Room, Bed & Board

Code
ROO001
ROO002
ROO003

ROOM, BED & BOARD

ROOM/BED AND BOARD : PER DAY
OPERATION ROOM CHARGES(30% OF THE
SURGICAL FEE)
ROOM - (RETAINED BY THE ATTENDANTS)

PR
3000

SPR
1800

NSB
1100

30%

30%

30%

3000

1800

1100

GOPD

POPD

CASUALTY

GOPD

POPD

CASUALTY

Note : The charges for 'Operating Room' will be 30% of the Surgeon's fee.

Medical Care
Code
MED005
MED006

MEDICAL CARE
VISITS
CONSULTATIONS

PR
600
600

SPR
500
500

NSB
400
400

Note : The above mentioned 'Visiting charges' will not be applicable to the patients admitted by Visiting Consultants as their 'PRIVATE PATIENT'. Visiting
Consultants are free to charge a differential fee for their Private Patients.

ICU/CCU & Board

Code
ICU001
ICU002
ICU003
ICU004

ICU/CCU & BOARD

ICU / CCU AND BOARD CHARGES : PER DAY
PED. ICU/305 AND BOARD CHARGES : PER DAY
INTENSIVE NURSING CARE UNIT - 415
POST OP. ICU / SEMI ICU AND BOARD
CHARGES : PER DAY

PR
4000
1200
1800

SPR
4000
1200
1800

NSB
4000
1200
1800

3000

3000

3000

GOPD

POPD

CASUALTY

Note : ICU / CCU (Intensive / Coronary Care Unit) / Post-op. ICU and Ped. ICU charges include bed and monitoring charges for all vital parameters. All other
service charges will be as per the category in which the patient is admitted.

Delivery
Code
DEL001
DEL002

DELIVERY
NORMAL DELIVERY
FORCEPS DELIVERY

PR
7000
8000

SPR
6000
7000

NSB
5000
6000

GOPD

POPD

CASUALTY

SPR
500

NSB
400

GOPD

POPD

CASUALTY

Note : The charges for 'Operating Room for Delivery cases' will be 30% of the Delivery fee.

Cardiac Monitoring
Code
CAR001
CAR002

CARDIAC MONITORING
CARDIAC MONITOR : PER DAY
CARDIAC MONITORING IN CASUALTY

PR
500

100

Surgery : General
Code
GES001
GES002
GES003
GES004
GES005
GES006
GES007
GES008
GES009
GES010
GES011
GES012
GES013
GES015
GES016
GES017
GES018
GES019
GES020

SURGERY : GENERAL
APPENDICECTOMY
CHOLECYSTECTOMY WITH DUCT
EXPLORATION
EXPLORATORY LAPAROTOMY ONLY
GASTRECTOMY
GASTRECTOMY WITH VAGOTOMY
GASTROJEJNOSTOMY
GASTROJEJUNOSTOMY WITH VAGOTOMY
GASTROSTOMY
INTESTINAL RESECTION WITH ANASTOMOSIS SINGLE
LYSIS OF INTESTINAL ADHESION
LYSIS OF ADHESION WITH BOWEL RESECTION
WITHANASTOMOSIS
HEMICOLECTOMY
COLECTOMY WITH ILEOSTOMY
PYLOROPLASTY WITH VAGOTOMY
SPLENECTOMY
DRAINAGE OF SMALL ABSCESS
ASPIRATION OF SUPERFICIAL COLD ABSCESS
SUTURING OF SMALL WOUNDS
LYMPH NODE BIOPSY

PR
12000

SPR
9600

NSB
7200

18000

14400

10800

8000
17000
18000
14000
16000
10000

6400
13600
14400
11200
12800
8000

4800
10200
10800
8400
9600
6000

14000

11200

8400

11000

8800

6600

14000

11200

8400

18000
18000
14000
16000
2000
2000
2500
5000

14400
14400
11200
12800
1600
1600
2000
4000

10800
10800
8400
9600
1200
1200
1500
3000

1/37

GOPD

POPD

CASUALTY

GES021
GES022
GES023
GES024
GES025
GES026
GES027
GES028
GES029
GES030
GES031
GES032
GES033
GES035
GES036
GES037
GES038
GES039
GES040
GES041
GES042
GES043
GES044
GES045
GES046
GES047
GES048
GES049
GES050
GES051
GES052
GES053
GES054
GES055
GES056
GES057
GES058
GES059
GES060
GES061
GES062
GES063
GES064
GES065
GES066
GES067
GES068
GES069
GES070
GES071
GES072
GES073
GES074
GES075
GES076
GES077
GES078
GES079

AXILLARY LYMPH NODE BIOPSY

EXCISION BIOPSY-SUPERFICIAL LUMPS
TRUCUT NEEDLE BIOPSY
INTESTINAL PERFORATION
ILEOTRANSVERSE COLOSTOMY
SIGMOID DIVERTICULUM
PARTIAL SUBTOTAL GASTRECTOMY CA./ULCER
TOTAL GASTRECTOMY FOR CA.
REPAIR OF COMMON BILE DUCT (C.B.D.)
TOTAL COLECTOMY
GLAND BIOPSY
EXCISION OF MESENTERIC CYST
EXCISION OF SMALL INTESTINAL FISTULA
DUODENAL DIVERTICULAM
RECURRENT INTESTINAL OBSTRUCTION
ADRENALECTOMY
OPERATION FOR PANCREAS
OESOPHAGO GASTRECTOMY
PANCREATICO DUODONECTOMY
PAROTIDECTOMY
BLOCK DISSECTION NECK
THYROIDECTOMY TOTAL
HEMI THYROIDECTOMY
PARATHYROIDECTOMY
EXCISION OF PILONIDAL SINUS
LIGATION OF VARICOSE VEINS : UNILATERAL
COLOSTOMY
EXCISION OF SUBMANDIBULAR GLAND
RESUTURING OF WOUNDS - SMALL
SECONDARY SUTURING OF ABDOMINAL WALL
LAPAROSCOPIC CHOLECYSTECTOMY
DIVERTICULECTOMY
OMENTECTOMY
COLOSTOMY / ILEOSTOMY CLOSURE
EXCISION OF SEBACEOUS CYST
INTESTINAL OBSTRUCTION
DEBRIDEMENT(LARGE)
DEBRIDEMENT(SMALL)
EXCISION OF LARGE SUPERFICIAL SOFT
TISSUE MASS /TUMOUR
LAPAROSCOPIC APPENDICECTOMY
LAPAROSCOPIC DEROOTING OF NON-HYDATID
LIVER CYST
LAPAROSCOPIC DRAINAGE OF LIVER ABCESS
LAPAROSCOPIC GASTRIC PERFORATION
CLOSURE
LAPAROSCOPIC GASTRO-JEJUNOSTOMY (GJ)
LAPAROSCOPIC TRUNCAL VAGOTOMY AND
GASTRO JEJUNOSTO
LAPAROSCOPIC DRAINAGE OF
INTRA-ABDOMINAL COLLECTIO
LAPAROSCOPIC DUODENAL PERFORATION
CLOSURE
HIGHLY SELECTIVE VAGOTOMY
LAPAROTOMY AND BOWEL RESECTION FOR
INTUSSUSCEPTION
LAPAROTOMY AND CLOSURE OF INTESTINAL
PERFORATION
LAPAROTOMY AND REDUCTION OF
INTUSSUSCEPTION
LAPAROTOMY AND DIVISION OF
INTRA-ABDOMINAL ADHESIONS/BANDS
LEFT HEPATECTOMY
LEFT LIVER LOBECTOMY
MULTIPLE INTESTINAL RESECTION WITH
ANASTOMOSIS
RADICAL CHOLECYSTECTOMY
RESUTURING OF WOUNDS - LARGE
SUB-TOTAL COLECTOMY

6000
6000
3000
14000
15000
15000
18000
24000
18000
22000
5000
14000
14000
20000
14000
17500
22000
22000
22000
18000
20000
18000
14000
14000
11000
10000
10000
8500
3500
8000
15000
10000
12000
12000
4000
14000
5000
3000

4800
4800
2400
11200
12000
12000
14400
19200
14400
17600
4000
11200
11200
16000
11200
14000
17600
17600
17600
14400
16000
14400
11200
11200
8800
8000
8000
6800
2800
6400
12000
8000
9600
9600
3200
11200
4000
2400

3600
3600
1800
8400
9000
9000
10800
14400
10800
13200
3000
8400
8400
12000
8400
10500
13200
13200
13200
10800
12000
10800
8400
8400
6600
6000
6000
5100
2100
4800
9000
6000
7200
7200
2400
8400
3000
1800

12000

9600

7200

12000

9600

7200

17000

13600

10200

16000

12800

9600

18000

14400

10800

18000

14400

10800

20000

16000

12000

15000

12000

9000

18000

14400

10800

12000

9600

7200

14000

11200

8400

14000

11200

8400

12000

9600

7200

14000

11200

8400

22000
24000

17600
19200

13200
14400

20000

16000

12000

22000
5000
18000

17600
4000
14400

13200
3000
10800

2/37

GES080
GES081
GES082
GES083
GES084
GES085
GES086
GES087
GES088
GES089
GES090
GES091
GES092
GES093
GES094
GES095
GES096
GES098
GES099
GES100
GES101
GES102
GES103
GES104
GES105
GES106
GES107
GES108

TRUNCAL VAGOTOMY AND GASTRO

JEJUNOSTOMY
TRUNCAL VAGOTOMY AND PYLOROPLASTY
OPEN CHOLECYSTECTOMY
PARATHYROID ADENOMA WITH HEMI
THYROIDECTOMY
EXP.LAPAROTOMY+CHOLEDOCHLITHOTOMY +
CHOLEDOCHO DUODENOSTOMY
DRAINAGE OF LARGE INTRA ABDOMINAL
ABSCESS
EXP.LAP.RESECTION OF LIVER SEG.-EXCISION
OF UMBILICAL PORT
DELTOID MUSCLE BIOPSY
REMOVAL OF DEEP FOREIGN BODY-LIMBS
REMOVAL OF SUPERFICIAL FOREIGN
BODY-LIMBS
SCLEROTHERAPY
DIAGNOSTIC LAPAROSCOPY ONLY
DIAGNOSTIC LAPAROSCOPY WITH BIOPSY
DIAGNOSTIC LAPAROSCOPY WITH MULTIPLE
BIOPSIES
FASCIOTOMY (WITH DRAINAGE OF
DISCHARGING SINUS)
FASCIOTOMY - MULTIPLE (WITH DRAINAGE OF
DISCHARGING SINUS)
NEEDLE ASPIRATION OF ABSCESS
DEBRIDEMENT(MEDIUM)
EXCISION OF CARBUNCLE
EXCISION OF MEDIUM SUPERFICIAL SOFT
TISSUE MASS /TUMOUR
EXCISION OF SMALL SUPERFICIAL SOFT
TISSUE MASS /TUMOUR
DRAINAGE OF LARGE AND DEEP ABSCESS
FASCIOTOMY - REDO
FASCIOTOMY - REDO (MULTIPLE)
INTESTINAL RESECTION WITH ANASTOMOSIS MULTIPLE
OPEN CHOLECYSTECTOMY WITH CBD
EXPLORATION
REMOVAL OF SUPERFICIAL FOREIGN
BODY-LIMBS - MINOR
REMOVAL OF MESH & TACKERS

17000

13600

10200

18000
15000

14400
12000

10800
9000

18000

14400

10800

20000

16000

12000

10000

8000

6000

20000

16000

12000

4000
12000

3200
9600

2400
7200

7000

5600

4200

5000
7000
11000

4000
5600
8800

3000
4200
6600

13000

10400

7800

8000

6400

4800

12000

9600

7200

3000
4000
12000

2400
3200
9600

1800
2400
7200

9000

7200

5400

7000

5600

4200

4000
6000
9000

3200
4800
7200

2400
3600
5400

18000

14400

10800

17000

13600

10200

4000

3200

2400

10000

8000

6000

PR
8000
5000
10000
11000
6000
4000

SPR
6400
4000
8000
8800
4800
3200

NSB
4800
3000
6000
6600
3600
2400

24000

19200

14400

16000

12800

9600

18000

14400

10800

12000
5000

9600
4000

7200
3000

PR
5000
6000
4500
12000

SPR
4000
4800
3600
9600

NSB
3000
3600
2700
7200

18000

14400

10800

Surgery : Rectal
Code
RES001
RES002
RES003
RES004
RES005
RES006
RES007
RES008
RES009
RES010
RES011

SURGERY : RECTAL
FISSURECTOMY
ANAL DILATATION
FISTULECTOMY
HAEMORRHOIDECTOMY
I. & D. OF ISCHIO-RECTAL ABSCESS
RECTAL POLYP EXCISION
ABDOMINAL PERINEAL RESECTION FOR CA.
RECTUM
ANTERIOR RESECTION
ANTERIOR RESECTION WITH TOTAL
MESORECTAL EXCISION
STAPLED HAEMORRHOIDECTOMY
PERIANAL ABSCESS DRAINAGE

GOPD

POPD

CASUALTY

GOPD

POPD

CASUALTY

Surgery : Breast
Code
BRS001
BRS002
BRS003
BRS004
BRS005

SURGERY : BREAST
BIOPSY OF BREAST
EXCISION OF SMALL FIBROADENOMA
I. & D. OF BREAST ABSCESS
MASTECTOMY SIMPLE
MASTECTOMY RADICAL WITH AUX. LYMPH
NODES

3/37

BRS006
BRS007
BRS008
BRS009
BRS010

EXCISION OF MAMMARY FISTULA

SEGMENTAL RESECTION OF BREAST
LUMPECTOMY - LARGE
WIDE EXCISION BIOPSY OF BREAST
LUMPECTOMY - SMALL

7500
7500
8000
9000
6000

6000
6000
6400
7200
4800

4500
4500
4800
5400
3600

PR
10000
12000
14000
12000
10000
7000
10000
12000
12000
15000
14000

SPR
8000
9600
11200
9600
8000
5600
8000
9600
9600
12000
11200

NSB
6000
7200
8400
7200
6000
4200
6000
7200
7200
9000
8400

12000

9600

7200

16000
10500

12800
8400

9600
6300

16000

12800

9600

22000

17600

13200

12000

9600

7200

14000

11200

8400

14000

11200

8400

17000

13600

10200

14000

11200

8400

11000

8800

6600

18000

14400

10800

14000

11200

8400

18000

14400

10800

18000

14400

10800

15000

12000

9000

15000

12000

9000

17000

13600

10200

12000
18000
16000
14000
14000

9600
14400
12800
11200
11200

7200
10800
9600
8400
8400

PR
18000
17000
19000
3600
6000
2500
3000
3500
3000

SPR
14400
13600
15200
2880
4800
2000
2400
2800
2400

NSB
10800
10200
11400
2160
3600
1500
1800
2100
1800

Surgery : Hernia
Code
HES001
HES002
HES003
HES004
HES005
HES006
HES007
HES008
HES009
HES010
HES011
HES012
HES013
HES014
HES015
HES017
HES018
HES019
HES020
HES022
HES023
HES024
HES025
HES026
HES027
HES028
HES029
HES030
HES031
HES032
HES033
HES034
HES035
HES036

SURGERY : HERNIA
INGUINAL HERNIA : UNILATERAL
INGUINAL HERNIA WITH ORCHIDECTOMY
RECURRENT HERNIA (INCISIONAL) B/L
VENTRAL HERNIA (INCISIONAL)
UMBILICAL HERNIA
HYDROCELECTOMY : UNILATERAL
ORCHIDECTOMY : UNILATERAL OR BILATERAL
EPIGASTRIC HERNIA
FEMORAL HERNIA
HIATUS HERNIA
STRANGULATED HERNIA
INGUINAL HERNIA WITH MESH REPAIR :
UNILATERAL
ABDOMINOPLASTY WITH MESH
HYDROCELECTOMY : BILATERAL
INGUINAL HERNIA WITH MESH REPAIR :
BILATERAL
INCISIONAL HERNIA REPAIR WITH
ABDOMINOPLASTY
INGUINAL HERNIA - BILATERAL
LAPAROSCOPIC EPIGASTRIC HERNIA
REPAIR-ONLAY MESH
LAPAROSCOPIC EPIGASTRIC HERNIA
REPAIR-INLAY MESH
LAPAROSCOPIC FUNDOPLICATION(NISSEN)
LAPAROSCOPIC INGUINAL HERNIORRHAPHY
B/L
LAPAROSCOPIC INGUINAL HERNIORRHAPHY
U/L
LAPAROSCOPIC INGUINAL
HERNIORRHAPHY+MESH B/L
LAPAROSCOPIC INGUINAL
HERNIORRHAPHY+MESH U/L
LAPAROSCOPIC LUMBAR HERINA REPAIR
LAPAROSCOPIC TOTAL EXTRA- (TEP )
BILATERAL
LAPARASCOPIC TOTAL EXTRA PERITONEAL
MESH - (TEP) - UNILATERAL
LAPAROSCOPIC UMBILICAL HERNIA REPAIRONLAY MESH
NISSEN FUNDOPLICATION AND HIATUS HERNIA
REPAIR
RECURRENT HERNIA (INCISIONAL) U/L
RECURRENT HERNIA WITH MESH B/L
RECURRENT HERNIA WITH MESH U/L
UMBILICAL HERNIA REPAIR WITH MESH
INCISIONAL HERNIA REPAIR WITH MESH

GOPD

POPD

CASUALTY

GOPD

POPD

CASUALTY

Surgery : O.B. & Gynae

Code
OGS001
OGS002
OGS003
OGS004
OGS005
OGS006
OGS007
OGS008
OGS009

SURGERY : O.B. & GYNAE

VAGINOPLASTY
NON DESCENT VAGINAL HYSTERECTOMY
RADICAL VULVECTOMY
HYSTEROSCOPY
HYSTEROSCOPY WITH D. & C.
E.U.A. (EXAMINATION UNDER ANEASTHESIA)
DILATATION & EVACUATION (D. & E.)
D. & C. WITH CERVIX BIOPSY
DILATATION & CURETTAGE (D.& C.)

4/37

OGS010
OGS011
OGS012
OGS013
OGS014
OGS015
OGS016
OGS017
OGS018
OGS019
OGS020
OGS021
OGS022
OGS023
OGS024
OGS025
OGS026
OGS027
OGS028
OGS029
OGS030
OGS031
OGS032
OGS033
OGS034
OGS035
OGS036
OGS037
OGS038
OGS040
OGS041
OGS042
OGS043
OGS044
OGS045
OGS046
OGS048
OGS049
OGS050
OGS051
OGS052
OGS053
OGS055
OGS056
OGS057
OGS058
OGS060
OGS061
OGS062
OGS063
OGS064
OGS065
OGS066
OGS068
OGS069
OGS070
OGS071
OGS072

PANHYSTERECTOMY/TAH WITH BSO

VAGINAL HYSTERECTOMY WITH VAGINAL AND
PELVIC FLOOR REPAIR
ABDOMINAL HYSTERECTOMY
OOPHRECTOMY/SALPINGECTOMY
SALPINGO-OOPHRECTOMY
MAC DONALD STITCH / CERVICAL ENCIRCLAGE
ANTERIOR & POSTERIOR COLPORRHAPHY
L.S.C.S. WITH TUBECTOMY
L.S.C.S. WITH HYSTERECTOMY
REPAIR OF VESICO-VAGINAL FISTULA
LAPAROSCOPIC CYST ASPIRATION
L.S.C.S.
OVARECTOMY
OVARIAN CYSTECTOMY
WEDGE RESECTION OF OVARY
EXCISION OF LABIAL CYST / BARTHOLINS CYST
VAULT PROLASE REPAIR - VAGINAL ROUTE
VAULT PROLASE REPAIR - ABDOMINAL
COLPOSUSPENSION
DRAINAGE OF ABSCESS BARTHOLINS CYST
HYSTEROSCOPIC POLYPECTOMY
MYOMECTOMY
DIAGNOSTIC LAPROSCOPY
CRYOSURGERY
COMPLETE PERINEAL TEAR REPAIR
LAPROTOMY FOR ECTOPIC PREGNANCY
LAPROSCOPIC ASSISTED VAGINAL
HYSTERECTOMY(LAVH)
MANUAL REMOVAL OF PLACENTA
HEMATOMA DRAINAGE
HYMENECTOMY
FOTHERGILS / MANCHESTER OPERATION FOR
UTERINE PROLAPSE
LAPROTOMY FOR TWISTED OVARIAN
SHIRODHKAR SUTURE
RESUTURING OF ABDOMINAL WOUND - MINOR
RESUTURING OF EPISIOTOMY WOUND
VULVAL BIOPSY
I & D OF LABIAL ABCESS U/L OR B/L
LAPROTOMY & REPOSITIONING OF
UTERUS(HAULTENS TECH.)
D. & C. WITH POLYPECTOMY
OVARIAN CYST ASPIRATION WITHOUT
BIOPSY-U/L
OVARIAN CYST ASPIRATION WITH BIOPSY-U/L
OVARIAN CYST ASPIRATION WITHOUT
BIOPSY-B/L
OVARIAN CYST ASPIRATION WITH BIOPSY-B/L
SUCTION AND EVACUATION
DIAGNOSTIC LAPROSCOPY WITH TUBAL
MILKING (FOR ECTOPIC PREGNANCY)
RESUTURING OF ABDOMINAL WOUND - MAJOR
HYSTEROTOMY
ANTERIOR COLPORRAPHY
INTERNAL ILIAC ARTERY LIGATION
SIMPLE VULVECTOMY
CAUTERY OF VAGINAL VALUT GRANULOMA
REPOSITIONING OF INVERTED UTERUS (
UTERINE INVERSION)
REPAIR OF RECTOVAGINAL FISTULA (RVF)
CONE BIOPSY OF CERVIX
DIAGNOSTIC LAPAROSCOPY AND
HYSTEROSCOPY
MANUAL REMOVAL OF PLACENTA IN O.T.
END TO END FALLOPIAN TUBAL
RECANALISTION / ANASTOMISIS - U /L OR B/L
LAPAROSCOPY WITH OVARIAN BIOPSY
LAPAROSCOPY & HYSTEROSCOPY WITH
OVARIAN DRILLING

19000

15200

11400

17000

13600

10200

17000
9500
9500
5000
8500
14000
18000
17000
8000
12500
9500
9500
9500
6000
16000

13600
7600
7600
4000
6800
11200
14400
13600
6400
10000
7600
7600
7600
4800
12800

10200
5700
5700
3000
5100
8400
10800
10200
4800
7500
5700
5700
5700
3600
9600

16000

12800

9600

4000
8000
14000
7000
6000
5000
12000

3200
6400
11200
5600
4800
4000
9600

2400
4800
8400
4200
3600
3000
7200

18000

14400

10800

3000
3000
3000

2400
2400
2400

1800
1800
1800

10000

8000

6000

12000
5000
2500
3000
2500
4000

9600
4000
2000
2400
2000
3200

7200
3000
1500
1800
1500
2400

14000

11200

8400

3500

2800

2100

7000

5600

4200

8000

6400

4800

8500

6800

5100

10000
3000

8000
2400

6000
1800

12000

9600

7200

4000
12000
7000
8000
15000
1000

3200
9600
5600
6400
12000
800

2400
7200
4200
4800
9000
600

5000

4000

3000

10000
6000

8000
4800

6000
3600

8500

6800

5100

4000

3200

2400

16000

12800

9600

10000

8000

6000

10000

8000

6000

5/37

OGS073
OGS074
OGS075
OGS076
OGS077
OGS078
OGS079
OGS080
OGS081
OGS082
OGS083
OGS084
OGS085
OGS086

EXCISION OF VAGINAL WALL CYST

LAPAROSCOPY & HYSTEROSCOPY WITH
OVARIAN BIOPSY
FOREGIN BODY REMOVAL FROM VAGINA
LAPAROSCOPIC SALPINGO-OOPHORECTOMY
LAPAROSCOPIC SALPINGOSTOMY FOR
ECTOPIC PREGNANCY
HEMATOCOLPOS DRAINAGE / COLPOTOMY
LAPAROSCOPIC SALPINGECTOMY FOR
ECTOPIC PREGNANCY
HYSTEROSCOPIC DIVISION OF THICK
SYNECHAIE
LAPAROSCOPIC OVARIAN CYSTECTOMY
HYSTEROSCOPIC DIVISION OF THIN
SYNECHAIE
HYSTEROSCOPIC REMOVAL OF IUCD
HYSTEROSCOPIC REMOVAL OF RETAINED
PRODUCTS OF CONCEPTION
LAPAROSCOPIC ADHESIOLYSIS AND
HYSTEROSCOPY
HYSTEROSCOPIC RESECTION OF UTERINE
SEPTUM

6000

4800

3600

10000

8000

6000

3000
12000

2400
9600

1800
7200

12000

9600

7200

5000

4000

3000

12000

9600

7200

10000

8000

6000

12000

9600

7200

5000

4000

3000

5000

4000

3000

6000

4800

3600

12000

9600

7200

10000

8000

6000

PR
2400
14500
14500
14500
13500
13500

SPR
1920
11600
11600
11600
10800
10800

NSB
1440
8700
8700
8700
8100
8100

14000

11200

8400

13500
2000
1800
2400
3000
5000
7000
5000

10800
1600
1440
1920
2400
4000
5600
4000

8100
1200
1080
1440
1800
3000
4200
3000

10000

8000

6000

12000

9600

7200

10000

8000

6000

13000

10400

7800

10000
16000
13500
12000
4000
6000
10000
6000
15000

8000
12800
10800
9600
3200
4800
8000
4800
12000

6000
9600
8100
7200
2400
3600
6000
3600
9000

6000

4800

3600

7500

6000

4500

7500

6000

4500

11000

8800

6600

10000
13000
7500
12500

8000
10400
6000
10000

6000
7800
4500
7500

Surgery : Ophthalmology
Code
OPS001
OPS002
OPS003
OPS004
OPS005
OPS006
OPS007
OPS008
OPS009
OPS010
OPS011
OPS012
OPS013
OPS014
OPS015
OPS016
OPS017
OPS018
OPS019
OPS020
OPS021
OPS022
OPS023
OPS024
OPS025
OPS026
OPS027
OPS028
OPS029
OPS030
OPS031
OPS032
OPS033
OPS034
OPS035
OPS036

SURGERY : OPHTHALMOLOGY
EXTRACTION OF CHALAZION
CORNEAL GRAFTING
RETINAL DETACHMENT SURGERY
VITRECTOMY
MAJOR RECONSTRUCTIVE SURGERY
SOCKET RECONSTRUCTION
PHACOEMULSIFICATION WITH I.O.L.
IMPLANTATION
TUMOR OF IRIS
NEEDLING & ASPIRATION
EXAMINATION UNDER G.A.
CYSTS LID CONJ.
CONJ. TEAR
LID INJURY MINOR
LID INJURY MAJOR
AC WASH
SQUINT CORRECTION: UPTO 2-MUSCLES /
HORIZONTAL MUSCLE
SQUINT CORRECTION: MORE THAN 2-MUSCLES
/ VERTICAL MUSCLE
CATARACT EXTRACTION / GLAUCOMA
CATARACT EXTRACTION WITH
I.O.L.IMPLANTATION
DACROCYSTORHINOSTOMY
RETINAL DETACHMENT WITH VITRECTOMY
INTRA-OCULAR FOREIGN BODY REMOVAL
PERFORATING INJURY REPAIR
CRYOPEXY/CYCLOCRYO : UNILATERAL
CRYOPEXY/CYCLOCRYO : BILATERAL
PTOSIS
CAPSULOTOMY
ENDOSCOPIC DACROCYSTORHINOSTOMY
ENUCLEATION / EVICERATION OF EYES
(WTHOUT IMPLANT)
BLEPHAROPLASTY FOR ECTROPION (WITHOUT
GRAFTING)
BLEPHAROPLASTY FOR ENTROPION (WITHOUT
GRAFTING)
BLEPHAROPLASTY FOR ECTROPION (WITH
GRAFTING)
ENUCLEATION / EVICERATION WITH IMPLANT
EPICANTHUS + TELECANTHUS CORRECTION
EPICANTHUS CORRECTION
EXENTRATION OF ORBIT + SOCKET REPAIR

6/37

GOPD

POPD

CASUALTY

OPS037
OPS038
OPS039
OPS040
OPS041
OPS043
OPS044

LID TUMORS EXCISION AND REPAIR-WITH

GRAFTING
LID TUMORS EXCISON AND REPAIR -WITHOUT
GRAFTING
PTERYGIUM SURGERY WITH GRAFTING
PTERYGIUM SURGERY WITHOUT GRAFTING
TARSORRHPHY
TRABECULECTOMY
PROBING & SYRINGING OF NASO-LACRIMAL
DUCT

11500

9200

6900

8000

6400

4800

6000
3000
3000
10000

4800
2400
2400
8000

3600
1800
1800
6000

2000

1600

1200

PR
15000

SPR
12000

NSB
9000

15000

12000

9000

14000

11200

8400

17000

13600

10200

6000
8500
12000
24000
13000
10000
16000
8500
8000

4800
6800
9600
19200
10400
8000
12800
6800
6400

3600
5100
7200
14400
7800
6000
9600
5100
4800

5000

4000

3000

12000
6000

9600
4800

7200
3600

15000

12000

9000

13000

10400

7800

15000

12000

9000

6000
11000
8500
14000
6000
14000
14000
20000
6000

4800
8800
6800
11200
4800
11200
11200
16000
4800

3600
6600
5100
8400
3600
8400
8400
12000
3600

18000

14400

10800

12000
6000
16000
10000
10000

9600
4800
12800
8000
8000

7200
3600
9600
6000
6000

PR
6000
9000
16000
20000
6000
11000
7000
12000
13000

SPR
4800
7200
12800
16000
4800
8800
5600
9600
10400

NSB
3600
5400
9600
12000
3600
6600
4200
7200
7800

20000

16000

12000

Surgery : Orthopedics - Upper Limb

Code
ORU001
ORU002
ORU003
ORU004
ORU005
ORU006
ORU007
ORU008
ORU009
ORU010
ORU011
ORU012
ORU013
ORU014
ORU015
ORU016
ORU017
ORU018
ORU019
ORU020
ORU021
ORU022
ORU023
ORU024
ORU025
ORU026
ORU027
ORU028
ORU029
ORU030
ORU031
ORU032
ORU033
ORU034

SURGERY : ORTHOPEDICS - UPPER LIMB

TENDON TRANSFER MULTIPLE
TRIPLE ARTHRODESIS SHOULDER/ELBOW/WRIST
DISARTICULATION - SHOULDER
O.R.I.F. WITH PLATING WITH BONE GRAFT
(BOTH BONE)
CLOSED REDUCTION
O.R.I.F. WITH K.WIRE
OPEN REDUCTION WITH NAILING/PLATING
TOTAL REPLACEMENT - SHOULDER
RECONSTRUCTION OF JOINTS
REPAIR OF TENDONS - 3 OR LESS
REPAIR OF TENDONS -MORE THAN 3 TENDONS
CARPAL TUNNEL DECOMPRESSION
EXCISION HEAD OF RADIUS/LOWER END ULNA
MINOR PROCEDURES-GANGLION/NAIL
REMOVAL
TENDON TRANSFER & REPAIR
WOUND DEBRIDEMENT AND TOILETTING
O.R.I.F. WITH NAILING / PLATING WITH BONE
GRAFT
ULNAR NERVE TRANSFER
PUTTI PLATE RECONSTRUCTION OF
SHOULDER
MINOR AMPUTATIONS
MAJOR AMPUTATIONS
BONE GRAFTING - SMALL
EXTERNAL FIXATIONS/ILIAZAROV TECHNIQUE
ARTHRODESIS OF MINOR JOINTS
ARTHRODESIS OF MAJOR JOINTS
OSTEOTOMY AND CORRECTIVE SURGERY
TOTAL REPLACEMENT - ELBOW/WRIST JOINT
TRIGGER THUMB
ARTHROSCOPIC REPAIR
SHOULDER-RECURRENT DISLOCATION
ARTHROSCOPY SHOULDER - DIAGNIOSTIC
MANIPULATION UNDER ANESTHESIA (M.U.A.)
O.R.I.F. WITH PLATING (BOTH BONES)
TENSION BAND WIRING
FASCIOTOMY - FORE ARM

GOPD

POPD

CASUALTY

GOPD

POPD

CASUALTY

Surgery : Orthopedics -Lower Limb

Code
ORL001
ORL002
ORL004
ORL005
ORL006
ORL007
ORL008
ORL009
ORL010
ORL011

SURGERY : ORTHOPEDICS -LOWER LIMB

CLOSED REDUCTION
O.R.I.F. WITH K.WIRE
O.R.I.F. WITH PLATING AND BONE GRAFTING
INTERLOCKING NAILING
WOUND DEBRIDEMENT & TOILETTING
SKIN GRAFTING - MAJOR
SKIN GRAFTING - MINOR
EXTERNAL FIXATION - LONG BONES & PELVIS
CONDYLAR PLATING/D.C.S.
HEMIARTHROPLASTY WITH OR WITHOUT
CEMENTING

7/37

ORL012
ORL013
ORL014
ORL015
ORL016
ORL017
ORL018
ORL019
ORL020
ORL021
ORL022
ORL023
ORL024
ORL025
ORL026
ORL027
ORL028
ORL029
ORL030
ORL031
ORL032
ORL033
ORL034
ORL035
ORL036
ORL037
ORL038
ORL039
ORL040
ORL041
ORL042
ORL043
ORL044
ORL045
ORL046
ORL047
ORL048
ORL049
ORL050
ORL051
ORL052
ORL053
ORL054
ORL055
ORL056
ORL057
ORL058
ORL059
ORL060
ORL061
ORL062
ORL063
ORL064

ORL065

ORL066

TOTAL HIP REPLACEMENT

OSTEOTOMY AROUND HIP
C.D.H. (RED. & SPICA)
C.D.H. (OPEN REDUCTION)
FIXATION & PLATING - PELVIC
ACETABULAR RECONSTRUCTION
ARTHRODESIS OF HIP
DISARTICULATION THROUGH HIP
TUMOR EXCISION & RECONSTRUCTION
(MAJOR)
MINOR EXCISION OF SWELLING/TUMOR WITH
OR WITHOUT BIOPSY
DRAINAGE : HIP/KNEE/ANKLE/SPINE
DIAGNOSTIC ARTHROSCOPY
OPERATIVE
ARTHROSCOPY/QUADRICEPSPLASTY
TENSION BAND WIRING : ISOLATED MED.
MALLEOLUS
TIBIAL/FEMORAL OESTEOTOMIES
TIBIAL PLATEAU ELEVATION & FIXATION ( I
GRAFTING )
TOTAL KNEE REPLACEMENT
TENDON TRANSFERS AROUND KNEE
BIOPSY : BONES
PATELLECTOMY
TENSION BAND WIRING : PATELLA
MINOR RECONSTRUCTION : NERVES/TENDONS
MAJOR RECONSTRUCTION : NERVE/TENDONS
(MORE THAN 3)
ARTHROTOMY : HIP/KNEE/SHOULDER
ARTHROTOMY : OTHER SMALL JOINTS
MENISCECTOMY
SYNOVECTOMY : HIP/KNEE/SHOULDER/WRIST
SYNOVECTOMY : OTHER SMALL JOINTS
CLUB FOOT RELEASE (CTEV) : UNILATERAL
CLUB FOOT RELEASE (CTEV) : BILATERAL
TENDON TRANSFERS : ANKLE/FOOT
ARTHRODESIS : ANKLE
ARTHRODESIS : KNEE
EXCISION : NAIL & NAIL BED/GANGLION
MINOR PROCEDURES IN FOOT
TENDON ACHILLES/REPAIR &
RECONSTRUCTION
OSTEOTOMY : MID FOOT
AMPUTATION THROUGH FEMUR & TIBIA
AMPUTATION THROUGH SMALL BONES/DIGITS
LIMB LENGTHENING WITH INSTRUMENTATION
REMOVAL OF IMPLANTS : MINOR
REMOVAL OF IMPLANTS : MAJOR
TARGETTED DELIVERY OF STEROID
DISARTICULATION - KNEE/ANKLE
REVISION ARTHROPLASTY - HIP/KNEE
HALLUX VALGUS/VARUS
OPEN/ARTHROSCOPIC ANT. C. LIGAMENT
RECONSTRUCTION
PSOAS/PARA VERTEBRAL ABSCESS
O.R.I.F. WITH PLATING AND BONE GRAFTING
(BOTH BONES)
TRIPLE ARTHRODESIS - FOOT
PELVIC OSTEOTOMIES
FAILED CLUB FOOT FIXATOR CORRECTION
CLOSED REDUCTION WITH ELEVATION AND
CANNULATED SCREW FIXATION TIBIAL /
FEMORAL CONDYLER
CORE DECOMPRESSION AND FIBULAR
GRAFTING FOR AVN / NON-UNION HIP WITH
FIXATION
CORE DECOMPRESSION AND FIBULAR
GRAFTING FOR AVN / NON-UNION HIP
WITHOUT FIXATION

27000
15000
10000
17000
14000
18000
18000
15000

21600
12000
8000
13600
11200
14400
14400
12000

16200
9000
6000
10200
8400
10800
10800
9000

19000

15200

11400

6000

4800

3600

5500
8000

4400
6400

3300
4800

14000

11200

8400

10000

8000

6000

15000

12000

9000

15000

12000

9000

27000
12000
6000
9000
10000
12000

21600
9600
4800
7200
8000
9600

16200
7200
3600
5400
6000
7200

16000

12800

9600

9000
8000
10000
10000
8500
11000
13000
12000
15000
15000
6000
6000

7200
6400
8000
8000
6800
8800
10400
9600
12000
12000
4800
4800

5400
4800
6000
6000
5100
6600
7800
7200
9000
9000
3600
3600

9000

7200

5400

12000
12000
6000
18000
4000
6000
2500
10000
30000
8500

9600
9600
4800
14400
3200
4800
2000
8000
24000
6800

7200
7200
3600
10800
2400
3600
1500
6000
18000
5100

17000

13600

10200

8000

6400

4800

18500

14800

11100

15000
15000
14000

12000
12000
11200

9000
9000
8400

12000

9600

7200

16000

12800

9600

14000

11200

8400

8/37

ORL067
ORL068
ORL069
ORL070
ORL071
ORL072
ORL073
ORL074
ORL075
ORL076
ORL077
ORL078
ORL080
ORL081
ORL082
ORL083
ORL084
ORL085
ORL086
ORL087
ORL088
ORL089

ISOLATED GRAFTING - MINOR/CORE

HARVESTING
ISOLATED GRAFTING - STANDARD/MAJOR
HARVESTING
MUSCLE PEDICLE GRAFTING
O.R.I.F ANKLE - BIMALLEOLAR FIXATION
OSTEOMYELITIS - LONG BONES
OSTEOMYELITIS - SMALL BONES
PERCUTANEOUS TENOTOMY (3 OR LESS)
PERCUTANEOUS TENOTOMY (MORE THAN 3)
O.R.I.F. WITH SCREWS
O.R.I.F. WITH PLATING
O.R.I.F. WITH PLATING (BOTH BONES)
O.R.I.F. WITH DHS
O.R.I.F. WITH K.NAILING / FLAG NAIL /
RE-CONSTRUCTION NAIL
C.R.I.F. WITH K.WIRE
TENSION BAND WIRING / ENCIRCLAGE WIRING
SEQUESTRECTOMY - SMALL BONES
SEQUESTRECTOMY - LONG BONES
TENSION BAND WIRING
SKELETAL TRACTION (IN O.T.)
O.R.I.F. ANKLE - TRIMAZLEOLAR FIXATION
FASCIOTOMY - THREE COMPARTMENT LEG
FASCIOTOMY - FOOT

6000

4800

3600

10000

8000

6000

18000
12000
12000
8000
6000
8000
9000
14000
16000
14000

14400
9600
9600
6400
4800
6400
7200
11200
12800
11200

10800
7200
7200
4800
3600
4800
5400
8400
9600
8400

14000

11200

8400

8000
10000
7500
12000
10000
3500
15000
12000
10000

6400
8000
6000
9600
8000
2800
12000
9600
8000

4800
6000
4500
7200
6000
2100
9000
7200
6000

PR

SPR

NSB

22000

17600

13200

25000

20000

15000

19000
18000
26000

15200
14400
20800

11400
10800
15600

PR
13000

SPR
10400

NSB
7800

6000

4800

3600

20000
17500
18000

16000
14000
14400

12000
10500
10800

20000

16000

12000

6000
3000
6000
5000
10000
20000
25000
20000
5000
18000
15000
15000
25000
12000
10000
5000
2000

4800
2400
4800
4000
8000
16000
20000
16000
4000
14400
12000
12000
20000
9600
8000
4000
1600

3600
1800
3600
3000
6000
12000
15000
12000
3000
10800
9000
9000
15000
7200
6000
3000
1200

Surgery : Orthopedics - Spine

Code
ORS001
ORS002
ORS003
ORS004
ORS005

SURGERY : ORTHOPEDICS - SPINE

LAMINECTOMY (LUMBAR/CERVICAL) /
DISCECTOMY
POSTERIOR/ANTERIOR FUSION &
INSTRUMENTATION
POSTERIOR/ANTERIOR FUSION ONLY
ANTEROLATERAL DECOMPRESSION
CERVICAL VERTIBRECTOMY

GOPD

POPD

CASUALTY

GOPD

POPD

CASUALTY

Surgery : Thoracic
Code
THS001
THS002
THS003
THS004
THS005
THS006
THS007
THS008
THS009
THS010
THS011
THS012
THS013
THS014
THS015
THS017
THS018
THS019
THS020
THS021
THS022
THS023
THS027

SURGERY : THORACIC
EXPLORATORY THORACOTOMY
BRONCHOSCOPY WITH OR WITHOUT
F.B.REMOVAL/BIOPSY
MEDIASTINAL TUMOR EXCISION
SURGERY FOR PORTAL HYPERTENSION
HIATUS OR DIAPHRAGMATIC HERNIA
RECONSTRUCTION OF PERIPHERAL
VASCULAR INJURY
OESOPHAGOSCOPY WITH F.B.REMOVAL
CHEST ASPIRATION
INTERCOSTAL DRAINAGE
PLEURALNEEDLE BIOPSY- PLEURA/LUNG
OPEN BIOPSY - PLEURA/LUNG
LOBECTOMY - WEDGE, SEGMENT/LOBE
PNEUMENECTOMY
DECORTICATION THORACOTOMY - EX.TUMOR
PERICARDIAL ASPIRATION
PERICARDECTOMY
PERICARDIOSTOMY
THORACOTOMY WITH LIGATION OF PDA
DECORTICATION WITH LOBECTOMY
RIB RESECTION AND DRAINAGE
MEDIASTINAL LYMPHNODE EXCISION & BIOPSY
SCALENE NODE BIOPSY
PLEURODESIS EACH SITTING

Surgery : Neuro

9/37

Code
NES001
NES002
NES003
NES004
NES005
NES006
NES007
NES008
NES009
NES010
NES011
NES012
NES013
NES014
NES015
NES016
NES017
NES018
NES019
NES020
NES021
NES022
NES023
NES024
NES025
NES026
NES027
NES028
NES029
NES030
NES032
NES034
NES035
NES036
NES037
NES038
NES039
NES040
NES041
NES042

SURGERY : NEURO
BURR HOLES FOR CH SDH/ABSCESS
VENTRICULO AURICULAR SHUNT
SHUNT FOR HYDRO CEPHALUS
REVISION OF SHUNT
CRANIOPLASTY
CRANIOTOMY - INTRACEREBRAL HEMATOMA
CRANIOTOMY - SUBDURAL HEMATOMA
CRANIOTOMY - EXTRADURAL HEMATOMA
CRANIOTOMY - VASCULAR TUMOR
CRANIOTOMY - POST. FOSSA TUMOR
CRANIOTOMY - PITUITARY TUMOR
CRANIOTOMY - CRANIOPHARYNGIOMA
CRANIOTOMY - ABSCESS/CYSTS
CRANIOTOMY - A.V.MALFORMATION
CRANIOTOMY - ANEURYSM
CRANIOTOMY - ACOUSTIC NEUROMA
CRANIOTOMY - BRAIN STEM TUMOR
CRANIOTOMY - FOR CSF RHINORRHEA
REPAIR OF MENINGOCELE
REPAIR OF MENINGOMYELOCELE
REPAIR OF ENCEPHALOCELE
LAMINECTOMY (LUMBAR)
DISCECTOMY (CERVICAL/DORSAL/MICRO-II
LEVELS)
OPERATION FOR CANAL STENOSIS
(LUMBAR/CERVICAL)
MICRODISCECTOMY - MORE THAN II LEVELS
SPINAL TUMOR/HEMATOMA/ABSCESS
TRANS SPHENOIDAL PITUITARY /SELLAR
SURGERY
NEURO-ENDOSCOPIC SKULL BASE SURGERY
CORPECTOMY
SURGERY FOR CRANIOSYNOSTOSIS
CRANIOTOMY - CONTUSIONS
DECOMPRESSIVE CRANIOTOMY
ENDODSCOPIC SURGERY
PERIPHERAL NERVE SURGERY
SPINAL DYSRAPHISM
SPINAL INSTRUMENTATION
VENTRIC TAP
VERTEBROPLASTY
CRANIOTOMY - TEMPORAL CRANIOTOMY
CERVICAL TRACTION (IN O.T.)

PR
23000
16000
16000
16000
23000
25000
26000
24000
29000
29000
29000
29000
29000
34000
34000
29000
34000
29000
17000
17000
17000
21000

SPR
18400
12800
12800
12800
18400
20000
20800
19200
23200
23200
23200
23200
23200
27200
27200
23200
27200
23200
13600
13600
13600
16800

NSB
13800
9600
9600
9600
13800
15000
15600
14400
17400
17400
17400
17400
17400
20400
20400
17400
20400
17400
10200
10200
10200
12600

21000

16800

12600

23000

18400

13800

23000
29000

18400
23200

13800
17400

29000

23200

17400

29000
29000
23000
29000
29000
35000
21000
23000
29000
3500
23000
26000
2400

23200
23200
18400
23200
23200
28000
16800
18400
23200
2800
18400
20800
1920

17400
17400
13800
17400
17400
21000
12600
13800
17400
2100
13800
15600
1440

PR

SPR

NSB

3500

2800

2100

6000

4800

3600

3500
5500
6000
5000
15000

2800
4400
4800
4000
12000

2100
3300
3600
3000
9000

6000

4800

3600

11500
13000
7500
2500
15000
14000
15000
7000
2500
7000
6500

9200
10400
6000
2000
12000
11200
12000
5600
2000
5600
5200

6900
7800
4500
1500
9000
8400
9000
4200
1500
4200
3900

GOPD

POPD

CASUALTY

GOPD

POPD

CASUALTY

Surgery: E.N.T.
Code
ENS001
ENS002
ENS003
ENS004
ENS005
ENS006
ENS007
ENS008
ENS009
ENS010
ENS011
ENS012
ENS013
ENS014
ENS015
ENS016
ENS017
ENS018
ENS019

SURGERY: E.N.T.
POSTERIOR NASAL PACK (WITH PACK
REMOVAL)
OESOPHAGOSCOPY WITH F.BODY REMOVAL +
BIOPSY
TURBINECTOMY : UNILATERAL
TURBINECTOMY : BILATERAL
TONSILLECTOMY
MICRO LARYNGOSCOPY WITH BIOPSY
OSSICULOPLASTY
BRONCHOSCOPY WITH OR WITHOUT
F.B.REMOVAL / BIOPSY
ETHMOIDECTOMY (EXTERNAL)
TYMPANOPLASTY
SEPTOPLASTY WITH S.M.D.
FOREIGN BODY REMOVAL - EAR/NOSE/THROAT
ENDOSCOPIC DACROCYSTORHINOSTOMY
MASTOIDECTOMY (MODIFIED)
STAPEDECTOMY
S.M.R.
LARYNGOSCOPY - DIRECT
TRACHEOSTOMY
ABSCESS TONSILLECTOMY - I. & D.

10/37

ENS020
ENS021
ENS022
ENS023
ENS024
ENS025
ENS026
ENS027
ENS028
ENS029
ENS030
ENS031
ENS032
ENS033
ENS034
ENS035
ENS036
ENS037
ENS038
ENS039
ENS040
ENS041
ENS042
ENS043
ENS044
ENS045
ENS046
ENS047
ENS048
ENS049
ENS050
ENS051
ENS052
ENS053
ENS054
ENS055
ENS056
ENS057
ENS058
ENS059
ENS060
ENS061
ENS062
ENS063
ENS064
ENS065
ENS067
ENS068
ENS069
ENS070
ENS071
ENS072
ENS073
ENS074
ENS076
ENS077
ENS078
ENS079
ENS084
ENS085

STYLOIDECTOMY : UNILATERAL
STYLOIDECTOMY : BILATERAL
FRACTURE NASAL BONES
HEMATOMA PINNA : UNILATERAL
HEMATOMA PINNA : BILATERAL
FACIAL NERVE DECOMPRESSION OR
GRAFTING
MICRO LARYNGEAL SURGERY
ANTERIOR WITH POST. NASAL PACKING WITH
REMOVAL
MAXILLARY SINUS SURGERY
EXCISION THYROGLOSSAL CYST
I. & D. OF THYROGLOSSAL CYST
LARYNGECTOMY (TOTAL)
NASAL POLYPECTOMY : UNILATERAL
NASAL POLYPECTOMY : BILATERAL
MYRINGOPLASTY
MYRINGOTOMY WITH OR WITHOUT GROMMET :
UNILATERAL
MYRINGOTOMY WITH OR WITHOUT GROMMET :
BILATERAL
MASTOIDECTOMY WITH TYMPANOPLASTY
MICROSCOPIC EXAMINATION (E.U.M.)
SEPTOPLASTY
CALDWELL LUC : UNILATERAL
CALDWELL LUC : BILATERAL
DIAGNOSTIC NASAL ENDOSCOPY
FESS : UNILATERAL
FESS : BILATERAL
ADENO-TONSILLECTOMY
ANTRAL WASH : UNILATERAL OR BILATERAL
SMD
NASAL CAUTERY IN EPISTAXIS
SPLIT EAR LOBULE : UNILATERAL
SPLIT EAR LOBULE : BILATERAL
PRE AURICULAR SINUS : UNILATERAL
PRE AURICULAR SINUS : BILATERAL
I. & D. OF PARA PHARYNGEAL ABSCESS
YOUNG OPERATION
LYMPH NODE BIOPSY
BIOPSY CHEEK OR TONGUE : UNILATERAL OR
BILATERAL
I. & D. QUINCY
ANT. NASAL PACK (WITH PACK REMOVAL)
I. & D. TONSILLAR ABSCESS : UNILATERAL OR
BILATERAL
LATERAL RHINOTOMY
SEPTORHINOPLASTY
ADENOIDECTOMY
CHANGE OF TRACHEOSTOMY TUBE
ANGIOFIBROMA REMOVAL
ANTRAL POLYPECTOMY
CAUTERY PATCHING EAR
COCHLEAR IMPLANT
ENDOLYMPHATIC SAC DECOMPRESSION
ENDOSCOPIC CSF RHINORRHEA REPAIR
FACIAL REANIMATION PROCEDURE - LID
LOADING
FACIAL REANIMATION PROCEDURE TEMPORALIS TRANSFER
FESS - LIMITED
NASAL ENDOSCOPIC CAUTERISATION FOR
EPISTAXIS
RHINOPLASTY
THYROPLASTY
THYROPLASTY WITH ARYTENOID ABDUCTION/ADDUCTION
VOCAL CORD LATERLIZATION
LARYNGOSCOPY - FIBER OPTOC
FESS - EXTENDED

7000
12000
6000
3000
5000

5600
9600
4000
2400
4000

4200
7200
3600
1800
3000

20000

16000

12000

8000

6400

4800

5000

4000

3000

7000
8000
4000
18000
5000
7000
10000

5600
6400
3200
14400
4000
5600
8000

4200
4800
2400
10800
3000
4200
6000

3000

2400

1800

5500

4400

3300

18000
1500
5500
6000
8000
2000
8500
13000
8500
3000
3000
3000
2000
3000
7000
8000
7000
8000
5000

14400
1200
4400
4800
6400
1600
6800
10400
6800
2400
2400
2400
1600
2400
5600
6400
5600
6400
4000

10800
900
3300
3600
4800
1200
5100
7800
5100
1800
1800
1800
1200
1800
4200
4800
4200
4800
3000

4000

3200

2400

4000
2500

3200
2000

2400
1500

7000

5600

4200

14000
14000
6000
1000
18000
5000
3000
30000
18000
18000

11200
11200
4800
800
14400
4000
2400
24000
14400
14400

8400
8400
3600
600
10800
3000
1800
18000
10800
10800

12000

9600

7200

14000

11200

8400

7000

5600

4200

5000

4000

3000

12000
10000

9600
8000

7200
6000

12000

9600

7200

7000
5000
15000

6400
4000
12000

4200
3000
9000

11/37

Surgery : Vascular
Code
VAS001
VAS002
VAS003
VAS004
VAS005
VAS006
VAS007
VAS008
VAS009
VAS010
VAS011
VAS012
VAS013
VAS014
VAS015
VAS016
VAS017
VAS018
VAS019
VAS020
VAS021
VAS022
VAS023
VAS024
VAS025
VAS026
VAS027
VAS028

SURGERY : VASCULAR
THROMBO ENDARTERECTOMY AORTA
LUMBAR SYMPATHECTOMY : UNILATERAL
CERVICO THORACIC SYMPATHECTOMY
TEMPORARY PACING
PERMANENT PACING
HEPATIC RESECTION (LOBECTOMY)
A.V.FISTULA FOR DIALYSIS
FEMORAL EMBOLECTOMY : UNILATERAL
FEMORAL EMBOLECTOMY : BILATERAL
ENDARTERECTOMY OF PERIPHERAL VESSELS
CAROTID ENDARTERECTOMY
AV GRAFT FOR VASCULAR ACCESS FOR
HAEMODIALYSIS
AORTO-FEMORAL BYPASS
FEMORO-POPLITEAL BYPASS
PERIPHERAL ANEURYSM REPAIR
EXCISION OF A.V. MALFORMATION
CERVICAL RIB EXCISION
ABDOMINAL ANEURYSM
EXCISION OF HAEMANGIOMA - MAJOR
EXCISION OF HAEMANGIOMA - MEDIUM
EXCISION OF HAEMANGIOMA - MINOR
FEMORO-FEMORAL CROSS OVER GRAFT
FEMORO-POPLITEAL , BYPASS WITH
VEIN/GRAFT
VARICOSE VEINS
VENOUS RECONSTRUCTION
ILLIAC ARTERY ANRURYSM
BRACHIAL ARTERY REPAIR WITH GRAFT
CLOT EVACUATION

PR
21000
10000
15000
6000
11000
17000
8500
18000
25000
22000
22000

SPR
16800
8000
12000
4800
8800
13600
6800
14400
20000
17600
17600

NSB
12600
6000
9000
3600
6600
10200
5100
10800
15000
13200
13200

18000

14400

10800

22000
22000
18000
15000
15000
24000
17000
13000
8000
25000

17600
17600
14400
12000
12000
19200
13600
10400
6400
20000

13200
13200
10800
9000
9000
14400
10200
7800
4800
15000

25000

20000

15000

15000
15000
24000
24000
4000

12000
12000
19200
19200
3200

9000
9000
14400
14400
2400

PR
11000

SPR
8800

NSB
6600

10000

8000

6000

9000
4000

7200
3200

5400
2400

5000

4000

3000

16000
16000
22000
9000
10000
10000

12800
12800
17600
7200
8000
8000

9600
9600
13200
5400
6000
6000

14000

11200

8400

16000
20000
25000
10000
14000
17000
16000
22000
22000
16000
11000
9000

12800
16000
20000
8000
11200
13600
12800
17600
17600
12800
8800
7200

9600
12000
15000
6000
8400
10200
9600
13200
13200
9600
6600
5400

19000

15200

11400

6000
17000
19000
9000

4800
13600
15200
7200

3600
10200
11400
5400

GOPD

POPD

CASUALTY

GOPD

POPD

CASUALTY

Surgery : Urology
Code
URS001
URS002
URS003
URS004
URS005
URS006
URS007
URS008
URS009
URS010
URS011
URS012
URS013
URS014
URS015
URS016
URS017
URS018
URS019
URS020
URS021
URS022
URS023
URS024
URS025
URS026
URS027
URS029
URS030

SURGERY : UROLOGY
T.U.R. - POSTERIOR URETHRAL VALVES
ENDOSCOPIC CORRECTION OF REFLUX :
UNILATERAL OR BILATERAL
ENDOSCOPIC REMOVAL OF URETHRAL STONE
CYSTOSCOPY (DIAGNOSTIC)
CYSTOSCOPY WITH BLADDER BIOSPY OR
R.G.P.
T.U.R. - PROSTATE
T.U.R. - BLADDER TUMOR
COMBINATION OF T.U.R.P. + STONE OR TUMOR
CYSTOLITHOTRIPSY/CYSTOLITHALOPEXY
BLADDER NECK INCISION
OPTICAL INTERNAL URETHROTOMY
ENDOSCOPIC VENTRO-SUSPENSION FOR
STRESS/TVT/TOT
URETERONEODYSTOSTOMY : UNILATERAL
URETERONEODYSTOSTOMY : BILATERAL
EXTROPHY/EPISPADIAS REPAIR
ORCHIOPEXY OR ORCHIDOPEXY : UNILATERAL
ORCHIOPEXY OR ORCHIDOPEXY : BILATERAL
NEPHRECTOMY (SIMPLE OR PARTIAL)
NEPHROLITHOTOMY (ANATROPHIC)
NEPHRECTOMY (RADICAL)
NEPHROURETERECTOMY
PYELOPLASTY WITH OR WITHOUT R.G.P.
NEPHROSTOMY - OPEN
NEPHROSTOMY - PERCUTANEOUS (P.C.N.)
URETEROINTESTINAL
DIVERSON/RE-IMPLANTATION OF URETER
TROCAR CYSTOSTOMY
PARTIAL CYSTECTOMY
AUGMENTATION CYSTOPLASTY
CLOSURE OF URETHRAL FISTULA

12/37

URS031
URS032
URS033
URS034
URS035
URS036
URS037
URS038
URS039
URS040
URS041
URS042
URS043
URS044
URS045
URS046
URS047
URS048
URS049
URS050
URS051
URS052
URS053
URS054
URS055
URS056
URS057
URS058
URS059
URS060
URS061
URS062
URS063
URS064
URS065
URS066
URS067
URS068
URS069
URS070
URS071
URS072
URS073
URS074
URS075
URS076
URS077
URS078
URS079
URS080
URS081
URS082
URS084
URS085
URS086
URS087
URS088
URS089
URS090
URS091
URS092
URS094
URS095
URS096

URETHROPLASTY - 1ST STAGE

URETHROPLASTY - 2ND STAGE
PERINEAL URETHROSTOMY
AMPUTATION OF PENIS - TOTAL
AMPUTATION OF PENIS - PARTIAL
VARICOCELECTOMY UNILATERAL
EXPLORATORY SCROTOTOMY
VASOVASAL ANASTOMOSIS
VASO-EPIDIDYMAL ANASTOMOSIS
OPERATION FOR DOUBLE URETER
OPERATION FOR ECTOPIC URETER
Y.V.PLASTY OF BLADDER NECK
REPAIR OF V.V.FISTULA
REPAIR OF URETHRAL INJURY
NEPHRECTOMY RENAL TUMOR
OPERATION FOR INJURY OF BLADDER
P.C.N.L.
URETEROSCOPY : DIAGNOSTIC
URETEROSCOPIC STONE REMOVAL
URETEROSCOPIC LITHOTRIPSY
D.J.STENTING : BILATERAL
REMOVAL OF D.J.STENT
BASKETING
URETHRAL DILATATION
LAPAROSCOPIC URETEROLITHOTOMY
BLADDER NECK RECONSTRUCTION
MEATOPLASTY
RADICAL CYSTOPROSTATECTOMY
RADICAL RETROPUBIC PROSTATECTOMY
LAPAROSCOPIC SIMPLE NEPHRECTOMY
LAPAROSCOPIC RADICAL NEPHRECTOMY
LAPAROSCOPIC ADRENALECTOMY
MEATOTOMY
EPIDIDYMAL CYST
URETERIC CATHETERISATION - UNILATERAL
OR BILATERAL
CIRCUMCISION
COMBINATION OF T.U.R.P. + B.N.I
CYSTOSCOPY WITH BIOPSY/CATHERISATION
CYSTOSTOMY (SUPRAPUBIC)
D.J.STENTING : UNILATERAL
FRENULOPLASTY
NEPHRECTOMY
ENDOPYELOTOMY - PCN OR URS
ENDOSCOPIC DILATATION OF URETERAL
STRICTURE
EPIDYDMECTOMY - BILATERAL
EPIDYDMECTOMY - UNILATERAL
ORCHIDECTOMY - UNILATERAL OR BILATERAL
PROSTATIC BIOPSY
PYELOLITHOTOMY
RADICAL/TOTAL CYSTECTOMY WITH URINARY
DIVERSION
RECTO-URETHERAL FISTULA - POST SAGGITAL
REPAIR
SUPRAPUBIC DRAINAGE (CLOSED)
SUPRAPUBIC DRAINAGE (OPEN)
SUPRAPUBIC PROSTATECTOMY
TESTICULAR BIOPSY
TRANS URETHRAL ELECTRO VAPOUIZATION
OF PROSTATE
URETEROLITHOTOMY
URETEROSCOPIC URETEROTOMY
P.C.N.L. - MULTIPLE PUNCTURE
NEEDLE BIOPSY OF PROSTATE
DEROOFING OF PROSTATIC ABSCESS
NEEDLE ASPIRATION OF PROSTATE
CYSTOSCOPY + CLOT EVACUATION WITH
FULGRATION
SEPARATION AND DISSECTION OF BLADDER

10000
9000
5000
14000
10000
9000
9000
14000
18000
18000
19000
14000
22000
14000
19000
13000
18000
7000
11500
14000
9000
3000
9000
2500
16000
23000
4000
23000
22000
17000
19000
19000
2500
7000

8000
7200
4000
11200
8000
7200
7200
11200
14400
14400
15200
11200
17600
11200
15200
10400
14400
5600
9200
11200
7200
2400
7200
2000
12800
18400
3200
18400
17600
13600
15200
15200
2000
5600

6000
5400
3000
8400
6000
5400
5400
8400
10800
10800
11400
8400
13200
8400
11400
7800
10800
4200
6900
8400
5400
1800
5400
1500
9600
13800
2400
13800
13200
10200
11400
11400
1500
4200

5000

4000

3000

5000
18000
5000
6000
6000
7000
17000
17000

4000
14400
4000
4800
4800
5600
13600
13600

3000
10800
3000
3600
3600
4200
10200
10200

14000

11200

8400

10000
7000
9000
3000
14000

8000
5600
7200
2400
11200

6000
4200
5400
1800
8400

23000

18400

13800

23000

18400

13800

5000
5000
14000
4000

4000
4000
11200
3200

3000
3000
8400
2400

16000

12800

9600

11000
14000
20000
2500
10000
2500

8800
11200
16000
2000
8000
2000

6600
8400
12000
1500
6000
1500

5000

4000

3000

8000

6400

4800

13/37

URS097
URS098
URS099
URS100
URS101
URS102

URS103
URS104
URS105
URS106
URS107
URS108
URS109
URS110
URS111
URS112
URS113
URS114
URS115
URS116
URS117
URS118
URS119
URS120
URS121
URS122
URS123
URS124
URS125
URS126
URS127
URS128
URS129
URS130
URS131
URS132
URS133

T.U.R. - PROSTATE WITH T.U.E.V.P

EXCISION OF GROWTH PENIS
VARICOCELECTOMY BILATERAL
HYPOSPADIAS REPAIR - 1ST STAGE
HYPOSPADIAS REPAIR - 2ND STAGE
BUCCAL MUCOSAL GRAFT ( B/L OR I/L )
URITHROPLASTY OR SUBSTITUTION
URETHROPLASTY
URETHROPLASTY FOR POSTERIOR URETHRAL
DISTRACTION DEFECT ( PUDD )
VARICOCELECTOMY OPEN MICROSURGICAL
HYPOSPADIAS REPAIR - SINGLE STAGE
RADICAL CYSTECTOMY WITH NEOBLADDER
SURGERY FOR RECTOURETHRAL FISTULA
SURGERY FOR PEYRONIS DISEASE
SURGERY FOR PRIAPISM
OPERATION FOR MEGA URETER
RPLND (RETRO-PERITONEAL LYMPHNODE
DISSECTION)
RGP WITH SCLERO THERAPY FOR CHYLURA
ISTHARMECTOMY WITH NEPHROPEXY
NEPHROPEXY FOR PTOTIC KIDNEY
LAPAROSCOPIC ASSISTED PCNL
T U R E D (TRANS URETHRAL RESECTION OF
EJACULATING DUCT)
PERINEPHRIC ABSCESS DRAINAGE PERCUTANEOUS
PERINEPHRIC ABSCESS DRAINAGE - OPEN
ILEO-INGUINAL LYMPHADENECTOMY - B/L
RELOOK PCNL
P.C.N.L. - BILATERAL
CHORDEE WITHOUT HYPOSPADIAS
ADRENELECTOMY OPEN
VARICOCELECTOMY LAPAROSCOPIC
ILEO-INGUINAL LYMPHADENECTOMY - U/L
URETEROPLASTY WITH ILEAL REPOSITION
URETERONEOCYSTOSTOMY WITH BOARI FLAP
TRANS URETERO URETEROSTOMY
URETERO URETEROSTOMY
URETEROLYSIS FOR RETROPERITONEAL
FIBRIOSIS
PERCUTANEOUS CYSTOLITHOTRIPSY (PCLT)
CYSTOLITHOTOMY
INTRAVESICAL INJECTION OF BOTULINUM
TOXIN FOR O.A.B. (OVER ACTIVE BLADDER)

16000
9000
12000
10000
9000

12800
7200
9600
8000
7200

9600
5400
7200
6000
5400

18000

14400

10800

20000

16000

12000

9000
15000
23000
20000
15000
15000
15000

7200
12000
18400
16000
12000
12000
12000

5400
9000
13800
12000
9000
9000
9000

18000

14400

10800

7000
15000
10000
18000

5600
12000
8000
14400

4200
9000
6000
10800

10000

8000

6000

6000

4800

3600

8000
20000
5000
22000
10000
15000
9000
15000
15000
15000
15000
12000

6400
16000
4000
17600
8000
12000
7200
12000
12000
12000
12000
9600

4800
12000
3000
13200
6000
9000
5400
9000
9000
9000
9000
7200

15000

12000

9000

10000
9000

8000
7200

6000
5400

8000

6400

4800

Surgery : Miscellaneous
Code
MSS001
MSS002
MSS003
MSS004

SURGERY : MISCELLANEOUS
PERITONEOSCOPY - BIOPSY
GASTROSCOPY/SIGMOIDSCOPY
ECT
EPIDURAL INJECTION

PR
3000
3000
2500
2000

SPR
2400
2400
2000
1600

NSB
1800
1800
1500
1200

PR
14000
18000

SPR
11200
14400

NSB
8400
10800

18000

14400

10800

17000
21000
17000
10000
17000
16000
20000
19000

13600
16800
13600
8000
13600
12800
16000
15200

10200
12600
10200
6000
10200
9600
12000
11400

GOPD

POPD

CASUALTY

POPD

CASUALTY

Surgery : Plastic
Code
PLS001
PLS002
PLS003
PLS004
PLS005
PLS006
PLS007
PLS008
PLS009
PLS010
PLS011

SURGERY : PLASTIC
CLEFT LIP/PALATE : UNILATERAL
CLEFT LIP/PALATE : BILATERAL
SECONDARY DEFORMITY - CLEFT
LIP/PALATE/NOSE
CLEFT PALATE & LIP : UNILATERAL
CLEFT PALATE & LIP : BILATERAL
CLEFT PALATE WITH PHARYNGOPLASTY
CLEFT PALATE-FISTULA SIMPLE
CLEFT PALATE FISTULA WITH FLAP
CLEFT LIP NOSTRIL
CLEFT LIP CASE RHINOPLASTY
RHINOPLASTY (COSMETIC)

14/37

GOPD

PLS012
PLS013
PLS014
PLS015
PLS016
PLS017
PLS018
PLS019
PLS020
PLS021
PLS022
PLS023
PLS024
PLS025
PLS026
PLS027
PLS028
PLS029
PLS030
PLS031
PLS032
PLS033
PLS034
PLS035
PLS036
PLS037
PLS038
PLS039
PLS040
PLS041
PLS042
PLS043
PLS044
PLS045
PLS046
PLS047
PLS048
PLS049
PLS050
PLS051
PLS052
PLS053
PLS054
PLS055
PLS056
PLS057
PLS058
PLS059
PLS060
PLS061
PLS062
PLS063
PLS064
PLS065
PLS066
PLS067
PLS068
PLS069
PLS070

SEPTO-RHINOPLASTY
NOSE TIP RHINOPLASTY
MINOR CORRECTION ON CLEFT LIP
HYPOSPADIAS - MEATOTOMY
HYPOSPADIAS - CHORDEE CORRECTIONS
HYPOSPADIAS - URETHRA RECONSTRUCTION
SIMPLE Z PLASTY ANYWHERE
Z PLASTY - SCAR EXCISION WITH OR WITHOUT
SKINGRAFT
SIMPLE SCAR EXCISION
COMPLICATED SCAR FACE/MULTIPLE SCARS
DERMABRASION FACE
CHEMICAL PEELING
FAT OR FULL THICKNESS GRAFT - SMALL
FAT OR FULL THICKNESS GRAFT - LARGE
LIPOSUCTION - SMALL AREA
LIPOSUCTION - LARGE AREA
ABDOMINOPLASTY WITH LIPOSUCTION
(COSMETIC)
PREAURICULAR SINUS : UNILATERAL
PREAURICULAR SINUS : BILATERAL
FACE LIFT WITH OR WITHOUT NECK LIFT
(COSMETIC)
BLEPHEROPLASTY TWO LIDS
BLEPHEROPLASTY FOUR LIDS
EYE LIDS - PTOSIS : UNILATERAL
EYE LIDS- PTOSIS : BILATERAL
EYE LIDS : PARTIAL EXCISION & REPAIR WITH
SKIN GRAFT & FLAP
EYE LIDS TUMOR EXCISION & REPAIR WITH
SKIN GRAFT & FLAP
EYE LIDS FOLD RECONSTRUCTION
BREAST AUGMENTATION (IMPLANT) :
UNILATERAL
BREAST AUGMENTATION (IMPLANT) :
BILATERAL
BREAST AUGMENTATION BY FLAP
TISSUE EXPANDER (INSERTION)
WOUND REPAIR - FACE/HAND/LIMBS - SMALL
WOUND REPAIR - FACE/HAND/LIMBS - MEDIUM
WOUND REPAIR - FACE/HAND/LIMBS - LARGE
WOUND REPAIR - FACE/HAND/LIMBS MULTIPLE
PHARYNGOPLASTY
ABDOMINOPLASTY
FASCIO CUTANEOUS FLAP REPAIR - LARGE
FASCIO CUTANEOUS FLAP REPAIR - MEDIUM
FASCIO CUTANEOUS FLAP REPAIR - SMALL
FASCIO CUTANEOUS FLAP WITH SKIN GRAFT SMALL
FASCIO CUTANEOUS FLAP WITH SKIN GRAFT MEDIUM
FASCIO CUTANEOUS FLAP WITH SKIN GRAFT LARGE
VAGINOPLASTY WITH SKIN GRAFT AND FLAP
FACE MOLE OR CYST EXCISION - MULTIPLE
DRESSING - MAJOR
DRESSING - MINOR
SKIN GRAFTING - SMALL
SKIN GRAFTING - MEDIUM
SKIN GRAFTING - LARGE/EXTENSIVE
SPLIT EAR LOBULES : UNILATERAL
SPLIT EAR LOBULES : BILATERAL
EAR LOBULE KELOID : UNILATERAL
EAR LOBULE KELOID : BILATERAL
SYNDACTYLE FINGERS : ONE WEB
SYNDACTYLE FINGERS : MORE THAN ONE WEB
BAT EAR BILATERAL
BREAST REDUCTION : UNILATERAL
BREAST REDUCTION : BILATERAL

13000
10000
9000
3500
10000
17000
7000

10400
8000
7200
2800
8000
13600
5600

7800
6000
5400
2100
6000
10200
4200

14000

11200

8400

8000
16000
12000
17000
8000
14000
10000
16000

6400
12800
9600
13600
6400
11200
8000
12800

4800
9600
7200
10200
4800
8400
6000
9600

20000

16000

12000

6000
7000

4800
5600

3600
4200

23000

18400

13800

17000
21000
10000
14000

13600
16800
8000
11200

10200
12600
6000
8400

15000

12000

9000

15000

12000

9000

15000

12000

9000

14000

11200

8400

21000

16800

12600

24000
16000
3000
6000
12000

19200
12800
2400
4800
9600

14400
9600
1800
3600
7200

16000

12800

9600

14000
16000
16000
12000
7000

11200
12800
12800
9600
5600

8400
9600
9600
7200
4200

9000

7200

5400

14000

11200

8400

21000

16800

12600

21000
12000
3500
1700
7000
12000
15000
3000
4000
6000
7000
16000
19000
14000
14000
21000

16800
9600
2800
1360
5600
9600
12000
2400
3200
4800
5600
12800
15200
11200
11200
16800

12600
7200
2100
1020
4200
7200
9000
1800
2400
3600
4200
9600
11400
8400
8400
12600

15/37

PLS071
PLS072
PLS073
PLS075
PLS076
PLS077
PLS078
PLS079
PLS080
PLS081
PLS082
PLS083
PLS084
PLS085
PLS086
PLS087
PLS088
PLS089
PLS090
PLS091
PLS092
PLS093
PLS094
PLS095
PLS096
PLS097
PLS098
PLS099
PLS100
PLS101
PLS102
PLS103
PLS105
PLS106
PLS107
PLS108
PLS109
PLS110
PLS111
PLS112
PLS113
PLS114
PLS115
PLS116

EXTRA DIGIT EXCISION

HAND - TENDON WITH NERVE REPAIR
(MAGNIFICATION)
HAND - TENDON REPAIR (MAGNIFICATION)
MULTIPLE
NASAL FRACTURE - CLOSED
NASAL FRACTURE WITH COMPOUND WOUND
MALAR FRACTURE - CLOSED
MALAR FRACTURE - MINI INTERNAL FIXATION
FRACTURE MANDIBLE OR MAXILLA A.O.
FRACTURE MANDIBLE + MAXILLA + ORBIT +
NOSE
T.M. JOINT ANKYLOSIS/CONDYLECTOMY :
UNILATERAL
T.M. JOINT ANKYLOSIS WITH RIB GRAFT
CONTRACTURE RELEASE WITH SKIN GRAFT
ONE FINGER
CONTRACTURE RELEASE WITH SKIN GRAFT
MORE FINGERS
CONTRACTURE RELEASE WITH FLAP &
SKINGRAFT
VAS RECANALISATION (MAGNIFICATION)
RELEASE OF TONGUE TIE
RELEASE OF TONGUE TIE - Z PLASTY REPAIR
FRACTURE FLOOR OF ORBIT
LOCAL FLAP/CROSS FINGER FLAP
LOCAL FLAP - MINOR
LOCAL FLAP - MEDIUM
LOCAL FLAP - LARGE
REPAIR OF FRACTURE ZYGOMA
REPAIR OF ONE FINGER
REPAIR OF MORE THAN ONE FINGER
MANDIBLE WIRING
DETACHMENT OF FLAP
REPAIR OF PINNA
EXCISION OF CYST - SINGLE
EXCISION OF CYST - MULTIPLE
SMALL NAEVUS - SINGLE
CYST OR GANGLION MULTIPLE
JOINT REPLACEMENT (MINOR)
NERVE GRAFT (UNDER MAGNIFICATION)
NERVE REPAIR (MULTIPLE)
NERVE REPAIR (SINGLE)
NERVE REPLANTATION (UNDER
MAGNIFICATION)
RADIAL CLUB HAND CORRECTION
TENDON TRANSFER (MULTIPLE)
TENDON TRANSFER (SINGLE)
EXCISION OF MOLE - FACE
DRESSING - MEDIUM
INTRAVELAR VELOPLASTY
LARGE SCAR EXCISION

7000

5600

4200

17000

13600

10200

19000

15200

11400

6000
9000
10000
14000
10000

4800
7200
8000
11200
8000

3600
5400
6000
8400
6000

21000

16800

12600

16000

12800

9600

21000

16800

12600

14000

11200

8400

20000

16000

12000

16800

21000

12600

16000
3000
7000
14000
14000
6000
9000
12000
10000
6000
7000
10000
9500
6000
3500
7000
6000
9500
12000
21000
21000
16000

12800
2400
5600
11200
11200
4800
7200
9600
8000
4800
5600
8000
7600
4800
2800
5600
4800
7600
9600
16800
16800
12800

9600
1800
4200
8400
8400
3600
5400
7200
6000
3600
4200
6000
5700
3600
2100
4200
3600
5700
7200
12600
12600
9600

24000

19200

14400

19000
16000
12000
3500
2500
18000
10000

15200
12800
9600
2800
2000
14400
8000

11400
9600
7200
2100
1500
10800
6000

PR
10000
20000
21000
14000
15000
18000
22000
14000
14000
18000
700
2500
10000
14000

SPR
8000
16000
16800
11200
12000
14400
17600
11200
11200
14400
560
2000
8000
11200

NSB
6000
12000
12600
8400
9000
10800
13200
8400
8400
10800
420
1500
6000
8400

Surgery : Pediatric
Code
PES001
PES002
PES003
PES004
PES005
PES006
PES007
PES008
PES009
PES010
PES011
PES012
PES013
PES014

SURGERY : PEDIATRIC
PERINEAL ANOPLASTY
ABDOMINOPERINEAL PULL THROUGH / PSARP
TRACHEOESOPHAGEAL FISTULA (T.O.F.)
INTESTINAL OBSTRUCTION
COLOSTOMY/ILEOSTOMY CLOSURE
PNEUMONECTOMY
BILIARY ATRESIA/CHOLEDOCHAL CYST
OESOPHAGOSTOMY
CYSTOGASTROSTOMY
CYSTIC HYGROMA - MAJOR
CHEST TUBE MANIPULATION
PERITONEAL DRAINAGE
COLOSTOMY/ILEOSTOMY/JEJUNOSTOMY
RECURRENT INTESTINAL OBSTRUCTION

16/37

GOPD

POPD

CASUALTY

PES015
PES016
PES017
PES019
PES020
PES022
PES023
PES024
PES025
PES026
PES027
PES028
PES029
PES030
PES031
PES032
PES033
PES034
PES035
PES036
PES037
PES038
PES039
PES040
PES041
PES042
PES043
PES044
PES045
PES046
PES047
PES048
PES049
PES050
PES051
PES052
PES054
PES055
PES056
PES057
PES058
PES059
PES060
PES061
PES062
PES063
PES064
PES065
PES066
PES067
PES068
PES069
PES070
PES071
PES072
PES074
PES075
PES076
PES077
PES078
PES079
PES080
PES081
PES082
PES083
PES084

ORCHIDOPEXY UNILAT
PARTIAL DECORTICATION / RIB RESECTION
PERITONEAL ASPIRATION
PYELOPLASTY
PYLORMYOTOMY
RESECTION AND ANASTMOSIS INTESTINE
SIGMOIDOSCOPY
SPLEENECTOMY
SUTURING MULTIPLE WOUND
SUTURING OF WOUND
TONGUE TIE EXCISION
ANAL DILATATION
ANORECTAL MYOMECTOMY
APPENDECTOMY
AXILLARY LYMPH NODE BIOPSY
BRONCHOSCOPY DIAGNOSTIC/FB/BIOPSY
CATHETERISATION AND MCU
CENTRAL VENOUS LINE IN NEONATE
CERVICAL LYMPH NODE BIOPSY
CHEST ASPIRATION
CHEST TUBE INSERTION
GASTROSTOMY
COMPLETE
DECORICATION/OPEN/THORACOSCOPIC
DIAGNOSTIC LAPROSCOPY
DIAPHRAGMATIC HERNIA / EVENTRATION
DRAINAGE OF DEEP/LARGE ABCESS
DRAINAGE OF SMALL ABCESS
DRESSING LARGE
ESPOHAGEAL DILATATION
ESOPHAGOSCOPY /FB
EXCISION BIOPSY SUP.LUMP/SEB CYST
EXCISION BRANCHIAL SINUS/FISTULA
EXCISION THYROGLOSSAL CYST/FISTULA
EXPLORATORY LAPROTOMY
FUNDOPLICATION
GASTROSCHISIS
HYDROCOELE BILAT
HYDROCOELE UNILAT
INGUINAL HERNIA IN NENOATE BILAT
INGUINAL HERNIA IN NEONATE UNILAT
INGUINAL HERNIA REPAIR BILAT
INGUINAL HERNIA REPAIR UNILAT
INTESTINAL FISTULA
INTUSSUSCEPTION AND RESECTON
ANASTMOSIS
INTUSSUSCEPTON REDUCTION (XRAY OR
OPERATIVE)
LAPROSCOPIC APPENDICECTOMY
LIVER ABCESS ASPIRATION
LIVER ABCESS ASPIRATION MULTIPLE
LIVER BIOPSY CLOSED
LOBECTOMY
LYSIS OF INTESTINAL ADHESIONS
MALROTATION INTESTINE
MESENTERIC CYST/DUPLICATION
MULTIPLE RESECTION ANASTMOSIS
MULTIPLE POLYPS
NEONATAL INTESTINAL OBSTRUCTION
/ATRESIA
OBSTRUCTED/STRANGULATED HERNIA
OBPHALOCOELE MAJOR/GASTROSCHISIS
OMPHALOCOELE MINOR
ORCHIDOPEXY BILAT
RADIAL ARTERY CATH
RECTAL POLYP
RECTAL SUCTION BIOPSY/OPEN BIOPSY
UMBILICAL /EPIGASTRIC HERNIA
UMBILICAL CATH ARTERIAL
UMBILICAL CATH VENOUS

11000
12000
2000
19000
12000
15000
3000
16000
5000
3000
3000
5000
11000
12000
6000
7000
2500
2000
5000
2500
6000
10000

8800
9600
1600
15200
9600
12000
2400
12800
4000
2400
2400
4000
8800
9600
4800
5600
2000
1600
4000
2000
4800
8000

6600
7200
1200
11400
7200
9000
1800
9600
3000
1800
1800
3000
6600
7200
3600
4200
1500
1200
3000
1500
3600
6000

18000

14400

10800

7000
20000
5000
3500
2500
3500
5000
6000
10000
10000
8000
14000
18000
12000
8000
14000
10000
12000
9000
17000

5600
16000
4000
2800
2000
2800
4000
4800
8000
8000
6400
11200
14400
9600
6400
11200
8000
9600
7200
13600

4200
12000
3000
2100
1500
2100
3000
3600
6000
6000
4800
8400
10800
7200
4800
8400
6000
7200
5400
10200

14500

11600

8700

10000

8000

6000

12000
3500
6000
2000
18000
12000
15000
15000
20000
10000

9600
2800
4800
1600
14400
9600
12000
12000
16000
8000

7200
2100
3600
1200
10800
7200
9000
9000
12000
6000

18000

14400

10800

14000
18000
12000
16000
2500
6000
5000
9000
2500
2500

11200
14400
9600
12800
2000
4800
4000
7200
2000
2000

8400
10800
7200
9600
1500
3600
3000
5400
1500
1500

17/37

PES085
PES086
PES087
PES088
PES089
PES090
PES091
PES092
PES095
PES096
PES097
PES098
PES099
PES100
PES101
PES102

UMBILICAL GRANULOMA
URACHUS EXCISION
V Y PLASTY TONGUE TIE
VARICOCOELE
VENESECTION / CENTRAL LINE
VITELLINE DUCT EXCISION
KIDNEY BIOPSY
CYSTIC HYGROMA MINOR
EXCISION/SCLEROTHERAPY
EXCISION OF EXTRA DIGIT - (IN NEONATE
CASES)
EXCISION OF RETRO-PERITONEAL TUMOR
DRESSING SMALL
SOFT TISSUE TUMOR (LARGE)
SOFT TISSUE TUMOR (SMALL)
PARAVERTIBRAL ABCESS
RETRO PERITONEAL ABSCESS / HAEMATOMA
SCLEROTHERAPY RECTAL PROLAPSE /
HAEMANGIOMA

2500
10000
6000
10000
2000
10000
8000

2000
8000
4800
8000
1600
8000
6400

1500
6000
3600
6000
1200
6000
4800

10000

8000

6000

4000

3200

2400

20000
1500
9000
6000
9000
12000

16000
1200
7200
4800
7200
9600

12000
900
5400
3600
5400
7200

5000

4000

3000

Radiology : C.T. Scan

Code
CTS001
CTS002
CTS003
CTS004
CTS005
CTS006
CTS007
CTS008
CTS009
CTS010
CTS011
CTS012
CTS014
CTS015
CTS017
CTS018
CTS019
CTS021
CTS022
CTS023
CTS024
CTS025
CTS026
CTS027
CTS028
CTS029
CTS030
CTS031
CTS032
CTS033
CTS034
CTS035
CTS036
CTS037
CTS038
CTS039
CTS040
CTS041
CTS043
CTS044
CTS045
CTS046
CTS047

RADIOLOGY : C.T. SCAN

HEAD - PLAIN
LOWER THORAX + UPPER ABDOMEN-CT
HEAD - PLAIN + CONTRAST (CONTRAST
CHARGE EXT.)
WHOLE ABDOMEN - PLAIN + CONTRAST - CT
UPPER ABDOMEN - CT
LOWER ABDOMEN - CT
L3 TO S1- 4 VERTEBRAE
C4 TO C7- 4 VERTEBRAE
EVERY ADDITIONAL VERTEBRA
THORAX/CHEST -CT
UPPER THORAX
LOWER THORAX/CHEST
ORBIT
TEMPORAL BONE [IAM]
PITUITARY GLAND
PNS FULL
PNS : AXIAL + CORONAL + SAGITAL
FACE- CT
NECK - CT
EXTREMITIES
3D
GUIDANCE BIOPSY(LAB AND DISPOSABLES
EXTRA)-CT
GUIDED ASPIRATION (LAB AND DISPOSABLES
EXTRA) -CT
GUIDED F.N.A.C. (LAB AND DISPOSABLES
EXTRA)
MISCELLANEOUS [ANKLE/HIP/WRIST ETC.]
VIRTUAL COLONOSCOPY
ANGIO-CEREBRAL
PULMONARY ANGIOGRAPHY
ANGIO-ABDOMINAL
ANGIO-RENAL
ANGIO-UPPER ABDOMEN (DUAL PHASE LIVER)
ANGIO-WHOLE ABDOMEN (DUAL PHASE LIVER)
EXTRA FOR M.L.C. CASES
EXTRA FOR EMERGENCY CASES [**]
KUB PLAIN - CT
CONTRAST OMNIPAQUE 10 ML - CT
HRCT THORAX FULL
HEAD & NECK / FACE-CT
CONTRAST OMNIPAQUE 10 ML - CT
CONTRAST OMNIPAQUE 50 ML -CT
CONTRAST IOPAMIRO 15 ML - CT
CONTRAST IOPAMIRO 30 ML -CT
CONTRAST UROVIDEO 20 ML 75 PER - CT

PR
1600
6000

SPR
1600
6000

NSB
1600
6000

GOPD
1300
4800

POPD
1600
6000

2500

2500

2500

2000

2500

6000
3500
3500
3200
3000
600
3400
2600
2800
2800
3000
2200
2000
3200
2800
2800
2200
3600

6000
3500
3500
3200
3000
600
3400
2600
2800
2800
3000
2200
2000
3200
2800
2800
2200
3600

6000
3500
3500
3200
3000
600
3400
2600
2800
2800
3000
2200
2000
3200
2800
2800
2200
3600

4800
2800
2800
2600
2400
480
2700
2100
2200
2200
2400
1800
1600
2600
2200
2200
1800
2900

6000
3500
3500
3200
3000
600
3400
2600
2800
2800
3000
2200
2000
3200
2800
2800
2200
3600

2500

2500

2500

2000

2500

2500

2500

2500

2000

2500

2500

2500

2500

2000

2500

2200
7000
6000
6000
8000
6000
5500
6000
500
500
4000
275
4000
3500
275
625
250
500
150

2200
7000
6000
6000
8000
6000
5500
6000
500
500
4000
275
4000
3500
275
625
250
500
150

2200
7000
6000
6000
8000
6000
5500
6000
500
500
4000
275
4000
3500
275
625
250
500
150

1800
5600
4800
4800
6400
4800
4400
4800
500
500
3200
275
3200
2800
275
625
250
500
150

2200
7000
6000
6000
8000
6000
5500
6000
500
500
4000
275
4000
3500
275
625
250
500
150

18/37

CASUALTY

CTS048
CTS049
CTS050
CTS051
CTS052
CTS053
CTS054
CTS055
CTS056
CTS057
CTS058
CTS059
CTS061

CONTRAST UROVIDEO 20 ML 60 PER -C T

CONTRAST VISIPAQUE 50ML 350 MG
CONTRAST OMNIPAQUE 100ML 300MG
CONTRAST ULTRA VIST 50ML 370MG-CT
HEAD NECT
HEAD NCCT
LARYNX
ANGIO - PERIPHERAL
ANGIO-ABDOMEN AORTA
KUB PLAIN + CONTRAST - CT
WHOLE ABDOMEN - DIRECT CONTRAST - CT
LIVER - TRIPPLE PHASE
EXTRA FILM - CT (PER FILM)

120
1080
1250
875
1600
1600
2600
8000
8000
5000
5000
5000
125

120
1080
1250
875
1600
1600
2600
8000
8000
5000
5000
5000
125

120
1080
1250
875
1600
1600
2600
8000
8000
5000
5000
5000
125

120
1080
1250
875
1300
1300
2100
6400
6400
4000
4000
4000
100

120
1080
1250
875
1600
1600
2600
8000
8000
5000
5000
5000
125

Note : Contrast charges are extra i.e.to be added to above mentioned C.T. SCAN Charges. ** Emergency charge is extra for scans done between 5.00 pm to
8.00 am or on holidays.

Radiology : X Ray
Code
XRA001
XRA002
XRA003
XRA005
XRA006
XRA008
XRA009
XRA010
XRA012
XRA018
XRA019
XRA020
XRA021
XRA022
XRA023
XRA024
XRA025
XRA026
XRA027
XRA028
XRA029
XRA030
XRA031
XRA032
XRA033
XRA034
XRA035
XRA036
XRA037
XRA055
XRA056
XRA057
XRA058
XRA059
XRA061
XRA062
XRA063
XRA064
XRA065
XRA066
XRA067
XRA068
XRA069
XRA072
XRA074
XRA075
XRA077
XRA078
XRA079

RADIOLOGY : X RAY
ADDITIONAL VIEWS FOR ANY REGION
KUB/ABDOMEN (SINGLE VIEW) -XRAY
ABDOMEN ERECT & SUPINE
ERCP
TTC
CHEST (SINGLE VIEW)
PORTABLE X-RAY (PER EXPOSER)
DEPTT. SCREENING /FLUOROSCOPY
XRAY (PER EXPOSER)
PELVIS AP
ANKLE AP & LAT
ARM (HUMERUS) AP & LAT
ELBOW AP & LAT
FEMUR AP & LAT
FOOT AP & OBLIQUE
FOREARM AP&LAT
HAND (FINGERS) AP + OBLIQUE
HIP AP
HIP AP&LAT
HIP LATERAL
KNEE AP & LAT
KNEE AP & LAT AXIAL
LEG AP & LAT
SHOULDER AP
SHOULDER AXIAL
THIGH / FEMUR AP
WRIST AP & LAT
SI JOINT PA/SACRO ILIAC JOINT
SI JOINT PA + BOTH OBL.
BA. SWALLOW /OESOPHAGOGRAPHY
BA. MEAL U.G.I.T.
BA. MEAL FOLLOW THROUGH
BA. ENEMA
BA. ENEMA (DOUBLE CONTRAST)
MANDIBLE 3 VIEWS (AP + BOTH OBL)
MASTOIDS (TOWNS + 2 LATERAL OBLIQUE) 3
VIEWS
PNS
SKULL : ANY SINGLE VIEW
SKULL AP & LATERAL
STYLOID PROCESS (SINGLE VIEW)
TM JOINTS (BILATERAL)
PER ORBITAL VIEW / IAM
MANDIBLE AP
NASOPHARAYNX/ ADENOIDS
HSG .
VENOGRAPHY/PHLEBOGRAPHY (1 SIDE)
PORTABLE SKULL (PER EXPOSER)
COLOGRAM WITH BARIUM OR
GASTROGRAFFIN
VENOGRAPHY/PHLEBOGRAPHY (BILATERAL)

PR
200
200
400
3000
1200
200
300
150
200
200
300
300
300
400
300
300
300
200
400
200
300
400
400
200
200
200
300
200
600
1000
1300
2200
2400
3000
600

SPR
200
200
400
3000
1200
200
300
150
200
200
300
300
300
400
300
300
300
200
400
200
300
400
400
200
200
200
300
200
600
1000
1300
2200
2400
3000
600

NSB
200
200
400
3000
1200
200
300
150
200
200
300
300
300
400
300
300
300
200
400
200
300
400
400
200
200
200
300
200
600
1000
1300
2200
2400
3000
600

GOPD
160
160
320
2400
1000
160
240
120
160
160
240
240
240
320
240
240
240
160
320
160
240
320
320
160
160
160
240
160
480
800
1200
1800
1900
2400
480

POPD
200
200
400
3000
1200
200
300
150
200
200
300
300
300
400
300
300
300
200
400
200
300
400
400
200
200
200
300
200
600
1000
1600
2200
2400
3000
600

600

600

600

480

600

200
200
400
200
600
300
200
200
1200
1900
300

200
200
400
200
600
300
200
200
1200
1900
300

200
200
400
200
600
300
200
200
1200
1900
300

160
160
320
160
480
240
160
160
950
1500
240

200
200
400
200
600
300
200
200
1200
1900
300

1600

1600

1600

1200

1600

3800

3800

3800

3000

3800

19/37

CASUALTY

XRA080
XRA082
XRA083
XRA084
XRA085
XRA086
XRA087
XRA088
XRA089
XRA090
XRA091
XRA092
XRA093
XRA094
XRA095
XRA099
XRA100
XRA101
XRA102
XRA103
XRA104
XRA105
XRA106
XRA107
XRA108
XRA109
XRA111
XRA112
XRA113
XRA114
XRA115
XRA116
XRA118
XRA119
XRA120
XRA121
XRA122
XRA123
XRA124
XRA125
XRA126
XRA127
XRA130
XRA131
XRA132
XRA133
XRA134
XRA135
XRA136
XRA142
XRA144
XRA147
XRA148
XRA149
XRA150
XRA151
XRA152
XRA154
XRA155
XRA156
XRA157
XRA159

FISTULOGRAM/SINOGRAM
SCREENING P.C.N.L. (UPTO 15 MTS)
SCREENING P.C.N.L. (ABOVE 15 MTS)
SCREENING PACEMAKER (UPTO 15 MTS)
SCREENING PACEMAKER (ABOVE 15 MTS)
SCREENING S.P.NAILING (UPTO 15 MTS)
SCREENING S.P.NAILING (ABOVE 15 MTS)
SCREENING RGP (UPTO 15 MTS)
SCREENING RGP (ABOVE 15 MTS)
SCREENING (UPTO 15 MTS.)
SCREENING (ABOVE 15 MTS.)
DORSO-LUMBAR SPINE AP+LATERAL
CERVICAL SPINE/NECK AP LATERAL
SPINE (2 VIEWS)
LS SPINE AP LATERAL
COCCYX AP LATERAL
SACRO - COCCYX AP LATERAL
CONTRAST OMNIPAQUE 10 ML-XRAY
CONTRAST OMNIPAQUE 50 ML-XRAY
CONTRAST IOPAMIRO 15 ML -XRAY
CONTRAST IOPAMIRO 30 ML - XRAY
CONTRAST UROVIDEO 20 ML 75%-XRAY
CONTRAST UROVIDEO 20 ML 60%-XRAY
CONTRAST VISIPAQUE 50 ML 350MG-XRAY
CONTRAST OMNIPAQUE 100 ML 300MG-XRAY
NEPHROSTOGRAM
IVP + MCU.
RGU + M.C.U.
RGP -RETROGRADE PYELOGRAM
RGU/ASCENDING URETHROGRAM
MCU
CONTRAST ULTRA VIST 50 ML 370MG- XRAY
ANKLE LAT AXIAL
ANKLE AP BOTH
ANKLE LATERAL BOTH
WRIST AP BOTH
KNEE AP LATERAL BOTH
KNEE AP BOTH
KNEE AP LATERAL AXIAL BOTH
FOOT AP LATERAL BOTH
HANDS AP BOTH
CERVICAL SPINE EXTENSION/FLEXION
SCAPULA AP
SCAPULA AP LATERAL
SIALOGRAPHY
SPINE (SINGLE VIEW)
NASAL BONE
APICOGRAM
PORTABLE CHEST
PORTABLE ABDOMEN (PER EXPOSER)
PORTABLE SPINE (2 FILM)
PORTABLE ABDOMEN ERECT/SUPINE
CHEST (2 VIEWS)
OESOPHAGEAL DILATION UNDER
FLUROSCOPY
IVP
PORTABLE SPINE (PER EXPOSER)
PORTABLE EXTREMITIES (PER EXPOSER)
MANDIBLE BOTH OBLIQUE
GASTROGRAFFIN SWALLOW
GASTROGRAFFIN FOLLOW THROUGH
WRIST AP & LAT + OBLIQUE(SCAPHOID)
EXTRA FILM - X-RAY (PER FILM)

1000
1000
1200
1000
1200
1000
1200
1000
1200
1000
1200
400
400
400
500
400
400
275
625
250
500
150
120
1080
1250
1700
2400
1500
1400
1300
1400
875
300
200
300
200
400
200
600
600
200
400
200
400
1000
200
200
200
300
300
600
600
400

1000
1000
1200
1000
1200
1000
1200
1000
1200
1000
1200
400
400
400
500
400
400
275
625
250
500
150
120
1080
1250
1700
2400
1500
1400
1300
1400
875
300
200
300
200
400
200
600
600
200
400
200
400
1000
200
200
200
300
300
600
600
400

1000
1000
1200
1000
1200
1000
1200
1000
1200
1000
1200
400
400
400
500
400
400
275
625
250
500
150
120
1080
1250
1700
2400
1500
1400
1300
1400
875
300
200
300
200
400
200
600
600
200
400
200
400
1000
200
200
200
300
300
600
600
400

800
800
1000
800
1000
800
1000
800
1000
800
1000
320
320
320
400
320
320
275
625
250
500
150
120
1080
1250
1350
2000
1200
1100
1000
1100
875
240
160
240
160
320
160
480
480
160
320
160
320
800
160
160
160
240
240
480
480
320

1000
1000
1200
1000
1200
1000
1200
1000
1200
1000
1200
400
400
400
500
400
400
275
625
250
500
150
120
1080
1250
1700
2400
1500
1400
1300
1400
875
300
200
300
200
400
200
600
600
200
400
200
400
1000
200
200
200
300
300
600
600
400

1200

1200

1200

1000

1200

2000
300
300
400
1000
2200
450
125

2000
300
300
400
1000
2200
450
125

2000
300
300
400
1000
2200
450
125

1600
240
240
320
800
1800
360
100

2000
300
300
400
1000
2200
450
125

PR
500
500

SPR
500
500

NSB
500
500

GOPD
400
400

POPD
500
500

Note : COST OF DYE / CONTRAST EXTRA WHEREVER APPLICABLE.

Radiology : Ultra Sound

Code
ULT001
ULT002

RADIOLOGY : ULTRA SOUND

ABDOMINAL - SINGLE ORGAN
GALL BLADDER

20/37

CASUALTY

ULT003
ULT004
ULT005
ULT006
ULT007
ULT008
ULT009
ULT010
ULT011
ULT012
ULT014
ULT015
ULT016
ULT017
ULT018
ULT019
ULT020
ULT021
ULT022
ULT023
ULT024
ULT026
ULT027
ULT028
ULT029
ULT030
ULT031
ULT032
ULT033
ULT034
ULT036
ULT037
ULT038
ULT039
ULT040
ULT041
ULT042
ULT045
ULT046
ULT047
ULT048
ULT050
ULT051
ULT052
ULT053

KIDNEY -U/S
LIVER -U/S
SPLEEN -U/S
CHEST -U/S
UPPER ABDOMEN -U/S
LOWER ABDOMEN -U/S
WHOLE ABDOMEN -U/S
UPPER ABDOMEN + PLEURAL SPACE -U/S
KUB -U/S
PELVIS + T.V.S. -U/S
FOLLICULAR/OVALUTION STUDIES
GUIDED ASPIRATION -U/S
GUIDED BIOPSY -U/S
GUIDED ASPIRATION IN O.T. -U/S
GUIDED MULTI ORGAN ASPIRATION -U/S
PORTABLE CHARGES (ULTRASOUND)
EMERGENCY (ON CALL) CHARGE [**]
OBS. ULTRASOUND EACH
OBS. + T.V.S. (7WEEKS)
OBS. + B.P.P. + DOPPLER
OBS. + B.P.P.
WHOLE ABDOMEN + OBS. (UPTO 10 WEEKS)
WHOLE ABDOMEN + OBS. (ABOVE 10 WEEKS)
OBS LEVEL II - 3D/4D (U/S)
THYROID-U/S
MUSCULAR SKELETON-SONOGRAPHY
SCROTUM / TESTIS
BREAST -U/S
EYES -U/S
TRANSRECTAL
NEONATAL HEAD -U/S
SCROTUM / TESTIS DOPPLER
WHOLE ABDOMEN +TVS -U/S
RENAL DOPPLER -U/S
WHOLE ABDOMEN + DOPPLER -U/S
UPPER ABDOMEN DOPPLER -U/S
PELVIS -U/S
WHOLE ABDOMEN + BPP + DOPPLER -U/S
UPPER ABDOMEN + BPP + DOPPLER
OBS WITH DOPPLER
TVS EXTRA PAYMENT
3D/4D (US)
FOETAL ECHO
PENILE DOPPLER
EXTRA FILM - ULTRASOUND (PER FILM)

500
500
500
500
750
750
1000
750
750
800
1200
800
800
1200
1200
250
400
700
800
1500
1000
1000
1200
1400
600
650
700
500
600
800
600
1400
1200
1800
1500
1200
700
1600
1500
1200
100
1400
1800
1200
125

500
500
500
500
750
750
1000
750
750
800
1200
800
800
1200
1200
250
400
700
800
1500
1000
1000
1200
1400
600
650
700
500
600
800
600
1400
1200
1800
1500
1200
700
1600
1500
1200
100
1400
1800
1200
125

500
500
500
500
750
750
1000
750
750
800
1200
800
800
1200
1200
250
400
700
800
1500
1000
1000
1200
1400
600
650
700
500
600
800
600
1400
1200
1800
1500
1200
700
1600
1500
1200
100
1400
1800
1200
125

400
400
400
400
600
600
800
600
600
650
1000
650
650
1000
950
200
320
550
650
1200
800
800
950
1100
500
520
550
400
500
650
500
1100
950
1500
1200
950
550
1300
1200
950
100

500
500
500
500
750
750
1000
750
750
800
1200
800
800
1200
1200
250
400
700
800
1500
1000
1000
1200
1400
600
650
700
500
600
800
600
1400
1200
1800
1500
1200
700
1600
1500
1200
100

1200
950
100

1800
1200
125

Note : ** Emergency Charge is extra for scans done between 5.00 pm to 8.00 am or on holidays.

Radiology : Mammography
Code
MAM001
MAM002

RADIOLOGY : MAMMOGRAPHY
MAMMOGRAPHY [BILATERAL]
MAMMOGRAPHY [ONE SIDE]

PR
1200
600

SPR
1200
600

NSB
1200
600

GOPD
950
500

POPD
1200
600

CASUALTY

PR
2800
1400
1800
2200
1400
1800

SPR
2800
1400
1800
2200
1400
1800

NSB
2800
1400
1800
2200
1400
1800

GOPD
2600
1100
1400
1800
1100
1400

POPD
3200
1400
1800
2200
1400
1800

CASUALTY

CASUALTY

Radiology : BMD
Code
BMD001
BMD002
BMD003
BMD004
BMD005
BMD006

RADIOLOGY : BMD
BMD - WHOLE BODY
BMD -SPINE
BMD -SPINE + SINGLE HIP
BMD -SPINE + PELVIS
BMD - SINGLE HIP
BMD - PELVIS (BOTH HIPS)

Laboratory : Clinical Chemistry & Hormones

Code
CCH001

LABORATORY : CLINICAL CHEMISTRY &

HORMONES
RBS - RANDOM BLOOD SUGAR

PR

SPR

NSB

GOPD

POPD

70

70

70

60

70

21/37

CCH002
CCH003
CCH004
CCH005
CCH006
CCH007
CCH008
CCH009
CCH010
CCH011
CCH012
CCH013
CCH014
CCH015
CCH016
CCH017
CCH018
CCH020
CCH021
CCH022
CCH023
CCH024
CCH025
CCH027
CCH028
CCH029
CCH030
CCH031
CCH032
CCH033
CCH034
CCH035
CCH036
CCH037
CCH038
CCH039
CCH040
CCH041
CCH042
CCH043
CCH044
CCH046
CCH047
CCH048
CCH049
CCH050
CCH051
CCH052
CCH053
CCH054
CCH055
CCH057
CCH058
CCH059
CCH060
CCH061
CCH062
CCH063
CCH064
CCH065
CCH067
CCH068
CCH069
CCH070
CCH071
CCH072
CCH073
CCH074
CCH075

UREA
CREATININE
CALCIUM
PHOSPORUS (INORGANIC PHOS.)
AMYLASE
GTT-GLUCOSE TOLERANCE TEST
URIC ACID-SERUM
FDP (FIBRIN/FIBRINOGEN DEGRADATION
PRODUCT)
FLUID ALBUMIN
CALCIUM/CREATININE RATIO- URINE FASTING
PROTEIN/CREATININE RATIO -URINE FASTING
GCT - GLUCOSE CHALLENGE TEST
PPS- AFTER GLUCOSE
TOTAL/SERUM PROTEIN(TP,ALB,GLOB,A/G)
PT (PRO TIME)
BILIRUBIN ( DIRECT,INDIRECT,TOTAL)
ALKALINE P TASE-ALP
SGPT/ALT
SGOT /AST
LFT-LIVER FUNCTION TEST
PLASMA FIBRINOGEN
APTT
TROPONIN T (TROP. T)
SODIUM (NA+) ONLY
POTASSIUM (K+) ONLY
SODIUM & POTASSIUM
CHLORIDE (CL-)
BICARBONATE (HCO3-)
ABG - ARTERIAL BLOOD GAS
CHOLESTEROL TOTAL-SERUM
HDL CHOLESTROL - DIRECT
TRIGLYCERIDES
LIPID PROFILE
CPK
CPK (MB)
CHOLESTEROL - FLUID
LDH FLUID
ELECTROLYTES_SERUM
LIPASE-SERUM
GAMMA GT / GGT/ GGTP
LDH-SERUM
MAGNESIUM -SERUM
SODIUM-URINE RANDOM SPECIMEN
AMYLASE-URINE
D-DIMER TEST
FT 3 -FREE T3
FT 4 -FREE T4
TSH
FT3, FT4 & TSH (TOGETHER)
FT3 & FT4 (TOGETHER)
CORTISOL -SERUM
PROLACTIN -SERUM
FSH
LH
PSA - PROSTATE SPECIFIC ANTIGEN
FERRITIN
FBS - FASTING BLOOD SUGAR
PPS (POST PRANDIAL SUGAR)
SBR - BILIRUBIN TOTAL (MICRO METHOD)
ADA
CALCIUM - MICRO METHOD
PPS AFTER BREAKFAST
PPS AFTER LUNCH
PPS AFTER DINNER
URINE FOR CREATININE
NEONATAL TSH SCREEN (NEO TSH)
FBS AND PPS
SERUM ALBUMIN
CORD BLOOD PROLACTIN

90
90
120
120
200
400
110

90
90
120
120
200
400
110

90
90
120
120
200
400
110

70
70
100
100
160
320
90

90
90
120
120
200
400
110

900

900

900

720

900

70
180
140
90
90
110
140
120
120
110
110
500
600
190
850
120
120
200
120
120
500
140
190
200
450
200
300
140
200
300
300
180
220
190
120
200
950
290
290
290
750
550
420
420
420
420
600
600
70
70
100
320
120
70
70
70
90
240
140
70
350

70
180
140
90
90
110
140
120
120
110
110
500
600
190
850
120
120
200
120
120
500
140
190
200
450
200
300
140
200
300
300
180
220
190
120
200
950
290
290
290
750
550
420
420
420
420
600
600
70
70
100
320
120
70
70
70
90
240
140
70
350

70
180
140
90
90
110
140
120
120
110
110
500
600
190
850
120
120
200
120
120
500
140
190
200
450
200
300
140
200
300
300
180
220
190
120
200
950
290
290
290
750
550
420
420
420
420
600
600
70
70
100
320
120
70
70
70
90
240
140
70
350

60
140
120
70
70
90
120
100
100
90
90
400
480
150
700
100
100
160
100
100
400
120
160
160
350
160
240
120
160
240
240
150
180
150
100
160
760
230
230
230
600
450
340
350
350
350
480
480
60
60
80
250
100
60
60
60
70
200
120
60
300

70
180
140
90
90
110
140
120
120
110
110
500
600
190
850
120
120
200
120
120
500
140
190
200
450
200
300
140
200
300
300
180
220
190
120
200
950
290
290
290
750
550
420
420
420
420
600
600
70
70
100
320
120
70
70
70
90
240
140
70
350

22/37

CCH076
CCH077
CCH078
CCH079

CBG - CAPILLARY BLOOD GAS

CORD BLOOD PH FOR FETAL WELL BEING
CRP
HCG WITH LIPIDS

450
150
280
600

450
150
280
600

450
150
280
600

360

450

220
600

280
600

PR
300
300
300
580
660

SPR
300
300
300
580
660

NSB
300
300
300
580
660

GOPD
240
240
240
450
530

POPD
300
300
300
580
660

CASUALTY

PR
90
90
90
140
90
90
250
140
200
90
90
90
90
300
300
80
90
180
130
80
70
100
120
300
200
600
280
180
340

SPR
90
90
90
140
90
90
250
140
200
90
90
90
90
300
300
80
90
180
130
80
70
100
120
300
200
600
280
180
340

NSB
90
90
90
140
90
90
250
140
200
90
90
90
90
300
300
80
90
180
130
80
70
100
120
300
200
600
280
180
340

GOPD
70
70
70
120
70
70
200
120
160
70
70
70
70
240
240
60
70
140
100
60
60
70
100
240
160
480
220
140
260

POPD
90
90
90
140
90
90
250
140
200
90
90
90
90
300
300
80
90
180
130
80
70
100
120
300
200
600
280
180
340

CASUALTY

840

840

840

670

840

480

480

480

420

480

PR
350
125
380
650

SPR
350
125
380
650

NSB
350
125
380
650

GOPD
280
120
300
520

POPD
350
150
380
650

420

420

420

340

420

180
300

180
300

180
300

140
240

180
300

PR
1800
60

SPR
1800
60

NSB
1800
60

GOPD
1400
50

POPD
1800
60

Laboratory : Cytopathology
Code
CYT001
CYT002
CYT003
CYT004
CYT005

LABORATORY : CYTOPATHOLOGY
PAPANICULA SMEAR
FLUIDS FOR MALIGNANT CYTOLOGY
CSF FOR MALIGNANT CYTOLOGY
FNAC
FNAC- CT/US GUIDED

Laboratory : Hematology
Code
HAE001
HAE002
HAE003
HAE004
HAE005
HAE006
HAE007
HAE008
HAE009
HAE010
HAE012
HAE013
HAE014
HAE015
HAE016
HAE017
HAE018
HAE019
HAE020
HAE021
HAE022
HAE023
HAE024
HAE025
HAE026
HAE027
HAE028
HAE029
HAE030
HAE031
HAE033

LABORATORY : HEMATOLOGY
HB (HEMOGLOBIN)
TLC (WBC COUNT)
MALARIAL PARASITES (MP)
PERIPHERAL SMEAR
RBC COUNT
HEMATOCRIT (HCT/PCV)
CBC (COMPLETE BLOOD COUNT)
TLC & DLC
RED CELL INDICES
ESR
MCH
MCHC
DLC
CBC & MP (TOGETHER)
CBC & PS (TOGETHER)
GASTRIC LAVAGE FOR PMNS
MCV
RETIC COUNT
EOSINOPHIL COUNT
CLOT RETRACTION
BT AND CT
SICKLE CELL PREP.
PLATELET COUNT
RBC FRAGILITY
FILARIAL PREP.
BONE MARROW EXAMINATION
FALCIPARUM & PLASMODIUM VIVAX TEST (F&V)
BONE MARROW IRON STAINING
KALA - AZAR DETECT
BONE MARRROW (ASPIRATION AND
EXAMINATION)
FILARIAL ANTIGEN

Laboratory : Special Hematology

Code
HAS001
HAS002
HAS003
HAS004
HAS005
HAS006
HAS007

LABORATORY : SPECIAL HEMATOLOGY

GLYCOSYLATED HB/HB 1AC
FETAL HB.
G6 PD (CONFIRMATORY)
HB ELECTROPHORESIS
G6 PD SCREENING (SCREENING +
CONFIRMATORY)
SERUM IRON
SERUM IRON & TIBC

CASUALTY

Laboratory : Histopathology
Code
HIS001
HIS002

LABORATORY : HISTOPATHOLOGY
FROZEN SECTION WITH BIOPSY SPECIMEN
TISSUE FOR GROSS/DOCUMENTATION ONLY

23/37

CASUALTY

HIS003
HIS004
HIS005
HIS006
HIS007

SLIDE FOR HISTOPATHOLOGY

BLOCK FOR HISTOPATHOLOGY
TISSUE -SMALL FOR HISTOPATHOLOGY
TISSUE - MEDIUM FOR HISTOPATHOLOGY
TISSUE - LARGE FOR HISTOPATHOLOGY

400
500
500
750
1000

400
500
500
750
1000

400
500
500
750
1000

320
400
400
600
800

400
500
500
750
1000

PR
300
300
90
90
90
120
120
180
130
300
240
600
750
60
300
300
300
300
300
300
120
120
600
600
600
600
700
90
300
120
120
120
120
120
750
120
90

SPR
300
300
90
90
90
120
120
180
130
300
240
600
750
60
300
300
300
300
300
300
120
120
600
600
600
600
700
90
300
120
120
120
120
120
750
120
90

NSB
300
300
90
90
90
120
120
180
130
300
240
600
750
60
300
300
300
300
300
300
120
120
600
600
600
600
700
90
300
120
120
120
120
120
750
120
90

GOPD
240
240
70
70
70
100
100
140
100
240
190
480
600
50
240
240
240
240
240
240
100
100
480
480
480
480
560
70
240
100
100
100
100
100
600
100
70

POPD
300
300
90
90
90
120
120
180
130
300
240
600
750
60
300
300
300
300
300
300
120
120
600
600
600
600
700
90
300
120
120
120
120
120
750
120
90

CASUALTY

PR
240
240
320
90

SPR
240
240
320
90

NSB
240
240
320
90

GOPD
190
190
250
70

POPD
240
240
320
90

CASUALTY

240

240

240

190

240

60
50
180

60
50
180

60
50
180

50
40
150

60
50
180

180

180

180

150

180

70

70

70

60

70

PR
90
60

SPR
90
60

NSB
90
60

GOPD
70
50

POPD
90
60

Laboratory : Microbiology
Code
MIC001
MIC002
MIC003
MIC004
MIC005
MIC007
MIC008
MIC009
MIC010
MIC011
MIC012
MIC013
MIC014
MIC015
MIC016
MIC017
MIC018
MIC019
MIC020
MIC021
MIC022
MIC023
MIC024
MIC025
MIC026
MIC027
MIC028
MIC036
MIC037
MIC038
MIC039
MIC040
MIC041
MIC042
MIC044
MIC045
MIC046

LABORATORY : MICROBIOLOGY
CULTURE - BLOOD-ROUTINE
CULTURE & SENSITIVITY - MISC.
STOOL FOR CHOLERA (HANGING DROP)
GRAMS STAIN
FUNGUS PREP. -KOH PREP
DIPHTHERIA SMEAR
AFB - SMEAR MISC SPECIMEN.
RAPID UREASE TEST
CRYPTOCOCUS- SMEAR - CSF
FUNGUS CULTURE
CULTURE & SENSITIVITY - URINE
AFB CULTURE - MISC (MYCOBACTERIUM)
CULTURE- BLOOD -RAPID
WET SMEAR FOR TROPHOZOITES
CULTURE & SENSITIVITY - STOOL
CULTURE & SENSITIVITY - PUS
CULTURE & SENSITIVITY - HVS
CULTURE & SENSITIVITY - THROAT SWAB
CULTURE & SENSITIVITY - CSF
CULTURE & SENSITIVITY - EAR SWAB
AFB -SPUTUM (SAMPLE I)
AFB-URINE (SAMPLE I)
AFB CULTURE - SPUTUM (MYCOBACTERIUM)
AFB CULTURE - URINE (MYCOBACTERIUM)
AFB CULTURE - PUS (MYCOBACTERIUM)
AFB CULTURE - FLUIDS (MYCOBACTERIUM)
MTB/MOTT IDENTIFICATION
SMEAR FOR FUNGUS
CULTURE & SENSIT- SPUTUM
AFB -SPUTUM (SAMPLE II)
AFB -SPUTUM(SAMPLE III )
AFB-URINE (SAMPLE II)
AFB-URINE (SAMPLE III)
URETHERAL SMEAR G.C.
CULTURE OTHERS RAPID
CRYPTOSPORIDIUM - ZN STAIN
PNEUMOCYSTIC CARINI - GRAM STAIN

Laboratory : Miscellaneous
Code
MIS001
MIS002
MIS003
MIS004
MIS005
MIS006
MIS007
MIS008
MIS009
MIS011

LABORATORY : MISCELLANEOUS
FLUID - ROUTINE EXAMINATION
CSF- (SPINAL FLUID) - ROUTINE
SEMEN ANALYSIS
PCT (POST COITAL TEST)
C.S.F. ROUTINE WITH SMEAR FOR
CRYPTOCOCCUS
GA FOR OCCULT BLOOD
FLUID FOR CRYSTALS
STONE ANALYSIS (OTHERS)
URINARY CALCULI (STONE FOR CHEMICAL
ANALYSIS)
FLUID FOR SUGAR

Laboratory : Parasitology
Code
PAR001
PAR002

LABORATORY : PARASITOLOGY
STOOL ROUTINE EXAMINATION
STOOL OCCULT BLOOD

24/37

CASUALTY

PAR003
PAR004
PAR005
PAR006

STOOL FOR PH
STOOL REDUCING SUBSTANCES
STOOL FOR WBC/HPF
STOOL/PUS AMOEBA

50
60
50
50

50
60
50
50

50
60
50
50

PR
100
190
300
150
500
100
100
100
180
380
1100
420
420
420
420
550
700
950
750
750
750
700
1100
420
420
420
420
2000
850
850
550
320
900
800
1400

SPR
100
190
300
150
500
100
100
100
180
380
1100
420
420
420
420
550
700
950
750
750
750
700
1100
420
420
420
420
2000
850
850
550
320
900
800
1400

NSB
100
190
300
150
500
100
100
100
180
380
1100
420
420
420
420
550
700
950
750
750
750
700
1100
420
420
420
420
2000
850
850
550
320
900
800
1400

40
50
40
40

50
60
50
50

GOPD
80
160
240
120
400
80
80
80
140
300
880
330
330
330
330
450
550
750
600
600
600
550
880
330
330
330
330
1600
680
680
440
250
720
640
1200

POPD
100
190
300
150
500
100
100
100
180
380
1100
420
420
420
420
550
700
950
750
750
750
700
1100
420
420
420
420
2000
850
850
550
320
900
800
1400

CASUALTY

POPD
90
50
50
40
50
40
40
50
60
40
40
50
60
60
120
180
50
50
140
140
140
140

CASUALTY

Labroatory : Serology
Code
SER001
SER002
SER003
SER004
SER005
SER006
SER007
SER008
SER009
SER010
SER012
SER013
SER014
SER015
SER016
SER017
SER018
SER019
SER020
SER021
SER022
SER023
SER025
SER026
SER027
SER028
SER029
SER030
SER031
SER034
SER036
SER037
SER038
SER039
SER041

LABROATORY : SEROLOGY
VDRL
WIDAL
HBS AG(HEPATITIS B SURFACE ANTIGEN)
ASO (ASLO) TEST
ANF/ ANA.
CRP (LATEX)
RA TEST
PREGNANCY TEST
VDRL IN DILUTION
HIV TEST
TORCH TEST (IGM)
TOXOPLASMA (IGM)
RUBELLA (IGM)
CYTOMEGALOVIRUS (CMV) (IGM)
HERPES - II (IGM)
HEPATITIS - C (HCV)
HEPATITIS - A (HAV)
HEPATITIS - E (HEV)
TB. ELISA IGM
TB. ELISA IGG
TB. ELISA IGA
DS DNA (DOUBLE STRANDED DNA)
TORCH TEST (IGG)
TOXOPLASMA (IGG)
RUBELLA (IGG)
CYTOMEGALOVIRUS (CMV) (IGG)
HERPES - II (IGG)
BACTERIAL ANTIGEN (5 TESTS)
DENGUE SEROLOGY
DENGUE ANTIGEN
HCG (MATERNAL)
RA FACTOR QUANTITATIVE
ANTI CCP
TTG
PRO-CALCITONIN

Laboratory : Urinalysis
Code
URI001
URI002
URI003
URI004
URI005
URI006
URI007
URI008
URI009
URI010
URI011
URI012
URI013
URI014
URI015
URI016
URI017
URI018
URI019
URI020
URI021
URI022

LABORATORY : URINALYSIS
URINE ROUTINE EXAMINATION
ALBUMIN AND SUGAR
ACETONE
URINE FOR HEMOGLOBIN
URINE FOR MYOGLOBIN
URINE FOR SP. GRAVITY
URINE FOR PH
URINE FOR CHYLE
APT TEST
URINE FOR ALBUMIN
URINE FOR SUGAR
URINE FOR PORPHOBILINOGEN
BILE PIGMENT
UROBILINOGEN
BENCE JONES PROTEIN
24 HR. URINARY ALBUMIN (QUANTITATIVE)
URINE OCCULT BLOOD
URINE FOR REDUCING SUBSTANCES
24 HR. URINARY URIC ACID
24 HR. URINARY CALCIUM
24 HR. URINARY SODIUM
24 HR. URINARY POTASSIUM

PR
90
50
50
40
50
40
40
50
60
40
40
50
60
60
120
180
50
50
140
140
140
140

25/37

SPR
90
50
50
40
50
40
40
50
60
40
40
50
60
60
120
180
50
50
140
140
140
140

NSB
90
50
50
40
50
40
40
50
60
40
40
50
60
60
120
180
50
50
140
140
140
140

GOPD
70
40
40
30
40
30
30
40
50
30
30
40
50
50
100
140
40
40
120
120
120
120

URI023
URI024

24 HR. URINARY PHOSPHORUS

CREATININE CLEARANCE

140
240

140
240

140
240

120
190

140
240

Laboratory : Blood Bank

Code
BLO001
BLO002
BLO003
BLO004
BLO005
BLO006
BLO007
BLO008
BLO009
BLO010
BLO011
BLO012
BLO013
BLO014
BLO015
BLO016
BLO017
BLO018
BLO019
BLO020
BLO021
BLO022
BLO024
BLO027
BLO030

LABORATORY : BLOOD BANK

CROSS MATCHING
GROUPING & TYPING
RELATIVE DONATED BLOOD : PROC.CHARGES
WHOLE BLOOD/RED CELLS :HOSPITALPROCESSING
OTHER BLOOD BANKS : BLOOD ISSUE
FFP - DONATED - PROCESSING
FFP - HOSPITAL - PROCESSING
FFP - PEDIATRIC HOSPITAL - PROCESSING
FFP - PAEDIATRIC - DONATED - PROCESSING
RAPID DONOR TESTING
PLATELET CONCEN.(RD) - DONATED :
PROCESSING
PLATELET CONCEN(RD) HOSPITAL :
PROCESSING
DU FACTOR
DIRECT COOMBS
INDIRECT COOMBS
RH ANTIBODY TITRE
DONOR SCREENING CHARGES
REPLACEMENT FFP
REPLACEMENT FFP PEDIATRICS
REPLACEMENT PLATELET CONCENTRA
COLD AGGLUTININS
VENESECTION PROCEDURE
PLATELET APHERESIS
REPLACEMENT WHOLE BLOOD / PACKED
CELLS
TRANSFER BAGS

PR
170
100
1200

SPR
170
100
1200

NSB
170
100
1200

GOPD
140
80
1000

POPD
170
100
1200

1700

1700

1700

1400

1700

200
850
1100
800
500
250

200
850
1100
800
500
250

200
850
1100
800
500
250

160
700
900
640
400
200

200
850
1100
800
500
250

900

900

900

720

900

1300

1300

1300

1040

1300

180
180
180
600
100
-250
-300
-400
180
180
11000

180
180
180
600
100
-250
-300
-400
180
180
11000

180
180
180
600
100
-250
-300
-400
180
180
11000

150
150
150
480
80

180
180
180
600
100

150
150
9000

180
180
11000

-500

-500

-500

100

100

100

100

100

CASUALTY

Physical Therapy
Code
PHY001
PHY002
PHY003
PHY004
PHY005
PHY006
PHY007
PHY008
PHY009
PHY010
PHY011
PHY012
PHY013
PHY014
PHY015
PHY016
PHY017
PHY018
PHY019
PHY020
PHY021
PHY022
PHY023
PHY024
PHY025
PHY026
PHY027
PHY028

PHYSICAL THERAPY
CONSULTATION (PHYSIOTHERAPY)
INFRA RED RAY THERAPY (SINGLE)
INFRA RED RAY THERAPY (MULTIPLE)
STEAM PACKS(SINGLE)
STEAM PACKS(MULTIPLE)
WAX BATH (SINGLE)
WAX BATH (MULTIPLE)
COLD PACK (SINGLE)
COLD PACK (MULTIPLE)
ULTRA VIOLET THERAPY (SINGLE)
ULTRA VIOLET THERAPY (MULTIPLE)
TENS (SINGLE)
TENS (MULTIPLE)
SHORT WAVE DIATHERMY (SINGLE)
SHORT WAVE DIATHERMY (MULTIPLE)
IFT + US 2 + HP + EXERCISE
IFT + HP + EXERCISE
ULTRA SONIC THERAPY (SINGLE)
CERVICAL TRACTION
ULTRA SONIC THERAPY (MULTIPLE)
LUMBAR TRACTION
CPM - CONTINUOUS PASSIVE MOVEMENT
(SINGLE)
CPM - CONTINUOUS PASSIVE MOVEMENT
(MULTIPLE)
PULSED S.W.D. (SINGLE)
PULSED S.W.D. (MULTIPLE)
CONTRAST BATH (SINGLE)
CONTRAST BATH (MULTIPLE)
STIMULATION (NEURO-MUSCULAR ) SINGLE

PR
150
70
100
80
100
90
120
70
100
120
150
80
100
120
150
300
200
100
100
150
120

SPR
150
70
100
80
100
90
120
70
100
120
150
80
100
120
150
300
200
100
100
150
120

NSB
150
70
100
80
100
90
120
70
100
120
150
80
100
120
150
300
200
100
100
150
120

GOPD
90
40
60
50
60
60
70
40
60
70
90
50
60
70
100
200
120
60
60
100
70

POPD
150
70
100
80
100
90
120
70
100
120
150
80
100
120
150
300
200
100
100
150
120

100

100

100

60

100

150

150

150

100

150

150
200
100
150
150

150
200
100
150
150

150
200
100
150
150

100
150
60
90
100

150
200
100
150
150

26/37

CASUALTY

PHY029
PHY030
PHY031
PHY032
PHY033
PHY034
PHY035
PHY036
PHY037
PHY038
PHY039
PHY040
PHY041
PHY042
PHY043
PHY044
PHY045
PHY046
PHY047
PHY048
PHY049
PHY050
PHY051
PHY052
PHY053
PHY055
PHY056
PHY062
PHY063
PHY064
PHY065
PHY066
PHY067
PHY068
PHY069
PHY070
PHY071
PHY072
PHY073
PHY074
PHY075
PHY076
PHY077
PHY078
PHY079
PHY080
PHY081
PHY082
PHY083
PHY084
PHY085
PHY086
PHY087
PHY088
PHY089
PHY090
PHY091
PHY092
PHY093
PHY094
PHY095
PHY096
PHY097
PHY098
PHY099
PHY100

STIMULATION (NEURO-MUSCULAR) MULTIPLE

INTERFERENTIAL THERAPY (SINGLE)
INTERFERENTIAL THERAPY (MULTIPLE)
LASER -INFRA RED (SINGLE)
LASER - INFRA RED (MULTIPLE)
MANUAL MUSCLE TESTING (SINGLE)
MANUAL MUSCLE TESTING (MULTIPLE)
ELECTRICAL MUSCLE TESTING (SINGLE)
ELECTRICAL MUSCLE TESTING (MULTIPLE)
EMG BIO-FEEDBACK (SINGLE)
EMG BIO-FEEDBACK (MULTIPLE)
INFRA RED SAUNA
BREATHING EXERCISE
POST OP. CHEST PHYSIO-THERAPY
CHEST PHYSIO-THERAPY (SINGLE)
SIMPLE EXERCISE (SINGLE)
SPECIAL EXERCISE (SINGLE)
EXTENSIVE EXERCISE
SUSPENSION THERAPY
TILT TABLE THERAPY
GAIT TRAINING
NEURO-DEVELOPMENTAL THERAPY
MOBILIZATION (SINGLE)
ANTE-NATAL EXERCISES PER SITTING
IFT + US + HP + EXERCISE
POST NATAL EXERCISES (ALL
SESSIONS)(MULTIPLE)
SWD + US + EXERCISE
WAX + EXERCISE (SINGLE)
WAX + EXERCISE (MULTIPLE)
SPECIAL EXERCISE (MULTIPLE)
WAX + EXERCISE + ULTRA SONIC THERAPY
(SINGLE)
WAX + EXERCISE + ULTRA SONIC
THERAPY(MULTIPLE)
SWD + EXERCISE (SINGLE)
SWD + EXERCISE (MULTIPLE)
US + HOT PACK + EXERCISE (SINGLE)
US + HOT PACK + EXERCISE (MULTIPLE)
MOBILAZATION (MULTIPLE)
2 SIMPLE TREATEMENT (SINGLE)
3 SIMPLE TREATMENT (SINGLE)
2 SIMPLE TREATMENT (MULTIPLE)
3 SIMPLE TREATMENT (MULTIPLE)
4 SIMPLE EXERCISE (SINGLE)
4 SIMPLE EXERCISE (MULTIPLE)
STIMULATION + EXERCISE (SINGLE)
STIMULATION + EXERCISE (MULTIPLE)
IFT + SWD + EXERCISE (SINGLE)
IFT + SWD + EXERCISE (MULTIPLE)
SWD + US + CERVICAL TRACTION (SINGLE)
SWD + US + CERVICAL TRACTION (MULTIPLE)
LASER + EXERCISE
MULTIPLE TREATMENTS
ANTENATAL EXERCISE - PACKAGE
PACKAGE FOR PEDIATRIC/CHRONIC CASES
PER MONTH
COMPRESSION THERAPY (SINGLE)
COMPRESSION THERAPY (MULTIPLE)
IFT + US 2 + HP 2 + EXERCISE
IFT 2 + US 2 + EXERCISE
HP+EXERCISE
EXERCISE+WALKING
WAX+EXERCISE+WALKING
STIMULATION + WAX+EXERCISE
STIMULATION+WAX+EXERCISE+WALKING
EXERCISE+COLD PACK+CPM
WAX+EXERCISE+CPM
WAX+EXERCISE+CPM+WALKING
WAX2+EXERCISE

200
150
200
250
350
200
250
250
300
250
350
250
100
100
150
150
200
250
120
120
200
200
250
150
250

200
150
200
250
350
200
250
250
300
250
350
250
100
100
150
150
200
250
120
120
200
200
250
150
250

200
150
200
250
350
200
250
250
300
250
350
250
100
100
150
150
200
250
120
120
200
200
250
150
250

150
100
150
150
200
120
150
150
200
150
200
150
60
60
100
100
120
150
70
70
120
120
150
100
150

200
150
200
250
350
200
250
250
300
250
350
250
100
100
150
150
200
250
120
120
200
200
250
150
250

350

350

350

250

350

250
200
250
250

250
200
250
250

250
200
250
250

150
120
150
150

250
200
250
250

250

250

250

150

250

300

300

300

150

300

200
250
200
250
200
200
200
250
300
300
350
200
250
250
300
250
300
350
400
600

200
250
200
250
200
200
200
250
300
300
350
200
250
250
300
250
300
350
400
600

200
250
200
250
200
200
200
250
300
300
350
200
250
250
300
250
300
350
400
600

120
150
120
150
100
100
120
150
180
200
250
120
150
150
180
150
180
200
250
400

200
250
200
250
200
200
200
250
300
300
350
200
250
250
300
250
300
350
400
600

3000

3000

3000

1500

3000

250
300
300
250
200
250
300
300
350
350
300
350
200

250
300
300
250
200
250
300
300
350
350
300
350
200

250
300
300
250
200
250
300
300
350
350
300
350
200

150
200
200
180
120
150
150
200
250
200
200
250
120

250
300
300
250
200
250
300
300
350
350
300
350
200

27/37

PHY101
PHY102
PHY103
PHY104
PHY105
PHY106
PHY107
PHY108
PHY115
PHY116
PHY117
PHY118
PHY119
PHY120

WAX4+EXERCISE
WAX4+HP2+EXERCISE
IFT+HP2+EXERCISE
IFT2+HP2+EXERCISE
LASER+IFT+EXERCISE
CTR+US2+IFT+EXERCISE
SWD+US2+CTR+EXERCISE
LASER+IFT+CTR+EXERCISE
RESPERESY EXERCISE
SWD2+US2+EXERCISE
IFT2+SWD2+EXERCISE
US4
SAUNA + EXERCISE
WALKING + WAX + EXERCISE + CPM
(MULTIPLE)

250
300
250
300
350
300
300
400
275
250
250
200
400

250
300
250
300
350
300
300
400
275
250
250
200
400

250
300
250
300
350
300
300
400
275
250
250
200
400

150
180
150
180
250
200
180
250
250

250
300
250
300
350
300
300
400
400

400

400

400

PR
3100
6700
7200
3100
4800
12000
4000
7200
6200
12000
6700

SPR
2800
5800
6200
2800
4200
10200
3400
6200
5500
10200
5800

NSB
2300
4600
5000
2300
3400
8400
2800
5000
4600
8400
4600

GOPD
1600
3400
3600
1600
2400
6000
1700
3600
3100
6000
3400

POPD
2800
5800
6200
2800
4200
10200
3400
6200
5500
10200
5800

8600

7600

6200

4300

7600

12000
12000
36
3100
900
35
2500
12000
8500
10200
3875
1000

10200
10200
36
3100
900
35
2500
10200
7000
8400
3875
1000

8400
8400
36
3100
900
35
2500
8400
5500
6600
3875
600

6000
6000
36
3100
900
35
2500
6000
3700
4600
3875

10200
10200
36
3100
900
35
2500
10200
7000
8400
3875

Endoscopy
Code
END001
END002
END003
END004
END005
END006
END007
END008
END009
END010
END011
END012
END013
END014
END015
END016
END017
END019
END020
END021
END022
END023
END024
END026

ENDOSCOPY
ENDOSCOPY UPPER G.I.
EST-ENDOSCOPIC SCLEROTHERAPY
FOREIGN BODY REMOVAL
COLONOSCOPY - I
COLONOSCOPY - 2
POLYPECTOMY
OESOPHAGEAL ACHALASIA
DILATATION
ERCP - ENDOSCOPY
PAPILLOTOMY WITH STONE EXTRACTION
EVL-ENDOSCOPIC VARICES LIGATION
PERCUTANEOUS ENDOSCOPIC GASTROTOMY PEG
THERAPEUTIC ERCP
EPT - STONE EXTRACTION
DISPOSABLE MOUTH PIECE
BOSTON SCIENTIFIC INJECTOR
INJECTOR FOR FUNDAL VARICES
CD - ENDOSCOPY
MULTIPLE BAND LIGATOR SET - OMNIVIEW
OESOPHAGEAL METAL STENT PLACEMENT
UGIE & APC
COLONOSCOPY & APC
MBL (WILSON COOK)
ANAESTHESIA FOR ENDOSCOPY - FLAT RATE

CASUALTY

Note : (1). 25% of the above procedures fee will be levied as G.E.Room and Equipment charges. (2). The charges for disposables and
laboratory will be extra.

Exchange Blood Transfusion

Code
EXB001

EXCHANGE BLOOD TRANSFUSION

EXCHANGE TRANSFUSION (FLAT RATE)

PR
3500

SPR
3000

NSB
2000

GOPD
1200

POPD
1800

CASUALTY

SKIN PROCEDURES
BIOPSY OF SKIN
CHEMICAL CAUTERY
SKIN REMOVAL OF BLACKHEADS
SKIN REMOVAL OF MOLUSEUM
SKIN SCRAPING
PATCH TESTING - UPTO 4 ANTIGENS
PATCH TESTING - ABOVE 4 ANTIGENS
WOODS LAMP EXAMINATION

PR
1125
400
400
400
400
500
800
200

SPR
1125
400
400
400
400
500
800
200

NSB
875
400
400
400
400
500
800
200

GOPD
400
250
250
250
250
400
800
150

POPD
800
500
500
500
500
600
1000
300

CASUALTY

DRESSING

PR

GOPD

POPD

CASUALTY

Skin Procedures
Code
SKO002
SKO003
SKO007
SKO008
SKO009
SKO010
SKO011
SKO012

Dressing
Code

28/37

SPR

NSB

DRE001
DRE002
DRE003

COLOSTOMY DRESSING
TRACHEOSTOMY DRESSING
WOUND DRESSING

60
100
200

60
100
200

60
100
200

TREATMENT
FIBREOPTIC BRONCHOSCOPIC INTUBATION
CHLAZION
LUMBAR PUNCTURE
BONE MARROW ASPIRATION/STERNAL
PUNCTURE
CUT DOWN/VENESECTION
CENTRAL VENOUS PRESSURE LINE
(CETROFIX) INSERTION
I&D - INCISION & DRAINAGE OF ABSCESS
ENDOTRACHEAL INTUBATION
MINOR SURGICAL PROCEDURE
CAVAFIX INTRODUCTION
PLEURAL FLUID
ASPIRATION(TAPING)/THORACENTESIS
ASCITIC FLUID ASPIRATION/PARACENTESIS
INTER COSTAL (TUBE) DRAINAGE [COST OF
CHEST TUBE E
BIOPSY OF BONE
BIOPSY OF LIVER
BIOPSY OF MUSCLE
URETHERAL DILATATION
ANAL DILATATION
INCIDENTAL ABORTION
TEMPORARY PACING
FEMORAL CATHETERISATION
PERITONEAL DIALYSIS
SUBCLAVIAN CANNULATION
NST -NON STRESS TEST (PER 20 MINUTES)
NON STRESS MONITORING (PER TWO HOURS)
SUTURING UP TO 5 STITCHES
ABOVE 5 STICHES EACH STITCH
INCIDENTAL DELIVERY INCLUDING SUTURING
HYDRO CORTIZONE INJ.
EXCISION BIOPSY(SUTURE MATERIAL CHARGE
EXT)
PROSTATE BIOPSY
SODIUM NITRATE CAUTERY
COPPER SULPHATE CAUTERY
MAC DONALD STITCH REMOVAL
EXCISION OF NAIL
EAR LOBE STITCHING UNDER L.A. (SINGLE)
EAR LOBE STITCHING UNDER L.A. (BOTH)
EAR PIERCING : BILATERAL
K-WIRE REMOVAL
CLOSED REDUCTION MANIPULATION : UPPER
EXTREMITY
CLOSED REDUCTION MANIPULATION : LOWER
EXTREMITY
PILES INJECTION (HAEMORRHOIDS)
I.V.SERVICE CHARGES (COST OF I.V. EXTRA)
INJ. GIVING CHARGES
KNEE ASPIRATION
STRAPPING
PULLED ELBOW
SIMPLE MANIPULATION
JAW MANNUAL REDUCTION
PARAPHIMOSIS REDUCTION
MANNUAL EVACUATION
SUPRA PUBIC CATHETERISATION
CHANGE OF SUPRA PUBIC CATHETERISATION
EYE SYRINGING / NEEDLING
CATHETERIZATION PLAIN
SPOT RBS

PR
6000

SPR
4800

NSB
3600

30
50
100

60
100
200

GOPD

POPD
800
800

Treatment
Code
ANC021
EYE007
TRE001
TRE002
TRE003
TRE004
TRE005
TRE006
TRE008
TRE009
TRE010
TRE011
TRE012
TRE013
TRE015
TRE016
TRE017
TRE018
TRE020
TRE021
TRE022
TRE023
TRE024
TRE025
TRE026
TRE029
TRE030
TRE031
TRE033
TRE034
TRE036
TRE039
TRE040
TRE041
TRE042
TRE043
TRE044
TRE045
TRE046
TRE047
TRE048
TRE050
TRE051
TRE052
TRE053
TRE054
TRE055
TRE056
TRE057
TRE058
TRE059
TRE060
TRE061
TRE062
TRE063
TRE064

900

900

800

400
400

1000

1000

800

400

800

1000

1000

800

250

500

1000

1000

800

750
1000
900
1000

750
1000
900
1000

625
800
800
800

400
400
500

800
800
1000
800

1000

1000

800

400

800

1000

1000

800

400

800

1400

1400

1100

500

1000

1400
1400
1400
1400
1400
2300
5000
1400
2750
2750
500
200
200

1400
1400
1400
1400
1400
2300
5000
1400
2750
2750
500
200
200

1100
1100
1100
1100
1100
1500
4000
1100
2000
2000
400
200
200

1500
200

1500
200

1500
200

500
600
500
400
400
1000
1500
400
750
750
250
100
150
75
3000
150

1000
1200
1000
800
800
1500
3000
800
1500
1500
500
200
300
150
3000
300

600

600

600

400

800

800
200
200
400
600
600
800
400
800

800
200
200
400
600
600
800
400
800

800
200
200
400
600
600
800
400
800

500
150
150
300
400
500
700
300
500

1000
300
300
600
800
1000
1500
600
1000

1500

1500

1500

800

1600

2000

2000

2000

1000

2000

200
20
20
400

200
20
20
400

200
20
20
400

650

650

650

600

600

600

150
25
20
300
70
150
250
300
400
200
400
400
100

50

50

50

300
25
20
600
70
300
500
600
800
400
800
400
200
150
60

29/37

800

40

CASUALTY

TRE066
TRE067
TRE068
TRE071
TRE072
TRE073
TRE074
TRE075
TRE088
TRE089
TRE090
TRE091
TRE092
TRE093
TRE094
TSI001
TSI002
TSI003
TSI005
TSI006
TSI007

ELECTRIC SHOCK IN CASUALTY

DEBRIDEMENT OF THE WOUND
CHEST STRAPPING
MONTOUX TEST
CHEMOTHERAPY- BED & NURSING
CHEMOTHERAPY- GENERAL SUPPLIES
CHEMOTHERAPY-THERAPY CHARGES
KIDNEY BIOPSY (LAB CHARGES EXT.)
NASAL PACKING + PACK REMOVAL (BED SIDE)
EPIDURAL INJECTION (BED SIDE)
NORMAL SALINE NEBULISATION
MINOR SUTURING
BIOPSY OF SKIN
ENDOMETRIAL BIOPSY
INCISION & DRAINAGE OF ABSCESS
RBS DONE WITH GLUCOMETER
URINE FOR SUGAR/ALBUMIN - TREATMENT
URINE FOR ACETONE -TREATMENT
SALSOL NEBULISATION
BLADDER IRRIGATION
SPO2 MONITORING

25
100
200
1000
3000
1500
2000
30
900
1400
2300
1000
40
20
20
30

25
100
200
1000
3000
1500
1600
30
900
1400
2300
1000
40
20
20
30

20
100
200
1000
2400
1200
1200
20
800
1100
1500
800
40
20
20
20

100
300
250
25
150
200
1250
300

100
300
250
30
150
200
1250
600

15

20

100

300
100

GOPD
800
1350
800
450
300
1100
550

POPD
1100
1800
1100
600
375
1400
750

3150

4250

9500

12700

11200

15000

300

375

375
375

500
500

300

375

Note : COST OF SUTURES AND OTHER MATERIALS i.e. P.O.P., COTTON ROLL ETC. EXTRA

Psycholgical Services
Code
PSY001
PSY002
PSY003
PSY004
PSY005
PSY006
PSY007
PSY008
PSY009
PSY010
PSY011
PSY012
PSY013
PSY014

PSYCHOLGICAL SERVICES
IQ TESTING (BELOW 6)
IQ TESTING (ABOVE 6 TILL 16)
EDUCATIONAL/DIAGNOSTIC
DEVELOPMENTAL SCREENING
ASSESSMENT SHARING REPORT GUIDANCE
IQ TESTING (ADULTS/CHILDREN-1 SESSION)
DEVELOPMENT (DQ) TESTING-1 SESSION
TESTING FOR ACADEMIC PROBLEMS-3
SESSIONS
TESTING FOR CHILDREN-OTH. PROB.(5/6
SESSSIONS)
TESTING FOR ADULTS-OTH. PROB.(5/6
SESSIONS)
FOLLOWUP COUNSELING/REMEDIAL INPUT
PER SESSION
PSYCHOTHERAPY AND COUNSELING PER HR
SPECIAL EDUCATION THERAPY-PER HOUR
EARLY CHILDHOOD INTERVENTION STIM. PER
HR

PR

SPR

NSB

CASUALTY

Special Investigations Treatme

Code
SIN003
SIN004

SPECIAL INVESTIGATIONS TREATME

URO-FLOWMETRY
PFT

PR
500
800

SPR
500
800

NSB
400
600

GOPD
300
550

POPD
500
800

CASUALTY

PR

SPR

NSB

GOPD
10

POPD
20

CASUALTY

PR
40
35
400

SPR
40
35
400

NSB
30
35
300

GOPD
50

POPD
75

CASUALTY

100

200

Nursing Procedures
Code
NUP001

NURSING PROCEDURES
STEAM INHALATION.

Special Nursing Procedure

Code
SNP001
SNP002
SNP003

SPECIAL NURSING PROCEDURE

NEBULIZATION
LACTODEX MILK PER DAY
SKIN/PELVIC TRACTION APPLICATION

Peadiatric Procedures

30/37

Code
PEP001
PEP002
PEP003
PEP004
PEP005
PEP006
PEP007
PEP008

PEADIATRIC PROCEDURES
PREPUTIAL DILATATION
LABIAL ADHESIONS
MINOR SUTURING (PEADIATRIC)
DRESSING : MINOR (PEDIATRIC)
DRESSING : MAJOR (PEDIATRIC)
UMBILICAL GRANULOMA
EXCISION CYST/MOLE
ABSCESS DRAINAGE (PEADIATRIC)

PR

SPR

NSB

GOPD
500
500
250
100
200
300
500
500

POPD
1000
1000
500
300
500
600
1000
1000

CASUALTY

PR
1200

SPR
1000

NSB
900

GOPD
850
1650

POPD
850
1650

CASUALTY
850

Dialysis
Code
DIA001
DIA003

DIALYSIS
DIALYSIS
JUGULAR CANULISATION

Note : HAEMODIALYSIS CHARGES INCLUDE PROFESSIONAL FEE OF NEPHROLOGIST FOR HAEMODIALYSIS. HOWEVER, IT DOES NOT INCLUDE
CHARGES FOR ANY CONSUMABLES, VASCULAR ACCESS AND INVESTIGATIONS.

Audiological Testing
Code
AUD001
AUD002
AUD003
AUD004
AUD005
AUD006
AUD007
AUD008
AUD009
SIN001
SIN002

AUDIOLOGICAL TESTING
ABLB/SISI/TD
SCREENING OAE
OAE-TEOAE/DPOAE DIAGNOSTIC
AC BERA
BC AERA
ASSR
ECOCH G
SPEECH THERAPY
COCHLEAR IMPLANT C-C
AUDIOMETRY-PTA/BOA
TYMPANOMETRY-IMPEDANCE

PR
300
500
800
1500
1500
1900
2500
200
750
250
500

SPR
300
500
800
1500
1500
1900
2500
200
750
250
500

NSB
300
500
800
1500
1500
1900
2500
200
750
250
500

GOPD
250
250
650
1350
1350
1700
2300
125
600
200
400

POPD
300
500
800
1500
1500
1900
2500
200
750
300
500

CASUALTY

Oxygen (Casualty)
Code
OXI001

OXYGEN (CASUALTY)
NASAL OXYGEN [0 TO 2 HOURS]

PR

SPR

NSB

GOPD

POPD

CASUALTY
100

OXYGEN
OXYGEN BY HOOD/MASK (PER DAY)
OXYGEN BY NASAL CATHETER (PER DAY)
OXYGEN BY HOOD/MASK (LESS THAN 6
HOURS)

PR
350
250

SPR
350
250

NSB
350
250

GOPD

POPD

CASUALTY

200

200

200

ECG
ECG

PR
180

SPR
180

NSB
180

GOPD
150

POPD
180

CASUALTY

NURSERY
NEO-NATAL UNIT:NURSERY - PER DAY
PHOTO THERAPY :SINGLE- PER DAY
INCUBATOR : PER DAY
OPEN CARE : PER DAY
PHOTO THERAPY - DOUBLE PER DAY
WARMER CARE

PR
600
400
500
500
500
300

SPR
500
300
400
400
400
250

NSB
400
200
300
300
300
200

GOPD

POPD

CASUALTY

VENTILATOR
VENTILATOR PER DAY

PR
1800

SPR
1800

NSB
1800

GOPD

POPD

CASUALTY

Oxygen
Code
OXY001
OXY002
OXY003

ECG
Code
ECG001

Nursery
Code
NUR001
NUR002
NUR003
NUR004
NUR005
NUR006

Ventilator
Code
VEN001

31/37

VEN002
VEN003

BI-PAP /C PAP
INFANT VENTILATOR

1200
1500

1200
1500

1200
1500

PR
1500

SPR
1500

NSB
1500

GOPD
1200

POPD
1500

CASUALTY

PR
400

SPR
400

NSB
250

GOPD

POPD

CASUALTY

20

20

Tread Mill Test

Code
TMT001

TREAD MILL TEST

TMT- TREAD MILL TEST

Nursing Care
Code
NUM001
NUM002

NURSING CARE
NURSING CARE : PER DAY
SITZ BATH

Note : Nursing care is professional charges for routine nursing care provided by the nurses to all admitted patients.

Holter Monitor
Code
HOL001

HOLTER MONITOR
HOLTER MONITORING

PR
1500

SPR
1500

NSB
1500

GOPD
900

POPD
1500

CASUALTY

PR
1100

SPR
1100

NSB
1100

GOPD
850

POPD
1100

CASUALTY

POPD

CASUALTY

Electro Encephalogram
Code
EEG001

ELECTRO ENCEPHALOGRAM
EEG

Diet For Attendants

Code
DIE001
DIE002
DIE003
DIE004
DIE005
DIE007
DIE009
DIE010
DIE011
DIE012
DIE013
DIE014
DIE015
DIE016
DIE017
DIE018
DIE019
DIE020

DIET FOR ATTENDANTS

FULL MEALS FOR ATTENDANT (VEG): PER DAY
BREAKFAST (VEG.) ONLY
LUNCH (VEG) ONLY
DINNER (VEG) ONLY
TEA WITH SNACKS
AERATED COLD DRINKS : 500 ML. BOTTLE
MILK : PER GLASS
BOTTLED DRINKING WATER (1 LITRE BOTTLE)
TEA (ONE CUP)
COFEE (ONE CUP)
COFEE WITH SNACKS
FROOTI (200ml)
PACKED JUICES (200ml)
SANDWICHES - VEG (4 SLICES)
BREAKFAST (NON-VEG.) ONLY
LUNCH (NON - VEG) ONLY
DINNER (NON - VEG) ONLY
FULL MEALS FOR ATTENDANT (NON - VEG):
PER DAY

PR
300
70
100
100
30
35
15
20
15
20
40
15
25
30
80
130
130

SPR
300
70
100
100
30
35
15
20
15
20
40
15
25
30
80
130
130

NSB
300
70
100
100
30
35
15
20
15
20
40
15
25
30
80
130
130

GOPD

350

350

350

PR
1800
1800
1800
1800
1800
1800

SPR
1800
1800
1800
1800
1800
1800

NSB
1800
1800
1800
1800
1800
1800

GOPD
1200
1200
1200
1200
1200
1200

POPD
1800
1800
1800
1800
1800
1800

CASUALTY

PR
600
500
300
200

SPR
600
500
300
200

NSB
600
500
300
200

GOPD
400
400
350
150

POPD
600
600
500
300

CASUALTY

Echocardiography
Code
ECH001
ECH002
ECH003
ECH004
ECH005
ECH006

ECHOCARDIOGRAPHY
DOPPLER STUDY
ECHOCARDIOGRAPHY
VENOUS DOPPLER - LOWER LIMB
VENOUS DOPPLER - UPPER LIMB
ARTERY DOPPLER - LOWER LIMB
ARTERY DOPPLER - UPPER LIMB

ENT
Code
ENO001
ENO002
ENO003
ENO004

ENT
ANTRAL WASH OUT
BIOPSY NOSE,ORAL CAVITY
CAUTERY OF NASAL BLEEDERS
CHEMI.CAUTERISA OF THROAT

32/37

ENO005
ENO006
ENO008
ENO009
ENO010
ENO011
ENO012
ENO013
ENO014
ENO015
ENO016
ENO017
ENO018
ENO019
ENO020
ENO021
ENO022
ENO023
ENO024
ENO025
ENO026
ENO027
ENO028
ENO029
ENO031

EOM PATCH OR CAUTERY AND PATCH

EUM -EXAMINATION UNDER MICROSCOPE
FOREIGN BODY REMOVAL-(NOSE/EAR)
FOREIGN BODY THROAT(FISH BONE)
MYRINGOTOMY FOR ASOM
NASAL ENDOSCOPY
NASAL PACK
SPLIT EAR LOBE {BILATERAL)
SPLIT EAR LOBE {UNILATERAL)
SUB MUCUS DIATHERMY
NASAL ENDOSCOPY WITH SUCTION CLERANCE
SYRINGING ENT
WAX REMOVAL IMPACTED(EAR)
EXCISION OF TONGUE TIE
MEROCIL
GROMMET
SEPTAL PLATE (STIFF)
NASAL SPLINT (STIFF)
NASAL SPLINT (EXTENDED)
SEPTAL PLATE (FLEXIBLE)
EAR STUD
NASAL STUD
EPLEY MANEUVER
FIBRE OPTIC DIRECT LARYNGOSCOPY
NASAL PACK REMOVAL

450
300
450
800
750
400
1500
800
600
600
450
200
300
400
650
500
500
500
1200
750
300
250
400

450
300
450
800
750
400
1500
800
600
600
450
200
300
400
650
500
500
500
1200
750
300
250
400

450
300
450
800
750
400
1125
800
600
600
450
200
300
400
650
500
500
500
1200
750
300
250
400

400
300
300
750
700
350
350
600
500
500
400
150
250
400
650

600
400
450
1000
900
500
500
1000
800
800
600
300
400
600
650

500
500
1200
750

500
500
1200
750

250

250

1300
100

1500
200

Laser Procedures
Code
LAP001
LAP002
LAP003
LAP004
LAP005
LAP006
LAP007
LAP008
LAP009

LASER PROCEDURES
FLUORESCIEN ANGIOGRAPHY [SUPPLIES
EXTRA]
LASER PHOTOCAGULATION
LASER PERIPHERAL IRIDECTOMY
LASER PHOTOCAGULATION - LATTICE & HOLES
LASER PHOTOCAGULATION - R O P
OCT
AUTOPERIMETRY
COLOUR PHOTOS
YAG CAPSULOTOMY

PR

SPR

NSB

GOPD

POPD

2000

2000

2000

2000

2000

2500
3000
4000
6500
2500
1500
500
2500

2500
3000
4000
6500
2500
1500
500
2500

2500
3000
4000
6500
2500
1500
500
2500

2500
3000
4000
6500
2500
1500
500
2500

2500
3000
4000
6500
2500
1500
500
2500

PR
4300
3500
52000
7800
7000
2600
3500
5200
3000
3850
4800
5650
13000
10500
10500
9500
10400
4300
4300
8650
16500
26000
8650
3500
1200
10200

SPR
4300
3500
52000
7800
7000
2600
3500
5200
3000
3850
4800
5650
13000
10500
10500
9500
10400
4300
4300
8650
16500
26000
8650
3500
1200
10200

GOPD
3500
2800
41500
6250
5500
2200
2800
4200
2400
3100
3850
4600
10400
8500
8400
7600
8300
3500
3500
7000
13200
21000
7000
2800
1000
8400

POPD
4300
3500
52000
7800
7000
2600
3500
5200
3000
3850
4800
5650
13000
10500
10500
9500
10400
4300
4300
8650
16500
26000
8650
3500
1200
10200

CASUALTY

Ayurvedic Treatment
Code
AYT001
AYT002
AYT003
AYT004
AYT005
AYT006
AYT007
AYT008
AYT009
AYT010
AYT011
AYT012
AYT013
AYT014
AYT015
AYT016
AYT017
AYT018
AYT019
AYT020
AYT021
AYT022
AYT023
AYT024
AYT025
AYT026

AYURVEDIC TREATMENT
SARVANG ABHYANGA-ADULT 7- SITTINGS
SARVANG ABHYANGA-CHILD 7- SITTINGS
SNEHADHARA SWEDA+YOGA BASTI 14+8 DAYS
SHASHTIK SHALI PINDA SWEDA-ADULT 7-DAYS
SHASHTIK SHALI PINDA SWEDA-CHILD 7-DAYS
PATRA PINDA SWEDA-ONE LIMB 7-DAYS
PATRA PINDA SWEDA-TWO LIMBS 7-DAYS
PATRA PINDA SWEDA-FULL BODY 7-DAYS
NADI SWEDA-ONE LIMB 7-DAYS
NADI SWEDA-TWO LIMBS 7-DAYS
NADI SWEDA-FULL BODY 7-DAYS
SARVANGA BASHPA SWEDA 7-DAYS
TAILA DHARA 7-DAYS
KSHEERA DHARA 7-DAYS
TAKRA DHARA 7-DAYS
EKANGA TAILA DHARA 7-DAYS
ANNALEPANAM 7-DAYS
VAMANA KARMA 12-DAYS
VIRECHAN KARMA 12-DAYS
YOGA BASTI(5A+3N) 8-DAYS
KALA BASTI (10A+6N) 16-DAYS
KARMA BASTI (18A+12N) 30-DAYS
UTTARA BASTI 7-DAYS
NASYA KARMA 7-DAYS
RAKTAMOKSHANA (PER SITTING)
KATI BASTI 7-DAYS

33/37

NSB
4300
3500
52000
7800
7000
2600
3500
5200
3000
3850
4800
5650
13000
10500
10500
9500
10400
4300
4300
8650
16500
26000
8650
3500
1200
10200

CASUALTY

AYT027
AYT028
AYT029
AYT030
AYT031
AYT032
AYT034

AVAGAHA SWEDA 7-DAYS

NETRA TARPAN 7-DAYS
AGNI KARMA (PER SITTING)
TWARITA BASTI (PER SITTING)
SHIROBASTI 7-DAYS
COST OF PATRAPINDA BUNDLE (EACH)
MATRA BASTI

6500
4800
850
500
8650
125
250

6500
4800
850
500
8650
125
250

6500
4800
850
500
8650
125
250

5200
3850
720
360
7000
125
200

6500
4800
850
500
8650
125
250

Plastering Charges
Code
PLC001
PLC002
PLC003
PLC004
PLC005

PLASTERING CHARGES
PLASTERING : FOOT/ARM/HAND
PLASTERING : LEG
PLASTERING : HIP
PLASTERING : BODY CAST
REPLASTERING ROUTINE (REPAIR)

PR
600
750
900
1500

SPR
600
750
900
1500

NSB
450
550
600
1000

GOPD
250
300
400
600
150

POPD
500
600
800
1200
300

CASUALTY

PR
750

SPR
750

NSB
750

GOPD
600

POPD
900

CASUALTY

1050

1050

1050

800

1200

50

100

350
1200
75
500
400
400
150
500
1200

700
2000
150
1000
800
800
300
1000
2000

NSB
500
300

GOPD

POPD

CASUALTY

Note : MATERIAL COST WILL BE EXTRA.

Gynaec Procedures
Code
COL001
COL002
COL003
TRE007
TRE019
TRE027
TRE032
TRE035
TRE037
TRE038
TRE065
TRE069

GYNAEC PROCEDURES
COLPOSCOPY DIAGNOSTIC
COLPOSCOPY WITH PUNCH BIOPSY (LAB
CHARGES EXTRA)
LOCALISATION OF FOETAL HEART BY USG IN
LABOR ROOM
MINOR SUTURING EPISIOTOMY
ENDOMETRIAL BIOPSY -D&C
PAP SMEAR TAKING
HYDRO TUBATION (MED. COST EXT.)
CERVICAL BIOPSY(LAB CHARGES EXTRA)
ELECTRIC CAUTERY OF CERVIX
COPPER-T REMOVAL
RESUTURING
CRYO CAUTERY

750
1500
100
900
600
500
200

750
1500
100
900
600
500
200

625
1500
100
900
600
500
200

1500

1500

1500

Note : LABORATORY CHARGES FOR BIOPSY WILL BE EXTRA.

Psychotherapy
Code
PST001
PST002

PSYCHOTHERAPY
PSYCHOTHERAPY - FULL SESSION
PSYCHOTHERAPY - SHORT SESSION

PR
500
300

SPR
500
300

Eye Procedures
Code
EYE001
EYE002
EYE003
EYE004
EYE005
EYE006

EYE PROCEDURES
ORTHOPTIC WORK UP(SINGLE VISIT)
PERIMETRY
SQUINT WORK UP
REFRACTION
SYRINGING EYE
CONVERGENCE EXERCISE (15 DAYS COURSE)

PR
50
1200
100
100
200
750

SPR
50
1200
100
100
200
750

NSB
50
1200
100
100
200
750

GOPD
40
1200
50
50
150
500

POPD
60
1200
100
100
300
800

CASUALTY

PR
1250
2100
2800
3400
4000

SPR
1250
2100
2800
3400
4000

NSB
1250
2100
2800
3400
4000

GOPD

POPD

CASUALTY

NSB

GOPD
400

POPD
500

CASUALTY

Chemotherapy
Code
CMT001
CMT002
CMT003
CMT004
CMT005

CHEMOTHERAPY
CHEMOTHERAPY - 1 DAY CYCLE
CHEMOTHERAPY - 2 DAYS CYCLE
CHEMOTHERAPY - 3 DAYS CYCLE
CHEMOTHERAPY - 4 DAYS CYCLE
CHEMOTHERAPY - 5 DAYS CYCLE

Dental : Procedure
Code
DEN001

DENTAL : PROCEDURE
PRIMARY TOOTH EXTRACTION

PR

34/37

SPR

DEN002
DEN003
DEN004
DEN005
DEN006
DEN007
DEN008
DEN009
DEN010
DEN011
DEN012
DEN013
DEN014
DEN015
DEN016
DEN017
DEN018
DEN019
DEN021
DEN022
DEN023
DEN024
DEN025
DEN026
DEN027
DEN028
DEN029
DEN030
DEN031
DEN032
DEN033
DEN034
DEN035
DEN036
DEN037
DEN038
DEN039
DEN040
DEN041
DEN042
DEN043
DEN044
DEN045
DEN046
DEN047
DEN048
DEN050
DEN051
DEN052
DEN053
DEN054
DEN055
DEN056
DEN057
DEN058
DEN061
DEN073
DEN074

EXTRACTION GRADE II
EXTRACTION GRADE I
FIRM TOOTH
SURGICAL EXTRACTION
REGULAR 3RD MOLAR IMPACTION
CLASS I GLASS LONOMER CEMENT (GIC)
FILLING
CLASS I LIGHT CURE COMP. (LCC) FILLING
CLASS II GIC FILLING
CLASS II LCC FILLING
CERVICAL CLASS V GIC FILLING
CERVICAL CLASS V LCC FILLING
INLAY METALIC *
CERAMIC INLAY *
ONLAYS FOR CERAMIC *
COMPOSITE VENEERS
CORE BUILD UP GIC
CORE BUILD UP LCC
POST AND CORE CARBON FIBRE
DESENSITIZATION / TOOTH
PIT AND FISSURE SEALANTS / TOOTH
RCT-SINGLE ROOTED TOOTH
RCT-MULTI ROOTED
RE-RCT
APICOECTOMY WITH BONE GRAFT PER SITE
APICOECTOMY
APICOECTOMY WTH MEMBRANE BARRIER PER
SITE
REMOVABLE PARTIAL DENTURE - ACRYLIC UNILATERAL *
RPD-ACRYLIC-BI-LATERAL *
RPD-INJECTION MOLDED-UNILAT *
RPD-INJECTION-BILAT *
RPD-FLEXIBLE-UNILAT *
RPD-FLEXIBLE-BILAT *
CAST PARTIAL DENTURE *
MAXILLO-FACIAL PROSTHESIS (OBTURATORS)
*
COMPLETE DENTURE-ACRYLIC *
COMPLETE DENTURE-INJECTION MOLDED *
COMPLETE DENTURE-BPS *
DENTURE RELINING /ARCH *
CROWN BASE METAL * $
CROWN PFM -METAL CERAMIC *
CROWN NOBLE METAL *
CROWN METAL FREE CASTABLE CERAMIC EMPRESS *
CROWN CAD-CAM -PROCERA ,CERCON , LAVA
CERAMIC VENEERS / TOOTH
POST AND CORE CAST BASE METAL *
CROWN REMOVAL PER UNIT
ORAL PHOPHYLAXIS GRADE II
ORAL PROPHYLAXIS GRADE I
BLEACHING IN OFFICE
BLEACHING AT HOME
BLEACHING TRAYS * $
NIGHT GUARD-SOFT * $
ENDOSTEAL TITANIUM DENTAL IMPLANTS $
IMPLANT CROWN CERAMIC CAD *
IMPLANT PRECISION ATTACHMENT $
TITANIUM POST + CORE
IMPLANT CROWN CERAMIC CAM *
IOPA X-RAYS

400
800
800
2000
4000

500
1000
1000
2500
5000

400

500

400
640
1200
560
640
1600
2400
2800
2000
400
800
2000
400
640
3200
3600
4800
2000
4000

500
800
1500
700
800
2000
3000
3500
2500
500
1000
2500
500
800
4000
4500
6000
2500
5000

2000

2500

1600

2000

2400
2400
3200
2400
3600
8800

3000
3000
4000
3000
4500
11000

6400

8000

8000
10400
16000
2400
1840
2240
9600

10000
13000
20000
3000
2300
2800
12000

6400

8000

8800
4000
1200
800
2000
1200
2800
4000
1200
1200
16000
4000
6400
2000
12000
120

11000
5000
1500
1000
2500
1500
3500
5000
1500
1500
20000
5000
8000
2500
15000
150

GOPD

POPD

2340

2700

Dental : Lab Test

Code
DLT001

DENTAL : LAB TEST

INLAY / ONLAY IN IPS E.MAX (400 MPA) IVOCLAR

PR

35/37

SPR

NSB

CASUALTY

DLT002
DLT003
DLT004
DLT005
DLT006
DLT007
DLT008
DLT009
DLT010
DLT011
DLT012
DLT013
DLT014
DLT015
DLT016
DLT017
DLT018
DLT019
DLT020
DLT021
DLT022
DLT023
DLT024
DLT025
DLT026
DLT027
DLT028
DLT029
DLT030
DLT031
DLT032
DLT033
DLT034
DLT035
DLT036
DLT037
DLT039
DLT040
DLT041
DLT042
DLT043
DLT044
DLT045
DLT046
DLT047
DLT048
DLT049
DLT050
DLT051
DLT052

LAMINATE VENEER IN IPS E.MAX (400 MPA) IVOCLAR

ALL CERAMIC CROWN IN IPS E.MAX
ALL CERAMIC CROWN IN ZIRCONIUM
REMAKE ALL C. UNIT IN IPS E.MAX (400 MPA)
ZIRCOMIC LAVA, 3 M
METAL CERAMIC-BASE METAL-IPS D.SIGN &
BEGO
METAL CERAMIC-BASE METAL-VITA CLASSIC
ALL PORCELAIN COLLAR SHOULDER
PORCELAIN-(EXTRA)
GOLD CONDITIONER-ALL AROUND
CERVICALLY(EXTRA)
GOLD CONDITIONER-FACIAL
CERVICALLY(EXTRA)
TISSUE TINT-PINK GINGIVAL
PORCELAIN(EXTRA)
INTEGRATED CAST PAST & CROWN
REST SEAT IN METAL FOR CAST PARTIAL
DENTURE
METAL CERAMIC-CERAMIC FACING BASE
METAL
METAL CERAMIC-HIGH NOBLE (PONTO STAR
G-BEGO)
METAL CERAMIC-HIGH NOBLE(BIO PONTO
STAR-BEGO)
METAL CERAMIC-HIGH NOBLE(BRITE GOLD
-IVOCLAR)
METAL CERAMIC-CERAMIC FACING-HIGH
NOBLE-POSTERIORS ONLY
DIAGNOSTIC/MOCK WAX UP IN ESTHETIC WAX
METAL REST IN BASE METAL ALLOY
MARYLAND BRIDGE IN METAL CERAMIC IN
BASE METAL ALLOY
MARYLAND BRIDGE-ADDITIONAL PONTIC
MARYLAND BRIDGE-ADDITIONAL WING
REMAKE-METAL CERAMIC -BASE METAL
REMAKE-CERAMIC ONLY
REMAKE-METAL ONLY
FULL CAST-BASE METAL ALLOY - BEGO
CAST INLAY-BASE METAL ALLOY - BEGO
FULL CAST-HIGH NOBLE/NOBLE
CAST INLAY IN HIGH NOBLE / NOBLE ALLOY
SEPERATE CAST POST AND CORE IN BASE
METAL ALLOY -BEGO
OVER DENTURE COPING
IMPLANT-METAL CERAMIC-BASE METAL
IMPLANT-METAL CERAMIC-HIGH NOBLE
BALL & SOCKET-DISTAL EXTENSION
BALL & SOCKET-OVER DENTURE
BALL & SOCKET-DISTAL EXTENSION-CASTABLE
HOUSING
BALL & SOCKET-OVER DENTURE-CASTABLE
HOUSING(EXTRA)
BAR ATTACHMENT-CASTABLE HOUSING
BAR ATTACHMENT-CASTABLE
HOUSING-ADDITIONAL BAR(EXTRA)
BAR ATTACHMENT-CASTABLE
HOUSING-CLIP(EXTRA)
EXTRA CORONAL VERTICAL ATTACHMENT
IMPLANT-ALL CERAMIC-IPS E.MAX
IMPLANT-ALL CERAMIC-ZIRCONIUM-CERCON
BILATERAL CAST PARTIAL FRAMEWORK U/L
UNILATERAL FLEXIBLE PARTIAL DENTURE U/L
DESIGNING ONLY CAST PARTIAL U/LI
CAST BASE FOR COMPLETE DENTURE IN
CR-CO
BITE RAISING APPLIANCE IN CAST ALLOY U/L
BILATERAL CAST PARTIAL DENTURE U/L

36/37

2600

3000

2860
4940
1560
5135

3300
5700
1800
5925

1300

1500

1100

1275

260

300

390

450

200

225

260

300

130

150

200

225

900

1050

7930

9150

8190

9450

6600

7650

1560

1800

130
130

150
150

1625

1875

1100
260
400
260
130
450
400
900
780

1275
300
450
300
150
525
450
1050
900

400

450

450
1625
2000
1690
1690

525
1875
2400
1950
1950

1560

1800

1560

1800

5200

6000

2600

3000

400

450

3250
3380
5980
3300
2340
3250

3750
3900
6900
3825
2700
3750

2925

3375

3900
3250

4500
3750

DLT053
DLT054
DLT055
DLT056
DLT057
DLT058
DLT059
DLT060
DLT061
DLT062
DLT063
DLT064
DLT065
DLT066
DLT067
DLT068
DLT069
DLT070
DLT071
DLT072
DLT073
DLT074
DLT075
DLT076
DLT077
DLT078
DLT079
DLT080
DLT081

BALL & SOCKET-DISTAL

EXTENSION-PREFABRICATED STEEL HOUSING
ACRYLISATION OF BILATERAL FRAMEWORK
U/L
BILATERAL COMBO PARTIAL DENTURE U/L
RPD ONE TOOTH - INJECTION MOLDING
SCREW RETAINED
RPD ONE TOOTH IN ACRYLIC
RPD ONE TOOTH IN ACRYLIC-ADDITIONAL
TOOTH (EXTRA)
BALL & SOCKET-PREFABRICATED STEEL
HOUSING (EXTRA)
REPAIR HEART CARE
ACRYLIC SPLINT/BITE PLATE IN CLEAR
ACRYLIC
REBASING U/L
INJECTION MOLDING IN SR IVOCAP U&L
FOUR LAYERED & DOUBLE CROSS LINKED
TEETH(EXTRA)
HIGH IMPACT U&L-LUCITONE 199,DENTSPLY
DENTURE GRID
STRENGTH.0.4MM-DENTAURUM
IMPLANT OVER DENTURE-B&S PER
ATTACHMENT
IMPLANT OVER DENTURE-BAR ATTACHMENT
IMPLANT OVER DENTURE-ADDITIONAL BAR
HOLLOW OBTURATOR
TRIPLE LAYERED TEETH SET(EXTRA)
LIGHT CURED TRAYS U&L
WAX UP & ACRYLIZATION ONLU U/L(EXTRA)
SET UP & WAX UP ONLY U/L(EXTRA)
PREMIUM COMPLETE DENTURE-DOUBLE
LAYER TEETH
BPS COMPLETE DENTURE-FOUR LAYERED
BPS COMPLETE DENTURE -TRIPLE LAYERED
TEETH
REMAKE-CAST PARITAL FRAMEWORK OR FPD
MODIFICATION ADDITION IN FLEXIBLE PARTIAL
RPD ONE TOOTH - ADDITIONAL TOOTH (EXTRA)

37/37

900

1050

585

675

5850
780
1950
390

6750
900
2250
450

65

75

900

1050

390

450

650

750

650
2200

750
2550

5460

6300

900

1050

900

1050

400

450

3900
1300
780
1560
390
650
650

4500
1500
900
1800
450
750
750

2340

2700

12350

14250

8450

9750

1560
1300
130

1800
1500
150