13 DEMECLOCYCLINE (ledermycin)
14 FAROPENEM (faronem)
15 FORTUM INJ 1GM VIAL
16 IMIPENEM+CILASTATIN (cilanem, zienem)
17 INJ. LIPOSOMAL AMPHOTERICIN B (ambisome, fungisome,abelcet)
18 JNTRALIPID 20% 250ML
19 LINCOMYCIN (lynx)
20 MEROPENAM (meronem, merotroyl)
21 MINOCYCLINE(cynomycin, minoz)
22 PERCUTANEOUS TRACHEOSTOMY 7 FR(PCT KIT) WITHOUT FORECEP - PORTEX
23 PERCUTANEOUS TRACHEOSTOMY 8 FR(PCT KIT) WITH FORECEP - PORTEX
24 PERCUTANEOUS TRACHEOSTOMY 8 FR(PCT KIT) WITHOUT FORECEP - PORTEX
25 PERITONIAL DIALYSIS CATHETER - ADULT (ROMSONS)
26 PERITONIAL DIALYSIS FLUID 1 LITRE
27 PERITONIAL DIALYSIS INFUSION SET (B.BRAUN)
28 PIPERACILIN SODIUM + TAZOBACT SODIUM (tajact, zosyn)
29 PIPERACILLIN SODIUM (pipracil)
30 POLYMYXINS (poly-b)
31 PRIMACOR 10 ML INJECTION
32 SOLU- MEDROL INJ 125MG/2 ML VIAL
33 TARGOCID 200MG INJ
34 TARGOCID 400MG INJ
35 TAZACT 2.25GM INJ
36 TAZACT 4.5GM INJ
37 TICARCILLIN +CLAVULANATE K (timentin)
38 VORICONAZOLE (vgend, voraz)

HEART TRANSPLANT LVAD PACKAGE


Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit Investigation Limit
38784 Heart Transplant LVAD 5+15 - 7,020,000 7,020,000 7,720,000 8,920,000 535,000 201,300

Inclusions
1 Investigations and pharmacy up to above defined limit. Rest on actual.
2 Psychological counseling and Physiotherapy sitting will be part of package within package stay.
3 Blood Bank - Cross Matching, Whole Blood, Fresh Frozen Plasma and Random Donor Platelet Concentrate processing charges up to 5 units.
4 CTVS OT charges, procedure changes and surgeon fee shall be included in package.
5 Cardiac Surgeon visit and Intensvisit consult during defined ICU days shall be included in package.

Page 11 of 29
KNEE REPLACEMENT PACKAGE
Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit Investigation Limit
20163 Ortho Unilateral Total Knee Replacement 1+5 177,600 195,000 238,500 282,100 325,600 45,000 31,000
29293 Ortho Co plex TKR –U/L 1+5 202,000 219,000 263,000 306,000 350,000 45,000 31,000
46574 Ortho Complex Revision TKR-U/L 1+5 226,000 246,000 297,000 347,000 397,000 45,000 31,000
46573 Ortho Complex TKR -B/L 1+5 330,000 360,000 436,000 513,000 589,000 55,000 37,300
22929 Ortho Unilateral Total Knee Replacement Revision 1+5 222,000 243,800 298,100 352,600 407,000 45,000 31,000
20164 Ortho Bilateral TKR (Single Sitting) 2+6 299,500 330,000 406,300 482,500 558,800 55,000 37,300

Inclusions
1 Investigations and pharmacy up to above defined limit.
2 Orthopedics & Internal medicine consult charges are included in cost of package.
3 Procedures like strapping, dressing etc are included in cost of package
4 Pre Anesthesia consult is included in cost of package
5 Blood Bank - Cross Maching charges and Red Blood Cells processing charges up to 2 units.
6 OT charges, procedure change,surgeon fee and surgeon consult shall be included in package.
Exclusions
1 Implant(s) will be charged extra to package cost on actual with applicable taxes and surcharges.
2 For use of computer assisted surgery, Rs 10,000/- per joint will be charged extra to package cost.
3 Accessories like walker, belts etc are not a part of the package.

HIP REPLACEMENT PACKAGE


Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit Investigation Limit
21156 Ortho Unilateral Total Hip Replacement/ASR 1+5 159,700 177,400 221,800 266,100 310,500 45,000 30,100
36469 Ortho Unilateral THR Revision 1st Stage 1+5 151,800 168,700 210,900 253,100 295,200 45,000 30,100
29291 Ortho Complex Primary / THR 1+5 170,400 189,300 236,600 284,000 331,300 45,000 30,100
20669 Ortho Unilateral Total Hip Replacement Revision 1+5 199,600 221,800 277,300 332,700 388,200 45,000 30,100
20171 Ortho Bilateral THR (Single Sitting) 2+6 279,700 310,800 388,500 466,200 543,900 55,000 37,300

Inclusions
1 Investigations and pharmacy up to above defined limit.
2 Orthopedics & Internal medicine consult charges are included in cost of package.
3 Procedures like strapping, dressing etc are included in cost of package
4 Pre Anesthesia consult is included in cost of package
5 Blood Bank - Cross Maching charges and Red Blood Cells processing charges up to 2 units.
6 OT charges, procedure change,surgeon fee and surgeon consult shall be included in package.
Exclusions
1 Implant(s) will be charged extra to package cost on actual with applicable taxes and surcharges.
2 For use of computer assisted surgery, Rs 10,000/- per joint will be charged extra to package cost.
3 Accessories like walker, belts etc are not part of the package.

Page 12 of 29
OTHER ORTHO SURGERY PACKAGE
Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit Investigation Limit
44872 ACL/PCL/MCL/Benkart/Rotator Cuff Repair 0+2 76,500 89,500 102,500 119,200 158,500 26,900 19,200
44874 Arthoscopy/Meniscus/Biopsy 0+2 54,900 62,950 77,900 90,500 127,000 18,900 16,900

Inclusions
1 Investigations and pharmacy up to above defined limit.
2 Procedures like strapping, dressing etc are included in cost of package
3 Pre Anesthesia consult is included in cost of package
4 OT charges, procedure change,surgeon fee and surgeon consult shall be included in package.
Exclusions
1 Implant(s) will be charged extra to package cost on actual with applicable taxes and surcharges.
2 Accessories like walker, belts etc are not part of the package.

GENERAL SURGERY PACKAGE


Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit Investigation Limit
43855 Fissurectomy 0+2 44,100 50,900 67,000 80,900 129,300 7,500 8,100
43856 Haemorrhoidectomy with Fissurectomy 0+2 81,100 91,400 114,600 139,000 212,000 10,800 19,000
43859 Fistula in Ano - Low End 0+2 50,100 55,800 68,300 81,900 121,700 9,000 12,100
43858 Fistula in Ano - High End 0+2 59,500 67,700 86,500 104,300 162,000 10,500 11,900
43853 Haemorrhoidectomy 0+2 59,000 67,200 86,000 103,800 161,500 10,700 11,500
43849 Lap Ventral/Incisional Hernia Repair 0+2 78,500 87,500 109,100 131,000 198,200 21,100 12,100
43850 Umbilical Herniorraplasty 0+2 69,900 78,600 98,300 117,600 178,800 17,300 12,100
45009 Lap Appendectomy 0+2 90,300 99,300 120,900 142,800 210,000 29,500 15,300

Inclusions
1 Investigations and pharmacy up to above defined limit.
2 OT charges, procedure change,surgeon fee and surgeon consult shall be included in package.
Exclusions
1 Ace harmonic scalpel, if used, will be charged extra to package cost on actual.
2 Cartridge for linear cutter gun will be charged on actual if used along with linear cutter gun.
3 PAC if done will be charged extra to package cost on actual.

GENERAL SURGERY PACKAGE


Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit Investigation Limit
28658 Lap Cholecystectomy 0+2 68,000 85,500 109,000 128,300 149,600 7,000 -
28665 Lap Inguinal Hernia Repair - B/L 0+2 79,000 101,600 126,000 152,400 177,800 20,200 -

Inclusions
1 Pharmacy up to above defined limit.
2 OT charges, procedure change,surgeon fee and surgeon consult shall be included in package.
Exclusions
1 Investigations will be charged extra to package cost on actual.
2 Ace harmonic scalpel, if used, will be charged extra to package cost on actual.
3 Cartridge for linear cutter gun will be charged on actual if used along with linear cutter gun

Page 13 of 29
4 PAC if done will be charged extra to package cost on actual.

COCHLEAR IMPLANT SURGERY PACKAGE


Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit Investigation Limit
38528 Cochlear Implant Surgery 0+2 98,000 103,000 110,000 117,000 130,000 - -

Inclusions
1 OT charges, procedure change,surgeon fee and surgeon consult shall be included in package.
Exclusions
1 Pharmacy and Investigations will be charged extra to package cost on actual.
2 Laser/ Special Equipment if used, will be charged extra to package cost.

ENT SURGERY PACKAGE


Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit Investigation Limit
44883 FESS 0+2 73,100 84,100 108,600 134,900 212,600 7,500 9,000
46416 Total Thyroidectomy 0+2 105,000 120,000 150,000 185,000 285,000 15,000 6,000
46417 Minimal Invasive Cochlear Implantation 0+2 150,000 175,000 220,000 276,000 428,000 15,000 6,000

Inclusions
1 Investigations and pharmacy only up to defined limit.
2 OT charges, procedure change,surgeon fee and surgeon consult shall be included in package.
Exclusions
1 Laser/ Special Equipment if used, will be charged extra to package cost.

CAESAREAN MATERNITY PACKAGE


Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit Investigation Limit
22870 Caesarean Section Delivery (LSCS) 0+3 78,200 86,900 108,600 130,400 173,800 - 1,000
31328 Caesarean Section Delivery - High Risk 0+3 89,900 99,900 124,900 150,000 199,900 - 1,000
34636 Caesarean Delivery - Special Package 0+3 98,600 109,600 137,000 164,400 219,200 - 1,000

Inclusions
1 OPV , Hep B and BCG Immunization is included in package
2 Package includes observation of Baby in Nursery immediately after delivery up to 6 hours.
If the stay of baby exceeds beyond 6 hrs due to complication then all services including bed charge will be charged on actual depending on the NICU level.

Page 14 of 29
3 OAE screening is part of package.
4 Physiotherapy is included in package
5 Fetal Monitoring up to 9 hrs will be included in package. Rest will be charged as per policy.
6 OT/ Labour room charges, procedure changes and surgeon fee shall be included in package.
7 Obs & Gyne visit and Pediatric doctor consult shall be included in package.
Exclusions
1 Pharmacy and investigations are not included in package and will be charged on actual.
2 Pre Anesthesia consult will be charged extra
3 In case of twin delivery; all charges related to the child will be charged X 2 and mother X 1.5
4 All other services other than above heads will be charged additional.
5 Charges for Epidural (if used) will be extra.
6 In case of Normal delivery, epidural will be charged 100%.
7 In case Epidural is given and later patient is taken up for caesarean the charges will be 50% of Epidural + 100% of SA/RA/GA
8 Incase Epidural fails it should be written by the Gynecologist on OT/activity sheet that it shall not be charged to the patient.
Note
1 Incase of High-risk Pregnancy, please ask for High-risk package and clarify the reason for High Risk from your Gynecologist.
2 Packages are non negotiable, No refunds if the patient leaves early.

NORMAL DELIVERY MATERNITY PACKAGE


Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit Investigation Limit
22702 Normal Delivery (NVD) 0+3 78,200 86,900 108,600 130,400 173,800 - 1,000
35552 Normal Delivery (NVD) - High Risk 0+3 89,900 99,900 124,900 150,000 199,900 - 1,000

Inclusions
1 OPV , Hep B and BCG Immunization is included in package
2 Package includes observation of Baby in Nursery immediately after delivery up to 6 hours.
If the stay of baby exceeds beyond 6 hrs due to complication then all services including bed charge will be charged on actual depending on the NICU level.
3 OAE screening is part of package.
4 Physiotherapy is included in package
5 Fetal Monitoring up to 9 hrs will be included in package. Rest will be charged as per policy.
6 Labour room charges, procedure changes and surgeon fee shall be included in package.
7 Obs & Gyne visit and Pediatric doctor consult shall be included in package.
Exclusions
1 Pharmacy and investigations are not included in package and will be charged on actual.
2 Pre Anesthesia consult will be charged extra
3 In case of twin delivery; all charges related to the child will be charged X 2 and mother X 1.5
4 All other services other than above heads will be charged additional.
5 Charges for Epidural (if used) will be extra.
6 In case of Normal delivery, epidural will be charged 100%.
7 In case Epidural is given and later patient is taken up for caesarean the charges will be 50% of Epidural + 100% of SA/RA/GA
8 Incase Epidural fails it should be written by the Gynecologist on OT/activity sheet that it shall not be charged to the patient.
Note
1 Incase of High-risk Pregnancy, please ask for High-risk package and clarify the reason for High Risk from your Gynecologist.
2 Packages are non negotiable, No refunds if the patient leaves early.

Page 15 of 29
LDR MATERNITY PACKAGE
Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit Investigation Limit
31598 Normal Delivery (NVD) - LDR Room 0+3 118,600 118,600 118,600 130,400 173,800 6,700 1,000
31597 C Section Maternity - LDR Room 0+3 118,600 118,600 118,600 130,400 173,800 11,000 1,000

Inclusions
1 OPV , Hep B and BCG Immunization is included in package
2 Package includes observation of Baby in Nursery immediately after delivery up to 6 hours.
If the stay of baby exceeds beyond 6 hrs due to complication then all services including bed charge will be charged on actual depending on the NICU level.
3 OAE screening is part of package.
4 Physiotherapy is included in package
5 Fetal Monitoring up to 9 hrs will be included in package. Rest will be charged as per policy.
6 OT/ Labour room charges, procedure changes and surgeon fee shall be included in package.
7 Obs & Gyne visit and Pediatric doctor consult shall be included in package.
Exclusions
1 Pharmacy and investigations are not included in package and will be charged on actual.
2 Pre Anesthesia consult will be charged extra
3 In case of twin delivery; all charges related to the child will be charged X 2 and mother X 1.5
4 All other services other than above heads will be charged additional.
5 Charges for Epidural (if used) will be extra.
6 In case of Normal delivery, epidural will be charged 100%.
7 In case Epidural is given and later patient is taken up for caesarean the charges will be 50% of Epidural + 100% of SA/RA/GA
8 Incase Epidural fails it should be written by the Gynecologist on OT/activity sheet that it shall not be charged to the patient.
Note
1 Incase of High-risk Pregnancy, please ask for High-risk package and clarify the reason for High Risk from your Gynecologist.
2 Packages are non negotiable, No refunds if the patient leaves early.

TWIN DELIVERY MATERNITY PACKAGE


Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit Investigation Limit
34825 Twin Delivery Normal (NVD) 0+3 117,300 130,400 162,900 195,600 260,700 - 1,000
34826 Twin Delivery Caesarean (LSCS) 0+3 117,300 130,400 162,900 195,600 260,700 - 1,000

Inclusions
1 OPV , Hep B and BCG Immunization is included in package
2 Package includes observation of Baby in Nursery immediately after delivery up to 6 hours.
If the stay of baby exceeds beyond 6 hrs due to complication then all services including bed charge will be charged on actual depending on the NICU level.
3 OAE screening is part of package.
4 Physiotherapy is included in package
5 Fetal Monitoring up to 9 hrs will be included in package. Rest will be charged as per policy.
6 OT/ Labour room charges, procedure changes and surgeon fee shall be included in package.
7 Obs & Gyne visit and Pediatric doctor consult shall be included in package.

Page 16 of 29
Exclusions
1 Pharmacy and investigations are not included in package and will be charged on actual.
2 Pre Anesthesia consult will be charged extra
3 In case of twin delivery; all charges related to the child will be charged X 2 and mother X 1.5
4 All other services other than above heads will be charged additional.
5 Charges for Epidural (if used) will be extra.
6 In case of Normal delivery, epidural will be charged 100%.
7 In case Epidural is given and later patient is taken up for caesarean the charges will be 50% of Epidural + 100% of SA/RA/GA
8 Incase Epidural fails it should be written by the Gynecologist on OT/activity sheet that it shall not be charged to the patient.
Note
1 Incase of High-risk Pregnancy, please ask for High-risk package and clarify the reason for High Risk from your Gynecologist.
2 Packages are non negotiable, No refunds if the patient leaves early.

TRIPLET DELIVERY CAESAREAN MATERNITY PACKAGE


Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit Investigation Limit
37227 Triplet Delivery Caesarean Section 0+3 136,900 152,100 190,100 228,200 304,200 - 1,000

Inclusions

Page 17 of 29
1 OPV , Hep B and BCG Immunization is included in package
2 Package includes observation of Baby in Nursery immediately after delivery up to 6 hours.
If the stay of baby exceeds beyond 6 hrs due to complication then all services including bed charge will be charged on actual depending on the NICU level.
3 OAE screening is part of package.
4 Physiotherapy is included in package
5 Fetal Monitoring up to 9 hrs will be included in package. Rest will be charged as per policy.
6 OT/ Labour room charges, procedure changes and surgeon fee shall be included in package.
7 Obs & Gyne visit and Pediatric doctor consult shall be included in package.
Exclusions
1 Pharmacy and investigations are not included in package and will be charged on actual.
2 Pre Anesthesia consult will be charged extra
3 In case of twin delivery; all charges related to the child will be charged X 2 and mother X 1.5
4 All other services other than above heads will be charged additional.
5 Charges for Epidural (if used) will be extra.
6 In case of Normal delivery, epidural will be charged 100%.
7 In case Epidural is given and later patient is taken up for caesarean the charges will be 50% of Epidural + 100% of SA/RA/GA
8 Incase Epidural fails it should be written by the Gynecologist on OT/activity sheet that it shall not be charged to the patient.
Note
1 Incase of High-risk Pregnancy, please ask for High-risk package and clarify the reason for High Risk from your Gynecologist.
2 Packages are non negotiable, No refunds if the patient leaves early.

ONCOLOGY SURGERY PACKAGE


Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit Investigation Limit
29272 Breast Conservation Surgery 0+2 85,100 94,600 118,300 141,900 165,600 - 16,300
28725 Modified Radical Mastectomy 0+2 105,900 117,700 147,100 176,500 206,000 19,200 32,400
30612 Modified Radical Mastectomy (MRM)/BCS Without IHC 0+2 94,825 105,383 131,681 158,091 184,355 19,200 16,300
30613 Modified Radical Mastectomy (MRM)/BCS With IHC 0+2 103,660 115,087 143,743 172,644 201,397 19,200 16,300
30615 Modified Radical Mastectomy/BCS with IHC B/L 0+2 145,300 161,400 201,800 242,100 282,500 19,200 16,300

Inclusions
1 Investigations and pharmacy only up to defined limit.
2 Physiotherapy - Exercise/Therapy up to 2 sittings.
3 OT charges, procedure change,surgeon fee and surgeon consult shall be included in package.
Exclusions
1 Other diagnostice procedure if done shall be charged extra on actual.

THYROIDECTOMY - TOTAL / COMPLETION PACKAGE


Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit Investigation Limit
28730 Thyroidectomy-Total/Completion thyroidectomy 0+3 56,000 74,900 103,500 112,400 131,100 - 7,000

Inclusions
1 Investigations up to above defined limit.
2 Physiotherapy - Exercise/Therapy up to 2 sittings.
3 OT charges, procedure change,surgeon fee and surgeon consult shall be included in package.
Exclusions
1 Pharmacy is not included in package and will be charged on actual.

Page 18 of 29
2 Other diagnostice procedure if done shall be charged extra on actual.

LAP HEMICOLECTOMY PACKAGE


Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit Investigation Limit
28727 Lap Hemicolectomy 1+7 111,000 143,900 197,600 215,900 251,800 - 25,000

Inclusions
1 Investigations up to above defined limit.
2 Physiotherapy - Exercise/Therapy 8 sittings.
3 Blood Bank - Cross Matching charges up to 4 units.
4 OT charges, procedure change,surgeon fee and surgeon consult shall be included in package.
Exclusions
1 Pharmacy is not included in package and will be charged on actual.
2 Other diagnostice procedure if done shall be charged extra on actual.

NEPHRECTOMY PACKAGE
Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit Investigation Limit
28728 Nephrectomy 1+4 100,400 111,500 139,400 167,300 195,100 - 15,600

Inclusions
1 Investigations up to above defined limit.
2 Physiotherapy - Exercise Therapy 4 sittings.
3 Blood Bank - Cross Matching charges up to 2 units.
4 OT charges, procedure change,surgeon fee and surgeon consult shall be included in package.
Exclusions
1 Pharmacy is not included in package and will be charged on actual.
2 Other diagnostice procedure if done shall be charged extra on actual.

RENAL TRANSPLANTATION
Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit Investigation Limit
35378 Renal Transplantation - Recipient 3+5 - 445,000 470,000 505,000 615,000 122,000 111,100

Page 19 of 29
Inclusions
1 Investigations and pharmacy up to above defined limit.
2 1 Dialysis - Pre operative
3 Urologist & Nephrologist consultation(s) are included in package as per policy and 7 Post discharge consultations.
4 For Recipient - 4 components of Blood Bank, 1 qty each of Bair Hugger, DVT Pump, Fixomull, Sonosite
5 For Donor - 4 components of Blood Bank, 5 of DVT Pump and 1 qty each of Fixomull, Sonosite
6 Oxygen and Ventilator up to 3 days of stay in ICU
7 OT charges, procedure changes and surgeon fee shall be included in package.
8 Intensvisit consult during defined ICU days shall be included in package.
9 Donor stay for 5 days is included.
Exclusions
1 Pre Operative Donor Work ups & recipient preparation.
2 Medication like Simulect Inj, ATG Mycophenalate ,Gancyclovir, Hbig, OKT3 , FK506 ,and other imported medication will be charged extra
3 Corrective surgery if any, after transplant for complications or biopsy after 10 days
4 Any invasive Cardiac Imaging or Intervention for heart disease that is required post operatively.
5 Difference of room rent will be charges additionally if the donor or recipient stays in higher category of ward other than included in package.
6 Medications & management of any pre existing illness like diobetes Mellitus, Hypertension T B Etc.
7 Any Special equipment used will be charged extra.

CADAVER RENAL TRANSPLANTATION


Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit Investigation Limit
36976 Cadaver Renal Transplantation 3+5 - 425,000 450,000 480,000 585,000 110,000 89,900

Inclusions
1 Investigations and pharmacy up to above defined limit. Rest on actual.
2 1 Dialysis - Pre operative
3 Consult(s) of Urologist & Nephrologist will be included in package & Post discharge 7 consultations.
4 Only Urologist & Nephrologist consultation will be charged inside the package as per policy & Post discharge consultation (7 visits)
5 Blood Bank - Cross Matching and PackedRBC Leucodepleted By Integral processing charges up to 4 units.
6 Equipment - DVT pump up to 5 units and Fixomull, Sonosite up to 2 units
7 Ventilator Equipment charges during defined ICU stay(s).
8 OT charges, procedure changes and surgeon fee shall be included in package.
9 Intensvisit consult during defined ICU days shall be included in package.
Exclusions
1 Pre Operative Donor Work ups & recipient preparation.
2 Medication like Simulect Inj, ATG Mycophenalate ,Gancyclovir, Hbig, OKT3 , FK506 ,and other imported medication will be charged extra
3 Corrective surgery if any, after transplant for complications or biopsy after 10 days
4 Any invasive Cardiac Imaging or Intervention for heart disease that is required post operatively.
5 Difference of room rent will be charges additionally if the donor or recipient stays in higher category of ward other than included in package.
6 Medications & management of any pre existing illness like diobetes Mellitus, Hypertension T B Etc.
7 Any Special equipment used will be charged extra.

LIVER TRANSPLANTATION
Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit
45082 Liver Transplantation (Adult) 21 days - 1,830,000 1,900,000 2,000,000 2,100,000 500,000
45085 Liver Transplantation (Cadaver) 21 days - 2,100,000 2,200,000 2,300,000 2,400,000 500,000
45083 Liver Transplantation (Child above 5 yrs) 21 days - 1,530,000 1,600,000 1,700,000 1,800,000 500,000

Page 20 of 29
45084 Liver Transplantation (Child below 5 yrs) 21 days - 1,430,000 1,500,000 1,600,000 1,700,000 500,000

Inclusions
1 Pharmacy up to defined limit.
2 Investigations are all inclusive.
3 Post discharge medicines for 5 days
4 ERCP, Endoscopy, Nephrology Consultations
5 Re-exploration during package stay will not be charged extra.
6 In case of stay beyond package days (upto 15 additional days) only pharmacy and doctor visit fee shall be charged
7 Donor stay for 10 days is included.
8 OT charges, procedure changes and surgeon fee shall be included in package.
Exclusions
1 OPD pre work-up package for Recipient Rs 90,000/- and Donor Rs 75,000/-
2 Immunosuppressant, Nova 7, DNA Profiling, DSA Lab procedure
3 In case of High Risk, High Risk Charges for Liver Transplantation for Rs 300,000/- will be charged extra.

LIVER AND KIDNEY TRANSPLANTATION


Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit
45086 Liver and Kidney Transplantation (Adult) 21 days - 2,430,000 2,500,000 2,600,000 2,700,000 600,000
45087 Liver and Kidney Transplantation (Cadaver) 21 days - 2,700,000 2,800,000 2,900,000 3,000,000 600,000

Inclusions
1 Pharmacy up to defined limit.
2 Investigations are all inclusive.
3 Post discharge medicines for 5 days
4 ERCP, Endoscopy, Nephrology Consultations
5 Re-exploration during package stay will not be charged extra.
6 In case of stay beyond package days (upto 15 additional days) only pharmacy and doctor visit fee shall be charged
7 Donor stay for 10 days is included.
8 OT charges, procedure changes and surgeon fee shall be included in package.
Exclusions
1 OPD pre work-up package for Recipient Rs 100,000/- and Donor Rs 80,000/-
2 Immunosuppressant, Nova 7, DNA Profiling, DSA Lab procedure
3 In case of High Risk, High Risk Charges for Liver Transplantation for Rs 300,000/- will be charged extra.

Page 21 of 29
UROLOGY SURGERY
Item ID Package Name ICU+Ward Economy Double Single Classic Deluxe Suite Pharmacy Limit Investigation Limit
35633 Bladder neck incision with Holmium Laser 0+2 82,200 91,300 114,100 137,000 159,800 12,900 -
35632 Lap Renal Cyst Deroofing 0+2 117,500 130,500 163,100 195,800 228,400 18,500 7,600
35628 PCNL - Redo 0+3 63,000 70,000 87,500 105,000 122,500 16,500 -
35629 TURBT 0+3 86,900 96,500 120,600 144,800 168,900 13,700 4,600
35625 TURP 0+3 98,400 109,300 136,600 164,000 191,300 30,900 4,600
37096 Open Renal Cyst Deroofing 0+3 121,200 134,700 168,400 202,100 235,700 19,100 7,600
35643 Lap Pyeloplasty 0+4 179,500 199,400 249,300 299,100 349,000 28,200 4,600
35639 Laser TURP (Holep) 0+4 179,500 199,400 249,300 299,100 349,000 56,400 4,600
35626 PCNL - U/L 0+4 123,200 136,900 171,100 205,400 239,600 32,300 7,600
37092 Open partial Nephrectomy 0+5 196,700 218,600 273,300 327,900 382,600 41,200 11,000
37093 Open Pyeloplasty 0+5 168,000 186,700 233,400 280,100 326,700 26,400 7,600
35641 Lap Radical Nephrectomy 1+3 179,500 199,400 249,300 299,100 349,000 37,600 6,700

Inclusions
1 Investigations and pharmacy only up to defined limit.
2 OT charges, procedure change,surgeon fee and surgeon consult shall be included in package.
Exclusions
1 Laser/ Special Equipment if used, will be charged extra to package cost.

Page 22 of 29
ANGIOGRAPHY
Pharmacy Investigation
Item ID Package Name ICU+Ward Day Care Economy Double Single Classic Deluxe Suite
Limit Limit
19453 Coronary Angiography 0+1 15,000 16,700 18,500 28,000 37,000 39,500 6,000 5,500
25279 Peripheral Angiography 0+1 15,600 17,100 19,000 26,000 28,500 33,300 4,200 5,500
20935 Renal Angiography 0+1 15,200 16,700 18,500 23,100 27,800 32,400 4,200 5,500
19456 Carotid Angiography 0+1 14,900 16,400 18,200 22,800 27,300 31,900 4,200 5,500
20555 Coronary plus Carotid Angiography 0+1 19,400 21,300 23,700 29,600 35,600 41,500 4,200 5,500
25280 Coronary plus Peripheral Angiography 0+1 19,400 21,300 23,700 29,600 35,600 41,500 4,200 5,500
25281 Coronary plus Renal Angiography 0+1 19,800 21,800 24,200 30,300 36,300 42,400 4,200 5,500
19520 Check Angiography 0+1 12,400 13,600 15,100 18,900 22,700 26,400 4,200 4,000
39240 Endomyocardial Biopsy 0+1 39,500 49,400 61,800 65,000 78,000 86,000 4,200 5,500

Inclusions
1 Investigations and pharmacy up to above defined limit.
2 Cath Lab charges, procedure charges and surgeon fee shall be included in package.
3 Cardiologist visit and Intensvisit consult during defined ICU stay shall be included in package.
Exclusions
1 VISIPAQUE dye & Antibiotics used will be charged extra on actual
2 Integrilin, Reopro, Eptiflo, Streptokinase, Coromaxe, Aggramed, Urokinase or any other Blood Thinner will be charged on actual
3 Antibiotics if used will be charged extra on actual.
Note
** Check CAG will be charged to the following patients
1.1 Who had PTCA or CABG within one year in MAX network
1.2 Who, as a part of a Study / Trial and following PTCA or CABG in the same hospitalization due to some clinical indication to restudy
1.3 When Angio and Angioplasty done in same sitting Package stay will be for 2 days for both procedures together.

PACEMAKER EXPLANATION
Pharmacy Investigation
Item ID Package Name ICU+Ward Day Care Economy Double Single Classic Deluxe Suite
Limit Limit
39169 Pacemaker Explanation 0+1 39,900 43,800 48,700 60,900 73,100 85,200 - -

Inclusions
1 Only Room Rent, Procedure cost & Doctor consult.
Inclusions
1 Pharmacy and investigation is not included in package and will be charged on actual.

EPS/ RF ABLATION
Pharmacy Investigation
Item ID Package Name ICU+Ward Day Care Economy Double Single Classic Deluxe Suite
Limit Limit
20052 EPS Basic 0+1 16,900 18,500 20,600 25,800 30,900 36,100 3,500 5,500
20053 EPS Complete 0+1 27,300 30,000 33,300 41,600 50,000 58,300 6,500 5,500
20051 RF Ablation with EP 0+1 87,700 87,700 98,700 115,500 138,700 162,300 20,000 11,400
29715 3D R F Ablation with EPS 0+1 - 151,800 168,700 210,900 253,100 295,200 75,000 11,400

Page 23 of 29
Inclusions
1 Investigations and pharmacy up to above defined limit.
2 Cath Lab charges, procedure charges and surgeon fee shall be included in package.
3 Cardiologist visit and Intensvisit consult during defined ICU stay shall be included in package.
Exclusions
1 Device(s) if used, will be charged extra to package cost on actual.
2 Antibiotics if used will be charged extra on actual.

ECMO Initiation
Pharmacy Investigation
Item ID Package Name ICU+Ward Day Care Economy Double Single Classic Deluxe Suite
Limit Limit
35326 ECMO Initiation 1+0 409,600 409,600 409,600 409,600 409,600 409,600 - -

Inclusions
1 Package includes initiation charges, Permanent Life support set
2 Arterial Cannula
3 Venuous Cannula
Exclusions
1 Drugs and Medical consumables (except that mentioned in inclusion) will be charged on actual
2 ECMO Maintenance Charges are subject to per day usage if patient does not require for a week under any circumstances

UROLOGY SURGERY PACKAGE


Pharmacy Investigation
Item ID Package Name ICU+Ward Day Care Economy Double Single Classic Deluxe Suite
Limit Limit
35607 A-V Fistula 0+1 36,200 39,700 44,100 55,100 66,200 77,200 1,500 1,300
35622 CAPD Insertion 0+1 36,200 39,700 44,100 55,100 66,200 77,200 6,000 1,300
35608 Circumcision 0+1 18,700 19,600 26,500 33,100 39,800 46,400 1,500 1,300
35623 Cystoscopy + Bladder Biopsy 0+1 36,200 39,700 44,100 55,100 66,200 77,200 1,500 1,300
35609 Cystoscopy Diagnostic 0+1 26,900 29,500 32,800 41,000 49,200 57,400 1,500 1,300
30546 D/J Stent Removal - B/L 0+1 20,900 23,000 25,500 31,900 38,300 44,600 1,500 1,300
35663 D/J Ste t Re oval – U/L 0+1 16,600 18,200 20,200 25,300 30,300 35,400 1,500 1,300
35614 ESWl stone <1 cm 0+1 31,300 34,400 38,200 47,800 57,300 66,900 8,500 1,300
35615 ESWl stone >1 cm 0+1 36,200 39,700 44,100 55,100 66,200 77,200 10,000 1,300
30543 Hydrocele Surgery-UL 0+1 24,400 26,700 29,700 37,100 44,600 52,000 4,200 1,300
35635 Microscopic Vaicocelectomy 0+1 81,600 89,600 99,500 124,400 149,300 174,100 12,600 1,300
35662 OIU 0+1 49,500 54,400 60,400 75,500 90,600 105,700 7,700 1,300
35611 Orchidectomy - B/L 0+1 33,000 36,300 40,300 50,400 60,500 70,500 5,100 1,300
35621 PCN Percutaneous Nephrostomy 0+1 47,400 52,000 57,800 72,300 86,700 101,200 7,700 1,300
35619 RIRS - U/L 0+1 84,300 92,500 102,800 128,500 154,200 179,900 23,800 1,300
35613 Trus Guided Prostate Biopsy 0+1 30,200 33,100 36,800 46,000 55,200 64,400 1,500 1,300
35783 Urethral Dilatation 0+1 15,700 17,200 19,100 23,900 28,700 33,400 2,700 1,300
35617 URS - U/L 0+1 64,800 71,100 79,000 98,800 118,500 138,300 11,000 1,300
37089 DJ Stenting - U/L 0+1 24,400 26,700 29,700 37,100 44,600 52,000 2,300 1,300
37090 DJ Stenting - B/L 0+1 29,800 32,800 36,400 45,500 54,600 63,700 2,500 1,300

Inclusions
1 Investigations and pharmacy up to above defined limit.

Page 24 of 29
2 OT charges, procedure change,surgeon fee and surgeon consult shall be included in package.
Exclusions
1 Laser Equipment if used shall be charged extra on actual.

KIDNEY BIOPSY
Pharmacy Investigation
Item ID Package Name ICU+Ward Day Care Economy Double Single Classic Deluxe Suite
Limit Limit
37244 Kidney Biopsy 0+1 32,100 35,300 39,200 49,000 58,800 68,600 3,500 10,700

Inclusions
1 Investigations and pharmacy up to above defined limit.
2 OT charges, procedure change,surgeon fee and surgeon consult shall be included in package.
Exclusions
1 Electro Microscopic Investigation (s)

ENT SURGERY
Pharmacy Investigation
Item ID Package Name ICU+Ward Day Care Economy Double Single Classic Deluxe Suite
Limit Limit
42897 Adenotosillectomy 0+1 60,400 66,100 73,600 89,600 108,600 160,800 9,000 7,500
42893 Septoplasty 0+1 33,600 36,900 40,500 44,500 49,000 54,000 7,500 7,500
37625 Tonsillectomy 0+1 39,500 43,900 48,200 58,300 68,000 99,000 7,500 7,500
42895 Tympanoplasty 0+1 45,000 49,500 54,400 59,800 65,500 72,000 7,500 7,500
37756 Adeno-Tonsillectomy Coblation 0+1 69,000 69,000 77,000 95,000 117,000 176,000 15,000 6,000
39605 DL Assessment + Biopsy 0+1 45,000 45,000 50,000 61,000 69,000 102,000 15,000 6,000
37766 FESS+Septoplasty+Turbinate Reduction B/L 0+1 103,000 103,000 116,000 140,000 192,000 290,000 15,000 6,000
37965 M.L.S. 0+1 53,000 53,000 62,000 75,000 85,000 128,000 15,000 6,000
46415 Mastiodectomy 0+1 95,000 95,000 107,000 132,000 166,000 252,000 15,000 6,000
37628 Myringoplasty 0+1 69,000 69,000 77,000 95,000 117,000 176,000 15,000 6,000
46413 Septoplasty+Fess 0+1 90,000 90,000 102,000 126,000 155,000 234,000 15,000 6,000
37762 Septoplasty+Turbinate Reduction 0+1 70,000 70,000 79,000 96,000 118,000 178,000 15,000 6,000

Inclusions
1 Investigations and pharmacy up to above defined limit.
2 OT charges, procedure changes and surgeon fee and Consult shall be included in package.
Exclusions
1 Laser Equipment if used shall be charged extra on actual.

GENERAL SURGERY
Pharmacy Investigation
Item ID Package Name ICU+Ward Day Care Economy Double Single Classic Deluxe Suite
Limit Limit
30028 Excision- Superficial Benign Tumors 0+1 12,100 13,300 14,800 18,500 22,200 25,900 2,400 1,300
30081 Diagnostic Laparoscopy-MAS 0+1 40,600 44,600 49,500 61,900 74,300 86,600 5,700 1,300
30050 Excision- Sebaceous Cyst 0+1 16,000 17,600 19,500 24,400 29,300 34,100 2,100 1,300
30043 Lymphnode Biopsy - Axillary 0+1 20,300 22,300 24,800 31,000 37,200 43,400 2,100 1,300
30047 Incision and Drainage of Abscess 0+1 23,900 26,300 29,200 36,500 43,800 51,100 3,400 1,300
30049 Excision- Superficial Tumors 0+1 32,300 35,500 39,400 49,300 59,100 69,000 3,400 1,300
30062 Drainage of Ischiorectal Abscess 0+1 32,900 36,100 40,100 50,100 60,200 70,200 3,900 1,300

Page 25 of 29
30063 Sphincterotomy for Anal Fissure 0+1 27,300 30,000 33,300 41,600 50,000 58,300 3,900 1,300
30068 Wound Debridement 0+1 35,300 38,700 43,000 53,800 64,500 75,300 6,000 1,300
30073 Perianal Abscess Drainage 0+1 21,600 23,700 26,300 32,900 39,500 46,000 6,000 1,300
30079 MIPH 0+1 63,600 69,800 77,600 97,000 116,400 135,800 27,000 1,300
44880 Excision of Pilonoidal Sinus 0+1 52,000 57,100 63,400 77,000 92,300 136,100 9,500 15,300
30008 Colposcopy with Biopsy 0+1 18,300 20,100 22,300 27,900 33,500 39,000 2,500 1,300
30009 Colposcopy with LEEP Biopsy 0+1 19,500 21,400 23,800 29,800 35,700 41,700 3,900 1,300
30023 Colposcopy with Biopsy+Cryotherapy 0+1 22,800 25,000 27,800 34,800 41,700 48,700 2,500 1,300
29687 Coloscopy+Hysteroscopy+LEEP+EB 0+1 38,100 41,900 46,500 58,100 69,800 81,400 3,900 1,300

Inclusions
1 Investigations and pharmacy up to above defined limit.
2 OT charges, procedure change,surgeon fee and surgeon consult shall be included in package.
Exclusions
1 Other diagnostice procedures will be charged extra on actual.

OBS & GYNE


Pharmacy Investigation
Item ID Package Name ICU+Ward Day Care Economy Double Single Classic Deluxe Suite
Limit Limit
29683 Cryocautery 0+1 8,400 9,300 10,300 12,900 15,500 18,000 800 1,300
30022 Dilatation & Curettage 0+1 14,600 16,000 17,800 22,300 26,700 31,200 2,500 1,300
30021 MTP Ist Trimester 0+1 14,600 16,000 17,800 22,300 26,700 31,200 2,500 1,300
30016 MTP (USG Guided) 0+1 16,800 18,500 20,500 25,600 30,800 35,900 2,500 1,300
30015 Missed / Incomplete Abortion S&E 0+1 14,600 16,000 17,800 22,300 26,700 31,200 2,500 1,300
30005 Mirena Insertion 0+1 18,500 20,300 22,500 28,100 33,800 39,400 10,200 1,300
30007 Cervical Polypectomy/Fractional Curettage 0+1 13,400 14,800 16,400 20,500 24,600 28,700 2,300 1,300
33815 Diagnostic Hysteroscopy 0+1 18,000 19,700 21,900 27,400 32,900 38,300 3,600 2,800
29691 Hysteroscopic Synechilolysis -Simple 0+1 23,400 25,700 28,500 35,600 42,800 49,900 3,700 2,800
29690 Hysteroscopy + D&C 0+1 24,500 26,900 29,900 37,400 44,900 52,300 3,700 2,800
30010 Hysteroscopy + D&C + Mirena Insertion 0+1 38,500 42,300 47,000 58,800 70,500 82,300 12,300 2,800
29554 Hysteroscopic Polypectomy/D&C 0+1 34,700 38,100 42,300 52,900 63,500 74,000 3,700 2,800
29693 Hysteroscopic Septum Resection-Partial 0+1 32,300 35,500 39,400 49,300 59,100 69,000 4,100 2,800
29697 Hysteroscopic Myoma Resection-Small 0+1 37,000 40,600 45,100 56,400 67,700 78,900 4,300 2,800
29555 Diagnostic Laparoscopy-Gyne 0+1 31,200 34,200 38,000 47,500 57,000 66,500 6,500 2,800
30011 MTP + Lap ligation 0+1 40,300 44,200 49,100 61,400 73,700 85,900 8,000 2,800
29557 Diagnostic Lap Hysteroscopy 0+1 38,100 41,900 46,500 58,100 69,800 81,400 6,500 2,800
29558 Diagnostic lap+Hystero+EB+Chromotubation 0+1 48,500 53,200 59,100 73,900 88,700 103,400 6,500 2,800
29702 Lap Ovarian Drilling/Cyst Aspiration/Lost IUD 0+1 33,900 37,200 41,300 51,600 62,000 72,300 6,500 2,800
29559 Laparoscopic Ovarian Cystectomy 0+1 39,000 42,800 47,600 59,500 71,400 83,300 6,500 2,800

Inclusions
1 Investigations and pharmacy up to above defined limit.
2 OT charges, procedure change,surgeon fee and surgeon consult shall be included in package.

Page 26 of 29
Exclusions
1 Other diagnostice procedures will be charged extra on actual.

ENT
Pharmacy Investigation
Item ID Package Name ICU+Ward Day Care Economy Double Single Classic Deluxe Suite
Limit Limit
42895 Tympanoplasty 0+1 45,000 49,500 54,400 59,800 65,500 72,000 2,000 7,500
42893 Septoplasty 0+1 33,600 36,900 40,500 44,500 49,000 54,000 3,000 7,500

Inclusions
1 Pharmacy up to above defined limit.
2 OT charges, procedure changes and surgeon fee and Consult shall be included in package.
Exclusions
1 Laser Equipment if used shall be charged extra on actual.
2 investigation shall be charged extra on actual.

OPTHAL PROCEDURE
Pharmacy Investigation
Item ID Package Name ICU+Ward Day Care Economy Double Single Classic Deluxe Suite
Limit Limit
34724 Corneal Grafting 0+1 44,100 48,400 53,800 67,300 80,700 94,200 9,000 250
34726 Perforating Globe Injury Major 0+1 36,100 39,600 44,000 55,000 66,000 77,000 2,000 250
34816 Tarsorrhaphy 0+1 15,800 17,400 19,300 24,100 29,000 33,800 1,800 250
30000 Pterygium 0+1 11,600 12,700 14,100 17,600 21,200 24,700 1,000 250
30001 Intravitreal Injection of Avastin 0+1 21,600 23,700 26,300 32,900 39,500 46,000 10,000 250
31558 Cataract Micro Incision Phacoemulsification 0+1 26,800 29,400 32,700 40,900 49,100 57,200 1,200 250
29997 Cataract Surgery - Phacoemulsification 0+1 21,600 23,700 26,300 32,900 39,500 46,000 1,200 250
36005 Cataract Refractive Phacoemulsification 0+1 30,900 33,900 37,700 47,100 56,600 66,000 1,200 250
38981 Cataract - MICS & Multifocal Lens 0+1 37,900 41,600 46,200 57,800 69,300 80,900 1,200 250
40730 Complicated Ocular Trauma Surgery 0+1 41,200 45,200 50,200 62,800 75,300 87,900 1,200 250
40758 Core Vitrectomy 0+1 10,500 11,500 12,800 16,000 19,200 22,400 1,200 250
40708 Cornea Transplan-DSAEK 0+1 61,800 67,900 75,400 94,300 113,100 132,000 1,200 250
40704 Cornea Transplant - Penetrating Keratoplasty 0+1 51,500 56,500 62,800 78,500 94,200 109,900 1,200 250
40707 Cornea Transplant-DALK 0+1 61,800 67,900 75,400 94,300 113,100 132,000 1,200 250
40721 Glaucoma Implant Surgery 0+1 36,100 39,600 44,000 55,000 66,000 77,000 1,200 250
40698 MICS & Premium IOL 0+1 36,100 39,600 44,000 55,000 66,000 77,000 1,200 250
40702 Post Cataract Surgery Secondary Intervention 0+1 10,500 11,500 12,800 16,000 19,200 22,400 1,200 250
40743 Ptosis Surgery - Fasenella Servat 0+1 25,800 28,400 31,500 39,400 47,300 55,100 1,200 250
40762 Retina Endolaser 0+1 13,700 15,000 16,700 20,900 25,100 29,200 1,200 250
40699 Secondary IOL Implantation 0+1 15,800 17,400 19,300 24,100 29,000 33,800 1,200 250
40771 Squint Surgery - Horizontal Muscles Both Eyes 0+1 36,100 39,600 44,000 55,000 66,000 77,000 1,200 250
40766 Squint Surgery - Horizontal Muscles One Eye 0+1 25,800 28,400 31,500 39,400 47,300 55,100 1,200 250
40768 Squint Surgery - Vertical Muscles Both Eyes 0+1 41,200 45,200 50,200 62,800 75,300 87,900 1,200 250
40767 Squint Surgery - Vertical Muscles One Eye 0+1 30,900 33,900 37,700 47,100 56,600 66,000 1,200 250
40770 Squint Surgery-Horizon&Vertical Muscles Both Eye 0+1 46,400 50,900 56,600 70,800 84,900 99,100 1,200 250
40769 Squint Surgery-Horizontal&Vertical Muscles One E 0+1 36,100 39,600 44,000 55,000 66,000 77,000 1,200 250
40722 Trabeculotomy & Trabeculectomy Combined 0+1 36,100 39,600 44,000 55,000 66,000 77,000 1,200 250
40759 Vitreo Retinal Surgery - Advanced 0+1 51,500 56,500 62,800 78,500 94,200 109,900 1,200 250

Page 27 of 29
38982 ICL Implantation Surgery 0+1 36,100 39,600 44,000 55,000 66,000 77,000 1,200 250
40719 Femtosecond Laser Assisted Bioptic (L&F)-One Eye 0+1 128,800 141,400 157,100 196,400 235,700 274,900 - 250
40714 Femtosecond Laser Assisted Cataract Refractive 0+1 103,000 113,000 125,600 157,000 188,400 219,800 - 250
40718 Femtosecond Laser Assisted CRI-One Eye 0+1 61,800 67,900 75,400 94,300 113,100 132,000 - 250
40717 Femtosecond Laser Assisted CRI-Both Eyes 0+1 103,000 113,000 125,600 157,000 188,400 219,800 - 250
40716 Femtosecond Laser Assisted Lamellar Keratoplasty 0+1 103,000 113,000 125,600 157,000 188,400 219,800 - 250
40715 Femtosecond Laser Assisted Penetrating Keratopla 0+1 103,000 113,000 125,600 157,000 188,400 219,800 - 250
40720 Femtosecond Laser Astigmatic Keratotomy 0+1 51,500 56,500 62,800 78,500 94,200 109,900 - 250
40712 Femtosecond LASIK - Both Eyes 0+1 103,000 113,000 125,600 157,000 188,400 219,800 - 250
40713 Femtosecond LASIK - One Eye 0+1 61,800 67,900 75,400 94,300 113,100 132,000 - 250
34708 Dacryocystorhinostomy with Intubation 0+1 41,200 45,200 50,200 62,800 75,300 87,900 1,200 250
34694 Examination under Anesthesia 0+1 8,400 9,200 10,200 12,800 15,300 17,900 1,200 250
31560 Glaucoma Surgery/Trabeculectomy with Mitomyci 0+1 30,900 33,900 37,700 47,100 56,600 66,000 1,200 250
34695 Intravitreal Injection - Antibiotics 0+1 10,500 11,500 12,800 16,000 19,200 22,400 1,200 250
36504 Intravitreal Lucentis Injection 0+1 12,600 13,900 15,400 19,300 23,100 27,000 1,200 250
34806 Lid Lesion Excision 0+1 20,600 22,600 25,100 31,400 37,700 43,900 1,200 250
34805 Lid lesion Small - Wart, Cyst etc 0+1 10,500 11,500 12,800 16,000 19,200 22,400 1,200 250
34808 Limbal Mass Excision with Cryo Amniotic membrance0+1 20,600 22,600 25,100 31,400 37,700 43,900 1,200 250
34689 Probing & Syringing - Both Eye 0+1 12,600 13,900 15,400 19,300 23,100 27,000 1,200 250
34699 Pterygium with Conjunctival Grafting 0+1 15,800 17,400 19,300 24,100 29,000 33,800 1,200 250
34715 Ptosis - LPS Correction 0+1 36,100 39,600 44,000 55,000 66,000 77,000 1,200 250
34696 Punctal Snip 0+1 12,600 13,900 15,400 19,300 23,100 27,000 1,200 250
34717 Retinal Detachment 0+1 39,100 42,900 47,700 59,600 71,600 83,500 1,200 250
34698 Silicon Oil Removal 0+1 18,900 20,700 23,000 28,800 34,500 40,300 1,200 250
29546 Small Incision or Extra Capsular Cataract surgery 0+1 18,900 20,700 23,000 28,800 34,500 40,300 1,200 250
39196 Socket Surgery Secondary Orbital Implant 0+1 25,200 27,600 30,700 38,400 46,100 53,700 1,200 250
34721 Vitrectomy 0+1 36,100 39,600 44,000 55,000 66,000 77,000 1,200 250
34723 Vitreo Retinal Surgery 0+1 39,100 42,900 47,700 59,600 71,600 83,500 1,200 250

Inclusions
1 Investigations and pharmacy up to above defined limit.
2 Pharmacy limit includes general medical consumable.
3 Investigation limit included Blood Sugar Glucometer up to 1 qty.
4 OT charges, procedure change,surgeon fee and surgeon consult shall be included in package.
5 For Femto Cataract, Acrysoft IQ Lens @ Rs 9,575/- is included.
Exclusion
1 Lenses will be charged on actual at MRP

FIRST DIALYSIS PACKAGE


Item ID Package Name ICU+Ward Day Care Economy Double Single Classic Deluxe Suite
43814 First Dialysis Package 0+1 15,200 15,600 17,300 21,600 26,000 30,300

Inclusions
1 Nephrologist consult
2 Cost of dialyser F6 & double lumen sub clevean catheter up to one qty
3 Below mentioned investigations

Page 28 of 29
Item ID Item Name
28755 Dialysis Serology Panel
5835 Potassium, Serum
5837 Sodium, Serum
5847 Creatinine, Serum
6085 CBC (Complete Blood Count),EDTA
84 X-Ray Chest PA/AP View

Exclusion
1 Other diagnostice procedures will be charged extra on actual.

SLEEP STUDY
Pharmacy Investigation
Item ID Package Name ICU+Ward Day Care Economy Double Single Classic Deluxe Suite
Limit Limit
32997 Sleep Study - Diagnostic 0+1 19,100 21,000 23,300 29,100 35,000 40,800 - -
32999 Sleep Study - Split Night 0+1 24,500 26,900 29,900 37,400 44,900 52,300 - -

Inclusions
1 Admitting Doctor and procedure charges included
Exclusion
1 Pharmacy and investigation shall be charged extra on actual.

OZONE DISCOLYSIS
Pharmacy Investigation
Item ID Package Name ICU+Ward Day Care Economy Double Single Classic Deluxe Suite
Limit Limit
26425 Ozone Discolysis - Cervical (Single Sitting) 0+1 21,200 23,200 25,800 32,300 38,700 45,200 - -

Inclusions
1 Ozone charges & C-Arm
2 Procedure and doctor consult will be included in package.
Exclusions
1 Any diagnostic procedure and investigations done will be charged extraon actual.
2 Pharmacy and investigation shall be charged extra on actual.

Page 29 of 29
SCHEDULE OF CHARGES
Updated as on
December 20, 2017

Max Super Speciality Hospital


1,2, Press Enclave Marg
Saket-110017
Room Traiff & IP Consultation charges

Consultant Charges (per


SL No. Room Type Room Rent (Per Day)
visit)

1 Suite 31,600 2,200

2 Classic Deluxe 15,250 1,700

3 Single 12,400 1,350

4 Double Bed 6,850 1,150

5 Economy Room 4,750 1,000

6 Day Care Bed 3,150 1,150

7 ICU/NICU/PICU/HDU 12,900 1,400

8 HDU (Ortho/Neuro) 10,000 1,400

9 NICU Level -1 4,750 1,050

10 NICU Level -2 6,300 1,250

11 NICU Level -3 8,400 1,350

12 PICU Level -1 6,300 1,050

13 PICU Level -2 7,900 1,250

14 PICU Level -3 9,500 1,350

15 Cardiac ICU 12,900 1,600

16 NSICU 13,500 1,400

17 Labor Room 6,850 1,150

PHP Packages

Item ID Item Name OP Price

32191 Basic (New) Male - Preventive Health Check 3,500


33354 Basic (New) Female - Preventive Health Check 4,000
33355 Bronze (New) Male- Preventive Health Check 5,500
33356 Bronze (New) Female- Preventive Health Check 6,000
34506 Silver (New) Male - Preventive Health Check 7,500
33358 Silver (New) Female (<40Yrs) - Preventive Health Check 8,500
33359 Silver (New) Female (>40Yrs) - Preventive Health Check 8,500
33360 Gold (New) Male - Preventive Health Check 10,300
33362 Gold (New) Female (<40Yrs) - Preventive Health Check 11,300

33361 Gold (New) Female (>40Yrs) - Preventive Health Check 11,300

33366 Titanium Male - Preventive Health Check 15,900

33370 Titanium Female (<40Yrs) - Preventive Health Check 17,300

33371 Titanium Female (>40Yrs) - Preventive Health Check 17,300

2
PHP Components

Description Basic Basic Bronze Bronze Silver Silver Silver Gold Gold Gold Titanium Titanium Titanium
(New) (New) (New) (New) (New) (New) (New) (New) (New) (New) Package Package for Package
Package Package Package Package Package Package Package Package Package Package for Male Female ( < >for
for Male for for Male for for Male for for for Male for for 40 years ) Female (
Female Female Female( Female ( Female ( < Female ( > 40 years )
< 40 > 40 40 years ) 40 years )
years ) years )

Consultations:
Dietician • • • • • • • • • • • • •
Internal Medicine Consultation • • • • • • • • • • • • •
Internal Medicine Review • • • • • • • • • • • • •
General Surgery • • • •
Obs & Gyne • • • • • • • •
ENT • • • • • •
Opthal • • • • • • • • • • •
Cardiologist • • • • • •
Dental • • • • • • • • •
Investigations:
Blood Grouping and RH Factor • • • • • • • • • • • • •
Complete Haemogram,
• • • • • • • • • • • • •
Peripheral Smear and ESR
Urine Routine and Microscopy • • • •
MAU / Creatinine Ratio Urine • • • • • •
Stool Routine and Microscopy • • • • • • • • • • • • •
Stool for Occult Blood • • • • • • • • •
Liver Function Test Profile • • • • • • • • •
Bilirubin Total and Direct • • • •
SGOT - Aspartate Amino
• • • •
Transferase, Serum
SGPT - Alakaline Phosphatese • • • •
Renal Profile • • • • • • • • •
Creatinine, Serum • • • •
Blood Urea • •
Uric Acid, Serum • • • • • • • • • • •
Blood Sugar Fasting • • • • • • • • • • • • •
Glycosylated Haemoglobin • • • • • • • • •
Lipid Profile • • • • • • • • • • • • •
ECG • • • • • • • • • • • • •
Tread Mill Test (TMT) • • • • • • • • • • •
Echo • • • • • •
TSH • • • • • • • • • • • • •
Total PSA (Prostate Specific
• • • •
Antigen)
Pap Smear • • • • • • • •
Mammography Both Breast • • •
Ultrasound Breasts • • •
Calcium, Serum • • • • • •
Inorganic Phosphorus, Serum • • • • • •
Vitamin D3 ,B-12 • • •
Iron Studies • • •
Ultrasound Whole Abdomen • • • • • • • • • • • • •
X-Ray Chest PA/AP View • • • • • • • • • • • • •
PFT / SPIROMETERY • • • • • •
PFT(with /without
• • •
Broncodialater)

Dexa-Bone Spine & Femur study • • • • • •

USG Carotid Doppler • • •


Pure Tone Audiogram • • • • • •

3
Other Procedures & Investigations

Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Administration 30632 Registration Charge 200 200 200 200 200 200
Administration 32291 Nebulisation Charges (Nursing) 180 190 190 190 190 190
Administration 32292 Catheterization Charges—Male (Nursing) 160 170 320 450 590 820
Administration 32293 Catheterization Charges—Female (Nursing) 130 140 150 200 250 400
Administration 32294 Ryles Tube Insertion (Nursing) 230 240 310 430 560 780
Administration 32295 Dressing Charges – Small (Nursing) 240 250 320 400 590 820
Administration 32296 Dressing Charges – Medium (Nursing) 660 690 870 1,050 1,400 2,000
Administration 31660 MLC Charges 1,000 1,000 1,000 1,000 1,000 1,000
Administration 30585 Medical History Assessment 1,500 1,500 1,500 1,500 1,500 1,500
Administration 34205 Duplicate / Photocopy of MRD File 100 - - - - -
Administration 34652 Duplicate Card (Birth/Others) 100 - - - - -
Administration 36964 Wifi Charges Per Day 270 270 270 270 270 270
Administration 41379 RMO Fees - 600 600 600 600 600
Nursing 45672 ICU Nursing Charges - 500 500 500 500 500
Note - In HDU, Rs. 300 will be charged as Nursing charge
Ambulance 38854 Cannulation 210 210 210 210 210 210
Ambulance 38855 Cannulation + Medicine 530 530 530 530 530 530
Ambulance 38856 Cannulation + O2 Therapy/ Neb 840 840 840 840 840 840
Ambulance 38857 Cannulation + O2 Therapy/ Neb. + Drugs 1,580 1,580 1,580 1,580 1,580 1,580
Ambulance 38858 Cannulation, Ventilation, Intubation 4,200 4,200 4,200 4,200 4,200 4,200
Ambulance 34445 Doctor Charges-Outstation Ambulance (Till 500 Km) 5,000 5,000 5,000 5,000 5,000 5,000
Ambulance 38531 Doctor Charges-Outstation Ambulance( 525-1000 Km) 10,000 10,000 10,000 10,000 10,000 10,000
Ambulance 34441 Local Ambulance - ALS+Specialist Doctor 5,500 5,500 5,500 5,500 5,500 5,500
Ambulance 34442 Local Ambulance - ALS+Super Specialist Doctor 10,500 10,500 10,500 10,500 10,500 10,500
Ambulance 34438 Local Ambulance - Patient Transport 1,000 1,000 1,000 1,000 1,000 1,000
Ambulance 34444 Outstation Ambulance ALS (per KM) 45 45 45 45 45 45
Ambulance 34443 Outstation Ambulance BLS (per KM) 45 45 45 45 45 45
Ambulance 34440 Primary- Local(ALS) 2,500 3,000 3,000 3,000 3,000 3,000
Ambulance 34439 Primary- Local(BLS) 1,500 2,000 2,000 2,000 2,000 2,000
Ambulance 46466 Oxygen therapy /Nebulisation 300 300 300 300 300 300
Ambulance 34446 Specialist Doctor Chrg - Outstation Ambulance 6,200 6,200 6,200 6,200 6,200 6,200
Ambulance 34447 Super Specialist Doctor Chrg - Outstation Amb 11,000 11,000 11,000 11,000 11,000 11,000
Ambulance 43232 Tertiary-ALS 2,500 - - - - -
Ambulance 43233 Tertiary-BLS 1,500 - - - - -
Anaethesia 18040 Arterial Line (Anaes) 1,900 2,000 2,200 2,700 3,700 5,700
Anaethesia 36125 ICU patient transfer (nonventilated) - 1,400 1,400 1,400 1,400 1,400
Anaethesia 22612 Epidural Injection / Caudal Block 3,200 3,400 4,400 5,600 7,200 11,100
Anaethesia 37539 Intravenous Cannulation 460 480 570 720 930 1,400
Anaethesia 37540 Venous Sampling 630 660 780 880 1,200 1,400
Anaethesia 37543 Peripheral nerve blocks - Advanced 4,800 5,400 6,100 7,600 10,000 11,700
Anaethesia 20393 Ventilator Initiation Charges 1,900 2,000 2,000 2,000 2,000 2,000
Anaethesia 37544 Arterial Cannulation 1,470 1,700 1,900 2,300 2,900 3,600
Anaethesia 37545 HD Line insertion 1,400 1,600 1,800 2,200 2,800 3,400
Anaethesia 37541 Acute Pain Services 740 780 780 780 780 780
Anaethesia 37542 Peripheral nerve block - Basic 2,300 2,400 2,800 3,600 4,500 7,100
Anaethesia 37604 Parenteral Sedation Level 2 (Anaes) 4,600 4,800 4,800 4,800 4,800 4,800
Anaethesia 37605 Fiberoptic Intubation 1,200 1,300 1,400 1,700 2,200 3,400
Anaethesia 37606 Peripherally Inserted Central Venous Cannulation 1,790 1,900 1,900 1,900 1,900 1,900
Anaethesia 18441 Endotracheal Intubation (Anaes) 1,200 1,300 1,500 1,800 2,300 3,600
Anaethesia 33532 Lumbar Puncture 2,100 2,200 2,500 3,200 4,200 6,400
Anaethesia 37128 Anaesthesia Charges for Endoscopy 2,700 2,800 2,800 2,800 2,800 2,800
Anaethesia 37129 STAND BY Anaesthesia Charges CT-/US/MRI 1,700 1,800 1,800 1,800 1,800 1,800
Anaethesia 18445 Insertion of Swanganz Line (Anaes) 1,400 1,500 1,500 1,500 1,500 1,500
Anaethesia 21654 Pre Anaesthesia Check-Up 790 880 1,100 1,400 1,700 2,300
Anaethesia 17339 Central Venous Catheterization 3,900 4,300 4,800 6,100 7,900 12,200
Anaethesia 37409 Parenteral Sedation Level 1 (Anaes) 2,900 3,100 3,100 3,100 3,100 3,100
Anaethesia 18439 Cardio - Pulmonary Resuscitation 1,900 2,100 2,400 3,100 4,000 6,100
Anaethesia 18440 CVP Line 1,700 1,900 2,100 2,600 3,500 5,300
Anaethesia 18442 Epidural Analgesia incl. Caudal & Paravertebral Block 1,700 1,800 1,800 1,800 1,800 1,800
Anaethesia 18444 Initiation of Ventilation including Intubation /BIPAP 1,700 1,800 1,800 1,800 1,800 1,800
Anaethesia 33597 Femoral Line 2,300 2,400 2,400 2,400 2,400 2,400
Anaethesia 33601 Ryles tube insertion (Children) 1,700 1,800 2,000 2,500 3,400 5,100
Blood Bank 19492 Fresh Frozen Plasma processing charges 1,249 1,249 1,249 1,249 1,249 1,249
Blood Bank 21645 Therapeutic Plasmapheresis/ Cycle 25,500 26,900 26,900 26,900 26,900 26,900
Blood Bank 31363 Apheresis Platelet Processing ChargesW/O Donor Scr 9,000 9,000 9,000 9,000 9,000 9,000
Blood Bank 35875 Autologous PRP Therapy 3,570 3,800 3,800 3,800 3,800 3,800
Blood Bank 24023 Donor Screening for Plateletpheresis 2,000 2,000 2,000 2,000 2,000 2,000
Blood Bank 21647 Cryosupernatant Plasma-Processing charge 1,020 1,100 1,100 1,100 1,100 1,100
Blood Bank 21648 Cryoprecipitate Processing charges 899 899 899 899 899 899

4
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Blood Bank 22407 Cross Matching Charges 280 280 280 280 280 280
Blood Bank 24024 CBC , Blood group, & Irregular Antibody Screening 3,060 3,200 3,200 3,200 3,200 3,200
Blood Bank 24025 Irregular Antibody Identification 4,590 4,800 4,800 4,800 4,800 4,800
Blood Bank 25176 Therapeutic Platelet Apheresis 15,300 16,100 16,100 16,100 16,100 16,100
Blood Bank 45173 Apheresis plasma processing charges W/O donor scr 9,000 9,000 9,000 9,000 9,000 9,000
Blood Bank 45172 Donor Screening for plasmapheresis 2,000 2,000 2,000 2,000 2,000 2,000
Blood Bank 29936 Random Donor Platelet Concentrates(RDPC)Processing 1,299 1,299 1,299 1,299 1,299 1,299
Blood Bank 30174 Aliquot Charges-One 820 860 860 860 860 860
Blood Bank 41125 Donor CBC 550 550 550 550 550 550
Blood Bank 27041 Donor grouping for Apheresis 150 150 150 150 150 150
Blood Bank 45013 FFP for intas (Per Litre) 1,600 1,600 1,600 1,600 1,600 1,600
Blood Bank 45014 CPP for Intas (Per litre) 1,600 1,600 1,600 1,600 1,600 1,600
Blood Bank 25177 Therapeutic Phlebotomy 1,000 1,000 1,000 1,000 1,000 1,000
Blood Bank 41127 Washed packed red blood cell processing 3,500 3,500 3,500 3,500 3,500 3,500
Blood Bank 19490 Whole blood processing 4,050 4,050 4,050 4,050 4,050 4,050
Cryopreservation of PBSC AT -80 C Processing (For 6
Blood Bank 47311 36,000 36,000 36,000 36,000 36,000 36,000
BAGS)

Blood Bank 47310 Cryopreservation of PBSC AT -80 C Processing (For 1 BAG) 6,000 6,000 6,000 6,000 6,000 6,000

Blood Bank 47312 Donor Leucapheresis procedure 9,000 9,000 9,000 9,000 9,000 9,000
Blood Bank 47313 Donor screening for Leuca Pheresis 2,000 2,000 2,000 2,000 2,000 2,000
Blood Bank 30175 Blood Grouping for Patient 720 760 760 760 760 760
Blood Bank 31354 Packed Red Blood Cells processing charges 3,129 3,129 3,129 3,129 3,129 3,129
Blood Bank 31359 Therapeutic Leucapheresis 20,400 21,500 21,500 21,500 21,500 21,500
Blood Bank 31362 PackedRBC Leucodepleted By Integral processing ch 4,129 4,129 4,129 4,129 4,129 4,129
Blood Bank 32129 Stem Cell Harvesting 35,700 37,600 37,600 37,600 37,600 37,600
Blood Bank 33139 Antibody Titration 2,250 2,400 2,400 2,400 2,400 2,400
Blood Bank 37068 Antibodies Screening for Patients 510 540 540 540 540 540
Blood Bank 37069 Anti A/B Titration 2,000 2,100 2,100 2,100 2,100 2,100
Blood Bank 33142 Rh+ Kell Phenotyping Processing Charge 500 500 500 500 500 500
Blood Bank 33202 Antenatal Antibody Screening Test for Gynae Patien 1,020 1,100 1,100 1,100 1,100 1,100
Blood Bank 33204 Blood Grouping (Mother) 620 650 650 650 650 650
Blood Bank 33205 Random Donor Platelet Concentrate Leucodepleted Pr 2,800 2,800 2,800 2,800 2,800 2,800
Blood Bank 36142 Plasma Exchange with Filtration (Evaflux) 57,120 60,100 60,100 60,100 60,100 60,100
Blood Bank 33607 Packed RBC processing charges (Rotary) 1,350 1,400 1,400 1,400 1,400 1,400
Blood Bank 33608 Packed RBC processing charges(Red Cross) 850 900 900 900 900 900
Cardiology 6923 Echo Review (Screening) 2,000 2,500 2,500 2,500 2,500 2,500
Cardiology 6924 PFT with Broncodilator 1,850 1,900 1,900 1,900 1,900 1,900
Cardiology 6926 B. P. Check-up 120 150 150 150 150 150
Cardiology 6930 Tread Mill Test (TMT) 2,500 3,200 3,200 3,200 3,200 3,200
Cardiology 45776 Paediatric Echo Review (Screening) 1,200 1,400 1,500 1,600 1,700 1,700
Cardiology 6931 ECG 425 530 530 530 530 530
Cardiology 36612 ELR – Electronic Loop Recorder 17,600 22,200 22,200 22,200 22,200 22,200
Cardiology 6935 Holter Monitoring 3,000 3,800 3,800 3,800 3,800 3,800
Cardiology 6939 Holter Affixation Charge for Outside 460 560 630 630 740 740
Cardiology 6942 Ambulatory B.P. Monitoring 24 hrs 2,300 2,900 2,900 2,900 2,900 2,900
Cardiology 6943 Stress Echo 5,100 6,400 6,400 6,400 6,400 6,400
Cardiology 6964 Dobutamine Stress Echo 5,700 7,200 7,200 7,200 7,200 7,200
Cardiology 6966 Tilt Test 3,500 4,400 4,400 4,400 4,400 4,400
Cardiology 16679 Echo 3,000 3,800 3,800 3,800 3,800 3,800
Cardiology 17852 TEE Echo 4,600 5,800 5,800 5,800 5,800 5,800
Cardiology 17853 Temporary Pacing 10,200 12,800 12,800 12,800 12,800 12,800
Cardiology 18153 Carotid Doppler 2,900 3,700 3,700 3,700 3,700 3,700
Cardiology 19351 Test analysis report in CD 1,000 - - - - -
Cardiology 19776 Test analysis report in CD (Echo) 500 500 500 500 500 500
Cardiology 20271 Radial Doppler 1,900 2,400 2,400 2,400 2,400 2,400
Cardiology 20274 Renal Doppler-Cardiology 3,200 4,000 4,000 4,000 4,000 4,000
Cardiology 22648 Peripheral Vascular Doppler Arterial Both Limbs 6,700 8,400 8,400 8,400 8,400 8,400
Cardiology 22649 Peripheral Vascular Doppler Venous Single Limb 3,300 4,200 4,200 4,200 4,200 4,200
Cardiology 22658 Groin Doppler Single Limb 2,900 3,700 3,700 3,700 3,700 3,700
Cardiology 22659 Groin Doppler Both Limbs 3,800 4,800 4,800 4,800 4,800 4,800
Cardiology 23872 Echo Bedside 3,700 4,600 4,600 4,600 4,600 4,600
Cardiology 23873 Echo Review (Bedside) 2,000 2,500 2,500 2,500 2,500 2,500
Cardiology 27480 Abdominal aorta Scanning 950 1,200 1,200 1,200 1,200 1,200
Cardiology 28201 Paediatric Echo / TEE 2,400 3,100 3,100 3,100 3,100 3,100
Cardiology 29265 Fetal Echocardiography 3,000 3,800 3,800 3,800 3,800 3,800
Cardiology 39784 Bronchogram - 4,100 4,100 4,100 4,100 4,100
Cardiology 32068 Pacemaker Programming 1,500 1,900 1,900 1,900 1,900 1,900
Cardiology 39011 Replacement Service Charges for Pacemaker 5,650 6,800 6,800 6,800 6,800 6,800
Cardiology 36272 Reexploration For Bleeding (Procedure Charges Only 11,500 12,100 12,100 12,100 12,100 12,100
Cardiology 20832 Insertion of IABP - 14,600 14,600 14,600 14,600 14,600
Cardiology 20907 Pericardial Tapping - 7,100 7,100 7,100 7,100 7,100

5
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Cardiology 39010 Pacemaker Follow up Service Charge 1,050 1,250 1,250 1,250 1,250 1,250
Cardiology 23170 Balloon atrial Septostomy (Procedure Charge Only) - 23,300 23,300 23,300 23,300 23,300
Cardiology 45056 Fractional Flow Reserve (FFR) 30,000 31,600 31,600 31,600 31,600 31,600
Cardiology 20906 IVC Filter 50,000 52,700 52,700 52,700 52,700 52,700
Cardiology 39683 IVUS (Intravascular Ultrasound) 30,000 31,600 31,600 31,600 31,600 31,600
Cardiology 30371 Lead Repositioning - 26,300 26,300 26,300 26,300 26,300
Cardiology 39882 Optical Coherence Tomography (OCT) 50,000 52,700 52,700 52,700 52,700 52,700
Cardiology 45297 Pericardiocentesis 25,000 26,300 26,300 26,300 26,300 26,300
Cardiology 23163 PTCA 2 Stage/Redo Charges - 45,000 45,000 45,000 45,000 45,000
Cardiology 43952 PTCA Cath Lab Charges 20,000 20,000 20,000 20,000 20,000 20,000
Dental 5297 Radiology - (RVG) 530 530 530 530 530 530
Dental 5300 Restorations - G.I. Filling 1,010 1,010 1,010 1,010 1,010 1,010
Dental 5301 Restoration of Cervical abrasion 1,260 1,260 1,260 1,260 1,260 1,260
Dental 5305 Pulp Capping Dycal 800 800 800 800 800 800
Dental 5308 Bleaching-Bleaching Grade 1 13,400 13,400 13,400 13,400 13,400 13,400
Dental 5309 Metal Crown 4,200 4,200 4,200 4,200 4,200 4,200
Dental 5311 Rehabilitation - Metal Bridge (per unit) 3,640 3,640 3,640 3,640 3,640 3,640
Dental 5312 PFM Crown Grade II 8,400 8,400 8,400 8,400 8,400 8,400
Dental 5317 Post & Core 5,250 5,250 5,250 5,250 5,250 5,250
Dental 5329 Impaction Grade II 7,400 7,400 7,400 7,400 7,400 7,400
Dental 44621 CBCT Both Arches / TMJ- Bilateral / Paranasal Sinu 5,000 5,000 5,000 5,000 5,000 5,000
Dental 44620 CBCT Per Quadrant 3,000 3,000 3,000 3,000 3,000 3,000
Dental 35593 Root Canal Treatment with Crown 7,700 7,700 7,700 7,700 7,700 7,700
Dental 5330 Oral Surgical Procedures-Alveoloplasty Grade - 1 3,750 3,750 3,750 3,750 3,750 3,750
Dental 5334 Oral Surgical Procedures-Drainage of E.O Absess 8,500 8,500 8,500 8,500 8,500 8,500
Dental 5336 Miscellaneous-Polishing 870 870 870 870 870 870
Dental 5337 Soft Tissue Management - Curettage ( Per Tooth) 740 740 740 740 740 740
Dental 5340 Gingivectomy 1,600 1,600 1,600 1,600 1,600 1,600
Dental 5341 Operculectomy 2,840 2,840 2,840 2,840 2,840 2,840
Dental 5400 Temporary Filling 630 630 630 630 630 630
Dental 5401 Refixing of Crown 840 840 840 840 840 840
Dental 5466 Study Model 1,580 1,580 1,580 1,580 1,580 1,580
Dental 5662 Rehabilitation - Night Guard 3,090 3,090 3,090 3,090 3,090 3,090
Dental 5664 Removable Appliance Therapy - Bite Plate 4,860 4,860 4,860 4,860 4,860 4,860
Dental 5665 Fixed Appliance Therapy-Space Maintainer -2 4,860 4,860 4,860 4,860 4,860 4,860
Dental 5672 Feeding appliance 6,300 6,300 6,300 6,300 6,300 6,300
Dental 5674 Pit & Fissure Sealant ( per tooth) 950 950 950 950 950 950
Dental 5675 Fluoride Varnish Application (per arch) 2,600 2,600 2,600 2,600 2,600 2,600
Dental 5684 Rehabilit-Repair Work of Fracture Denture Gr 1 730 730 730 730 730 730
Dental 5689 Apexification 5,800 5,800 5,800 5,800 5,800 5,800
Dental 5690 Apexogenesis 8,400 8,400 8,400 8,400 8,400 8,400
Dental 5693 Cast Partial frame work 15,800 15,800 15,800 15,800 15,800 15,800
Dental 5698 Core Build up 1,300 1,300 1,300 1,300 1,300 1,300
Dental 5701 Oral Surgical Procedures-Alveolectomy Grade - I 3,750 3,750 3,750 3,750 3,750 3,750
Dental 12469 Oral Splint 3,680 3,680 3,680 3,680 3,680 3,680
Dental 12470 Miscellaneous-Splint Grade 2 3,640 3,640 3,640 3,640 3,640 3,640
Dental 12472 Soft Tissue Mgmt-Full Mouth Scaling&Polising Gr 1 1,410 1,410 1,410 1,410 1,410 1,410
Dental 12473 Scaling & Polishing Grade I 2,500 2,500 2,500 2,500 2,500 2,500
Dental 12474 Scaling & Polishing Grade II 3,000 3,000 3,000 3,000 3,000 3,000
Dental 12478 Oral Surgical Procedures-Tumour Excision 12,100 12,100 12,100 12,100 12,100 12,100
Dental 16938 Removal Appliance Therapy with Retainer 10,500 10,500 10,500 10,500 10,500 10,500
Dental 16939 Removable Appli Therapy-Removable Appli Gr 2(Screw 10,700 10,700 10,700 10,700 10,700 10,700
Dental 16940 Removal Appliance Therapy with Screw 15,230 15,230 15,230 15,230 15,230 15,230
Dental 17738 Apicoectomy Grade I 6,300 6,300 6,300 6,300 6,300 6,300
Dental 17739 Apicoectomy Grade II 11,600 11,600 11,600 11,600 11,600 11,600
Dental 17744 Oral Surgical Procedures-Biopsy - Large 8,400 8,400 8,400 8,400 8,400 8,400
Dental 17745 Oral Surgical Procedures-Biopsy - Medium 5,250 5,250 5,250 5,250 5,250 5,250
Dental 17746 Oral Surgical Procedures-Biopsy - Small 4,200 4,200 4,200 4,200 4,200 4,200
Dental 17748 Bleaching Trays 2,900 2,900 2,900 2,900 2,900 2,900
Dental 17749 Miscellaneous-Chem Cauterization ( Per Sitting) 680 680 680 680 680 680
Dental 17753 Restorations - Composite Filling Grade 1 1,330 1,330 1,330 1,330 1,330 1,330
Dental 17754 Restorations-Composite Filling Grade 2 1,660 1,660 1,660 1,660 1,660 1,660
Dental 17758 Oral Surgical Procedures-Cyst Enucleation Large 17,500 17,500 17,500 17,500 17,500 17,500
Dental 17759 Cyst Enucleation Grade II 15,800 15,800 15,800 15,800 15,800 15,800
Dental 17760 Cyst Enucleation Grade I 10,500 10,500 10,500 10,500 10,500 10,500
Dental 17764 Dental Implant Grade II 52,500 52,500 52,500 52,500 52,500 52,500
Dental 17765 Dental Implant Grade III 63,000 63,000 63,000 63,000 63,000 63,000
Dental 17766 Dental Implant Grade I 47,300 47,300 47,300 47,300 47,300 47,300
Dental 43860 PFM Crown Grade III 9,450 9,450 9,450 9,450 9,450 9,450
Dental 40626 Porcelain Veneers Grade II 15,750 15,750 15,750 15,750 15,750 15,750
Dental 40627 Porcelain Veneers Grade III 17,850 17,850 17,850 17,850 17,850 17,850
Dental 43861 Obturators-Surgical 8,400 8,400 8,400 8,400 8,400 8,400

6
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Dental 43862 Obturators-Temporary 15,750 15,750 15,750 15,750 15,750 15,750
Dental 43863 Bite Analysis 7,400 7,400 7,400 7,400 7,400 7,400
Dental 43864 Zoom Bleach Grade I 18,380 18,380 18,380 18,380 18,380 18,380
Dental 43865 Mock Up 2,100 2,100 2,100 2,100 2,100 2,100
Dental 43866 Full Mouth Flap Surgery 14,200 14,200 14,200 14,200 14,200 14,200
Dental 43867 Closure of OAF Gr-II(posterior) 21,000 21,000 21,000 21,000 21,000 21,000
Dental 43868 Fixed Appliance Metal(both arches) 52,500 52,500 52,500 52,500 52,500 52,500
Dental 43869 Fixed Appliance self ligation metal(BA) 78,800 78,800 78,800 78,800 78,800 78,800
Dental 43870 Fixed Appliance Ceramic (Single arch) 63,000 63,000 63,000 63,000 63,000 63,000
Dental 43871 Fixed Appliance Ceramic self ligating 99,800 99,800 99,800 99,800 99,800 99,800
Dental 43872 Lingual Incognito (both arches) 204,000 204,000 204,000 204,000 204,000 204,000
Dental 43873 Incognito Lite (both arches) 153,000 153,000 153,000 153,000 153,000 153,000
Dental 43874 Temporary anchorage appliance 5,250 5,250 5,250 5,250 5,250 5,250
Dental 43875 Fixed functional appliance 15,800 15,800 15,800 15,800 15,800 15,800
Dental 43876 Aligners 153,000 153,000 153,000 153,000 153,000 153,000
Dental 43877 Aligners Fabrication 61,200 61,200 61,200 61,200 61,200 61,200
Dental 43878 Fixed retention appliance - per arch 7,400 7,400 7,400 7,400 7,400 7,400
Dental 43879 Ortho Instalment Grade I 5,250 5,250 5,250 5,250 5,250 5,250
Dental 43880 Ortho Instalment Grade II 10,500 10,500 10,500 10,500 10,500 10,500
Dental 39044 Vital Staining 3,150 3,150 3,150 3,150 3,150 3,150
Dental 39031 Brush Biopsy for dysplasia/malignancy 8,400 8,400 8,400 8,400 8,400 8,400
Dental 39037 Management of Chronic Orofacial Pain 1,580 1,580 1,580 1,580 1,580 1,580
Dental 39042 T-scan 3,680 3,680 3,680 3,680 3,680 3,680
Dental 39045 Xerostomia Management 2,100 2,100 2,100 2,100 2,100 2,100
Dental 39030 Arthrocentesis/Lavage (per side) 16,800 16,800 16,800 16,800 16,800 16,800
Dental 39039 Scalpel biopsy (per site) 6,300 6,300 6,300 6,300 6,300 6,300
Dental 39032 CBCT referral (per arch) 4,200 4,200 4,200 4,200 4,200 4,200
Dental 39040 Sialography 8,400 8,400 8,400 8,400 8,400 8,400
Dental 39041 Tongue/Floor of mouth Biopsy/Hard palate Biopsy 10,500 10,500 10,500 10,500 10,500 10,500
Dental 39038 Mucocele Management 8,400 8,400 8,400 8,400 8,400 8,400
Dental 39043 Velscope (per session) 2,100 2,100 2,100 2,100 2,100 2,100
Dental 39036 Halimeters for oral malodour assessment 3,200 3,200 3,200 3,200 3,200 3,200
Dental 39926 Laser Excisional Biopsy 8,400 8,400 8,400 8,400 8,400 8,400
Dental 39927 Laser Incisional Biopsy 5,250 5,250 5,250 5,250 5,250 5,250
Dental 39928 Laser Flap preparation (per quadrant) 10,500 10,500 10,500 10,500 10,500 10,500
Dental 39929 Laser Gingivectomy (per tooth) 1,580 1,580 1,580 1,580 1,580 1,580
Dental 39930 Laser Gingivoplasty (per sextant) 5,250 5,250 5,250 5,250 5,250 5,250
Dental 39931 Laser Reduction of gingival hypertrophy (per session) 1,050 1,050 1,050 1,050 1,050 1,050
Laser Gingival troughing for crown impressions (per
Dental 39932 1,580 1,580 1,580 1,580 1,580 1,580
tooth)
Dental 39933 Laser Operculectomy (per tooth) 4,730 4,730 4,730 4,730 4,730 4,730
Dental 39934 Laser Frenectomy and frenotomy 7,350 7,350 7,350 7,350 7,350 7,350
Dental 39935 Laser Soft tissue crown lengthening (per tooth) 2,100 2,100 2,100 2,100 2,100 2,100
Dental 39936 Laser Sulcular debridement (per session) 1,050 1,050 1,050 1,050 1,050 1,050

Dental 39937 Laser Oral Submucous fibrosisband resction (per band) 4,200 4,200 4,200 4,200 4,200 4,200

Dental 39938 Laser Vestibuloplasty (per arch) 15,750 15,750 15,750 15,750 15,750 15,750
Dental 39939 Laser Biostimulation (per session) 1,580 1,580 1,580 1,580 1,580 1,580
Dental 39940 Laser Incision and drainage of abscesses 4,200 4,200 4,200 4,200 4,200 4,200
Dental 39941 Laser Treatment of ulcers (per session) 1,580 1,580 1,580 1,580 1,580 1,580
Dental 39034 Depigmentation Laser Ablation Less than 3 8,400 8,400 8,400 8,400 8,400 8,400
Dental 39033 Depigmentation Laser Ablation between 3- 5 10,500 10,500 10,500 10,500 10,500 10,500
Dental 39035 Depigmentation Laser Ablation More than 5 12,600 12,600 12,600 12,600 12,600 12,600
Dental 43881 Laser Assisted Root Canal Grade I 10,500 10,500 10,500 10,500 10,500 10,500
Dental 43882 Laser Assisted Root Canal Grade II 12,600 12,600 12,600 12,600 12,600 12,600
Dental 17772 Enameloplasty 740 740 740 740 740 740
Dental 17775 Soft Tissue Management - Flap Surgery Grade 1 6,100 6,100 6,100 6,100 6,100 6,100
Dental 17776 Flap Surgery Grade I 6,800 6,800 6,800 6,800 6,800 6,800
Dental 17777 Flap Surgery Grade II 9,500 9,500 9,500 9,500 9,500 9,500
Dental 17778 Flap Surgery Grade III 10,500 10,500 10,500 10,500 10,500 10,500
Dental 17779 Soft Tissue Mgmt-Flap Surgery With Bone Graft Gr 1 10,300 10,300 10,300 10,300 10,300 10,300
Dental 17780 Bone Graft Gr I 12,600 12,600 12,600 12,600 12,600 12,600
Dental 17781 Bone Graft Gr II 18,400 18,400 18,400 18,400 18,400 18,400
Dental 17786 Gingival Curettage 1,300 1,300 1,300 1,300 1,300 1,300
Dental 17804 Pulpectomy Grade I (anterior) 4,730 4,730 4,730 4,730 4,730 4,730
Dental 17805 Pulpotomy 3,150 3,150 3,150 3,150 3,150 3,150
Dental 17806 Restorations - Refixing of Bridge 1,010 1,010 1,010 1,010 1,010 1,010
Dental 17815 Stainless Steel Crown 3,150 3,150 3,150 3,150 3,150 3,150
Dental 17818 Oral Surgical Procedures-TMJ - Arthocentesis- pe 24,300 24,300 24,300 24,300 24,300 24,300
Dental 17820 Bleaching-Walking Bleach 3,090 3,090 3,090 3,090 3,090 3,090
Dental 17821 Radiology - (IOPA) 400 400 400 400 400 400
Dental 17923 RCT Grade I 5,000 5,000 5,000 5,000 5,000 5,000

7
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Dental 17926 Root Canal Treatment - RCT ( Posterior) 5,190 5,190 5,190 5,190 5,190 5,190
Dental 18700 Restorations - Silver Amalgam Grade 1 1,010 1,010 1,010 1,010 1,010 1,010
Dental 19757 PFM Crown Grade I 6,830 6,830 6,830 6,830 6,830 6,830
Dental 20109 Radiology - (OPG) 630 630 630 630 630 630
Dental 20986 Bleaching-Bleaching Grade 2 18,200 18,200 18,200 18,200 18,200 18,200
Dental 20988 Composite Filling Grade I 2,600 2,600 2,600 2,600 2,600 2,600
Dental 20994 Crown Removal(per tooth) 2,100 2,100 2,100 2,100 2,100 2,100
Dental 20997 Restorations-Silver Amalgam Grade 2 1,210 1,210 1,210 1,210 1,210 1,210
Dental 21011 Repair work of Fractured Denture 1,580 1,580 1,580 1,580 1,580 1,580
Dental 21015 Rehabilitation - Cast Partial Denture Grade 2 18,200 18,200 18,200 18,200 18,200 18,200
Dental 21025 Pulpectomy Grade II (posterior) 6,300 6,300 6,300 6,300 6,300 6,300
Dental 21029 Rehabilitation - Porcelain Crown 6,700 6,700 6,700 6,700 6,700 6,700
Dental 21037 Temporary Crown 1,050 1,050 1,050 1,050 1,050 1,050
Dental 21059 Oral Surgical Procedures-Dental Suturing Gr 1 800 800 800 800 800 800
Dental 21060 Dental Suturing 1,600 1,600 1,600 1,600 1,600 1,600
Dental 21061 Oral Surgical Procedures-Dental Suturing Gr 3 2,100 2,100 2,100 2,100 2,100 2,100
Dental 21063 Oral Surgical Procedures-Dental Suturing Remova 630 630 630 630 630 630
Dental 21065 Root Canal Treatment-Initial Pulp Therapy VPT 2,100 2,100 2,100 2,100 2,100 2,100
Dental 21069 Soft Tissue Mgmt-Mucogingival Sur Per Tooth Gr 1 3,090 3,090 3,090 3,090 3,090 3,090
Dental 21070 Mucogingival Surgery Gr I 4,730 4,730 4,730 4,730 4,730 4,730
Dental 21071 Mucogingival Surgery Gr II 9,980 9,980 9,980 9,980 9,980 9,980
Dental 21073 Oral Surgical Procedures-Drainage of Abscess 800 800 800 800 800 800
Dental 21080 Root Canal Treatment - Root Canal Perforation Repa 2,870 2,870 2,870 2,870 2,870 2,870
Dental 21081 Rehabilitation - Flexible Denture 10,000 10,000 10,000 10,000 10,000 10,000
Dental 21115 Oral Surgical Procedures-Alveolectomy Grade 2 5,200 5,200 5,200 5,200 5,200 5,200
Dental 21116 Oral Surgical Procedures-Alveoloplasty Grade - 2 5,200 5,200 5,200 5,200 5,200 5,200
Dental 21121 Implant Crown Gr I 10,500 10,500 10,500 10,500 10,500 10,500
Dental 21122 Implant Crown Gr II 13,650 13,650 13,650 13,650 13,650 13,650
Dental 21123 Implant Crown Gr III 23,100 23,100 23,100 23,100 23,100 23,100
Dental 21124 Impaction Grade III 10,000 10,000 10,000 10,000 10,000 10,000
Dental 21131 Oral Surgical Procedures-Closure of OAF Grade-I 6,700 6,700 6,700 6,700 6,700 6,700
Dental 21132 Oral Surgical Procedures-IMF 21,000 21,000 21,000 21,000 21,000 21,000
Dental 21133 Closure of OAF Gr-I(anterior) 15,800 15,800 15,800 15,800 15,800 15,800
Dental 21138 Tooth Re-Implantation 6,300 6,300 6,300 6,300 6,300 6,300
Dental 21139 Oral Surgical Procedures-Suturing Laceration 2,650 2,650 2,650 2,650 2,650 2,650
Dental 26228 RCT Grade II 7,000 7,000 7,000 7,000 7,000 7,000
Dental 26371 Rehabilitation - Semi precious crown with ceramic 9,700 9,700 9,700 9,700 9,700 9,700
Dental 26376 Restorations - Composite veneers 4,530 4,530 4,530 4,530 4,530 4,530
Dental 26377 Smile Designing 19,950 19,950 19,950 19,950 19,950 19,950
Dental 26378 Rehabilitation - Smile Design Lower 19,600 19,600 19,600 19,600 19,600 19,600
Dental 27150 Zoom Bleach Grade II 23,100 23,100 23,100 23,100 23,100 23,100
Dental 27151 Bleaching-Zoom Follow up 6,400 6,400 6,400 6,400 6,400 6,400
Dental 27459 Extractions of Fractured Root 3,700 3,700 3,700 3,700 3,700 3,700
Dental 27460 Impaction Grade I 5,300 5,300 5,300 5,300 5,300 5,300
Dental 27461 Extractions-Dental Surgical Removal of Tooth Gr 3 6,400 6,400 6,400 6,400 6,400 6,400
Dental 27464 Ceramic Inlay 11,600 11,600 11,600 11,600 11,600 11,600
Dental 28196 Root Canal Treatment - RCT (Single Anterior) 4,970 4,970 4,970 4,970 4,970 4,970
Dental 28264 Removable Appliance Therapy - Trainer Therapy 12,100 12,100 12,100 12,100 12,100 12,100
Dental 28266 Fixed Appli Therapy-SS Braces Treatment-Initial In 18,900 18,900 18,900 18,900 18,900 18,900
Dental 28268 Fixed Appli Therapy-SS Braces Treatment-Balance 4 6,300 6,300 6,300 6,300 6,300 6,300
Dental 28269 Fixed Appliance Ceramic (both arches) 89,300 89,300 89,300 89,300 89,300 89,300
Dental 28270 Lingual Incognito (single arch) 102,000 102,000 102,000 102,000 102,000 102,000
Dental 28271 Fixed Appliance Therapy-Lingual Treatment Gr 2 135,700 135,700 135,700 135,700 135,700 135,700
Dental 29804 Radiology - (Lateral Ceph) 630 630 630 630 630 630
Dental 29806 Canine Exposure (Buccal APPROACH) 5,800 5,800 5,800 5,800 5,800 5,800
Dental 29807 Canine Exposure (Palatal APPROACH) 10,000 10,000 10,000 10,000 10,000 10,000
Dental 29810 Single Complete Denture 11,550 11,550 11,550 11,550 11,550 11,550
Dental 29811 Composite Inlay 4,800 4,800 4,800 4,800 4,800 4,800
Dental 29812 Composite Filling Grade III 4,200 4,200 4,200 4,200 4,200 4,200
Dental 29813 Restorations - Composite filling 1,010 1,010 1,010 1,010 1,010 1,010
Dental 29814 All Ceremic Crown Gr I 14,700 14,700 14,700 14,700 14,700 14,700
Dental 29815 All Ceremic Crown Gr II 18,900 18,900 18,900 18,900 18,900 18,900
Dental 29816 Oral Surgical Proce-Cyst Marsupilization Gr 2 18,300 18,300 18,300 18,300 18,300 18,300
Dental 29823 Soft Tissue Mgmt-Full Mouth Flap Surgery 24,500 24,500 24,500 24,500 24,500 24,500
Dental 29824 Soft Tissue Mgmt-Flap Surg Plus Bone Graft gtr Gr1 14,700 14,700 14,700 14,700 14,700 14,700
Dental 29826 Flexible Resin System Gr I 13,700 13,700 13,700 13,700 13,700 13,700
Dental 29827 Flexible Resin System Gr II 17,900 17,900 17,900 17,900 17,900 17,900
Dental 29831 Scaling & Polishing Grade III 4,000 4,000 4,000 4,000 4,000 4,000
Dental 29835 Fixed Appliance Therapy-Growth Modification Gr 1 12,300 12,300 12,300 12,300 12,300 12,300
Dental 29836 Fixed Appliance Therapy-Growth Modification Gr 2 20,200 20,200 20,200 20,200 20,200 20,200
Dental 29839 Rehabilitation - Laminates 12,300 12,300 12,300 12,300 12,300 12,300
Dental 29840 Porcelain Veneers Grade I 13,650 13,650 13,650 13,650 13,650 13,650

8
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Dental 29841 Fixed Appliance Therapy-Lingual Treatment Gr 3 151,000 151,000 151,000 151,000 151,000 151,000
Dental 29842 Fixed Appliance Therapy-Incognito 178,500 178,500 178,500 178,500 178,500 178,500
Dental 29844 Rehabilitation - Sleep Guard 3,640 3,640 3,640 3,640 3,640 3,640
Dental 29848 Fibre Post 4,200 4,200 4,200 4,200 4,200 4,200
Dental 29850 Root Canal Treatment - RCT ( Re treatment) 10,000 10,000 10,000 10,000 10,000 10,000

Dental 29851 Removable Appliance Therapy-Retainer Remaking Gr 1 1,880 1,880 1,880 1,880 1,880 1,880

Dental 29855 Removal of root (Maxillary Sinus) 12,600 12,600 12,600 12,600 12,600 12,600
Dental 29858 Restorations - Silver Amalgam Grade 3 1,880 1,880 1,880 1,880 1,880 1,880
Dental 29859 Restorations - Silver Amalgam (MOD) 2,650 2,650 2,650 2,650 2,650 2,650
Dental 29860 Space Maintainer 5,250 5,250 5,250 5,250 5,250 5,250
Dental 29862 Restorations - IRM Filling 630 630 630 630 630 630
Dental 29863 Oral Surgical Procedures-Socket Curettage 1,210 1,210 1,210 1,210 1,210 1,210
Dental 29864 Oral Surgical Procedures-Bone Graft Grade 1 12,300 12,300 12,300 12,300 12,300 12,300
Dental 29865 Oral Surgical Procedures-Bone Graft Grade 2 18,300 18,300 18,300 18,300 18,300 18,300
Dental 29866 Miscellaneous-Local Anesthesia Block (Diagnostic 500 500 500 500 500 500
Dental 29868 Rehabilitation - Lumineers 24,500 24,500 24,500 24,500 24,500 24,500
Dental 29869 Fixed Appliance Therapy-Self Ligating (Additiona 18,300 18,300 18,300 18,300 18,300 18,300
Dental 29934 GIC Filling 1,300 1,300 1,300 1,300 1,300 1,300
Dental 29991 All Ceremic Crown Gr III 22,100 22,100 22,100 22,100 22,100 22,100
Dental 30571 Oral Surgical Procedures-Sinus Lift Direct-( Per 42,000 42,000 42,000 42,000 42,000 42,000
Dental 30574 Oral Surgical Procedures-Sinus Lift Indirect 15,750 15,750 15,750 15,750 15,750 15,750
Dental 30577 Obturators-Definative 21,000 21,000 21,000 21,000 21,000 21,000
Dental 30854 Oral Surgical Procedures-Apexification (Per Visi 630 630 630 630 630 630
Dental 30855 Oral Surgical Procedures-Apexogenesis (Per Visit 630 630 630 630 630 630
Dental 30856 Oral Surgical Procedures-Bone Graft - Intra oral 12,100 12,100 12,100 12,100 12,100 12,100
Dental 30857 Oral Surgical Procedures-Cryotherapy 18,200 18,200 18,200 18,200 18,200 18,200
Dental 30858 Cyst Marsupilization 10,500 10,500 10,500 10,500 10,500 10,500
Dental 30859 Oral Surgical Procedures-Frenectomy Major 6,100 6,100 6,100 6,100 6,100 6,100
Dental 30860 Oral Surgical Procedures-Frenectomy Minor 3,090 3,090 3,090 3,090 3,090 3,090
Dental 30861 Oral Surgical Procedures-Nerve Avulsion 21,000 21,000 21,000 21,000 21,000 21,000
Dental 30862 Oral Surgical Procedures-Ridge Splitting 15,750 15,750 15,750 15,750 15,750 15,750
Dental 30863 Oral Surgical Procedures-Vestibuloplasty 15,750 15,750 15,750 15,750 15,750 15,750
Dental 30864 Extractions-Removal of Tooth Grade 1 1,000 1,000 1,000 1,000 1,000 1,000
Dental 30866 Extractions of Fractured Crown 2,600 2,600 2,600 2,600 2,600 2,600
Dental 30867 Extractions-Removal Of Decayed Root 2,650 2,650 2,650 2,650 2,650 2,650
Dental 30868 Extraction of mobile Tooth 1,600 1,600 1,600 1,600 1,600 1,600
Dental 30871 Extractions-Removal of Tooth Grade-2 1,330 1,330 1,330 1,330 1,330 1,330
Dental 30873 Bleaching-Additional bleach tube 1,880 1,880 1,880 1,880 1,880 1,880
Dental 30874 Removable Appliance Therapy - Mouthguards 3,640 3,640 3,640 3,640 3,640 3,640
Dental 30875 Removable Appliance Therapy - Oral Screen 3,640 3,640 3,640 3,640 3,640 3,640
Dental 30876 Removable Appliance Therapy - Pediatric Obturator 6,100 6,100 6,100 6,100 6,100 6,100

Dental 30877 Removable Appliance Therapy - Simple Removable Oth 6,700 6,700 6,700 6,700 6,700 6,700

Dental 30878 Removable Appliance Therapy -Thumbsucking Grade 1 7,900 7,900 7,900 7,900 7,900 7,900
Dental 30879 Removable Appliance Therapy -Thumbsucking Grade 2 9,200 9,200 9,200 9,200 9,200 9,200
Dental 30880 Removable Appliance Therapy -Z-spring appliance 7,300 7,300 7,300 7,300 7,300 7,300
Dental 30881 Restorations-Desensitivity Treatment 1,010 1,010 1,010 1,010 1,010 1,010
Dental 30882 Incognito Lite (single arch) 94,500 94,500 94,500 94,500 94,500 94,500
Dental 30883 Fixed Appliance Therapy-Ingognito Installment 2 60,200 60,200 60,200 60,200 60,200 60,200
Dental 30884 Fixed Appliance Therapy-Ingognito Installment 3 60,200 60,200 60,200 60,200 60,200 60,200
Dental 30885 Ortho Breakage Charges 2,100 2,100 2,100 2,100 2,100 2,100
Dental 30886 Fixed Appliance Therapy-Self ligating Metal Brack 66,300 66,300 66,300 66,300 66,300 66,300
Dental 30887 Fixed Appliance self ligation metal(SA) 47,300 47,300 47,300 47,300 47,300 47,300
Dental 30888 Rehabilitation-All Ceramic Metal Free Grade 4 24,300 24,300 24,300 24,300 24,300 24,300
Dental 30889 Rehabilitation-Band & Loop Space Maintainer 4,300 4,300 4,300 4,300 4,300 4,300
Dental 30890 Complete Denture Grade I 22,100 22,100 22,100 22,100 22,100 22,100
Dental 30891 Complete Denture Grade II 35,700 35,700 35,700 35,700 35,700 35,700
Dental 30892 Rehabilitation -Crown & Loop Space Maintainer 4,860 4,860 4,860 4,860 4,860 4,860
Dental 30893 Flexible Resin System Gr III 22,100 22,100 22,100 22,100 22,100 22,100
Dental 30894 Rehabilitation -Removable Space Maintainer 2,650 2,650 2,650 2,650 2,650 2,650
Dental 30895 Rehabilitation - Thinners 24,300 24,300 24,300 24,300 24,300 24,300
Dental 30896 Rehabilitation - Relining Grade 1 1,660 1,660 1,660 1,660 1,660 1,660
Dental 30897 Relining Direct Technique 4,200 4,200 4,200 4,200 4,200 4,200
Dental 30898 Relining indirect Technique 6,300 6,300 6,300 6,300 6,300 6,300
Dental 30899 RPD additional tooth 1,050 1,050 1,050 1,050 1,050 1,050
Dental 30900 Rehabilitation - RPD Single Tooth Type -1 1,090 1,090 1,090 1,090 1,090 1,090
Dental 30901 RPD 2,630 2,630 2,630 2,630 2,630 2,630
Dental 30902 Root Canal Treatment - Pulp Therapy 1 3,640 3,640 3,640 3,640 3,640 3,640
Dental 30903 Root Canal Treatment - Pulp Therapy 2 4,860 4,860 4,860 4,860 4,860 4,860
Dental 30904 Root Canal Treatment - Pulp Therapy 3 6,100 6,100 6,100 6,100 6,100 6,100
Dental 30905 RCT Grade III 9,000 9,000 9,000 9,000 9,000 9,000

9
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Dental 30906 Miscellaneous-Breakage Charges 1,210 1,210 1,210 1,210 1,210 1,210
Dental 30907 Miscellaneous-Esthetic Recontouring (Per Tooth) 630 630 630 630 630 630
Dental 30908 Radiology - Bitewing 500 500 500 500 500 500
Dental 30913 Extractions–Decayed/Over Retained Dec Tooth 1 1,090 1,090 1,090 1,090 1,090 1,090
Dental 30914 Extractions–Decayed/Over Retained Dec Tooth 2 1,210 1,210 1,210 1,210 1,210 1,210
Dental 30915 Extractions–Decayed/Over Retained Dec Tooth 3 1,880 1,880 1,880 1,880 1,880 1,880
Dental 30916 Fixed Appliance Therapy-Self Ligating MB Third Ins 12,100 12,100 12,100 12,100 12,100 12,100
Dental 30917 Fixed Appliance Metal(single arch) 31,500 31,500 31,500 31,500 31,500 31,500
Dental 30918 Fixed Appliance Therapy-Self Ligating MB Second In 24,300 24,300 24,300 24,300 24,300 24,300
Dental 30919 Drainage of I.O abcess 4,700 4,700 4,700 4,700 4,700 4,700
Dental 30920 Oral Surgical Proce-Drainage of I.O Abscess Gr 1 3,090 3,090 3,090 3,090 3,090 3,090
Dental 30921 Soft Tissue Mgmt-Flap Surg Plus Bone Graft gtr Gr2 18,200 18,200 18,200 18,200 18,200 18,200
Dental 30922 Soft Tissue Mgmt-Subgi Scaling&Root Planing Gr1(Pe 1,300 1,300 1,300 1,300 1,300 1,300
Dental 30923 Soft Tissue Mgmt-Subgi Scaling&Root Planing Gr2(Pe 2,160 2,160 2,160 2,160 2,160 2,160

Dental 30924 Removable Appliance Therapy-Retainer Remaking Gr 2 2,650 2,650 2,650 2,650 2,650 2,650

Dental 30926 Removable Appliance Therapy – HBA- 1 4,300 4,300 4,300 4,300 4,300 4,300
Dental 30927 Habit Breaking Appliance 7,900 7,900 7,900 7,900 7,900 7,900
Dental 31374 Fixed Appliance Therapy-Ortho Installment Gr 1 3,640 3,640 3,640 3,640 3,640 3,640
Dental 31375 Fixed Appliance Therapy-Ortho Installment Gr 2 6,100 6,100 6,100 6,100 6,100 6,100
Dental 31376 Composite Filling Grade II 3,200 3,200 3,200 3,200 3,200 3,200
Dental 31377 Soft Tissue Management-Full Mouth Scaling & Polisi 2,060 2,060 2,060 2,060 2,060 2,060
Dermatology 17943 Slit Smear for AFB (Derm) 630 630 630 630 630 630
Dermatology 20695 Mole Excision 3,600 3,600 3,600 3,600 3,600 3,600
Dermatology 25152 Skin Prick Test 8,300 8,300 8,300 8,300 8,300 8,300
Dermatology 32847 HAIR REMOVAL-Chin (Per Sitting) 2,350 2,350 2,350 2,350 2,350 2,350
Dermatology 32848 HAIR REMOVAL-Chin ( 6 visit package) 11,800 11,800 11,800 11,800 11,800 11,800
Dermatology 32849 HAIR REMOVAL-Chin Maintainance Session 2,240 2,240 2,240 2,240 2,240 2,240
Dermatology 32850 HAIR REMOVAL-Upper Lip + Lower Lip (Chin) (Per Sit 4,200 4,200 4,200 4,200 4,200 4,200
Dermatology 32851 HAIR REMOVAL-Upper Lip + Lower Lip (Chin) ( 6 visi 20,700 20,700 20,700 20,700 20,700 20,700
Dermatology 32853 HAIR REMOVAL-Upper lip (Per Sitting) 2,350 2,350 2,350 2,350 2,350 2,350
Dermatology 32855 HAIR REMOVAL-Upper lip Maintainance Session 2,240 2,240 2,240 2,240 2,240 2,240
Dermatology 32856 HAIR REMOVAL-Neck (Per Sitting) 2,960 2,960 2,960 2,960 2,960 2,960
Dermatology 32857 HAIR REMOVAL-Neck ( 6 visit package) 14,800 14,800 14,800 14,800 14,800 14,800
Dermatology 32865 HAIR REMOVAL-Posterior neck (Per Sitting) 2,960 2,960 2,960 2,960 2,960 2,960
Dermatology 32866 HAIR REMOVAL-Posterior neck ( 6 visit package) 14,800 14,800 14,800 14,800 14,800 14,800
Dermatology 32868 HAIR REMOVAL-Side Lock (Per Sitting) 2,960 2,960 2,960 2,960 2,960 2,960
Dermatology 32869 HAIR REMOVAL-Side Lock ( 6 visit package) 14,800 14,800 14,800 14,800 14,800 14,800
Dermatology 32870 HAIR REMOVAL-Side Lock Maintainance Session 2,550 2,550 2,550 2,550 2,550 2,550
Dermatology 32871 HAIR REMOVAL-Forehead (Per Sitting) 3,600 3,600 3,600 3,600 3,600 3,600
Dermatology 32872 HAIR REMOVAL-Forehead ( 6 visit package) 17,600 17,600 17,600 17,600 17,600 17,600

Dermatology 32874 HAIR REMOVAL-Lower Face(Cheeks+Jaw+Chin+U/L+S/L)(P 5,900 5,900 5,900 5,900 5,900 5,900

Dermatology 32875 HAIR REMOVAL-Lower Face(Cheek+Jaw+Chin+U/L+S/L)(6 29,600 29,600 29,600 29,600 29,600 29,600

Dermatology 32876 HAIR REMOVAL-Lower Face(Cheek+Jaw+Chin+U/L+S/L)Mai 5,400 5,400 5,400 5,400 5,400 5,400

Dermatology 32877 HAIR REMOVAL-Jawline & side locks (Per Sitting) 4,700 4,700 4,700 4,700 4,700 4,700
Dermatology 32878 HAIR REMOVAL-Jawline & side locks ( 6 visit packag 23,700 23,700 23,700 23,700 23,700 23,700
Dermatology 32879 HAIR REMOVAL-Jawline & side locks Maintainance Ses 4,200 4,200 4,200 4,200 4,200 4,200
Dermatology 32880 HAIR REMOVAL-Full Face (Per Sitting) 8,900 8,900 8,900 8,900 8,900 8,900
Dermatology 32881 HAIR REMOVAL-Full Face ( 6 visit package) 44,300 44,300 44,300 44,300 44,300 44,300
Dermatology 32882 HAIR REMOVAL-Full Face Maintainance Session 6,500 6,500 6,500 6,500 6,500 6,500
Dermatology 32883 HAIR REMOVAL-Cheeks Men (Per Sitting) 3,400 3,400 3,400 3,400 3,400 3,400
Dermatology 32885 HAIR REMOVAL-Cheeks Men Maintainance Session 2,960 2,960 2,960 2,960 2,960 2,960
Dermatology 32886 HAIR REMOVAL-Under arms (Per Sitting) 4,700 4,700 4,700 4,700 4,700 4,700
Dermatology 32887 HAIR REMOVAL-Under arms ( 6 visit package) 23,700 23,700 23,700 23,700 23,700 23,700
Dermatology 32888 HAIR REMOVAL-Under arms Maintainance Session 3,500 3,500 3,500 3,500 3,500 3,500
Dermatology 32889 HAIR REMOVAL-Full Arms (Per Sitting) 9,400 9,400 9,400 9,400 9,400 9,400
Dermatology 32891 HAIR REMOVAL-Full Arms Maintainance Session 9,300 9,300 9,300 9,300 9,300 9,300
Dermatology 32893 HAIR REMOVAL-Fore Arms ( 6 visit package) 29,600 29,600 29,600 29,600 29,600 29,600
Dermatology 32894 HAIR REMOVAL-Fore Arms Maintainance Session 5,800 5,800 5,800 5,800 5,800 5,800
Dermatology 32895 HAIR REMOVAL-Full Legs (Per Sitting) 14,200 14,200 14,200 14,200 14,200 14,200
Dermatology 32896 HAIR REMOVAL-Full Legs ( 6 visit package) 70,900 70,900 70,900 70,900 70,900 70,900
Dermatology 32897 HAIR REMOVAL-Full Legs Maintainance Session 10,500 10,500 10,500 10,500 10,500 10,500
Dermatology 32898 HAIR REMOVAL-Lower legs (Per Sitting) 8,300 8,300 8,300 8,300 8,300 8,300
Dermatology 32900 HAIR REMOVAL-Lower legs Maintainance Session 6,500 6,500 6,500 6,500 6,500 6,500
Dermatology 32901 HAIR REMOVAL-Chest (Per Sitting) 9,400 9,400 9,400 9,400 9,400 9,400
Dermatology 32903 HAIR REMOVAL-Chest Maintainance Session 6,900 6,900 6,900 6,900 6,900 6,900
Dermatology 32904 HAIR REMOVAL-Abdomen (Per Sitting) 9,400 9,400 9,400 9,400 9,400 9,400
Dermatology 32907 HAIR REMOVAL-Abdomen Line (Per Sitting) 3,400 3,400 3,400 3,400 3,400 3,400
Dermatology 32908 HAIR REMOVAL-Abdomen Line ( 6 visit package) 16,500 16,500 16,500 16,500 16,500 16,500

10
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Dermatology 32911 HAIR REMOVAL-Upper Back ( 6 visit package) 47,200 47,200 47,200 47,200 47,200 47,200
Dermatology 32913 HAIR REMOVAL-Lower Back (Per Sitting) 9,400 9,400 9,400 9,400 9,400 9,400
Dermatology 32915 HAIR REMOVAL-Lower Back Maintainance Session 8,200 8,200 8,200 8,200 8,200 8,200
Dermatology 32919 HAIR REMOVAL-Full Front (Per Sitting) 14,200 14,200 14,200 14,200 14,200 14,200
Dermatology 32922 HAIR REMOVAL-Bikini (Per Sitting) 4,700 4,700 4,700 4,700 4,700 4,700
Dermatology 32924 HAIR REMOVAL-Bikini Maintainance Session 4,600 4,600 4,600 4,600 4,600 4,600
Dermatology 32928 HAIR REMOVAL-Buttocks (Per Sitting) 5,900 5,900 5,900 5,900 5,900 5,900
Dermatology 32933 HAIR REMOVAL-Full body Maintainance Session 29,600 29,600 29,600 29,600 29,600 29,600
Dermatology 32940 HAIR REMOVAL-Ears (Both) (Per Sitting) 2,960 2,960 2,960 2,960 2,960 2,960
Dermatology 32941 HAIR REMOVAL-Ears (Both) ( 6 visit package) 14,800 14,800 14,800 14,800 14,800 14,800
Dermatology 32942 HAIR REMOVAL-Ears (Both) Maintainance Session 1,170 1,170 1,170 1,170 1,170 1,170
Dermatology 32943 HAIR REMOVAL-Cleavage (Per Sitting) 3,900 3,900 3,900 3,900 3,900 3,900
Dermatology 32945 HAIR REMOVAL-Cleavage Maintainance Session 3,500 3,500 3,500 3,500 3,500 3,500
Dermatology 32948 HAIR REMOVAL-Beaker Nevus Maintainance Session 3,500 3,500 3,500 3,500 3,500 3,500
Dermatology 32949 IPL-Full Face Rejuvenation (Per Sitting) 4,600 4,600 4,600 4,600 4,600 4,600
Dermatology 32951 IPL-Face & Neck Rejuvenation (Per Sitting) 8,700 8,700 8,700 8,700 8,700 8,700
Dermatology 32953 IPL-Forearms (Per Sitting) 11,600 11,600 11,600 11,600 11,600 11,600
Dermatology 32955 IPL-Age Spots (Per Sitting) 4,600 4,600 4,600 4,600 4,600 4,600
Dermatology 32957 IPL-Cafe Au Lait Spots (Per Sitting) 4,600 4,600 4,600 4,600 4,600 4,600
Dermatology 32967 IPL-Telangiectasia (Per Sitting) 3,500 3,500 3,500 3,500 3,500 3,500
Dermatology 32969 IPL-Port Wine Stain SMALL (Per Sitting) 4,600 4,600 4,600 4,600 4,600 4,600
Dermatology 32971 IPL-Port Wine Stain MEDIUM (Per Sitting) 6,900 6,900 6,900 6,900 6,900 6,900
Dermatology 32978 FRACTIONAL-Full face resufacing 21,200 21,200 21,200 21,200 21,200 21,200
Dermatology 32979 FRACTIONAL-Acne Scars cheeks 14,200 14,200 14,200 14,200 14,200 14,200
Dermatology 32980 FRACTIONAL-Scar -Small 4,700 4,700 4,700 4,700 4,700 4,700
Dermatology 32981 FRACTIONAL-Scar -Medium 7,000 7,000 7,000 7,000 7,000 7,000
Dermatology 32982 FRACTIONAL-Scar -Big 9,400 9,400 9,400 9,400 9,400 9,400
Dermatology 32983 FRACTIONAL-Deep Wrinkles (Face) 21,200 21,200 21,200 21,200 21,200 21,200
Dermatology 32988 FRACTIONAL-Fine Wrinkles 14,200 14,200 14,200 14,200 14,200 14,200
Dermatology 32990 FRACTIONAL-Chicken Pox Scars 11,800 11,800 11,800 11,800 11,800 11,800
Dermatology 32991 FRACTIONAL-Stretch Marks -Small 4,700 4,700 4,700 4,700 4,700 4,700
Dermatology 32992 FRACTIONAL-Stretch Marks -Medium 10,600 10,600 10,600 10,600 10,600 10,600
Dermatology 32993 FRACTIONAL-Stretch Marks -Large 17,600 17,600 17,600 17,600 17,600 17,600
Dermatology 33080 Cryotherapy - small area < 5 1,840 1,840 1,840 1,840 1,840 1,840
Dermatology 33081 Cryotherapy - Medium grade area 5-10 2,960 2,960 2,960 2,960 2,960 2,960
Dermatology 33083 Cryotherapy - > 20 lesums 7,000 7,000 7,000 7,000 7,000 7,000
Dermatology 33084 Skin Biopsy - Punch Biopsy 1,840 1,840 1,840 1,840 1,840 1,840
Dermatology 33085 Skin Biopsy - Excisional Biopsy 2,960 2,960 2,960 2,960 2,960 2,960
Dermatology 33086 Nail Excision - Single Nail 3,600 3,600 3,600 3,600 3,600 3,600
Dermatology 33087 Curettage - < 5 lesions 1,170 1,170 1,170 1,170 1,170 1,170
Dermatology 33088 Curettage - 5-10 lesions 2,350 2,350 2,350 2,350 2,350 2,350
Dermatology 33089 Curettage - >10 lesions 3,600 3,600 3,600 3,600 3,600 3,600
Dermatology 33104 Dermaroller procedure charges 2,350 2,350 2,350 2,350 2,350 2,350
Dermatology 33107 DERMA SURGERY (Excission) MEDIUM SIGZED 4,700 4,700 4,700 4,700 4,700 4,700

Dermatology 33108 DERMA SURGERY (Excission) MULTIPLE OR VERY LARGE C 7,000 7,000 7,000 7,000 7,000 7,000

Dermatology 35101 Platelet Rich Plasma Infusion 12,400 12,400 12,400 12,400 12,400 12,400
Dermatology 35130 Radio frequency - Lesion (extra small) 3,500 3,500 3,500 3,500 3,500 3,500
Dermatology 35131 Radio frequency - Lesion (small) 5,300 5,300 5,300 5,300 5,300 5,300
Dermatology 35132 Radio frequency - lesion (large) 7,600 7,600 7,600 7,600 7,600 7,600
Dermatology 35133 Radio frequency - lesion (extra large) 8,100 8,100 8,100 8,100 8,100 8,100
Dermatology 35134 Radio frequency - Lesion (Medium) 6,900 6,900 6,900 6,900 6,900 6,900
Dermatology 36371 Chemical Cautery(single&small) 660 660 660 660 660 660
Dermatology 36372 Chemical Cautery(few&small) 1,170 1,170 1,170 1,170 1,170 1,170
Dermatology 36373 Chemical Cautery(many&small/ large&single) 1,840 1,840 1,840 1,840 1,840 1,840
Dermatology 36374 Chemical Cautery(large&few) 2,350 2,350 2,350 2,350 2,350 2,350
Dermatology 36375 Chemical Cautery(large&many) 2,960 2,960 2,960 2,960 2,960 2,960
Dermatology 36376 Cryo Cauterization (small&single) 1,200 1,200 1,200 1,200 1,200 1,200
Dermatology 36377 Cryo Cauterization(small&few) 2,300 2,300 2,300 2,300 2,300 2,300
Dermatology 36378 Cryo Cauterization(small&many/large&single) 3,500 3,500 3,500 3,500 3,500 3,500
Dermatology 36379 Cryo Cauterization(large&few) 4,600 4,600 4,600 4,600 4,600 4,600
Dermatology 36380 Cryo Cauterization(large&many) 5,800 5,800 5,800 5,800 5,800 5,800
Dermatology 36381 Cryo Cauterization large & multiple lesions 6,900 6,900 6,900 6,900 6,900 6,900
Dermatology 36382 Electro/RF Cauterization - (small&single) 2,350 2,350 2,350 2,350 2,350 2,350
Dermatology 36383 Electro/RF Cauterization(small&few) 4,700 4,700 4,700 4,700 4,700 4,700
Dermatology 36384 Electro/RF Cauterization (small&many/large&single) 7,000 7,000 7,000 7,000 7,000 7,000
Dermatology 36385 Electro/RF Cauterization(large&few) 9,400 9,400 9,400 9,400 9,400 9,400
Dermatology 36386 Electro/RF Cauterization(large&many) 11,800 11,800 11,800 11,800 11,800 11,800
Dermatology 36387 Ear Lobe repair(single) 3,600 3,600 3,600 3,600 3,600 3,600
Dermatology 36388 Ear Lobe repair(both) 5,900 5,900 5,900 5,900 5,900 5,900
Dermatology 36389 Cyst excision ( small) 3,600 3,600 3,600 3,600 3,600 3,600
Dermatology 36390 Cyst excision (small & few) 5,900 5,900 5,900 5,900 5,900 5,900

11
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Dermatology 36391 Cyst excision (small & many/Large & single) 8,300 8,300 8,300 8,300 8,300 8,300
Dermatology 36392 Cyst excision (large & few) 10,600 10,600 10,600 10,600 10,600 10,600
Dermatology 36393 Cyst excision (large & many) 14,200 14,200 14,200 14,200 14,200 14,200
Dermatology 36394 Intralesional Inj(single) 660 660 660 660 660 660
Dermatology 36395 Intralesional Inj(few&large) 1,160 1,160 1,160 1,160 1,160 1,160
Dermatology 36396 Intralesional Inj(many&small) 1,840 1,840 1,840 1,840 1,840 1,840
Dermatology 36397 Intralesional Inj(many large ) 2,960 2,960 2,960 2,960 2,960 2,960
Dermatology 36399 Nail Excision - Two 5,900 5,900 5,900 5,900 5,900 5,900
Dermatology 36400 Paring for corn - small&single 660 660 660 660 660 660
Dermatology 36401 Paring for corn - small&few/single large 1,170 1,170 1,170 1,170 1,170 1,170
Dermatology 36406 Scrapping for Fungus 660 660 660 660 660 660
Dermatology 36407 Subcision (small) 2,350 2,350 2,350 2,350 2,350 2,350
Dermatology 36409 Chemical Peel - Back/Legs (GLYCOLIC/ LACTIC ) 4,200 4,200 4,200 4,200 4,200 4,200
Dermatology 36412 Chemical Peel - Back/Legs (YELLOW PEEL ) 7,800 7,800 7,800 7,800 7,800 7,800
Dermatology 36413 Chemical Peel - Face (GLYCOLIC/ LACTIC ) 1,790 1,790 1,790 1,790 1,790 1,790
Dermatology 36414 Chemical Peel - Face (TCA 15/ BLUE ) 2,960 2,960 2,960 2,960 2,960 2,960
Dermatology 36415 Chemical Peel - Face (TCA/NMP ) 4,200 4,200 4,200 4,200 4,200 4,200
Dermatology 36416 Chemical Peel - Face (YELLOW PEEL ) 5,400 5,400 5,400 5,400 5,400 5,400

Dermatology 36418 Chemical Peel - Face & Neck/Arms (GLYCOLIC/ LACTIC ) 2,300 2,300 2,300 2,300 2,300 2,300

Dermatology 36419 Chemical Peel - Face & Neck/Arms (TCA 15/ BLUE ) 4,200 4,200 4,200 4,200 4,200 4,200
Dermatology 36420 Chemical Peel - Face & Neck/Arms (TCA/NMP ) 4,700 4,700 4,700 4,700 4,700 4,700
Dermatology 36421 Chemical Peel - Face & Neck/Arms (YELLOW PEEL ) 5,900 5,900 5,900 5,900 5,900 5,900
Dermatology 36422 Mesotherapy-face Grade A 4,700 4,700 4,700 4,700 4,700 4,700
Filler inj. - NASOLABIAL FOLD/jowl/marionette lines
Dermatology 36434 4,700 4,700 4,700 4,700 4,700 4,700
(Grade B) (Procedure charges only)
Dermatology 20685 Cryotherapy per Lesion 1,100 1,100 1,100 1,100 1,100 1,100
Dermatology 35103 Cryotherapy Spray 1,200 1,200 1,200 1,200 1,200 1,200
Dermatology 35321 Ramicade Infusion 6,200 6,200 6,200 6,200 6,200 6,200
Dialysis 26879 Haemodialysis ,single use,F8,Routine,HD unit 3,500 4,100 4,100 4,100 4,200 4,200
Dialysis 26884 Haemodialysis, single use, F8, emergency, bedside 3,900 4,200 4,200 4,200 4,500 4,500
Dialysis 20180 Haemo Femoral Catherization 2,200 2,200 3,400 4,400 6,100 7,800
Dialysis 20285 Insertion of Femoral Dialysis catheter, emergency 2,700 2,700 3,900 5,000 6,700 8,400
Dialysis 20286 Insertion of internal Jugular Dialysis catheter, routine 3,000 3,200 3,600 4,600 6,300 9,000

Dialysis 20287 Insertion of internal Jugular Dialysis catheter, emergency 3,300 3,300 3,900 5,000 6,700 9,600

Dialysis 20288 Insertion of Subclavian Dialysis catheter, routine 2,200 2,200 3,400 4,400 6,100 8,800
Dialysis 38881 Haemodialysis, Re Use, F8, Routine 2,600 3,200 3,200 3,200 3,300 3,300
Dialysis 38882 Haemodialysis, Single Use, FX8, Routine 3,200 3,800 3,800 3,800 3,900 3,900
Dialysis 20290 Insertion of Acute PD catheter, routine 3,700 3,700 4,400 5,600 7,100 11,000
Dialysis 20291 Insertion of Acute PD catheter, emergency 4,100 4,100 4,900 6,100 7,800 11,600
Dialysis 20294 Plasamapharesis Procedure 4,200 4,200 6,300 8,400 11,600 16,800
Dialysis 20335 Hemodialysis, Single Use, F6, Routine 3,200 3,800 3,800 3,800 3,900 3,900
Dialysis 20336 Hemodialysis, Single Use, F6, Bedside 3,600 3,800 3,800 3,800 4,000 4,000
Dialysis 20337 Hemodialysis, Single Use, F6, Emergency 3,800 3,900 3,900 3,900 4,100 4,100
Dialysis 20339 Hemodialysis, Single Use, Asahi/Baxter, Routine 3,000 3,600 3,600 3,600 3,800 3,800
Dialysis 20343 Hemodialysis, Re Use, F6, Routine 2,400 2,900 2,900 2,900 3,000 3,000
Dialysis 23585 Haemodialysis, Single Use, F60, Routine 3,100 3,700 3,700 3,700 3,900 3,900
Dialysis 46884 SLED F-6 Single Use- 6 hours 7,500 8,000 8,000 8,000 8,500 8,500
Dialysis 46885 SLED F-6 Single Use - 8 hours - 9,000 9,000 9,000 10,000 10,000
Dialysis 46886 SLED F-6 Single Use- 10 hours - 10,000 10,000 10,000 12,000 12,000
Dialysis 46887 SLED F-6 Single Use- 12 hours - 11,000 11,000 11,000 14,000 14,000
Dialysis 30453 Small Dressing (Neph) 230 290 340 560 590 590
Dialysis 30458 CRRT (24 Hrs) - 16,000 16,000 16,000 17,000 17,000
Dialysis 30459 Endotoxin Filtration 10,500 10,500 10,500 10,500 12,600 12,600
Dialysis 35591 Heamo Dialysis 5008S 4,200 4,400 4,400 4,400 4,500 4,500
Dialysis 35349 Transfer Set (Neph) 800 800 800 1,700 1,700 1,700
Dialysis 35350 CAPD Training 10,500 10,500 10,500 10,500 12,600 12,600
Dialysis 35352 PET / Adequacy (Neph) 1,300 1,300 1,300 2,600 2,800 2,800
Dialysis 36273 Automated Peritoneal Dialysis 2,200 2,400 2,400 2,400 2,600 2,600
Dietician 34627 Oncology Recipe Booklet 110 110 110 110 110 110
Dietician 34628 Bariatric Recipe Booklet 110 110 110 110 110 110
Dietician 45265 Patient Diet Charges 450 450 450 450 450 450
Emergency 34202 IV Infusion Charges 275 290 290 290 290 290
Endocrinology 40020 Endocrinology Procedure fee 5,500 5,800 5,800 5,800 5,800 5,800
Endocrinology 42514 Diabetes Edu-Consult - 170 170 170 170 170
Endocrinology 41781 Flash Glucose Monitoring System 3,700 3,900 3,900 3,900 3,900 3,900
Endoscopy 16401 Colonoscopy Limited Diagnostic 4,800 5,100 5,800 7,300 9,400 14,100
Endoscopy 37041 Colonoscopy Pediatric 9,300 9,300 10,700 13,300 17,200 26,000
Endoscopy 16403 Sigmoidoscopy Diagnostic 4,100 4,300 4,900 6,200 8,000 12,100
Endoscopy 16404 Sigmoidoscopy with Biopsy 4,500 4,700 5,500 6,700 8,700 13,300
Endoscopy 16406 UGI Endoscopy H Pylori test 5,100 5,400 6,200 7,700 9,900 15,100

12
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Endoscopy 16408 UGI Endoscopy Diagnostic 4,700 4,900 5,700 7,100 9,200 13,900
Endoscopy 38989 UGI Endoscopy Diagnostic (Complex) 7,100 7,500 8,600 10,700 13,800 21,000
Endoscopy 38990 UGI Endoscopy Therapeutic (Complex) 11,200 11,800 13,600 16,800 21,800 33,100
Endoscopy 38991 Colonoscopy full (Cecum) Diagnostic (Complex) 11,100 11,700 13,500 16,700 21,600 32,700
Endoscopy 38992 Colonoscopy full (Cecum) Therapeutic (Complex) 16,100 17,000 19,500 24,200 31,400 47,500
Endoscopy 39119 Fibro Scan (LSM) 5,000 5,700 6,500 8,100 10,500 15,900
Endoscopy 16409 ERCP Papillotomy 16,200 17,100 19,600 24,400 31,600 47,800
Endoscopy 16412 ERCP Mechanical lithotripsy 24,900 26,200 30,100 37,500 48,500 73,400
Endoscopy 36825 EUS with Guide sheath 11,300 11,900 13,700 17,100 22,000 33,300
Endoscopy 36826 EBUS Diagnostic 12,100 12,700 14,600 18,200 23,600 35,700
Endoscopy 36829 Sigmoidoscopy with Polypectomy 8,700 8,700 10,000 12,400 16,100 24,400
Endoscopy 36828 Endoscopy Intra-Operative 14,900 15,700 18,000 22,400 29,100 43,900
Endoscopy 16415 UGI Endoscopy Varices Sclerotherapy 7,600 8,000 9,200 11,500 14,800 22,400
Endoscopy 16418 UGI Endoscopy Achalasia Dilatation 12,100 12,700 14,600 18,200 23,600 35,700
Endoscopy 16419 UGI Endoscopy Dilatation of Strcture 7,600 8,000 9,200 11,500 14,800 22,400
Endoscopy 16422 UGI Endoscopy PEG Placement 9,000 9,500 11,000 13,600 17,600 26,500
Endoscopy 16423 Colonoscopy Polypectomy (>5 Polyps) 15,000 15,800 18,200 22,600 29,300 44,200
Endoscopy 16424 Colonoscopy Polypectomy 13,100 13,800 15,900 19,700 25,500 38,600
Endoscopy 16425 Colonoscopy Dilatation 9,500 10,000 11,500 14,300 18,500 28,000
Endoscopy 16426 Sigmoidoscopy therapy for bleeding 6,000 6,000 6,900 8,600 11,100 16,800
Endoscopy 16429 ERCP Pseudocyst Drainage 24,900 26,200 30,100 37,500 48,500 73,400
Endoscopy 16431 ERCP Biliary stent Placement 21,000 22,100 25,400 31,600 41,000 61,900
Endoscopy 16432 ERCP Diagnostic 15,000 15,800 18,200 22,600 29,300 44,200
Endoscopy 24027 UGI Endoscopy Endo therapy for bleed (Injection, C 7,600 8,000 9,200 11,500 14,800 22,400
Endoscopy 24028 UGI Endoscopy Banding of varices 7,600 8,000 9,200 11,500 14,800 22,400
Endoscopy 24029 UGI Endoscopy Argon Plasma Coagulation 10,700 11,300 13,000 16,100 20,800 31,600
Endoscopy 24030 UGI Endoscopy Glue Injection of varices 7,600 8,000 9,200 11,500 14,800 22,400
Endoscopy 24031 UGI Endoscopy Polypectomy 7,600 8,000 9,200 11,500 14,800 22,400
Endoscopy 24032 UGI Endoscopy Foreign Body removal 7,600 8,000 9,200 11,500 14,800 22,400
Endoscopy 24033 UGI Endoscopy Metal Stent Placement 13,700 14,400 16,600 20,600 26,600 40,400
Endoscopy 24034 UGI Endoscopy Nasojejunal tube placement 5,800 6,100 7,100 8,700 11,300 17,100
Endoscopy 24035 UGI Endoscopy Ryles tube placement 5,100 5,400 6,200 7,700 9,900 15,100
Endoscopy 24036 UGI Endoscopy Side viewing scope+/-Stent removal 5,700 6,000 6,900 8,600 11,100 16,800
Endoscopy 24037 Sengstaken Tube Placement 3,100 3,300 3,800 4,600 6,000 9,200
Endoscopy 24038 PEG Replacement (without endoscopy) 1,600 1,700 1,900 2,400 3,200 4,700
Endoscopy 24039 Small Bowel Enteroscopy Diagnostic 8,300 8,700 10,000 12,500 16,200 24,400
Endoscopy 24040 Sigmoidoscopy Banding of Hemarrhoids 5,800 6,100 7,100 8,700 11,300 17,100
Endoscopy 24041 Colonoscopy Full (Cecum) Diagnostic 7,300 7,700 8,800 11,000 14,200 21,900
Endoscopy 24042 Colonoscopy Endo therapy for Bleeding 12,200 12,800 14,700 18,300 23,800 36,000
Endoscopy 24043 Colonoscopy Argon Plasma coagulation 13,100 13,800 15,900 19,700 25,500 38,600
Endoscopy 24045 ERCP Papillotomy+Stone Extraction 21,000 22,100 25,400 31,600 41,000 61,900
Endoscopy 24047 ERCP Pancreatic Stent 21,000 22,100 25,400 31,600 41,000 61,900
Endoscopy 24048 ERCP Brushing and Biopsy 18,400 19,400 22,300 27,700 35,800 54,200
Endoscopy 24050 ERCP Metal stent placement 23,600 24,900 28,500 35,500 46,000 69,600
Endoscopy 24051 Paracentesis Diagnostic Abdominal 2,600 2,700 3,200 3,900 5,100 7,700
Endoscopy 24052 Paracentesis Therapeutic 4,100 4,300 4,900 6,200 8,000 12,100
Endoscopy 24053 ERCP Pancreatic Stone extraction 21,000 22,100 25,400 31,600 41,000 61,900
Endoscopy 24056 Liver Biopsy 4,200 4,400 5,100 6,300 8,200 12,400
Endoscopy 24058 UGI Endoscopy with Biopsy 5,100 5,400 6,200 7,700 9,900 15,100
Endoscopy 24272 Colonoscopy Long with Biopsy 8,300 8,700 10,000 12,500 16,200 24,400
Endoscopy 26451 Colonoscopic Decompression of Colon 10,800 11,400 13,100 16,200 21,100 31,800
Endoscopy 29625 Sigmoidoscopy + APC 9,300 9,800 11,300 14,000 18,100 27,400
Endoscopy 29626 ERCP EPT+Stone Extraction+Stent Placement 22,200 23,400 26,900 33,400 43,300 65,500
Endoscopy 29628 Endoscopy Capsule 17,900 18,800 21,700 27,000 34,900 52,800
Endoscopy 31443 Colonoscopy Metal Stent Placement 13,700 14,400 16,600 20,600 26,600 40,400
Endoscopy 31444 ERCP Nasobiliary drainage 21,000 22,100 25,400 31,600 41,000 61,900
Endoscopy 31445 ERCP Minor Papilla sphincterotomy 22,200 23,400 26,900 33,400 43,300 65,500
Endoscopy 31446 EUS-FNA 27,700 29,200 33,600 41,700 53,900 81,700
Endoscopy 35279 Endoscopic Ultrasound–Diagnostics 13,100 13,800 15,900 19,700 25,500 38,600
Endoscopy 35280 EUS-FNA (with NN) 33,100 34,900 40,100 49,800 64,400 97,600
Endoscopy 35281 EBUS - TBNA (O) 28,700 30,200 34,700 43,200 55,900 84,700
Endoscopy 35322 EBUS - TBNA (with NN-O) 34,400 36,200 41,700 51,800 67,000 101,400
Endoscopy 43692 EBUS - TBNA (with NN-C) 39,300 41,400 47,600 59,200 76,600 115,800
Endoscopy 43802 EBUS-TBNA (C) 33,600 35,400 40,600 50,500 65,500 99,100
ENT 5359 Speech Therapy Consultation 850 850 850 850 850 850
ENT 20449 Audiometery- special test 450 450 450 450 450 450
ENT 5295 Audiometry - Caloric test 2,400 2,400 2,400 2,400 2,400 2,400
ENT 5344 Audiometry - Hearing Aid trail 640 640 640 640 640 640
ENT 5345 Audiometry - Impedance 1,060 1,060 1,060 1,060 1,060 1,060
ENT 5348 Audiometry - Speech Test 640 640 640 640 640 640
ENT 19994 Pure Tone Audiogram 740 740 740 740 740 740
ENT 19995 Short Increment Sensitivity Index (SISI) 470 470 470 470 470 470

13
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
ENT 19996 Tone Decay Test (TDT) 470 470 470 470 470 470
ENT 39749 Epley’s manoeuvre 3,700 3,700 3,700 3,700 3,700 3,700
ENT 43909 Intratympanic decadron inj. 3,800 3,800 3,800 3,800 3,800 3,800
ENT 43207 Stroboscopy 1st sitting 9,100 9,100 9,100 9,100 9,100 9,100
ENT 38517 Drug Induce Sleep Endoscopy 20,500 20,500 20,500 20,500 20,500 20,500
ENT 34211 Diagnostic Nasal Endoscopy 2,500 - - - - -
ENT 21689 Wax Removal 1,100 1,100 1,300 1,600 2,100 3,200
ENT 26147 OAE Screening 950 950 950 950 950 950
ENT 28502 BERA 4,100 4,100 4,100 4,100 4,100 4,100
ENT 28503 ASSR 4,700 4,700 4,700 4,700 4,700 4,700
ENT 30644 Pure Tone Audiogram (PTA)+Speech Audiometry 850 850 850 850 850 850
ENT 30646 Tympanometry 640 640 640 640 640 640
ENT 30648 Eustachian Tube Function 640 640 640 640 640 640
ENT 30649 Hearing Aid Adjustment (External Clients 490 490 490 490 490 490
ENT 30651 VNG (Video Nystagmography) 4,350 4,350 4,350 4,350 4,350 4,350
ENT 34843 Cochlear Implant Mapping session 2,000 2,000 2,000 2,000 2,000 2,000
ENT 34846 Speech Therapy - (Package of 7 sessions) 4,660 4,660 4,660 4,660 4,660 4,660
Equipment Charges 36019 Microdissection Needle - 370 370 370 370 370
Equipment Charges 37721 Laproscope (Cardiac Surgery) - 3,500 3,500 3,500 3,500 3,500
Equipment Charges 39399 Fixomull Small - 220 220 220 220 220
Equipment Charges 39400 Fixomull Medium - 350 350 350 350 350
Equipment Charges 39401 Fixomull Large - 450 450 450 450 450
Equipment Charges 39343 Vessel Harvesting Charges - 24,400 24,400 24,400 24,400 24,400
Equipment Charges 37729 C-Arm (Neuro Cases) - 1,300 1,500 2,000 2,500 3,000
Equipment Charges 37725 C-Arm less than 1Hr - 2,000 2,200 2,700 3,500 5,300
Equipment Charges 37726 C-Arm more than 1Hr - 2,400 2,700 3,400 4,400 6,700
Equipment Charges 24008 Oxygen support charges per hour 120 120 120 120 120 120
Equipment Charges 16853 Oxygen support charges between 4 - 12 hours - 1,000 1,000 1,000 1,000 1,000
Equipment Charges 21631 Oxygen support Charges (24 Hour) - 1,700 1,700 1,700 1,700 1,700
Equipment Charges 39231 Bipolar Charges - 16,000 16,000 16,000 16,000 16,000
Equipment Charges 20389 Infusion Pump/Syringe Pump(0-12hrs) - 300 300 300 300 300
Equipment Charges 24875 Syringe Pump (Up to 24 hrs) - 580 580 580 580 580
Equipment Charges 35283 Laser Bipolar Charges - 16,000 16,000 16,000 16,000 16,000
Equipment Charges 37087 Laser Charges for Stone - 16,000 16,000 16,000 16,000 16,000
Equipment Charges 37562 Laser CO2 Fiber Charges - 31,900 31,900 31,900 31,900 31,900
Equipment Charges 30408 Laser Holmium Charges - 31,900 31,900 31,900 31,900 31,900
Equipment Charges 39230 Laser Luminos Charges - 31,900 31,900 31,900 31,900 31,900
Equipment Charges 28707 Laser Charges for Varicose Veins (Both Leg) - 26,600 26,600 26,600 26,600 26,600
Equipment Charges 28708 Laser Charges for Varicose Veins (Single Leg) - 21,300 21,300 21,300 21,300 21,300
Equipment Charges 36023 Non-Stick Disposable Forceps - 740 740 740 740 740
Equipment Charges 37307 ICP Monitor - 16,000 16,000 16,000 16,000 16,000
Equipment Charges 37308 Fibreoptic - 1,200 1,200 1,200 1,200 1,200
Equipment Charges 37309 Bronchoscope - 1,500 1,500 1,500 1,500 1,500
Equipment Charges 38226 SPY Imaging Charges Type 1 - 6,000 6,000 6,000 6,000 6,000
Equipment Charges 38227 SPY Imaging Charges Type 2 - 9,500 9,500 9,500 9,500 9,500
Equipment Charges 22590 High Frequency Ventilator With Sterilized circuit - 4,100 4,100 4,100 4,100 4,100
Equipment Charges 26348 DVT Pump 10 Per Day - 900 900 900 900 900
Equipment Charges 26349 DVT Pump 20 Per Day - 900 900 900 900 900
Equipment Charges 26350 Alpha Bed (Trancel) Per Day - 530 530 530 530 530
Equipment Charges 26351 Alpha Bed (Excel) Per Day - 530 530 530 530 530
Equipment Charges 37066 Alpha Bed (Auto Logic) Per Day - 840 840 840 840 840
Equipment Charges 36975 Alpha Bed (Easy Carel) Per Day - 530 530 530 530 530
Equipment Charges 37065 Alpha Bed (Trancell Deluxe) Per Day - 530 530 530 530 530
Equipment Charges 21682 Alpha Bed Charges - per day - 530 530 530 530 530
Equipment Charges 39246 Alpha Bed (Response) Per Day - 530 530 530 530 530
Equipment Charges 26352 Alpha Bed (Nimbus) Per Day - 840 840 840 840 840
Equipment Charges 26353 Alpha Bed (Auto Excel) Per Day - 530 530 530 530 530
Equipment Charges 27170 VAC Machine Per Day - 1,800 1,800 1,800 1,800 1,800
Equipment Charges 29294 DVT Kendall Per day - 900 900 900 900 900
Equipment Charges 29707 Bilirubin Transcutaneous 470 470 470 470 470 470
Equipment Charges 30610 Ventillator (NICU/PICU) - 2,900 2,900 2,900 2,900 2,900
Equipment Charges 43769 Fetal Monitoring Per Hour Charges - 320 320 320 320 320
Equipment Charges 34192 Oil Diffuser - 460 460 460 460 460
Equipment Charges 34195 Disposable perforator - 2,600 2,600 2,600 2,600 2,600
Equipment Charges 34196 Reflective Marker Sphere - 1,700 1,700 1,700 1,700 1,700
Equipment Charges 34197 Image Guidance - 11,600 11,600 11,600 11,600 11,600
Equipment Charges 36203 Avastin Inj Charges - 10,500 10,500 10,500 10,500 10,500
Equipment Charges 39321 Bilrubinometer 230 230 230 230 230 230
Equipment Charges 37102 C-MAC - 1,200 1,200 1,200 1,200 1,200
Equipment Charges 39642 Colorado Needle - 580 580 580 580 580
Equipment Charges 33769 Dressing Set - 120 120 120 120 120
Equipment Charges 40262 Fluoroscopy Equipment Charge - 1,400 1,400 1,400 1,400 1,400

14
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Equipment Charges 39396 Fundoscopy 260 260 260 260 260 260
Equipment Charges 34200 Lithocast - 3,500 3,500 3,500 3,500 3,500
Equipment Charges 34201 Sonosite - 1,700 1,700 1,700 1,700 1,700
Equipment Charges 35324 ECMO Retrieval - 57,900 57,900 57,900 57,900 57,900
Equipment Charges 35325 ECMO Maintenance Charges - 115,800 115,800 115,800 115,800 115,800
Equipment Charges 24125 BIPAP - Per Day - 2,200 2,200 2,200 2,200 2,200
Equipment Charges 24127 CPAP - Per Day - 3,300 3,300 3,300 3,300 3,300
Equipment Charges 20396 Ventilator - Per day - 4,800 4,800 4,800 4,800 4,800
OT Equipment - Laproscope - 1,900 2,200 2,700 2,860 4,700
OT Equipment - Cystoscope - 1,000 1,100 1,400 1,430 2,700
OT Equipment - Hysteroscope - 1,000 1,100 1,400 1,800 2,700
OT Equipment - Ureteroscope - 1,000 1,100 1,400 1,800 2,700
OT Equipment - Endoscope - 1,000 1,100 1,400 1,800 2,700
OT Equipment - Harmonic Scalpel - 1,400 1,600 2,000 3,500 4,000
OT Equipment - Brain Suite - 25,000 25,000 25,000 25,000 25,000
OT Equipment - Nerve Monitoring System - 6,000 6,000 6,000 6,000 6,000
Nephrology 18008 CAPD Catheter Implant (Neph) 16,390 16,390 18,720 23,400 30,430 46,820
Nephrology 18018 Kidney Biopsy (Neph) 6,300 6,300 9,450 12,600 16,800 25,200
Nephrology 18020 Peritoneal Dialysis (Neph) 4,200 4,200 6,300 8,400 9,500 10,500
Nephrology 18021 Plasma Exchange (Neph) 7,000 7,000 8,100 9,200 10,300 11,400
Nephrology 35353 Stitch / Clip Removal (Neph) 530 530 530 1,050 1,150 1,150
Nephrology 35356 IV Iron Infusion Charges 1,150 1,150 1,150 1,150 1,150 1,150
Neurology 36126 EEG with Iinduction 3,600 3,800 4,900 6,100 7,600 9,500
Neurology 5292 BAER 2,900 3,100 4,000 4,800 6,100 7,700
Neurology 5383 SSEP (1/2 Limbs) 1,800 1,900 2,400 3,100 3,800 4,700
Neurology 18162 EEG - Routine 2,400 2,500 3,300 4,000 5,100 6,300
Neurology 21765 VEP-P (Evoke Potential) 1,500 1,600 2,100 2,500 3,200 4,000
Neurology 22548 Nerve conduction study+EMG. 2,600 2,700 3,600 4,400 5,500 6,800
Neurology 22550 EEG Video routine 2,800 2,900 3,800 4,700 5,900 7,400
Neurology 22551 EEG 12 Hour video 8,200 8,600 11,300 13,800 17,300 21,600
Neurology 22552 EEG 24 hour Video 13,900 14,600 19,100 23,400 29,300 36,600
Neurology 22553 EEG.06 Emergency 3,600 3,800 4,900 6,100 7,600 9,500
Neurology 34300 EEG 6 hour Video 6,200 6,500 8,500 10,400 13,100 16,300
Neurology 34559 EEG upto 2 hrs video 4,800 5,100 6,600 8,100 10,100 12,600
Neurology 46487 Repetitive nerve stimulation (Portable) 4,500 4,700 6,200 7,600 9,500 11,800
Neurology 46488 Myojet Needle for Botox injection 3,200 3,400 4,400 5,400 6,700 8,400
Neurology 46537 DBS Programming Charges 3,000 3,200 4,100 5,100 6,300 7,900
Neurology 22575 Botox for tics/Botox for hemifacial spasm 3,200 3,400 4,400 5,400 6,700 8,400
Neurology 22554 Portable EEG 5,100 5,400 6,900 8,700 11,400 13,500
Neurology 36155 Prolonged EEG (1 Hour) 4,600 4,800 6,300 7,800 9,700 12,100
Neurology 22555 EEG Additional hour 1,200 1,300 1,700 2,000 2,500 3,200
Neurology 22556 Sedation in neurophysiology 600 630 840 1,050 1,300 1,600
Neurology 22557 Nerve conduction study 1 limb 1,800 1,900 2,400 3,100 3,800 4,700
Neurology 22558 Nerve conduction study 2 limb 3,600 3,800 4,900 6,100 7,600 9,500
Neurology 22560 EMG 1 Limb 2,800 2,900 3,800 4,800 5,900 7,400
Neurology 22561 EMG 2 Limbs 3,600 3,800 4,900 6,100 7,600 9,500
Neurology 22562 EMG more than 2 limbs 5,900 6,200 8,100 9,900 12,400 15,600
Neurology 22563 Repetitive nerve stimulation 3,600 3,800 4,900 6,100 7,600 9,500
Neurology 22564 Bllink reflex 1,800 1,900 2,400 3,100 3,800 4,700
Neurology 22565 VEP 3,600 3,800 4,900 6,100 7,600 9,500
Neurology 22566 BAEP 2,100 2,200 2,800 3,600 4,400 5,600
Neurology 22573 Botox for blepharospasm 2,800 2,900 3,800 4,700 5,900 7,400
Neurology 22576 Botox for forehead lines/frown lines 2,800 2,900 3,800 4,700 5,900 7,400
Neurology 22577 Botox for migraine 2,800 2,900 3,800 4,700 5,900 7,400
Neurology 22578 Botox for dystonias 4,900 5,200 6,700 8,200 10,300 13,000
Neurology 22579 Botox for spasticity 4,900 5,200 6,700 8,200 10,300 13,000
Neurology 22584 Sleep Study diagnostic (Neurology) 17,400 18,300 23,800 29,300 36,600 45,800
Neurology 38780 IV Thrombolysis Charges 17,400 18,300 18,300 18,300 18,300 18,300
Neurology 24910 Nerve/Muscle Biopsy 2,600 2,700 3,600 4,400 5,500 6,800
Neurology 26219 SSEP (4limbs) 4,600 4,800 6,300 7,800 9,700 12,100
Neurology 26220 Brachial plexus study 5,900 6,200 8,100 9,900 12,400 15,600
Neurology 26358 Autonomic Function Test 5,900 6,200 8,100 9,900 12,400 15,600
Neurology 27071 Nerve conduction study more than 2 limbs 4,600 4,800 6,300 7,800 9,700 12,100
Neurology 27860 Lumbar Puncture 1,400 1,500 1,900 2,300 2,900 3,700
Neurology 28617 Sleep Deprived EEG 2,500 2,600 3,500 4,200 5,300 6,600
Neurology 28681 SSEP Upper limb 2,300 2,400 3,200 3,900 4,800 6,100
Neurology 28682 SSEP Lower limb 2,300 2,400 3,200 3,900 4,800 6,100
Neurology 28683 Portable NCV 2 Limb 6,900 7,300 9,500 11,600 14,500 18,200
Neurology 28684 Portable NCV 4 Limb 10,500 11,100 14,400 17,700 22,100 27,700
Neurology 28687 SSR (UL & LL) 1,800 1,900 2,400 3,100 3,800 4,700
Neurology 28689 Sleep study with CPAP Titration ( Neurology) 20,300 21,400 27,800 34,200 42,800 53,500
Neurology 28693 Portable EEG (Emergency) 6,900 7,300 9,500 11,600 14,500 18,200

15
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Neurology 29276 Carpal Tunnel Syndrome Inj. Procedure Charges 2,100 2,200 2,800 3,600 4,400 5,600
Neurology 31516 QST Charges 2,800 2,900 3,800 4,700 5,900 7,400
Neurology 32619 DBS Neurologist Charges 26,700 28,100 36,500 45,000 55,800 63,200
Neurology 39684 Neostigmin Test 2,800 2,900 3,900 4,700 5,900 7,400
Neurology 34328 TransCranial doppler (TCD) 5,600 5,900 7,700 9,500 11,800 14,700
Neurology 34330 TCD-Bubble Test 5,600 5,900 7,700 9,500 11,800 14,700
Neurology 37664 TCD with Thrombolysis 5,600 5,900 7,700 9,500 11,800 14,700
Neurology 46187 Caudal Epidural/Facet Block 10,000 10,500 10,500 10,500 10,500 10,500
Nuclear Medicine 19686 Bone Marrow Scan 6,600 7,700 7,700 7,700 7,700 7,700
Nuclear Medicine 19688 DMSA Renal Scan 6,000 6,700 6,700 6,700 6,700 6,700
Nuclear Medicine 19689 Dobutamine Thallium M.P Scan with Spect 14,300 16,500 16,500 16,500 16,500 16,500
Nuclear Medicine 19690 DRCG(Catheter Method) 4,300 4,500 4,500 4,500 4,500 4,500
Nuclear Medicine 19691 DRCG(Suprapubic Method) 3,400 3,900 3,900 3,900 3,900 3,900
Nuclear Medicine 19694 GE Reflux(GER)/Gastric Emptying 4,200 4,400 4,400 4,400 4,400 4,400
Nuclear Medicine 39325 Sir Sphere therapy 837,800 960,800 960,800 960,800 960,800 960,800
Nuclear Medicine 19695 GFR-blood sampling method(absolute GFR) 3,600 4,200 4,200 4,200 4,200 4,200
Nuclear Medicine 40304 Y-90 citrate colloidal therapy 121,200 140,400 140,400 140,400 140,400 140,400
Nuclear Medicine 47100 PET Review (outside scan) 4,500 - - - - -
Nuclear Medicine 28263 I-131 MIBG Therapy (200 MCI) 101,545 106,900 106,900 106,900 106,900 106,900
Nuclear Medicine 19742 I-131 Therapy (100 MCI) (BRIT) 20,930 22,000 22,000 22,000 22,000 22,000
Nuclear Medicine 44122 Lu 177 DOTA (100mCi) 210,000 221,100 221,100 221,100 221,100 221,100
Nuclear Medicine 44123 Lu 177 DOTA (150mCi) 240,000 252,700 252,700 252,700 252,700 252,700
Nuclear Medicine 44124 Lu 177 DOTA (200mCi) 280,000 294,800 294,800 294,800 294,800 294,800
Nuclear Medicine 44125 Lu 177 PSMA (100mCi) 235,000 247,500 247,500 247,500 247,500 247,500
Nuclear Medicine 44126 Lu 177 PSMA (150mCi) 270,000 284,300 284,300 284,300 284,300 284,300
Nuclear Medicine 44127 Lu 177 PSMA (200mCi) 310,000 326,400 326,400 326,400 326,400 326,400
Nuclear Medicine 46442 Lung shunting study 16,500 17,400 17,400 17,400 17,400 17,400
Nuclear Medicine 46443 Sirsphere / Therasphere Dose 790,000 831,900 831,900 831,900 831,900 831,900
Nuclear Medicine 46444 Dosimetry and Monitoring (TARE) 6,500 6,800 6,800 6,800 6,800 6,800
Nuclear Medicine 46446 Post TARE – PET / SPECT-CT     15,000 15,800 15,800 15,800 15,800 15,800
Nuclear Medicine 39576 Ga-68 Dotatoc/Dotanoc Scan (w/o Contrast) 32,400 34,100 34,100 34,100 34,100 34,100
Nuclear Medicine 39577 Ga-68 Dotatoc/Dotanoc Scan (Contrast) 37,800 39,800 39,800 39,800 39,800 39,800
Nuclear Medicine 39578 Ga-68 PSMA Scan (w/o Contrast) 25,200 26,500 26,500 26,500 26,500 26,500
Nuclear Medicine 39579 Ga-68 PSMA Scan (Contrast) 26,300 27,700 27,700 27,700 27,700 27,700
Nuclear Medicine 19696 GI bleed (To-RBS/SCOLLOID) 6,900 8,000 8,000 8,000 8,000 8,000
Nuclear Medicine 36916 TRODAT Brain Spect scan 16,600 17,900 17,900 17,900 17,900 17,900
Nuclear Medicine 19697 HEPATO-BILLIARY Scan (HIDA) 5,200 5,500 5,500 5,500 5,500 5,500
Nuclear Medicine 19698 HMPAO Brain Perusion Scan (SPECT) 16,600 17,500 17,500 17,500 17,500 17,500
Nuclear Medicine 19699 HMPAO Leucocyte Scan 20,200 21,300 21,300 21,300 21,300 21,300
Nuclear Medicine 19700 I-131 MIBG Scan 34,500 36,300 36,300 36,300 36,300 36,300
Nuclear Medicine 19701 I-131 Uptake + Thyroid Scan 5,000 5,300 5,300 5,300 5,300 5,300
Nuclear Medicine 19703 Liver Scan (SPECT) 4,000 4,600 4,600 4,600 4,600 4,600
Nuclear Medicine 19704 Angmented Lymphoscintigraphy 5,700 6,000 6,000 6,000 6,000 6,000
Nuclear Medicine 19705 MECKEL''s Diverticulum 4,000 4,200 4,200 4,200 4,200 4,200
Nuclear Medicine 19707 MUGA (GBP) Resting 4,300 4,900 4,900 4,900 4,900 4,900
Nuclear Medicine 19711 Renal Dynamic Scan (TC-99M DTPA) with GFR GA 6,000 6,700 6,700 6,700 6,700 6,700
Nuclear Medicine 19714 Scrotal Scan 3,300 3,800 3,800 3,800 3,800 3,800
Nuclear Medicine 19716 Stress MIBI/Tetrafosmin M.P. Scan with Gated 14,800 17,200 17,200 17,200 17,200 17,200
Nuclear Medicine 19718 SUB. Para Thyroid Scan/MIBI Para Thyroid Scan 7,200 8,300 8,300 8,300 8,300 8,300
Nuclear Medicine 19720 Stress Thallium 201 M.P. Scan with SPECT (REINJ) 14,800 17,200 17,200 17,200 17,200 17,200
Nuclear Medicine 19721 Resting Thallium M.P. Scan with SPECT 10,800 12,500 12,500 12,500 12,500 12,500
Nuclear Medicine 19722 Thyroid Scan 3,500 4,100 4,100 4,100 4,100 4,100
Nuclear Medicine 19723 Ventilation Perfusion Scan 9,100 10,500 10,500 10,500 10,500 10,500
Nuclear Medicine 19724 Whole Body I-131 Scan 6,000 6,900 6,900 6,900 6,900 6,900
Nuclear Medicine 19725 Whole Body Bone Scan 5,100 5,900 5,900 5,900 5,900 5,900
Nuclear Medicine 19726 Whole Body Bone Scan Spect 6,300 7,300 7,300 7,300 7,300 7,300
Nuclear Medicine 19727 Adenosine MIBI M.P. Scan with Gated Spect 17,500 19,400 19,400 19,400 19,400 19,400
Nuclear Medicine 19728 Captropril Renogram (Pre & Post) with GFR GA 8,200 9,100 9,100 9,100 9,100 9,100
Nuclear Medicine 19730 GHA Brain Spect 9,200 10,600 10,600 10,600 10,600 10,600
Nuclear Medicine 19731 Stress Thallium 201 M.P. Scan with Spect 12,600 14,600 14,600 14,600 14,600 14,600
Nuclear Medicine 19732 Adenosine Thallium 201 M.P. Scan with Spect 16,600 19,300 19,300 19,300 19,300 19,300
Nuclear Medicine 19734 I-131 Therapy (10 MCI) (BRIT) 8,050 8,500 8,500 8,500 8,500 8,500
Nuclear Medicine 19735 I-131 Therapy (15 MCI) (BRIT) 9,315 9,800 9,800 9,800 9,800 9,800
Nuclear Medicine 19736 I-131 Therapy (20 MCI) (BRIT) 10,925 11,500 11,500 11,500 11,500 11,500
Nuclear Medicine 19737 I-131 Therapy (5 MCI) 5,635 5,900 5,900 5,900 5,900 5,900
Nuclear Medicine 19738 I-131 Therapy (7 MCI) 6,440 6,800 6,800 6,800 6,800 6,800
Nuclear Medicine 19740 I-131 Therapy (25 MCI) (BRIT) 12,650 13,300 13,300 13,300 13,300 13,300
Nuclear Medicine 19741 I-131 Therapy (50 MCI) (BRIT) 14,030 14,800 14,800 14,800 14,800 14,800
Nuclear Medicine 19752 Liver Blood Pool Scan with Spect 5,000 5,800 5,800 5,800 5,800 5,800
Nuclear Medicine 19753 I-131 Thyroid Uptake 3,000 3,200 3,200 3,200 3,200 3,200
Nuclear Medicine 20325 Post high dose I-131 therapy scan 2,800 3,300 3,300 3,300 3,300 3,300
Nuclear Medicine 21264 Lung PerfusionScan 7,500 7,900 7,900 7,900 7,900 7,900

16
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Nuclear Medicine 21265 Lung VentilationScan 3,500 3,700 3,700 3,700 3,700 3,700
Nuclear Medicine 21266 3 Phase Bone Scan 5,500 5,800 5,800 5,800 5,800 5,800
Nuclear Medicine 21267 3 Phase Bone Scan with Spect 6,200 6,500 6,500 6,500 6,500 6,500
Nuclear Medicine 21268 I - 131 Therapy ( 30 MCI ) (BRIT) 12,650 13,300 13,300 13,300 13,300 13,300
Nuclear Medicine 22976 Test analysis report in CD(Nuclear Med) 500 500 500 500 500 500
Nuclear Medicine 24245 Samarium 153 18,000 19,000 19,000 19,000 19,000 19,000
Nuclear Medicine 26871 Dose administration and monitoring charges 4,600 4,800 4,800 4,800 4,800 4,800
Nuclear Medicine 27110 Whole Body I-131 Scan with Thyrogen 111,800 117,700 117,700 117,700 117,700 117,700
Nuclear Medicine 27111 Thyrogen 104,000 109,500 109,500 109,500 109,500 109,500
Nuclear Medicine 27654 Tc99m TEKTROTYD whole body scan 80,900 85,200 85,200 85,200 85,200 85,200
Sentinel Lymph Node mapping with intra-operative
Nuclear Medicine 28241 12,500 14,500 14,500 14,500 14,500 14,500
localization
Nuclear Medicine 28435 Whole Body PET-CT With Contrast 25,000 27,900 27,900 27,900 27,900 27,900
Nuclear Medicine 28436 Whole Body PET-CT Without Contrast 23,000 25,300 25,300 25,300 25,300 25,300
Nuclear Medicine 28437 Brain PET-CT Routine (without contrast) 16,500 19,000 19,000 19,000 19,000 19,000
Nuclear Medicine 28439 Cardiac PET-CT FDG PET with perfusion 20,100 23,300 23,300 23,300 23,300 23,300
Nuclear Medicine 28444 Regional PET-CT 18,600 21,600 21,600 21,600 21,600 21,600
Nuclear Medicine 29597 PET-CT 4D Gated CT with contrast 15,000 15,800 15,800 15,800 15,800 15,800
Nuclear Medicine 29599 PET-CT 4D Gated PET with contrast 23,000 26,600 26,600 26,600 26,600 26,600
Nuclear Medicine 30413 I-131 Therapy (75 MCI) (GE) 35,305 37,200 37,200 37,200 37,200 37,200
Nuclear Medicine 30414 I-131 Therapy (100 MCI) (GE) 38,065 40,100 40,100 40,100 40,100 40,100
Nuclear Medicine 30415 I-131 Therapy (150 MCI) (GE) 40,940 43,100 43,100 43,100 43,100 43,100
Nuclear Medicine 30416 I-131 Therapy (200 MCI) (GE) 57,040 60,100 60,100 60,100 60,100 60,100
Nuclear Medicine 31988 I-131 MIBG scan (BRIT) 23,920 25,200 25,200 25,200 25,200 25,200
Nuclear Medicine 31991 Dobutamine MIBI/Tetrafosmin MP scan with Gated 15,000 17,400 17,400 17,400 17,400 17,400
Orthopaedics 40604 NFC 2,500 2,600 2,600 2,600 2,600 2,600
Orthopaedics 43518 Computer Assisted Surgery Bilateral - 29,000 29,000 29,000 29,000 29,000
Orthopaedics 35659 Computer Assisted Surgery Unilateral - 15,800 15,800 15,800 15,800 15,800
Obs& Gyne. 32051 Mirena Insertion - (LA) 16,200 - - - - -
Obs& Gyne. 34218 IUI ( Intra Utrine Insemination ) 6,100 - - - - -
Obs& Gyne. 17620 IUCD insertion (Obs-Gyn) 3,200 3,400 3,800 4,700 6,100 9,400
Obs& Gyne. 17622 IUCD removal (Obs-Gyn) 1,400 1,500 1,700 2,000 2,600 4,000
Obs& Gyne. 17632 Polypectomy (Gr.I) (Obs-Gyn) 3,700 3,900 4,500 5,600 7,400 11,300
Obs& Gyne. 20068 Artificial Insemination (Obs-Gyn) 2,900 2,900 3,300 4,200 5,400 8,300
Obs& Gyne. 17628 Non Stress Test (Obs-Gyn) 1,150 1,200 1,300 1,700 2,200 3,300
Obs&Gyne 33420 Multifetal Pregnancy Reduction ( Foetal Medicine ) 17,300 18,200 20,800 26,100 34,000 52,300
Obs&Gyne 33424 Genetic Counselling ( Foetal Medicine ) 2,300 2,400 2,400 2,400 2,400 2,400
Obs&Gyne 33426 Fetal ECHO ( Foetal Medicine ) 3,000 3,200 3,200 3,200 3,200 3,200
Obs&Gyne 33679 Amniodrainage (Foetal Medicine) 16,600 17,500 19,900 24,900 32,400 49,800
Oncology 28648 I V Bolus Chemotherapy (Medical Onco) 1,300 1,300 1,300 1,300 1,300 1,300
Oncology 35758 Mouth care 130 140 140 140 140 140
Oncology 28666 Chemoport Flushing Charges (Medical Onco) 390 - - - - -
Oncology 28673 Chemotherapy Day care Minor (Medical Onco) 3,200 3,200 3,200 3,200 3,200 3,200
Oncology 28674 Chemotherapy Day care major (Medical Onco) 4,000 4,000 4,000 4,000 4,000 4,000
Oncology 28675 Chemotherapy per day 4,300 4,300 4,300 4,300 4,300 4,300
Oncology 28676 Cancer Bisphosphonates charges/day (Medical Onco) 2,200 2,300 2,300 2,300 2,300 2,300
Oncology 28759 PICC Line (Medical Onco) 3,900 4,100 4,100 4,100 4,100 4,100
Oncology 29611 Intracavitary Intrathecal. (Medical Onco) 3,600 3,800 4,300 5,400 6,900 10,700
Oncology 30132 Test analysis report in CD (Lymphedema) 70 70 70 70 70 70
Oncology 42888 Matched Unrelated Donor Search (DKMS) 10,500 11,100 11,100 11,100 11,100 11,100
Oncology 32132 Bone Marrow Transplant–Allogeneic (Medi-Oncology) 173,700 182,900 182,900 182,900 182,900 182,900
Oncology 32131 Bone Marrow Transplant–Autologous (Medi-Oncolgy 115,800 121,900 121,900 121,900 121,900 121,900
Oncology 36766 Bone Marrow Transplant-Heploidentical - 243,800 243,800 243,800 243,800 243,800
Oncology 36767 Bone Marrow Transplant-Matched Unrelated Donor (MU - 243,800 243,800 243,800 243,800 243,800
Oncology 34587 Test analysis report in CD (Oncology) 500 500 500 500 500 500
Oncology Chemotherapy for HIPEC surgery - 20,000 20,000 20,000 20,000 20,000
Oncology 39339 Punch Biopsy 1,200 1,300 1,300 1,300 1,300 1,300
Oncology 39340 Cervical Punch Biopsy 1,200 1,300 1,300 1,300 1,300 1,300
Oncology 39184 Colostomy Care 630 660 660 660 660 660
Oncology 39185 PEG dressing 360 380 380 380 380 380
Oncology 39186 Tracheostomy care 440 460 460 460 460 460
Oncology 39187 Tracheostomy tube change (cuffed) 2,000 2,100 2,100 2,100 2,100 2,100
Oncology 39188 Tracheostomy tube change (non-cuffed) 950 1,000 1,000 1,000 1,000 1,000
Oncology 39189 Incisional Biopsy 630 660 660 660 660 660
Oncology 39190 Incisional Biopsy w/ sutures 1,680 1,800 1,800 1,800 1,800 1,800
Oncology 39191 Seroma Aspiration 220 230 230 230 230 230
Oncology 39192 Clip Removal 740 780 780 780 780 780
Oncology 39193 Bowel wash (Enema) 220 230 230 230 230 230
Oncology 39194 Corrugated drain insertion 1,160 1,200 1,200 1,200 1,200 1,200

Oncology 30490 Chemoport Flush without Chemotherapy (Medical Onco 430 430 430 430 430 430

17
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Oncology 30493 Immunotherapy Major 4,100 4,300 4,300 4,300 4,300 4,300
Oncology 30494 Immunotherapy Minor 3,300 3,500 3,500 3,500 3,500 3,500
Oncology 30495 Hormonal Injection for Cancer treatment (Medical O 630 660 660 660 660 660
Oncology 30496 Intrathecel chemotherapy (Medical Onco) 3,900 4,100 4,100 4,100 4,100 4,100
Oncology 30498 Chemotherapy Treatment Letter (Medical Onco) 3,000 3,000 3,000 3,000 3,000 3,000
Oncology 33373 Lumbar puncture charges (Medical Onco) 3,000 3,200 3,700 4,600 6,000 9,200
Oncology 33374 Chemo Pump charges/ day (Medical Onco) 1,700 1,700 1,700 1,700 1,700 1,700
Oncology 33375 PICC dressing charges (Medical Onco) 660 690 690 690 690 690
Oncology 34766 Adjuvant Chemotherapy - 2,200 2,200 2,200 2,200 2,200
Oncology 28677 Chemoport Removal (Onco) 4,000 4,000 4,600 5,800 7,500 8,300
Oncology 35752 PEG Feeding 120 130 130 130 130 130
Oncology 35755 Suctioning 130 140 140 140 140 140
Oncology 34767 Targeted Thearpy - 1,600 1,600 1,600 1,600 1,600
Oncology 34768 Concurrent Chemoadiation - 1,700 1,700 1,700 1,700 1,700
Ophthalmology 33024 Standard Lasik with Ultra Thin Flap 40,000 - - - - -
Ophthalmology 33025 Customised Lasik with Ultra thin Flap 50,000 50,000 50,000 50,000 50,000 50,000
Ophthalmology 26938 C3R (Corneal Collaigen Crosslinking with Riboflavi 31,500 31,500 31,500 31,500 31,500 31,500
Ophthalmology 29505 Biometry (Opthal) 1,100 1,100 1,100 1,100 1,100 1,100
Ophthalmology 20972 Perimetry (Visual Field Examination) 2,000 2,000 2,000 2,000 2,000 2,000
Ophthalmology 20956 OCT 3,500 3,500 3,500 3,500 3,500 3,500
Ophthalmology 31551 OCT Retina & Glaucoma 3,500 3,500 3,500 3,500 3,500 3,500
Ophthalmology 20955 PACHYMETRY 500 500 500 500 500 500
Ophthalmology 30509 Fundus Fluorescein Angiography 3,000 3,000 3,000 3,000 3,000 3,000
Ophthalmology 20961 FUNDUS PHOTO BOTH EYES 1,500 1,500 1,500 1,500 1,500 1,500
Ophthalmology 20967 TOPOGRAPHY 2,500 2,500 2,500 2,500 2,500 2,500
Ophthalmology 31550 Lasik Work up 2,500 2,500 2,500 2,500 2,500 2,500
Ophthalmology 32859 Refraction 250 250 250 250 250 250
Ophthalmology 36686 IOP Measurement With Applation Tonometry 700 700 700 700 700 700
Ophthalmology 36684 Indirect Ophthalmoscopy 350 350 350 350 350 350
Ophthalmology 20980 GONIOSCOPY 500 500 500 500 500 500
Ophthalmology 17383 Orthoptic Exercise (Max. 10 Sitting) 1,500 1,500 1,500 1,500 1,500 1,500
Ophthalmology 17712 Chalazion 4,000 4,000 4,000 4,000 4,000 4,000
Ophthalmology 17714 Drainage Lid Abscess 3,000 3,000 3,000 3,000 3,000 3,000
Ophthalmology 17726 Corneal Foreign Body Removal 750 750 750 750 750 750
Ophthalmology 20962 USG B-SCAN PER EYE 1,500 1,500 1,500 1,500 1,500 1,500
Ophthalmology 17389 Yag Capsulotomy 3,500 3,500 3,500 3,500 3,500 3,500
Ophthalmology 18790 Peripheral Iridotomy Laser 4,000 4,000 4,000 4,000 4,000 4,000
Ophthalmology 20957 YAG PI PER EYE 4,000 4,000 4,000 4,000 4,000 4,000
Ophthalmology 20963 PHOTOCOAGULATION PER EYE 4,500 4,500 4,500 4,500 4,500 4,500
Ophthalmology 20964 PRP PER EYE 12,000 12,000 12,000 12,000 12,000 12,000
Ophthalmology 17388 Intravitreal Injection 4,000 4,000 4,000 4,000 4,000 4,000
Ophthalmology 36765 Retinopathy of Prematurity (ROP) Screening 1,500 1,500 1,500 1,500 1,500 1,500
Ophthalmology 35291 Retinopathy of Prematurity (ROP)-Laser Treatment 15,000 15,000 15,000 15,000 15,000 15,000
Ophthalmology 40694 Laser Retinopexy - One Quadrant 6,000 6,000 6,000 6,000 6,000 6,000
Ophthalmology 40695 Laser Retinopexy - Two Quadrants 10,000 10,000 10,000 10,000 10,000 10,000
Ophthalmology 40696 Posterior Sub-Tenon Injection 5,000 5,000 5,000 5,000 5,000 5,000
Ophthalmology 40697 Lid Laceration Repair 5,000 5,000 5,000 5,000 5,000 5,000
Ophthalmology 33569 Lasik - Basic 30,000 30,000 30,000 30,000 30,000 30,000
Ophthalmology 20948 Lasik - Standard 35,000 35,000 35,000 35,000 35,000 35,000
Ophthalmology 33570 LASIK STANDARD - SINGLE EYE 20,000 20,000 20,000 20,000 20,000 20,000
Ophthalmology 21192 Lasix Standard (Single Eye) 20,000 20,000 20,000 20,000 20,000 20,000
Ophthalmology 20949 Lasik - Custom 45,000 45,000 45,000 45,000 45,000 45,000
Ophthalmology 21746 LASIK CUSTOMISED - SINGLE EYE 25,000 25,000 25,000 25,000 25,000 25,000
Ophthalmology 26405 PRK (Photorefractive Keratectomy) for Both Eyes 30,000 30,000 30,000 30,000 30,000 30,000
Ophthalmology 34219 PRK (Photorefractive Keratectomy) for Single Eye 20,000 20,000 20,000 20,000 20,000 20,000
Ophthalmology 41283 Lasik - SBK Standard (Both Eyes) 40,000 40,000 40,000 40,000 40,000 40,000
Ophthalmology 41284 Lasik - SBK Standard One Eye) 25,000 25,000 25,000 25,000 25,000 25,000
Ophthalmology 41285 Lasik - SBK Custom (Both Eyes) 50,000 50,000 50,000 50,000 50,000 50,000
Ophthalmology 41286 Lasik - SBK Custom (One Eye) 30,000 30,000 30,000 30,000 30,000 30,000
Medical Supervision
43790 Medical Evaluation for TPA 300 300 300 300 300 300
Fee
Medical Supervision
43961 Medical Evaluation for TPA per cycle 50 50 50 50 50 50
Fee
Other Charges 34319 Attendant / Visitor Pass Deposit 300 300 300 300 300 300
Other Charges 34759 Test Analysis report in DVD form 500 500 500 500 500 500
Other Charges 43738 Ward monitoring charges - 1,000 1,500 2,000 2,000 2,000
Other Charges 44491 Misc. Common Items (Per day) - 70 70 70 70 70
For Common store Items, Rs. 90 will be charged in case of ICU/HDU.
Other Procedures 36971 Endotracheal Intubation (critical care) - 1,700 1,900 2,400 3,100 4,800
Other Procedures 9185 Injection Administration Charges 70 70 70 70 70 70
Other Procedures 39530 Intensivist charges for CT/MRI 1,250 1,300 1,300 1,300 1,300 1,300
Other Procedures 41070 Mini-BAL - 7,600 7,600 7,600 7,600 7,600

18
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Other Procedures 36973 USG Guided Central Line Insertion 2,250 2,400 2,600 3,400 4,300 6,600
Pathology 6483 Antibody to Malaria 1,030 1,300 1,300 1,300 1,300 1,300
Pathology 35467 Urine Protein/Creatinine Ratio (Nephro) 570 - - - - -
Pathology 5810 Ascitic Fluid-Cell Count & Type/Glucose & Prot./Alb 910 1,200 1,200 1,200 1,200 1,200
Pathology 5811 Ascitic Fluid - Glucose & Protein 490 660 660 660 660 660
Pathology 5812 Ascitic Fluid - Gram's Stain 530 740 740 740 740 740
Pathology 5813 Ascitic Fluid -Culture & Sensitivity 860 1,100 1,100 1,100 1,100 1,100
Pathology 5814 Ascitic Fluid for Malignant Cells 910 1,200 1,200 1,200 1,200 1,200
Pathology 5816 Ascitic Fluid - LDH (Lactate Dehydrogenase) 460 620 620 620 620 620
Pathology 39536 Allergy Individual Marker - Potato 1,120 1,400 1,400 1,400 1,400 1,400

Pathology 37688 Glucose Challenge Test (GCT) with 75 gm,Fluoride Plasma 160 170 170 170 170 170

Pathology 47095 HLA DNA Typing (A,B,DR,DQ & DP) 21,800 21,800 21,800 21,800 21,800 21,800
Pathology 47096 HLA DP DNA Typing 5,000 5,000 5,000 5,000 5,000 5,000
Pathology 47097 HLA DQ & DP DNA Typing 10,000 10,000 10,000 10,000 10,000 10,000
Pathology 32074 Beta-2 Glycoprotein 1, IgA 940 1,050 1,050 1,050 1,050 1,050
Pathology 32075 Beta-2 Glycoprotein 1, IgG 940 1,050 1,050 1,050 1,050 1,050
Pathology 32076 Beta-2 Glycoprotein 1, IgM 940 1,050 1,050 1,050 1,050 1,050
Pathology 33411 Beta-2-Glycoprotein 1panel-IGA,IGG& IGM 2,620 2,900 2,900 2,900 2,900 2,900

Pathology 39650 Autoimmune Hepatitis Panel-1( ANA, SMA, AMA, LKM-1 4,760 5,000 5,000 5,000 5,000 5,000

Pathology 45797 Myositis LIA 6,750 7,100 7,100 7,100 7,100 7,100
Pathology 45798 Systemic Sclerosis LIA 6,950 7,300 7,300 7,300 7,300 7,300
Pathology 45787 Gastrointestinal Panel (FilmArray PCR) 13,500 14,200 14,200 14,200 14,200 14,200
Pathology 45827 PAC Panel ( Ortho ) 6,100 6,400 6,400 6,400 6,400 6,400
Pathology 45874 HLA DNA Typing (A, B, DR & DQ) 18,500 19,500 19,500 19,500 19,500 19,500
Pathology 45875 HLA DQ, DNA typing 5,000 5,300 5,300 5,300 5,300 5,300
Pathology 46003 PAC Package Serology 6,820 7,200 7,200 7,200 7,200 7,200
Pathology 46142 PAC Package - 6 7,030 7,400 7,400 7,400 7,400 7,400
Pathology 46290 STD panel (9), PCR 5,300 5,600 5,600 5,600 5,600 5,600
Pathology 46388 MDS Panel Fish 9,499 10,000 10,000 10,000 10,000 10,000
Pathology 46389 CLL Panel Fish 13,999 14,700 14,700 14,700 14,700 14,700
Pathology 46390 Brush Biopsy 890 940 940 940 940 940
Pathology 34571 NMDA Receptor Antibody 6,220 6,900 6,900 6,900 6,900 6,900
Pathology 30469 Arthiritis Panel 3,360 - - - - -
Pathology 46868 Senior Wellness Profile 3,800 4,000 4,000 4,000 4,000 4,000
Pathology 46991 Bal Galactomannan 2,570 2,570 2,570 2,570 2,570 2,570
Pathology 34572 VGKC, Serum 8,020 9,000 9,000 9,000 9,000 9,000
Pathology 40611 Semen Analysis with Semen Fructose 890 1,100 1,100 1,100 1,100 1,100
Pathology 42517 Other Fluid - Sodium 270 310 310 310 310 310
Pathology 42518 Other Fluid - Potassium 270 310 310 310 310 310
Pathology 42519 Other Fluid - Chloride 270 310 310 310 310 310
Pathology 39262 DIABESITY SCREENING PANEL 1,990 2,400 2,400 2,400 2,400 2,400
Pathology 38667 Neuro Surgery PAC Panel 7,740 8,600 8,600 8,600 8,600 8,600
Pathology 6330 Creatine Kinase MB,Serum 760 1,200 1,200 1,200 1,200 1,200
Pathology 19957 Ionized Calcium 620 760 760 760 760 760
Pathology 37958 Allergy Wheeze/Rhinitis Profile (Child) 5,380 6,600 6,600 6,600 6,600 6,600
Pathology 37959 Allergy Rhinitis Profile (Adult) 5,380 6,600 6,600 6,600 6,600 6,600
Pathology 37960 Allergy Eczema Profile,Serum 5,590 6,900 6,900 6,900 6,900 6,900
Pathology 37923 Natural Killer Cells, Flow Cytometry 3,770 4,600 4,600 4,600 4,600 4,600
Pathology 46422 Total - Thyroid Profile 900 950 950 950 950 950
Pathology 46484 Febrile Antigen Panel 1,230 1,300 1,300 1,300 1,300 1,300
Pathology 46399 General Wellness Profile 999 1,050 1,050 1,050 1,050 1,050
Pathology 45803 Max-Basic Wellness Panel 1,899 2,000 2,000 2,000 2,000 2,000
Pathology 45036 Total Wellness Profile 2,999 3,200 3,200 3,200 3,200 3,200
Pathology 44859 Max Wellness Adolescent Profile 2,450 - - - - -
Pathology 44863 Diabetes Screening Profile 450 - - - - -
Pathology 44865 Diabetes Screening Profile 2 350 - - - - -
Pathology 45792 Max-Pre-operative Panel 3,170 - - - - -
Pathology 45793 Max-Vitamine Panel (Basic) 1,720 - - - - -
Pathology 45805 Max-Thrombophilia Profile (Extended) 17,360 - - - - -
Pathology 45806 Max-Fertility hormonal profile 2,760 - - - - -
Pathology 45807 Max-Fertility hormonal followup profile 1,090 - - - - -
Pathology 45810 Max-Fertility panel - Female 4,650 - - - - -
Pathology 45808 Max-Fertility panel - Male (Basic) 3,560 - - - - -
Pathology 45791 Max-Antenatal Profile (Basic 2) 3,570 - - - - -
Pathology 45804 Max-Thrombophilia Profile (Basic) 13,010 - - - - -
Pathology 46596 Max Chemo DayCare\Screening Profile 1,800 1,900 1,900 1,900 1,900 1,900
Pathology 46822 Chemo Profile (Basic) 1,999 2,100 2,100 2,100 2,100 2,100
Pathology 46847 Cryostat coated slides 500 530 530 530 530 530
Pathology 5817 AFB Stain 350 470 470 470 470 470
Pathology 37838 HIV - 1 Qualitative Real Time PCR 4,520 5,300 5,300 5,300 5,300 5,300

19
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Pathology 37407 FREE Prostate Specific Antigen Percentage,Serum 2,040 2,900 2,900 2,900 2,900 2,900
Pathology 37794 Protein/Creatinine Ratio, 24 hrs Urine 885 1,200 1,200 1,200 1,200 1,200
Pathology 37795 Calcium/Creatinine Ratio, 24 hrs Urine 650 870 870 870 870 870
Pathology 37781 Osmolal Gap, Serum 1,600 2,000 2,000 2,000 2,000 2,000
Pathology 37799 Bladder Tumor Antigen Test (BTA Test) 2,700 3,300 3,300 3,300 3,300 3,300
Pathology 21595 Cyclosporine,Peak level (C2),Serum 2,380 2,900 2,900 2,900 2,900 2,900
Pathology 32078 Qualitative CMV, PCR 5,320 6,400 6,400 6,400 6,400 6,400
Pathology 6141 C-Peptide,Serum 1,070 1,300 1,300 1,300 1,300 1,300
Pathology 21596 Cyclosporine,Trough level (C0),Serum 2,220 2,700 2,700 2,700 2,700 2,700
Pathology 35586 Dialysis Advance Panel 5,940 7,300 7,300 7,300 7,300 7,300
Pathology 35336 Nephro Panel - Basic 725 900 900 900 900 900
Pathology 26384 Hep B Core Antibody-IgM,Serum 1,120 1,400 1,400 1,400 1,400 1,400
Pathology 35687 Histo Biopsy slide & block review (upto 5 slides & 1,680 2,100 2,100 2,100 2,100 2,100
Pathology 35686 Histo Biopsy slide review (upto 5 slides) 1,350 1,700 1,700 1,700 1,700 1,700
Pathology 32090 HLA DNA Typing (A, B & DR) 15,800 19,400 19,400 19,400 19,400 19,400

Pathology 6222 Anti Taenia Solium/Cysticercosis Antibody-IgG,Serum 1,350 1,700 1,700 1,700 1,700 1,700

Pathology 35402 KTP Advance 3,370 3,800 3,800 3,800 3,800 3,800
Pathology 35401 KTP Basic P 850 1,030 1,030 1,030 1,030 1,030
Pathology 35400 KTP Basic S 850 1,030 1,030 1,030 1,030 1,030
Pathology 6428 Measels/Rubeola -IgG 1,680 2,100 2,100 2,100 2,100 2,100
Pathology 21737 Measels/Rubeola -IgG+ IgM 3,170 3,900 3,900 3,900 3,900 3,900
Pathology 6429 Measels/Rubeola -IgM 1,680 2,100 2,100 2,100 2,100 2,100
Pathology 35404 Nephro Panel - Advance 1,910 2,300 2,300 2,300 2,300 2,300
Pathology 6300 Progesterone OH-17,Serum 1,330 1,600 1,600 1,600 1,600 1,600
Pathology 21736 Varicella Zoster / Chicken pox (IgG+ IgM) 2,350 2,900 2,900 2,900 2,900 2,900
Pathology 6408 Varicella Zoster IgG/Chicken Pox IgG 1,260 1,500 1,500 1,500 1,500 1,500
Pathology 6409 Varicella Zoster IgM/Chicken Pox IgM 1,260 1,500 1,500 1,500 1,500 1,500
Pathology 36287 HLA-T & B Cell Lymphocyte Cross Match 5,540 6,800 6,800 6,800 6,800 6,800
Pathology 5818 Ascitic Fluid-AFB Staining 360 470 470 470 470 470
Pathology 5819 Ammonia, EDTA Sample 1,330 1,600 1,600 1,600 1,600 1,600
Pathology 5820 Amylase, Serum 630 790 790 790 790 790
Pathology 5821 SGOT - Aspartate Amino Transferase, Serum 280 400 400 400 400 400
Pathology 5822 Bilirubin Total and Direct 490 710 710 710 710 710
Pathology 5823 Calcium, Serum 280 380 380 380 380 380
Pathology 5824 Chloride, Serum 280 370 370 370 370 370
Pathology 5825 Cholesterol 250 350 350 350 350 350
Pathology 5827 Bicarbonate, Serum 260 350 350 350 350 350
Pathology 5828 Fibrinogen 860 1,100 1,100 1,100 1,100 1,100
Pathology 5829 GGTP (Gamma GT), Serum 330 460 460 460 460 460
Pathology 5830 Glycosylated Haemoglobin,EDTA 1,090 1,800 1,800 1,800 1,800 1,800
Pathology 5831 HDL Cholesterol 370 490 490 490 490 490
Pathology 5832 LDH (Lactate Dehydrogenase) Total , Serum 460 620 620 620 620 620
Pathology 5833 LDL Cholesterol, Serum 370 490 490 490 490 490
Pathology 5834 Lipase 820 1,100 1,100 1,100 1,100 1,100
Pathology 5835 Potassium, Serum 280 490 490 490 490 490
Pathology 5836 Protein Electrophoresis, Serum 820 1,100 1,100 1,100 1,100 1,100
Pathology 5837 Sodium, Serum 280 510 510 510 510 510
Pathology 5838 B.U.N (Blood Urea Nitrogen), Serum 320 450 450 450 450 450
Pathology 5839 Total Proteins with Albumin,Globulin,A/G 260 350 350 350 350 350
Pathology 5840 Triglycerides, Serum 410 560 560 560 560 560
Pathology 5841 Urea, Serum 350 510 510 510 510 510
Pathology 5842 Uric Acid, Serum 330 450 450 450 450 450
Pathology 5843 VLDL Cholesterol 360 470 470 470 470 470
Pathology 5844 Alkaline Phosphatase 260 350 350 350 350 350
Pathology 5845 SGPT - Alanine Amino Transferase, Serum 280 400 400 400 400 400
Pathology 5847 Creatinine, Serum 340 520 520 520 520 520
Pathology 5848 Creatinine Clearance Test,24Hrs Urine 670 930 930 930 930 930
Pathology 5849 Creatine Kinase (CPK),Serum 490 760 760 760 760 760
Pathology 5853 Blood Sugar 2 Hr. PP,Plasma 140 230 230 230 230 230
Pathology 5854 Blood Sugar (Random),Plasma 140 230 230 230 230 230
Pathology 5855 Blood Sugar Fasting,Plasma 130 230 230 230 230 230
Pathology 5857 Glucose Tolerance Test - (GTT 2 specimens),Plasma 300 450 450 450 450 450
Pathology 5858 IgE (Immunoglobulin-E) 1,060 1,400 1,400 1,400 1,400 1,400
Pathology 5860 IgA (Immunoglobulin-A) 540 750 750 750 750 750
Pathology 5861 IgG (Immunoglobulin-G) 540 750 750 750 750 750
Pathology 5862 IgM (Immunoglobulin-M) 540 750 750 750 750 750
Pathology 5863 Iron and Total Iron Binding capacity, serum 760 1,050 1,050 1,050 1,050 1,050
Pathology 5866 Inorganic Phosphorus, Serum 250 350 350 350 350 350
Pathology 5874 Bence Jones Proteins-Urine 280 370 370 370 370 370
Pathology 5875 Calcium,24hrs Urine 370 490 490 490 490 490
Pathology 5876 Chloride, 24 Hrs Urine 370 490 490 490 490 490

20
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Pathology 5877 Creatinine, 24 Hrs Urine 540 730 730 730 730 730
Pathology 5879 Glucose,24Hrs Urine 290 380 380 380 380 380
Pathology 5880 Inorganic Phosphorus, 24 Hrs Urine 370 490 490 490 490 490
Pathology 5881 Potassium, 24 Hrs Urine 370 490 490 490 490 490
Pathology 5882 Protein,24hrs Urine 410 540 540 540 540 540
Pathology 5883 Sodium, 24 Hrs Urine 360 470 470 470 470 470
Pathology 5885 Uric Acid, 24 Hrs Urine 370 490 490 490 490 490
Pathology 5886 Urobilinogen (Qualitative)-24hrs Urine 160 200 200 200 200 200
Pathology 5887 Semen Analysis 680 940 940 940 940 940
Pathology 5888 Urine Routine and Microscopy 190 270 270 270 270 270
Pathology 5889 Stool Routine and Microscopy 230 310 310 310 310 310
Pathology 5892 Post Coital High Vaginal Swab 590 730 730 730 730 730
Pathology 5897 Urine Sugar Random 170 240 240 240 240 240
Pathology 5906 Sample Collection Charge (Within 8 kms) 320 - - - - -
Pathology 5910 Buccal Smear 450 560 560 560 560 560
Pathology 5912 Slide Review - Cytopathology 1,510 2,000 2,000 2,000 2,000 2,000
Pathology 5913 Nasal Smear for Eosinophils 250 320 320 320 320 320
Pathology 5914 Sputum for Cytology 1,510 2,000 2,000 2,000 2,000 2,000
Pathology 5915 Smear for Cytology 1,510 2,000 2,000 2,000 2,000 2,000
Pathology 5920 Carbamazepine (Tegretol),Serum 1,060 1,400 1,400 1,400 1,400 1,400
Pathology 5921 Phenobarbitone, Serum 1,160 1,600 1,600 1,600 1,600 1,600
Pathology 5922 Phenytoin 1,160 1,600 1,600 1,600 1,600 1,600
Pathology 5925 FSH - Follicle Stimulating Hormone,Serum 735 1,020 1,020 1,020 1,020 1,020
Pathology 5927 LH-Luteinizing Hormone , Serum 735 1,030 1,030 1,030 1,030 1,030
Pathology 5928 TSH,Serum 650 1,000 1,000 1,000 1,000 1,000
Pathology 5929 Estradiol (Total),Serum 810 1,100 1,100 1,100 1,100 1,100
Pathology 5930 Free T4,Serum 540 770 770 770 770 770
Pathology 5931 HCG - Beta Specific,Serum 930 1,300 1,300 1,300 1,300 1,300
Pathology 5932 Progesterone,Serum 790 1,100 1,100 1,100 1,100 1,100
Pathology 5933 Prolactin, Serum 790 1,100 1,100 1,100 1,100 1,100
Pathology 5942 Absolute Eosinophil Count 260 350 350 350 350 350
Pathology 5943 Blood Grouping and RH Factor 510 690 690 690 690 690
Pathology 5947 G - 6 PD Deficiency Test,Quantitative,EDTA 950 1,300 1,300 1,300 1,300 1,300
Pathology 5948 LE Cells 460 620 620 620 620 620
Pathology 5951 Reticulocyte Count 480 650 650 650 650 650
Pathology 5957 APTT (Partial Thromboplastin Time),Citrate Plasma 770 1,050 1,050 1,050 1,050 1,050
Pathology 5958 Prothrombin Time (with INR),Citrate Plasma 520 770 770 770 770 770
Pathology 5961 Coombs Test Direct 950 1,400 1,400 1,400 1,400 1,400
Pathology 5962 Coombs Test Indirect 950 1,400 1,400 1,400 1,400 1,400
Pathology 5964 Haemoglobin Estimation,EDTA 160 250 250 250 250 250
Pathology 5970 TLC 180 260 260 260 260 260
Pathology 5971 DLC 170 260 260 260 260 260
Pathology 5972 RBC 170 240 240 240 240 240
Pathology 5976 Peripheral Smear Examination 320 440 440 440 440 440
Pathology 5977 Bone Marrow Examination 1,320 1,800 1,800 1,800 1,800 1,800
Pathology 5983 Histo Biopsy Large (<15 Blocks) 3,560 5,200 5,200 5,200 5,200 5,200
Pathology 5986 Histo Biopsy Small 1,660 2,000 2,000 2,000 2,000 2,000
Pathology 5989 Scraping for Fungus 370 450 450 450 450 450
Pathology 5991 Eye Swab - Culture and Sensitivity 860 1,200 1,200 1,200 1,200 1,200
Pathology 5993 Culture and Sensitivity (Other Specimen) 860 1,200 1,200 1,200 1,200 1,200
Pathology 5995 CSF- Culture & Sensitivity 900 1,100 1,100 1,100 1,100 1,100
Pathology 5996 Ear Discharge - Culture & Sensitivity 860 1,200 1,200 1,200 1,200 1,200
Pathology 5999 Smear for Fungus 350 450 450 450 450 450
Pathology 6000 Fungal Culture 1,120 1,400 1,400 1,400 1,400 1,400
Pathology 6001 Pus - Culture & Sensitivity 860 1,100 1,100 1,100 1,100 1,100
Pathology 6003 Semen - Culture & Sensitivity 860 1,100 1,100 1,100 1,100 1,100
Pathology 6004 Gram's Staining 500 610 610 610 610 610
Pathology 6006 Sputum - Culture & Sensitivity 860 1,100 1,100 1,100 1,100 1,100
Pathology 6009 AFB Culture 1,340 1,900 1,900 1,900 1,900 1,900
Pathology 6010 Throat Swab - Culture & Sensitivity 860 1,100 1,100 1,100 1,100 1,100
Pathology 6011 Urine - Culture & Sensitivity 1,000 1,400 1,400 1,400 1,400 1,400
Pathology 6015 Other Fluid - Cell Count &Type/Gluco. & Prot. 910 1,200 1,200 1,200 1,200 1,200
Pathology 6016 Other Fluid-Albumin 170 240 240 240 240 240
Pathology 6017 Other Fluid - Glucose & Protein 490 660 660 660 660 660
Pathology 6018 Other Fluid-Amylase 620 810 810 810 810 810
Pathology 6019 Other Fluid - Culture & Sensitivity 860 1,100 1,100 1,100 1,100 1,100
Pathology 6020 Other Fluid For Malignant Cells 910 1,200 1,200 1,200 1,200 1,200
Pathology 6021 Other Fluid - LDH (Lactate Dehydrogenase) 460 620 620 620 620 620
Pathology 6022 Pleural Fluid - Glucose & Protein 490 660 660 660 660 660
Pathology 6023 Peritoneal Fluid Fluid - Glucose & Protein 490 660 660 660 660 660
Pathology 6024 Pleural Fluid - Grams Stain 530 740 740 740 740 740
Pathology 6025 Pleural Fluid - AFB Stain 360 470 470 470 470 470

21
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Pathology 6027 Pleural Fluid for Malignant Cells 910 1,200 1,200 1,200 1,200 1,200
Pathology 6029 Pleural Fluid - LDH (Lactate Dehydrogenase) 620 810 810 810 810 810
Pathology 6030 Pleural Fluid - Culture & Sensitivity 860 1,100 1,100 1,100 1,100 1,100
Pathology 6033 CRP (C-Reactive Protein), High Sensitive 810 1,020 1,020 1,020 1,020 1,020
Pathology 6035 Mantoux / PPD/ TuberculinTest 230 310 310 310 310 310
Pathology 6036 Widal Test (Tube Method) 400 560 560 560 560 560
Pathology 6037 VDRL Serum (RPR) 300 420 420 420 420 420
Pathology 6038 Toxoplasma Antibody (IgG) 775 1,030 1,030 1,030 1,030 1,030
Pathology 6039 Toxoplasma Antibody (IgM) 775 1,030 1,030 1,030 1,030 1,030
Pathology 6040 HIV Test ( I and II ),Serum 1,020 1,900 1,900 1,900 1,900 1,900
Pathology 6041 Prostate Specific Antigen (P.S.A.) - Total 1,010 1,400 1,400 1,400 1,400 1,400
Pathology 6045 Hepatitis B Surface Antigen,Serum 650 1,400 1,400 1,400 1,400 1,400
Pathology 6048 Rheumatoid Factor(Quantitative), Serum 705 970 970 970 970 970
Pathology 6050 ASO (Anti Streptolysin O), Serum 775 1,030 1,030 1,030 1,030 1,030
Pathology 6071 Total Protein, Serum 230 310 310 310 310 310
Pathology 6073 Urine Pregnancy Test 290 370 370 370 370 370
Pathology 6075 Effusion Fluid-Cell Count & Type/Clucose & Protein 910 1,200 1,200 1,200 1,200 1,200
Pathology 6076 FNAC with Procedure 2,220 3,000 3,000 3,000 3,000 3,000
Pathology 6077 Pap Smear 890 1,200 1,200 1,200 1,200 1,200
Pathology 6081 FREE T3,Serum 540 770 770 770 770 770
Pathology 6082 Free PSA (Prostate Specific Antigen),Serum 1,060 1,400 1,400 1,400 1,400 1,400
Pathology 6085 CBC (Complete Blood Count),EDTA 490 830 830 830 830 830

Pathology 6086 Complete Haemogram, Peripheral Smear and ESR,EDTA 810 1,100 1,100 1,100 1,100 1,100

Pathology 6087 Haemoglobin HPLC,EDTA 1,150 1,600 1,600 1,600 1,600 1,600
Pathology 6088 Histo Biopsy - Endometrial 1,660 2,400 2,400 2,400 2,400 2,400
Pathology 6091 HISTO BIOPSY - HEMI/TOTAL/SIGMOID COLECTOMY 3,320 4,100 4,100 4,100 4,100 4,100
Pathology 6095 Kidney Stone Analysis 1,080 1,500 1,500 1,500 1,500 1,500
Pathology 6099 Flow Cytometry- CD2 2,940 3,600 3,600 3,600 3,600 3,600
Pathology 6100 Flow Cytometry- CD20 2,940 3,600 3,600 3,600 3,600 3,600
Pathology 6102 Flow Cytometry- CD33 2,940 3,600 3,600 3,600 3,600 3,600
Pathology 6103 CD4 - Flow Cytometry 2,070 2,800 2,800 2,800 2,800 2,800
Pathology 6119 CA - 125 (Ovarian Cancer Marker),Serum 1,650 2,200 2,200 2,200 2,200 2,200
Pathology 6122 Cortisol (Morning Sample),Serum 755 1,020 1,020 1,020 1,020 1,020
Pathology 6123 Cortisol (Evening Sample),Serum 755 1,020 1,020 1,020 1,020 1,020
Pathology 6125 Ferritin,Serum 900 1,200 1,200 1,200 1,200 1,200
Pathology 6128 Vitamin B12, Serum 1,180 1,700 1,700 1,700 1,700 1,700
Pathology 6130 Absolute Monocyte Count 260 350 350 350 350 350
Pathology 6131 Absolute Neutrophil Count 260 350 350 350 350 350
Pathology 6132 Hydatid Serology/Anti Echinococcus,IgG 1,150 1,600 1,600 1,600 1,600 1,600
Pathology 6138 Anti Thyroglobulin Antibody (Anti TGO),Serum 1,500 2,200 2,200 2,200 2,200 2,200
Pathology 6145 PTH (Parathyroid Hormone)- Intact 1,980 2,700 2,700 2,700 2,700 2,700
Pathology 6148 Absolute Basophil Count 260 350 350 350 350 350
Pathology 6149 Malaria Antigen 910 1,200 1,200 1,200 1,200 1,200
Pathology 6153 Rubella IgG,Serum 775 1,030 1,030 1,030 1,030 1,030
Pathology 6154 Rubella IgM,Serum 775 1,030 1,030 1,030 1,030 1,030
Pathology 6158 HLA B-27, Flow Cytometry 2,830 3,800 3,800 3,800 3,800 3,800
Pathology 6163 Amoebic Serology IgG 1,810 2,400 2,400 2,400 2,400 2,400
Pathology 6168 Aspergillus Antibody IgM,Serum 1,640 2,200 2,200 2,200 2,200 2,200
Pathology 6169 Aspergillus Antibody IgG+IgM,Serum 3,110 4,200 4,200 4,200 4,200 4,200
Pathology 6182 Cryptococus Antigen, CSF 2,570 3,400 3,400 3,400 3,400 3,400
Pathology 6185 Cryptosporidium/Isospora Identification 370 460 460 460 460 460
Pathology 6200 Folate , Serum 1,600 2,200 2,200 2,200 2,200 2,200
Pathology 6202 Vitamin B12 & Folate, Serum 2,680 4,300 4,300 4,300 4,300 4,300
Pathology 6215 Absolute Lymphocyte Count 260 350 350 350 350 350
Pathology 6216 ESR (Westergren),EDTA 230 310 310 310 310 310
Pathology 6218 Osmolality, Random Urine 840 1,100 1,100 1,100 1,100 1,100
Pathology 6220 Anti-ds-DNA Antibody (Double Stranded),ELISA 1,420 1,700 1,700 1,700 1,700 1,700
Pathology 6223 Anti Thyroid Peroxidase AntiBody (Anti Tpo),Serum 1,500 2,200 2,200 2,200 2,200 2,200
Pathology 6226 Flow Cytometry- CD19 2,940 3,600 3,600 3,600 3,600 3,600
Pathology 6231 Free Testosterone,Serum 2,150 2,900 2,900 2,900 2,900 2,900
Pathology 6232 Testosterone, Total,Serum 840 1,100 1,100 1,100 1,100 1,100
Pathology 6234 HAV-IgM (Hepatitis A IgM),Serum 1,640 2,300 2,300 2,300 2,300 2,300
Pathology 6235 HEV - IgM,Serum 2,150 2,900 2,900 2,900 2,900 2,900
Pathology 6236 HCV IgG,Serum 1,900 2,400 2,400 2,400 2,400 2,400
Pathology 34207 Rapid Card Test - HCV 450 630 630 630 630 630
Pathology 6238 Albumin, Serum 160 240 240 240 240 240
Pathology 6240 Herpes Simplex Virus IgM (1+2),Serum 1,400 1,700 1,700 1,700 1,700 1,700
Pathology 6241 Herpes Simplex Virus IgG (1+2),Serum 1,400 1,700 1,700 1,700 1,700 1,700
Pathology 6249 TORCH (IgG, IgM),Serum 4,130 5,600 5,600 5,600 5,600 5,600
Pathology 6250 TORCH - IgG,Serum 2,390 3,200 3,200 3,200 3,200 3,200
Pathology 6251 TORCH - IgM,Serum 2,390 3,200 3,200 3,200 3,200 3,200

22
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Pathology 6252 TPHA 530 740 740 740 740 740
Pathology 6255 ACE (Angiotensing Converting Enzyme) 1,140 1,600 1,600 1,600 1,600 1,600
Pathology 6257 Filarial Antigen 1,010 1,300 1,300 1,300 1,300 1,300
Pathology 6261 Triple Test 3,670 5,000 5,000 5,000 5,000 5,000
Pathology 6265 Urine for Bile Salt 170 240 240 240 240 240
Pathology 6266 Urine for Bile Pigment 170 240 240 240 240 240
Pathology 6267 Anti Thyroid Anti Body Panel,Serum 3,200 4,300 4,300 4,300 4,300 4,300
Pathology 6268 25 Hydroxy Vitamin D Level,Serum 1,920 2,400 2,400 2,400 2,400 2,400
Pathology 6270 Magnesium Serum 640 870 870 870 870 870
Pathology 6271 Immunoglobulin Profile (IgG + IgA + IgM), Serum 1,510 2,000 2,000 2,000 2,000 2,000
Pathology 6273 Glucose Tolerance Test - (GTT 4 specimen),Plasma 530 800 800 800 800 800
Pathology 6276 Stool for Reducing Substance 230 310 310 310 310 310
Pathology 6277 Stool for Occult Blood 180 270 270 270 270 270
Pathology 6278 HBV DNA Quantitative, Real Time PCR 7,970 10,100 10,100 10,100 10,100 10,100
Pathology 6289 Urine Striptest 170 240 240 240 240 240
Pathology 6290 CSF-Cell Type& Count, Glucose, Protein 910 1,200 1,200 1,200 1,200 1,200
Pathology 6293 Wound Swab - Culture & Sensitivity 860 1,100 1,100 1,100 1,100 1,100
Pathology 6295 Ear Swab - Culture & Sensitivity 860 1,100 1,100 1,100 1,100 1,100
Pathology 6296 Anti Cardiolipin Antibody Panel (IgG,IgA,IgM),Serum 2,980 4,000 4,000 4,000 4,000 4,000
Pathology 6297 Lipoprotein(a) ; Lp (a) 1,180 1,600 1,600 1,600 1,600 1,600
Pathology 6302 Glucose Tolerance Test - (GTT 6 specimen),Plasma 755 1,100 1,100 1,100 1,100 1,100
Pathology 6304 Catheter Tip - Culture & Sensitivity 900 1,100 1,100 1,100 1,100 1,100
Pathology 6305 Calcium,Spot Urine 320 440 440 440 440 440
Pathology 6306 Creatinine, Spot Urine 490 660 660 660 660 660
Pathology 6308 Tzank Smear 370 490 490 490 490 490
Pathology 6311 Cytomegalo Virus (CMV) - IgG,Serum 880 1,020 1,020 1,020 1,020 1,020
Pathology 6312 Cytomegalo Virus (CMV) - IgM,Serum 880 1,020 1,020 1,020 1,020 1,020
Pathology 6313 Stool for Hanging Drop 180 270 270 270 270 270
Pathology 6315 Hep B Core Antibody-Total,Serum 1,330 1,800 1,800 1,800 1,800 1,800
Pathology 6316 TROPONIN-T 1,890 2,500 2,500 2,500 2,500 2,500
Pathology 6321 C3 Complement,Serum 900 1,200 1,200 1,200 1,200 1,200
Pathology 6325 Tip - Culture & Sensitivity 860 1,100 1,100 1,100 1,100 1,100
Pathology 6326 C4 Complement,Serum 900 1,200 1,200 1,200 1,200 1,200
Pathology 6327 Blood Gas Analysis 1,020 1,300 1,300 1,300 1,300 1,300
Pathology 6331 High Vaginal Swab Culture and Sensitivity 860 1,200 1,200 1,200 1,200 1,200
Pathology 6337 Peripheral Smear Examination for Micro Filaria 320 440 440 440 440 440
Pathology 6338 Histo Biopsy Gall Bladder 1,780 2,400 2,400 2,400 2,400 2,400
Pathology 6345 Glucose Challenge Test (GCT),Plasma 180 280 280 280 280 280
Pathology 6348 Glucose Tolerance Test - (GTT 3 Specimen),Plasma 410 610 610 610 610 610
Pathology 6350 Vaginal Discharge (Direct Microscopy) 230 270 270 270 270 270
Pathology 6351 Erythropoietin Levels 1,970 2,700 2,700 2,700 2,700 2,700
Pathology 6385 HCV RNA Qualitative, Real Time PCR 5,220 6,400 6,400 6,400 6,400 6,400
Pathology 6388 Sodium, Spot Urine 280 370 370 370 370 370
Pathology 6390 Conjuctival Swab-Culture & Sensitivity 860 1,100 1,100 1,100 1,100 1,100
Pathology 6391 CA 19.9 , Serum 1,550 2,100 2,100 2,100 2,100 2,100
Pathology 6392 Theophylline, Serum 1,030 1,400 1,400 1,400 1,400 1,400
Pathology 6394 Gestational GTT (4 Specimen) after 100gm Glucose 510 780 780 780 780 780
Pathology 6395 Peripheral Smear for Malarial Parasite 320 440 440 440 440 440
Pathology 6396 Serum Thyroglobulin 1,980 2,700 2,700 2,700 2,700 2,700
Pathology 6404 MCH 170 240 240 240 240 240
Pathology 6405 MCHC 170 240 240 240 240 240
Pathology 6406 MCV 170 240 240 240 240 240

Pathology 6410 LKM Antibody(Liver Kidney Microsomal Antibody),Serum 1,830 2,500 2,500 2,500 2,500 2,500

Pathology 6413 HCV RNA Quantitative, Real Time PCR 7,900 10,900 10,900 10,900 10,900 10,900
Pathology 6414 ASMA (Anti Smooth Muscle Antibody), Serum 1,900 2,300 2,300 2,300 2,300 2,300
Pathology 6415 Anti Mitochondrial Antibody, Serum 1,980 2,700 2,700 2,700 2,700 2,700
Pathology 6419 Urine Ketone 170 240 240 240 240 240
Pathology 6421 Groin Swab - Culture & Sensitivity 860 1,200 1,200 1,200 1,200 1,200
Pathology 6430 CA 15.3 (Breast Cancer Marker),Serum 1,810 2,400 2,400 2,400 2,400 2,400
Pathology 6431 Transferrin, Serum 1,330 1,800 1,800 1,800 1,800 1,800
Pathology 6434 EBV (Epstein-Barr Virus ) to VCA, IgM 1,830 2,500 2,500 2,500 2,500 2,500
Pathology 6442 Digoxin, Serum 1,160 1,600 1,600 1,600 1,600 1,600
Pathology 6444 Stool PH 180 270 270 270 270 270
Pathology 6445 Fructosamine,Serum 610 750 750 750 750 750
Pathology 27508 Semen Fructose 360 440 440 440 440 440
Pathology 6450 Anti Thrombin - III - Functional,Citrate Plasma 6,880 8,400 8,400 8,400 8,400 8,400
Pathology 6451 Factor VIII Studies,Citrate Plasma 1,810 2,400 2,400 2,400 2,400 2,400
Pathology 6457 Cytology For Nipple Discharge 840 1,100 1,100 1,100 1,100 1,100
Pathology 6462 HBV DNA Qualitative, Real Time PCR 5,320 6,400 6,400 6,400 6,400 6,400
Pathology 6465 Growth Hormone Stimulation Test-Clonidone 3,930 5,300 5,300 5,300 5,300 5,300
Pathology 6470 Urine Sugar Fasting 170 240 240 240 240 240

23
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Pathology 6471 Urine Sugar PP 170 240 240 240 240 240
Pathology 6487 EBV (Epstein-Barr Virus ) to VCA, IgG 1,830 2,500 2,500 2,500 2,500 2,500
Pathology 6496 Stool for Eosinophills 250 320 320 320 320 320
Pathology 6504 EBV (Epstein-Barr Virus ) to VCA Panel 3,490 4,700 4,700 4,700 4,700 4,700
Pathology 6505 Urine for Blood/Haematuria 170 240 240 240 240 240
Pathology 6507 BAL (Bronchio Alveolar Lavage) For Malignant Cells 910 1,200 1,200 1,200 1,200 1,200
Pathology 6512 Beta-2-Microglobulin, Urine 1,470 2,000 2,000 2,000 2,000 2,000
Pathology 6515 HBeAb (Hepatitis B envelope Antibody),Serum 950 1,300 1,300 1,300 1,300 1,300
Pathology 6529 ANCA - C,Serum 2,040 2,700 2,700 2,700 2,700 2,700
Pathology 6530 ANCA - P,Serum 2,040 2,700 2,700 2,700 2,700 2,700
Pathology 6532 Antiphospholipid Antibody IgG + IgM,Serum 1,550 2,100 2,100 2,100 2,100 2,100
Pathology 6534 Anti Phospho Lipid Antibody IgM,Serum 890 1,200 1,200 1,200 1,200 1,200
Pathology 6555 Effusion Fluid for Malignant Cells 910 1,200 1,200 1,200 1,200 1,200
Pathology 6560 Histo Biopsy Muscle 2,220 2,800 2,800 2,800 2,800 2,800
Pathology 6565 Histo Biopsy Hysterectomy 2,670 3,800 3,800 3,800 3,800 3,800
Pathology 6566 Histo Biopsy Kidney Needle Biopsy 2,670 3,800 3,800 3,800 3,800 3,800
Pathology 6570 Histo Biopsy Kidney / Nephrectomy 3,050 4,500 4,500 4,500 4,500 4,500
Pathology 6593 Immunofixation Electrophoresis,Serum 7,470 10,100 10,100 10,100 10,100 10,100
Pathology 6596 Osmolality, Serum 910 1,200 1,200 1,200 1,200 1,200
Pathology 6598 Haptoglobin,Serum 1,940 2,400 2,400 2,400 2,400 2,400
Pathology 6599 Sputum for Occult Blood 180 270 270 270 270 270
Pathology 6601 Flow Cytometry- CD38 2,940 3,600 3,600 3,600 3,600 3,600
Pathology 9120 Renal Profile,Serum + Urine 1,260 2,100 2,100 2,100 2,100 2,100
Pathology 9121 Lipid Profile,Serum 1,370 1,800 1,800 1,800 1,800 1,800
Pathology 9124 Cardiac profile 1,910 2,600 2,600 2,600 2,600 2,600
Pathology 9125 Liver Function Test Profile,Serum 1,390 2,000 2,000 2,000 2,000 2,000
Pathology 9245 Thyroid Profile*,Serum 1,330 2,100 2,100 2,100 2,100 2,100
Pathology 9246 Coagulation Profile 1,600 2,000 2,000 2,000 2,000 2,000
Pathology 9247 Female Fertility Profile 4,230 5,200 5,200 5,200 5,200 5,200
Pathology 9249 Thalassemia Profile 2,460 3,300 3,300 3,300 3,300 3,300
Pathology 11594 Electrolytes (Na, K, CI) Serum 680 950 950 950 950 950
Pathology 11596 TLC,DLC,Peripheral Smear-Finger prick 300 420 420 420 420 420
Pathology 16227 Histo Biopsy Appendix 1,660 2,000 2,000 2,000 2,000 2,000
Pathology 16228 Histo Biopsy Bone Marrow 2,100 2,900 2,900 2,900 2,900 2,900
Pathology 16229 Histo Biopsy Bronchial biopsy/TBLB 1,780 2,500 2,500 2,500 2,500 2,500
Pathology 16230 Histo Biopsy Cervix Biopsy 1,660 2,400 2,400 2,400 2,400 2,400
Pathology 16231 Histo Biopsy Cervix Conisation specimen 3,050 3,800 3,800 3,800 3,800 3,800
Pathology 16233 Histo Biopsy Colon biopsy 1,660 2,400 2,400 2,400 2,400 2,400
Pathology 16234 Histo Biopsy Duodenum 1,660 2,400 2,400 2,400 2,400 2,400
Pathology 16236 Histo Biopsy Endoscopic of Esophageal 1,660 2,400 2,400 2,400 2,400 2,400
Pathology 16237 Histo Biopsy Endoscopic of stomach 1,660 2,400 2,400 2,400 2,400 2,400
Pathology 16238 Histo Biopsy Endoscopic Of Duodenum 1,780 2,500 2,500 2,500 2,500 2,500
Pathology 16241 Histo Biopsy Endoscopic of Tracheal 1,660 2,000 2,000 2,000 2,000 2,000
Pathology 16242 Histo Biopsy Eye Enucleation 2,350 2,900 2,900 2,900 2,900 2,900
Pathology 16243 Histo Biopsy Fistula 2,350 3,400 3,400 3,400 3,400 3,400

Pathology 16244 Histo Biopsy Hysterectomy with Salpingo Oopherectomy 3,320 4,100 4,100 4,100 4,100 4,100

Pathology 16245 Histo Biopsy Immunoflorescence 3,310 4,900 4,900 4,900 4,900 4,900
Pathology 16250 Histo Biopsy Of Larynx 1,660 2,400 2,400 2,400 2,400 2,400
Pathology 16251 Histo Biopsy Of Epiglottis 1,660 2,000 2,000 2,000 2,000 2,000
Pathology 16252 Histo Biopsy Of Vocal Cord, Vocal Nodule 1,660 2,000 2,000 2,000 2,000 2,000
Pathology 16253 Histo Biopsy Liver Needle Biopsy 2,670 3,800 3,800 3,800 3,800 3,800
Pathology 16254 Histo Biopsy Lymph Node 2,350 2,900 2,900 2,900 2,900 2,900
Pathology 16256 Histo Biopsy Medium Specimens 2,300 2,900 2,900 2,900 2,900 2,900
Pathology 16257 Histo Biopsy Nasopharynx/Nasal polyp/Nasal cavity 1,660 2,400 2,400 2,400 2,400 2,400
Pathology 16258 Histo Biopsy Nerve 2,670 3,800 3,800 3,800 3,800 3,800
Pathology 16260 Histo Biopsy Orchiectomy 2,350 3,400 3,400 3,400 3,400 3,400

Pathology 16261 Histo Biopsy Oropharynx(gum/palate/pharynx/tonsils) 1,780 2,200 2,200 2,200 2,200 2,200

Pathology 16262 Histo Biopsy Ovary / Cyst 1,680 2,400 2,400 2,400 2,400 2,400

Pathology 16263 Histo Biopsy Pneumonectomy/Lobectomy (Non Tumour) 3,050 3,800 3,800 3,800 3,800 3,800

Pathology 16264 Histo Biopsy Products of Conception 1,660 2,400 2,400 2,400 2,400 2,400
Pathology 16267 Histo Biopsy Salivary Gland 1,660 2,000 2,000 2,000 2,000 2,000
Pathology 16268 Histo Biopsy Sinus/PilonidalSinus/Fissure/H'rhoids 2,350 3,400 3,400 3,400 3,400 3,400
Pathology 16269 Histo Biopsy Skin 1,860 2,700 2,700 2,700 2,700 2,700
Pathology 16272 Histo Biopsy Swelling / Lump / Mass 1,780 2,200 2,200 2,200 2,200 2,200
Pathology 16273 Histo Biopsy Synovium 1,660 2,400 2,400 2,400 2,400 2,400
Pathology 16274 Histo Biopsy Tongue 1,660 2,400 2,400 2,400 2,400 2,400
Pathology 16275 HISTO BIOPSY TURP 3,320 4,800 4,800 4,800 4,800 4,800
Pathology 16276 Histo Biopsy Cyst 1,660 2,400 2,400 2,400 2,400 2,400
Pathology 16277 Histo Biopsy Endoscopic Of Rectum 1,660 2,000 2,000 2,000 2,000 2,000

24
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Pathology 16278 Histo Biopsy Endoscopic of bladder mucosa 1,660 2,400 2,400 2,400 2,400 2,400
Pathology 17145 Phencyclidine(PCP) Screen, Urine 870 1,100 1,100 1,100 1,100 1,100
Pathology 17230 Insulin Level (Fasting) 1,050 1,400 1,400 1,400 1,400 1,400
Pathology 17231 Insulin Level (PP) 1,050 1,400 1,400 1,400 1,400 1,400
Pathology 17232 Insulin Level (Random) 1,050 1,400 1,400 1,400 1,400 1,400
Pathology 17368 DHEA-S (Dehydroepiandrosterone Sulphate) 1,350 1,800 1,800 1,800 1,800 1,800
Pathology 17437 Semen Sample Preparation for IU Insemination 1,720 2,100 2,100 2,100 2,100 2,100
Pathology 19439 CVP Line Tip for Culture & Sensitivity 790 1,100 1,100 1,100 1,100 1,100
Pathology 19440 Central Line Tip for Culture & Sensitivity 860 1,100 1,100 1,100 1,100 1,100
Pathology 19442 Arterial Line Tip for Culture & Sensitivity 860 1,100 1,100 1,100 1,100 1,100
Pathology 19443 Tissue - Culture & Sensitivity 810 1,030 1,030 1,030 1,030 1,030
Pathology 19444 ET Secretions - Culture & Sensitivity 860 1,200 1,200 1,200 1,200 1,200
Pathology 19445 Femoral Line Tip - Culture & Sensitivity 860 1,200 1,200 1,200 1,200 1,200
Pathology 19446 Tracheal Secretions - Culture & Sensitivity 860 1,100 1,100 1,100 1,100 1,100
Pathology 19447 ET TIP - Culture & Sensitivity 860 1,200 1,200 1,200 1,200 1,200
Pathology 19448 BAL (Bronchio Alveolar Lavage) - Culture & Sensitivity 860 1,100 1,100 1,100 1,100 1,100
Pathology 19449 Nasal Swab - Culture & Sensitivity 860 1,200 1,200 1,200 1,200 1,200
Pathology 19552 Allergy Comprehensive Profile,Serum 11,240 13,800 13,800 13,800 13,800 13,800
Pathology 39630 Surgical Wound Swab Culture 860 1,100 1,100 1,100 1,100 1,100
Pathology 39337 Scrub Typhus IgM Elisa 1,860 2,400 2,400 2,400 2,400 2,400
Pathology 19554 Amphetamine and Metabolite Screen, Urine 870 1,100 1,100 1,100 1,100 1,100
Pathology 19564 Apolipoproteins A1 & B,Serum 920 1,200 1,200 1,200 1,200 1,200
Pathology 19565 Bacterial Meningitis Panel,CSF 3,100 4,000 4,000 4,000 4,000 4,000
Pathology 19566 Barbiturate Screen, Urine 870 1,100 1,100 1,100 1,100 1,100
Pathology 19567 Benzodiazepine Screen, Urine 910 1,200 1,200 1,200 1,200 1,200
Pathology 19568 Bone Marrow, Iron Stain 725 970 970 970 970 970
Pathology 19570 C3 & C4 Complement Panel,Serum 1,650 2,200 2,200 2,200 2,200 2,200
Pathology 19575 Cannabinoids Screen, Urine 870 1,100 1,100 1,100 1,100 1,100
Pathology 19577 CEA (Carcino Embryonic Antigen),Serum 940 1,300 1,300 1,300 1,300 1,300
Pathology 19583 Cocaine ( Benzoylecgonine ) Screen, Urine 870 1,100 1,100 1,100 1,100 1,100
Pathology 19588 Anaerobic (Miscellaneous) - Culture & Sensitivity 1,170 1,400 1,400 1,400 1,400 1,400
Pathology 19611 Culture & Sensitivity - Bone Marrow (Rapid) 1,730 2,300 2,300 2,300 2,300 2,300
Pathology 19612 Culture - Cholera 860 1,200 1,200 1,200 1,200 1,200
Pathology 19618 Culture, Nocardia 1,020 1,100 1,100 1,100 1,100 1,100
Pathology 19621 Culture- Water; Presumptive Coliform Count 1,260 1,800 1,800 1,800 1,800 1,800
Pathology 19624 D-Dimer, (Quantitative),Citrate Plasma 1,580 2,000 2,000 2,000 2,000 2,000
Pathology 19632 Factor V Leiden,Citrate Plasma 6,100 7,500 7,500 7,500 7,500 7,500
Pathology 19636 FDP (Fibrinogen Degradation Products) 1,120 1,500 1,500 1,500 1,500 1,500
Pathology 19640 Growth Hormone,Serum 920 1,200 1,200 1,200 1,200 1,200
Pathology 19643 Antibodies to HBs,Serum 840 1,100 1,100 1,100 1,100 1,100
Pathology 19645 HBeAg (Hepatitis B envelope Antigen) 1,040 1,400 1,400 1,400 1,400 1,400
Pathology 19646 Hepatitis Be Panel (HBe Ab & HBe Ag),Serum 1,760 2,400 2,400 2,400 2,400 2,400
Pathology 19651 Homocysteine, Quantitative 1,040 1,400 1,400 1,400 1,400 1,400
Pathology 19664 Opiates/Morphine Screen, Urine 870 1,100 1,100 1,100 1,100 1,100
Pathology 19666 Protein C, Functional 3,930 5,300 5,300 5,300 5,300 5,300
Pathology 19668 Free Protein S,Citrate Plasma 3,930 5,300 5,300 5,300 5,300 5,300
Pathology 19670 Gonococcus Smear Examination 250 320 320 320 320 320
Pathology 19922 Tracheostomy Tip for Culture & Sensitivity 420 540 540 540 540 540
Pathology 19924 Venous Line Tip for Culture & Sensitivity 860 1,100 1,100 1,100 1,100 1,100
Pathology 20086 Stool - Culture & Sensitivity 810 1,030 1,030 1,030 1,030 1,030
Pathology 20102 Other Fluid - ADA 840 1,100 1,100 1,100 1,100 1,100
Pathology 20103 ANA (Anti Nuclear Antibody) Immunofluorescence 1,680 2,100 2,100 2,100 2,100 2,100
Pathology 20104 PCR For Tuberculosis 2,310 3,200 3,200 3,200 3,200 3,200
Pathology 20214 ACT 130 170 170 170 170 170
Pathology 20284 Swab for MRSA 725 900 900 900 900 900
Pathology 20328 Trop I,Serum 2,320 3,100 3,100 3,100 3,100 3,100
Pathology 20799 Platelet concentrate processing charges 1,170 1,500 1,500 1,500 1,500 1,500
Pathology 21291 Procalcitonin*, Serum 3,450 4,300 4,300 4,300 4,300 4,300
Pathology 21409 Valporic Acid 1,010 1,300 1,300 1,300 1,300 1,300
Pathology 21594 Anti-CCP (Anti Cyclic Citrullinated Peptide),Serum 2,300 3,100 3,100 3,100 3,100 3,100
Pathology 21628 Anti Cardiolipin Antibody,IgA,Serum 1,080 1,500 1,500 1,500 1,500 1,500
Pathology 21629 Anti Cardiolipin Antibody,IgM,Serum 1,080 1,500 1,500 1,500 1,500 1,500
Pathology 21630 Anti Cardiolipin Antibody,IgG,Serum 1,080 1,500 1,500 1,500 1,500 1,500
Pathology 21722 Fine Needle Aspiration - Slide review 1,440 1,800 1,800 1,800 1,800 1,800
Pathology 21723 Hepatitis B Confirmatory test,Serum 775 1,030 1,030 1,030 1,030 1,030
Pathology 21724 Cytomegalo Virus (CMV) - IgM + IgG Combined,Serum 1,420 1,800 1,800 1,800 1,800 1,800
Pathology 21725 Herpes Simplex Virus IgG + IgM Combined,Serum 1,580 2,100 2,100 2,100 2,100 2,100
Pathology 21726 Rubella IgG + Rubella IgM,Serum 1,440 1,900 1,900 1,900 1,900 1,900
Pathology 21728 Body Fluid (Rapid) - Culture & Sensitivity 1,650 2,200 2,200 2,200 2,200 2,200
Pathology 21731 CSF (Rapid) - Culture & Sensitivity 1,650 2,200 2,200 2,200 2,200 2,200
Pathology 21732 Blood - Culture & Sensitivity 1,600 2,100 2,100 2,100 2,100 2,100
Pathology 21778 Histo Biopsy Bone 2,010 2,800 2,800 2,800 2,800 2,800

25
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Pathology 21780 Histo Biopsy Conjuctival 1,660 2,000 2,000 2,000 2,000 2,000
Pathology 21781 Histo Biopsy Fallopian tube 1,660 2,400 2,400 2,400 2,400 2,400
Pathology 21782 HISTO BIOPSY CARDIAC VALVE 1,660 2,400 2,400 2,400 2,400 2,400
Pathology 21783 Histo Biopsy Lung 1,860 2,700 2,700 2,700 2,700 2,700
Pathology 21784 Histo Biopsy Orbital 1,660 2,400 2,400 2,400 2,400 2,400
Pathology 21785 Histo Biopsy Pancreatic 1,660 2,400 2,400 2,400 2,400 2,400
Pathology 21786 Histo Biopsy Parathyroid 1,660 2,400 2,400 2,400 2,400 2,400
Pathology 21789 Histo Biopsy Placenta 2,350 3,400 3,400 3,400 3,400 3,400
Pathology 21792 Histo Biopsy Splenectomy 2,350 3,400 3,400 3,400 3,400 3,400
Pathology 21793 Histo Biopsy Thymectomy 2,350 3,400 3,400 3,400 3,400 3,400
Pathology 21794 Histo Biopsy Vulva 1,660 2,000 2,000 2,000 2,000 2,000
Pathology 21799 Histo Biopsy Vessels 1,660 2,000 2,000 2,000 2,000 2,000
Pathology 40453 Immunohistochemistry 2 Marker 4,670 6,800 6,800 6,800 6,800 6,800
Pathology 40470 Histo Biopsy Brain Tumor With 2 IHC 5,740 7,100 7,100 7,100 7,100 7,100
Pathology 40471 Histo Biopsy Brain Tumor With 4 IHC 8,640 10,800 10,800 10,800 10,800 10,800
Pathology 21801 Histo Biopsy Pitutory gland 1,660 2,000 2,000 2,000 2,000 2,000
Pathology 21802 Histo Biopsy Frozen section 2,350 3,400 3,400 3,400 3,400 3,400
Pathology 21815 Flow Cytometry- CD3 2,940 3,600 3,600 3,600 3,600 3,600
Pathology 21816 Flow Cytometry- CD5 1,940 2,400 2,400 2,400 2,400 2,400
Pathology 21817 Flow Cytometry- CD10 1,940 2,400 2,400 2,400 2,400 2,400
Pathology 21820 Flow Cytometry- CD23 1,940 2,400 2,400 2,400 2,400 2,400
Pathology 21827 c-erbB2/Her-2-neu - Immunohistochemistry 2,670 3,500 3,500 3,500 3,500 3,500
Pathology 21831 ImmunoHistoChemistry EG FR 2,350 2,900 2,900 2,900 2,900 2,900
Pathology 21833 ImmunoHistoChemistry ER (Estrogen Receptor) 2,350 3,400 3,400 3,400 3,400 3,400
Pathology 21835 Immunohistochemistry-Growth Hormone 3,050 4,500 4,500 4,500 4,500 4,500
Pathology 21837 Immunohistochemistry KI-67 - Tissue 2,350 3,400 3,400 3,400 3,400 3,400
Pathology 21843 ImmunoHistoChemistry PR (Progesterone Receptor) 2,350 3,400 3,400 3,400 3,400 3,400
Pathology 21844 Immunohistochemistry-Prolactin 2,350 3,400 3,400 3,400 3,400 3,400
Pathology 22188 Protein,Spot Urine 260 350 350 350 350 350
Pathology 22450 Neonatal Haemogram 320 450 450 450 450 450
Pathology 23062 Leptospira Antibody, IgM 1,650 2,200 2,200 2,200 2,200 2,200
Pathology 23063 Leptospira Antibody, IgG 1,650 2,200 2,200 2,200 2,200 2,200
Pathology 23064 Leptospira Antibody Panel 3,110 4,200 4,200 4,200 4,200 4,200
Pathology 23074 Synovial Fluid Analysis - Cell Count & Type 480 630 630 630 630 630
Pathology 23098 Tissue Transglutaminase,IgA 1,160 1,600 1,600 1,600 1,600 1,600
Pathology 23099 Parasitic Index 170 240 240 240 240 240
Pathology 23100 Urine for Eosinophils 260 350 350 350 350 350
Pathology 24067 Potassium, Spot Urine 280 370 370 370 370 370
Pathology 24068 Chloride, Spot Urine 280 370 370 370 370 370
Pathology 24070 Urine For Fat Globules 170 240 240 240 240 240
Pathology 24071 Urine For Reducing Substances 170 240 240 240 240 240
Pathology 24072 Magnesium, 24Hrs Urine 735 980 980 980 980 980
Pathology 24135 Blood sugar-Glucometer* 140 230 230 230 230 230
Pathology 24167 Dialysis Water for Calcium 260 330 330 330 330 330
Pathology 24168 Dialysis Water for Inorganic phosphorus 250 320 320 320 320 320
Pathology 24169 Dialysis Water for Sodium 260 330 330 330 330 330
Pathology 24170 Dialysis Water for Potassium 260 330 330 330 330 330
Pathology 24171 Dialysis Water - Culture 860 1,200 1,200 1,200 1,200 1,200
Pathology 24181 Cord Blood TSH,Serum 690 980 980 980 980 980
Pathology 24182 Cord Blood Free -T4,Serum 540 770 770 770 770 770
Pathology 24183 Cord Blood -FT3,Serum 540 770 770 770 770 770
Pathology 24192 NT-proBNP 2,070 2,500 2,500 2,500 2,500 2,500
Pathology 24193 Lactate, Plasma 910 1,200 1,200 1,200 1,200 1,200
Pathology 24194 Lactate,CSF 1,000 1,200 1,200 1,200 1,200 1,200
Pathology 24195 Thyroid Profile(Cord Blood),Serum 1,370 2,000 2,000 2,000 2,000 2,000
Pathology 24224 Immunohistochemistry Individual Marker 2,350 3,400 3,400 3,400 3,400 3,400
Pathology 24225 Immunohistochemistry Panel (4 markers) 8,650 10,700 10,700 10,700 10,700 10,700
Pathology 24226 Immunohistochemistry Panel (6 markers) 11,450 15,500 15,500 15,500 15,500 15,500
Pathology 24227 Immunohistochemistry Panel (8 markers) 14,270 20,900 20,900 20,900 20,900 20,900
Pathology 24269 Cryoglobulin Screening 1,160 1,600 1,600 1,600 1,600 1,600
Pathology 24274 APT TEST 180 270 270 270 270 270
Pathology 24429 VDRL, CSF 300 420 420 420 420 420
Pathology 24867 Issue of Slide (2-5) 300 420 420 420 420 420
Pathology 24868 Issue of Slide (5-10) 430 530 530 530 530 530
Pathology 24869 Issue Of Slide. (Less Than 2) 150 190 190 190 190 190
Pathology 24870 Issue of Slide (More Than 10) 690 840 840 840 840 840
Pathology 24974 India Ink Preparation 350 450 450 450 450 450
Pathology 25119 Neonatal Sepsis Profile (Panel) 630 770 770 770 770 770
Pathology 25120 Peripheral Smear Toxic Granules 320 440 440 440 440 440
Pathology 25126 Gastric Aspiration for Polymorphs 250 320 320 320 320 320
Pathology 25147 ADA, Serum 840 1,100 1,100 1,100 1,100 1,100
Pathology 25148 CSF- ADA Analysis 840 1,100 1,100 1,100 1,100 1,100

26
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Pathology 25149 Pleural Fluid - ADA 840 1,100 1,100 1,100 1,100 1,100
Pathology 33046 Allergy Asthma/Rhinitis Profile (Adult) 5,380 6,600 6,600 6,600 6,600 6,600
Pathology 40446 GFR, Estimated (eGFR), Serum 350 520 520 520 520 520
Glucose Tolerance Test-(GTT 5 Specimen),Fluoride
Pathology 39472 650 790 790 790 790 790
Plasma
Pathology 40592 Respiratory Panel PCR 9,200 11,300 11,300 11,300 11,300 11,300
Pathology 25198 Infection Control Culture 300 370 370 370 370 370
Pathology 25200 ANA (Anti Nuclear Antibody) - ELISA 910 1,300 1,300 1,300 1,300 1,300
Pathology 25201 Sepsis (Panel) 7,020 11,600 11,600 11,600 11,600 11,600
Pathology 25202 Acute Inflammatory (Panel) 630 780 780 780 780 780
Pathology 25203 Chronic Inflammatory (Panel) 1,220 1,500 1,500 1,500 1,500 1,500
Pathology 25205 Kala Azar Screening 1,650 2,200 2,200 2,200 2,200 2,200
Pathology 25312 Growth Hormone Stimulation Test-Insulin 8,990 11,000 11,000 11,000 11,000 11,000
Pathology 25313 Comprehensive Peadeatric Sepsis Packge (Panel) 2,980 3,700 3,700 3,700 3,700 3,700
Pathology 25314 Peadiatric Pyrexia Package (Panel) 4,080 5,000 5,000 5,000 5,000 5,000

Pathology 25544 Blood Grouping For Patients (Infants) Less Than 4 months 560 810 810 810 810 810

Pathology 25553 Albert Stain 330 420 420 420 420 420
Pathology 25555 AFP (Alpha Feto Protein),Serum 1,080 1,500 1,500 1,500 1,500 1,500
Pathology 25556 AFP (Alpha Feto Protein)-Amniotic Fluid 1,080 1,500 1,500 1,500 1,500 1,500
Pathology 25563 ANCA -Immunofluorescence 1,720 2,100 2,100 2,100 2,100 2,100
Pathology 25566 Beta-2-Microglobulin,Serum 1,470 2,000 2,000 2,000 2,000 2,000
Pathology 25573 Anaerobic Blood - Culture & Sensitivity 1,070 1,400 1,400 1,400 1,400 1,400
Pathology 25575 Culture & Sensitivity- Drain Fluid 860 1,200 1,200 1,200 1,200 1,200
Pathology 25576 Pericardial Fluid - Culture & Sensitivity 860 1,100 1,100 1,100 1,100 1,100
Pathology 25577 Peritoneal Fluid - Culture & Sensitivity 860 1,100 1,100 1,100 1,100 1,100
Pathology 25578 Synovial Fluid - Culture & Sensitivity 860 1,100 1,100 1,100 1,100 1,100
Pathology 25585 Culture & Sensitivity -Valve 860 1,200 1,200 1,200 1,200 1,200
Pathology 25588 Fungal Smear Examination 360 490 490 490 490 490
Pathology 25592 Direct Smear Examination 180 240 240 240 240 240
Pathology 25615 Mono Spot Test (Infectious Mononucleosis Antibody) 1,180 1,600 1,600 1,600 1,600 1,600
Pathology 25620 Pericardial Fluid - Cell Count & Type/Gluc & Prot. 910 1,200 1,200 1,200 1,200 1,200
Pathology 25621 Peripheral Smear Examination for Abnormal Cells 320 440 440 440 440 440
Pathology 25622 Peripheral Smear Examination for Band Cells 320 440 440 440 440 440
Pathology 25623 Peripheral Smear Examination for Haemolysis 320 440 440 440 440 440
Pathology 25624 Peripheral Smear Examination for Type of Anaemia 320 440 440 440 440 440
Pathology 25626 Smear for Malignant Cells 1,510 2,000 2,000 2,000 2,000 2,000
Pathology 25630 Quantiferon TB-Gold 4,120 5,100 5,100 5,100 5,100 5,100
Pathology 25631 Toxoplasma Antibody ,Combined (IgG+IgM) 1,360 1,700 1,700 1,700 1,700 1,700
Pathology 25633 Amylase, Spot Urine 590 730 730 730 730 730
Pathology 25634 Inorganic phosphorus, Spot Urine 370 490 490 490 490 490
Pathology 25637 Urine for Crystals 170 240 240 240 240 240
Pathology 25638 Urine for pH 170 240 240 240 240 240
Pathology 25639 Urine for Protein (Qualitative) 170 240 240 240 240 240
Pathology 25640 Urine for Red Blood Cells 130 180 180 180 180 180
Pathology 25641 Urine for Specific Gravity 170 240 240 240 240 240
Pathology 25642 Urine for Sugar(Qualitative) 170 240 240 240 240 240
Pathology 25645 Magnesium, Random Urine 640 870 870 870 870 870
Pathology 25782 Mother Blood Grouping 420 600 600 600 600 600
Pathology 26018 MAU (Microalbumin),24Hrs Urine 755 940 940 940 940 940
Pathology 6427 MAU (Microalbumin), Random Urine 830 1,010 1,010 1,010 1,010 1,010
Pathology 26104 Electrolytes (Na,K,CI), 24Hrs Urine 660 810 810 810 810 810
Pathology 26111 Urea 24 Hrs Urine 370 470 470 470 470 470
Pathology 26112 MAU / Creatinine Ratio Urine 1,100 1,500 1,500 1,500 1,500 1,500
Pathology 26113 Histo Biopsy Breast - True cut Biopsy 1,660 2,000 2,000 2,000 2,000 2,000
Pathology 26115 HISTO BIOPSY AORTA 1,660 2,000 2,000 2,000 2,000 2,000
Pathology 26146 Ryle Tube Aspiration for Occult Blood 260 350 350 350 350 350
Pathology 26248 Ascitic Fluid - ADA 840 1,100 1,100 1,100 1,100 1,100
Pathology 26249 Calcium/Creatinine Ratio, Urine 540 750 750 750 750 750
Pathology 26250 CSF - Glucose & Protein 490 660 660 660 660 660
Pathology 26251 Pericardial Fluid - ADA 840 1,100 1,100 1,100 1,100 1,100
Pathology 26252 Pericardial Fluid - Glucose & Protein 490 660 660 660 660 660
Pathology 26253 Peritoneal Fluid Fluid - LDH 460 620 620 620 620 620
Pathology 26254 Peritoneal Fluid Fluid - ADA 840 1,100 1,100 1,100 1,100 1,100
Pathology 26255 Synovial Fluid - LDH (Lactate Dehydrogenase) 460 620 620 620 620 620
Pathology 26256 Other Fluid-Lipase 810 1,100 1,100 1,100 1,100 1,100
Pathology 26257 Stool for Fat Globules 180 270 270 270 270 270
Pathology 26259 CSF for Malignant Cells 910 1,200 1,200 1,200 1,200 1,200
Pathology 26260 Pericardial Fluid for Malignant Cells 910 1,200 1,200 1,200 1,200 1,200
Pathology 26261 Synovial Fluid for Malignant Cells 910 1,200 1,200 1,200 1,200 1,200
Pathology 26262 Ascitic Fluid - Cell Count & Type 480 630 630 630 630 630
Pathology 26264 Other Fluid - Cell Count & Type 480 630 630 630 630 630

27
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Pathology 26265 Pericardial Fluid - Cell Count & Type 480 630 630 630 630 630
Pathology 26266 Peritoneal Fluid - Cell Count & Type/Gluc & Prot. 910 1,200 1,200 1,200 1,200 1,200
Pathology 26267 Pleural Fluid - Cell Type& Count, Glucose, Protein 910 1,200 1,200 1,200 1,200 1,200
Pathology 26268 Synovial Fluid - Cell Count/Type & Gluc./Prot. 870 1,100 1,100 1,100 1,100 1,100
Pathology 26269 Smear for Eosinophils 320 440 440 440 440 440
Pathology 26273 Histo Biopsy Breast - Lump 1,660 2,400 2,400 2,400 2,400 2,400
Pathology 26274 Histo Biopsy Large (15 Or More Blocks) 4,380 5,500 5,500 5,500 5,500 5,500
Pathology 26275 Cortisol (Random Sample),Serum 755 1,020 1,020 1,020 1,020 1,020
Pathology 26276 CSF- Gram's Stain 510 620 620 620 620 620
Pathology 26277 CSF-AFB Stain 360 470 470 470 470 470
Pathology 26278 Peritoneal Fluid - Malignant Cells 910 1,200 1,200 1,200 1,200 1,200
Pathology 26279 Peritoneal Fluid Fluid - Cell Count & Type 480 630 630 630 630 630
Pathology 26281 Skin - Culture & Sensitivity 860 1,100 1,100 1,100 1,100 1,100
Pathology 26282 Other Fluid - AFB Stain 360 470 470 470 470 470
Pathology 26283 Other Fluid - Gram Stain 530 740 740 740 740 740
Pathology 26284 Pericardial Fluid - AFB Stain 360 470 470 470 470 470
Pathology 26285 Pericardial Fluid - Gram Stain 530 740 740 740 740 740
Pathology 26286 Peritoneal Fluid - Gram Stain 530 740 740 740 740 740
Pathology 26287 Peritoneal Fluid - AFB Stain 360 470 470 470 470 470
Pathology 26288 Synovial Fluid - AFB Stain 360 470 470 470 470 470
Pathology 26289 Synovial Fluid - Gram Stain 530 740 740 740 740 740
Pathology 26312 Acute Leukemia Comprehensive Panel,Heparin+EDTA 17,700 23,800 23,800 23,800 23,800 23,800
Pathology 26313 Acute Lymphoblastic Leukemia; ALL-B,Heparin+EDTA 9,590 11,800 11,800 11,800 11,800 11,800
Pathology 26314 Acute Lymphoblastic Leukemia; ALL-T,Heparin+EDTA 9,590 11,800 11,800 11,800 11,800 11,800
Pathology 26315 Acute Myeloid Leukemia, AML,Heparin+EDTA 10,860 13,300 13,300 13,300 13,300 13,300
Pathology 26316 CLL Comprehensive Panel 15,950 19,600 19,600 19,600 19,600 19,600
Pathology 26317 CD4+CD8 Count, Flow Cytometry 2,960 4,000 4,000 4,000 4,000 4,000
Pathology 26340 Tacrolimus EDTA 1,970 2,200 2,200 2,200 2,200 2,200
Pathology 26344 Pericardial Fluid - LDH (Lactate Dehydrogenase) 460 620 620 620 620 620
Pathology 26345 Synovial Fluid - Glucose & Protein 490 660 660 660 660 660
Pathology 26346 Pleural Fluid - Cell Count & Type 480 630 630 630 630 630
Pathology 26383 Urine Drug Assay Panel 5,340 6,500 6,500 6,500 6,500 6,500
Pathology 26404 Ryle tube for RBCs 250 320 320 320 320 320
Pathology 26409 Other Fluid- Uric Acid 330 450 450 450 450 450
Pathology 26414 Other Fluid- Rheumatoid Factor(Quantitative) 705 960 960 960 960 960
Pathology 26459 Fungal Susceptibility (9 Drugs) 1,900 2,700 2,700 2,700 2,700 2,700
Pathology 26490 Antenatal Antibody Screening Test 660 810 810 810 810 810
Pathology 26492 Antibody Identification - 11cell Panel 4,610 5,100 5,100 5,100 5,100 5,100
Pathology 26493 Antibody Identification with Prophylaxis - 6 cell 1,780 2,300 2,300 2,300 2,300 2,300
Pathology 26541 Typhidot 640 870 870 870 870 870
Pathology 26546 Double Marker 2,650 3,700 3,700 3,700 3,700 3,700
Pathology 26605 Flow Cytometry- CD7 1,940 2,400 2,400 2,400 2,400 2,400
Pathology 26606 Flow Cytometry- CD11c 1,940 2,400 2,400 2,400 2,400 2,400
Pathology 26607 Flow Cytometry- CD13 1,940 2,400 2,400 2,400 2,400 2,400
Pathology 26608 Flow Cytometry- CD14 1,940 2,400 2,400 2,400 2,400 2,400
Pathology 26609 Flow Cytometry- CD15 1,940 2,400 2,400 2,400 2,400 2,400
Pathology 26610 Flow Cytometry- CD16 1,940 2,400 2,400 2,400 2,400 2,400
Pathology 26611 Flow Cytometry- CD22 1,940 2,400 2,400 2,400 2,400 2,400
Pathology 26612 Flow Cytometry- CD25 1,940 2,400 2,400 2,400 2,400 2,400
Pathology 26613 Flow Cytometry- CD34 1,940 2,400 2,400 2,400 2,400 2,400
Pathology 26614 Flow Cytometry- CD45 1,940 2,400 2,400 2,400 2,400 2,400
Pathology 26615 Flow Cytometry- CD56 1,940 2,400 2,400 2,400 2,400 2,400
Pathology 26620 Flow Cytometry- CD64 1,940 2,400 2,400 2,400 2,400 2,400
Pathology 26622 Flow Cytometry- CD79a 2,270 2,800 2,800 2,800 2,800 2,800
Pathology 26623 Flow Cytometry- CD103 V 1,940 2,400 2,400 2,400 2,400 2,400
Pathology 26624 Flow Cytometry- CD117 1,940 2,400 2,400 2,400 2,400 2,400
Pathology 26656 HVS Culture for Group B streptococcus 860 1,200 1,200 1,200 1,200 1,200
Pathology 26747 ANA - LIA,Serum 3,690 4,500 4,500 4,500 4,500 4,500
Pathology 26748 Vasculitis - LIA 3,690 4,500 4,500 4,500 4,500 4,500
Pathology 26749 ANA & Vasculitis Panel-LIA,Serum 7,030 8,600 8,600 8,600 8,600 8,600
Pathology 26960 Ascitic Fluid-Fungus Examination 350 450 450 450 450 450
Pathology 26964 BAL (Bronchio Alveolar Lavage) -Fungus Examination 350 450 450 450 450 450
Pathology 26968 CSF-Indian Ink 350 450 450 450 450 450
Pathology 26972 Other Fluid -Fungus Examination 350 450 450 450 450 450
Pathology 26976 Pericardial Fluid-Fungus Examination 350 450 450 450 450 450
Pathology 26980 Peritoneal Fluid-Fungus Examination 350 450 450 450 450 450
Pathology 26984 Pleural Fluid-Fungus Examination 350 450 450 450 450 450
Pathology 26987 Pus -Fungus Examination 350 450 450 450 450 450
Pathology 26992 Synovial Fluid -Fungus Examination 350 450 450 450 450 450
Pathology 26996 Wound Swab- Gram's Stain 530 740 740 740 740 740
Pathology 26997 Wound Swab-Fungus Examination 350 450 450 450 450 450
Pathology 27001 Tracheal Secretions - Gram's Stain 530 740 740 740 740 740

28
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Pathology 27002 Tracheal Secretions -AFB Stain 360 470 470 470 470 470
Pathology 27008 ET Secretions-AFB Stain 360 470 470 470 470 470
Pathology 27009 ET Secretions-Fungus Examination 350 450 450 450 450 450
Pathology 27013 Sputum-Gram's Stain 510 620 620 620 620 620
Pathology 27014 Sputum-AFB Stain 360 440 440 440 440 440
Pathology 27015 Sputum-Fungus Examination 350 450 450 450 450 450
Pathology 27017 BAL (Bronchio Alveolar Lavage) - Gram's Stain 530 740 740 740 740 740
Pathology 27018 Pus - Gram's Stain 530 740 740 740 740 740
Pathology 37689 Encephalitis/Meningitis Panel ( FirmArray PCR) 13,520 16,300 16,300 16,300 16,300 16,300
Pathology 27028 Testicular FNAC 3,530 4,300 4,300 4,300 4,300 4,300
Pathology 27492 IMMUNOHISTOCHEMISTRY DYSTROPHIN 1 AND 2 6,910 8,500 8,500 8,500 8,500 8,500
Pathology 27493 Rotavirus antigen test 520 690 690 690 690 690
Pathology 27500 Cortisol Stimulation Test (2 Specimen) 1,440 1,900 1,900 1,900 1,900 1,900
Pathology 27501 Cortisol Stimulation Test (3 Specimen) 2,090 2,800 2,800 2,800 2,800 2,800
Pathology 27502 Cortisol Stimulation Test (4 Specimen) 2,830 3,800 3,800 3,800 3,800 3,800
Pathology 27503 Silver Methanamine for PCP Staining 520 720 720 720 720 720
Pathology 27504 Modified AFB Stain 350 450 450 450 450 450
Pathology 27505 Cell Block Preparation 1,680 2,100 2,100 2,100 2,100 2,100
Pathology 27524 Histo Biopsy TRUS Guided Biopsy Prostate 2,670 3,300 3,300 3,300 3,300 3,300
Pathology 27657 Allergy Screen-PhadiaTop/Inf 1,000 1,300 1,300 1,300 1,300 1,300
Pathology 27800 Protein /Creatinine Ratio Random Urine 690 950 950 950 950 950
Pathology 37389 Antibody Titration 2,380 2,900 2,900 2,900 2,900 2,900
Pathology 27993 Anti Phospho Lipid Antibody IgG,Serum 850 1,030 1,030 1,030 1,030 1,030
Pathology 28155 Unconjugated Estriol Serum 1,510 2,000 2,000 2,000 2,000 2,000
Pathology 28247 SAAG (Serum-Ascites Albumin Gradient) 370 490 490 490 490 490
Pathology 28248 Anti Mullerian Hormone, Serum 1,990 2,400 2,400 2,400 2,400 2,400
Pathology 28324 Other Fluid- Urea 330 450 450 450 450 450
Pathology 28325 Other Fluid- Creatinine 330 450 450 450 450 450
Pathology 28387 Uric Acid Random Urine 330 450 450 450 450 450
Pathology 28390 Cytomegalovirus Avidity IgG,Serum 510 670 670 670 670 670
Pathology 28393 Rubella (German measles) Avidity IgG,Serum 530 740 740 740 740 740
Pathology 28450 CK- MB (Mass),Serum 775 1,200 1,200 1,200 1,200 1,200
Pathology 28457 Rapid Test for HIV I & II 450 560 560 560 560 560
Pathology 28458 Rapid Test for Hepatitis B Surface Antigen 250 320 320 320 320 320
Pathology 28575 C.B.C (ONCOLOGY),EDTA 480 680 680 680 680 680
Pathology 28578 Thin Prep/Sure Path Cytology 1,510 2,000 2,000 2,000 2,000 2,000
Pathology 28620 Bariatric Profile (New) 5,650 6,900 6,900 6,900 6,900 6,900
Pathology 28621 Bariatric Profile (follow up) 3,860 4,700 4,700 4,700 4,700 4,700
Pathology 28622 LAP CHOLE Profile 2,750 3,400 3,400 3,400 3,400 3,400
Pathology 28623 Myeloma Profile-New 10,460 12,800 12,800 12,800 12,800 12,800
Pathology 28624 Myeloma Profile- Follow up 3,640 4,900 4,900 4,900 4,900 4,900
Pathology 28647 Thrombophilia Profile 16,300 22,000 22,000 22,000 22,000 22,000
Pathology 28649 HPV DNA High Risk, Hybrid Capture 2,570 3,200 3,200 3,200 3,200 3,200
Pathology 28669 Smear for Amoebic Trophozoite 310 380 380 380 380 380
Pathology 28670 Cold Agglutination Test, Serum 1,060 1,300 1,300 1,300 1,300 1,300
Pathology 28679 Fecal Occult Blood 180 270 270 270 270 270
Pathology 28736 Slide Review & IHC (Piramal) 4,390 5,400 5,400 5,400 5,400 5,400
Pathology 28755 Dialysis Serology Panel 2,980 3,700 3,700 3,700 3,700 3,700
Pathology 28756 Other Fluid-Cholesterol 260 350 350 350 350 350
Pathology 28757 Other Fluid-Triglycerides 410 560 560 560 560 560
Pathology 28920 Urine Dipstix Test 230 270 270 270 270 270
Pathology 28990 Blood Sugar PP (After Lunch) 140 230 230 230 230 230
Pathology 29221 Semen for Pus Cells 120 160 160 160 160 160
Pathology 29274 Ascitic Fluid- AFB Culture 1,340 1,600 1,600 1,600 1,600 1,600
Pathology 29275 Ascitic Fluid- Fungus Culture 1,170 1,400 1,400 1,400 1,400 1,400
Pathology 29334 BAL (Bronchio Alveolar Lavage) - AFB Stain 360 470 470 470 470 470
Pathology 29335 BAL (Bronchio Alveolar Lavage) - AFB Culture 1,340 1,600 1,600 1,600 1,600 1,600
Pathology 29336 BAL (Bronchio Alveolar Lavage) - Fungus Culture 1,170 1,400 1,400 1,400 1,400 1,400
Pathology 29338 BAL - Silver Methanamine Staining 520 720 720 720 720 720
Pathology 29339 BAL - Modified AFB Stain 350 450 450 450 450 450
Pathology 29340 CSF - AFB Culture 1,340 1,600 1,600 1,600 1,600 1,600
Pathology 29341 CSF - Fungus Culture 1,170 1,400 1,400 1,400 1,400 1,400
Pathology 29342 Other Fluid - AFB Culture 1,340 1,800 1,800 1,800 1,800 1,800
Pathology 29343 Other Fluid - Fungus Culture 1,170 1,400 1,400 1,400 1,400 1,400
Pathology 29344 Pericardial Fluid - AFB Culture 1,340 1,700 1,700 1,700 1,700 1,700
Pathology 29345 Pericardial Fluid - Fungal Culture 1,170 1,400 1,400 1,400 1,400 1,400
Pathology 29346 Peritoneal Fluid - AFB Culture 1,340 1,700 1,700 1,700 1,700 1,700
Pathology 29347 Peritoneal Fluid - Fungus Culture 1,170 1,400 1,400 1,400 1,400 1,400
Pathology 29348 Pleural Fluid - AFB Culture 1,340 1,700 1,700 1,700 1,700 1,700
Pathology 29349 Pleural Fluid - Fungus Culture 1,170 1,400 1,400 1,400 1,400 1,400
Pathology 29350 Pus - AFB Stain 360 470 470 470 470 470
Pathology 29351 Pus - AFB Culture 1,340 1,700 1,700 1,700 1,700 1,700

29
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Pathology 29352 Pus - Fungus Culture 1,170 1,400 1,400 1,400 1,400 1,400
Pathology 29353 Pus - Modified AFB Stain 350 430 430 430 430 430
Pathology 29354 Sputum - AFB Culture 1,340 1,700 1,700 1,700 1,700 1,700
Pathology 29355 Sputum - Fungus Culture 1,170 1,400 1,400 1,400 1,400 1,400
Pathology 29357 Sputum - Silver Methanamine for PCP Staining 520 720 720 720 720 720
Pathology 29358 Sputum - Modified AFB Stain 350 450 450 450 450 450
Pathology 29359 Synovial Fluid - AFB Culture 1,340 1,700 1,700 1,700 1,700 1,700
Pathology 29360 Synovial Fluid - Fungus Culture 1,070 1,400 1,400 1,400 1,400 1,400
Pathology 29362 Flow Cytometry - Multiple Myeloma Panel 7,670 9,400 9,400 9,400 9,400 9,400
Pathology 29749 Allergy Individual Marker,Serum 1,120 1,500 1,500 1,500 1,500 1,500
Pathology 29880 Histo Onco BCS/MRM With IHC 13,810 17,000 17,000 17,000 17,000 17,000
Pathology 29881 Histo Onco BCS/MRM Without IHC 7,800 9,600 9,600 9,600 9,600 9,600
Pathology 29882 Histo Onco Radical Hysterectomy for Ovarian Mass 8,250 10,200 10,200 10,200 10,200 10,200
Pathology 29883 Histo Onco Radical Hysterectomy for Ca Endometrium 5,590 6,900 6,900 6,900 6,900 6,900
Pathology 29884 Histo Onco Radical Hysterectomy for Ca Cervix 6,920 8,600 8,600 8,600 8,600 8,600
Pathology 29885 Histo Onco APR/AR 6,920 8,600 8,600 8,600 8,600 8,600
Pathology 29886 Histo Onco Hemicolectomy (Tumour) 5,590 6,900 6,900 6,900 6,900 6,900
Pathology 29887 Histo Onco Gastrectomy (Total/Partial) 6,920 8,600 8,600 8,600 8,600 8,600
Pathology 29888 Histo Onco Esophagectomy 6,920 8,600 8,600 8,600 8,600 8,600
Pathology 29889 Resection (Oral Cavity/Larynx) 6,690 8,200 8,200 8,200 8,200 8,200
Pathology 29890 Histo Onco Lung Resection (Tumour) 6,920 8,600 8,600 8,600 8,600 8,600
Pathology 29891 Histo Onco Soft Tissue Sarcoma Resection 6,920 8,600 8,600 8,600 8,600 8,600
Pathology 29892 Histo Onco Amputation Of Digits 2,920 3,600 3,600 3,600 3,600 3,600
Pathology 29893 Histo Onco Amputation Of Limbs 5,590 6,900 6,900 6,900 6,900 6,900
Pathology 29894 Histo Onco Radical Nephrectomy 5,590 6,900 6,900 6,900 6,900 6,900
Pathology 29895 Histo Onco Skin Tumor Resection 5,590 6,900 6,900 6,900 6,900 6,900
Pathology 29896 Histo Onco Radical Cystectomy 5,590 6,900 6,900 6,900 6,900 6,900
Pathology 29897 Histo Onco Radical Prostatectomy 5,590 6,900 6,900 6,900 6,900 6,900
Pathology 29898 Histo Onco Pancreaticoduodencetomy(Whipple's proc) 6,920 8,600 8,600 8,600 8,600 8,600
Pathology 29899 Histo Onco Radical Cholecystectomy 5,590 6,900 6,900 6,900 6,900 6,900
Pathology 29900 Histo Onco High Orchidectomy 5,590 6,900 6,900 6,900 6,900 6,900
Pathology 29901 High Orchidectomy with Lymph Node Dissection 6,590 8,100 8,100 8,100 8,100 8,100
Pathology 29902 Histo Onco Block Dissection Specimen 5,590 6,900 6,900 6,900 6,900 6,900
Pathology 29903 Histo Onco Curettage Of Bone Tumour 2,920 3,600 3,600 3,600 3,600 3,600
Pathology 29904 Small Biopsy (Single Container) 1,660 2,400 2,400 2,400 2,400 2,400
Pathology 29905 Small Biopsy (Two Container) 2,780 3,400 3,400 3,400 3,400 3,400
Pathology 29906 Small Biopsy (3-5 Container) 4,050 5,000 5,000 5,000 5,000 5,000
Pathology 29907 Small Biopsy (More than 5 Container) 9,130 11,200 11,200 11,200 11,200 11,200
Pathology 29910 Lupus Anticoagulant 2,280 3,100 3,100 3,100 3,100 3,100
Pathology 29922 Histo Onco-Maxillectomy 4,250 5,300 5,300 5,300 5,300 5,300
Pathology 29923 Histo Onco Thyroidectomyy 4,250 5,300 5,300 5,300 5,300 5,300
Pathology 29924 Histo Onco Parotidectomy 4,250 5,300 5,300 5,300 5,300 5,300

Pathology 29925 Submandbular Gland Resection without Lymphnode Dis 4,050 5,000 5,000 5,000 5,000 5,000

Pathology 29926 Histo Onco Adrenalectomy 4,250 5,300 5,300 5,300 5,300 5,300
Pathology 29927 Histo Onco Maxillectomy With Lymphnode Dissection 5,590 6,900 6,900 6,900 6,900 6,900
Pathology 29928 Histo Onco Thyroidectomy with Lymphnode Dissection 5,590 6,900 6,900 6,900 6,900 6,900
Pathology 29929 Histo Onco Parotidectomy with Lymphnode Dissection 5,590 6,900 6,900 6,900 6,900 6,900

Pathology 29930 Submandbular Gland Resection with Lymphnode Dissec 5,320 6,500 6,500 6,500 6,500 6,500

Pathology 29931 Histo Onco Adrenalectomy with Lymphnode Dissection 5,590 6,900 6,900 6,900 6,900 6,900
Pathology 29992 Gestational GTT (3 specimens) after 75gm Glucose 410 560 560 560 560 560
Pathology 30216 Contrast Panel 560 690 690 690 690 690
Pathology 30275 Paired Blood Culture & Sensitivity 1,680 2,100 2,100 2,100 2,100 2,100
Pathology 30276 Ketone,Blood 430 530 530 530 530 530
Pathology 30278 Mixing Studies - PT & APTT 3,220 3,900 3,900 3,900 3,900 3,900
Pathology 30279 Mixing Studies- APTT 2,160 2,600 2,600 2,600 2,600 2,600
Pathology 30280 Mixing Studies- PT 1,630 2,000 2,000 2,000 2,000 2,000
Pathology 30372 AFB sensitivity 1st line {5 drugs} 4,620 5,900 5,900 5,900 5,900 5,900
Pathology 30373 AFB sensitivity 2nd line {7 drugs} 4,620 5,900 5,900 5,900 5,900 5,900
Pathology 30463 Obesity Screening Package 1,230 - - - - -
Pathology 30519 Thrombolysis PT & APTT Profile 910 1,100 1,100 1,100 1,100 1,100
Pathology 30722 Hains 1st Line 3,420 3,800 3,800 3,800 3,800 3,800
Pathology 30723 Hains 2nd Line 4,690 6,400 6,400 6,400 6,400 6,400
Pathology 30724 Hains Mott species identification 4,690 6,400 6,400 6,400 6,400 6,400
Pathology 30838 Galactomannan 2,570 3,200 3,200 3,200 3,200 3,200
Pathology 30840 Flow Cytometry- CD41 1,940 2,400 2,400 2,400 2,400 2,400
Pathology 30841 Flow Cytometry- Tdt 2,160 2,600 2,600 2,600 2,600 2,600
Pathology 30842 Flow Cytometry- HLA DR 1,850 2,300 2,300 2,300 2,300 2,300
Pathology 30843 Flow Cytometry- Gly A 1,850 2,300 2,300 2,300 2,300 2,300
Pathology 30844 Flow Cytometry- cMPO 2,270 2,800 2,800 2,800 2,800 2,800
Pathology 30845 Flow Cytometry- cCD3 2,270 2,800 2,800 2,800 2,800 2,800

30
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Pathology 30846 Flow Cytometry - Kappa+Lambda 3,730 4,600 4,600 4,600 4,600 4,600
Pathology 31415 iSTAT 380 460 460 460 460 460
Pathology 31476 HIV-1 RNA Quantitative,Real Time PCR 6,050 7,400 7,400 7,400 7,400 7,400
Pathology 31477 HSV 1 & 2, REAL TIME PCR , C.S.F 6,090 7,600 7,600 7,600 7,600 7,600
Pathology 31485 Protein Electrophoresis-24Hrs Urine 4,710 5,800 5,800 5,800 5,800 5,800
Pathology 31486 Immunofixation Electrophoresis,24 hrs Urine 9,300 11,400 11,400 11,400 11,400 11,400
Pathology 31487 CSF Protein Electrophoresis,Oligoclonal Bands 4,500 5,500 5,500 5,500 5,500 5,500
Pathology 31488 CMV Quantitative RT PCR 9,890 12,100 12,100 12,100 12,100 12,100
Pathology 31494 Ceruloplasmin,Serum 1,150 1,400 1,400 1,400 1,400 1,400
Pathology 31581 Methotrexate,Serum 2,190 2,700 2,700 2,700 2,700 2,700
Pathology 32025 Combined Test for FNAC and Biopsy 1,910 2,300 2,300 2,300 2,300 2,300
Pathology 32099 Stem Cell Count (CD-34 enumeration) 4,520 6,100 6,100 6,100 6,100 6,100
Pathology 32101 Sezary Syndrome, Flow Cytometry 8,720 11,900 11,900 11,900 11,900 11,900
Pathology 32298 Sepsis Screen Panel 4,770 5,900 5,900 5,900 5,900 5,900
Pathology 32299 ICU Sepsis Screen Panel 6,740 8,500 8,500 8,500 8,500 8,500
Pathology 33043 MRD Panel 12,390 15,200 15,200 15,200 15,200 15,200
Pathology 33049 Allergy Panel - Food,Serum 5,540 6,800 6,800 6,800 6,800 6,800
Pathology 33054 Home Sample Collection (Within 3KM) 370 - - - - -
Pathology 33055 Home Sample Collection (Beyond 3KM) 600 - - - - -
Pathology 33056 Specimen Collection for DNA 1,890 2,300 2,300 2,300 2,300 2,300
Pathology 33206 Triage Cardiac Panel 3,190 4,600 4,600 4,600 4,600 4,600
Pathology 33269 CSF Panel 1,700 2,300 2,300 2,300 2,300 2,300
Pathology 33376 WATER DEPRIVATION TEST,6 SPECIMENS 9,160 12,400 12,400 12,400 12,400 12,400
Pathology 33377 WATER DEPRIVATION TEST, 4 SPECIMENS 6,110 8,300 8,300 8,300 8,300 8,300
Pathology 34180 Flow Cytometry-Immunodeficiency Panel 7,550 10,300 10,300 10,300 10,300 10,300

Pathology 34181 Flow Cytometry-Cytoplasmic Panel(cMPO,cCD79a,cCD3 3,960 5,400 5,400 5,400 5,400 5,400

Pathology 34748 Aspergillus Antibody IgG,Serum 1,640 2,000 2,000 2,000 2,000 2,000
Pathology 34856 Histo Biopsy Penectomy 2,450 3,500 3,500 3,500 3,500 3,500
Pathology 34857 Histo Biopsy Penectomy with inguinal block dissect 4,110 6,000 6,000 6,000 6,000 6,000
Pathology 34987 Histo Biopsy Stomach/Gastric/Antrum 1,780 2,600 2,600 2,600 2,600 2,600
Pathology 34988 Histo Biopsy Sleeve Gastrectomy 2,780 4,100 4,100 4,100 4,100 4,100
Pathology 34989 Histo Biopsy Resection Small Intestine 3,320 4,900 4,900 4,900 4,900 4,900
Pathology 34990 Histo Biopsy Prostate 1,780 2,600 2,600 2,600 2,600 2,600
Pathology 34991 Histo Biopsy Ileum/ Jejunum 1,780 2,600 2,600 2,600 2,600 2,600
Pathology 34992 Histo Biopsy Ear 1,780 2,600 2,600 2,600 2,600 2,600
Pathology 34993 Histo Biopsy Penile/Prepuce 1,780 2,600 2,600 2,600 2,600 2,600
Pathology 34994 Histo Biopsy Pelvis/Puj/Ureter 1,780 2,600 2,600 2,600 2,600 2,600

Pathology 34995 Histo Biopsy Rectum for Hirschprungs Disease with IHC 4,440 6,500 6,500 6,500 6,500 6,500

Pathology 34996 Histo Biopsy Trucut 1,810 2,200 2,200 2,200 2,200 2,200
Pathology 34997 Histo Biopsy Lump (Soft Tissue) 1,780 2,600 2,600 2,600 2,600 2,600
Pathology 34998 Histo Biopsy Nail 1,780 2,600 2,600 2,600 2,600 2,600
Pathology 34999 Histo Biopsy Scalp 1,780 2,600 2,600 2,600 2,600 2,600
Pathology 35000 Histo Onco Laryngectomy 7,010 10,300 10,300 10,300 10,300 10,300
Pathology 35001 Histo Onco Glossectomy 4,990 7,300 7,300 7,300 7,300 7,300
Pathology 35002 Histo Onco Mandibulectomy/Commando 7,010 10,300 10,300 10,300 10,300 10,300
Pathology 35003 Histo Onco Buccal Mucosa/Bite Resection 4,990 7,300 7,300 7,300 7,300 7,300
Pathology 35004 Histo Onco Buccal Mucosa With RND 7,010 10,300 10,300 10,300 10,300 10,300
Pathology 35005 Histo Onco Radical Neck Dissection (RND) 3,890 5,700 5,700 5,700 5,700 5,700
Pathology 35006 Histo Onco Glossectomy With RND 7,010 10,300 10,300 10,300 10,300 10,300
Pathology 35007 Histo Biopsy Myoma 2,220 3,200 3,200 3,200 3,200 3,200
Pathology 35008 Histo Biopsy RND 3,320 4,900 4,900 4,900 4,900 4,900
Pathology 35009 Histo Biopsy Review of Blocks & Slides 3,320 4,900 4,900 4,900 4,900 4,900
Pathology 35010 Histo Biopsy Ganglion 1,780 2,600 2,600 2,600 2,600 2,600
Pathology 35011 Histo Onco Bcs/Mrm With Extended IHC 16,560 24,200 24,200 24,200 24,200 24,200
Pathology 44836 Absolute Atypical Lymphocytes 260 280 280 280 280 280
Pathology 44835 Absolute Band Count 260 280 280 280 280 280
Pathology 32079 Anti NMO Antibody 4,020 4,500 4,500 4,500 4,500 4,500
Pathology 44356 Blood Gas Analysis with Electrolytes 1,180 1,300 1,300 1,300 1,300 1,300
Pathology 26462 Brucella IgG+IgM Antibodies, Quantitative 1,870 2,100 2,100 2,100 2,100 2,100
Pathology 43460 Chemo Fever Panel-1 2,508 2,800 2,800 2,800 2,800 2,800
Pathology 43458 Chemo Profile Minor 2,484 2,800 2,800 2,800 2,800 2,800
Pathology 40777 Chromosome Interphase Profiling Product of Concept 10,220 12,500 12,500 12,500 12,500 12,500
Pathology 45108 Clostridium toxin A&B PCR 3,720 4,300 4,300 4,300 4,300 4,300
Pathology 45046 Cord Blood Haemoglobin 160 180 180 180 180 180
Pathology 45111 CRE Screening 720 800 800 800 800 800
Pathology 44374 CTD LIA/ANA LIA 3,690 4,500 4,500 4,500 4,500 4,500
Pathology 45023 Elisa C. Difficile Toxin A&B 2,720 3,000 3,000 3,000 3,000 3,000
Pathology 30134 Extended Dialysis Panel 7,630 8,500 8,500 8,500 8,500 8,500
Pathology 34578 GeneXpert MTB/RIF 3,420 3,800 3,800 3,800 3,800 3,800
Pathology 40510 Growth Hormone Suppression Test 4,100 5,000 5,000 5,000 5,000 5,000

31
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Pathology 41374 Histobiopsy kidney biopsy for Electron Microscopy 16,020 17,900 17,900 17,900 17,900 17,900
Pathology 36731 HLA-DSA (Donor Specific IgG Antibodeis),Class I&II 13,020 14,500 14,500 14,500 14,500 14,500
Pathology 43649 iHealth-T2D study (HBAiC) 500 580 580 580 580 580
Pathology 44676 Immunohistochemistry Androgen Receptor 2,350 3,400 3,400 3,400 3,400 3,400
Pathology 44601 Infection Control Home Care 320 360 360 360 360 360
Pathology 28723 Inhibin A Reproductive Marker 770 860 860 860 860 860
Pathology 30250 Kidney Metabolic Panel 920 1,020 1,020 1,020 1,020 1,020
Pathology 37330 Legionella Pneumophila Antigen Urine 4,520 5,000 5,000 5,000 5,000 5,000
Pathology 45124 Liver Transplant Profile 1,520 1,600 1,600 1,600 1,600 1,600
Pathology 45169 Liver Transplant Profile with Cyclosporine 4,772 5,000 5,000 5,000 5,000 5,000
Pathology 45170 Liver Transplant Profile with Everolimus 6,932 7,300 7,300 7,300 7,300 7,300
Pathology 45168 Liver Transplant Profile with Tacrolimus 4,547 4,800 4,800 4,800 4,800 4,800
Pathology 45161 LTP Donor Profile - Step - 1 14,840 16,600 16,600 16,600 16,600 16,600
Pathology 45163 LTP Donor Profile - Step - 3 4,988 5,600 5,600 5,600 5,600 5,600
Pathology 45164 LTP Donor Profile - Step - 4 803 900 900 900 900 900
Pathology 45165 LTP Followup Profile (First) 3,240 3,600 3,600 3,600 3,600 3,600
Pathology 45166 LTP Followup Profile (Second) 2,790 3,100 3,100 3,100 3,100 3,100
Pathology 45162 LTP Recepient Profile 19,650 21,900 21,900 21,900 21,900 21,900
Pathology 44916 Max Allergy Profile-Comprehensive 7,520 - - - - -
Pathology 44915 Max Allergy Screening Profile 1,370 - - - - -
Pathology 44913 Max Anemia Profile 2,420 - - - - -
Pathology 44906 Max Arthiritis Panel (Female)-Basic 2,170 - - - - -
Pathology 44905 Max Arthiritis Panel (Male)-Basic 4,020 - - - - -
Pathology 44908 Max Arthiritis Panel(Female)-Comprehensive 4,820 - - - - -
Pathology 44907 Max Arthiritis Panel(Male)-Comprehensive 5,820 - - - - -
Pathology 44860 Max Bone Profile 2,170 - - - - -
Pathology 44861 Max Cardiac Profile 1,770 - - - - -
Pathology 44923 Max Cervical Screening 1,820 - - - - -
Pathology 44864 Max Diabetes Extended Profile 2,570 - - - - -
Pathology 44862 Max Diabetes Profile 1,970 - - - - -
Pathology 44909 Max Electrolyte Panel 400 - - - - -
Pathology 44925 Max Fever Profile Basic 670 - - - - -
Pathology 44912 Max Fever Profile Comprehensive 2,220 - - - - -
Pathology 44917 Max Gynaecological Hormone Profile 1,470 - - - - -
Pathology 44921 Max Infertility Panel 3,820 - - - - -
Pathology 44910 Max Kidney Health Profile-Comprehensive 970 - - - - -
Pathology 44904 Max Nutrition Profile 1,470 - - - - -
Pathology 43238 Max PCOD Panel 2,820 - - - - -
Pathology 44922 Max STD Panel 1,670 - - - - -
Pathology 44914 Max Thalassamia Profile 740 - - - - -
Pathology 44918 Max Tuberculosis Profile I 1,820 - - - - -
Pathology 44919 Max Tuberculosis Profile II 2,820 - - - - -
Pathology 44920 Max Tuberculosis Profile III 2,420 - - - - -
Pathology 37329 Mucopolysaccharidosis (MPS) Type -I( Hurler ),Quan 4,720 5,300 5,300 5,300 5,300 5,300
Pathology 29748 Neisseria gonorrhoeae,PCR 3,020 3,400 3,400 3,400 3,400 3,400
Pathology 38208 Neonatal Screening Panel 4,140 4,600 4,600 4,600 4,600 4,600
Pathology 6248 Packed Cell Volume (PCV) 50 50 50 50 50 50
Pathology 30520 PCR FOR HLA B27,EDTA 2,920 3,300 3,300 3,300 3,300 3,300
Pathology 27656 Quad Screen Test 3,690 4,100 4,100 4,100 4,100 4,100
Pathology 45159 Single Antigen Bead, DSA - Class I & II 50,000 52,700 52,700 52,700 52,700 52,700
Pathology 39548 StrandAdvantage Non-Small Cell Lung Carcinoma Pane 21,520 24,000 24,000 24,000 24,000 24,000
Pathology 45029 Strong Bones JG2 1,620 - - - - -
Pathology 43459 Tumerlysis Panel 1,364 1,500 1,500 1,500 1,500 1,500
Pathology 6589 Vancomycin 4,750 5,000 5,000 5,000 5,000 5,000
Pathology 45028 Wellness JG1 2,520 - - - - -
Pathology 32072 Anti Hepatitis A Virus-IgG,Serum 1,260 1,500 1,500 1,500 1,500 1,500
Pathology 35128 Rapid & Conventional Cytology (<10 smears) 2,450 3,300 3,300 3,300 3,300 3,300
Pathology 35129 Rapid & Conventional Cytology (>10 smears) 3,010 4,100 4,100 4,100 4,100 4,100
Pathology 35163 ANCA Panel (ELISA + IF) 5,540 6,800 6,800 6,800 6,800 6,800
Pathology 36269 BAL–Perl Iron Stain 520 720 720 720 720 720
Pathology 36223 Mononuclear Cell Viability- Flow Cytometry 1,940 2,400 2,400 2,400 2,400 2,400
Pathology 36129 Anti A /B titers 860 1,050 1,050 1,050 1,050 1,050
Pathology 34179 BK Virus Quantitive, PCR 5,420 6,700 6,700 6,700 6,700 6,700
Pathology 26347 EBV (Epstein Barr Virus), PCR 4,220 5,400 5,400 5,400 5,400 5,400
Pathology 36182 Peadiatric Obesity Profile 3,700 - - - - -
Pathology 19661 Mumps Virus Antibody Panel (IgG+IgM) 3,160 3,900 3,900 3,900 3,900 3,900
Pathology 25616 Mumps Virus Antibody,IgG 1,680 2,100 2,100 2,100 2,100 2,100
Pathology 25617 Mumps Virus Antibody,IgM 1,680 2,100 2,100 2,100 2,100 2,100
Pathology 36467 Renal Profile (Without Urine),Serum 1,080 1,800 1,800 1,800 1,800 1,800
Pathology 35414 Aspergillus IgE Specific,Serum 1,070 1,300 1,300 1,300 1,300 1,300
Pediatrics 32839 Parenteral Sedation (Radiology) 2,100 2,200 2,200 2,200 2,200 2,200
Anaethesia 35034 Lumbar Drain 5,300 5,600 6,200 7,900 10,300 14,600

32
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Pediatrics 23984 Oto acoustic emission - Repeat (OAE) 350 370 370 370 370 370
Pediatrics 23983 Oto acoustic emission (OAE) 600 630 630 630 630 630
Pediatrics 23009 Paracentesis 1,400 1,500 1,500 1,500 1,500 1,500
Pediatrics 39879 Immunisation Charge 600 630 630 630 630 630
Pediatrics 29714 Initiation of CPAP 1,200 1,300 1,300 1,300 1,300 1,300
Pediatrics 35031 PICC Line (pead) 4,700 4,900 5,700 7,100 9,300 13,300
Pediatrics 37310 Neonatal Care - 2,700 2,700 2,700 2,700 2,700
Physiotherapy 19861 Chest Physiotherapy 560 590 590 590 590 590
Physiotherapy 22232 Any modality 380 400 430 450 600 880
Physiotherapy 22234 Pain packages 7days 5,700 - - - - -
Physiotherapy 22235 Pain packages 10days 7,400 - - - - -
Physiotherapy 22236 Exercise therapy/session 880 930 930 930 930 930
Physiotherapy 22237 Exercise therapy/25 sessions 17,500 18,400 18,400 18,400 18,400 18,400
Physiotherapy 22238 Pre Op Assessment 470 490 510 660 830 1,300
Physiotherapy 22246 Biofeed back/day 950 1,900 2,100 2,700 3,400 5,200
Physiotherapy 22247 Biofeedback (7 sessions) 6,300 - - - - -
Physiotherapy 22358 Chest Physiotherapy (Night) 570 600 600 600 600 600
Physiotherapy 43930 Robotic Gait Training - 10 sessions 15,500 16,300 16,300 16,300 16,300 16,300
Physiotherapy 43931 Robotic Gait Training - 15 sessions 23,000 24,200 24,200 24,200 24,200 24,200
Physiotherapy 43932 Robotic Gait Training - per session 1,700 1,800 1,800 1,800 1,800 1,800
Physiotherapy 22233 Tow modality 560 590 660 660 780 1,200
Physiotherapy 42135 Chest Physiotherapy with Ambulation - 790 790 790 790 790
Physiotherapy 42136 Chest + Limb Physiotherapy - 1,300 1,300 1,300 1,300 1,300
Physiotherapy 42137 Combination Therapy 880 930 930 930 930 930
Physiotherapy 19852 Compression Therapy 1,150 1,200 1,200 1,200 1,200 1,200
Physiotherapy 42138 Compression Therapy for 10 days 10,000 - - - - -
Physiotherapy 42139 Compression Therapy for 25 days 23,500 - - - - -
Physiotherapy 42140 Dysphagia Review 320 340 340 340 340 340
Physiotherapy 42141 Dysphagia Management 950 1,000 1,000 1,000 1,000 1,000
Physiotherapy 42142 Dysphagia Management with vitalstim 2,900 3,100 3,100 3,100 3,100 3,100
Physiotherapy 42143 Electrotherapy (Two modality) 630 660 740 740 840 1,200
Physiotherapy 42144 Hot Pack/Cold Pack 300 320 320 320 320 320
Physiotherapy 42145 Mobilisation/ Ambulation - 340 340 340 340 340

Physiotherapy 42146 Pain management/ Electrotherapy with exercise therapy 1,150 1,200 1,200 1,200 1,200 1,200

Pain management/ Electrotherapy with exercise therapy


Physiotherapy 42147 7,300 - - - - -
for 7 days
Physiotherapy 42148 Pain management with exercise therapy for 10 days 10,000 - - - - -
Physiotherapy 42149 Rehabilitation /session 1,150 1,200 1,200 1,200 1,200 1,200
Physiotherapy 42150 Rehabilitation for 7 days 7,300 - - - - -
Physiotherapy 42151 Rehabilitation for 10 days 10,000 - - - - -
Physiotherapy 42152 Rehabilitation for 25 days 23,500 - - - - -
Physiotherapy 42153 Traction (Cervical/Lumbar) 320 - - - - -
Physiotherapy 42154 Wheel Chair Mobilisation for 20 minutes - 280 280 280 280 280
Physiotherapy 22248 Two modality 560 590 660 660 830 1,300
Physiotherapy 22373 Additional Modality 290 310 360 380 460 660
Physiotherapy 27470 Electrodes for vitalstim Therapy/Session 2,900 3,100 3,100 3,100 3,100 3,100
Physiotherapy 30516 Consultation PT/OT/Dysphagia 950 1,000 1,000 1,000 1,000 1,000
Physiotherapy 33250 Speech and language consultation 850 900 900 900 900 900
Physiotherapy 33253 SLP - (Package of 7 sessions) 4,600 - - - - -
Plastic Surgery 26765 Cosmetic Botox Package 18,000 - - - - -
Plastic Surgery 40013 Diabetic foot screening 3,400 - - - - -
Plastic Surgery 34298 Dressing Post discharge 790 - - - - -
Plastic Surgery 30955 Aesthetic Ultra Pulse Full Face 88,000 - - - - -
Plastic Surgery 30956 Aesthetic Ultra Pulse Partial Face 59,000 - - - - -
Plastic Surgery 30957 Aesthetic Ultra Pulse Subunit Face 29,500 - - - - -
Plastic Surgery 30958 Aesthetic Ultra Pulse Scar 24,000 - - - - -
Plastic Surgery 30959 Aesthetic Ultra Pulse Minor 12,200 - - - - -
Plastic Surgery 30960 Aesthetic Ultra Pulse Full Face (Reconstructive) 88,000 - - - - -
Plastic Surgery 30961 Aesthetic Ultra Pulse Partial Face (Reconstructive 59,000 - - - - -
Plastic Surgery 30962 Aesthetic Ultra Pulse Subunit Face (Reconstructive 29,500 - - - - -
Plastic Surgery 30963 Aesthetic Ultra Pulse Scar (Reconstructive) 24,000 - - - - -
Plastic Surgery 30964 Aesthetic Ultra Pulse Minor (Reconstructive) 12,200 - - - - -
Plastic Surgery 30965 Aesthetic IPL Full Face per sitting 24,000 - - - - -
Plastic Surgery 30966 Aesthetic IPL Partial Face per sitting 12,200 - - - - -
Plastic Surgery 30967 Aesthetic IPL Full Face (Reconstructive) per sitti 24,000 - - - - -
Plastic Surgery 30968 Aesthetic IPL Partial Face (Reconstructive) per si 12,200 - - - - -
Plastic Surgery 30969 Aesthetic Q Switch QS 1 per sitting 12,200 - - - - -
Plastic Surgery 30970 Aesthetic Q Switch QS 2 per sitting 18,000 - - - - -
Plastic Surgery 30971 Aesthetic Q Switch QS 3 per sitting 24,000 - - - - -
Plastic Surgery 30972 Aesthetic Q Switch QS 4 per sitting 35,500 - - - - -
Plastic Surgery 30973 Aesthetic Q Switch QS 1 (Reconstructive) per sitti 12,200 - - - - -

33
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Plastic Surgery 30974 Aesthetic Q Switch QS 2 (Reconstructive) per sitti 18,000 - - - - -
Plastic Surgery 30975 Aesthetic Q Switch QS 3 (Reconstructive) per sitti 24,000 - - - - -
Plastic Surgery 30976 Aesthetic Q Switch QS 4 (Reconstructive) per sitti 35,500 - - - - -
Plastic Surgery 30977 Aesthetic Consultation 2,400 - - - - -
Plastic Surgery 39551 Aesthetic grade 1 3,000 - - - - -
Plastic Surgery 39552 Aesthetic grade 2 4,600 - - - - -
Plastic Surgery 39553 Aesthetic grade 3 6,800 - - - - -
Plastic Surgery 39554 Aesthetic grade 4 10,000 - - - - -
Plastic Surgery 39555 Aesthetic grade 5 15,900 - - - - -
Plastic Surgery 39556 Aesthetic grade 6 20,800 - - - - -
Plastic Surgery 39557 Aesthetic grade 7 24,100 - - - - -
Plastic Surgery 39558 Aesthetic grade 8 29,300 - - - - -
Plastic Surgery 39559 Aesthetic grade 9 37,500 - - - - -
Podiatry 24820 Debridement – Small (Podi) 6,200 6,200 6,200 6,200 6,200 6,200
Podiatry 24847 Suturing (Small) (Podi) 400 400 400 400 400 400
Podiatry 24848 Wound Debridement (Podi) 670 670 670 670 670 670
Podiatry 5388 Podiatry - Nail Trimming 450 450 450 450 450 450
Podiatry 5392 Podiatry - Ingrowth Toe Nail (Podiatry) 2,200 2,200 2,200 2,200 2,200 2,200
Podiatry 12491 Podiatry - Dressing Medium 610 610 610 610 610 610
Podiatry 12496 Podiatry - Removal of Avulsed Nail 840 840 840 840 840 840
Podiatry 12499 Podiatry - Abscess Drainage (Small) 840 840 840 840 840 840
Podiatry 12504 Podiatry - Abscess Drainage (Large) 2,200 2,200 2,200 2,200 2,200 2,200
Podiatry 17727 Podiatry - Scrapping of Corns and Callosity (Small 460 460 460 460 460 460
Podiatry 20557 Podiatry Small Dressing 370 370 370 370 370 370
Podiatry 20561 Podiatry - Other Minor Procedure (Small) 550 550 550 550 550 550
Podiatry 20563 Podiatry - Other Minor Procedure (Medium) 1,150 1,150 1,150 1,150 1,150 1,150
Podiatry 25915 Podiatry - Other Minor Procedure (Large) 2,200 2,200 2,200 2,200 2,200 2,200
Podiatry 25916 Podiatry - Scrapping of Corns and Callosity (Big) 740 740 740 740 740 740
Podiatry 25918 Diabetic Ulcer debridement (Medium) 1,700 1,700 1,700 1,700 1,700 1,700
Podiatry 25921 Podiatry - Paronychea I & D 1,700 1,700 1,700 1,700 1,700 1,700
Podiatry 34171 Diabetic Ulcer Debridement (Small) 840 840 840 840 840 840
Podiatry 34172 Diabetic Ulcer Debridement (Large) 2,700 2,700 2,700 2,700 2,700 2,700
Podiatry 34173 Podiatry-Abscess Drainage (Medium) 1,700 1,700 1,700 1,700 1,700 1,700
Podiatry 34174 Suturing (Medium) 1,150 1,150 1,150 1,150 1,150 1,150
Psychology 41405 Comprehensive Geriatric Assessment 3,000 3,000 3,000 3,000 3,000 3,000
Psychology 20359 Neuropsychological test 4,800 4,800 4,800 4,800 4,800 4,800
Psychology 37347 Basic Child Package (3 to 18 yrs) 9,200 9,200 9,200 9,200 9,200 9,200

Psychology 37349 Comprehensive Assessment for Autism & Related Diso 18,400 18,400 18,400 18,400 18,400 18,400

Psychology 37348 Family Enrichment Advance Package (5 to 18 yrs) 15,300 15,300 15,300 15,300 15,300 15,300
Psychology 37351 Hyperactive Child ADHD 9,000 9,000 9,000 9,000 9,000 9,000
Psychology 37350 Learning Portfolio 11,600 11,600 11,600 11,600 11,600 11,600
Psychology 21653 Comprehensive Psychological Assessment Type I 6,600 6,600 6,600 6,600 6,600 6,600
Psychology 37748 Comprehensive Psychological Assessment Type II 5,500 5,500 5,500 5,500 5,500 5,500
Psychology 21698 Psychological testing IQ 3,000 3,000 3,000 3,000 3,000 3,000
Pulmonology 17963 Bronchoscopy Fiberoptic to Assist Intubation 6,200 6,500 7,500 9,200 12,100 18,600
Pulmonology 17966 Foreign Body Removal 4,000 4,200 4,800 5,900 7,800 12,000
Bronchoscopy(Fibreoptic) Inclusive BAL/Bronchial
Pulmonology 17969 9,000 9,500 11,000 13,300 17,600 27,100
washing
Pleuroscopy-Medical Thoracoscopy (Diagnostic &
Pulmonology 36774 16,900 17,800 20,400 25,000 33,000 50,800
Therapeutic)
PLEURAL ASPIRATION/THORACENTESIS/PARACENTESIS
Pulmonology 17973 3,500 3,700 4,200 5,200 6,800 10,500
(DIA
Pulmonology 39162 Level 1 Sleep Study 19,300 20,300 20,300 20,300 20,300 20,300
Pulmonology 39163 Level 2 Sleep Study 14,000 14,700 14,700 14,700 14,700 14,700
Pulmonology 39164 Level 2 Home Sleep Study 15,000 15,800 15,800 15,800 15,800 15,800
Pulmonology 39165 Level 3 Sleep Study Screening 7,500 7,900 7,900 7,900 7,900 7,900
Pulmonology 39166 Auto CPAP/BIPAP for 3 days 5,500 5,800 6,600 8,100 10,700 16,500
Pulmonology 39167 Oximetery Recording 3,300 3,500 4,000 4,800 6,400 9,900
Pulmonology 17974 Pleural Biopsy 4,900 5,200 5,900 7,300 9,600 14,700
Pulmonology 17975 Fine Needle Aspiration Lung 3,400 3,600 4,100 5,100 6,600 10,200
Pulmonology 22291 Pleurodiesis / Fibrinolysis 3,500 3,700 4,200 5,200 6,800 10,500
Pulmonology 22293 Bronchoscopy Fibreoptic 5,800 6,100 7,100 8,500 11,300 17,400

Pulmonology 22302 Bronchoscopy(Fibreoptic) with Endobronchial Biopsy(PKG) 12,400 13,100 15,100 18,300 24,100 37,200

Bronchoscopy (Fibreoptic) with Transbronchial Lung


Pulmonology 22303 15,700 16,500 19,100 23,200 30,500 47,100
Biopsy
Pulmonology 29567 Balloon Dilatation endobronchial 5,900 6,200 7,200 8,700 11,500 17,700
Pulmonology 29568 Bronchoscopy(Fibreoptic) with TBNA(PKG) 14,400 15,200 17,500 21,300 28,000 43,200
Pulmonology 29569 Bronchoscopy(Fibreoptic) with EBB & TBNA(PKG) 15,500 16,300 18,700 22,900 30,200 46,500
Pulmonology 29570 Bronchoscopy(Fibreoptic) with TBB & TBNA(PKG) 16,600 17,500 20,100 24,400 32,300 49,800
Pulmonology 29571 Endobronchial Biopsy 4,800 5,100 5,800 7,100 9,400 14,400

34
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Pulmonology 29572 Electrocautery Treatment 5,900 6,200 7,200 8,700 11,500 17,700
Pulmonology 29573 Glue Therapy Endobronchial 3,500 3,700 4,200 5,200 6,800 10,500
Pulmonology 29574 ICD Repositioning / Dressing/(Removal) 900 950 1,100 1,400 1,800 2,800
Intercostal Drainage / Pigtail Drainage of
Pulmonology 29575 9,100 9,600 11,100 13,400 17,700 27,300
Empyema/Pleural fluid /Pneumothorax
Laryngoscopy /Bronchoscopic (assessement of upper
Pulmonology 29576 4,600 4,800 5,600 6,700 9,000 13,800
airway)
Pulmonology 29577 Laser Treatment 7,100 7,500 8,600 10,400 13,800 21,300
PLEURAL ASPIRATION/THORACENTESIS/PRACENTESIS
Pulmonology 29578 6,200 6,500 7,500 9,200 12,100 18,600
(THER
Pulmonology 29579 RESCU NIV Care 740 780 880 1,100 1,400 2,200
Pulmonology 29580 RESCU NIV Care and CPAP/ BIPAP Machine 1,800 1,900 2,200 2,600 3,500 5,400
Pulmonology 29581 RESCU NIV Initiation 930 980 1,200 1,400 1,800 2,800
Pulmonology 29582 RESCU Six Minute Walk Test/ Oxygen Titration test 500 530 630 740 950 1,500
Pulmonology 29585 Stent Metallic Placement 9,000 9,500 11,000 13,300 17,600 27,100
Pulmonology 29588 TBNA 7,100 7,500 8,600 10,400 13,800 21,300
Anaethesia 29589 Tracheostomy Change 740 780 880 1,100 1,400 2,200
Pulmonology 29590 Transbronchial Biopsy 4,600 4,800 5,600 6,700 9,000 13,800
Pulmonology 30036 ReSCU Ventilator Care 840 880 880 1,100 1,400 2,200
Pulmonology 31447 Bronchoalveolar Lavage / Bronchial Washing 3,500 3,700 4,200 5,200 6,800 10,500
Pulmonology 31448 Bronchoscopy(Fibreoptic) With TBB,EBB & TBNA(PKG) 18,600 19,600 22,500 27,400 36,200 55,800
Pulmonology 31449 Brushing (Endobronchial - Proximal/ Distal) 1,800 1,900 2,200 2,600 3,500 5,400
Pulmonology 31450 Brachytherapy One Catheter Placement 4,700 4,900 5,800 6,900 9,200 14,100
Pulmonology 31451 Rescu ABG Sampling Procedure 400 420 530 630 740 1,200
Pulmonology 39152 Pleural Catheter Tunneled Placement. 19,780 20,800 23,800 29,800 38,700 59,500
Pulmonology 31456 PFT - Simple Spirometery 1,400 1,500 1,500 1,500 1,500 1,500
Pulmonology 31457 PFT - Bronchodilator Reversibility (BDR) Only 400 420 420 420 420 420
Pulmonology 31458 PFT - Spirometery With BDR 1,850 1,900 1,900 1,900 1,900 1,900
Pulmonology 31459 PFT - Diffusion Study With Lung Volume Static Only 1,400 1,500 1,500 1,500 1,500 1,500
Pulmonology 31460 PFT - DETAILED (SPIRO + BDR + DIFF) 3,500 3,700 3,700 3,700 3,700 3,700
Radiology 1 CT Head / Brain - Plain 3,360 4,300 4,300 4,300 4,300 4,300
Radiology 5 CT Neck - Plain 5,090 6,600 6,600 6,600 6,600 6,600
Radiology 7 CT Lower Abdomen - Contrast 6,620 8,600 8,600 8,600 8,600 8,600
Radiology 11 CT Sella / Pitutary - Plain 3,890 5,000 5,000 5,000 5,000 5,000
Radiology 35097 CT Enteroclysis/ Enterography 8,090 10,500 10,500 10,500 10,500 10,500
Radiology 37602 CT Thorax, Abdomen & Pelvis Contrast 15,340 19,900 19,900 19,900 19,900 19,900
Radiology 37603 CT Thorax, Abdomen & Pelvis Plain 12,560 16,300 16,300 16,300 16,300 16,300
Radiology 38331 CT Head & Spine Cervical -Plain 7,510 9,700 9,700 9,700 9,700 9,700
Radiology 39181 CT Cranial/Brain/head angio with venous 16,440 21,300 21,300 21,300 21,300 21,300
Radiology 39228 CT distal loopogram 7,870 10,200 10,200 10,200 10,200 10,200
Radiology 39725 CT Spine Cervical (plain) Flexion and extension 6,940 9,000 9,000 9,000 9,000 9,000
Radiology 41287 CT-PNS Coronal Contrast 6,620 8,600 8,600 8,600 8,600 8,600
Radiology 39243 MRI Brain (Vertigo package) 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 39242 MRI Brain+CISS 11,240 14,600 14,600 14,600 14,600 14,600
Radiology 41289 MRI Face Plain 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 44777 MRI Enteroclysis/ Enterography 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 41290 MRI Lower Extremeity With (C) Right 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 39266 MRI Pelvis/Lower Abdomen 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 39267 MRI Pelvis/Lower Abdomen (Contrast) 10,030 13,000 13,000 13,000 13,000 13,000
Radiology 40640 NT / NB scan (Triplet) 4,440 5,700 5,700 5,700 5,700 5,700
Radiology 40639 NT / NB scan (Twins) 3,330 4,300 4,300 4,300 4,300 4,300
Radiology 40638 NT / NB scan (Single) 2,340 3,000 3,000 3,000 3,000 3,000
Radiology 41293 US Breast Wire Localisation Procedure 3,230 4,200 4,200 4,200 4,200 4,200
Radiology 41291 US Guided Trus Biopsy 6,310 8,200 8,200 8,200 8,200 8,200
Radiology 40093 USG Biophysical Profile (Twins) 4,440 5,700 5,700 5,700 5,700 5,700
Radiology 40352 USG Elastography Breast 2,660 3,400 3,400 3,400 3,400 3,400
Radiology 40354 USG Elastography Prostate 2,660 3,400 3,400 3,400 3,400 3,400
Radiology 40353 USG Elastography Thyroid 2,660 3,400 3,400 3,400 3,400 3,400
Radiology 39229 USG guidance for procedure 3,200 4,100 4,100 4,100 4,100 4,100
Radiology 36575 USG Guided Biopsy 3,200 4,100 4,100 4,100 4,100 4,100
Radiology 36574 USG Guided Biopsy & Expiration Taping 3,780 4,900 4,900 4,900 4,900 4,900
Radiology 41292 USG Guided Prostate Biopsy 6,310 8,200 8,200 8,200 8,200 8,200
Radiology 40641 USG Triplet Pregnancy 4,440 5,700 5,700 5,700 5,700 5,700
Radiology 39226 USG Whole Abdomen With TVS 2,440 3,200 3,200 3,200 3,200 3,200
Radiology 41296 Fluoroscopy Ercp 3,000 3,900 3,900 3,900 3,900 3,900
Radiology 39215 Interventional U/S Diagnostic aspiration/tapping 3,780 4,900 4,900 4,900 4,900 4,900
Radiology 39219 Interventional USG guided abscess drainage 6,940 9,000 9,000 9,000 9,000 9,000
Radiology 39216 Interventional U/S Therapeutic aspiration 6,940 9,000 9,000 9,000 9,000 9,000
Radiology 45366 X-ray Left Hand Bone Age 480 600 600 600 600 600
Radiology 45367 X-ray Right Hand Bone Age 480 600 600 600 600 600
Radiology 45365 MRI Peripheral Angiography - Plain 12,300 15,500 15,500 15,500 15,500 15,500
Radiology 41297 X-RAY BOTH HAND OBLIQUE 490 630 630 630 630 630

35
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Radiology 40313 X-ray Chest (for visa only) 490 630 630 630 630 630
Radiology 41298 X-RAY CLAVICLE AP-Right 490 630 630 630 630 630
Radiology 40315 X-Ray dorsal spine AP & lateral view 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 39227 X-Ray Nasal bone (Right) 490 630 630 630 630 630
Radiology 44497 X- Ray Whole Spine / Whole Limb 2,000 2,600 2,600 2,600 2,600 2,600
Radiology 44703 CT Extremities-Lower (Plain) Left 6,040 7,800 7,800 7,800 7,800 7,800
Radiology 44702 CT Extremities-Lower(Contrast) Left 7,510 9,700 9,700 9,700 9,700 9,700
Radiology 44705 CT Extremities-Upper (Plain) Left 6,040 7,800 7,800 7,800 7,800 7,800
Radiology 44704 CT Extremities-Upper(Contrast) Left 7,510 9,700 9,700 9,700 9,700 9,700
Radiology 44706 Mammography Single Breast-Left 1,370 1,800 1,800 1,800 1,800 1,800
Radiology 44707 MRI Brachial Plex (Unilateral) Left 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 44713 MRI Extremity (Non Joint) - Left 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 44712 MRI Extremity (Non Joint)+C - Left 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 44709 MRI Lower Extremeity With-(C )-Left 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 44708 MRI lower Extremeity-Left 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 44710 MRI Single Ankle Joint (C ) - Left 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 44711 MRI Single Ankle Joint (Plain) - Left 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 44714 MRI Single Hip Joint (C) - Left 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 44715 MRI Single Hip Joint (Plain) - Left 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 44716 MRI Single Knee Joint (C) - Left 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 44717 MRI Single Knee Joint (Plain) - Left 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 44718 MRI Single Shoulder Joint (C) - Left 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 44719 MRI Single Shoulder Joint (P) - Left 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 44720 MRI Single Wrist Joint (C) - Left 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 44721 MRI Single Wrist Joint (Plain) - Left 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 44722 MRI TM Joint - Left 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 44724 MRI Upper Extermity - Left 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 44726 USG Doppler for AV fistula - Left 3,280 4,200 4,200 4,200 4,200 4,200
Radiology 44727 USG Shoulder - Left 1,610 2,100 2,100 2,100 2,100 2,100
Radiology 44728 USG U/L Arterial Venous Dopplr-Left 7,910 10,200 10,200 10,200 10,200 10,200
Radiology 44729 USG U/L Limb Arterial Doppler-Left 4,330 5,600 5,600 5,600 5,600 5,600
Radiology 44731 USG U/L Varicose Venous Dopplr-Left 4,330 5,600 5,600 5,600 5,600 5,600
Radiology 44732 USG U/L Venous Doppler for DVT-Left 3,280 4,200 4,200 4,200 4,200 4,200
Radiology 44730 USG upper limb joints-Left 1,610 2,100 2,100 2,100 2,100 2,100
Radiology 44769 X-ray Ankle single AP-Left 490 630 630 630 630 630
Radiology 44768 X-ray Ankle single AP & Lat-Left 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 44770 X-ray Ankle single-Lateral-Left 490 630 630 630 630 630
Radiology 44737 X-ray Elbow Joint-AP & Lateral-Left 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 44738 X-ray Elbow:Any Joint-AP Only-Left 490 630 630 630 630 630
Radiology 44739 X-ray Elbow:Any Joint-Lateral-Left 490 630 630 630 630 630
Radiology 44741 X-ray Femur/Thigh AP & Lateral-Left 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 44740 X-ray Femur/Thigh(AP Only)-Left 490 630 630 630 630 630
Radiology 44742 X-ray Foot(Any Joint-AP & Lat)-Left 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 44744 X-ray Foot(Any Joint-AP Only)-Left 490 630 630 630 630 630
Radiology 44745 X-ray Foot(Any Joint-Lat)-Left 490 630 630 630 630 630
Radiology 44746 X-ray Forearm(AP & Lateral)-Left 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 44748 X-ray Hip(Any Joint-AP & Lat)-Left 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 44749 X-ray Hip(Any Joint-AP Only)-Left 490 630 630 630 630 630
Radiology 44750 X-ray Hip(Any Joint-Lateral)-Left 490 630 630 630 630 630
Radiology 44751 X-ray Humerus/Arm(AP & Lat)-Left 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 44752 X-ray Knee(Any Joint-AP & Lat)-Left 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 44753 X-ray Knee(Any Joint-AP Only)-Left 490 630 630 630 630 630
Radiology 44754 X-ray Knee(Any Joint-Lateral)-Left 490 630 630 630 630 630
Radiology 44755 X-ray Leg AP & Lateral-Left 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 44756 X-ray Mandible-Single Oblique-Left 490 630 630 630 630 630
Radiology 44757 X-Ray Mastoid Unilateral-Left 490 630 630 630 630 630
Radiology 44758 X-Ray Nasal bone(Left) 490 630 630 630 630 630
Radiology 44759 X-ray Scaphoid views for Wrist-Left 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 44760 X-ray Shoulder Any-AP & Lat(Left) 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 44761 X-ray Shoulder(Any Joint-AP)Left 490 630 630 630 630 630
Radiology 44762 X-ray Shoulder(Any Joint-Lat) Left 490 630 630 630 630 630
Radiology 44763 X-Ray SI Joint Single Oblique-Left 490 630 630 630 630 630
Radiology 44764 X-ray TM-Single Oblique(Left) 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 44766 X-ray Wrist(Any Joint-AP Only) Left 490 630 630 630 630 630
Radiology 44765 X-ray Wrist(Any Joint-AP&Lat) Left 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 44767 X-ray Wrist(Any Joint-Lat) Left 490 630 630 630 630 630
Radiology 44725 Single Breast Mst - Left 4,570 5,900 5,900 5,900 5,900 5,900
Radiology 44736 X-RAY CLAVICLE AP - Left 490 630 630 630 630 630
Radiology 46567 Interventional CT guided FNAC 7,850 10,200 10,200 10,200 10,200 10,200
Radiology 40452 MR Defecography 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 28 MRI Angio Neck - Plain 10,030 13,000 13,000 13,000 13,000 13,000
Radiology 29 MRI Brain with MR Venogram - Plain 14,390 18,600 18,600 18,600 18,600 18,600

36
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Radiology 38689 MR Guided Breast Biopsy 31,670 41,000 41,000 41,000 41,000 41,000
Radiology 36 USG Whole Abdomen 2,440 3,200 3,200 3,200 3,200 3,200
Radiology 38406 Single Breast Mst-Right 4,570 5,900 5,900 5,900 5,900 5,900
Radiology 38404 Skeletal Survey Paediatric 2,420 3,100 3,100 3,100 3,100 3,100
Radiology 38405 Skeletal Survey Routine Adult 4,890 6,300 6,300 6,300 6,300 6,300
Radiology 37 MRI Single Extremity (Non Joint)-Plain-Right 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 40 USG Breasts 1,760 2,300 2,300 2,300 2,300 2,300
USG Small Part (Thyroid/ Neck/ Lymphnode/Orbit/ Soft
Radiology 41 1,760 2,300 2,300 2,300 2,300 2,300
Tissue)
Radiology 41281 USG Contrast Charge 5,175 6,700 6,700 6,700 6,700 6,700
Radiology 37496 Review of Outside Scan 1,100 1,400 1,400 1,400 1,400 1,400
Radiology 38154 Mammo & Sonomammo Both Breast 4,200 5,400 5,400 5,400 5,400 5,400
Radiology 38151 Mammo Sonomammo - TVS Both Breast 5,830 7,600 7,600 7,600 7,600 7,600
Radiology 38152 Mammo & Sonomammo Single Breast 3,000 3,900 3,900 3,900 3,900 3,900
Radiology 38153 Mammo Sonomammo TVS Single Breast 4,780 6,200 6,200 6,200 6,200 6,200
Radiology 42 MRI Brain Plain 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 45 Mammography Both Breast 2,730 3,500 3,500 3,500 3,500 3,500
Radiology 46 MRI Spine Cervical (Plain) 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 48 MRI Spine Lumbar (Plain) 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 35724 USG PVR (Post Void Residual Urine) 560 730 730 730 730 730
Radiology 49 USG Lower Abdomen 1,550 2,000 2,000 2,000 2,000 2,000
Radiology 50 MRI Chest / Mediastinum 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 51 MRI Neck/thyroid (Plain) 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 52 MRI Orbits (Contrast) 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 53 MRI Extra Film 300 300 300 300 300 300
Radiology 54 Mammography Single Breast-Right 1,370 1,800 1,800 1,800 1,800 1,800
Radiology 56 MRI Upper Abdomen - Plain 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 57 MRI Lower Abdomen 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 58 USG Screening Without Film 1,340 1,700 1,700 1,700 1,700 1,700
Radiology 60 MRI Whole Abdomen - Plain 14,760 19,100 19,100 19,100 19,100 19,100
Radiology 61 MRI Cholangiography (MRCP) 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 39309 USG Bilateral Limb Arterial Doppler 7,910 10,200 10,200 10,200 10,200 10,200
Radiology 39307 USG Single Limb Arterial & Venous Doppler-Right 7,910 10,200 10,200 10,200 10,200 10,200
Radiology 39308 USG Bilateral Limb Arterial & Venous Doppler 13,680 17,700 17,700 17,700 17,700 17,700
Radiology 63 USG Upper Abdomen 1,550 2,000 2,000 2,000 2,000 2,000
Radiology 68 USG Cranium / Skull Neonatal 1,340 1,700 1,700 1,700 1,700 1,700
Radiology 69 USG Joint 1,660 2,100 2,100 2,100 2,100 2,100
Radiology 71 USG Follicular Study 2,180 2,800 2,800 2,800 2,800 2,800
Radiology 39629 USG Elastography Liver 2,660 3,400 3,400 3,400 3,400 3,400
Radiology 73 USG Pregnancy Doppler 3,280 4,200 4,200 4,200 4,200 4,200
Radiology 77 USG Scrotal Doppler 3,280 4,200 4,200 4,200 4,200 4,200
Radiology 79 USG Abdominal Doppler (Porto Caval) 3,130 4,100 4,100 4,100 4,100 4,100
Radiology 37400 Multi-parametric MRI of Prostate with Contrast 17,490 22,700 22,700 22,700 22,700 22,700
Radiology 80 Interventional USG Pleural / Peritoneal tap 3,780 4,900 4,900 4,900 4,900 4,900
Radiology 81 Interventional U/S FNAC 6,620 8,600 8,600 8,600 8,600 8,600
Radiology 83 USG Transvaginal (TVS) 1,910 2,500 2,500 2,500 2,500 2,500
Radiology 84 X-Ray Chest PA/AP View 490 630 630 630 630 630
Radiology 85 X-Ray KUB 490 630 630 630 630 630
Radiology 93 X-Ray Skull - AP & Lateral 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 96 X-ray Pelvis with both hips - AP 490 630 630 630 630 630
Radiology 103 Barium Swallow 3,780 4,900 4,900 4,900 4,900 4,900
Radiology 107 Barium Meal Follow Through 4,890 6,300 6,300 6,300 6,300 6,300
Radiology 109 Small Bowel Enema / Double Contrast Enema 5,990 7,800 7,800 7,800 7,800 7,800
Radiology 110 Barium Enema 5,040 6,500 6,500 6,500 6,500 6,500
Intravenous Pyelogram (IVP) / Intravenous Ureothrogram
Radiology 118 4,990 6,500 6,500 6,500 6,500 6,500
(IVU)
Radiology 119 Micturating Cysto Urethrogram (MCU) 3,780 4,900 4,900 4,900 4,900 4,900
Radiology 120 Hystero Salphingo Gram(HSG) 3,780 4,900 4,900 4,900 4,900 4,900
Radiology 124 Sinogram / Fistulogram 3,780 4,900 4,900 4,900 4,900 4,900
Radiology 132 Dexa - Spine 3,200 4,100 4,100 4,100 4,100 4,100
Radiology 133 Dexa-Bone Spine & Femur study 3,780 4,900 4,900 4,900 4,900 4,900
Radiology 135 Dexa Complete study (Spine, Dual Femur, Fore Arm) 5,830 7,600 7,600 7,600 7,600 7,600
Radiology 136 Dexa-Total Body Fat Analysis 5,990 7,800 7,800 7,800 7,800 7,800
Radiology 144 CT Head / Brain - Contrast 3,890 5,000 5,000 5,000 5,000 5,000
Radiology 145 Barium UGIT 3,780 4,900 4,900 4,900 4,900 4,900
Radiology 151 X-Ray Skull - Lateral 490 630 630 630 630 630
X-ray T.M. Joints - Both Obliques (including open & closed
Radiology 154 1,750 2,300 2,300 2,300 2,300 2,300
mouth views)
Radiology 158 USG KUB 1,760 2,300 2,300 2,300 2,300 2,300
Radiology 164 USG Pregnancy 2,130 2,800 2,800 2,800 2,800 2,800
Radiology 170 X-Ray Apicogram 490 630 630 630 630 630
Radiology 171 X-Ray Abdomen - Erect & Supine 1,020 1,300 1,300 1,300 1,300 1,300

37
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Radiology 192 X-Ray Both SI Joints - AP / PA 490 630 630 630 630 630
Radiology 193 X-Ray Both SI Joints - Oblique 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 194 X-Ray SI Joint - Single Oblique (Right) 490 630 630 630 630 630
Radiology 207 X-Ray Skull AP 490 630 630 630 630 630
Radiology 210 X-Ray Para Nasal Sinuses [PNS] 490 630 630 630 630 630
Radiology 211 X-ray Mandible (Both Obliques) 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 214 X-ray Mandible-Single Oblique-Right 490 630 630 630 630 630
Radiology 215 X-ray Soft Tissue Neck/Nasopharynx-Lateral 490 630 630 630 630 630
Radiology 216 X-Ray Styloid Process AP 490 630 630 630 630 630
Radiology 244 X-Ray Joint Any AP Only 490 630 630 630 630 630
Radiology 253 X-Ray Skyline View for Patella 490 630 630 630 630 630
Radiology 264 X-ray Extra Film (Per Film) 300 300 300 300 300 300
Radiology 37145 X-ray Femur/Thigh (AP Only) Right 490 630 630 630 630 630
Radiology 269 CT Whole Abdomen with Contrast 10,390 13,500 13,500 13,500 13,500 13,500
Radiology 276 USG Carotid Doppler 3,330 4,300 4,300 4,300 4,300 4,300
Radiology 280 MRI Contrast Charges 3,940 5,100 5,100 5,100 5,100 5,100
Radiology 281 USG Chest 1,440 1,900 1,900 1,900 1,900 1,900
Radiology 283 MRI Venogram (Plain) 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 290 MRI Spine Dorsal (Plain) 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 40985 MRI Spine Dorsal (Contrast) 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 292 USG Renal Doppler 3,280 4,200 4,200 4,200 4,200 4,200
Radiology 293 USG Scrotum 1,970 2,500 2,500 2,500 2,500 2,500
Radiology 294 Mammography Coned/Mag View 790 1,020 1,020 1,020 1,020 1,020
Radiology 313 CT Angiography - Renal 11,190 14,500 14,500 14,500 14,500 14,500
Radiology 314 CT Thorax / Chest - Contrast 7,410 9,600 9,600 9,600 9,600 9,600
Radiology 319 Gastrograffin 4,420 5,700 5,700 5,700 5,700 5,700
Radiology 339 USG Guided MTP/USG Guided in OT 3,780 4,900 4,900 4,900 4,900 4,900
Radiology 344 Mammography Stereotactic Breast FNAC 3,940 5,100 5,100 5,100 5,100 5,100
Radiology 345 Mammography Stereotactic Breast Biopsy 6,350 8,200 8,200 8,200 8,200 8,200
Radiology 349 USG Penile Doppler 5,430 7,000 7,000 7,000 7,000 7,000
Radiology 353 USG Pelvis 1,550 2,000 2,000 2,000 2,000 2,000
Radiology 357 USG Breast Doppler 2,760 3,600 3,600 3,600 3,600 3,600
Radiology 358 CT Thorax / Chest - Plain 6,090 7,900 7,900 7,900 7,900 7,900
Radiology 359 CT PNS (HRCT Coronal only) 2,620 3,400 3,400 3,400 3,400 3,400
Radiology 6777 USG Prostate / TRUS 1,970 2,500 2,500 2,500 2,500 2,500
Radiology 12149 X-Ray Infantogram 490 630 630 630 630 630
Radiology 12205 MRI Brain With Orbit - Plain 10,920 14,100 14,100 14,100 14,100 14,100
Radiology 18079 USG Pregnancy Level II 3,540 4,600 4,600 4,600 4,600 4,600
Radiology 18793 USG Both Limb Arterial Doppler 7,590 9,800 9,800 9,800 9,800 9,800
Radiology 19899 MRI Venogram (Plain + Contrast) 13,080 16,900 16,900 16,900 16,900 16,900
Radiology 19900 MRI Brain (Contrast) 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 19901 MRI Angio Brain - Plain 10,030 13,000 13,000 13,000 13,000 13,000
Radiology 19909 CT Cranial/Brain/Head angio 12,030 15,600 15,600 15,600 15,600 15,600
Radiology 19911 CT Thorax / Chest - HRCT Plain 6,090 7,900 7,900 7,900 7,900 7,900
Radiology 19913 CT KUB Contrast (CT IVP/Urography) 9,820 12,700 12,700 12,700 12,700 12,700
Radiology 20451 CT Cardiac / Coronary Angiography 14,440 18,700 18,700 18,700 18,700 18,700
Radiology 20626 CT Thorax / Chest - HRCT Contrast 7,410 9,600 9,600 9,600 9,600 9,600
Radiology 20637 CT Angio Brain & Neck 16,440 21,300 21,300 21,300 21,300 21,300
Radiology 20720 CT Neck with contrast 7,140 9,200 9,200 9,200 9,200 9,200
Radiology 20723 CT Polytrauma Plain 14,860 19,200 19,200 19,200 19,200 19,200
Radiology 38471 CT Polytrauma Contrast 17,010 22,000 22,000 22,000 22,000 22,000
Radiology 20725 CT Upper Abdomen - Plain 4,520 5,900 5,900 5,900 5,900 5,900
Radiology 20726 CT Lower Abdomen (Plain) 4,520 5,900 5,900 5,900 5,900 5,900
Radiology 20728 CT KUB:Plain (NCCT KUB) 7,300 9,500 9,500 9,500 9,500 9,500
Radiology 20731 CT Angio-Peripheral 14,710 19,000 19,000 19,000 19,000 19,000
Radiology 20734 CT Extra Film (Per Film) 300 300 300 300 300 300
Radiology 38106 Test analysis report in CD (MRI/CT) 500 500 500 500 500 500
Radiology 38342 Test analysis report in CD (X-Ray) 200 200 200 200 200 200
Radiology 20822 MRI Screening (Plain) 5,510 7,100 7,100 7,100 7,100 7,100
Radiology 20823 MR Urography (MRU) 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 20824 CT Scan Temporal Bone HRCT 5,510 7,100 7,100 7,100 7,100 7,100
Radiology 21202 CT Angio- Whole Abdomen 14,710 19,000 19,000 19,000 19,000 19,000
Radiology 21203 CT Angiography–Pulmonary+Peripheral 18,490 23,900 23,900 23,900 23,900 23,900
Radiology 21204 CT Angiography- Coronary + Renal 17,330 22,400 22,400 22,400 22,400 22,400
Radiology 21401 CT Venogram 15,130 19,600 19,600 19,600 19,600 19,600
Radiology 21403 CT Angiography–Whole Abdomen+Peripheral 18,490 23,900 23,900 23,900 23,900 23,900
Radiology 21411 CT Angiography–Coronary+Pulmonary 18,490 23,900 23,900 23,900 23,900 23,900
Radiology 40500 Interventional CT Trucut Biopsy 9,240 12,000 12,000 12,000 12,000 12,000
Radiology 21414 CT Angiography- Pulmonary 11,760 15,200 15,200 15,200 15,200 15,200
Radiology 21416 CT Calcium Scoring 4,410 5,700 5,700 5,700 5,700 5,700
Radiology 21435 CT-HRCT Internal Ear (Contrast) 6,720 8,700 8,700 8,700 8,700 8,700
Radiology 21438 CT Face / Orbit (Plain) 4,990 6,500 6,500 6,500 6,500 6,500

38
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Radiology 21463 CT Upper Abdomen with contrast 6,620 8,600 8,600 8,600 8,600 8,600
Radiology 21464 CT Whole Abdomen - Plain 7,870 10,200 10,200 10,200 10,200 10,200
Radiology 21466 X-ray Per Exposure 490 630 630 630 630 630
Radiology 21500 CT Angiography – Neck Vessels 11,190 14,500 14,500 14,500 14,500 14,500
Radiology 21756 USG Unilateral Varicose Vein Venous Doppler-Right 4,330 5,600 5,600 5,600 5,600 5,600
Radiology 21757 USG Bilateral Varicose Vein Venous Doppler 8,220 10,600 10,600 10,600 10,600 10,600
Radiology 21758 USG Single Limb Arterial Doppler-Right 4,330 5,600 5,600 5,600 5,600 5,600
Radiology 21762 MRI WHOLE BODY 21,220 27,500 27,500 27,500 27,500 27,500
Radiology 21763 MR Angiography per Area - Contrast 16,810 21,800 21,800 21,800 21,800 21,800
Radiology 23448 Fluoroscopy Screening / Tilt Test 3,150 4,100 4,100 4,100 4,100 4,100
Radiology 24174 CT Aortogram 14,710 19,000 19,000 19,000 19,000 19,000
Radiology 25042 MRI Orbit (Plain) 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 25209 MRI Spectroscopy 10,920 14,100 14,100 14,100 14,100 14,100
Radiology 25210 MRI Functional (one area) 9,460 12,300 12,300 12,300 12,300 12,300
Radiology 25211 MRI CSF Flow Study (NPH) 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 25212 MRI Brain Suite Protocol - Contrast 19,850 25,700 25,700 25,700 25,700 25,700
Radiology 26900 CT Head (Plain + Contrast) 5,510 7,100 7,100 7,100 7,100 7,100
Radiology 26901 CT Sella / Pitutary (Contrast) 5,510 7,100 7,100 7,100 7,100 7,100
Radiology 26902 CT Face / Orbit (Contrast) 6,620 8,600 8,600 8,600 8,600 8,600
Radiology 26903 CT PNS Axial, Coronal & Sagittal (HRCT) 4,990 6,500 6,500 6,500 6,500 6,500
Radiology 26908 CT Multiphase Study 12,560 16,300 16,300 16,300 16,300 16,300
Radiology 26910 Interventional U/S guided procedure(Pigtail) 12,510 16,200 16,200 16,200 16,200 16,200
Radiology 26911 USG Transperineal 1,760 2,300 2,300 2,300 2,300 2,300
Radiology 26912 USG Biophysical Profile 3,810 4,900 4,900 4,900 4,900 4,900
Interv. USG Billiary Drainage Procedure (Ext Dra)W/t
Radiology 26913 18,650 24,200 24,200 24,200 24,200 24,200
Procedure set
Radiology 26915 USG Pelvic Doppler 2,760 3,600 3,600 3,600 3,600 3,600
Radiology 26917 X-ray Abdomen - Erect 490 630 630 630 630 630
Radiology 26918 X-ray Abdomen - Supine 490 630 630 630 630 630
Radiology 26919 X-ray Scaphoid views for Wrist (Right) 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 26920 X-ray TM Joints-Single Oblique (Right) 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 26921 X-ray Invertogram 490 630 630 630 630 630
Radiology 26922 X-ray (any Portable single exposure) 650 840 840 840 840 840
Radiology 26924 RGU 3,780 4,900 4,900 4,900 4,900 4,900
Radiology 26925 RGU + MCU 4,890 6,300 6,300 6,300 6,300 6,300
Radiology 26927 Nephrostogram 3,370 4,400 4,400 4,400 4,400 4,400
Radiology 26928 MRI Brain Stroke Protocol (Brain + Diffusion) 10,920 14,100 14,100 14,100 14,100 14,100
Radiology 26929 MRI Brain Seizure / Epilepsy Protocol 11,240 14,600 14,600 14,600 14,600 14,600
Radiology 26930 MRI Posterior Fossa with CISS 11,240 14,600 14,600 14,600 14,600 14,600
Radiology 26931 MRI Sella / Pitutary (Plain) 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 26932 MRI Sella / Pitutary (Contrast) 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 26933 MR Fistulogram 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 26934 Dexa Complete Study For < 20yrs Old 5,940 7,700 7,700 7,700 7,700 7,700
Radiology 26956 CT Topogram / Scanogram 1,420 1,800 1,800 1,800 1,800 1,800
Radiology 28310 CT Contrast Charges (50ml) 1,350 1,700 1,700 1,700 1,700 1,700
Radiology 28311 CT Contrast Charges (100ml) 2,450 3,200 3,200 3,200 3,200 3,200
Radiology 28312 CT Contrast Charge (50ml) for Visipaque 1,650 2,100 2,100 2,100 2,100 2,100
Radiology 29601 USG Pelvic Doppler with 3D/4D 4,910 6,400 6,400 6,400 6,400 6,400
Radiology 29602 Interventional Ultrasound Guided Procedure 3,200 4,100 4,100 4,100 4,100 4,100
Radiology 29603 Interventional USG Pleural / Peritoneal tap(Therape 6,940 9,000 9,000 9,000 9,000 9,000
Interventional Image guided alcohol ablation (non
Radiology 29604 6,890 8,900 8,900 8,900 8,900 8,900
vascular)
Radiology 29605 Interventional Image guided celiac plexis block 6,890 8,900 8,900 8,900 8,900 8,900
Radiology 29606 Fluoroscopy Screening / Hour Procedure Only 3,000 3,900 3,900 3,900 3,900 3,900
Radiology 31095 CT 3D Recon 2,620 3,400 3,400 3,400 3,400 3,400
Radiology 31097 CT Extremities-Upper (Contrast) Right 7,510 9,700 9,700 9,700 9,700 9,700
Radiology 31098 CT Extremities-Lower (Contrast) Right 7,510 9,700 9,700 9,700 9,700 9,700
Radiology 31099 CT Extremities-Upper (Plain) Right 6,040 7,800 7,800 7,800 7,800 7,800
Radiology 31100 CT Extremities-Lower (Plain) Right 6,040 7,800 7,800 7,800 7,800 7,800
Radiology 31101 CT Spine-Cervical (Contrast) 6,940 9,000 9,000 9,000 9,000 9,000
Radiology 31102 CT Spine-Thoracic (Contrast) 6,940 9,000 9,000 9,000 9,000 9,000
Radiology 31103 CT Spine-Lumbosacral (Contrast) 6,940 9,000 9,000 9,000 9,000 9,000
Radiology 31104 CT Spine-Cervical (Plain) 5,090 6,600 6,600 6,600 6,600 6,600
Radiology 31105 CT Spine-Thoracic (Plain) 5,090 6,600 6,600 6,600 6,600 6,600
Radiology 31106 CT Spine-Lumbosacral (Plain) 5,090 6,600 6,600 6,600 6,600 6,600
Radiology 31108 MRI Brain Angio (Contrast) 16,810 21,800 21,800 21,800 21,800 21,800
Radiology 31109 MRI Single Shoulder Joint (Plain) Right 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 31110 MRI Elbow 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 31111 MRI Single Wrist Joint (Plain) Right 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 31112 MRI Single Hip Joint (Plain) Right 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 31113 MRI Single Knee Joint (Plain) Right 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 31114 MRI Single Ankle Joint (Plain) Right 8,770 11,400 11,400 11,400 11,400 11,400

39
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Radiology 31115 X-ray Hand (Both Joints - AP & Lateral) 1,390 1,800 1,800 1,800 1,800 1,800
Radiology 31116 X-ray Wrist (Both Joints - AP & Lateral) 1,390 1,800 1,800 1,800 1,800 1,800
Radiology 31117 X-ray Hip (Both Joints - AP & Lateral) 1,390 1,800 1,800 1,800 1,800 1,800
Radiology 31118 X-ray Knee (Both Joints - AP & Lateral) 1,390 1,800 1,800 1,800 1,800 1,800
Radiology 31119 X-ray Ankle (Both Joints - AP & Lateral) 1,340 1,700 1,700 1,700 1,700 1,700
Radiology 31120 X-ray Foot (Both Joints - AP & Lateral) 1,340 1,700 1,700 1,700 1,700 1,700
Radiology 31121 X-ray Shoulder (Both Joints - AP only) 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 31122 X-ray Clavicle (Both Joints - AP only) 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 31123 X-ray Elbow (Both Joints - AP only) 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 31124 X-ray Hand (Both Joints - AP only) 490 630 630 630 630 630
Radiology 31125 X-ray Wrist (Both Joints - AP only) 490 630 630 630 630 630
Radiology 31126 X-ray Hip (Both Joints - AP only) 490 630 630 630 630 630
Radiology 31127 X-ray Knee (Both Joints - AP only) 490 630 630 630 630 630
Radiology 31128 X-ray Ankle (Both Joints - AP only) 490 630 630 630 630 630
Radiology 31129 X-ray Foot (Both Joints - AP only) 490 630 630 630 630 630
Radiology 31130 X-ray Shoulder (Both Joints Lateral only) 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 31131 X-ray Elbow (Both Joints Lateral only) 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 31132 X-ray Wrist (Both Joints Lateral only) 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 31133 X-ray Hand (Both Joints Lateral only) 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 31134 X-ray Hip (Both Joints Lateral only) 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 31135 X-ray Knee (Both Joints Lateral only) 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 31136 X-ray Foot (Both Joints Lateral only) 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 31137 X-ray Ankle (Both Joints Lateral only) 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 31138 X-ray Shoulder (Both Joints-AP & Lateral) 1,750 2,300 2,300 2,300 2,300 2,300
Radiology 31139 X-ray Elbow (Both Joints-AP & Lateral) 1,750 2,300 2,300 2,300 2,300 2,300
Radiology 31140 X-ray Shoulder Any-AP & Lat (Right) 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 31141 X-ray Elbow Joint-AP & Lateral-Right 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 31142 X-ray Wrist (Any Joint-AP & Lat) Right 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 31143 X-ray Hand (Any Joint-AP & Lateral) 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 31144 X-ray Hip (Any Joint-AP & Lat) Right 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 31145 X-ray Knee (Any Joint-AP & Lat) Right 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 31146 X-ray Ankle (Any Joint-AP & Lateral) Right 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 31147 X-ray Foot (Any Joint-AP & Lat) Right 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 31148 X-ray Shoulder(Any Joint-AP)Right 490 630 630 630 630 630
Radiology 31149 X-ray Elbow:Any Joint-AP Only-Right 490 630 630 630 630 630
Radiology 31150 X-ray Wrist (Any Joint-AP Only) Right 490 630 630 630 630 630
Radiology 31151 X-ray Hand (Any Joint-AP Only) 490 630 630 630 630 630
Radiology 31152 X-ray Hip (Any Joint-AP Only) Right 490 630 630 630 630 630
Radiology 31153 X-ray Knee (Any Joint-AP Only) Right 490 630 630 630 630 630
Radiology 31154 X-ray Ankle single AP-Right 490 630 630 630 630 630
Radiology 31155 X-ray Foot (Any Joint-AP Only) Right 490 630 630 630 630 630
Radiology 31156 X-ray Shoulder(Any Joint-Lat) Right 490 630 630 630 630 630
Radiology 31157 X-ray Elbow:Any Joint-Lateral-Right 490 630 630 630 630 630
Radiology 31158 X-ray Wrist(Any Joint-Lat) Right 490 630 630 630 630 630
Radiology 31159 X-ray Hand (Any Joint-Lateral Only) 490 630 630 630 630 630
Radiology 31160 X-ray Hip (Any Joint-Lateral)-Right 490 630 630 630 630 630
Radiology 31161 X-ray Knee(Any Joint-Lateral) Right 490 630 630 630 630 630
Radiology 31162 X-ray Ankle single-Lateral-Right 490 630 630 630 630 630
Radiology 31163 X-ray Foot(Any Joint-Lat) Right 490 630 630 630 630 630
Radiology 31164 X-ray Femur/Thigh AP & Lateral-Right 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 31165 X-ray Leg AP & Lateral-Right 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 31166 X-ray Mandible-AP View 490 630 630 630 630 630
Radiology 31167 X-ray Mandible-PA View 490 630 630 630 630 630
Radiology 31168 X-ray Spine Cervical (both obliques) 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 31169 X-ray Spine Thoracic (both obliques) 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 31170 X-ray Spine Lumbosacral (both obliques) 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 31171 X-ray Spine Cervical (AP & Lateral) 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 31172 X-ray Spine Thoracic (AP & Lateral) 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 31173 X-ray Spine Lumbosacral (AP & Lateral) 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 38403 Skeletal Survey For Multiple Myeloma 4,620 6,000 6,000 6,000 6,000 6,000
Radiology 33541 X-Ray Mastoid Unilateral-Right 490 630 630 630 630 630
Radiology 31174 X-ray Spine Sacrum/Coccyx (AP & Lateral) 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 31175 X-ray Spine Cervical (AP only) 490 630 630 630 630 630
Radiology 31176 X-ray Spine Thoracic (AP only) 490 630 630 630 630 630
Radiology 31177 X-ray Spine Lumbosacral (AP only) 490 630 630 630 630 630
Radiology 31178 X-ray Spine Sacrum/Coccyx (AP only) 490 630 630 630 630 630
Radiology 31179 X-ray Spine Cervical (Lateral only) 490 630 630 630 630 630
Radiology 31180 X-ray Spine Thoracic (Lateral only) 490 630 630 630 630 630
Radiology 31181 X-ray Spine Lumbosacral (Lateral only) 490 630 630 630 630 630
Radiology 31182 X-ray Spine Sacrum/Coccyx (Lateral only) 490 630 630 630 630 630
Radiology 31183 X-ray Spine Cervical (Lateral in Flexion & Extensi 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 31184 X-ray Spine Thoracic (Lateral in Flexion & Extensi 1,020 1,300 1,300 1,300 1,300 1,300

40
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Radiology 31185 X-ray Spine Lumbosacral (Lateral in Flexion & Exte 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 31186 X-ray Spine Cervical (Single oblique-Left/Right) 490 630 630 630 630 630
Radiology 31187 X-ray Spine Thoracic (Single oblique-Left/Right) 490 630 630 630 630 630
Radiology 31188 X-ray Spine Lumbosacral (Single oblique-Left/Right 490 630 630 630 630 630
Radiology 31189 X-ray Humerus/Arm (AP & Lat) Right 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 31190 X-ray Forearm (AP & Lateral) Right 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 36150 X-Ray Abdomen Supine (Portable) 650 840 840 840 840 840
Radiology 31193 MRI Cisternogram 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 31194 MRI Brain with MRA Brain - Plain 14,390 18,600 18,600 18,600 18,600 18,600
Radiology 31196 MRI Brain with Venogram Contrast 16,810 21,800 21,800 21,800 21,800 21,800
Radiology 31197 MRI Brachial Plexus (Unilateral) Right 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 31198 MRI Whole Spine Screening Degenerative 5,140 6,700 6,700 6,700 6,700 6,700
Radiology 31199 MRI Brain Screening 5,510 7,100 7,100 7,100 7,100 7,100
Radiology 31200 MRI CV Junction 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 31202 MRI Neck Angio Contrast 16,810 21,800 21,800 21,800 21,800 21,800
Radiology 31203 MRI Face and Neck with Contrast 13,080 16,900 16,900 16,900 16,900 16,900
Radiology 31204 MRI Brain Contrast (RadTxPlan) 15,810 20,500 20,500 20,500 20,500 20,500
Radiology 31205 MRI SI Joints (link to MRI single Joint) 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 31207 MRI Peripheral Angiography Contrast 16,810 21,800 21,800 21,800 21,800 21,800
Radiology 31210 MRI Upper Extermity-Right 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 31211 MRI lower Extremeity-Right 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 31212 MRI Prostate 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 31213 MRI TM Joint-Right 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 31214 MRI Triple Phase Study 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 31215 MRI Breast Implant Study 11,860 15,400 15,400 15,400 15,400 15,400
Radiology 31216 X-ray Spine any AP/Lateral / Flexion / Extension 490 630 630 630 630 630

Radiology 31217 Interventional U/S guided procedure(Aspiration/drainage) 7,570 9,800 9,800 9,800 9,800 9,800

Radiology 31218 Image guided procedure 7,990 10,400 10,400 10,400 10,400 10,400
Radiology 31417 MRI RT Planning Study (Contrast) 15,810 20,500 20,500 20,500 20,500 20,500
Radiology 31432 MRI Breast with Contrast 15,390 19,900 19,900 19,900 19,900 19,900
Radiology 31433 MRI Renal Angio - Plain 10,920 14,100 14,100 14,100 14,100 14,100
Radiology 31435 MRI Brain with Perfusion 15,390 19,900 19,900 19,900 19,900 19,900
Radiology 31436 MRI Knee with Cartilage Imaging 9,510 12,300 12,300 12,300 12,300 12,300
Radiology 31437 MRI Whole Body Diffusion 11,240 14,600 14,600 14,600 14,600 14,600
Radiology 31439 MRI Cardiac viability 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 31442 MRI T2 Iron Overload estimation in thallasemia 4,410 5,700 5,700 5,700 5,700 5,700
Radiology 32179 MRI Brain with whole spine screening Contrast 14,810 19,200 19,200 19,200 19,200 19,200
Radiology 33221 MRI Chest (Contrast) 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 33222 MRI Neck/thyroid (Contrast) 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 33223 MRI Screening (Contrast) 8,870 11,500 11,500 11,500 11,500 11,500
Radiology 33224 MRI Single Ankle Joint (Contrast) Right 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 33225 MRI Single Hip Joint (C) Right 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 33226 MRI Single Knee Joint (C) Right 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 33227 MRI Single Shoulder Joint (C) Right 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 33228 MRI Single Wrist Joint (Contrast) Right 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 33229 MRI Spine Cervical (Contrast) 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 33230 MRI Spine Lumbar (Contrast) 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 33231 MRI Whole Spine Screening (Contrast) 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 33261 Fluoroscopy T-Tube Cholangiogram 3,520 4,600 4,600 4,600 4,600 4,600
Radiology 33262 Fluoroscopy Pericatheter Study 3,840 5,000 5,000 5,000 5,000 5,000
Radiology 33263 USG Twin Pregnancy 3,440 4,500 4,500 4,500 4,500 4,500
Radiology 33266 Interventional Image guided PICC line insertion 5,990 7,800 7,800 7,800 7,800 7,800
Radiology 33267 CT Cisternography 8,240 10,700 10,700 10,700 10,700 10,700

Radiology 33285 Interventional Percutaneous transhepatic biliary drainage 22,750 29,500 29,500 29,500 29,500 29,500

Interventional Image guided dialysis catheter


Radiology 33286 14,700 19,000 19,000 19,000 19,000 19,000
inse(IJ,Fem)Tunnell
Radiology 33419 Foetal Medicine - USG Pregnancy Level I 2,340 3,000 3,000 3,000 3,000 3,000
Radiology 33427 Foetal Medicine - USG Pregnancy Level II 3,540 4,600 4,600 4,600 4,600 4,600
Radiology 33428 Foetal Medicine - USG Pregnancy Doppler 3,280 4,200 4,200 4,200 4,200 4,200
Radiology 33429 Foetal Medicine - USG Biophysical Profile 3,810 4,900 4,900 4,900 4,900 4,900
Radiology 38230 CT Perfusion 15,340 19,900 19,900 19,900 19,900 19,900
Radiology 38231 CT scan of Face & Neck Plain 7,140 9,200 9,200 9,200 9,200 9,200
Radiology 38232 CT scan of Brain & Orbits Plain 6,620 8,600 8,600 8,600 8,600 8,600
Radiology 38233 CT scan of Brain & Orbits Contrast 7,670 9,900 9,900 9,900 9,900 9,900
Radiology 38234 CT Scan of Paranasal Sinuses Contrast 7,140 9,200 9,200 9,200 9,200 9,200
Radiology 38235 3D CT Scan of Face 6,090 7,900 7,900 7,900 7,900 7,900
Radiology 38236 CT scan of Face & Neck Contrast 8,240 10,700 10,700 10,700 10,700 10,700
Radiology 38237 CT Scan of TM Joints/ Mandible (Plain) 7,140 9,200 9,200 9,200 9,200 9,200
Radiology 38238 CT Angio Pulmonary with DVT protocol 18,490 23,900 23,900 23,900 23,900 23,900
Radiology 38300 CT Angio Triple Rule Out (heart/pulmonary/aorta) 18,490 23,900 23,900 23,900 23,900 23,900

41
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Radiology 38239 3D CT of Chest 6,090 7,900 7,900 7,900 7,900 7,900
Radiology 38240 CT Colonography Plain 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 38241 CT Colonography Contrast 10,920 14,100 14,100 14,100 14,100 14,100
Radiology 38242 CT scan Whole spine Plain 17,650 22,900 22,900 22,900 22,900 22,900
Radiology 38243 CT scan Whole spine Contrast 18,490 23,900 23,900 23,900 23,900 23,900
Radiology 38244 CT Scan for Bony Pelvis Plain 6,090 7,900 7,900 7,900 7,900 7,900
Radiology 38245 CT Scan for Bony Pelvis Contrast 7,140 9,200 9,200 9,200 9,200 9,200
CT Scan per Joint
Radiology 38301 4,990 6,500 6,500 6,500 6,500 6,500
(shoulder/knee/elbow/ankle/wrist/other) Plain

CT Scan per Joint


Radiology 38302 6,090 7,900 7,900 7,900 7,900 7,900
(shoulder/knee/elbow/ankle/wrist/other) Plain 3D Recon

CT Scan per Joint


Radiology 38303 7,670 9,900 9,900 9,900 9,900 9,900
(shoulder/knee/elbow/ankle/wrist/other) Contrast
Radiology 38246 MR Arthrography (per joint) 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 37654 MRI Lower Abdomen (Contrast) 10,030 13,000 13,000 13,000 13,000 13,000
Radiology 32185 MRI Brain with MR Spectroscopy 18,540 24,000 24,000 24,000 24,000 24,000
Radiology 38305 MRI Brain MRA Brain & Neck with MRV 22,110 28,600 28,600 28,600 28,600 28,600
Radiology 38247 MRA Brain & Neck 19,750 25,600 25,600 25,600 25,600 25,600
Radiology 38248 MRI Angio Wholebody 21,220 27,500 27,500 27,500 27,500 27,500
Radiology 38249 MRI Both Ankles 10,920 14,100 14,100 14,100 14,100 14,100
Radiology 38250 MRI Both Ankles - Contrast 14,810 19,200 19,200 19,200 19,200 19,200
Radiology 38251 MRI Both Feet 10,920 14,100 14,100 14,100 14,100 14,100
Radiology 38252 MRI Both Feet - Contrast 14,810 19,200 19,200 19,200 19,200 19,200
Radiology 38253 MRI Both Hips 10,920 14,100 14,100 14,100 14,100 14,100
Radiology 38254 MRI Both Hips - Contrast 14,810 19,200 19,200 19,200 19,200 19,200
Radiology 38255 MRI Brachial Plexus (Bnilateral) 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 38304 MRI Brain with MRA Brain & Neck with MRV 22,110 28,600 28,600 28,600 28,600 28,600
Radiology 38256 MRI Brain with MRA Brain and MRV 19,750 25,600 25,600 25,600 25,600 25,600
Radiology 38082 MRI Brain with MRA Neck Vessels 18,010 23,300 23,300 23,300 23,300 23,300
Radiology 38257 MRI Brain With Orbit - Contrast 14,810 19,200 19,200 19,200 19,200 19,200
Radiology 38306 MRI Brain with Perfusion & Spectroscopy 18,010 23,300 23,300 23,300 23,300 23,300
Radiology 38307 MRI Brain with Perfusion, Spectrscopy & Tractography 19,750 25,600 25,600 25,600 25,600 25,600
Radiology 38258 MRI Brain with whole spine screening 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 38259 MRI Cardiac (Plain/ morphology) 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 38260 MRI Cardiac with Contrast 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 38261 MRI Face & Neck - Plain 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 38262 MRI Foot 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 38263 MRI Foot - Contrast 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 38264 MRI Full Limb - Contrast 19,750 25,600 25,600 25,600 25,600 25,600
Radiology 38265 MRI Full Limb - Plain 14,760 19,100 19,100 19,100 19,100 19,100
Radiology 38266 MRI Functional (three areas) 15,810 20,500 20,500 20,500 20,500 20,500
Radiology 38267 MRI Functional (two areas) 12,710 16,500 16,500 16,500 16,500 16,500
Radiology 38327 MRI Paranasal Sinuses - Contrast 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 38268 MRI Paranasal Sinuses - Plain 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 38269 MRI Sacroiliac Joints - Plain 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 38270 MRI Sacrum & Coccyx - Contrast 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 38271 MRI Sacrum & Coccyx - Plain 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 38272 MRI Single Extremity (Non Joint)-(C) Right 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 38273 MRI Soft Tissues (Per Area) - Contrast 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 38274 MRI Soft Tissues (Per Area) -Plain 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 38275 MRI Sterno-clavicular joints - Contrast 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 38276 MRI Sterno-clavicular joints - Plain 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 38277 MRI Sternum - Contrast 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 38278 MRI Sternum - Plain 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 38279 MRI Upper Abdomen - Contrast 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 38280 MRI Whole Abdomen - Contrast 19,750 25,600 25,600 25,600 25,600 25,600
Radiology 38308 MRI Whole Spine Screening Metastatic Screening 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 38281 MRI with ASL 10,920 14,100 14,100 14,100 14,100 14,100
Radiology 38309 USG Doppler + Complete Growth Scan including BPP 3,810 4,900 4,900 4,900 4,900 4,900
Radiology 38282 USG Fetal well being Scan + Doppler 3,810 4,900 4,900 4,900 4,900 4,900
Radiology 38310 USG for liquor Amnii Assessment + Doppler Scan 2,180 2,800 2,800 2,800 2,800 2,800
Radiology 38283 USG Pregnancy Dating Scan (TVS) 2,130 2,800 2,800 2,800 2,800 2,800
Radiology 38284 USG Pregnancy Doppler (Twins) 6,540 8,500 8,500 8,500 8,500 8,500
Radiology 38285 USG Pregnancy Growth Scan 3,080 4,000 4,000 4,000 4,000 4,000
Radiology 38286 USG Pregnancy Level I 2,760 3,600 3,600 3,600 3,600 3,600
Radiology 38287 USG Pregnancy Level I (Twins) 4,910 6,400 6,400 6,400 6,400 6,400
Radiology 38288 USG Pregnancy Level II (Twins) 6,540 8,500 8,500 8,500 8,500 8,500
Radiology 38289 USG Bilateral Venous Doppler for DVT 5,430 7,000 7,000 7,000 7,000 7,000
Radiology 38290 USG Unilateral Venous Doppler for DVT-Right 3,280 4,200 4,200 4,200 4,200 4,200
Radiology 39310 USG Doppler Evaluation of AV fistulas 3,280 4,200 4,200 4,200 4,200 4,200
Radiology 39311 USG Renal Transplant Doppler 3,280 4,200 4,200 4,200 4,200 4,200

42
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Radiology 39312 USG Pre Transplant Iliac Doppler 3,280 4,200 4,200 4,200 4,200 4,200
Radiology 36230 USG Pediatric Hip (DDH) 1,610 2,100 2,100 2,100 2,100 2,100
Radiology 36232 USG Post arthroplasty 1,610 2,100 2,100 2,100 2,100 2,100
Radiology 36225 USG Shoulder-Right 1,610 2,100 2,100 2,100 2,100 2,100
Radiology 36227 USG Spine and Para-spinal Region 1,610 2,100 2,100 2,100 2,100 2,100
Radiology 36226 USG Sternum and upper limb joints-Right 1,610 2,100 2,100 2,100 2,100 2,100
Radiology 36229 USG Symphysis Pubis 1,610 2,100 2,100 2,100 2,100 2,100
Radiology 36234 USG Trans- Fontenelle 1,910 2,500 2,500 2,500 2,500 2,500
Radiology 36231 Post arthroscopy USG for shoulder/ knee joint 2,660 3,400 3,400 3,400 3,400 3,400
Radiology 36228 Ultrasound S.I. Joints and lower limb joints 2,130 2,800 2,800 2,800 2,800 2,800
Radiology 34776 Ultrasound–Follicular Study (Single Sitting) 660 850 850 850 850 850
Radiology 33674 Foetal Medicine-USG Pregnancy Follow Up 3,080 4,000 4,000 4,000 4,000 4,000
Radiology 42903 Interventional CT guided procedure(pigtail) 12,850 16,600 16,600 16,600 16,600 16,600
Radiology 45148 MRI Left Femur / Thigh (C) 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 45147 MRI Left Femur / Thigh (P) 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 45152 MRI Left Hand / Forearm (C) 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 45151 MRI Left Hand / Forearm (P) 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 45146 MRI Right Femur / Thigh (C) 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 45145 MRI Right Femur / Thigh (P) 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 45150 MRI Right Hand / Forearm (C) 12,550 16,300 16,300 16,300 16,300 16,300
Radiology 45149 MRI Right Hand / Forearm (P) 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 44723 MRI TM Joint - Both 8,770 11,400 11,400 11,400 11,400 11,400
Radiology 45144 Triple Phase CT Angio LAI Volumetry 17,850 23,100 23,100 23,100 23,100 23,100
Radiology 44435 USG Guided Procedure (Rheumatology) 6,430 8,300 8,300 8,300 8,300 8,300
Radiology 44434 USG Guided synovial Biopsy 9,490 12,300 12,300 12,300 12,300 12,300
Radiology 45027 X-ray at Home -Four Views 5,000 5,300 5,300 5,300 5,300 5,300
Radiology 45024 X-ray at Home -One View 2,000 2,100 2,100 2,100 2,100 2,100
Radiology 45026 X-ray at Home -Three Views 4,000 4,200 4,200 4,200 4,200 4,200
Radiology 45025 X-ray at Home -Two Views 3,000 3,200 3,200 3,200 3,200 3,200
Radiology 44747 X-ray Foot(Any Joint-Lat Only)-Left 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 45153 X-ray Left Hand - AP & Lat Only 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 45154 X-ray Left Hand - AP Only 490 630 630 630 630 630
Radiology 45155 X-ray Left Hand - Lat Only 490 630 630 630 630 630
Radiology 45167 X-ray Merchant View for Patella 490 630 630 630 630 630
Radiology 38291 X-Ray Any Site One View 490 630 630 630 630 630
Radiology 38292 X-Ray Any Site Two Views 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 38293 X-Ray Mastoid Bilateral 1,020 1,300 1,300 1,300 1,300 1,300
Radiology 33675 Foetal Medicine - USG Pregnancy Level I ((Twins) 3,330 4,300 4,300 4,300 4,300 4,300
Radiology 33676 Foetal Medicine - USG Pregnancy Level II (Twins) 4,440 5,700 5,700 5,700 5,700 5,700
Radiology 33677 Foetal Medicine - USG Pregnancy Doppler (Twins) 4,440 5,700 5,700 5,700 5,700 5,700
Radiology 33678 Foetal Medicine - USG Biophysical Profile (Twins) 5,280 6,800 6,800 6,800 6,800 6,800

Radiology 46143 Interventional CT guided procedure(Aspiration/Drainage) 9,720 12,600 12,600 12,600 12,600 12,600

Radiology 34078 Interventional U/S Trucut Biopsy 7,040 9,100 9,100 9,100 9,100 9,100
Radiotherapy 28163 RT001 IMRT 183,900 193,600 193,600 193,600 193,600 193,600
Radiotherapy 28164 RT002 IGRT 241,600 254,400 254,400 254,400 254,400 254,400

43
Double/ Classic
Department Item ID Item Name OP Price Economy Single/ ICU Suite
Day care Deluxe
Radiotherapy 28165 RT003 Rapid arc IMRT 194,400 204,700 204,700 204,700 204,700 204,700
Radiotherapy 28166 RT004 Rapid arc IGRT 275,800 290,400 290,400 290,400 290,400 290,400
Radiotherapy 28167 RT005 IMRT with 4D Gating 292,300 307,800 307,800 307,800 307,800 307,800
Radiotherapy 28168 RT006 Stereotactic Body RT(SBRT) 275,800 290,400 290,400 290,400 290,400 290,400
Radiotherapy 28170 RT008 Stereotactic Radiothearpy (SRT) 185,000 194,800 194,800 194,800 194,800 194,800
Radiotherapy 28171 RT009 3D Conformal Radiotherapy 103,100 108,600 108,600 108,600 108,600 108,600
Radiotherapy 31567 RT009A Stereotactic Body RT (SBRT)–Spine 170,600 179,600 179,600 179,600 179,600 179,600
Radiotherapy 31595 RT009B Stereotactic Radiosurgery (SRS) Frameless F 185,700 195,500 195,500 195,500 195,500 195,500
Radiotherapy 31596 RT009C Stereotactic Radiosurgery (SRS) Frameless S 224,500 236,400 236,400 236,400 236,400 236,400
Radiotherapy 28172 RT010 Radical Radiotherapy 82,800 87,200 87,200 87,200 87,200 87,200
Radiotherapy 28173 RT011 Adjuvant Radiothearapy 71,700 75,500 75,500 75,500 75,500 75,500
Radiotherapy 28174 RT012 Palliative Radiothearapy Single site 38,700 40,800 40,800 40,800 40,800 40,800
Radiotherapy 28175 RT013 Palliative radiothearapy Multiple site 57,800 60,900 60,900 60,900 60,900 60,900
Radiotherapy 46144 Extra carporial bone radiation 30,000 31,600 31,600 31,600 31,600 31,600
Radiotherapy 46465 Electron beam with Linear Accelerator 110,000 115,800 115,800 115,800 115,800 115,800
Radiotherapy 28176 RTP 2D/3D 5,600 5,900 5,900 5,900 5,900 5,900
Radiotherapy 28177 CT MRI CT PET planning 11,000 11,600 11,600 11,600 11,600 11,600
Radiotherapy 28181 RT017 Blood irradiation per unit 1,000 1,000 1,000 1,000 1,000 1,000
Radiotherapy 28182 RT016 Electron Boost 23,200 24,400 24,400 24,400 24,400 24,400
Radiotherapy 28183 RT018 Intracavity Brachytherapy 19,400 20,400 20,400 20,400 20,400 20,400
Radiotherapy 28184 RT019 Intraluminal Brachytherapy 13,700 14,400 14,400 14,400 14,400 14,400
Radiotherapy 28187 RT022 Interstitial Brachytherapy Radical 71,700 75,500 75,500 75,500 75,500 75,500
Radiotherapy 28188 RT023 Interstitial Brachytherapy Boost 39,900 42,000 42,000 42,000 42,000 42,000
Radiotherapy 28189 RT024 Intraoperative Brachytherapy 33,000 34,700 34,700 34,700 34,700 34,700
Radiotherapy 28190 RT025 Intracavity with Implant 22,000 23,200 23,200 23,200 23,200 23,200
Radiotherapy 28203 RT026 Mould/ Cast/ Immobilization (in all cases) 5,600 5,900 5,900 5,900 5,900 5,900
Radiotherapy 28204 RT027 Planning CT in all cases 5,600 5,900 5,900 5,900 5,900 5,900
Radiotherapy 28205 RT028 Customised Shielding block (if used) 11,000 11,600 11,600 11,600 11,600 11,600
Radiotherapy 28206 RT029 Vacloc (if used) 1,750 1,800 1,800 1,800 1,800 1,800
Radiotherapy 28207 RT030 Conventional TPS planning 11,000 11,600 11,600 11,600 11,600 11,600
Radiotherapy 28208 RT031 3D CRT TPS planning 16,600 17,500 17,500 17,500 17,500 17,500
Radiotherapy 28209 RT032 IMRT TPS Planning 22,000 23,200 23,200 23,200 23,200 23,200
Radiotherapy 28210 RT033 IGRT TPS Planning 27,600 29,100 29,100 29,100 29,100 29,100
Radiotherapy 28211 RT034 Rapid Arc IMRT TPS Planning 33,000 34,700 34,700 34,700 34,700 34,700
Radiotherapy 28212 RT035 Rapid Arc IGRT TPS Planning 38,700 40,800 40,800 40,800 40,800 40,800
Radiotherapy 28213 RT036 SRT (Cranium) TPS Planning 22,000 23,200 23,200 23,200 23,200 23,200
Radiotherapy 28214 RT037 SRT (Body) TPS Planning 38,700 40,800 40,800 40,800 40,800 40,800
Radiotherapy 28215 RT038 4D Gating TPS Planning 38,700 40,800 40,800 40,800 40,800 40,800
Radiotherapy 28216 RT039 CT Respiratory Gating TPS Planning 38,700 40,800 40,800 40,800 40,800 40,800
Radiotherapy 28217 RT040 Conventional Per Fraction 2,100 2,200 2,200 2,200 2,200 2,200
Radiotherapy 28218 RT041 3D CRT Per Fraction 2,250 2,400 2,400 2,400 2,400 2,400
Radiotherapy 28219 RT042 IMRT Per Fraction 3,400 3,600 3,600 3,600 3,600 3,600
Radiotherapy 28220 RT043 IGRT Per Fraction 4,900 5,200 5,200 5,200 5,200 5,200
Radiotherapy 28221 RT044 Rapid Arc IMRT Per Fraction 4,400 4,600 4,600 4,600 4,600 4,600
Radiotherapy 28222 RT045 Rapid Arc IGRT Per Fraction 6,600 6,900 6,900 6,900 6,900 6,900
Radiotherapy 28223 RT046 SRT (Cranium) Per Fraction 3,400 3,600 3,600 3,600 3,600 3,600
Radiotherapy 28224 RT047 SRT (Body) Per Fraction 6,600 6,900 6,900 6,900 6,900 6,900
Radiotherapy 28225 RT048 4D Gating Per Fraction 6,600 6,900 6,900 6,900 6,900 6,900
Radiotherapy 28226 RT058 Radiation Course Cunsultation 8,400 8,800 8,800 8,800 8,800 8,800
Radiotherapy 34175 RT061 IG – SRT 241,600 254,400 254,400 254,400 254,400 254,400
Radiotherapy 36552 RT064 (SORBO- Intraluminal Brachy) Consultation 2,700 2,800 2,800 2,800 2,800 2,800
Radiotherapy 36554 RT066 (IG-SRT) Consultation 16,600 17,500 17,500 17,500 17,500 17,500
Radiotherapy 36555 RT067 - 3DCRT Consultation 9,500 10,000 10,000 10,000 10,000 10,000

Radiotherapy 36556 RT068 - IMRT/IMRT Rapid Arc/SRT/SRS - Consultation 11,500 12,100 12,100 12,100 12,100 12,100

Radiotherapy 36557 RT069 - IGRT/IGRT Rapid Arc - Consultation 13,700 14,400 14,400 14,400 14,400 14,400
Radiotherapy 36558 RT070 - IMRT 4D Gating/SBRT/ SBRT - Consultation 16,600 17,500 17,500 17,500 17,500 17,500
Urology 5418 Uroflowmetry 1,150 1,500 1,500 1,500 1,500 1,500
Urology 37233 US Doppler of Transplant Kidney 2,150 2,700 3,100 3,100 3,100 3,100
Urology 37234 US Guided Abscess Drainage (Uro) 6,400 8,100 8,100 8,100 8,100 8,100
Urology 43412 Bladder Scan 850 - - - - -
Urology 43055 Bladder wash 2,600 - - - - -
Urology 43054 Flexible Cystoscopy 10,200 12,900 12,900 12,900 12,900 12,900
Urology 44572 Oxidative Stress Testing 1,550 1,600 1,600 1,600 1,600 1,600
Urology 28227 Uro Dynamic Study 6,600 6,800 6,800 6,800 6,800 6,800
Urology 35731 Metal Dilatation 1,150 - - - - -
Urology 35733 Uro Dynamic Study - CMG 4,400 - - - - -
Urology 33689 Intravesical BCG Instilation 1,700 - - - - -
Urology 35735 Cathethete Removal/Drain Removal 580 - - - - -
vascular surgery 36991 RFA Charges for Varicose Veins (Single Leg) - 35,000 35,000 35,000 35,000 35,000
vascular surgery 36992 RFA Charges for Varicose Veins (Both Leg) - 40,000 40,000 40,000 40,000 40,000
vascular surgery 24090 Sclerotherapy (OPD) 2,300 2,300 2,300 2,300 2,300 2,300

44
Surgical Procedures

Surgeon fee
Surgery Double/ Single/ Classic
Department Surgery Name Category Economy Suite
ID Day care ICU Deluxe
Anaethesia 34851 ABG sampling (Anaes) 4 730 850 1,060 1,390 2,150
Anaethesia 34848 Percutaneous Tracheostomy (Anaes) 20 17,000 19,440 24,290 31,580 48,560
Anaethesia 29370 Epidural - Caudal / Lumbar. 14 7,720 8,800 11,000 14,310 22,020
Anaethesia 29374 Spinal root block - Sacral/Lumbar. 14 7,720 8,800 11,000 14,310 22,020
Anaethesia 29375 Joint injection - Sacroiliac /Lumbar/Coccyx peripheral. 10 4,310 4,930 6,150 8,000 12,310
Anaethesia 29920 Labour Analgesia / Epidural 11 4,980 5,550 7,130 9,270 14,250
Anaethesia 28476 Inter Costal Nerve Block (Anaes) 10 4,310 4,930 6,150 8,000 12,310
Superficial nerve intervention - Ilioinguinal / Occipital /Lat
Anaethesia 29376 14 7,720 8,800 11,000 14,310 22,020
cut N .
Anaethesia 29382 Myofascial Botox. 16 11,680 13,340 16,680 21,680 33,350
Cardiac Surgery 34862 Pulmonary Valvotomy 24 27,190 31,080 38,850 50,500 77,700
Maxillofaciall
43399 U/L Subcondylar Fracture 26 34,780 39,760 49,700 64,610 110,720
Surgery
Maxillofaciall
43400 Symphsis Fracture 26 34,780 39,760 49,700 64,610 110,720
Surgery
Maxillofaciall
43401 Archbar Wiring 20 17,000 19,440 24,290 31,580 48,560
Surgery
Maxillofaciall
45216 Suturing Minor 9 3,630 4,160 5,190 6,740 10,350
Surgery
Maxillofaciall
45217 Suturing Medium 14 7,720 8,800 11,000 14,310 22,020
Surgery
Maxillofaciall
45218 Suturing Major 19 15,870 18,130 22,670 29,450 45,320
Surgery
Maxillofaciall
45219 TMJ dislocation 11 4,980 5,550 7,130 9,270 14,250
Surgery
Maxillofaciall
45220 Dentoalveolar fracture Archabar/Splinting Grade-1 15 9,290 10,620 13,280 17,250 26,540
Surgery
Maxillofaciall
45221 Dentoalveolar fracture Archabar/Splinting Grade-2 16 11,680 13,340 16,680 21,680 33,350
Surgery
Maxillofaciall
45222 Extraction of tooth 8 2,820 3,230 4,050 5,250 8,110
Surgery
Maxillofaciall
45223 Control Of Bleeding-Oozing Socket Grade-1 10 4,310 4,930 6,150 8,000 12,310
Surgery
Maxillofaciall
45224 Control Of Bleeding-Oozing Socket Grade-2 11 4,980 5,550 7,130 9,270 14,250
Surgery
Maxillofaciall Removal of Foreign Material ( Wire/Glass/Wood/Brush)
45233 8 2,820 3,230 4,050 5,250 8,110
Surgery Perforated into Extraoral/Intraoral tissues Grade-1
Maxillofaciall Removal of Foreign Material ( Wire/Glass/Wood/Brush)
45234 10 4,310 4,930 6,150 8,000 12,310
Surgery Perforated into Extraoral/Intraoral tissues Grade-2
Maxillofaciall Removal of Foreign Material ( Wire/Glass/Wood/Brush)
45235 13 7,030 8,020 10,050 13,050 20,070
Surgery Perforated into Extraoral/Intraoral tissues Grade-3
Maxillofaciall
45225 Management Of Avulsed Tooth 15 9,290 10,620 13,280 17,250 26,540
Surgery
Maxillofaciall
40906 Archbar Removal 9 3,630 4,160 5,190 6,740 10,350
Surgery
Endoscopy 36827 EBUS with Guide Sheath 16 11,680 13,340 16,680 21,680 33,350
Endoscopy 25255 ERCP-Diagnostic 21 19,270 22,020 27,530 35,780 55,040
Endoscopy 25257 ERCP-Papillotomy+stone extraction 24 27,190 31,080 38,850 50,500 77,700
Endoscopy 25258 ERCP-Biliary stent placement 24 27,190 31,080 38,850 50,500 77,700
Endoscopy 25261 ERCP-Pancreatic Stone extraction 24 27,190 31,080 38,850 50,500 77,700
Endoscopy 25262 ERCP-Pancreatic Stent 24 27,190 31,080 38,850 50,500 77,700
Endoscopy 25263 ERCP-Brushing and biopsy 23 22,680 25,630 32,060 41,670 64,100
Endoscopy 25271 ERCP-Metal stent placement 25 30,950 35,340 44,200 57,450 88,390
Endoscopy 35525 UGI Endoscopy Diagnostic (Endo) 12 6,220 7,130 8,920 11,580 17,820
Endoscopy 16403 Sigmoidoscopy Diagnostic 16 11,680 13,340 16,680 21,680 33,350
Endoscopy 38970 Sigmoidoscopy Therapeutic 16 11,680 13,340 16,680 21,680 33,350
Endoscopy 38971 UGI Endoscopy Therapeutic 10 4,310 4,930 6,150 8,000 12,310
Endoscopy 25265 ERCP-Minor Papilla sphincterotomy 24 27,190 31,080 38,850 50,500 77,700
Endoscopy 25264 ERCP-Nasobiliary drainage 22 20,980 23,960 29,960 38,940 59,890
Endoscopy 25256 ERCP-Papillotomy 22 20,980 23,960 29,960 38,940 59,890
Endoscopy 25270 ERCP-Pseudocyst Drainage 25 30,950 35,340 44,200 57,450 88,390
Endoscopy 25260 ERCP-Subsequent (Within 2 Months)/Stent removal 22 20,980 23,960 29,960 38,940 59,890
Endoscopy 25259 ERCP-Mechanical Lithotripsy 20 17,000 19,440 24,290 31,580 48,560
Endoscopy 25266 ERCP+Percutaneous Transhepatic Cholangiography 24 27,190 31,080 38,850 50,500 77,700
Endoscopy 35527 UGI Endoscopy Achalasia Dilatation (Endo) 18 14,740 16,830 21,050 27,370 42,080
Endoscopy 35528 UGI Endoscopy Argon Plasma Coagulation (Endo) 17 13,150 15,020 18,770 24,410 37,560
Endoscopy 35529 UGI Endoscopy Banding of varices (Endo) 15 9,290 10,620 13,280 17,250 26,540
Endoscopy 35530 UGI Endoscopy Dilatation of Strcture (Endo) 15 9,290 10,620 13,280 17,250 26,540

Endoscopy 35531 UGI Endoscopy Endo therapy for bleed (Injection, C (Endo) 15 9,290 10,620 13,280 17,250 26,540

Endoscopy 35532 UGI Endoscopy Foreign Body removal (Endo) 15 9,290 10,620 13,280 17,250 26,540

45
Surgeon fee
Surgery Double/ Single/ Classic
Department Surgery Name Category Economy Suite
ID Day care ICU Deluxe
Endoscopy 35533 UGI Endoscopy Glue Injection of varices (Endo) 15 9,290 10,620 13,280 17,250 26,540
Endoscopy 35534 UGI Endoscopy H Pylori test (Endo) 12 6,220 7,130 8,920 11,580 17,820
Endoscopy 35535 UGI Endoscopy Metal Stent Placement (Endo) 19 15,870 18,130 22,670 29,450 45,320
Endoscopy 35536 UGI Endoscopy Nasojejunal tube placement (Endo) 13 7,030 8,020 10,050 13,050 20,070
Endoscopy 35537 UGI Endoscopy PEG Placement (Endo) 16 11,680 13,340 16,680 21,680 33,350
Endoscopy 35538 UGI Endoscopy Polypectomy (Endo) 15 9,290 10,620 13,280 17,250 26,540
Endoscopy 35539 UGI Endoscopy Ryles tube placement (Endo) 12 6,220 7,130 8,920 11,580 17,820

Endoscopy 35540 UGI Endoscopy Side viewing scope+/-Stent removal (Endo) 12 6,220 7,130 8,920 11,580 17,820

Endoscopy 35541 UGI Endoscopy Varices Sclerotherapy (Endo) 15 9,290 10,620 13,280 17,250 26,540
Endoscopy 35542 UGI Endoscopy with Biopsy (Endo) 14 7,720 8,800 11,000 14,310 22,020
Endoscopy 35697 Colonoscopy Argon Plasma cangulation 19 15,870 18,130 22,670 29,450 45,320
Endoscopy 35700 Colonoscopy Dilatation-(Endo) 16 11,680 13,340 16,680 21,680 33,350
Endoscopy 35701 Colonoscopy Endo therapy for Bleeding-(Endo) 18 14,740 16,830 21,050 27,370 42,080
Endoscopy 35702 Colonoscopy Foreign Body Removal-(Endo) 16 11,680 13,340 16,680 21,680 33,350
Endoscopy 35703 Colonoscopy Polypectomy-(Endo) 16 11,680 13,340 16,680 21,680 33,350
Endoscopy 35704 Colonoscopy Polypectomy (>5 Polyps)-(Endo) 11 4,980 5,550 7,130 9,270 14,250
Endoscopy 35705 Colonoscopy Full (Cecum) Diagnostic-(Endo) 15 9,290 10,620 13,280 17,250 26,540
Endoscopy 35706 Limited Colonoscopy Diagnostic-(Endo) 12 6,220 7,130 8,920 11,580 17,820
Endoscopy 35709 Colonoscopy Long with Biopsy-(Endo) 15 9,290 10,620 13,280 17,250 26,540
Endoscopy 31642 ERCP-EPT+ Stone extraction + Stent placement 24 27,190 31,080 38,850 50,500 77,700
ENT 14406 Incision & Drianage(ENT) ENT CAT 8 3,020 3,440 4,290 5,550 8,490
ENT 14408 Unilateral Myringotomy with Gromme ENT CAT 9 3,850 4,350 5,470 7,090 10,870
ENT 14410 Myringotomy (bilateral) ENT CAT 10 4,560 5,190 6,450 8,410 12,890
ENT 38528 Cochlear Implant Surgery ENT CAT 27 40,580 46,330 57,880 75,270 119,890
ENT 25951 Caloric Testing - Bilateral ENT CAT 8 3,020 3,440 4,290 5,550 8,490
ENT 30314 Thyroplasty I ENT CAT 24 28,450 32,520 40,650 52,840 81,290
ENT 39268 Cold caloric test ENT CAT 6 1,960 2,240 2,800 3,650 5,600
ENT 15077 Laryngofissure ENT CAT 24 28,450 32,520 40,650 52,840 81,290
ENT 30299 Partial Glossectomy with Supraomohyoid Dissection ENT CAT 26 36,380 41,630 52,000 67,550 115,780
ENT 14471 Bilateral Intra Nasal Antrostomy ENT CAT 11 5,350 5,930 7,510 9,750 14,930
ENT 14475 Posterior Nasal Packing ENT CAT 10 4,560 5,190 6,450 8,410 12,890
ENT 14617 Bilateral Nasal Polypectomy / Ethmoidectomy ENT CAT 17 13,800 15,770 19,700 25,590 39,330
ENT 16046 Total Maxillectomy ENT CAT 29 48,640 55,580 69,460 90,250 138,840
ENT 30300 Partial Maxillectomy ENT CAT 27 40,580 46,330 57,880 75,270 119,890
ENT 38478 Coblator adenotonsillectomy ENT CAT 20 17,810 20,390 25,450 33,090 50,820
ENT 14575 Caldwell – Luc Surgery – Unilateral ENT CAT 16 12,270 13,960 17,460 22,700 34,900
Facial Nerve Decompression Vertical or / and Tympanic
ENT 15074 ENT CAT 26 36,380 41,630 52,000 67,550 115,780
Segment
ENT 15081 Radical Mastoidectomy ENT CAT 24 28,450 32,520 40,650 52,840 81,290
ENT 15075 Lateral Pharyngotomy ENT CAT 24 28,450 32,520 40,650 52,840 81,290
ENT 16041 Tracheal Reconstruction ENT CAT 25 32,380 36,990 46,250 60,060 92,440
ENT 39805 Cordectomy ENT CAT 25 32,380 36,990 46,250 60,060 92,440
ENT 23478 Excission of Thyroglossal Cyst or Sinus ENT CAT 17 13,800 15,770 19,700 25,590 39,330
ENT 24538 Synachae Removal From Nose - Bilateral ENT CAT 9 3,850 4,350 5,470 7,090 10,870
ENT 25966 Foreign Body Removal Ear/Nose (Bilateral) ENT CAT 10 4,560 5,190 6,450 8,410 12,890
ENT 26123 dental Cyst & Tumour Excission ENT CAT 17 13,800 15,770 19,700 25,590 39,330
ENT 30257 CANALPLASTY with ear reconstruction ENT CAT 26 36,380 41,630 52,000 67,550 115,780
ENT 30258 Closed reduction Le Fort I ENT CAT 19 16,610 19,000 23,770 30,830 47,450
ENT 30307 Septal Perforation Repair ENT CAT 22 21,930 25,090 31,340 40,730 62,650
ENT 14476 Reduction of Fracture Nose ENT CAT 11 5,350 5,930 7,510 9,750 14,930
ENT 16044 Excision of Angiofibroma ENT CAT 28 44,570 50,950 63,710 82,780 127,330
ENT 24500 EUM Suction - Bilateral ENT CAT 5 1,350 1,540 1,900 2,450 3,790
ENT 24501 EUM Suction - Unilateral ENT CAT 5 1,350 1,540 1,900 2,450 3,790
ENT 24532 Suction Clearence Nose / Ear - Unilateral ENT CAT 4 840 920 1,130 1,480 2,240
ENT 24540 Syringing / Wax Removal (ENT) ENT CAT 5 1,350 1,540 1,900 2,450 3,790
ENT 14480 Bilateral Myringotomy with Grommet ENT CAT 13 7,370 8,410 10,520 13,670 21,030
ENT 14482 Adenoitectomy ENT CAT 12 6,520 7,510 9,330 12,130 18,640
ENT 14532 Hypopharygoscopy ENT CAT 12 6,520 7,510 9,330 12,130 18,640
ENT 14569 Tonsillectomy ENT CAT 15 9,750 11,150 13,960 18,080 27,820
ENT 22916 Lymph Node biopsy (ENT) ENT CAT 12 6,520 7,510 9,330 12,130 18,640
ENT 26229 Cyst & Benign Tumour of palate ENT CAT 15 9,750 11,150 13,960 18,080 27,820
ENT 14570 Turbinate reduction ENT CAT 14 8,070 9,260 11,570 15,010 23,060
ENT 14571 Septoplasty ENT CAT 16 12,270 13,960 17,460 22,700 34,900
ENT 14573 Drainage of retro-pharyngeal abscess ENT CAT 14 8,070 9,260 11,570 15,010 23,060
ENT 14574 Tracheostomy ENT CAT 16 12,270 13,960 17,460 22,700 34,900
ENT 14616 Adenotonsillectomy ENT CAT 17 13,800 15,770 19,700 25,590 39,330
ENT 14621 Unilateral Styloidectomy ENT CAT 17 13,800 15,770 19,700 25,590 39,330
ENT 14680 Bronchoscopy with FB Removal ENT CAT 18 15,420 17,670 22,010 28,670 44,000
ENT 14681 MLS Diagnostic / excision of Nodule / Polyp ENT CAT 16 12,270 13,960 17,460 22,700 34,900
ENT 14682 Ext. Drainage of Paraphyngeal Abscess ENT CAT 16 12,270 13,960 17,460 22,700 34,900
ENT 14683 Septoplasty + SMD ENT CAT 17 13,800 15,770 19,700 25,590 39,330
ENT 14686 FESS – Small/Unilateral/minor (endoscopic procedure) ENT CAT 16 12,270 13,960 17,460 22,700 34,900

46
Surgeon fee
Surgery Double/ Single/ Classic
Department Surgery Name Category Economy Suite
ID Day care ICU Deluxe
ENT 14870 Excision of Laryngeal Papillomata ENT CAT 20 17,810 20,390 25,450 33,090 50,820
ENT 14873 Endoscopic DCR ENT CAT 20 17,810 20,390 25,450 33,090 50,820
ENT 14874 Micro Laryngoscopic Decortication ENT CAT 20 17,810 20,390 25,450 33,090 50,820
ENT 14876 Endoscopic Spheno Ethmoidectomy – Unilateral ENT CAT 22 21,930 25,090 31,340 40,730 62,650
ENT 14877 Myringoplasty ENT CAT 20 17,810 20,390 25,450 33,090 50,820
ENT 15059 Ossiculoplasty ENT CAT 24 28,450 32,520 40,650 52,840 81,290
ENT 15060 Tympanoplasty ENT CAT 23 23,480 26,850 33,580 43,580 67,070
ENT 15061 Cortical Mastoidectomy ENT CAT 22 21,930 25,090 31,340 40,730 62,650
ENT 15073 Endoscopic Orbital Decompression ENT CAT 26 36,380 41,630 52,000 67,550 115,780
ENT 15076 Lateral Rhinotomy ENT CAT 24 28,450 32,520 40,650 52,840 81,290
ENT 15078 Mastoidectomy Cavity Obliteration ENT CAT 25 32,380 36,990 46,250 60,060 92,440
ENT 15079 Modified Radical Mastoidectomy ENT CAT 24 28,450 32,520 40,650 52,840 81,290
ENT 15082 Endoscopic Spheno Ethmoidectomy – Bilateral ENT CAT 24 28,450 32,520 40,650 52,840 81,290
ENT 15083 Stapedectomy ENT CAT 24 28,450 32,520 40,650 52,840 81,290
ENT 15084 Septo – Rhinoplasty ENT CAT 26 36,380 41,630 52,000 67,550 115,780
ENT 15085 Uvulo- Palato Pharyngoplasty ENT CAT 24 28,450 32,520 40,650 52,840 81,290
ENT 16042 Endoscopic CSF Fistula Repair ENT CAT 26 36,380 41,630 52,000 67,550 115,780
ENT 16043 Endoscopic Optic Nerve Depression ENT CAT 27 40,580 46,330 57,880 75,270 119,890
ENT 16045 Total Laryngectomy ENT CAT 29 48,640 55,580 69,460 90,250 138,840
ENT 16047 Radical Neck Dissection ENT CAT 30 56,620 64,750 80,940 105,190 161,810
ENT 22907 Dressing - (ENT) ENT CAT 4 840 920 1,130 1,480 2,240
ENT 22913 Myringotomy (Unilateral) ENT CAT 7 2,390 2,750 3,440 4,420 6,800
ENT 22914 Nasal Endoscopy (Diagnostic) ENT CAT 7 2,390 2,750 3,440 4,420 6,800
ENT 22919 Excision of Glomus-jugulare Tumor ENT CAT 30 56,620 64,750 80,940 105,190 161,810
ENT 22925 Skull Base Surgery ENT CAT 30 56,620 64,750 80,940 105,190 161,810
ENT 23308 Adeno Tonsilectomy with Bilateral Gromet Insertion ENT CAT 20 17,810 20,390 25,450 33,090 50,820
ENT 23311 Block Dissection of Cervical Nodes ENT CAT 16 12,270 13,960 17,460 22,700 34,900
ENT 23327 FESS - Minor (Endogenous Procedure Bilateral) ENT CAT 18 15,420 17,670 22,010 28,670 44,000
ENT 23334 Laser Tonsillectomy ENT CAT 20 17,810 20,390 25,450 33,090 50,820
ENT 23828 Facial wound Repair (Major) ENT CAT 13 7,370 8,410 10,520 13,670 21,030
ENT 24485 B/L Anterior & Posterior Nasal packing ENT CAT 12 6,520 7,510 9,330 12,130 18,640
ENT 24494 Chemical Cauterzation Nose / Throat / Ear ENT CAT 5 1,350 1,540 1,900 2,450 3,790
ENT 24497 Decanulation of Tracheostomy tube ENT CAT 5 1,350 1,540 1,900 2,450 3,790
ENT 24498 E.U.M ENT CAT 8 3,020 3,440 4,290 5,550 8,490
FESS-Bilateral/Extensive/Major/Complicated(endoscopy
ENT 24502 ENT CAT 20 17,810 20,390 25,450 33,090 50,820
proc)
ENT 24506 Foreign Body Removal - Nose ENT CAT 10 4,560 5,190 6,450 8,410 12,890
ENT 24517 Nasal Endoscopy ENT CAT 8 3,020 3,440 4,290 5,550 8,490
ENT 24518 Nasal Endoscopy with Biopsy ENT CAT 9 3,850 4,350 5,470 7,090 10,870
ENT 24519 Nasopharyngoscopy ENT CAT 9 3,850 4,350 5,470 7,090 10,870
ENT 24520 Nasopharyngoscopy with Biopsy ENT CAT 10 4,560 5,190 6,450 8,410 12,890
ENT 24521 Oral Biopsy ENT CAT 9 3,850 4,350 5,470 7,090 10,870
ENT 24531 Suction Clearence Nose / Ear - Bilateral ENT CAT 5 1,350 1,540 1,900 2,450 3,790
ENT 24536 Suturing (E N T) ENT CAT 5 1,350 1,540 1,900 2,450 3,790
ENT 24541 Tongue-tie release (in OR) ENT CAT 10 4,560 5,190 6,450 8,410 12,890
ENT 24542 Tracheostomy Tube Change ENT CAT 5 1,350 1,540 1,900 2,450 3,790
ENT 24543 Uvulectomy (in OR) ENT CAT 12 6,520 7,510 9,330 12,130 18,640
ENT 25075 Anterior Nasal Packing with Cauterization ENT CAT 12 6,520 7,510 9,330 12,130 18,640
ENT 25102 Fracture Mandible Repair & Plating ENT CAT 14 8,070 9,260 11,570 15,010 23,060
ENT 25106 Ligation of Ext. Carotid Artery / Ant. Ethmodial Artery ENT CAT 19 16,610 19,000 23,770 30,830 47,450
ENT 25113 Superficial Paraidectomy ENT CAT 23 23,480 26,850 33,580 43,580 67,070
ENT 25874 Anterior Nasal Packing (Unilateral) (ENT) ENT CAT 8 3,020 3,440 4,290 5,550 8,490
ENT 25875 Anterior Nasal Packing (Bilateral) ENT CAT 9 3,850 4,350 5,470 7,090 10,870
ENT 25877 Ear Packing with Dressing (Unilateral) ENT CAT 5 1,350 1,540 1,900 2,450 3,790
ENT 25879 FESS - Minor Non- complicated ( Unilateral) ENT CAT 17 13,800 15,770 19,700 25,590 39,330
ENT 25880 FESS - Minor Non- complicated (Bilateral) ENT CAT 19 16,610 19,000 23,770 30,830 47,450
ENT 25884 Submandibular Gland Excision ENT CAT 21 20,180 23,060 28,810 37,420 57,600
ENT 25887 Cautery Patching (ENT) ENT CAT 8 3,020 3,440 4,290 5,550 8,490
ENT 25888 Excission of Plunging Ranula ENT CAT 17 13,800 15,770 19,700 25,590 39,330
ENT 25889 Foreign Body Removal - Ear ENT CAT 8 3,020 3,440 4,290 5,550 8,490
ENT 25890 FESS - Complicated ENT CAT 24 28,450 32,520 40,650 52,840 81,290
ENT 25952 Cauterisation Nose (Little s area ) for Espistaxis (ENT) ENT CAT 8 3,020 3,440 4,290 5,550 8,490
ENT 25969 Aural Polypectomy ENT CAT 11 5,350 5,930 7,510 9,750 14,930
ENT 25976 Submucous Diathermy - Bilateral ENT CAT 11 5,350 5,930 7,510 9,750 14,930
ENT 26057 Sub total Thyoidectomy ENT CAT 23 23,480 26,850 33,580 43,580 67,070
ENT 26090 bronchoscopy Under LA (Diagnostic/Biopsy) ENT CAT 14 8,070 9,260 11,570 15,010 23,060
ENT 26098 Closed Reduction of Facial Bones ENT CAT 12 6,520 7,510 9,330 12,130 18,640
ENT 26152 Hemi Thyroidectomy ENT CAT 22 21,930 25,090 31,340 40,730 62,650
ENT 26179 Pre Auricular Sinus Excision ENT CAT 13 7,370 8,410 10,520 13,670 21,030
ENT 26230 Excission of brachial cyst and sinus ENT CAT 17 13,800 15,770 19,700 25,590 39,330
ENT 27987 FOL - ENT ENT CAT 9 3,850 4,350 5,470 7,090 10,870
Aspiration & Drainage with Pressure Bandage Haematoma
ENT 30253 ENT CAT 16 12,270 13,960 17,460 22,700 34,900
Pinna

47
Surgeon fee
Surgery Double/ Single/ Classic
Department Surgery Name Category Economy Suite
ID Day care ICU Deluxe
ENT 30255 Atticotomy ENT CAT 18 15,420 17,670 22,010 28,670 44,000
ENT 30261 Closed reduction nasal bone ENT CAT 17 13,800 15,770 19,700 25,590 39,330
ENT 30270 Direct Laryngoscopy ENT CAT 7 2,390 2,750 3,440 4,420 6,800
ENT 30271 Direct Laryngoscopy with biopsy ENT CAT 14 8,070 9,260 11,570 15,010 23,060
ENT 30274 Endoscopic cauterisation ENT CAT 17 13,800 15,770 19,700 25,590 39,330
ENT 30283 Endoscopic Skull Base repair (Extended) ENT CAT 34 78,210 89,420 111,700 145,270 223,400
ENT 30287 Exploratory Tympanotomy ENT CAT 23 23,480 26,850 33,580 43,580 67,070
ENT 30292 MLS with RFA ENT CAT 23 23,480 26,850 33,580 43,580 67,070
ENT 30293 Modified Neck Dissection ENT CAT 30 56,620 64,750 80,940 105,190 161,810
ENT 30297 Open reduction fracture nasal bone ENT CAT 22 21,930 25,090 31,340 40,730 62,650
ENT 30301 Pediatric Bronchoscopy ENT CAT 22 21,930 25,090 31,340 40,730 62,650
ENT 30302 Pediatric Bronchoscopy with FB removal ENT CAT 24 28,450 32,520 40,650 52,840 81,290
ENT 30305 Septal Abscess Incision & Drainage ENT CAT 16 12,270 13,960 17,460 22,700 34,900
ENT 30306 Septal Hematoma Incision & Drainage ENT CAT 17 13,800 15,770 19,700 25,590 39,330
ENT 30309 Snoring Surgery - Pillar Reduction ENT CAT 20 17,810 20,390 25,450 33,090 50,820
ENT 30313 Stapedotomy ENT CAT 24 28,450 32,520 40,650 52,840 81,290
ENT 30318 Total Thyroidectomy ENT CAT 24 28,450 32,520 40,650 52,840 81,290
ENT 30320 Tympanomastoidectomy ENT CAT 25 32,380 36,990 46,250 60,060 92,440
ENT 30321 Tympanotomy ENT CAT 20 17,810 20,390 25,450 33,090 50,820
ENT 30324 Adenotonsillectomy - RFA ENT CAT 22 21,930 25,090 31,340 40,730 62,650
ENT 30325 Endoscopic fronto Spheno Ethmoidectomy – Bilateral ENT CAT 27 40,580 46,330 57,880 75,270 119,890
ENT 30326 Endoscopic fronto Spheno Ethmoidectomy – Unilateral ENT CAT 25 32,380 36,990 46,250 60,060 92,440
ENT 31297 Rhinoplasty - Open ENT CAT 28 44,570 50,950 63,710 82,780 127,330
General Surgery 14463 Excision of small fibroadenoma- breast GS CAT 15 9,290 10,620 13,280 17,250 26,540
General Surgery 14464 Foreign body removal superficial GS CAT 10 4,310 4,930 6,150 8,000 12,310
General Surgery 14555 Varicocele – Unilateral GS CAT 18 14,740 16,830 21,050 27,370 42,080
General Surgery 14667 Ischiorectal Abscess GS CAT 18 14,740 16,830 21,050 27,370 42,080
General Surgery 14669 Orchidectomy- U/L GS CAT 16 11,680 13,340 16,680 21,680 33,350
General Surgery 14672 Psoas abscess drainage GS CAT 19 15,870 18,130 22,670 29,450 45,320
General Surgery 40666 TMJ Disc Repositioning GS CAT 26 34,780 39,760 49,700 64,610 110,720
General Surgery 40667 TMJ Arthrocentesis Right Side GS CAT 20 17,000 19,440 24,290 31,580 48,560
General Surgery 44166 Aper GS CAT 31 61,860 70,720 88,390 114,900 176,770
General Surgery 14775 Ileostomy GS CAT 21 19,270 22,020 27,530 35,780 55,040
General Surgery 14673 Perivertebral abscess drainage GS CAT 19 15,870 18,130 22,670 29,450 45,320
General Surgery 24932 Ascitic Tapping GS CAT 6 1,860 2,150 2,660 3,470 5,350
General Surgery 14849 Thyroid Lobectomy/Hemithyroidectomy GS CAT 22 20,980 23,960 29,960 38,940 59,890
General Surgery 14858 Incisional hernia repair(with or Without mesh) GS CAT 22 20,980 23,960 29,960 38,940 59,890
General Surgery 14954 Thyroidectomy – Sub Total GS CAT 23 22,680 25,630 32,060 41,670 64,100
General Surgery 14955 Superficial Parotidectomy GS CAT 22 20,980 23,960 29,960 38,940 59,890
General Surgery 14958 Cholecystectomy GS CAT 23 22,680 25,630 32,060 41,670 64,100
General Surgery 15050 Thyroidectomy - Total GS CAT 24 27,190 31,080 38,850 50,500 77,700
General Surgery 15207 Hydatid Cyst of Liver GS CAT 24 27,190 31,080 38,850 50,500 77,700
General Surgery 18567 CIRCUMCISION GS CAT 12 6,220 7,130 8,920 11,580 17,820
General Surgery 18569 Lymph Node Biopsy - Axillary & Cervical (Deep) GS CAT 16 11,680 13,340 16,680 21,680 33,350
General Surgery 22409 McKle’s Diverticulectomy GS CAT 21 19,270 22,020 27,530 35,780 55,040
General Surgery 26184 Sclerothepy of Haemorrhoids GS CAT 10 4,310 4,930 6,150 8,000 12,310
General Surgery 26185 Scrotal Abcess GS CAT 12 6,220 7,130 8,920 11,580 17,820
General Surgery 26187 Secondary Suturing of Burst Abdomen GS CAT 17 13,150 15,020 18,770 24,410 37,560
General Surgery 26449 Lap drainage of Perforated Appendicular Abscess GS CAT 23 22,680 25,630 32,060 41,670 64,100
Exploratory Laprotomy with Repair of Liver
General Surgery 26657 Laceration/Stomach GS CAT 22 20,980 23,960 29,960 38,940 59,890

General Surgery 26877 Lap Drainage of Mesenteric Abscess with Biopsy of wall GS CAT 21 19,270 22,020 27,530 35,780 55,040
General Surgery 27162 Lap. Bilateral Inguinal Hernia Repair GS CAT 26 34,780 39,760 49,700 64,610 110,720
General Surgery 40435 Fasciotomy and debridement of lesion GS CAT 23 22,680 25,630 32,060 41,670 64,100
General Surgery 40466 Debridement & Excision for Necrotising GS CAT 21 19,270 22,020 27,530 35,780 55,040
General Surgery 14850 Excision of Thyroglossal cyst GS CAT 19 15,870 18,130 22,670 29,450 45,320
General Surgery 15052 Partial Gastrectomy GS CAT 23 22,680 25,630 32,060 41,670 64,100
General Surgery 22788 Lumbar Puncture (Sur) GS CAT 8 2,820 3,230 4,050 5,250 8,110
General Surgery 22979 Pile Binding GS CAT 10 4,310 4,930 6,150 8,000 12,310
General Surgery 23306 Tube Drainage Of Peripancreatic Collection GS CAT 20 17,000 19,440 24,290 31,580 48,560
Interventional
23681 Intraarterial Thrombolysis DSA CAT - 26 43,700 58,360 72,630 94,540 145,380
Neurology
Interventional
23682 Carotid Artery Stenting DSA CAT - 28 51,990 69,310 86,260 112,380 172,780
Neurology
Interventional
23685 Venous Thrombolysis DSA CAT - 26 43,700 58,360 72,630 94,540 145,380
Neurology
Interventional
23683 Tumor Embolisation Complex DSA CAT - 28 51,990 69,310 86,260 112,380 172,780
Neurology
Interventional
39770 Embolization for bleeding DSA CAT - 29 56,700 75,550 94,030 122,440 188,320
Neurology
Interventional
39771 Chemoembolization of malignant brain tumour DSA CAT - 32 67,400 89,690 111,620 145,380 223,740
Neurology

48
Surgeon fee
Surgery Double/ Single/ Classic
Department Surgery Name Category Economy Suite
ID Day care ICU Deluxe
Interventional
39772 Intra arterial chemotherapy of Brain stem gliomas DSA CAT - 32 67,400 89,690 111,620 145,380 223,740
Neurology
Interventional
26116 Peripheral Artery Embolization DSA CAT - 21 28,370 37,820 47,270 61,460 94,540
Neurology
Interventional
23687 Cerbral AVM DSA CAT - 29 56,700 75,550 94,030 122,440 188,320
Neurology
Interventional
23688 Intracranial Aneursym-Single DSA CAT - 29 56,700 75,550 94,030 122,440 188,320
Neurology
Interventional
23690 Spinal AVM DSA CAT - 29 56,700 75,550 94,030 122,440 188,320
Neurology
Interventional
23691 Intracranial angioplasty for vasospasm DSA CAT - 29 56,700 75,550 94,030 122,440 188,320
Neurology
Interventional
23693 Complex Aneurysm DSA CAT - 32 67,400 89,690 111,620 145,380 223,740
Neurology
Interventional
23697 Check Angiogram DSA CAT - 12 6,330 8,420 10,530 13,680 21,050
Neurology
Interventional
23700 DSA Cerebral DSA CAT - 15 11,460 15,280 19,100 24,830 38,210
Neurology
Interventional
23701 Spinal Angiography DSA CAT - 16 14,480 19,310 24,120 31,360 48,250
Neurology
Interventional
23706 Tumor embolisation Simple DSA CAT - 22 30,960 41,280 51,470 67,020 103,080
Neurology
Interventional
29643 Complex AVM/AVF Transvenous Apoach DSA CAT - 32 67,400 89,690 111,620 145,380 223,740
Neurology
Interventional
29644 3D Rotational Angiography DSA CAT - 7 1,920 2,300 2,930 4,050 5,740
Neurology
Interventional
29645 Dyna CT DSA CAT - 6 1,630 1,950 2,430 3,230 4,050
Neurology
Interventional
29671 Kyphoplasty Neuro Surg CAT 29 47,520 73,980 92,460 120,240 184,980
Neurology
Interventional
32339 Embolization of haemangiomas or AVMS 29 46,470 53,090 66,380 86,290 132,740
Neurology
Interventional
23692 Intracranial Stenting DSA CAT - 29 56,700 75,550 94,030 122,440 188,320
Neurology
Interventional
23703 Intraarterial Vasodilatation DSA CAT - 20 21,280 28,370 35,450 46,090 70,910
Neurology
Interventional
46986 Acute Stroke DSA DSA CAT - 20 21,280 28,370 35,450 46,090 70,910
Neurology
Interventional
28565 Mechanical Thrombolysis DSA CAT - 27 47,650 63,580 79,120 103,080 158,500
Neurology
Interventional
29651 Bronchial artery embolization 28 42,600 48,680 60,870 79,120 121,750
Radiology
Interventional
37952 Angioplasty Stenting 30 54,160 61,920 77,370 100,610 154,760
Radiology
Interventional
29654 Selective Vessel Angiography 20 17,000 19,440 24,290 31,580 48,560
Radiology
Interventional
29656 Chemoembolization of Liver tumor 26 34,780 39,760 49,700 64,610 110,720
Radiology
Interventional
29657 Coil Embolization 26 34,780 39,760 49,700 64,610 110,720
Radiology
Interventional
29658 Stent Placement 26 34,780 39,760 49,700 64,610 110,720
Radiology
Interventional
45091 Trans arterial Radial embolization (TARE) 26 34,780 39,760 49,700 64,610 110,720
Radiology
Interventional
45093 Trans catheter arterial chemo embolization (TACE) 26 34,780 39,760 49,700 64,610 110,720
Radiology
Interventional
29664 Percutaneous transhepatic biliary drainage 23 22,680 25,630 32,060 41,670 64,100
Radiology
Interventional
29669 Alcohol / RFA ablation 24 27,190 31,080 38,850 50,500 77,700
Radiology
Interventional
32332 Image Guided Procedure (Interventional Radiology) 14 7,720 8,800 11,000 14,310 22,020
Radiology
Interventional
32333 Image Guided Pigtail Catheter Insetion (Interventi 16 11,680 13,340 16,680 21,680 33,350
Radiology
Interventional
32334 CT guided true cut biopsy / FNAC 15 9,290 10,620 13,280 17,250 26,540
Radiology
Interventional
32335 Ultrasound guided true cut biopsy / FNAC 14 7,720 8,800 11,000 14,310 22,020
Radiology
Interventional
47249 Interventional US Guided FNAC & Biopsy 17 13,150 15,020 18,770 24,410 37,560
Radiology
Interventional
47250 Interventional CT Guided FNAC & Biopsy 18 14,740 16,830 21,050 27,370 42,080
Radiology

49
Surgeon fee
Surgery Double/ Single/ Classic
Department Surgery Name Category Economy Suite
ID Day care ICU Deluxe
Interventional
47251 Interventional TRUS/TVS Sampling 16 11,680 13,340 16,680 21,680 33,350
Radiology
Interventional
47252 Interventional TRUS Guided Prostatic Biopsy 16 11,680 13,340 16,680 21,680 33,350
Radiology
Interventional
47253 Interventional Image Guided Percutaneous Renal Biopsy 16 11,680 13,340 16,680 21,680 33,350
Radiology
Interventional
47254 Interventional Image Guided Percutaneous Bone Biopsy 16 11,680 13,340 16,680 21,680 33,350
Radiology
Interventional
47255 Interventional Image Guided Specialised Biopsies 16 11,680 13,340 16,680 21,680 33,350
Radiology
Interventional
47256 Interventional Percutaneous Plugged Biopsy 16 11,680 13,340 16,680 21,680 33,350
Radiology
Interventional
47257 Interventional Image Guided Marker / J Wire Placement 16 11,680 13,340 16,680 21,680 33,350
Radiology
Interventional
47258 Interventional CT Guided Marker/J Wire Placement 17 13,150 15,020 18,770 24,410 37,560
Radiology
Interventional
47259 Image Guided Aspiration - Bedside 16 11,680 13,340 16,680 21,680 33,350
Radiology
Interventional
47260 Image Guided Drainage Catheter Placement (Bedside) 17 13,150 15,020 18,770 24,410 37,560
Radiology
Interventional
47261 Interventional Central Venous line placement 15 9,290 10,620 13,280 17,250 26,540
Radiology
Interventional Interventional Image Guided Tube Change / Upsizing /
47262 14 7,720 8,800 11,000 14,310 22,020
Radiology Repositioning
Interventional
47263 Invasive Pressure Measurement 15 9,290 10,620 13,280 17,250 26,540
Radiology
Interventional
47264 Transjugular Liver Biopsy with Pressure Measurements 19 15,870 18,130 22,670 29,450 45,320
Radiology
Interventional
47265 PTBD - Internal - External Drainage 24 27,190 31,080 38,850 50,500 77,700
Radiology
Interventional
47266 PTBD Double 26 34,780 39,760 49,700 64,610 110,720
Radiology
Interventional
47267 Interventional CBD Stenting 24 27,190 31,080 38,850 50,500 77,700
Radiology
Interventional
47272 PCN/PTBD with Primary Stenting ( Bilateral ) 30 54,160 61,920 77,370 100,610 154,760
Radiology
Interventional
47274 Interventional Percutaneous Nephrostomy 20 17,000 19,440 24,290 31,580 48,560
Radiology
Interventional
47277 Percutaneous Gastrostomy 20 17,000 19,440 24,290 31,580 48,560
Radiology
Interventional
47289 Percutaneous Cholecystostomy 20 17,000 19,440 24,290 31,580 48,560
Radiology
Interventional
47291 Interventional Alcohol Ablation 16 11,680 13,340 16,680 21,680 33,350
Radiology
Interventional
47293 Interventional Image Guided Chemical Ablation 16 11,680 13,340 16,680 21,680 33,350
Radiology
Interventional
47295 Tumor Ablation - Single 26 34,780 39,760 49,700 64,610 110,720
Radiology
Interventional
47297 Tumor Ablation - Multiple 28 42,600 48,680 60,870 79,120 121,750
Radiology
Interventional Interventional Image Guided Celiac / Splanchnic Plexus
47298 20 17,000 19,440 24,290 31,580 48,560
Radiology Ablation
Interventional
47299 Interventional Neural Ablation 20 17,000 19,440 24,290 31,580 48,560
Radiology
Interventional
47301 Cyst Ablation 24 27,190 31,080 38,850 50,500 77,700
Radiology
Interventional
47302 Interventional Sclerotherapy 14 7,720 8,800 11,000 14,310 22,020
Radiology
Interventional
47303 Lymphangiography 16 11,680 13,340 16,680 21,680 33,350
Radiology
Interventional
47304 BRTO or Varix Embolisation 30 54,160 61,920 77,370 100,610 154,760
Radiology
Interventional
47305 Microcatheter Angiography 24 27,190 31,080 38,850 50,500 77,700
Radiology
Interventional
47268 Tumor Embolisation 26 34,780 39,760 49,700 64,610 110,720
Radiology
Interventional
47269 Embolisation for Bleeding 28 42,600 48,680 60,870 79,120 121,750
Radiology
Interventional
47270 Vascular Embolisation 28 42,600 48,680 60,870 79,120 121,750
Radiology
Interventional
47271 Angioplasty & Stenting Multiple 32 65,720 75,120 93,900 122,060 187,780
Radiology

50
Surgeon fee
Surgery Double/ Single/ Classic
Department Surgery Name Category Economy Suite
ID Day care ICU Deluxe
Interventional
47273 Interventional Balloon Plasty Non-Vascular 20 17,000 19,440 24,290 31,580 48,560
Radiology
Interventional
47275 Balloon Plasty Vascular 24 27,190 31,080 38,850 50,500 77,700
Radiology
Interventional
47276 Vascular Stenting 26 34,780 39,760 49,700 64,610 110,720
Radiology
Interventional
37953 Thrombolysis 26 34,780 39,760 49,700 64,610 110,720
Radiology
Interventional
47278 AV Fistula Salvage 28 42,600 48,680 60,870 79,120 121,750
Radiology
Interventional Interventional Ultrasound Guided Joint Injections /
47279 11 4,980 5,550 7,130 9,270 14,250
Radiology Fenestrations
Interventional
47280 Interventional Percutaneous Angiography 11 4,980 5,550 7,130 9,270 14,250
Radiology
Interventional
47281 Interventional Evaluation for Procedure 5 1,250 1,410 1,800 2,320 3,560
Radiology
Interventional
47282 Fallopian Tube Recanalisation 16 11,680 13,340 16,680 21,680 33,350
Radiology
Interventional
47283 Interventional Tubal Flushing 14 7,720 8,800 11,000 14,310 22,020
Radiology
Interventional
47284 Vertebroplasty / Kyphoplasty 16 11,680 13,340 16,680 21,680 33,350
Radiology
Interventional
47285 Vertebroplasty / Kyphoplasty - Multiple 20 17,000 19,440 24,290 31,580 48,560
Radiology
Interventional
47286 Interventional Percutaneous Embolisation 16 11,680 13,340 16,680 21,680 33,350
Radiology
Interventional
47287 Interventional Varicose Vein Ablation 20 17,000 19,440 24,290 31,580 48,560
Radiology
Interventional
47288 Interventional Endobiliary brush cytology 15 9,290 10,620 13,280 17,250 26,540
Radiology
Interventional
32336 Image Guided Aspiration (Therapeutic) 15 9,290 10,620 13,280 17,250 26,540
Radiology
Interventional
32337 Image Guided Aspiration (Diagnostic) 11 4,980 5,550 7,130 9,270 14,250
Radiology
Interventional
32342 Image guided dialysis catheter insertion. (IJ,Femo 17 13,150 15,020 18,770 24,410 37,560
Radiology
Interventional Image guided dialysis catheter insertion. (IJ,Femoral)
32343 14 7,720 8,800 11,000 14,310 22,020
Radiology exchange
Interventional
32345 Ureteric stent (double pigtail/J) Rt/Lt 24 27,190 31,080 38,850 50,500 77,700
Radiology
Interventional
32346 Percutaneous transhepatic cholangiography & draina 21 19,270 22,020 27,530 35,780 55,040
Radiology
Interventional
32348 RFA of lesion – Single 24 27,190 31,080 38,850 50,500 77,700
Radiology
Interventional
32350 Drainage of liver abscess 14 7,720 8,800 11,000 14,310 22,020
Radiology
Interventional
29662 USG Guided Pigtail Catheter Insetion 16 11,680 13,340 16,680 21,680 33,350
Radiology
Interventional
29663 Image guided true cut biopsy / FNAC 11 4,980 5,550 7,130 9,270 14,250
Radiology
Interventional
29666 Ascitic / Pleural tap (Therapeutic) 12 6,220 7,130 8,920 11,580 17,820
Radiology
Interventional
29667 Ascitic / Pleural tap (Diagnostic) 8 2,820 3,230 4,050 5,250 8,110
Radiology
Interventional
29674 Uterine artery embolization for fibroids/PPH 24 27,190 31,080 38,850 50,500 77,700
Radiology
Interventional
29661 TIPS 37 90,660 103,590 129,500 168,340 259,010
Radiology
Liver and Biliary
45094 Liver Transplantation Surgery 40 107,650 123,030 153,790 199,930 307,570
Sciences
Minimal Access
31329 Thoracoscopy Diagnostics with drainage 20 17,000 19,440 24,290 31,580 48,560
Surgery
Minimal Access
31330 Thoracoscopy cervical sympathectomy 23 22,680 25,630 32,060 41,670 64,100
Surgery
Minimal Access
31332 Thoracoscopy decortication 25 30,950 35,340 44,200 57,450 88,390
Surgery
Minimal Access
31336 Thoracoscopy medisatinal lymph node biopsy 23 22,680 25,630 32,060 41,670 64,100
Surgery
Minimal Access
31337 Thoracoscopy mediastinal tumor excison 25 30,950 35,340 44,200 57,450 88,390
Surgery
Minimal Access
31338 Thorascoscopic thymectomy 28 42,600 48,680 60,870 79,120 121,750
Surgery

51
Surgeon fee
Surgery Double/ Single/ Classic
Department Surgery Name Category Economy Suite
ID Day care ICU Deluxe
Minimal Access
31340 Complex anal fistula 20 17,000 19,440 24,290 31,580 48,560
Surgery
Minimal Access
31343 Fistulotomy 18 14,740 16,830 21,050 27,370 42,080
Surgery
Minimal Access
31344 Lap gastric band removal 20 17,000 19,440 24,290 31,580 48,560
Surgery
Minimal Access
37345 Lap. Feeding Jejunostomy 22 20,980 23,960 29,960 38,940 59,890
Surgery
Nephrology 23410 Renal Biopsy 12 6,220 7,130 8,920 11,580 17,820
Nephrology 28013 Subclavian / Intrajuglar Catherisation 12 6,220 7,130 8,920 11,580 17,820
Nephrology 28014 CAPD Catherisattion insertion 17 13,150 15,020 18,770 24,410 37,560
Nephrology 28015 Permacath Insertion 17 13,150 15,020 18,770 24,410 37,560
Nephrology 28383 AV Fistula (Nephrology) 17 13,150 15,020 18,770 24,410 37,560
Neuro Surgery 21541 Craniotomy for Multiple Aneurysm Neuro Surg CAT 37 101,140 157,490 196,860 255,910 393,740
Neuro Surgery 21543 Trans Oral Decompression for CV Junction anomaly Neuro Surg CAT 32 67,230 104,670 130,840 170,070 261,670
Combined anterior and posterior procedure for Spine
Neuro Surgery 21545 Neuro Surg CAT 37 101,140 157,490 196,860 255,910 393,740
anomaly
Neuro Surgery 25687 Deep Brain Stimulation Neuro Surg CAT 37 101,140 157,490 196,860 255,910 393,740
Neuro Surgery 39972 Complex Scoliosis Correction Neuro Surg CAT 40 127,400 198,500 247,970 322,380 495,990
Neuro Surgery 21546 Therapeutic Stereotactic Procedures Neuro Surg CAT 32 67,230 104,670 130,840 170,070 261,670
Neuro Surgery 21559 Spinal intradural tumor Neuro Surg CAT 32 67,230 104,670 130,840 170,070 261,670
Neuro Surgery 21566 Craniotomy for Trauma / Hematoma / stroke Neuro Surg CAT 32 67,230 104,670 130,840 170,070 261,670
Neuro Surgery 21570 Laminectomy Cervical Neuro Surg CAT 29 47,520 73,980 92,460 120,240 184,980
Neuro Surgery 21571 Laminectomy Lumbar Neuro Surg CAT 29 47,520 73,980 92,460 120,240 184,980
Neuro Surgery 21578 Burr holes multiple Neuro Surg CAT 26 35,590 55,380 69,270 90,020 138,490
Neuro Surgery 21579 Carpal tunnel syndrome Neuro Surg CAT 20 18,190 28,250 35,390 46,020 70,770
Neuro Surgery 21581 Peripheral nerve surgery Neuro Surg CAT 29 47,520 73,980 92,460 120,240 184,980
Neuro Surgery 21585 Burr hole single Neuro Surg CAT 12 6,370 9,920 12,400 16,140 24,820
Neuro Surgery 21588 Manipulations / Skull Traction Neuro Surg CAT 12 6,370 9,920 12,400 16,140 24,820
Neuro Surgery 23825 VP Shunt Neuro Surg CAT 29 47,520 73,980 92,460 120,240 184,980
Neuro Surgery 23992 Bone Flap Removal Neuro Surg CAT 29 47,520 73,980 92,460 120,240 184,980
Neuro Surgery 23993 T P Shunt Neuro Surg CAT 26 35,590 55,380 69,270 90,020 138,490
Neuro Surgery 23994 Decompressive Craniotomy Neuro Surg CAT 32 67,230 104,670 130,840 170,070 261,670
Neuro Surgery 23996 Brain Abscess Drainage Neuro Surg CAT 29 47,520 73,980 92,460 120,240 184,980
Neuro Surgery 24001 Cranioplasty Neuro Surg CAT 29 47,520 73,980 92,460 120,240 184,980
Neuro Surgery 24250 Microdiscectomy-Lumbar/cervical Neuro Surg CAT 29 47,520 73,980 92,460 120,240 184,980
Neuro Surgery 24251 Craniotomy for Tumour Neuro Surg CAT 32 67,230 104,670 130,840 170,070 261,670
Neuro Surgery 25213 Kyphoplasty Neuro Surg CAT 29 47,520 73,980 92,460 120,240 184,980
Neuro Surgery 25688 Laceration Suturing For Scalp Avulsion Neuro Surg CAT 15 9,510 14,820 18,500 24,050 36,990
Neuro Surgery 25899 ICP Monitoring / Twist Drill Procedure Neuro Surg CAT 12 6,370 9,920 12,400 16,140 24,820
Neuro Surgery 25900 Laceration Suturing (Neuro) Neuro Surg CAT 7 2,330 3,620 4,520 5,880 9,010
Neuro Surgery 25901 Nerve / Muscle Biopsy (Neuro) Neuro Surg CAT 7 2,330 3,620 4,520 5,880 9,010
Neuro Surgery 25902 Ventricular Puncture (Neuro) Neuro Surg CAT 7 2,330 3,620 4,520 5,880 9,010
Neuro Surgery 25903 Debridement (Neuro) Neuro Surg CAT 7 2,330 3,620 4,520 5,880 9,010
Neuro Surgery 26124 Spinal Instrumentation Neuro Surg CAT 32 67,230 104,670 130,840 170,070 261,670
Neuro Surgery 30657 Spinal Extramedullary Tumor Neuro Surg CAT 30 53,310 83,020 103,760 134,900 207,510
Neuro Surgery 30658 Spine Surgery with Simple Instrumentation Neuro Surg CAT 30 53,310 83,020 103,760 134,900 207,510
Neuro Surgery 31370 Stereotactic Biopsy Neuro Surg CAT 30 53,310 83,020 103,760 134,900 207,510
Neuro Surgery 36360 Battery Charge for DBS Neuro Surg CAT 20 18,190 28,250 35,390 46,020 70,770
Neuro Surgery 36471 VA Shunt Neuro Surg CAT 29 47,520 73,980 92,460 120,240 184,980
Neuro Surgery 36361 Mini Craniotomy Neuro Surg CAT 30 53,310 83,020 103,760 134,900 207,510
Neuro Surgery 24055 Spinal Dysraphism (Complex) Neuro Surg CAT 32 67,230 104,670 130,840 170,070 261,670
Neuro Surgery 36362 TNTS Neuro Surg CAT 32 67,230 104,670 130,840 170,070 261,670
Complex Microdiscectomy ( more than 2 levels / obese
Neuro Surgery 36363 Neuro Surg CAT 32 67,230 104,670 130,840 170,070 261,670
patient /RE-DO)
Neuro Surgery 36364 CP Angle Tumor Neuro Surg CAT 34 80,350 125,120 156,390 203,330 312,800
Neuro Surgery 36365 Vascular Surgery for Brain/Spine Neuro Surg CAT 34 80,350 125,120 156,390 203,330 312,800
Neuro Surgery 36366 Spinal Tumor Decompression with Fixation Neuro Surg CAT 34 80,350 125,120 156,390 203,330 312,800

Neuro Surgery 36367 Complex Fusion ( more than 2 levels / obese patient /RE-DO) Neuro Surg CAT 34 80,350 125,120 156,390 203,330 312,800

Neurology 36359 Surgery for Scalp Tumor Neuro Surg CAT 15 9,510 14,820 18,500 24,050 36,990
Neurology 36368 Spinal Dysraphism (Simple) Neuro Surg CAT 29 47,520 73,980 92,460 120,240 184,980
Neurology 21562 Brachial Plexus surgery (microscopic) Neuro Surg CAT 32 67,230 104,670 130,840 170,070 261,670
Obs&Gyne 35193 Cervical Stitch Removal Obs & Gynae Cat 8 2,800 3,220 4,060 5,330 8,130
Obs&Gyne 28760 Incision & Drainage Of Vulva Or Perineal Abscess Obs & Gynae Cat 9 3,650 4,200 5,190 6,730 10,370
Obs&Gyne 28761 Incision & Drainage Of Bartholin'S Gl& Abscess Obs & Gynae Cat 9 3,650 4,200 5,190 6,730 10,370

Obs&Gyne 28762 Marsupialization Of Bartholin'S Gl& Cyst Obs & Gynae Cat 10 4,350 4,910 6,160 7,990 12,340

Obs&Gyne 28764 Hymenotomy, Simple Incision Obs & Gynae Cat 9 3,650 4,200 5,190 6,730 10,370
Obs&Gyne 28782 Colpotomy; With Exploration Obs & Gynae Cat 9 3,650 4,200 5,190 6,730 10,370

Obs&Gyne 28994 Incision & Drainage Of Vaginal Hematoma; Non-Obstetrical Obs & Gynae Cat 13 7,010 7,990 10,090 13,040 20,040

52
Surgeon fee
Surgery Double/ Single/ Classic
Department Surgery Name Category Economy Suite
ID Day care ICU Deluxe

Obs&Gyne 28813 Closure Of Rectovaginal Fistula; Abdominal Approach Obs & Gynae Cat 20 16,950 19,480 25,610 31,540 48,640

Plastic Operation On Urethral Sphincter, Vaginal Approach


Obs&Gyne 29002 Obs & Gynae Cat 12 6,160 7,150 8,960 11,630 17,810
(Eg, Kelly Urethral Plication)
Transperineal Closure Rectovaginal Fistula; Perineal Body
Obs&Gyne 29005 Obs & Gynae Cat 20 16,950 19,480 25,610 31,540 48,640
Reconstruction,+/- Levator Plication
Obs&Gyne 28865 Insertion Of Intrauterine Device (Iud) Obs & Gynae Cat 4 760 850 1,060 1,390 2,150
Total Abdo Hyst. total Partial Vaginectomy, Para-Aortic &
Obs&Gyne 29242 Obs & Gynae Cat 31 61,810 70,640 88,440 114,920 176,740
Pelvic L N Sampling, +/- Removal of
Perineoplasty, Repair Of Perineum, Nonobstetrical (Separate
Obs&Gyne 28779 Obs & Gynae Cat 12 6,160 7,150 8,960 11,630 17,810
Procedure)
Colpopexy, Vaginal; Intra-Peritoneal Approach (Uterosacral,
Obs&Gyne 28805 Obs & Gynae Cat 18 14,720 16,820 21,030 27,340 42,050
Levator Myorrhaphy)

Obs&Gyne 29215 Resuturing of burst Abdominal Wound Obs & Gynae Cat 18 14,720 16,820 21,030 27,340 42,050

Obs&Gyne 28836 Dilation Of Cervical Canal, Instrumental (Separate Procedure) Obs & Gynae Cat 7 2,240 2,530 3,220 4,200 6,450

Obs&Gyne 47048 Laparoscopic Adenomyomectomy Obs & Gynae Cat 29 46,530 53,120 66,430 86,340 132,730
Obs&Gyne 47049 Laparoscopic modified Purandare's sling procedure Obs & Gynae Cat 27 38,820 44,290 55,370 71,900 115,950
Obs&Gyne 47050 Laparoscopic Isthmocele repair Obs & Gynae Cat 27 38,820 44,290 55,370 71,900 115,950
Obs&Gyne 47051 Laparoscopic management of Recto Vaginal endometriosis Obs & Gynae Cat 29 46,530 53,120 66,430 86,340 132,730

Obs&Gyne 47052 Laparoscopic Burch's Colposuspension with enterocele repair Obs & Gynae Cat 27 38,820 44,290 55,370 71,900 115,950

Obs&Gyne 47044 Laparoscopic management of Deep Infiltrating Endometriosis Obs & Gynae Cat 29 46,530 53,120 66,430 86,340 132,730

Laparoscopic management of Mucinous Cystadenoma more


Obs&Gyne 47045 Obs & Gynae Cat 26 34,760 39,800 49,760 64,610 110,720
than 7 cms
Laparoscopic management of Dermoid Cyst / Ovarian
Obs&Gyne 47046 Obs & Gynae Cat 26 34,760 39,800 49,760 64,610 110,720
Fibroma more than 7 Cms
Laparoscopic management of Serous Cystadenoma more than
Obs&Gyne 47047 Obs & Gynae Cat 26 34,760 39,800 49,760 64,610 110,720
7cms
Ndvh (Non Descent Vaginal Hyst.< Than 250 Gm With Severe
Obs&Gyne 29044 Obs & Gynae Cat 28 42,600 48,640 60,820 79,200 121,800
Adhesiolysis +/- Bso
Fetal Monitoring In Labor By Consulting Physician With
Obs&Gyne 29091 Obs & Gynae Cat 5 1,250 1,410 1,800 2,320 3,560
Written Report; Supervision & Interpretation
Incision & drainage of vulval hematoma < 5cm diameter /125
Obs&Gyne 29144 Obs & Gynae Cat 12 6,160 7,150 8,960 11,630 17,810
CC

Obs&Gyne 29178 Bso With Total Omentectomy, Tah For Malignancy Obs & Gynae Cat 26 34,760 39,800 49,760 64,610 110,720

Obs&Gyne 29217 Hysteroscopic lateral meteroplasty Obs & Gynae Cat 19 15,840 18,080 22,700 29,300 45,270

Obs&Gyne 28775 Partial Hymenectomy Or Revision Of Hymenal Ring Obs & Gynae Cat 10 4,350 4,910 6,160 7,990 12,340

Colpoperineorrhaphy, Suture Of Injury Of Vagina &/Or


Obs&Gyne 28795 Obs & Gynae Cat 14 7,720 8,820 11,080 14,290 22,010
Perineum (Nonobstetrical)
Laparoscopy, Surgical, Colpopexy (Suspension Of Vaginal
Obs&Gyne 28822 Obs & Gynae Cat 23 22,810 25,640 32,100 41,920 64,050
Apex)

Obs&Gyne 28966 Single Pregnancy, Amniocentesis, Therapeutic Obs & Gynae Cat 12 6,160 7,150 8,960 11,630 17,810

Obs&Gyne 28776 Excision Of Bartholin S Gl& Or Cyst Obs & Gynae Cat 11 5,050 5,330 7,150 9,260 14,290

Incision & Drainage Of Vaginal


Obs&Gyne 28785 Obs & Gynae Cat 12 6,160 7,150 8,960 11,630 17,810
Hematoma;Obstetrical/Postpartum
Biopsy Of Vaginal Mucosa; Extensive, Requiring Suture
Obs&Gyne 28787 Obs & Gynae Cat 10 4,350 4,910 6,160 7,990 12,340
(Including Cysts)

Obs&Gyne 28788 Vaginectomy, Partial Removal Of Vaginal Wall Obs & Gynae Cat 14 7,720 8,820 11,080 14,290 22,010

Obs&Gyne 28791 Excision Of Vaginal Cyst Or Tumor Obs & Gynae Cat 12 6,160 7,150 8,960 11,630 17,810

Obs&Gyne 28794 Colporrhaphy, Suture Of Injury Of Vagina (Nonobstetrical) Obs & Gynae Cat 12 6,160 7,150 8,960 11,630 17,810

Anterior Colporrhaphy, Repair Of Cystocele With Or Without


Obs&Gyne 28797 Obs & Gynae Cat 14 7,720 8,820 11,080 14,290 22,010
Repair Of Urethrocele
Posterior Colporrhaphy, Repair Of Rectocele With Or Without
Obs&Gyne 28798 Obs & Gynae Cat 15 9,260 10,660 13,320 17,240 26,490
Perineorrhaphy

Obs&Gyne 28801 Repair Of Enterocele, Vaginal Approach (Separate Procedure) Obs & Gynae Cat 15 9,260 10,660 13,320 17,240 26,490

Obs&Gyne 28803 Colpopexy, Abdominal Approach Obs & Gynae Cat 22 21,030 23,970 29,990 38,960 59,850

Obs&Gyne 28821 Colposcopy Of The Entire Vagina, With Cervix If Present Obs & Gynae Cat 12 6,160 7,150 8,960 11,630 17,810

53
Surgeon fee
Surgery Double/ Single/ Classic
Department Surgery Name Category Economy Suite
ID Day care ICU Deluxe

Obs&Gyne 28823 Colposcopy Of The Cervix Including Upper/Adjacent Vagina Obs & Gynae Cat 9 3,650 4,200 5,190 6,730 10,370

Endocervical Curettage (Not Done As Part Of A Dilation &


Obs&Gyne 28824 Obs & Gynae Cat 9 3,650 4,200 5,190 6,730 10,370
Curettage)
Obs&Gyne 28825 Cautery Of Cervix; Electro Or Thermal Obs & Gynae Cat 9 3,650 4,200 5,190 6,730 10,370
Obs&Gyne 28826 Cautery Of Cervix; Cryocautery, Initial Or Repeat Obs & Gynae Cat 9 3,650 4,200 5,190 6,730 10,370
Obs&Gyne 28833 Dilation & Curettage Of Cervical Stump Obs & Gynae Cat 9 3,650 4,200 5,190 6,730 10,370
Dilation & Curettage, Diagnostic &/Or Therapeutic
Obs&Gyne 28837 Obs & Gynae Cat 10 4,350 4,910 6,160 7,990 12,340
(Nonobstetrical)
Total Abdominal Hysterectomy, + Removal Of Tube(S)/
Obs&Gyne 28839 Obs & Gynae Cat 22 21,030 23,970 29,990 38,960 59,850
Ovary(S)
Supracervical Abdominal Hysterectomy (Subtotal), 250-500
Obs&Gyne 28841 Obs & Gynae Cat 20 16,950 19,480 25,610 31,540 48,640
Gms

Obs&Gyne 28844 Repair Of 3Rd -4Th Degree Perineal Tear Obs & Gynae Cat 15 9,260 10,660 13,320 17,240 26,490

Obs&Gyne 28848 Vaginal Hysterectomy, For Uterus 250 G Obs & Gynae Cat 25 30,970 35,320 44,150 57,460 88,440

Obs&Gyne 28851 Lavh , For Uterus 250 G Or Less Obs & Gynae Cat 24 27,190 31,120 38,820 50,460 77,640

Obs&Gyne 28852 Lavh, For Uterus 250 G Or Less; +/- Bso / Mild Adhesiolysis Obs & Gynae Cat 25 30,970 35,320 44,150 57,460 88,440

Obs&Gyne 28854 Lavh , For Uterus 250-500 G Obs & Gynae Cat 25 30,970 35,320 44,150 57,460 88,440

Obs&Gyne 28856 Lavh, For Uterus 250-500 G +/- Bso Severe Adhesiolysis Obs & Gynae Cat 28 42,600 48,640 60,820 79,200 121,800

Obs&Gyne 28857 Lavh , For Uterus >500 G Obs & Gynae Cat 26 34,760 39,800 49,760 64,610 110,720

Obs&Gyne 28858 Lavh, For Uterus >500 G ; +/- Bso / Mild Adhesiolysis Obs & Gynae Cat 27 38,820 44,290 55,370 71,900 115,950

Lavh, For Uterus >500 G /+/- Bso Or Moderate Adhesiolysis /


Obs&Gyne 28859 Obs & Gynae Cat 28 42,600 48,640 60,820 79,200 121,800
Removal To Mass

Obs&Gyne 28861 Total Laproscopic Hysterectomy With Less Than 250 Gms Obs & Gynae Cat 26 34,760 39,800 49,760 64,610 110,720

Obs&Gyne 28862 Ndvh (Non Descent Vaginal Hysterectomy Less Than 250 Gm Obs & Gynae Cat 25 30,970 35,320 44,150 57,460 88,440

Obs&Gyne 28863 Ndvh 250-500Gm Obs & Gynae Cat 26 34,760 39,800 49,760 64,610 110,720

Obs&Gyne 28866 Removal Of Intrauterine Device (Iud) Obs & Gynae Cat 3 370 430 550 710 1,060
Obs&Gyne 28867 Chromotubation Of Oviduct, Including Materials Obs & Gynae Cat 6 1,820 2,110 2,660 3,510 5,330

Obs&Gyne 28878 Lap +/-Hysteroplasty, Repair Of Uterine Anomaly Level 3 Obs & Gynae Cat 22 21,030 23,970 29,990 38,960 59,850

Obs&Gyne 28880 Hysteroscopy, Diagnostic (Separate Procedure) Obs & Gynae Cat 12 6,160 7,150 8,960 11,630 17,810

Hysteroscopy, Surgical; > 2 Polypectomy, With Or Without D


Obs&Gyne 28881 Obs & Gynae Cat 15 9,260 10,660 13,320 17,240 26,490
&C

Obs&Gyne 28882 Hysteroscopy, Surgical; With Removal Of Small Leiomyomata Obs & Gynae Cat 18 14,720 16,820 21,030 27,340 42,050

Hysteroscopy, Surgical; With Removal Of Large / 2


Obs&Gyne 28883 Obs & Gynae Cat 19 15,840 18,080 22,700 29,300 45,270
Leiomyomata

Obs&Gyne 28884 Hysteroscopy, Surgical; With Removal Of 3-5 Leiomyomata Obs & Gynae Cat 20 16,950 19,480 25,610 31,540 48,640

Hysteroscopy, Surgical; With Removal Of 6 Or More


Obs&Gyne 28885 Obs & Gynae Cat 21 19,340 22,010 27,470 35,750 55,080
Leiomyomata
Laparoscopy, Surgical; With Salpingostomy
Obs&Gyne 28888 Obs & Gynae Cat 20 16,950 19,480 25,610 31,540 48,640
(Salpingoneostomy)

Obs&Gyne 28890 Tubotubal Anastomosis Obs & Gynae Cat 21 19,340 22,010 27,470 35,750 55,080

Obs&Gyne 28895 Laparoscopic Fimbrioplasty Obs & Gynae Cat 18 14,720 16,820 21,030 27,340 42,050

Obs&Gyne 28896 Salpingostomy (Salpingoneostomy) Obs & Gynae Cat 18 14,720 16,820 21,030 27,340 42,050

Obs&Gyne 28897 Laparoscopic Salpingostomy (Salpingoneostomy) Obs & Gynae Cat 20 16,950 19,480 25,610 31,540 48,640

Obs&Gyne 28903 Biopsy Of Ovary, Unilateral Or Bilateral (Separate Procedure) Obs & Gynae Cat 12 6,160 7,150 8,960 11,630 17,810

Obs&Gyne 28907 Oophorectomy, Partial Or Total, Unilateral Or Bilateral Obs & Gynae Cat 17 13,170 15,010 18,770 24,390 37,560

Obs&Gyne 28911 Fetal Contraction Stress Test Obs & Gynae Cat 4 760 850 1,060 1,390 2,150
Obs&Gyne 28912 Fetal Non-Stress Test Obs & Gynae Cat 3 370 430 550 710 1,060
Hysterotomy, Abdominal (Eg, For Hydatidiform Mole,
Obs&Gyne 28915 Obs & Gynae Cat 17 13,170 15,010 18,770 24,390 37,560
Abortion)
Surgical Treatment Of Ectopic Pregnancy; Abdominal
Obs&Gyne 28916 Obs & Gynae Cat 20 16,950 19,480 25,610 31,540 48,640
Pregnancy

54
Surgeon fee
Surgery Double/ Single/ Classic
Department Surgery Name Category Economy Suite
ID Day care ICU Deluxe

Obs&Gyne 28922 Curettage, Postpartum Obs & Gynae Cat 12 6,160 7,150 8,960 11,630 17,810

Episiotomy Or Vaginal Repair, By Other Than Attending


Obs&Gyne 28923 Obs & Gynae Cat 12 6,160 7,150 8,960 11,630 17,810
Physician

Obs&Gyne 28924 Cerclage Of Cervix, During Pregnancy; Vaginal Obs & Gynae Cat 14 7,720 8,820 11,080 14,290 22,010

Obs&Gyne 28927 FULL TERM NORMAL DELIVERY WITH EPISIOTOMY Obs & Gynae Cat 25 30,970 35,320 44,150 57,460 88,440

Obs&Gyne 28929 Delivery Of Placenta (Separate Procedure) Obs & Gynae Cat 9 3,650 4,200 5,190 6,730 10,370

Obs&Gyne 28930 Caesarian Delivery Only Obs & Gynae Cat 25 30,970 35,320 44,150 57,460 88,440

Treatment Of Missed Abortion, Completed Surgically; Second


Obs&Gyne 28932 Obs & Gynae Cat 14 7,720 8,820 11,080 14,290 22,010
Trimester

Obs&Gyne 28935 Induced Abortion, By Dilation & Evacuation Obs & Gynae Cat 10 4,350 4,910 6,160 7,990 12,340

Uterine Evacuation & Curettage For Hydatidiform Mole size <


Obs&Gyne 37752 Obs & Gynae Cat 12 6,160 7,150 8,960 11,630 17,810
12
Removal Of Cerclage Suture Under Anesthesia (Other Than
Obs&Gyne 28938 Obs & Gynae Cat 5 1,250 1,410 1,800 2,320 3,560
Local)

Obs&Gyne 28939 Insertion Of Levonorgestrel-Releasing Intrauterine System Obs & Gynae Cat 6 1,820 2,110 2,660 3,510 5,330

Obs&Gyne 28940 Hysteroscopic Removal Of Lost-IUCD Obs & Gynae Cat 14 7,720 8,820 11,080 14,290 22,010

Obs&Gyne 28944 Cervical Polypectomy Obs & Gynae Cat 9 3,650 4,200 5,190 6,730 10,370

Obs&Gyne 28947 MTP-High Risk Obs & Gynae Cat 12 6,160 7,150 8,960 11,630 17,810

Obs&Gyne 28948 Suction & Evacuation -High Risk Obs & Gynae Cat 12 6,160 7,150 8,960 11,630 17,810

Obs&Gyne 28953 Laparoscopic Removal Of Unilateral Endometrioma Obs & Gynae Cat 19 15,840 18,080 22,700 29,300 45,270

Laparoscopic Removal Of Unilateral Endometrioma With Mild


Obs&Gyne 28954 Obs & Gynae Cat 20 16,950 19,480 25,610 31,540 48,640
Adhesiolysis

Obs&Gyne 28955 Laparoscopic Removal Of Bilateral Endometrioma Obs & Gynae Cat 21 19,340 22,010 27,470 35,750 55,080

Laparoscopic Removal Of Bilateral Endometrioma With Mild


Obs&Gyne 28956 Obs & Gynae Cat 23 22,810 25,640 32,100 41,920 64,050
Adhesiolysis

Obs&Gyne 28960 Diag Laparo+Hystero Obs & Gynae Cat 19 15,840 18,080 22,700 29,300 45,270

Obs&Gyne 28961 Diagnostic Laparo+Hystero+Eb Obs & Gynae Cat 21 19,340 22,010 27,470 35,750 55,080

Obs&Gyne 28963 Diag Lap +Hystero+Chromotubation+Eb Obs & Gynae Cat 22 21,030 23,970 29,990 38,960 59,850

Obs&Gyne 28964 Diag Lap+Chromo+Eb Obs & Gynae Cat 19 15,840 18,080 22,700 29,300 45,270

Biopsy Of Vulva Or Perineum; Each Separate Additional


Obs&Gyne 28993 Obs & Gynae Cat 9 3,650 4,200 5,190 6,730 10,370
Lesion
Obs&Gyne 28995 Destruction Of Vaginal Lesion(S); Simple Obs & Gynae Cat 9 3,650 4,200 5,190 6,730 10,370
Colposcopy Of The Entire Vagina, With Cervix If Present;
Obs&Gyne 29007 Obs & Gynae Cat 15 9,260 10,660 13,320 17,240 26,490
With Biopsy(S) Of Vagina/Cervix
Colposcopy Of The Entire Vagina, With Cervix If Present;
Obs&Gyne 29008 Obs & Gynae Cat 15 9,260 10,660 13,320 17,240 26,490
With Biopsy(S) Of
Colposcopy Of The Cervix Including Upper/Adjacent Vagina;
Obs&Gyne 29009 Obs & Gynae Cat 15 9,260 10,660 13,320 17,240 26,490
With Biopsy(S) Of The Cervix & Endo, Cure,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina;
Obs&Gyne 29010 Obs & Gynae Cat 12 6,160 7,150 8,960 11,630 17,810
With Biopsy(S) Of The Cervix
Colposcopy Of The Cervix Including Upper/Adjacent Vagina;
Obs&Gyne 29013 Obs & Gynae Cat 15 9,260 10,660 13,320 17,240 26,490
With Loop Electrode Conization Of The Cerv
Biopsy, Single Or Multiple, Or Local Excision Of Lesion, With
Obs&Gyne 29014 Obs & Gynae Cat 9 3,650 4,200 5,190 6,730 10,370
Or Without Fulguration (Sep. Proc.)
Conization Cervix, +/- Fulguration, +/- Dilation & Curettage,
Obs&Gyne 29016 Obs & Gynae Cat 15 9,260 10,660 13,320 17,240 26,490
+/- Repair; Loop Electrode Excision
Endometrial Sampling +/- Endocervical Sampling, Without
Obs&Gyne 29020 Obs & Gynae Cat 9 3,650 4,200 5,190 6,730 10,370
Cervical Dilation, Any Method (Sep.Proc.)
Abdominal Myomectomy, 5 Or More Intramural Myomas +/-
Obs&Gyne 29022 Obs & Gynae Cat 25 30,970 35,320 44,150 57,460 88,440
Intramural Myomas With Total Weight > 250G
Total Abdominal Hyst +/- Removal Of Tube(S)/ Ovary(S); With
Obs&Gyne 29023 Obs & Gynae Cat 25 30,970 35,320 44,150 57,460 88,440
Colpo-Urethrocystopexy (Eg, Burch)
Vaginal Hyst, For Uterus 250 G Or Less With Anterior /
Obs&Gyne 29027 Obs & Gynae Cat 21 19,340 22,010 27,470 35,750 55,080
Posterior Repair
Vaginal Hyst, With Total Or Partial Vaginectomy; With Repair
Obs&Gyne 29029 Obs & Gynae Cat 23 22,810 25,640 32,100 41,920 64,050
Of Enterocele
Vaginal Hyst, For Descended Uterus 250-500 G; With Removal
Obs&Gyne 29030 Obs & Gynae Cat 26 34,760 39,800 49,760 64,610 110,720
Of Tube(S) &/Or Ovary(S)/Mild Adh.

55
Surgeon fee
Surgery Double/ Single/ Classic
Department Surgery Name Category Economy Suite
ID Day care ICU Deluxe
Vaginal Hyst, For Descended Uterus 250-500 G; With Removal
Obs&Gyne 29032 Obs & Gynae Cat 28 42,600 48,640 60,820 79,200 121,800
Of Tube(S) &/Or Ovary(S)/Severe Adh.
Vaginal Hyst, For Uterus Greater Than 250 G; With Repair Of
Obs&Gyne 29033 Obs & Gynae Cat 25 30,970 35,320 44,150 57,460 88,440
Enterocele
Lap, Supracervical Hyst, For Uterus > 250-500 G; With
Obs&Gyne 29036 Obs & Gynae Cat 25 30,970 35,320 44,150 57,460 88,440
Removal Of Tube(S) / Ovary(S) / Moderate Adhes
Lap, Supracervical Hyst, For Uterus >500 G; With Removal Of
Obs&Gyne 29037 Obs & Gynae Cat 26 34,760 39,800 49,760 64,610 110,720
Tube(S) / Ovary(S)/With Severe
Lavh, For Uterus 250 G Or Less; /+/- Bso Or Moderate
Obs&Gyne 29038 Obs & Gynae Cat 26 34,760 39,800 49,760 64,610 110,720
Adhesiolysis / Removal To Mass
Lavh, For Uterus 250-500 G /+/- Bso Or Moderate
Obs&Gyne 29039 Obs & Gynae Cat 27 38,820 44,290 55,370 71,900 115,950
Adhesiolysis / Removal To Mass
Total Laproscopic Hyst. With 250 -500Gms/ Or Mild Adhesions
Obs&Gyne 29040 Obs & Gynae Cat 27 38,820 44,290 55,370 71,900 115,950
/ +Bso
Total Lap.c Hyst.With Extensive Dense Adhesions Involving
Obs&Gyne 29041 Obs & Gynae Cat 29 46,530 53,120 66,430 86,340 132,730
Bowel & Bladder Muscle/Mucosa
Ndvh (Non Descent Vaginal Hyst<Than 250 Gm With
Obs&Gyne 29042 Obs & Gynae Cat 26 34,760 39,800 49,760 64,610 110,720
Cystectomy/Salpingo Oophorectomy/Mild Adhesi
Ndvh (Non Descent Vaginal Hyst.< Than 250 Gm With
Obs&Gyne 29043 Obs & Gynae Cat 27 38,820 44,290 55,370 71,900 115,950
Moderate Adhesiolysis +/- Bso
Ndvh (Non Descent Vaginal Hyst. 250-500Gm With Moderate
Obs&Gyne 29045 Obs & Gynae Cat 28 42,600 48,640 60,820 79,200 121,800
Adhesiolysis
Lap. Myomectomy, Excision;1 To 4 Intramural Myomas Total
Obs&Gyne 29057 Obs & Gynae Cat 25 30,970 35,320 44,150 57,460 88,440
Weight 250 G Or< /Removal Surface Myomas
Hysteroscopy, Surgical; With Sampling (Biopsy) Of
Obs&Gyne 29059 Obs & Gynae Cat 14 7,720 8,820 11,080 14,290 22,010
Endometrium &/Or Polypectomy, +/- D&C
Hysteroscopy, Surgical; With Lysis Of Grade 1 Intrauterine
Obs&Gyne 29060 Obs & Gynae Cat 14 7,720 8,820 11,080 14,290 22,010
Adhesions (Any Method)
Hysteroscopy, Surgical; With Lysis Of Grade 2 Intrauterine
Obs&Gyne 29061 Obs & Gynae Cat 15 9,260 10,660 13,320 17,240 26,490
Adhesions (Any Method)
Hysteroscopy, Surgical; With Lysis Of Grade 3 Intrauterine
Obs&Gyne 29062 Obs & Gynae Cat 18 14,720 16,820 21,030 27,340 42,050
Adhesions (Any Method)
Hysteroscopy, Surgical; With Lysis Of Grade 4 Intrauterine
Obs&Gyne 29063 Obs & Gynae Cat 20 16,950 19,480 25,610 31,540 48,640
Adhesions (Any Method)
Hysteroscopy,+ Endometrial Ablation (Endometrial
Obs&Gyne 29066 Obs & Gynae Cat 18 14,720 16,820 21,030 27,340 42,050
Resection/Electrosurgical Ablation/Thermoablation)
Ligation Or Transection Of Fallopian Tube(S), Abdominal/
Obs&Gyne 29067 Obs & Gynae Cat 14 7,720 8,820 11,080 14,290 22,010
Vaginal Approach, Unilateral Or Bilateral
Laparoscopy With Lysis Of Adhesions (Salpingolysis,
Obs&Gyne 29069 Obs & Gynae Cat 18 14,720 16,820 21,030 27,340 42,050
Ovariolysis) (Separate Procedure)
Laparoscopy With Removal Of Adnexal Structures (Partial /
Obs&Gyne 29070 Obs & Gynae Cat 18 14,720 16,820 21,030 27,340 42,050
Total Oophorectomy &/Or Salpingectomy)
Laparoscopy Fulguration Or Excision Of Lesions Of The Ovary,
Obs&Gyne 29071 Obs & Gynae Cat 18 14,720 16,820 21,030 27,340 42,050
Pelvic Viscera, Or Peritoneal Surface
Salpingectomy, Complete Or Partial, Unilateral Or Bilateral
Obs&Gyne 29074 Obs & Gynae Cat 17 13,170 15,010 18,770 24,390 37,560
(Separate Procedure)
Salpingo-Oophorectomy, Complete Or Partial, Unilateral Or
Obs&Gyne 29075 Obs & Gynae Cat 17 13,170 15,010 18,770 24,390 37,560
Bilateral (Separate Procedure)
Endometrial Ablation, Thermal, Without Hysteroscopic
Obs&Gyne 28869 Obs & Gynae Cat 17 13,170 15,010 18,770 24,390 37,560
Guidance
Lap, Radical Hyst, Bilateral Pelvic Lymphadenectomy & Para-
Obs&Gyne 29084 Obs & Gynae Cat 30 54,100 61,950 77,360 100,640 154,730
Aortic L N Sampling +/- Bso
Lap, Radical Hyst(Lavh) >500Gms, Bilat Pelviic L Ectomy & P-
Obs&Gyne 29087 Obs & Gynae Cat 32 65,740 75,130 93,910 122,070 187,800
Aortic L N Sampling +/- Bso
Lap Treatment Of Ectopic Pregnancy; Interstitial, Uterine
Obs&Gyne 29095 Obs & Gynae Cat 26 34,760 39,800 49,760 64,610 110,720
Pregnancy Requiring Tlh Hyst,
Lap / Vaginal Treatment Of Ectopic Pregnancy; Without
Obs&Gyne 29098 Obs & Gynae Cat 18 14,720 16,820 21,030 27,340 42,050
Salpingectomy &/Or Oophorectomy
Lap/ Vaginal Treatment Of Ectopic Pregnancy; With
Obs&Gyne 29099 Obs & Gynae Cat 21 19,340 22,010 27,470 35,750 55,080
Salpingectomy &/Or Oophorectomy
Subtotal / Total Hyst , After Cesarean (List Separately In
Obs&Gyne 29101 Obs & Gynae Cat 25 30,970 35,320 44,150 57,460 88,440
Addition To Code For Primary Procedure)
Induced Abortion /On /More Intra-Amniotic
Obs&Gyne 29105 Obs & Gynae Cat 16 11,630 13,320 16,680 21,730 33,360
Inj.(Amniocentesis-Injections), Delivery Of Fetus,+D&C
Induced Abortion, By One Or > Intra-Amniotic
Obs&Gyne 29106 Obs & Gynae Cat 18 14,720 16,820 21,030 27,340 42,050
Inj.(Amniocentesis-Inj.), Delivery Of Fetus+Hyst

Obs&Gyne 29107 Mid trimester abortion with or without D & C Obs & Gynae Cat 14 7,720 8,820 11,080 14,290 22,010

Induced Abortion, By Vaginal Suppositories (Eg, Prostagl&In)


Obs&Gyne 29108 Obs & Gynae Cat 18 14,720 16,820 21,030 27,340 42,050
Delivery Of Fetus Etc With Hyst
Lap Removal Of U/L Endometrioma With Moderate
Obs&Gyne 29110 Obs & Gynae Cat 22 21,030 23,970 29,990 38,960 59,850
Adhesiolysis / Involving Bowel/ Bladder Serosa

56
Surgeon fee
Surgery Double/ Single/ Classic
Department Surgery Name Category Economy Suite
ID Day care ICU Deluxe
Lap Removal Of U/L Endometrioma With Extensive
Obs&Gyne 29111 Obs & Gynae Cat 26 34,760 39,800 49,760 64,610 110,720
Adhesiolysis/Involving Bowel Bladder Muscle/Mucosa
Lap Removal Of B/L Endometrioma With Moderate
Obs&Gyne 29112 Obs & Gynae Cat 24 27,190 31,120 38,820 50,460 77,640
Adhesiolysis / Involving Bowel Bladder Serosa
Lap Removal Of B/L Endometrioma With Extensive
Obs&Gyne 29113 Obs & Gynae Cat 28 42,600 48,640 60,820 79,200 121,800
Adhesiolysis/Involving Bowel Bladder Muscle/Mucosa
Lap Removal Of B/L Endometrioma With Moderate
Obs&Gyne 29114 Obs & Gynae Cat 29 46,530 53,120 66,430 86,340 132,730
Adhesiolysis & Clearance Of Pod
Lap Removal Of B /L Endometrioma With Extensive
Obs&Gyne 29115 Obs & Gynae Cat 30 54,100 61,950 77,360 100,640 154,730
Adhesiolysis & Clearance Of Pod
Lap Mild Adhesiolysis-Add On Procedure (List Separately In
Obs&Gyne 29116 Obs & Gynae Cat 12 6,160 7,150 8,960 11,630 17,810
Addition To Code For Primary Procedure)
Abdominal Adhesiolysis Mild (Add on Procedure in Addition to
Obs&Gyne 29133 Obs & Gynae Cat 10 4,350 4,910 6,160 7,990 12,340
Code for Prim. Pro)-MILD
Abdominal Adhesiolysis Mild (Add on Procedure in Addition to
Obs&Gyne 29135 Obs & Gynae Cat 14 7,720 8,820 11,080 14,290 22,010
code for Prim. Pro.)-Sever
Abdominal Myomectomy, 1 To 4 Myoma(S)/Total Weight of =
Obs&Gyne 29136 Obs & Gynae Cat 21 19,340 22,010 27,470 35,750 55,080
< 250 G +/- Removal of Surface Myomas
Abdominal Myomectomy, 5 Or More Myomas +/- Intramural
Obs&Gyne 29137 Obs & Gynae Cat 22 21,030 23,970 29,990 38,960 59,850
Myomas /Total Weight 250-500 G
Abdominal Myomectomy, 5 Or More Myomas +/- Intramural
Obs&Gyne 29138 Obs & Gynae Cat 23 22,810 25,640 32,100 41,920 64,050
Myomas/ Total Weight > 500
Abdominal salpingectomy/ Complete Or Partial, U/L Or B/L
Obs&Gyne 29139 Obs & Gynae Cat 17 13,170 15,010 18,770 24,390 37,560
(Sepa. Pro)
Abdominal salpingo-Oophorectomy, Complete or Partial, U/L
Obs&Gyne 29140 Obs & Gynae Cat 19 15,840 18,080 22,700 29,300 45,270
or B/l (Sepa. Pro)
Hysteroscopic tubal cannulation for proximal tubal block
Obs&Gyne 29141 Obs & Gynae Cat 20 16,950 19,480 25,610 31,540 48,640
bilateral
Hysteroscopic tubal cannulation for proximal tubal block
Obs&Gyne 29142 Obs & Gynae Cat 18 14,720 16,820 21,030 27,340 42,050
unilateral
Incision & drainage of vulval hematoma > 5cm diameter /125
Obs&Gyne 29145 Obs & Gynae Cat 14 7,720 8,820 11,080 14,290 22,010
CC
Lap / Vaginal Ovarian Cystectomy, Unilateral or Bilateral < 5
Obs&Gyne 29147 Obs & Gynae Cat 18 14,720 16,820 21,030 27,340 42,050
CM
Lap / Vaginal Ovarian Cystectomy, Unilateral or Bilateral > 5
Obs&Gyne 29148 Obs & Gynae Cat 19 15,840 18,080 22,700 29,300 45,270
CM
Lap / vaginal salpingo-Oophorectomy, Complete or Partial,
Obs&Gyne 29151 Obs & Gynae Cat 19 15,840 18,080 22,700 29,300 45,270
Unilateral or Bilateral (Sepa.Pro)
Lap Myomectomy, Excision; 5 Or More Intramural Myomas/
Obs&Gyne 29153 Obs & Gynae Cat 27 38,820 44,290 55,370 71,900 115,950
Intramural Myomas Total Weight > 500 G
Lap Myomectomy, Excision; 5 Or More Intramural Myomas/
Obs&Gyne 29154 Obs & Gynae Cat 23 22,810 25,640 32,100 41,920 64,050
Intramural Myomas Total Weight > 250-500 G
Lap Salpingectomy/ Complete or Partial, Unilateral or
Obs&Gyne 29155 Obs & Gynae Cat 18 14,720 16,820 21,030 27,340 42,050
Bilateral (Sepa.Pro)

Obs&Gyne 29156 Laparotomy (Open & Close) Obs & Gynae Cat 20 16,950 19,480 25,610 31,540 48,640

Obs&Gyne 29157 Laparotomy with Adhesiolysis MILD Obs & Gynae Cat 18 14,720 16,820 21,030 27,340 42,050

Obs&Gyne 29159 Laparotomy with Adhesiolysis SEVERE Obs & Gynae Cat 22 21,030 23,970 29,990 38,960 59,850

Ligation/Transection Fallopian Tube(S),


Obs&Gyne 29161 Abdominal/Vaginal/Postpartum During Same Hospitalization Obs & Gynae Cat 14 7,720 8,820 11,080 14,290 22,010
(Se
Paravaginal Defect Repair (Including Cystocele, Stress
Obs&Gyne 29167 Obs & Gynae Cat 20 16,950 19,480 25,610 31,540 48,640
Urinary Incontinence, &/or Incomplete Vaginal

Obs&Gyne 29170 Total Abdominal Hysterectomy uterus 250-500 gms Obs & Gynae Cat 22 21,030 23,970 29,990 38,960 59,850

Obs&Gyne 29171 Total Abdominal Hysterectomy uterus < 250gms Obs & Gynae Cat 21 19,340 22,010 27,470 35,750 55,080

Obs&Gyne 29172 Total Abdominal Hysterectomy uterus > 500 gms Obs & Gynae Cat 23 22,810 25,640 32,100 41,920 64,050

Obs&Gyne 29177 Vaginal Hyst, For descended Uterus < 250 G;+ A/P repair Obs & Gynae Cat 25 30,970 35,320 44,150 57,460 88,440

Obs&Gyne 29179 Cerclage Of Uterine Cervix, Nonobstetrical Obs & Gynae Cat 12 6,160 7,150 8,960 11,630 17,810

Obs&Gyne 29185 Combined Anteroposterior Colporrhaphy Obs & Gynae Cat 16 11,630 13,320 16,680 21,730 33,360

Combined Anteroposterior Colporrhaphy; With Enterocele


Obs&Gyne 29186 Obs & Gynae Cat 17 13,170 15,010 18,770 24,390 37,560
Repair
Colpopexy, Vaginal; Extra-Peritoneal Approach (Sacrospinous,
Obs&Gyne 29187 Obs & Gynae Cat 16 11,630 13,320 16,680 21,730 33,360
Iliococcygeus)

Obs&Gyne 29188 Colposcopy +Hysteroscopy+Leep+Eb Obs & Gynae Cat 20 16,950 19,480 25,610 31,540 48,640

57
Surgeon fee
Surgery Double/ Single/ Classic
Department Surgery Name Category Economy Suite
ID Day care ICU Deluxe

Obs&Gyne 29190 Diagnostic Lap With Chromotubation Obs & Gynae Cat 17 13,170 15,010 18,770 24,390 37,560

Obs&Gyne 29191 Diagnostic Laparoscopy Obs & Gynae Cat 16 11,630 13,320 16,680 21,730 33,360

Endometrial Sampling Performed With Colposcopy (List


Obs&Gyne 29195 Obs & Gynae Cat 10 4,350 4,910 6,160 7,990 12,340
Separately In Addition To Code For Prim.Proc.)

Obs&Gyne 29197 Fractional Curettage Obs & Gynae Cat 10 4,350 4,910 6,160 7,990 12,340

Hysteroscopy, Surgical; With Division Or Resection Of


Obs&Gyne 29198 Obs & Gynae Cat 19 15,840 18,080 22,700 29,300 45,270
Complete Intrauterine Septum (Any Method)
Hysteroscopy, Surgical; With Division Or Resection Of
Obs&Gyne 29199 Obs & Gynae Cat 18 14,720 16,820 21,030 27,340 42,050
Intrauterine Sub Septate Septum (Any Method)
Lap / Vaginal Oophorectomy, Partial Or Total, Unilateral Or
Obs&Gyne 29200 Obs & Gynae Cat 18 14,720 16,820 21,030 27,340 42,050
Bilateral
Laparoscopic / Vaginal Biopsy Of Ovary, Unilateral Or
Obs&Gyne 29203 Obs & Gynae Cat 17 13,170 15,010 18,770 24,390 37,560
Bilateral (Separate Procedure)

Obs&Gyne 29204 Laparoscopic Ablation Of Endometriosis Obs & Gynae Cat 17 13,170 15,010 18,770 24,390 37,560

Obs&Gyne 29205 Laparoscopic Drainage Of Ovarian Abscess Obs & Gynae Cat 18 14,720 16,820 21,030 27,340 42,050

Laparoscopic Drainage Of Ovarian Cyst(S), Unilateral Or


Obs&Gyne 29206 Obs & Gynae Cat 17 13,170 15,010 18,770 24,390 37,560
Bilateral, (Sepa. Proc.); Approach
Laparoscopy, Surgical; With Fulguration Of Oviducts (With Or
Obs&Gyne 29208 Obs & Gynae Cat 15 9,260 10,660 13,320 17,240 26,490
Without Transection)
Laparoscopy, Surgical; With Occlusion Of Oviducts By Device
Obs&Gyne 29209 Obs & Gynae Cat 15 9,260 10,660 13,320 17,240 26,490
(Eg, B&, Clip, Or Falope Ring)

Obs&Gyne 29210 Laproscopic Ovarian Drilling Obs & Gynae Cat 17 13,170 15,010 18,770 24,390 37,560

Obs&Gyne 29211 Laproscopic Removal Of Lost IUCD Obs & Gynae Cat 18 14,720 16,820 21,030 27,340 42,050

Obs&Gyne 29212 Laproscopic Targeted Biopsy Obs & Gynae Cat 17 13,170 15,010 18,770 24,390 37,560

Obs&Gyne 29213 Pelvic Examination Under Anesthesia Obs & Gynae Cat 6 1,820 2,110 2,660 3,510 5,330
Lap/Vaginal Wedge Resection or Bisection of Ovary,
Obs&Gyne 29216 Obs & Gynae Cat 18 14,720 16,820 21,030 27,340 42,050
Unilateral or Bilateral
Lap Extensive Adhesiolysis / Involving Bowel Bladder
Obs&Gyne 29231 Obs & Gynae Cat 27 38,820 44,290 55,370 71,900 115,950
Muscle/Mucosa Prim. Pro.)
Lap Moderate Adhesiolysis / Involving Bowel Bladder Serosa
Obs&Gyne 29232 Obs & Gynae Cat 14 7,720 8,820 11,080 14,290 22,010
Prim. Pro.)
Lap Removal of B/L Endometrioma With Extensive
Obs&Gyne 29233 Obs & Gynae Cat 31 61,810 70,640 88,440 114,920 176,740
Adhesiolysis
Ligation/Transection Fallopian Tube(S) At Cesarean Or Intra-
Obs&Gyne 29234 Obs & Gynae Cat 12 6,160 7,150 8,960 11,630 17,810
Abdominal Surgery
NDVH 250-500Gm Previous 1Cs/Abdominal
Obs&Gyne 29235 Obs & Gynae Cat 27 38,820 44,290 55,370 71,900 115,950
Procedure/Nulliparous Removal Of Ovarian Mass
Total / near total resection Recurrent Ovar/ Tubal/ Prim.
Obs&Gyne 29240 Obs & Gynae Cat 32 65,740 75,130 93,910 122,070 187,800
Periton/ Uter Malign (Intra-Abd/ Retroperi
Total Lap. Hyst. With Extensive Dense Adhesions Involving
Obs&Gyne 29243 Obs & Gynae Cat 29 46,530 53,120 66,430 86,340 132,730
Bowel & Bladder Muscle / Mucosa
Total Lap.Hyst.With > 500 Gms/With Mod Adhesions/Involving
Obs&Gyne 29244 Obs & Gynae Cat 28 42,600 48,640 60,820 79,200 121,800
Bowel & Bladder Serosa R
Vag. Hyst, For Uterus >500 G; +Removal Of Tube(S) &/Or
Obs&Gyne 29246 Obs & Gynae Cat 28 42,600 48,640 60,820 79,200 121,800
Ovary(S),+ Repair Of Enterocele / Moderate Ad
Vag. Hyst,Uterus 250 G Or Less; Removal Of Tube(S), &/Or
Obs&Gyne 29247 Obs & Gynae Cat 23 22,810 25,640 32,100 41,920 64,050
Ovary(S),+ Repair Of Enterocele / Moderate
Vag. Hyst, >500 G; With Colpo-Urethrocystopexy Type,
Obs&Gyne 29251 Obs & Gynae Cat 29 46,530 53,120 66,430 86,340 132,730
Pereyra Type) +/- Endoscopic Control/ Severe Ad
Vag. Hyst, For descebded Uterus >500 G; Without Removal of
Obs&Gyne 29252 Obs & Gynae Cat 27 38,820 44,290 55,370 71,900 115,950
Tube(S) &/Or Ovary(S),+Repair Of Enteroce
Abdominal Adhesiolysis Mild (Add on procedure in Addition ot
Obs&Gyne 30020 Obs & Gynae Cat 12 6,160 7,150 8,960 11,630 17,810
Code for Prim. Pro.)-Moderate

Obs&Gyne 32010 Lap Myomectomy Excision >7 Obs & Gynae Cat 29 46,530 53,120 66,430 86,340 132,730

Obs&Gyne 32011 Trans Cervcal Resection of Endometrium Obs & Gynae Cat 20 16,950 19,480 25,610 31,540 48,640

Lap/ Vaginal Ovarian Cystectomy, Unilateral or Bilateral >7


Obs&Gyne 36202 Obs & Gynae Cat 22 21,030 23,970 29,990 38,960 59,850
CM

Obs&Gyne 32012 Lap Colposacropexy Obs & Gynae Cat 27 38,820 44,290 55,370 71,900 115,950

Biopsy Of Vulva Or Perineum (Separate Procedure) One


Obs&Gyne 28765 Obs & Gynae Cat 9 3,650 4,200 5,190 6,730 10,370
Lesion

Obs&Gyne 28777 Plastic Repair Of Introitus Obs & Gynae Cat 11 5,050 5,330 7,150 9,260 14,290

58
Surgeon fee
Surgery Double/ Single/ Classic
Department Surgery Name Category Economy Suite
ID Day care ICU Deluxe
Obs&Gyne 28780 Colposcopy Of The Vulva Obs & Gynae Cat 9 3,650 4,200 5,190 6,730 10,370
Obs&Gyne 28786 Biopsy Of Vaginal Mucosa; Simple (Separate Procedure) Obs & Gynae Cat 9 3,650 4,200 5,190 6,730 10,370
Repair Of Enterocele, Abdominal Approach (Separate
Obs&Gyne 28802 Obs & Gynae Cat 21 19,340 22,010 27,470 35,750 55,080
Procedure)

Obs&Gyne 28808 Pereyra Procedure, Including Anterior Colporrhaphy Obs & Gynae Cat 15 9,260 10,660 13,320 17,240 26,490

Obs&Gyne 28809 Construction Of Artificial Vagina; Without Graft Obs & Gynae Cat 20 16,950 19,480 25,610 31,540 48,640

Obs&Gyne 28818 Vaginoplasty For Intersex State Obs & Gynae Cat 23 22,810 25,640 32,100 41,920 64,050

Obs&Gyne 28819 Dilation Of Vagina Under Anesthesia Obs & Gynae Cat 6 1,820 2,110 2,660 3,510 5,330

Obs&Gyne 28827 Cautery Of Cervix; Laser Ablation Obs & Gynae Cat 12 6,160 7,150 8,960 11,630 17,810

Obs&Gyne 28840 Supracervical Abdominal Hysterectomy <250 Gms (Subtotal) Obs & Gynae Cat 19 15,840 18,080 22,700 29,300 45,270

Obs&Gyne 28842 Supracervical Abdominal Hysterectomy(Subtotal),>500 Gms Obs & Gynae Cat 21 19,340 22,010 27,470 35,750 55,080

Vaginal Hysterectomy, For Uterus 250 G Or Less;With Repair


Obs&Gyne 28843 Obs & Gynae Cat 22 21,030 23,970 29,990 38,960 59,850
Of Enterocele

Obs&Gyne 28845 Lap Burch Colposuspension (Obs & Gyn) Obs & Gynae Cat 23 22,810 25,640 32,100 41,920 64,050

Laparoscopic,Supracervical Hysterectomy, For Uterus 250-


Obs&Gyne 28849 Obs & Gynae Cat 24 27,190 31,120 38,820 50,460 77,640
500 G

Obs&Gyne 28855 Lavh, For Uterus 250-500 G ; +/- Bso / Mild Adhesiolysis Obs & Gynae Cat 26 34,760 39,800 49,760 64,610 110,720

Obs&Gyne 28860 Lavh, For Uterus >500 G +/- Bso Severe Adhesiolysis Obs & Gynae Cat 29 46,530 53,120 66,430 86,340 132,730

Obs&Gyne 28864 Ndvh (Non Descent Vaginal Hysterectomy More Than 500 Gms Obs & Gynae Cat 27 38,820 44,290 55,370 71,900 115,950

Obs&Gyne 28870 Hysterorrhaphy, Repair Of Ruptured Uterus (Nonobstetrical) Obs & Gynae Cat 21 19,340 22,010 27,470 35,750 55,080

Obs&Gyne 28872 Hysteroplasty, Repair Of Uterine Anomaly Level 1 Obs & Gynae Cat 18 14,720 16,820 21,030 27,340 42,050

Obs&Gyne 28873 Hysteroplasty, Repair Of Uterine Anomaly Level 2 Obs & Gynae Cat 19 15,840 18,080 22,700 29,300 45,270

Obs&Gyne 28887 Laparoscopy, Surgical; With Fimbrioplasty Obs & Gynae Cat 18 14,720 16,820 21,030 27,340 42,050

Obs&Gyne 28889 Lysis Of Adhesions (Salpingolysis, Ovariolysis) Obs & Gynae Cat 18 14,720 16,820 21,030 27,340 42,050

Obs&Gyne 28925 Cerclage Of Cervix, During Pregnancy; Abdominal Obs & Gynae Cat 16 11,630 13,320 16,680 21,730 33,360

Obs&Gyne 28936 ETC Obs & Gynae Cat 10 4,350 4,910 6,160 7,990 12,340

Obs&Gyne 28942 Drainage Of Abdominal Wall Hematoma Obs & Gynae Cat 9 3,650 4,200 5,190 6,730 10,370

Obs&Gyne 28968 Single Pregnancy, Amniocentesis, Therapeutic High Risk Obs & Gynae Cat 14 7,720 8,820 11,080 14,290 22,010

Vaginal Hyst,Uterus 250 G Or Less; Colpo-Urethrocystopexy


Obs&Gyne 28989 Obs & Gynae Cat 24 27,190 31,120 38,820 50,460 77,640
(Marshall-M-K / Pereyra) +/- Endos
Removal Of Impacted Vaginal Foreign Body (Separate
Obs&Gyne 29006 Obs & Gynae Cat 12 6,160 7,150 8,960 11,630 17,810
Procedure) Under Anesthesia
Colposcopy Of The Cervix Including Upper/Adjacent Vagina;
Obs&Gyne 29011 Obs & Gynae Cat 12 6,160 7,150 8,960 11,630 17,810
With Endocervical Curettage
Colposcopy Of The Cervix Including Upper/Adjacent Vagina;
Obs&Gyne 29012 Obs & Gynae Cat 12 6,160 7,150 8,960 11,630 17,810
With Loop Electrode Biopsy(S) Of The Cervi

Obs&Gyne 29034 Lap, Surgical, Supracervical Hyst, For Uterus 250 G Or Less Obs & Gynae Cat 23 22,810 25,640 32,100 41,920 64,050

Lap. Myomectomy, Excision; 5 Or More Intramural Myomas/


Obs&Gyne 29058 Obs & Gynae Cat 23 22,810 25,640 32,100 41,920 64,050
Intramural Myomas Total Weight >250 G
Occlusion Of Fallopian Tube(S) By Device (Eg, B&, Clip,
Obs&Gyne 29068 Obs & Gynae Cat 14 7,720 8,820 11,080 14,290 22,010
Falope Ring) Vaginal Or Suprapubic Approach
Radical Abdo Hyst, Bilat Total Pelvic Lymphadenectomy &
Obs&Gyne 29083 Obs & Gynae Cat 28 42,600 48,640 60,820 79,200 121,800
Para-Aortic L N Sampling (Biopsy)+/-Bso
Lap, Radical Hyst 250-500Gms, Bilat Pelviic L Ectomy & P-
Obs&Gyne 29086 Obs & Gynae Cat 31 61,810 70,640 88,440 114,920 176,740
Aortic L N Sampling +/- Bso
Total Lapradical Hyst(Tlh) <250Gms, Bilat Pelviic L Ectomy &
Obs&Gyne 29088 Obs & Gynae Cat 31 61,810 70,640 88,440 114,920 176,740
P-Aortic L N Sampling +/- Bso
Surgical Treatment Of Ectopic Pregnancy; Interstitial,
Obs&Gyne 29094 Obs & Gynae Cat 22 21,030 23,970 29,990 38,960 59,850
Uterine Pregnancy Requiring Total Hyst,
Lap Treatment Of Ectopic Pregnancy; Interstitial, Uterine
Obs&Gyne 29097 Obs & Gynae Cat 23 22,810 25,640 32,100 41,920 64,050
Pregnancy+ Partial Resection Of Uterus

Obs&Gyne 29102 VBAC(Vaginal Birth after previous caesarean surgery) Obs & Gynae Cat 25 30,970 35,320 44,150 57,460 88,440

59
Surgeon fee
Surgery Double/ Single/ Classic
Department Surgery Name Category Economy Suite
ID Day care ICU Deluxe

Induced Abortion, One /> Intra-Amniotic Inj.(Amniocentesis-


Obs&Gyne 29104 Obs & Gynae Cat 12 6,160 7,150 8,960 11,630 17,810
Inj.), Including Delivery Of Fetus & Secu

Obs&Gyne 29146 Induced abortion by medical method without D&C Obs & Gynae Cat 10 4,350 4,910 6,160 7,990 12,340

Obs&Gyne 29149 LAP/VAG treatment of ectopic with oophorectomy Obs & Gynae Cat 20 16,950 19,480 25,610 31,540 48,640

Obs&Gyne 29158 Laparotomy with Adhesiolysis MODERATE Obs & Gynae Cat 20 16,950 19,480 25,610 31,540 48,640

Mesh Insertion For Repair Pelvic Floor Defect (List An /Post


Obs&Gyne 29162 Obs & Gynae Cat 12 6,160 7,150 8,960 11,630 17,810
Separately In Addition To Code For Prim
Oophorectomy, Partial/Total, Unilat/Bilat For Malignancy P-
Obs&Gyne 29164 Obs & Gynae Cat 26 34,760 39,800 49,760 64,610 110,720
Aortic & Pelvic L N Biopsies, Periton Was
Obs&Gyne 29169 Resuturing of Abdominal Wound superficial Obs & Gynae Cat 9 3,650 4,200 5,190 6,730 10,370

Obs&Gyne 29192 Drainage Of Ovarian Abscess; Abdominal Approach Obs & Gynae Cat 15 9,260 10,660 13,320 17,240 26,490

Lap. Hysteroplasty, Repair Of Uterine Anomaly (Strassman


Obs&Gyne 29202 Obs & Gynae Cat 23 22,810 25,640 32,100 41,920 64,050
Type) / Unification Of Double Uterine Horns
Vaginal Hysterectomy, For descebded Uterus >500 G; Without
Obs&Gyne 29227 Obs & Gynae Cat 14 7,720 8,820 11,080 14,290 22,010
Removal Of Tube(S) &/Or Ovary(S), With Re
Drainage of Pelvic Abscess, Transvaginal or Transrectal
Obs&Gyne 29229 Obs & Gynae Cat 16 11,630 13,320 16,680 21,730 33,360
Approach, Percutaneous
Resect Ovarian/ Tubal/ Primary Peritoneal Malig BSO &
Obs&Gyne 29236 Obs & Gynae Cat 30 54,100 61,950 77,360 100,640 154,730
Omentec
Vag. Myom, of Uterus, 1 To 4 Myoma/ Total Weight of = 250-
Obs&Gyne 29248 Obs & Gynae Cat 22 21,030 23,970 29,990 38,960 59,850
500 G +/- Removal of Surface Myomas

Obs&Gyne 28766 Vulvectomy Simple, Partial Obs & Gynae Cat 16 11,630 13,320 16,680 21,730 33,360

Removal Or Revision Of Sling For Stress Incontinence (Eg,


Obs&Gyne 28806 Obs & Gynae Cat 20 16,950 19,480 25,610 31,540 48,640
Fascia Or Synthetic)

Obs&Gyne 28886 Hysteroscopy, With Removal Of Impacted Foreign Body Obs & Gynae Cat 14 7,720 8,820 11,080 14,290 22,010

Obs&Gyne 29182 Closure Of Urethrovaginal Fistula Obs & Gynae Cat 18 14,720 16,820 21,030 27,340 42,050

Oncology 28594 Intersitial Brachytherapy Radical (Onco) Onco 14 7,360 8,400 10,510 13,660 21,020
Oncology 28595 Intersitial Brachytherapy Boost (Onco) Onco 14 7,360 8,400 10,510 13,660 21,020
Oncology 28599 Intracavity Brachytherapy (Onco) Onco 9 3,470 3,970 4,950 6,430 9,890
Oncology 25716 Proctoscopy with biopsy (Onco) Onco 9 3,470 3,970 4,950 6,430 9,890
Oncology 23416 Chemoport Removal Onco 8 2,700 3,090 3,880 5,020 7,740
Oncology 28461 Chemotherapy per Day Multiple dose (Onco) Onco 8 2,700 3,090 3,880 5,020 7,740
Oncology 25454 Supraomohyoid dissection - Bilateral (Onco) Onco 24 25,950 29,670 37,090 48,210 74,160
Oncology 25461 Hepaticojejunostomy (Onco) Onco 25 29,550 33,740 42,190 54,840 84,380
Oncology 28596 Intraoperative Brachytherapy (Onco) Onco 12 5,940 6,800 8,520 11,060 17,010
Oncology 25702 Proctoscopy (Onco) Onco 5 1,190 1,350 1,720 2,210 3,390
Oncology 38377 Lap Radical Hysterectomy type III (Onco) Onco 28 40,670 46,470 58,100 75,530 116,220
Oncology 25500 Liver tumors - Wide excision - 2-4 in no. Onco 29 44,360 50,680 63,370 82,380 126,710
Oncology 38394 B/ L Oophorectomy Onco 17 12,550 14,330 17,920 23,290 35,850
Oncology 39668 Enucleation of Pancreatic Tumour Onco 28 40,670 46,470 58,100 75,530 116,220
Oncology 39685 Pulmonary Metastasectomy Onco 26 33,200 37,960 47,450 61,670 105,690
Oncology 39678 Excision of neck mass Onco 16 11,140 12,740 15,920 20,700 31,830
Oncology 38218 Hyperthermia Intraperitoneal Chemotherapy (HIPEC) Onco 32 62,740 71,700 89,620 116,510 179,250
Oncology 25338 Dressing - Medium (Onco) Onco 5 1,190 1,350 1,720 2,210 3,390
Oncology 25369 Excision of Superficial Lesion - large (Onco) Onco 11 4,760 5,300 6,800 8,850 13,600
Oncology 25382 LN biopsy Deep - Neck, Axilla (Onco) Onco 15 8,870 10,140 12,670 16,460 25,340
Oncology 25384 Superficial Tumor excision - Large (Onco) Onco 15 8,870 10,140 12,670 16,460 25,340
Oncology 25385 Debridement - Medium (Onco) Onco 14 7,360 8,400 10,510 13,660 21,020
Oncology 25387 Breast lump Excision Biopsy - Large Onco 15 8,870 10,140 12,670 16,460 25,340
Oncology 25388 Liver Biopsy under GA (Onco) Onco 15 8,870 10,140 12,670 16,460 25,340
Superficial tumor or multiple tumor - large - wide excision
Oncology 25391 Onco 16 11,140 12,740 15,920 20,700 31,830
(Onco)
Oncology 25394 Orchidectomy- U/L (Onco) Onco 16 11,140 12,740 15,920 20,700 31,830
Oncology 25396 Secondary suturing - large (Onco) Onco 16 11,140 12,740 15,920 20,700 31,830
Oncology 38463 Hickman’s Catheter Insertion (Onco) Onco 16 11,140 12,740 15,920 20,700 31,830
Oncology 25397 Feeding Gastrostomy Onco 17 12,550 14,330 17,920 23,290 35,850
Oncology 25398 Feeding Jejunostomy Onco 17 12,550 14,330 17,920 23,290 35,850
Oncology 25400 Orchidectomy - bilateral (Onco) Onco 17 12,550 14,330 17,920 23,290 35,850
Oncology 25401 ICD placement (Onco) Onco 17 12,550 14,330 17,920 23,290 35,850
Oncology 25402 Colostomy - Diversion or end (Onco) Onco 18 14,080 16,070 20,090 26,120 40,170
Oncology 25405 High Orchidectomy (Onco) Onco 18 14,080 16,070 20,090 26,120 40,170
Oncology 25411 Exploratory Laparotomy only (Onco) Onco 19 15,150 17,300 21,640 28,120 43,270
Oncology 25412 Omentectomy (Onco) Onco 19 15,150 17,300 21,640 28,120 43,270
Oncology 25413 Abscess drainage - Intra-abdominal (Onco) Onco 19 15,150 17,300 21,640 28,120 43,270
Oncology 25415 Neck Tumor - neck tumor (Onco) Onco 19 15,150 17,300 21,640 28,120 43,270

60
Surgeon fee
Surgery Double/ Single/ Classic
Department Surgery Name Category Economy Suite
ID Day care ICU Deluxe
Oncology 25416 Submandibular gland excision for tumor (Onco) Onco 19 15,150 17,300 21,640 28,120 43,270
Oncology 25418 Pelvic / Axillary LN disection-unilateral (Onco) Onco 20 16,220 18,550 23,190 30,140 46,360
Oncology 25419 Thyroid Lobectomy/Hemithyroidectomy (Onco) Onco 20 16,220 18,550 23,190 30,140 46,360
Oncology 25422 Soft tissue tumor excison (peripheral) - small (Onco) Onco 20 16,220 18,550 23,190 30,140 46,360
Oncology 25426 Simple Mastectomy - large tumor (Onco) Onco 21 18,400 21,020 26,270 34,150 52,540
Oncology 25427 Radical / Modified Radical Mastectomy (Onco) Onco 22 20,030 22,860 28,590 37,170 57,180
Oncology 25428 Resection and Anastomosis for small bowel tumor (Onco) Onco 22 20,030 22,860 28,590 37,170 57,180
Colectomy - Right hem / left hemi / transverse / signoid -
Oncology 25429 Onco 22 20,030 22,860 28,590 37,170 57,180
Radical (Onco)
Oncology 25431 Parathyroidectomy (Onco) Onco 22 20,030 22,860 28,590 37,170 57,180
Oncology 25432 Thyroidectomy -Sub Total (Onco) Onco 22 20,030 22,860 28,590 37,170 57,180
Oncology 25433 Superficial Parotidectomy (Onco) Onco 22 20,030 22,860 28,590 37,170 57,180
Oncology 25439 Soft tissue tumor excision (peripheral) - medium (Onco) Onco 22 20,030 22,860 28,590 37,170 57,180
Oncology 25435 Retroperitoneal Tumor Excision - medium (Onco) Onco 22 20,030 22,860 28,590 37,170 57,180
Oncology 25440 Pelvic / Axillary LN dissection - bilateral (Onco) Onco 23 21,650 24,470 30,600 39,770 61,190
Oncology 25441 TAH+BSO (Onco) Onco 23 21,650 24,470 30,600 39,770 61,190
Oncology 25446 Breast Conservation Surgery (Onco) Onco 24 25,950 29,670 37,090 48,210 74,160
Oncology 25448 Colectomy - Radical Extended right / left hemi (Onco) Onco 24 25,950 29,670 37,090 48,210 74,160
Oncology 25451 Diagnostic laparoscopy with biopsy (Onco) Onco 24 25,950 29,670 37,090 48,210 74,160
Oncology 25453 Total Parotidectomy (Nerve Preserving) (Onco) Onco 24 25,950 29,670 37,090 48,210 74,160
Oncology 25456 Radical / Modified Neck Dissection (Unilateral) (Onco) Onco 24 25,950 29,670 37,090 48,210 74,160
Oncology 25457 Inguinal LN dissection - bilateral (Onco) Onco 24 25,950 29,670 37,090 48,210 74,160
Soft tissue tumor excision (peripheral) - large / Central -
Oncology 25460 Onco 24 25,950 29,670 37,090 48,210 74,160
Medium (Onco)
Oncology 39804 Axillary mass excision Onco 24 25,950 29,670 37,090 48,210 74,160
Partial Amputation of Penis with bilateral Block dissection
Oncology 25463 Onco 25 29,550 33,740 42,190 54,840 84,380
(Onco)
Oncology 25464 Pancreatectomy - Partial (Onco) Onco 25 29,550 33,740 42,190 54,840 84,380
Oncology 25465 Colectomy - Radical Total (Onco) Onco 25 29,550 33,740 42,190 54,840 84,380

Oncology 25467 Liver tumor -Wide excision - single, small /simple (Onco) Onco 25 29,550 33,740 42,190 54,840 84,380

Oncology 25476 Adrenalectomy - Subtotal (Onco) Onco 26 33,200 37,960 47,450 61,670 105,690
Oncology 25477 Adrenalectomy - Total (Onco) Onco 26 33,200 37,960 47,450 61,670 105,690
Oncology 25479 Thyroidectomy with neck dissection level II-IV (Onco) Onco 26 33,200 37,960 47,450 61,670 105,690
Oncology 25480 Radical/ Modified Neck Dissection (Bilateral) (Onco) Onco 26 33,200 37,960 47,450 61,670 105,690
Oncology 25482 Diagnostic thoracoscopy and biopsy Onco 26 33,200 37,960 47,450 61,670 105,690
Oncology 25485 Anterior Resection - Low (Onco) Onco 27 36,990 42,280 52,850 68,710 110,680
Oncology 25486 Gastrectomy- Radical Subtotal (D2) (Onco) Onco 27 36,990 42,280 52,850 68,710 110,680
Liver tumor - Wide excision - large tumor / complex
Oncology 25488 Onco 27 36,990 42,280 52,850 68,710 110,680
resection (Onco)
Oncology 25489 Retroperitoneal Tumor Excision - large (Onco) Onco 27 36,990 42,280 52,850 68,710 110,680
Oncology 25490 Nephrectomy - Radical (Onco) Onco 27 36,990 42,280 52,850 68,710 110,680
Oncology 25491 TAH + BSO + Pelvic LN dissection (Onco) Onco 27 36,990 42,280 52,850 68,710 110,680
Oncology 25493 Gastrectomy - Radical Total (D2 dissection) (Onco) Onco 28 40,670 46,470 58,100 75,530 116,220
Oncology 25496 TAH + BSO + Pelvic LN dissection + Omentectomy (Onco) Onco 28 40,670 46,470 58,100 75,530 116,220
Oncology 25497 Mediastinal tumor -Excision - small / medium Onco 28 40,670 46,470 58,100 75,530 116,220
Thyroidectomy with neck dissection II-IV + VI/ MND/ RND
Oncology 25498 Onco 28 40,670 46,470 58,100 75,530 116,220
(Onco)
Oncology 25501 Laryngectomy - Total with neck dissection (Onco) Onco 29 44,360 50,680 63,370 82,380 126,710
Oncology 25504 Esophagectomy - total - Trans - hiatal (Onco) Onco 30 51,690 59,090 73,860 96,030 147,730
Composite resection for Buccal Mucosa / GB sulcus / Floor
Oncology 25507 Onco 30 51,690 59,090 73,860 96,030 147,730
mouth/tongue with unilateral MND /RND (Onc
TAH + BSO + Pelvic LN dissection + Omentectomy + Para-
Oncology 25508 Onco 30 51,690 59,090 73,860 96,030 147,730
aortic LN sampling + Peritoneal biopsy (Onco)
Oncology 25509 Laparoscopy assisted malignant tumor surgery (Onco) Onco 30 51,690 59,090 73,860 96,030 147,730
Oncology 25511 Esophagectomy - total - Trans-thoracic (Onco) Onco 32 62,740 71,700 89,620 116,510 179,250
Oncology 25512 Radical Pancreato-duodenectomy (Onco) Onco 32 62,740 71,700 89,620 116,510 179,250
Oncology 25518 Pneumonectomy / Lobectomy Onco 32 62,740 71,700 89,620 116,510 179,250
Oncology 25520 Pancretectomy - Total (Onco) Onco 32 62,740 71,700 89,620 116,510 179,250
Oncology 25523 Hemipelvectomy (Onco) Onco 32 62,740 71,700 89,620 116,510 179,250
Oncology 25706 Suturing - Single Stitch (Onco) Onco 6 1,780 2,040 2,550 3,320 5,110
Oncology 25707 Wedge Biopsy - Superficial (Onco) Onco 6 1,780 2,040 2,550 3,320 5,110
Oncology 25708 Secondary Closure of Wound (SMALL) (Onco) Onco 7 2,170 2,470 3,090 4,010 6,180
Oncology 25713 Pleural Tapping - diagnostic (Onco) Onco 8 2,700 3,090 3,880 5,020 7,740
Oncology 25719 LN biopsy Superficial -Inguinal neck (Onco) Onco 10 4,120 4,700 5,880 7,640 11,750
Oncology 25720 Abscess Drainage - Large (Onco) Onco 10 4,120 4,700 5,880 7,640 11,750
Oncology 25729 Excision of Superficial Lesion - small (Onco) Onco 9 3,470 3,970 4,950 6,430 9,890
Oncology 25735 Breast lump - Excision Biopsy - small Onco 12 5,940 6,800 8,520 11,060 17,010
Oncology 25736 Superficial tumor wide excision - small (Onco) Onco 12 5,940 6,800 8,520 11,060 17,010
Oncology 25732 Pleural Tapping - Therapeutic (Onco) Onco 12 5,940 6,800 8,520 11,060 17,010
Oncology 25737 Debridement - Minor (Onco) Onco 11 4,760 5,300 6,800 8,850 13,600
Oncology 25738 Secondary Suturing - Small (Onco) Onco 12 5,940 6,800 8,520 11,060 17,010
Oncology 25741 Re-exploration of neck for chyle leak / bleeding (Onco Onco 16 11,140 12,740 15,920 20,700 31,830

61
Surgeon fee
Surgery Double/ Single/ Classic
Department Surgery Name Category Economy Suite
ID Day care ICU Deluxe
Oncology 25742 Ileostomy - Deversion or end (Onco) Onco 18 14,080 16,070 20,090 26,120 40,170
Exploratory laparotomy with adhesiolysis for dense adhesions
Oncology 25743 Onco 22 20,030 22,860 28,590 37,170 57,180
/ trial dissection for
Exploratory laparotomy with adhesiolysis and trial dissection
Oncology 25744 Onco 23 21,650 24,470 30,600 39,770 61,190
for tumor removal

Oncology 25747 Thyroidectomy - Total / Completion thyroidectomy (Onco) Onco 24 25,950 29,670 37,090 48,210 74,160

Oncology 25748 Partial Gastrectomy - palliative or otherwise (Onco) Onco 24 25,950 29,670 37,090 48,210 74,160
Oncology 25749 Soft tissue tumor excision (central) - Medium (Onco) Onco 26 33,200 37,960 47,450 61,670 105,690
Soft tissue tumor excision (central) - large / compartment
Oncology 25750 Onco 27 36,990 42,280 52,850 68,710 110,680
excision for peripheral soft
Composite resection for Buccal Mucosa / GB sulcus / Floor
Oncology 25751 Onco 32 62,740 71,700 89,620 116,510 179,250
mouth / tongue with Bilateral MND/ RND(Onc
Oncology 25799 Chemoporat Insertion (Permanent) Onco 16 11,140 12,740 15,920 20,700 31,830
Oncology 25801 Open Biopsy (Onco) Onco 12 5,940 6,800 8,520 11,060 17,010
Oncology 25980 Bone Marrow Aspiration (Onco) Onco 9 3,470 3,970 4,950 6,430 9,890
Oncology 25981 Bone Marrow Biopsy (Onco) Onco 12 5,940 6,800 8,520 11,060 17,010
Anterior Resection - High / Abdominoperineal resection
Oncology 26013 Onco 26 33,200 37,960 47,450 61,670 105,690
(Onco)
Oncology 26015 Gastrectomy - Radical Partial (D2 dissection) (Onco) Onco 26 33,200 37,960 47,450 61,670 105,690
Oncology 26016 Retroperitoneal Lymph Node Dissection (Onco) Onco 26 33,200 37,960 47,450 61,670 105,690
Oncology 27904 Superficial Tumor Excision face Small (Onco) Onco 18 14,080 16,070 20,090 26,120 40,170
Oncology 27905 Superficial Tumor Excision face Medium/Large (Onco) Onco 20 16,220 18,550 23,190 30,140 46,360

Oncology 28016 TAH + BSO + Pelvic LN dissection + Peritoneal washing (Onco) Onco 28 40,670 46,470 58,100 75,530 116,220

Oncology 29317 Oesophagectomy Onco 32 62,740 71,700 89,620 116,510 179,250


Oncology 29318 Thoracotomy Onco 24 25,950 29,670 37,090 48,210 74,160
Oncology 30387 Direct Laryngoscopy (Onco) Onco 7 2,170 2,470 3,090 4,010 6,180
Oncology 30389 Partial Maxillectomy (Onco) Onco 22 20,030 22,860 28,590 37,170 57,180
Oncology 30392 Total Glossectomy With Neck Dissection Onco 30 51,690 59,090 73,860 96,030 147,730
Oncology 30395 Parotidectomy With Neck Dissection Onco 28 40,670 46,470 58,100 75,530 116,220
Oncology 30666 Partial Glossectomy With Neck Dissection Onco 28 40,670 46,470 58,100 75,530 116,220
Oncology 33875 Endometrial biopsy Onco 8 2,700 3,090 3,880 5,020 7,740
Oncology 37563 Laser Fulguration For Recurrent Lesions Onco 16 11,140 12,740 15,920 20,700 31,830
Oncology 37564 Laser Excision Of Vocal Nodule/ Polyp/Leukoplakia Onco 16 11,140 12,740 15,920 20,700 31,830
Oncology 37565 Laser Excision Of Leukoplakia/Oral Cavity Cancer -Small Onco 16 11,140 12,740 15,920 20,700 31,830
Oncology 37566 Laser Aretynoidectomy/Posterior Cordotomy Onco 20 16,220 18,550 23,190 30,140 46,360
Laser Microlaryngoscopy Cord Stripping, Excision Cordectomy
Oncology 37567 Onco 20 16,220 18,550 23,190 30,140 46,360
Type I & II
Oncology 37568 Laser Oral Cavity Excision Mid Size Lesion Onco 20 16,220 18,550 23,190 30,140 46,360
Laser Microlaryngoscopy Cord Stripping, Excision Cordectomy
Oncology 37569 Onco 22 20,030 22,860 28,590 37,170 57,180
Type III
Oncology 37570 Laser Endoscopic Excision For Hyporphapynx CA Onco 22 20,030 22,860 28,590 37,170 57,180
Oncology 37571 Laser Fulguration /Excision Trachea Onco 22 20,030 22,860 28,590 37,170 57,180
Oncology 37572 Laser Fulguration Respiratory Papilloma Onco 22 20,030 22,860 28,590 37,170 57,180
Oncology 37573 Laser Subglottic Trachel Stenosis Onco 22 20,030 22,860 28,590 37,170 57,180
Oncology 37574 Laser Excision Supraglottic Onco 26 33,200 37,960 47,450 61,670 105,690
Oncology 37575 Laser Excision Of Oral Cavity Large Onco 26 33,200 37,960 47,450 61,670 105,690
Oncology 37576 Laser Extended Cordectomy Type IV & V Onco 32 62,740 71,700 89,620 116,510 179,250
Ophthalmology 14439 Pterygium with conjunctival grafting 10 4,310 4,930 6,150 8,000 12,310
Ophthalmology 14484 Retinocryopexy 10 4,310 4,930 6,150 8,000 12,310
Ophthalmology 14440 Conjunctival Flapping 9 3,630 4,160 5,190 6,740 10,350
Ophthalmology 14576 Repair of Lid Injuries 15 9,290 10,620 13,280 17,250 26,540
Ophthalmology 14578 Evisceration 14 7,720 8,800 11,000 14,310 22,020
Ophthalmology 26878 Anterior Chamber Wash/Reformation 14 7,720 8,800 11,000 14,310 22,020
Ophthalmology 14656 Ectropion 15 9,290 10,620 13,280 17,250 26,540
Ophthalmology 14658 Lid Tumours Excision & Repair without Grafting & Flaps 15 9,290 10,620 13,280 17,250 26,540
Ophthalmology 14701 Dacryocystorhinostomy / Cystectomy 16 11,680 13,340 16,680 21,680 33,350
Ophthalmology 14412 Corneal Foreign Body Removal – OT 8 2,820 3,230 4,050 5,250 8,110
Ophthalmology 33025 Customised Lasik with Ultra thin Flap 24 27,190 31,080 38,850 50,500 77,700
Ophthalmology 14413 Pterygium 9 3,630 4,160 5,190 6,740 10,350
Ophthalmology 14700 Perforating injuries of Cornea 16 11,680 13,340 16,680 21,680 33,350
Ophthalmology 15094 Orbitotomy 23 22,680 25,630 32,060 41,670 64,100
Ophthalmology 23289 Lid Injuring Repair - Major Injury 20 17,000 19,440 24,290 31,580 48,560
Ophthalmology 26195 Cornea scleral perforation repair 24 27,190 31,080 38,850 50,500 77,700
Ophthalmology 14702 Glaucoma surgery/ Trabeculectomy 17 13,150 15,020 18,770 24,410 37,560
Ophthalmology 23558 Chalazion I & C 9 3,630 4,160 5,190 6,740 10,350
Ophthalmology 25906 Chalazion (Opthal) 6 1,860 2,150 2,660 3,470 5,350
Ophthalmology 14441 Tarsorrhaphy – Temporary 9 3,630 4,160 5,190 6,740 10,350
Ophthalmology 14485 Cyclocrypexy 10 4,310 4,930 6,150 8,000 12,310
Ophthalmology 14559 Entropion 13 7,030 8,020 10,050 13,050 20,070
Ophthalmology 14577 Symblephron Release 14 7,720 8,800 11,000 14,310 22,020
Ophthalmology 14579 Ptosis – Fasenella 14 7,720 8,800 11,000 14,310 22,020

62
Surgeon fee
Surgery Double/ Single/ Classic
Department Surgery Name Category Economy Suite
ID Day care ICU Deluxe
Ophthalmology 14657 Enucleation 16 11,680 13,340 16,680 21,680 33,350
Ophthalmology 14659 Repair of Lid Coloboma without Grafting & Flaps 15 9,290 10,620 13,280 17,250 26,540
Ophthalmology 14660 Epicanthus 15 9,290 10,620 13,280 17,250 26,540
Ophthalmology 14793 Entropion / Ectropion with Grafting 17 13,150 15,020 18,770 24,410 37,560
Ophthalmology 14797 Cataract Surgery - SICS (Small Incision cataract Surgery) 16 11,680 13,340 16,680 21,680 33,350
Ophthalmology 14799 Perforating injuries of the Cornea & Sclera 18 14,740 16,830 21,050 27,370 42,080
Ophthalmology 14932 Ptosis - Fascia Lata Sling 19 15,870 18,130 22,670 29,450 45,320
Ophthalmology 14933 Squint Vertical Muscle 19 15,870 18,130 22,670 29,450 45,320
Ophthalmology 14935 Lensectomy 19 15,870 18,130 22,670 29,450 45,320
Ophthalmology 14936 Retinal Surgery 19 15,870 18,130 22,670 29,450 45,320
Ophthalmology 14937 Intracular Foreign Body Removal 19 15,870 18,130 22,670 29,450 45,320
Ophthalmology 14938 Exenteration 19 15,870 18,130 22,670 29,450 45,320
Ophthalmology 14939 Corneal Grafting 19 15,870 18,130 22,670 29,450 45,320
Lid Tumours Excision & Repair with skin / Mucosal Grafting or
Ophthalmology 14940 19 15,870 18,130 22,670 29,450 45,320
Flap Construction
Repair of Lid Coloboma with skin / Mucosal Grafting or flap
Ophthalmology 14941 19 15,870 18,130 22,670 29,450 45,320
construction

Ophthalmology 15048 Epicanthus with Telecanthus correction (Trans Nasal Wiring) 21 19,270 22,020 27,530 35,780 55,040

Ophthalmology 22880 Subconjunctival injection (Optho) 3 370 430 550 710 1,060
Ophthalmology 22881 Stye I & D 4 730 850 1,060 1,390 2,150
Ophthalmology 22882 Corneal Foreign Body Removal-OPD 4 730 850 1,060 1,390 2,150
Ophthalmology 22884 Aspiration of cyst (superficial) 5 1,250 1,410 1,800 2,320 3,560
Ophthalmology 22886 Drainage Lactimal Abscess 6 1,860 2,150 2,660 3,470 5,350
Ophthalmology 22889 Probing Syringing 7 2,270 2,590 3,230 4,200 6,480
Ophthalmology 23285 Blepharoplasty 15 9,290 10,620 13,280 17,250 26,540
Ophthalmology 23560 Iridectomy 14 7,720 8,800 11,000 14,310 22,020
Ophthalmology 24215 Phakic IOL Implantation 20 17,000 19,440 24,290 31,580 48,560
Ophthalmology 24617 Orthoptic exercises - Additional sitting 1 200 220 250 330 450
Ophthalmology 24618 Orthoptic or convergence exercise (full course 10 sitting) 5 1,250 1,410 1,800 2,320 3,560
Ophthalmology 24620 Chemical Cacuterization 4 730 850 1,060 1,390 2,150
Ophthalmology 24621 Corneal scraping 3 370 430 550 710 1,060
Ophthalmology 24622 Diurnal variation + Admission 6 1,860 2,150 2,660 3,470 5,350
Ophthalmology 24624 Expression of Concretions 3 370 430 550 710 1,060
Ophthalmology 24625 Filament removal 3 370 430 550 710 1,060
Ophthalmology 24626 Fluorescein Angioscopy 5 1,250 1,410 1,800 2,320 3,560
Ophthalmology 24628 Fundus Photograhy 5 1,250 1,410 1,800 2,320 3,560
Ophthalmology 24629 Gonoisocpy 3 370 430 550 710 1,060
Ophthalmology 24631 Laser Photocoagulation per sitting eye 8 2,820 3,230 4,050 5,250 8,110
Ophthalmology 24632 Laser Prophylaxix 8 2,820 3,230 4,050 5,250 8,110
Ophthalmology 24633 Othoptic Exercises (Max. 10 Sitting) 5 1,250 1,410 1,800 2,320 3,560
Ophthalmology 24634 Probing & Syringing (Bilateral) 5 1,250 1,410 1,800 2,320 3,560
Ophthalmology 24636 PRP (Both eye maxium 4 sittings) 20 17,000 19,440 24,290 31,580 48,560
Ophthalmology 24637 PRP (Both eyes ) - 4 sitting 19 15,870 18,130 22,670 29,450 45,320
Ophthalmology 24638 PRP (Each eye 1 sitting) 8 2,820 3,230 4,050 5,250 8,110
Ophthalmology 24640 Schirmer s test Ph 2 250 270 360 460 720
Ophthalmology 24641 Schirmers Test 3 370 430 550 710 1,060
Ophthalmology 24642 Syringing 3 370 430 550 710 1,060
Ophthalmology 24643 Three mirror examination 3 370 430 550 710 1,060
Ophthalmology 24644 Water Drinking Test 4 730 850 1,060 1,390 2,150
Ophthalmology 24645 YAG Capsulotomy (opthal) 8 2,820 3,230 4,050 5,250 8,110
Ophthalmology 24646 Subtenons Injection 4 730 850 1,060 1,390 2,150
Ophthalmology 25905 Dressing (Opthal) 2 250 270 360 460 720
Ophthalmology 25907 Contact Lens Trial (Opthal) 4 730 850 1,060 1,390 2,150
Ophthalmology 25908 Electrolysis (Opthal) 5 1,250 1,410 1,800 2,320 3,560
Ophthalmology 25910 Peripheral Iridotomy Laser (Opthal) 9 3,630 4,160 5,190 6,740 10,350
Ophthalmology 25912 Squint work Up (Opthal) 4 730 850 1,060 1,390 2,150
Ophthalmology 25913 Visual Field Examination 30-2 (Opthal) 5 1,250 1,410 1,800 2,320 3,560
Ophthalmology 25945 Drainage Lid Abscess (Opthal) 6 1,860 2,150 2,660 3,470 5,350
Ophthalmology 26357 Glaucoma Valve Surgery 18 14,740 16,830 21,050 27,370 42,080
Ophthalmology 26870 Silicon Oil Removal 11 4,980 5,550 7,130 9,270 14,250
Ophthalmology 26876 Buccal Removal 9 3,630 4,160 5,190 6,740 10,350
Ophthalmology 14703 Cataract Surgery- ECCE 17 13,150 15,020 18,770 24,410 37,560
Ophthalmology 14792 Tarsorrhaphy - Permanent 17 13,150 15,020 18,770 24,410 37,560
Ophthalmology 14794 Repair of Lacrimal Canaliculi 17 13,150 15,020 18,770 24,410 37,560
Ophthalmology 44167 Retina Cyclocryotherapy & ARC 10 4,310 4,930 6,150 8,000 12,310
Ophthalmology 44168 ROP Laser Barrage-One Eye 10 4,310 4,930 6,150 8,000 12,310
Ophthalmology 44169 Socket Surgery Mucus membrane/Dermis fat graft 16 11,680 13,340 16,680 21,680 33,350
Ophthalmology 14795 Ptosis - LPS resection 18 14,740 16,830 21,050 27,370 42,080
Ophthalmology 14798 Cataract Surgery - Phacoemulsification 18 14,740 16,830 21,050 27,370 42,080
Ophthalmology 14934 Vitreo-Retinal Surgery 20 17,000 19,440 24,290 31,580 48,560
Ophthalmology 22883 Sutur removal (Corneo-scleral) 4 730 850 1,060 1,390 2,150
Ophthalmology 22888 Examination Under GA 7 2,270 2,590 3,230 4,200 6,480

63
Surgeon fee
Surgery Double/ Single/ Classic
Department Surgery Name Category Economy Suite
ID Day care ICU Deluxe
Ophthalmology 23288 Lid Injuring Repair - Minor Inury 16 11,680 13,340 16,680 21,680 33,350
Ophthalmology 24619 Biometry(opthal) 5 1,250 1,410 1,800 2,320 3,560
Ophthalmology 24630 Indirect opthalmoscopy 3 370 430 550 710 1,060
Ophthalmology 24635 Probing & Syringing (Unilateral) 5 1,250 1,410 1,800 2,320 3,560
Ophthalmology 24639 PRP One Eye (maximum 4 sittings) 14