To be substituted bearing same number and Date.

No. 2/56/2014-1HB-I
From
Additional Chief Secretary to Government Haryana
Health Department.
To
1. All the Heads of Departments.
2. All the Commissioners of Haryana.
3. The Registrar, Punjab and Haryana High Court, Chandigarh.
4. All the Deputy Commissioners in Haryana
5. All the Sub-Division Officers (Civil) in Haryana.

Dated:-14.7.2020

Subject Regarding implementation of 1340 Package Rates and Implants

applicable to Private Empanelled Hospitals/Private Empanelled
Medical Colleges.

Sir/Madam,
In supersession of Government letter issued vide even no. 21.5.2015, I have
been directed to invite your attention to the subject mentioned above and to state that the
State Government has decided to implement package/implant rates for providing medical
treatment to the Haryana Government employees/pensioners and their dependents in the
approved private Hospitals. The package rates have been worked out for common
procedures in consultation with specialists serving in various departments of Government
Hospitals and after comparing the rates with normal tariff of leading private empaneled
hospitals, CGHS (Delhi NCR rates) and package rates fixed by insurance companies. This
has been done to rationalize the charges across the various institutions. Under these new
guidelines, 1340 (which include already notified 152 packages) packages for major
procedures have been fixed, which include rates of certain implants as well. The details
are given as under
1. Definitions
i) "Hospital" A private hospital approved by the State Government.
i) "Private Medical Colleges" recognised by Medical Council of India (MCI) in
Haryana state and empanelled by the State Government.
ii) "Package Rate" a lump sum amount charged by the empanelled Private
Hospitals for packages/procedures.
iv) "Day Care" Day Care means indoor stay in the Hospital for less than 24
hours which is duly certified by the concerned hospital.
) "NABH" means hospitals possessing accreditation certificate of National
Accreditation Board for Hospitals & Healthcare Providers. It is further
categorised into a. Entry Level NABH b. Full NABH
vi) "JCI mean hospitals possessing accreditation certificate of Joint
Commission International.
vii) Card" means the ldentity Card issued by competent authority of any
department under Haryana Government.
vii) "Card Holder" shall mean a person having identity card.
ix) "Beneficiary" means a person who is eligible for coverage of medical
benefits and holds a valid card for the benefit.
X "Coverage" shall mean a type of person to be eligible as the scheme,
subject to the terms, conditions and limitations.
 xi) 1, 2, 3, 4, 5, 7,10 and 14 days package rate means the number
of
remains in hospital for a particular
days a
patient surgery/procedure normally
without any complication.
xii) "ICUICCU charges": Includes all charges like ventilator,
monitoring, nursing,
gas, drugs, etc. (charges of ICU/CCU inclusive of ventilator as per para C &1
(vii) of Guidelines, is not to be charged extra).
xii) "Package Rate" a lump sum amount charged by the empanelled Private
Hospitals/Private Empanelled Medical Colleges for packages/procedures.

2. Guidelines for Implementing Package/ Implant Rates

(a) The State Government has categorized private approved hospitals and
private medical coleges for the purpose of implementing package rates, which are
explained as under:

i) Following package rates shall be applicable to different types of empanelled

hospitals/empanelled Private Medical Colleges, which are categorized on
the basis of accreditation of hospitals namely; Entry level NABH, Full
NABH/JC.
All the State Government empanelled private hospitals and medical
colleges will charge from the employees as per the fixed package/implant
rates mentioned in Annexure-1&|l and these will be fully reimbursableto
the employees/pensioners and their dependents and/or to the private
approved hospitals/medical colleges for providing medical facility on
cashless basis, as the case may be.
ii) Entry level NABH package rates shall be applicable on Entry Level NABH &
NABH package rates shall be applicable on Full NABH/JCI Accredited
private hospitals empanelled with Government of Haryana.

(b) The empanelled hospitals shal provide treatment on 1340 procedures listed
in Annexure-I & lI at the prescribed package rates/implants (wherever implant rates have
been fixed and notified by Gol or State Government). The Hospital will raise the bill on
cashless or reimbursement mode (as the case may be) from the Haryana Government

employees/pensioners and their dependents. These package rates are applicable only for
procedures mentioned in Annexure-l.
A list of fixed 1340 packages/implants (this includes already notified 152
packages) applicable on NABH Entry Level, Full NABH/JCI empanelled
Hospitals/empanelled Private Medical Colleges in the state is attached at

Annexure-
The "Package rate" shall mean and include lump sum cost of inpatient
i) treatment/day care/diagnostic procedures for which patient goes to hospital
This includes all charges pertaining to a particular treatment/Procedure
fee, Patient's diet,
fee/consultation
including admission charges, visit
monitoring charges, preoperative investigation charges, investigation
anaesthesia charges, operation theatre
charges, operation charges,
anaesthetist's fee, cost of
charges, procedural charges/surgeon's fee,
used during hospitalization, consumables,
surgical disposals and all sundries
assistant charges, cost of medicine used
gas charges, Surgical charges/OT
nursing care charges for its
during hospitalization, physiotherapy charges,
in ICU, blood transfusion (blood
services, routine post operative stay
Transfusion) and medicines
grouping. cross matching, blood or component,
etc.
for a period of 7 days after discharge from the hospital
to all Government Hospitals,
A list of fixed cost of implants applicable
hospitals and non-
Government Medical Colleges, empanelled private
 fixed
empanelled hospitals is attached at Annexure-ll. The cost of implant as
from
by Government of India dated 13-02-2017, 16-08-2017 and amended
time to time will be applicable. Other implants for which the rates have not
been fixed by Government of India shall be charged as per the rates fixed by
the State Government from time to time or whichever is less. However
where the cost is not fixed, the actual cost of the implant will be given
The cost of coronary stents shall be alowed up to a maximum of three stents
iv)
at a time.
The information such as stickers/batch no. etc. related to items like implant,
v
stent and valves should be pasted/indicated on the bill.
If in case, beneficiary opts for category/implant over & above the entitlement
vi
or the implants rates fixed by the Government it will be the responsibility of
the hospital to explain and obtain undertaking from the beneficiary. The
charges over and above the entitlement will be borne by the beneficiary.
rates mentioned in column no. 3, 4 in table (Annexure-1)
are
vil) The package
same for both semi private ward and private ward entitlement.

The entitlement for Room Rent for indoor treatment:

(c)

| Sr. Category Revised Pay as per Hospital Accreditation

No. 7 pay commission Entry Full NABH
(B.P.+G.P. x 2.57 level IJCI
NABH
General ward Up to Rs. 50192/- 1560/ 1720/-
3125/- 3440/-
Semi-Private/ Twin Rs. 50217/-to
Sharing Room 64532/-
Rs. 64588/- and 4690/- 5160/-
|3. Private Room
(NoSharing) above

where single patient is

Private ward is defined as a hospital room,
accommodated and having an attached toilet (lavatory
and bath). The

room should have furnishings like wardrobe, dressing

table, bed-side
attendant. The room
table, sofa set, carpet, etc. as well as a bed for
has to be air-conditioned.
hospital room, where two to three
i) Semi Private Ward is defined as a

and having attached toilet facilities and

patients are accommodated

other necessary furnishings.

of bed, diet for the
it) Room rent will include charges for occupation
linen charges, nursing
patient, charges for water and electricity supply,
routine housekeeping, etc.
charges, heater/A.C. charges and
admissible up to Rs. 750/
iv) Day Care Room rent charges are
room rent will be admissible.
) During the ICU/CCU/HDU, no separate
accommodation than the entitled
vi) Treatment taken in higher category of
category will be borne by the beneficiary.
rates,
vii) In addition to thechargeable amount mentioned against package
room rent/ICU/CCU/HDU
including
implant rates (if any) the cost of treatment
However, when a
ventilator shall be charged separately.
and the post operative/ post
procedural
given under a fixed package No
needs stay in CCU/ICU/HDU,
treatment/management protocols
in CCUICU/HDU during post
extra charges shall be taken for the stay
of package rate.
operative/postprocedure period. It will be part
 vii The room rent charges are
according to the number days a patient
stays in the hospital i.e. 1, 2,3,4,5,7,14 days etc. as per the
package. prescribed
ix) If the beneficiary has to stay in the
hospital for his/her recovery for a
period more than the period covered in package rate, in exceptional
case, supported by relevant medical records and certified as such
hospital, the additional reimbursement may be allowed and that shall beby
limited to accommodation charges as
per entitlement, investigations
charges at approved rates and cost of medicine. The hospital shall
issue separate bill for the period of over
stay.
x) No additional charges on account of extended
period of stay shall be
allowed if that extension is due to infection on the consequences of
Surgical procedure/faulty investigation procedure, etc.
3. Thefixed cost of ICUICCU under medical management (indoor treatment)
No extra room rent for ICU/CCU patient shall be
charged.
i) For CCU cases per day cost shall be @ 6500/- day. It will include all
investigations, intra-arterial monitoring catheters, pressure bag, drugs,
including cardioversion and nothing is excluded. However, the routine
post operative stay in CCU shall be part of package as per Para 3(C) of
guidelines.
ii) For intra arterial balloon pump (1ABP) a onetime cost of Rs. 30000/-
shall be applicable.
iv) ICU with invasive ventilation includes use of ventilator, nursing, diet.
procedural charges, (such as intra arterial/neck line, catheterization of
all types, chest tube, infusion pump, IV line, Tracheostomy, Intubation,
change of tubes, change of Tracheostomy, splintage (Cervical/Limb),
etc.), Physiotherapy, drugs, consumables, all lab investigations,
diagnostics, dietician and doctor's/Specialists visit, nebulisation, alpha
bed charges, etc. and nothing is excluded.
The HDU charges shall be same as room rent charges. However, the
routine post operative stay in HDU shall be part of package as per Para
3(C) of guidelines.
vi) The fixed cost of ICU is as under:-

Sr. No. Name Entry level Full NABH Remarks

NABH Rates Rates (per
(perday) day)
ICU without 3000/ 34501- However, the routine
ventilation post operative stay in
ICU shall be part of
package as per para
3(C) of guidelines.
2 ICU with non | 5525/- 6500/- -do-
invasive
ventilation
ICU with 11050/- 13000/- -do-
3.
invasive
ventilation
4. Additional Guidelines: will be worked
(a) Apart from identified packages, any non-package procedure
out as under.
i. Room rent- as per the entitlement of the beneficiary.
ii. Lab and Diagnostics- As per the rates fixed (Annexure-l)

4
 i. Medicines and consumables - Rs. 1750 - per day. This will exclude
high cost injections such as Anti-D, Anti Haemophilic Factors,
Thrombolytic treatment (Streptokinase), Anti Cancer drugs, Antibiotics
(the per day cost of which is more than Rs. 2000/- irrespective of number
of doses), etc.
iv. The high cost injection is defined as an injection, the per day cost of
which comes out to be more than Rs.2000/- after decreasing 30% on
MRP of purchased injection by the hospital. In such case, health facility
shall give undertaking that no cheaper brand of same composition or
molecule is available in their inventory/ stock.
b) In case multiple packages are invoked in operative surgery at same time.
then the package rates shall be charged at following
rates:
Highest package 100%
2 highest package 50% of the identified package rate.
ii. highest and
3 package 25% of the identified package rate.
so on
iv. However, the room rent shall be charged once only.
(c) Rates of other minor/major surgeries, related to various specialities for which
there is no fixed package shall be charged as under:
Sr. No.proceduresurgery Amount/Rate
Any procedure/surgery done under local 5,000/
anaesthesia
2 Any procedure/surgery done under I 10,000/
sedation
3 (a). Any procedure/surgery related to 20,000/-
specialities other than Orthopaedics. Done
under spinal/ regional/ epidural
anaesthesia
3(b) Any Orthopaedic procedure/ surgery done 30,000/
under spinal/ regional/ epidural
anaesthesia.
Any procedure/surgery related to any 30,000/-
speciality done under general anaesthesia.
The Pathology and Radiology rates shall only be applicable on OPD
(d)
procedures, any non-surgical procedures for which there is no package, as per point no.
4(a) and point no. 4(c) above.
(e) It will be responsibility of the hospital to provide limited cashless medical
2PM-Cashless-2017/13626-13786
facility notified by State Government vide letter no.
dated 20.11.2017 amended time to time and the guidelines therein. However, for the

remaining diseases/conditions the reimbursement will be done as per the identified

package rates and for non-package procedures at the rates of 'PGIMER Chandigarh
+75% of balance amount'.
etc. and rates of
(1) Rates for any procedure/surgery like organ transplant,
from time to time shall be applicable on Govt.
devices/implants as fixed by the State Govt.
Health Facilities and empanelled private Hospitals/Medical Colleges in Haryana.
hospital /private medical
g) At a time of discharge, the empanelled private No extra charge
collegeshall medicines for a period of 7 days as a part of package.
give
shall be taken from the patient for the medicines.
services as per recording
(h) Follow-ups:- Patient shall be provided follow-up limited
under the six conditions as per
the same in the summary. The follow-ups
discharge 2PM-Cashless
Government vide letter no.
cashless medical facility notified by State
time to time and the guidelines
2017/13626-13786 dated 20.11.2017 and amended from
therein, will be done as per the identified packages.

5
 (i) The fixed package of any procedure/surgery mentioned in column 2 as OPD
in annexure 1 shall be applicable as per Government instructions dated 11.08.1992 and
08.06.2005 and amended from time to time.
The PPP mode packages shall only be applicable on Government Health
Institutions in Haryana State.
(k) Private empanelled hospitals/ Medical Colleges will also abide by the
guidelines and packages fixed under Rashtriya Bal Suraksha Karyakaram (RBSK) made
by Government of India, wherever applicable. However, this will not be applicable on
Haryana Government employees/pensioners and their dependents.
The reimbursement under Rashtriya Bal Suraksha Karyakaram (RBSK)
Scheme shall be paid to the hospital by NHM Haryana.
(m) Empanelled hospitals/ Medical Colleges shall register every cancer case and
report under Haryana Cancer Atlas (HCA) wherever applicable.
(n) All earlier instructions related to fixed packagelimplant rates stand
superseded. These fixed package/implant rates shall come into force with immediate
effect.

The above orders can be downloaded from the website of Health Department i.e.

harvanahealth.nic.in

This issue with the concurrence of the Finance Department conveyed vide
their U.O No. 18130/70/29/2001-FD-1/2019, dated 15.9.2019.

YOGESH KUMAR MEHTA, HCS

Additional Secretary, Health
for: Additional Chief Secretary to Government Haryana
Health Department

A copy is forwarded to all Administrative Secretaries to Government of

Haryana/Commissioners and Secretaries for

information and necessary action.

(Yogesh Kumar Mehta, HCS)

Additional Secretary, Health
for: Additional Chief Secretary to Government of Haryana
Health Department
To
and Secretaries,
All Administrative Secretaries/Commissioners
Government of Haryana.
Dated: 14.7.2020
U.O. No. 2/56/2014-1 HBIII

Chief Secretary to Government of

A copy is forwarded to Additional
Finance Department for information
and necessary action w.r.t. their U.O. No.
Haryana,
18130/70/29/2001-FD-1/2019, dated 15.9.2019.

(Yogesh Kumar Mehta, HCS)

Additional Secretary, Health

for: Additional Chief Secretary to Government of Haryana

Health Department_
To
Additional Chief Secretary to Government of Haryana
Finance Department. Dated: 14.7.2020
U.O. No. 2/56/2014-1HBII
 ANNEXURE-I
Fixed Package rates/ Implants applicable to Entry Level NABH/ Full NABH/ JCI/ Private Hospitals
& Medical Colleges

Specialty-wise Serial No.

Cost of
Stay in implant/Pace
Hospital maker/Mesh etc
SR. Treatment Procedure Entry Level Full NABH Room rent, as
(Day as per Annexure
No. NABH rates rates per entitlement
care/ 2 or the original
Days) cost (wherever
applicable)

CARDIOLOGY
1 1 ASD Closure 8 DAYS 68000 80000 extra
2 2 VSD with graft 8 DAYS 68000 80000 extra
TOF/ TAPVC/ TCPC/ REV/ RSOV
3 3 8 DAYS 127500 150000 extra
repair
4 4 B.D.Glenn/ Left atrium Myxoma 8 DAYS 93500 110000 extra
5 5 Senning/ ASO with graft 8 DAYS 127500 150000 extra
6 6 DSO 8 DAYS 110500 130000 extra
7 7 AV Canal repair 8 DAYS 157250 185000 extra
8 8 Fonten 8 DAYS 165750 195000 extra
9 9 Conduit repair 8 DAYS 165750 195000 extra
10 10 CABG 10 DAYS 127500 150000 extra
IABP cost as per
11 11 CABG + IABP 10 DAYS 165750 195000 extra
Para "J" iii
12 12 CABG + Valve 10 DAYS 165750 195000 extra
13 13 CABG without bypass 10 DAYS 153000 180000 extra
14 14 Ascendingaortareplacement 10 DAYS 144500 170000 extra
Original Cost of Two
15 15 DVR 10 DAYS 153000 180000 Valves is fully extra
reimbursible
origional Cost of
16 16 MVR/AVR 10 DAYS 110500 130000 extra
Valve
origional cost of
17 17 MV repair + AV repair 10 DAYS 110500 130000 extra
valve
18 18 Aorta femoral bypass 5 DAYS 51000 60000 extra
19 19 B.T Shunt/ Coaractation 5 DAYS 51000 60000 extra
20 20 P.A.Bandingseptostomy 5 DAYS 51000 60000 extra
21 21 Pericardectomy 5 DAYS 46750 55000 extra
22 22 CMV/ PDA 5 DAYS 55250 65000 extra
23 23 Gunshot injury 10 DAYS 55250 65000 extra
24 24 Heart transplant 10 DAYS 272000 320000 extra
Fixed cost of three
stents is/are
reimbursable+inj.
Eptifibatide/Abeixim
ab/Trofiban
Balloon coronary Angioplasty/ +Thermo suction
25 25 3 DAYS 89250 105000 extra
PTCA with VCD catheter (wherever
applicabel) It
includes the cost of
angiography if
performed in the
same sitting.
Fixed cost of three
stents is/are
reimbursable+inj.
Eptifibatide/Abeixim
ab/Trofiban
Balloon coronary Angioplasty/ +Thermo suction
26 26 3 DAYS 89250 105000 extra
PTCA without VCD catheter (wherever
applicabel) It
incluides the cost of
angiography if
performed in the
same sitting
27 27 Rotablation 3 DAYS 51000 60000 extra
28 28 balloon valvotomy/PTMC 3 DAYS 12750 15000 extra
29 29 CATH 1DAY 10200 12000 extra
30 30 Arch Replacement 3 DAYS 12750 15000 extra
31 31 Aortic Dissection 10 DAYS 17000 20000 extra
Thoraco Abdominal Aneurism
32 32 3 DAYS 21250 25000 extra
Repair
33 33 Embolectomy 3 DAYS 23800 28000 extra
34 34 Vascular Repair 3 DAYS 42500 50000 extra
35 35 Bentall Repair with Prosthetic Valve 10 DAYS 34000 40000 extra
36 36 Bentall Repair with Biologic Valve 10 DAYS 144500 170000 extra
37 37 Coaractation dilatation 10 DAYS 17000 20000 extra
Coaractation dilatation with
38 38 10 DAYS 21250 25000 extra
Stenting
39 39 TPI Single Chamber 1 DAY 8500 10000 extra
40 40 TPI Dual Chamber 1 DAY 10200 12000 extra
Permanent pacemaker
41 41 3 DAYS 34000 40000 fixed cost of implant extra
implantation- Single Chamber
Permanent pacemaker
42 42 3 DAYS 38250 45000 fixed cost of implant extra
implantation- Dual Chamber
Permanent pacemaker
43 43 3 DAYS 45900 54000 fixed cost of implant extra
implantation Biventricular
44 44 AICD implantation Single Chamber 3 DAYS 38250 45000 fixed cost of implant extra

45 45 AICD implantation Dual Chamber 3 DAYS 40800 48000 fixed cost of implant extra

46 46 Combo device implantation (CRTD) 3 DAYS 46750 55000 fixed cost of implant extra
Diagnostic Electrophysiological
47 47 1 DAY 10200 12000 extra
studies conventional
48 48 Ambulatory BP monitoring Day Care 850 1000 extra
49 49 External Loop/event recording Day Care 2975 3500 extra
50 50 RF Ablation conventional 1 DAY 42500 50000 extra
51 51 RF Ablation Atrial Tachycardia/Carto 1 DAY 51000 60000 extra
52 52 Endomyocardial biopsy 1 DAY 12750 15000 extra
53 53 IABP 1 DAY 10200 12000 extra
54 54 Intra vascular coils 3 DAYS 51000 60000 extra
55 55 Septostomy- Balloon 3 DAYS 21250 25000 extra
56 56 Septostomy- Blade 3 DAYS 23800 28000 extra
57 57 AVBD/PVBD 3 DAYS 55250 65000 extra
Digital subtraction angiography-
58 58 1 DAY 11900 14000 extra
Peripheral artery
Digital subtraction Angiography-
59 59 1 DAY 11900 14000 extra
venogram
60 60 C.T. Guided biopsy 1 DAY 1530 1800 extra
61 61 Sinogram Day Care 1530 1800 extra
62 62 Peripheral Angioplasty with VCD 3 DAYS 15300 18000 extra
63 63 Peripheral Angioplasty without VCD 3 DAYS 15300 18000 extra
64 64 Renal Angioplasty 3 DAYS 72250 85000 extra
65 65 IVUS 3 DAYS 25500 30000 extra
66 66 FFR 3 DAYS 15300 18000 extra
67 67 Holter analysis OPD 1275 1500 ***********
Aortic stent grafting for aortic
68 68 10 DAYS 93500 110000 extra
aneurysm
69 69 IVC Filter implantation 3 DAYS 23800 28000 extra
70 70 ASD/VSD/PDA device closure 3 DAYS 42500 50000 extra
71 71 ECG OPD 170 200 ************
72 72 HUTT OPD 2975 3500 ************
73 73 2 D echocardiography OPD 1275 1500 ************
74 74 3 D echocardiography OPD 1530 1800 ************
75 75 Fetal Echo OPD 1530 1800 ************
76 76 2 D TEE OPD 2125 2500 ************
77 77 3 D TEE (Transoesophageal echo) OPD 2125 2500 ************

78 78 Stress Echo- exercise OPD 2380 2800 ************

79 79 Stress Echo-Pharmacological OPD 2550 3000 ************
80 80 Stress MPI- exercise OPD 2550 3000 ************
81 81 Stress MPI-pharmacological OPD 2550 3000 ************
82 82 Coronary angiography 1 Day 9775 11500 extra
83 83 CT coronary angiography OPD 6375 7500 ************
84 84 Cardiac CT scan OPD 3400 4000 ************
85 85 Cardiac MRI OPD 4250 5000 ************
86 86 Stress Cardiac MRI OPD 4675 5500 ************
87 87 MR angiography. OPD 5950 7000 ************
88 88 Cardiac PET OPD 3825 4500 ************
89 89 Pericardiocentesis OPD 5525 6500 ************
ENT
90 1 Pure Tone Audiogram OPD 467.5 550 *******
91 2 Impedencewith stepedealreflex OPD 561 660 *******
92 3 SISI Tone Decay OPD 467.5 550 *******
93 4 Speech Discrimination Score OPD 467.5 550 *******
Multiple hearing assessment test to
94 5 OPD 467.5 550 *******
Adults
95 6 Speech Assessment OPD 467.5 550 *******
Speech Therapy per session of 30-
96 7 OPD 425 500 *******
40 minutes
Cold Calorie Test for vestibular
97 8 OPD 425 500 *******
function
98 9 Removal of foreign body from Nose OPD 595 700 *******
99 10 Removal of foreign body from ear OPD 595 700 *******
100 11 Syringing (Ear) OPD 340 400 *******
Pertitonsillar abscess Drainage
101 12 OPD 850 1000 *******
under LA
102 13 Tympanoplasty 2 days 23375 27500 extra
Tonsillectomy Under General
103 14 2 days 23375 27500 extra
Anaesthesia
Adenotonsillectomy Under General
104 15 2 days 25245 29700 extra
Anaesthesia
105 16 FESS [antral polyp] 2 days 25500 30000 extra
106 17 FESS [Ethmoidal Polyp] 2 days 25500 30000 extra
107 18 Septoplasty 2 days 21250 25000 extra
108 19 Septo-rhinoplasty 2 days 32300 38000 extra
109 20 Rhinoplasty (Non-cosmetic) 2 days 21250 25000 extra
110 21 Fracture reduction Nasal Bone Day Care 5100 6000 extra
111 22 Intra Nasal Diathermy 2 days 2125 2500 extra
112 23 Turbinectomy 2 days 17000 20000 extra
113 24 Endoscopic Surgery 2 days 25500 30000 extra
114 25 FESS Endoscopic Surgery Day Care 13600 16000 extra
115 26 Septal Perforation Repair 2 days 21250 25000 extra
Septal Perforation Repair Under
116 27 Day Care 13600 16000 extra
General Anaesthesia
Antrum Puncutre under General
117 28 Day Care 1275 1500 extra
Anaesthesia
118 29 Lateral Rhinotomy Day Care 127500 150000 extra
119 30 Angiofibroma Excision 3 Days 29750 35000 extra
120 31 Endoscopic Hypophysectomy 2 Days 34000 40000 extra
121 32 Decompression of Orbit 3 Days 42500 50000 extra
Punch /Wedge Biopsy Under Local
122 33 Day Care 1700 2000 extra
Anaesthesia
123 34 Endolymphatic Sac Decompression 2 days 14875 17500 extra
124 35 Diagnostic Endoscopy under GA Day Care 5100 6000 extra
Yonges Operation for Atrophic
125 36 3 days 29750 35000 extra
rhinitis
Vidian neurectomy for vasomotor
126 37 3 days 29750 35000 extra
rhinitis
127 38 Palatopharyngoplasty 3 days 29750 35000 extra
128 39 Pharyngoplasty 2 days 25500 30000 extra
129 40 Styloidectomy 2 days 15300 18000 extra
 Direct laryngoscopy including
130 41 Day Care 5100 6000 extra
Biopsy under GA
131 42 Ranula Excision Local Anaesthesia Day Care 6800 8000 extra
132 43 Tongue tie excision Day Care 1700 2000 extra
Modified Radical Mastoidectomy
133 44 3 days 42500 50000 extra
with Tympanoplasty
134 45 Polyp removal under GA Day Care 6800 8000 extra
135 46 Polyp removal under LA Day Care 3400 4000 extra
136 47 Cochlear Implant 10 days 58650 69000 fixed cost of implant extra
Fracture Nasal Bone setting Local
137 48 Day Care 8500 10000 extra
Anaesthesia
138 49 Myringoplasty 2 days 23800 28000 extra
139 50 Staepedectomy 3 days 29750 35000 extra
140 51 Tympanotomy Day Care 5100 6000 extra
141 52 Otoplasty 3 days 29750 35000 extra
142 53 Labyrinthecytomy 3 days 42500 50000 extra
143 54 Facial Nerve Decompression 3 days 42500 50000 extra
Submucous Resection under Local
144 55 2 days 12750 15000 extra
Anaesthesia
Submucous Resection under
145 56 2 days 21250 25000 extra
General Anaesthesia
146 57 Endoscopic DCR 2 days 29750 35000 extra
147 58 Caldwell Luc Surgery 2 days 17000 20000 extra
148 59 Uvulo-palatoplasty 3 days 42500 50000 extra
Polyp removal ear under Local
149 60 2 days 1700 2000 extra
Anaesthesia
150 61 Polyp removal nose (Septal Polyp) 2 days 12750 15000 extra
Under General Anaesthesia
151 62 Nasal Packing-Amteroe OPD 850 1000 ********
152 63 Nasal Packing-posterior under GA Day Care 3400 4000 extra
153 64 Sub Mandibular Duct Lithotomy 2 days 12750 15000 extra
Oesophagoscopy/ foreign body
154 65 2 days 14875 17500 extra
removal
Bronochoscopy with F.B. removal
155 66 2 days 14025 16500 extra
Under General Anaesthesia

156 67 Ear Lobe Repair One side OPD 935 1100 *******
Excision of pinna for Growth
157 68 (Squamous/ Basal/ Injuries) Skin 2 Days 1700 2000 extra
and Cartilage Local Anaesthesia
Excision of External Auditory
158 69 4675 5500 extra
Meatus under Local Anaesthesia
159 70 Excision of Branchial Cyst 2 days 14025 16500 extra
160 71 Excision of Branchial Sinus 2 days 14025 16500 extra
161 72 Excision of Pharyngeal Diverticulum 2 days 14025 16500 extra
162 73 Excision of Carotid Body Tumours 5 days 51000 60000 extra
163 74 Operation for Cervical Rib 5 days 29750 35000 extra
164 75 Pharyngectomy & Reconstruction 5 days 46750 55000 extra
Operation for Carcinoma Lip-
165 76 5 days 35700 42000 extra
Wedge Excision
166 77 Excision of the Maxilla 5 days 42500 50000 extra
167 78 Excision of mandible- segmental 5 days 42500 50000 extra
168 79 Mandibulectomy 5 days 42500 50000 extra
169 80 Partial Glossectomy 4 days 29750 35000 extra
170 81 Hemiglossectomy 4 days 34000 40000 extra
171 82 Total glossectomy 5 days 42500 50000 extra
172 83 Commondo Operation 5 days 42500 50000 extra
173 84 Parotidectomy – Superficial 3 days 25500 30000 extra
174 85 Parotidectomy – Total 5 days 38250 45000 extra
175 86 Parotidectomy – Radical 5 days 42500 50000 extra
176 87 Repair of Parotid Duct 3 days 23800 28000 extra
Removal of Submandibular
177 88 3 days 21250 25000 extra
Salivary Gland
178 89 Hemithyroidectomy 4 days 29750 35000 extra
179 90 Partial Thyroidectomy (Lobectomy) 4 days 29750 35000 extra
180 91 Total Thyroidectomy 5 days 42500 50000 extra
GYNAECOLOGY & OBSTETRICS
Normal delivery with or without
181 1 3 17000 20000 **** extra
Episiotomy & P. repair
182 2 vacuum delivery 3 21250 25000 **** extra
183 3 Forceps Delivery 3 21250 25000 **** extra
184 4 Cesarean Section 4 29750 35000 **** extra
185 5 Cesarean Hysterectomy 3 42500 50000 **** extra
Rupture Uterus closure & repair
186 6 3 42500 50000 **** extra
with Tubal Ligation
Perforation of Uterus after D/E
187 7 3 34000 40000 **** extra
Laparotomy & Closure
188 8 Laparotomy for Ectopic pregnancy 3 34000 40000 **** extra

Laparotomy- peritonitis Lavage and

189 9 3 34000 40000 **** extra
Drainage
Salphingo- Oophorectomy/
190 10 3 25500 30000 **** extra
Oophorectomy Laproscopic
191 11 Ovarian Cystectomy- laparoscopic. 3 29750 35000 **** extra
192 12 Ovarian Cystectomy- laparotomy. 3 25500 30000 **** extra
Salpingo- Oophorectomy-
193 13 3 25500 30000 **** extra
Laparotomy
Laproscopic Broad Ligament
194 14 3 17000 20000 **** extra
Hematoma Drainage with Repair
Exploration of Perineal Haematoma
195 15 3 17000 20000 **** extra
& Repair
Exploration of abdominal
196 16 Haematoma (after laparotomy + 3 21250 25000 **** extra
LSCS)
197 17 Manual Removal of Placenta 1 8075 9500 **** extra
 Examination under anesthesia
198 18 Day care 2550 3000 **** extra
(EUA)
199 19 Burst-abdomen Repair 3 25500 30000 **** extra
Gaping Perineal Wound Secondary
200 20 1 4250 5000 **** extra
Suturing
Gaping abdominal wound
201 21 1 8075 9500 **** extra
Secondary Suturing
202 22 Complete perineal tear-repair 1 6375 7500 **** extra
203 23 Exploration of PPH- tear repair 1 9350 11000 **** extra
204 24 Suction evacuation vesicular mole 3 12750 15000 **** extra
Suction evacuation Missed
205 25 1 8500 10000 **** extra
abortion/ incomplete abortion
206 26 Colpotomy 1 8500 10000 **** extra
Repair of post- coital tear/perineal
207 27 1 8500 10000 **** extra
injury
208 28 Shirodhkar/ Mc. Donald's stitch 1 8500 10000 **** extra
Abdominal Hysterectomy with or
209 29 3 42500 50000 **** extra
without salpingo-oophorectomy
210 30 Vaginal Hysterectomy (NDVH) 3 42500 50000 **** extra
Vaginal Hysterectomy with repairs
211 31 3 42500 50000 **** extra
(UV Prolapse)
212 32 Myomectomy - laparotomy 3 42500 50000 **** extra
213 33 Myomectomy - laparoscopic 3 42500 50000 **** extra
214 34 Vaginoplasty 3 42500 50000 **** extra
215 35 Vulvectomy - Simple 3 25500 30000 **** extra
216 36 Vulvectomy- Radical 3 25500 30000 **** extra
217 37 RVF Repair 3 34000 40000 **** extra
218 38 Manchester Operation 3 34000 40000 **** extra
Shirodkar's sling Operation or
219 39 other sling operations for prolapse 3 29750 35000 **** extra
uterus
Laparoscopic sling operations for
220 40 3 29750 35000 **** extra
prolapse uterus
221 41 Diagnostic Curettage 1 6375 7500 **** extra
222 42 Cervical Biopsy 1 4250 5000 **** extra
223 43 Polypectomy 1 4250 5000 **** extra
224 44 Other-Minor Operation Endometrial 1 6800 8000 **** extra

225 45 Excision Vaginal Cyst/Bartholin Cyst 1 9350 11000 **** extra

226 46 Excision Vaginal Septum 1 10200 12000 **** extra
Laparoscopy - Diagnostic with
227 47 chromopertubation and or 1 10200 12000 **** extra
adhesiolysis and drilling
228 48 Laparoscopy Sterilization 1 9350 11000 **** extra
229 49 LAVH 3 63750 75000 **** extra
230 50 Balloon Temponade for PPH 1 7225 8500 **** extra
231 51 Total laparoscopic hysterectomy 3 63750 75000 **** extra
Laparoscopic treatment of Ectopic
232 52 pregnancy- salpingectomy/ 3 25500 30000 **** extra
salpinostomy conservative
233 53 Conisation of cervix 1 10200 12000 **** extra
Trachhelectomy of cervix for early
234 54 1 17000 20000 **** extra
CA cervix
235 55 Hysteroscopic cannulation 1 7225 8500 **** extra
Laparotomy recannalization of
236 56 3 42500 50000 **** extra
Fallopian tubes- (Tubuloplasty)
Laparoscopic recannalization of
237 57 3 42500 50000 **** extra
Fallopian tubes- (Tubuloplasty)
238 58 Colposcopy 1 2125 2500 **** extra
Inversion of Uterus - Vaginal
239 59 2 8500 10000 **** extra
Reposition
Inversion of Uterus- Abdominal
240 60 2 8500 10000 **** extra
Reposition
241 61 Laparoscopic VVF Repair 3 63750 75000 **** extra
242 62 Abdominal VVF Repair 3 63750 75000 **** extra
243 63 Vaginal VVF Repair 3 63750 75000 **** extra
Interventional Ultrasonography
244 64 1 1700 2000 **** extra
(CVS)
245 65 Amniocentesis 1 1700 2000 **** extra
246 66 Karyotyping 1 1700 2000 **** extra
247 67 Thermal balloon ablation. 1 21250 25000 **** extra
248 68 Ultrasonographic myolysis 3 29750 35000 **** extra
249 69 Vaginal Myomectomy 3 29750 35000 **** extra
250 70 Intra Uterine Inseminition 3 2125 2500 **** extra
251 71 ICSI 3 34000 40000 **** extra
Laparotomy abdominal sacro-
252 72 3 42500 50000 **** extra
colpopexy
253 73 Vaginal Colpopexy 3 63750 75000 **** extra
Laparoscopic abdominal sacro-
254 74 3 59500 70000 **** extra
colpopexy
Endometrial aspiration
255 75 1 4250 5000 **** extra
cytology/biopsy
Transvaginal sonography (TVS for
256 76 1 1275 1500 **** extra
Follicular monitioring/aspiration)
Laparoscopic treatment for stress
257 77 3 38250 45000 **** extra
incontinence
Transvaginal tapes for Stress
258 78 3 38250 45000 **** extra
Incontinence
Trans-obturator tapes for Stress
259 79 3 38250 45000 **** extra
Incontinence
Interventional radiographic arterial
260 80 3 55250 65000 **** extra
embolization
261 81 Diagnostic cystoscopy 1 8500 10000 **** extra
Staging laparotomy surgery for CA
262 82 3 18700 22000 **** extra
Ovary
263 83 Internal Iliac ligation 1 8500 10000 **** extra
264 84 Assisted breech delivery 1 21250 25000 **** extra
265 85 Intra-uterine fetal blood transfusion 3 51000 60000 **** extra
266 86 Hysteroscopy TCRE 3 25500 30000 **** extra
267 87 Hysteroscopy Removal of IUCD 1 10200 12000 **** extra
268 88 Hysteroscopy Removal of Septum 1 10200 12000 **** extra
269 89 Hysteroscopy Diagnostic 2 17000 20000 **** extra
Radical Hysterectomy for Cancer
270 90 cervix with pelvic 3 42500 50000 **** extra
Lymphadenectomy
Radical Hysterectomy for Cancer
endometrium extending to cervix
271 91 3 42500 50000 **** extra
with pelvic and para aortic
lymphadenectomy
272 92 Sterilization Post partum (minilap) 1 9350 11000 **** extra
273 93 Sterilization interval (minilap) 1 9350 11000 **** extra
Ultrasonography Level II
274 94 OPD 850 1000 **** ******
scan/Anomaly Scan
275 95 Fetal nuchal Translucency OPD 850 1000 **** ******
Fetal Doppler/Umblical
276 96 OPD 1700 2000 **** ******
Doppler/Uterine Vessel Doppler
277 97 MTP-1st Trimester 1 8500 10000 **** extra
278 98 MTP - 2nd Trimester 3 17000 20000 **** extra
279 99 Quadruple test OPD 4250 5000 **** ******
280 100 Biophysical score OPD 1700 2000 **** ******
NEUROSURGERY
Aneurysms and AVM large/
281 1 10 59500 70000 extra
Extensive/ Complicated
Aneurysms and AVM - Small/
282 2 7 59500 70000 extra
localised/ Uncomplicated
Anterior Cranial Fossa Surgery
283 3 6 59500 70000 extra
(CSF Rhinnorhea)
Bilaterial/ Multiple Burr holes and
284 4 7 42500 50000 extra
Evacuation SDH
285 5 Burr hole and aspiration of abscess 5 34000 40000 extra
286 6 Burr Hole with of chronic SDH 3 38250 45000 extra
287 7 C.V. junction fusion PKG 7 59500 70000 extra
288 8 Conversion of EVD into VP Shunt 5 42500 50000 extra
Conversion of Frontal Twist into VP
289 9 5 42500 50000 extra
Shunt
290 10 Craniopharyngioma 10 63750 75000 extra
291 11 Cranioplasty large Defect 3 38250 45000 extra
292 12 Cranioplasty small Defect 2 34000 40000 extra
Craniotomy – Haematoma
293 13 10 59500 70000 extra
(Evacuation)
294 14 Craniotomy Tumours- Large 10 68000 80000 extra
295 15 Craniotomy Tumours - Small 8 59500 70000 extra
Craniotomy Evacuation of
296 16 10 68000 80000 extra
Contusions
Craniotomy and Excision of
297 17 10 76500 90000 extra
Intaorbital Tumor
Craniotomy and repair of growing
298 18 5 61200 72000 extra
fracture of skull
299 19 Debridment of scalp wound - large 3 21250 25000 extra
Decompressive Craniotomy with
300 20 8 68000 80000 extra
Duroplasty
Elevation of depressed fracture
301 21 6 46750 55000 extra
without dural repair
Endonasal Hypophysetomy with
302 22 7 68000 80000 extra
Celler reconstruction
303 23 Eventration of Sacral Cyst 5 42500 50000 extra
304 24 Excision of Pituitary 7 76500 90000 extra
External Ventricular (EVD) Replace
305 25 2 8500 10000 extra
of same Patient
306 26 External Ventricular Drainage 2 12750 15000 extra
307 27 Foramen Magnum decompression 5 68000 80000 extra
Interbody cage insertion for Spine
308 28 7 59500 70000 extra
Fusion
309 29 Meningo Enchephalcoele 7 63750 75000 extra
Microsugical Decompression for
310 30 7 63750 75000 extra
Trigeminal Nerve
Multidisc Corpectomy and
311 31 10 68000 80000 extra
Stabilization of Vertabral Spine
312 32 Occipitocervical fusion 7 72250 85000 extra
313 33 Odontoid Screw Fixation 5 55250 65000 extra
314 34 Placement of Bone innial Defect 5 51000 60000 extra
Posterior Fosa Craniotomy -
315 35 10 68000 80000 extra
Complicated
316 36 Programmable VP Shunt 5 46750 55000 extra
317 37 Resection of Intraventricular tumor 10 68000 80000 extra
Subcutaneous CSF Reservoir
318 38 3 29750 35000 extra
Implant
319 39 T.P. Shunt 3 42500 50000 extra
320 40 Skull Traction 2 4250 5000 extra
Temporo-Occipital craniotomy with
321 41 7 59500 70000 extra
EDH
Transphenoidal excision of Pituitary
322 42 7 72250 85000 extra
Gland
323 43 Trephin 3 55250 65000 extra
324 44 Tumor Biopsy 3 42500 50000 extra
325 45 VP Shunt 5 42500 50000 extra
326 46 VP Shunt Revision 5 42500 50000 extra
327 47 Ventriculo Atrial Shunt 5 55250 65000 extra
OPHTHALMOLOGY
Subconjunctival/ Subtenon's OPD/ DAY
328 1 850 1000
injection (one eye) CARE
Subconjunctival/ Subtenon's OPD/DAY
329 2 850 1000
injections (both eyes) CARE
OPD/DAY
330 3 Pterygium surgery Bare Sclera 4250 5000
CARE
 Pterygium Surgery Conjunctival OPD/DAY
331 4 12750 15000
Autograft CARE
OPD/DAY
332 5 Conjunctival Peritomy 765 900
CARE
Conjunctival wound repair or OPD/DAY
333 6 8500 10000
exploration following blunt trauma CARE
OPD/DAY
334 7 Removal of corneal foreign body 680 800
CARE
Cauterization of ulcer/ OPD/DAY
335 8 213 250
Subconjunctival injection (one eye) CARE
Cauterization of ulcer/
OPD/DAY
336 9 Subconjunctival injection in both 340 400
CARE
eyes
Corneal grafting—Penetrating OPD/DAY
337 10 25500 30000
keratoplasty CARE
Corneal grafting— Lamellar OPD/DAY
338 11 29750 35000
keratoplasty CARE
Cyanoacrylate /fibrin glue OPD/DAY
339 12 4250 5000
application for corneal perforation CARE
Bandage contact lenses for corneal OPD/DAY
340 13 2550 3000
perforation CARE
Scleral grafting or conjunctival flap
OPD/DAY
341 14 4250 5000
for corneal perforation CARE
Keratoconus correction with OPD/DAY
342 15 6375 7500
therapeutic contact lenses CARE
UV radiation for cross-linking for OPD/DAY
343 16 17000 20000
keratoconus (per eye) CARE
OPD/DAY
344 17 EDTA for band shaped keratopathy 1275 1500
CARE
OPD/DAY
345 18 Arcuate keratotomy for astigmatism 4250 5000
CARE
Re-suturing (Primary suturing) of OPD/DAY
346 19 4250 5000
corneal wound CARE
Penetrating keratoplasty-with OPD/DAY
347 20 34000 40000
glaucoma surgery CARE
Penetrating keratoplasty- with OPD/DAY
348 21 42500 50000
vitrectomy CARE
Penetrating keratoplasty-with IOL OPD/DAY
349 22 34000 40000 Fixed cost of IOL
implantation CARE
DALK- Deep anterior lamellar OPD/DAY
350 23 29750 35000
keratoplasty CARE
OPD/DAY
351 24 Keratoprosthesis stage I and II 21250 25000
CARE
DSAEK- Descemet's stripping OPD/DAY
352 25 29750 35000
automated endothelial keratoplasty CARE
ALTK- Automated lamellar OPD/DAY
353 26 29750 35000
therapeutic keratoplasty CARE
Probing and syringing of lacrimal OPD/DAY
354 27 595 700
sac (one eye) under LA CARE
Probing and Syringing of lacrimal
OPD/DAY
355 28 sac (one eye) Under General 2975 3500
CARE
Anaesthesia
Probing and Syringing of lacrimal
OPD/DAY
356 29 sac (both eye) Under Local 1020 1200
CARE
Anaesthesia
Probing and Syringing of lacrimal
OPD/DAY
357 30 sac- ( both eye) Under General 4250 5000
CARE
Anaesthesia
Dacryocystorhinostomy— Plain OPD/DAY
358 31 8500 10000
Under Local Anaesthesia CARE
Dacryocystorhinostomy— Plain OPD/DAY
359 32 14875 17500
Under General Anaesthesia CARE
Dacryocystorhinostomy- plain with
OPD/DAY
360 33 intubation and/or with lacrimal 12750 15000
CARE
implants Under Local Anaesthesia
Dacryocystorhinostomy—
OPD/DAY
361 34 conjunctival with implant General 19125 22500
CARE
Anaesthesia
Dacryocystorhinostomy—
OPD/DAY
362 35 conjunctival with implant Local 8500 10000
CARE
Anaesthesia
Dacryocystorhinostomy—
OPD/DAY
363 36 conjunctival with implant General 14875 17500
CARE
Anaesthesia
OPD/DAY
364 37 Caliculoplasty 6694 7875
CARE
Dacryocystectomy under General OPD/DAY
365 38 18700 22000
Anaesthesia CARE
Dacryocystectomy under Local OPD/DAY
366 39 10200 12000
Anaesthesia CARE
OPD/DAY
367 40 Punctal plugs for dry eyes 298 350
CARE
Perimetry/ field test—Goldman OPD/DAY
368 41 850 1000
(each eye) CARE
Perimetry/field test— automated OPD/DAY
369 42 850 1000
(each eye) CARE
Fluorescein angiography for fundus OPD/DAY
370 43 1700 2000
or iris CARE
OPD/DAY
371 44 Ultrasound B-Scan 595 700
CARE
OPD/DAY
372 45 Fundus PhotoTest 595 700
CARE
OPD/DAY
373 46 Indocyanin green angiography 2125 2500
CARE
Corneal endothelial cell count with OPD/DAY
374 47 850 1000
specular microscopy (each eye) CARE
OPD/DAY
375 48 Corneal Topography (each eye) 850 1000
CARE
 OPD/DAY
376 49 Corneal pachymetry 850 1000
CARE
OCT-Optical coherence OPD/DAY
377 50 850 1000
tomography (each eye) CARE
Chalazion incision and curettage OPD/DAY
378 51 850 1000
(one eye) CARE
Ptosis surgery with fasanellaservat OPD/DAY
379 52 17000 20000
procedure CARE
Ptosis surgery with LPS resection - OPD/DAY
380 53 21250 25000
one lid CARE
Ptosis surgery with Sling surgery - OPD/DAY
381 54 21250 25000
one lid CARE
OPD/DAY
382 55 Ectropion surgery- one lid 8500 10000
CARE
OPD/DAY
383 56 Ectropion surgery- both lids 12750 15000
CARE
OPD/DAY
384 57 Epicanthus correction 2550 3000
CARE
OPD/DAY
385 58 Cantholysis and canthotomy 1020 1200
CARE
OPD/DAY
386 59 Entropion surgery- one lid 8500 10000
CARE
OPD/DAY
387 60 Entropion surgery- both lids 12750 15000
CARE
OPD/DAY
388 61 Tarsorraphy 2975 3500
CARE
OPD/DAY
389 62 Suturing of lid lacerations 2550 3000
CARE
OPD/DAY
390 63 Lid retraction repair 1700 2000
CARE
OPD/DAY
391 64 Cheek rotation flap for lid tumors 12750 15000
CARE
OPD/DAY
392 65 Orbitotomy 25500 30000
CARE
OPD/DAY
393 66 Enucleation 8500 10000
CARE
Enucleation with orbital implants OPD/DAY
394 67 12750 15000
and artificial prosthesis CARE
OPD/DAY
395 68 Evisceration 8500 10000
CARE
Evisceration with orbital implants OPD/DAY
396 69 12750 15000
and artificial prosthesis CARE
OPD/DAY
397 70 Telecanthus correction 5950 7000
CARE
OPD/DAY
398 71 Orbital decompression 6800 8000
CARE
OPD/DAY
399 72 Exenteration 6800 8000
CARE
OPD/DAY
400 73 Exenteration with skin grafting 8500 10000
CARE
OPD/DAY
401 74 Fracture orbital repair 12750 15000
CARE
OPD/DAY
402 75 Retinal laser procedures 1275 1500
CARE
OPD/DAY
403 76 Retinal detachment surgery 29750 35000
CARE
Retinal detachment surgery with OPD/DAY
404 77 34000 40000
scleral buckling CARE
OPD/DAY
405 78 Buckle removal 3400 4000
CARE
OPD/DAY
406 79 Silicone oil removal 3400 4000
CARE
Squint correction for one eye - OPD/DAY
407 80 21250 25000
Local Anaesthesia CARE
Squint correction for one eye - OPD/DAY
408 81 25500 30000
General Anaesthesia CARE
Squint correction for both eyes - OPD/DAY
409 82 25500 30000
Local Anaesthesia CARE
Squint correction for both eyes - OPD/DAY
410 83 31875 37500
General Anaesthesia CARE
OPD/DAY
411 84 Trabeculectomy 19125 22500
CARE
Trabeculotomy under General OPD/DAY
412 85 21250 25000
Anaesthesia CARE
Trabeculectomy under Local OPD/DAY
413 86 19125 22500 Fixed Cost of Valve
Anaesthesia CARE
Glaucoma surgery with Glaucoma OPD/DAY
414 87 17000 20000 Fixed Cost of Valve
valves CARE
OPD/DAY
415 88 Cyclocryotherapy 2550 3000
CARE
OPD/DAY
416 89 YAG laser iridotomy (per eye) 850 1000
CARE
OPD/DAY
417 90 YAG laser capsulotomy(per eye) 680 800
CARE
OPD/DAY
418 91 ALT-Argon laser Trabeculoplasty 2550 3000
CARE
OPD/DAY
419 92 PDT-Photodymic Therapy 4250 5000
CARE
TTT- Transpupillary Thermal OPD/DAY
420 93 6800 8000
Therapy CARE
OPD/DAY
421 94 PTK- Phototherapeutic Keratectomy 8500 10000
CARE
Argon/Diode Laser for Retinal OPD/DAY
422 95 1275 1500
Detatchment CARE
Intralase application for OPD/DAY
423 96 8500 10000
keratoconus CARE
OPD/DAY
424 97 Vitrectomy- pars plana 25500 30000
CARE
OPD/DAY
425 98 Intravitreal injections- of antibiotics 1275 1500 Cost of drug extra
CARE
OPD/DAY
426 99 Intravitreal injections- lucentis 1275 1500 Cost of drug extra
CARE
 OPD/DAY
427 100 Dacryocystography 765 900
CARE
OPD/DAY
428 101 Orbital Angiographical studies 2550 3000
CARE
OPD/DAY Fixed Cost of PMMA
429 102 ECCE with IOL 6800 8000
CARE IOL
OPD/DAY Fixed Cost of PMMA
430 103 SICS with IOL 8500 10000
CARE IOL
OPD/DAY
431 104 Phaco with foldable IOL 19125 22500 Fixed Cost of IOL
CARE
OPD/DAY
432 105 Femtolaser Cataract Surgery 51000 60000 Fixed Cost of IOL
CARE
Pars planalensectomy with/without OPD/DAY
433 106 19125 22500 Fixed Cost of IOL
IOL CARE
Secondary IOL implantation- AC OPD/DAY
434 107 17000 20000 Fixed Cost of IOL
IOL PC IOL or scleral fixated IOL CARE
Cataract extraction with IOL with
OPD/DAY
435 108 capsular tension rings (Cionni's 21250 25000 Fixed Cost of IOL
CARE
ring)
OPD/DAY
436 109 Optic Nerve Sheathotomy 11900 14000
CARE
Iridodialysis repair or papillary OPD/DAY
437 110 8500 10000
reconstruction CARE
OPD/DAY
438 111 Iris cyst removal 1275 1500
CARE
OPD/DAY
439 112 Lid Abscess Incision and Drainage 3400 4000
CARE
Orbital Abscess Incision and OPD/DAY
440 113 2975 3500
Drainage CARE
OPD/DAY
441 114 Paracentesis 1275 1500
CARE
OPD/DAY
442 115 Amniotic membrane grafting 5950 7000
CARE
OPD/DAY
443 116 Cyclodiathermy 2975 3500
CARE
OPD/DAY
444 117 Electrolysis 850 1000
CARE
OPD/DAY
445 118 Biopsy 425 500
CARE
LASIK Refractive Surgery with
OPD/DAY
446 119 Micro Keratome for refrective error 21250 25000
CARE
more than 4 Diopters (Both Eyes)

LASIK Refractive Surgery with

OPD/DAY
447 120 Femtolaser for refrective error 38250 45000
CARE
more than 4 Diopters (Both Eyes)

ORTHOPEDICS

Close Reduction of Fractures of

448 1 2 8500 10000 extra
Limb & P.O.P under Anaesthesia
Reduction of Compound
449 2 2 9350 11000 extra
Fractures
Open Reduction & Internal
450 3 2 4250 5000 extra
Fixationof Fingers & Toes
Open Reduction and plating of
fracture of Long Bones of
451 4 5 34000 40000 extra
Upper/ Lower Limb - nailing &
External Fixation
Percutaneous and open pinning
452 5 3 23800 28000 extra
of fracture in Children
453 6 Tension Band Wirings 3 21250 25000 extra
454 7 Isolated Bone Grafting 3 15300 18000 extra
Bone grafting done along with
455 8 5 5100 6000 extra
fixation of fracture
Excision of Benign Bone
456 9 3 15300 18000 extra
Tumours
Excision or other Operations for
457 10 2 23800 28000 extra
Scaphoid Fractures
458 11 Sequestrectomy & Saucerisation 3 23800 28000 extra
Sequestrectomy & Saucerisation
459 12 3 19975 23500 extra
Arthrotomy
Multiple Pinning Fracture Neck
460 13 5 23800 28000 extra
Femur
Plate Fixations for Fracture Neck
461 14 5 29750 35000 extra
Femur
A.O.Compression Procedures for
462 15 5 29750 35000 extra
fracture neck femur

Open Reduction of Fracture

463 16 5 34000 40000 extra
Neck Femur Muscle Pedicle Graft

Close Reduction of Dislocations

464 17 of elbow, shoulder, hip, knee 3 8500 10000 extra
and ankle under Anesthesia
Open Reduction of Dislocations
465 18 of elbow, shoulder, hip, knee 3 25500 30000 extra
and ankle
Open reduction of dislocation of
466 19 3 15300 18000 extra
foot/hand under Anesthesia
467 20 Neurolysis/Nerve repair 3 18700 22000 extra
468 21 Nerve Repair with Grafting 3 25500 30000 extra
469 22 Tendon with Transplant or Graft 3 18700 22000 extra
Tendon Lengthening/ Tendon
470 23 3 21250 25000 extra
repair
471 24 Tendon Transfer 2 22100 26000 extra
Upto two tendon transfer/ more
472 25 2 25500 30000 extra
than 2
Endoscopy Excision Lumber
473 26 3 51000 60000 extra
spinal Disc and Tumours
Endoscopy Excision Cervical
474 27 3 59500 70000 extra
spinal Disc and Tumours
Spine Ostectomy and Internal
475 28 5 59500 70000 extra
Fixations
Anterolateral decompression for
476 29 tuberculosis/ Costo- 5 59500 70000 extra
Transversectorny
Antercolateral decompression
477 30 3 63750 75000 extra
and spine fusion
Corrective Ostectomy & Internal
478 31 3 25500 30000 extra
Fixation-short bones
Corrective Ostectomy & Internal
479 32 5 29750 35000 extra
Fixation -long bones
480 33 Arthrodesis of - Minor Joints 3 8500 10000 extra
481 34 Arthrodesis of - Major Joints 5 29750 35000 extra
Soft Tissue Operations for
482 35 C.T.E.V. (complete 3 21250 25000 extra
posteromedial release)
Percutaneous tenatomies under
483 36 2 8500 10000 extra
anaesthesia
484 37 Hemiarthroplasty- Hip 10 51000 60000 extra
485 38 Hemiarthroplasty-Shoulder 5 51000 60000 extra
Operations for Brachial Plexus &
486 39 3 38250 45000 extra
Cervical Rib
487 40 Amputations - Below Knee 3 25500 30000 extra
488 41 Amputations - Below Elbow 3 25500 30000 extra
489 42 Amputations - Above Knee 3 29750 35000 extra
490 43 Amputations - Above Elbow 3 25500 30000 extra
491 44 Amputations - Forequarter 5 42500 50000 extra
Amputations -Hindquarter and
492 45 7 42500 50000 extra
Hemipelvectomy
493 46 Disarticulations - Hip 5 29750 35000 extra
Disarticulations – other Joints
494 47 3 25500 30000 extra
(Long Bones)
Disarticulations of fingers and
495 48 1 5100 6000 extra
Toes
496 49 Arthrography 1 5100 6000 extra

497 50 Arthroscopy Diagnostic 1 12750 15000 extra

Arthroscopy-therapeutic:
498 51 1 25500 30000 extra
without implant
Atthroscopy-therapeutic: with
499 52 2 42500 50000 extra
implant
Myocutaneous and
500 53 Fasciocutaneous Flap 5 34000 40000 extra
Procedures for Limbs
Removal of Wires & Screw
501 54 1 12750 15000 extra
under Anesthesia
502 55 Removal of Plates and Nail 1 23800 28000 extra
503 56 Total Hip Replacement (U/L) 10 85000 100000 Cost of Implant extra
504 57 Total Hip Replacement (B/L) 10 127500 150000 Cost of Implant extra
Total Ankle Joint Replacement
505 58 7 68000 80000 Cost of Implant extra
(U/L)
Total Ankle Joint Replacement
506 59 7 102000 120000 Cost of Implant extra
(B/L)
Total Knee Joint Replacement
507 60 10 85000 100000 Cost of Implant extra
(U/L)
Total Knee Joint Replacement
508 61 10 127500 150000 Cost of Implant extra
(B/L)
Total Shoulder Joint
509 62 7 68000 80000 Cost of Implant extra
Replacement (U/L)
Total Shoulder Joint
510 63 7 102000 120000 Cost of Implant extra
Replacement (B/L)
Total Elbow Joint Replacement
511 64 7 59500 70000 Cost of Implant extra
(U/L)
Total Elbow Joint Replacement
512 65 7 89250 105000 Cost of Implant extra
(B/L)
Total Wrist Joint Replacement
513 66 7 59500 70000 Cost of Implant extra
(U/L)
Total Wrist Joint Replacement
514 67 7 89250 105000 Cost of Implant extra
(B/L)
515 68 Total finger joint replacement 7 21250 25000 Cost of Implant extra
516 69 Tubular external fixator 1 25500 30000 extra
517 70 Ilizarov's external fixator 3 29750 35000 extra
Pelvic-acetebular fracture-
518 71 3 46750 55000 extra
Internal fixation
519 72 Meniscectomy 3 23800 28000 extra
520 73 Meniscus Repair 3 23800 28000 extra
521 74 ACL Reconstruction 1 42500 50000 extra
522 75 PCL Reconstruction 1 42500 50000 extra
Knee Collateral Ligament
523 76 1 25500 30000 extra
Reconstruction
Arthroscopic Benkart Repair
524 77 1 42500 50000 extra
Shoulder
525 78 Arthroscopic Rotator Cuff Repair Day Care 29750 35000 extra

526 79 Biceps tenodesis 3 21250 25000 extra

527 80 Distal Biceps tendon repair 3 19975 23500 extra
Arthroscopic Arthrolysis of Stiff
528 81 3 22100 26000 extra
knee
529 82 Application for CTEV per sitting OPD 1275 1500 ******
Total Hip Replacement Revision
530 83 3 42500 50000 extra
Stage-I
Total Hip Replacement Revision
531 84 5 102000 120000 extra
Stage-II
Total Knee Replacement
532 85 5 42500 50000 extra
Revision Stage-I
Total Knee Replacement
533 86 5 102000 120000 extra
Revision Stage-II
Illizarov/ external fixation for
534 87 limb lengthening/ deformity 3 34000 40000 extra
correction
535 88 Lumbar Laminectomy 3 42500 50000 extra
536 89 Cervical Laminectomy 3 51000 60000 extra
Lumbar Laminectomy More than
537 90 5 51000 60000 extra
1 level
Cervical Laminectomy More
538 91 5 59500 70000 extra
than 1 level
Spinal Fixation Cervical/
539 92 5 59500 70000 extra
dorsolumbar/ lumbosacral
Fusion Surgery: Cervical
540 93 5 51000 60000 extra
Lumbar Spine upto 2 Level
Fusion Surgery: Cervical,
541 94 5 68000 80000 extra
Lumbar Spine More than 2 level

Fusion Surgery: Cervical,

542 95 5 68000 80000 extra
Lumbar Spine More than 2 level
Scoliosis Surgery: Deformity
543 96 5 68000 80000 extra
Correction of Spine
544 97 Vertebroplasty 4 34000 40000 extra
545 98 Spinal Injections Day care 4250 5000 extra
546 99 DHS for Fracture Neck Femur 5 34000 40000 extra
Proximal Femoral Nail (PFN for
547 100 5 38250 45000 extra
IT Fracture)
Closed interlocking nailing of
548 101 5 35700 42000 extra
femur
Closed interlocking nailing of
549 102 5 30600 36000 extra
Tibia
550 103 Spinal Osteotomy 5 38250 45000 extra
Illizarov's / External Fixation for
551 104 5 25500 30000 extra
Trauma
Soft Tissue Operations for
552 105 Polio/Cerebral Palsy for 5 21250 25000 extra
correction of deformity
Soft Tissue Operations for Polio/
553 106 Cerebral Palsy, if bony 5 21250 25000 extra
correction ofdeformity
554 107 Mini Fixator for Hand/Foot 3 21250 25000 extra
555 108 Plating of Ulna 3 27200 32000 extra
556 109 Plating of Radius 3 27200 32000 extra
557 110 Plating Both Radius and Ulna 3 34000 40000 extra
558 111 Psoas abscess drainage 3 25500 30000 extra
559 112 Carpal tunnel release 2 19125 22500 extra

PATHOLOGY (Investigations/Tests)

Urine routine (pH, Specific gravity,

560 1 ********* 43 50 ******* ********
sugar, protein) and Microscopy
561 2 Urine-Microalbumin ********* 106 125 ******* ********
562 3 Stool routine ********* 43 50 ******* ********
563 4 Stool occult blood ********* 43 50 ******* ********
564 5 Post coital smear examination ********* 43 50 ******* ********
565 6 Semen analysis ********* 43 50 ******* ********
566 7 Haemoglobin (Hb) ********* 26 30 ******* ********
567 8 Total Leucocytic Count (TLC) ********* 43 50 ******* ********
568 9 Differential Leucocytic Count (DLC) ********* 43 50 ******* ********
569 10 E.S.R. ********* 43 50 ******* ********
Total Red Cell count with
570 11 ********* 106 125 ******* ********
MCV,MCH,MCHC,DR W
Complete Haemogram/CBC
(Hb,RBC count and indices, TLC,
571 12 ********* 191 225 ******* ********
DLC, Platelet, ESR, Peripheral
smear examination)
572 13 Platelet count ********* 64 75 ******* ********
573 14 Reticulocyte count ********* 85 100 ******* ********
574 15 Absolute Eosinophil count ********* 85 100 ******* ********
575 16 Packed Cell Volume (PCV) ********* 21 25 ******* ********
Peripheral Smear
576 17 ********* 85 100 ******* ********
Examination
577 18 Smear for Malaria parasite ********* 51 60 ******* ********
578 19 Bleeding Time ********* 43 50 ******* ********
579 20 Osmotic fragility Test ********* 85 100 ******* ********
580 21 Bone Marrow Smear Examination ********* 106 125 ******* ********
Bone Marrow Smear Examination
581 22 ********* 340 400 ******* ********
with iron stain
Bone Marrow Smear Examination
582 23 ********* 595 700 ******* ********
and Cytochemistry
Activated partial
583 24 ********* 149 175 ******* ********
ThromboplastinTime (APTT)
584 25 Rapid test for malaria (card test) ********* 60 70 ******* ********
WBC cytochemistry for leukemia -
585 26 ********* 170 200 ******* ********
Complete panel
Bleeding Disorder panel- PT, APTT,
586 27 Thrombin Time, Fibrinogen, D- ********* 510 600 ******* ********
Dimer/ FDP
587 28 Factor Assays-Factor-VIII ********* 935 1100 ******* ********
588 29 Factor Assays-Factor-IX ********* 935 1100 ******* ********

589 30 Platelet Function test ********* 85 100 ******* ********

Tests for hypercoagulable states-

590 31 ********* 510 600 ******* ********
Protein C, Protein S, Antithrombin

591 32 Tests for lupus anticoagulant ********* 213 250 ******* ********
Tests for Antiphospholipid antibody
592 33 IgG, IgM (for cardiolipin and B2 ********* 680 800 ******* ********
Glycoprotein 1)
Thalassemia studies (Red Cell
593 34 ********* 723 850 ******* ********
indices and Hb HPLC)
594 35 Tests for Sickling / Hb HPLC) ********* 128 150 ******* ********

595 36 Blood Group & RH Type ********* 43 50 ******* ********

596 37 Cross match ********* 85 100 ******* ********
597 38 Coomb's Test Direct ********* 128 150 ******* ********
598 39 Coomb's Test Indirect ********* 128 150 ******* ********
3 cell panel- antibody screening for
599 40 ********* 234 275 ******* ********
pregnant female
11 cells panel for antibody
600 41 ********* 234 275 ******* ********
Identification
601 42 HBs Ag ********* 128 150 ******* ********
602 43 HCV ********* 170 200 ******* ********
603 44 HIV I and II ********* 213 250 ******* ********
604 45 VDRL ********* 64 75 ******* ********
605 46 RH Antibody titer ********* 106 125 ******* ********
606 47 Platelet Concentrate ********* 85 100 ******* ********
607 48 Random Donor Platelet (RDP) ********* 2125 2500 ******* ********
Single Donor Platelet (SDP-
608 49 ********* 2125 2500 ******* ********
Aphresis)
609 50 Routine-H & E ********* 128 150 ******* ********
610 51 special stain ********* 85 100 ******* ********
611 52 Immunohistochemistry (IHC) ********* 1020 1200 ******* ********
612 53 Frozen section ********* 1020 1200 ******* ********
613 54 Paraffin section ********* 468 550 ******* ********
614 55 Pap Smear ********* 213 250 ******* ********
615 56 Body fluid for Malignant cells ********* 213 250 ******* ********
616 57 FNAC ********* 255 300 ******* ********
617 58 Leukemia panel/ Lymphoma panel ********* 2550 3000.00 ******* ********
618 59 PNH Panel- CD55,CD59 ********* 1275 1500.00 ******* ********
619 60 Karyotyping ********* 2125 2500 ******* ********
620 61 FISH ********* 1275 1500 ******* ********
621 62 Blood Glucose Random ********* 34 40 ******* ********
24 hrs urine for Proteins, Sodium,
622 63 ********* 85 100 ******* ********
Creatinine
623 64 Blood Urea Nitrogen ********* 68 80 ******* ********
624 65 Serum Creatinine ********* 68 80 ******* ********
625 66 Urine Bile Pigment and Salt ********* 34 40 ******* ********
626 67 Urine Urobilinogen ********* 26 30 ******* ********
627 68 Urine Ketones ********* 34 40 ******* ********
628 69 Urine Occult Blood ********* 43 50 ******* ********
629 70 Urine total proteins ********* 43 50 ******* ********
630 71 Rheumatoid Factor test ********* 128 150 ******* ********
631 72 Bence Jones protein ********* 64 75 ******* ********
632 73 Serum Uric Acid ********* 85 100 ******* ********
633 74 Serum Bilirubin total & direct ********* 102 120 ******* ********
634 75 Serum Iron ********* 128 150 ******* ********
635 76 C.R.P. ********* 128 150 ******* ********
636 77 C.R.P Quantitative ********* 255 300 ******* ********
Body fluid (CSF/Ascitic Fluid etc.)-
637 78 ********* 425 500 ******* ********
Sugar, Protein etc.
638 79 Albumin. ********* 43 50 ******* ********
639 80 Creatinine clearance ********* 170 200 ******* ********
640 81 Serum Cholesterol ********* 85 100 ******* ********
641 82 Total Iron Binding Capacity ********* 102 120 ******* ********
642 83 Glucose (Fasting & PP) ********* 64 75 ******* ********
643 84 Serum Calcium -Total ********* 85 100 ******* ********
644 85 Serum Calcium -Ionic ********* 85 100 ******* ********
645 86 Serum Phosphorus ********* 85 100 ******* ********
646 87 Total Protein Alb/Glo Ratio ********* 85 100 ******* ********
647 88 IgG. ********* 340 400 ******* ********
648 89 IgM. ********* 340 400 ******* ********
649 90 IgA. ********* 340 400 ******* ********
650 91 ANA. ********* 255 300 ******* ********
651 92 Ds DNA. ********* 468 550 ******* ********
652 93 S.G.P.T. ********* 85 100 ******* ********
653 94 S.G.O.T. ********* 85 100 ******* ********
654 95 Serum amylase ********* 170 200 ******* ********
655 96 Serum Lipase ********* 213 250 ******* ********
656 97 Serum Lactate ********* 170 200 ******* ********
657 98 Serum Magnesium ********* 128 150 ******* ********
658 99 Serum Sodium ********* 85 100 ******* ********
659 100 Serum Potassium ********* 85 100 ******* ********
660 101 Serum Ammonia ********* 128 150 ******* ********
661 102 Anemia Profile ********* 298 350 ******* ********
662 103 Serum Testosterone ********* 213 250 ******* ********
663 104 Imprint Smear from Endoscopy ********* 340 400 ******* ********
664 105 Triglyceride ********* 94 110 ******* ********
665 106 Glucose Tolerance Test (GTT) ********* 128 150 ******* ********
666 107 Triple Marker. ********* 1020 1200 ******* ********
667 108 C.P.K. ********* 128 150 ******* ********
668 109 Foetal Haemoglobin (HbF) ********* 298 350 ******* ********
669 110 Prothrombin Time (P.T.) ********* 145 170 ******* ********
670 111 L.D.H. ********* 128 150 ******* ********
671 112 Alkaline Phosphatase ********* 85 100 ******* ********
672 113 Acid Phosphatase ********* 106 125 ******* ********
673 114 CK MB ********* 255 300 ******* ********
674 115 CK MB Mass ********* 191 225 ******* ********
675 116 Troponin I ********* 298 350 ******* ********
676 117 Troponin T ********* 765 900 ******* ********
Glucose Phosphate Dehydrogenase
677 118 ********* 128 150 ******* ********
(G-6PD)
678 119 Lithium. ********* 170 200 ******* ********
679 120 Dilantin (phenytoin). ********* 510 600 ******* ********
680 121 Carbamazepine. ********* 510 600 ******* ********
681 122 Valproic acid. ********* 425 500 ******* ********
682 123 Feritin. ********* 340 400 ******* ********
683 124 Blood gas analysis ********* 170 200 ******* ********
684 125 Blood gas analysis with electrolytes ********* 595 700 ******* ********
685 126 Urine pregnancy test ********* 85 100 ******* ********
Tests for Antiphospholipid
686 127 ********* 383 450 ******* ********
antibodies syndrome.
687 128 Hb A1 C ********* 255 300 ******* ********
688 129 Hb Electrophoresis/Hb HPLC ********* 298 350 ******* ********
689 130 Kidney Function Test. ********* 255 300 ******* ********
690 131 Liver Function Test. ********* 340 400 ******* ********
Lipid Profile (Total Cholesterol,
691 132 ********* 255 300 ******* ********
LDL, HDL, Trigylcerides)
692 133 Serum Iron ********* 128 150 ******* ********
693 134 Total Iron Binding Capacity ********* 128 150 ******* ********
694 135 Serum Ferritin ********* 128 150 ******* ********
695 136 Vitamin B12 assay. ********* 340 400 ******* ********
696 137 Folic Acid assay. ********* 425 500 ******* ********
Extended Lipid Profile (Total
697 138 cholesterol, LDL, HDL, ********* 680 800 ******* ********
trigylcerides, Apo A1, Apo B, Lp(a))
698 139 Apo A1. ********* 255 300 ******* ********
699 140 Apo B. ********* 255 300 ******* ********
700 141 Lp (a). ********* 595 700 ******* ********
701 142 CD 3,4 and 8 counts ********* 255 300 ******* ********
702 143 CD 3,4 and 8 percentage ********* 255 300 ******* ********
703 144 LDL. ********* 85 100 ******* ********
704 145 Homocysteine. ********* 510 600 ******* ********
705 146 HB Electrophoresis. ********* 595 700 ******* ********
706 147 Serum Electrophoresis. ********* 340 400 ******* ********
707 148 Fibrinogen. ********* 213 250 ******* ********
708 149 Chloride. ********* 85 100 ******* ********
709 150 Magnesium. ********* 213 250 ******* ********
710 151 GGTP. ********* 128 150 ******* ********
711 152 Lipase. ********* 340 400 ******* ********
712 153 Fructosamine. ********* 255 300 ******* ********
713 154 P2 Microglobulin ********* 128 150 ******* ********
714 155 Catecholamines. ********* 1360 1600 ******* ********
715 156 Creatinine clearance ********* 170 200 ******* ********
716 157 PSA- Total. ********* 425 500 ******* ********
717 158 PSA- Free. ********* 510 600 ******* ********
718 159 AFP. ********* 425 500 ******* ********
719 160 HCG. ********* 383 450 ******* ********
720 161 CA. 125. ********* 510 600 ******* ********
721 162 CA 19,9. ********* 850 1000 ******* ********
722 163 CA 15.3. ********* 765 900 ******* ********
723 164 Vinyl Mandelic Acid ********* 468 550 ******* ********
724 165 Calcitonin ********* 680 800 ******* ********
725 166 Carcioembryonic antigen(CEA) ********* 446 525 ******* ********
726 167 Immunofluorescence ********* 255 300 ******* ********
727 168 Direct (Skin and kidney Disease) ********* 595 700 ******* ********
Indirect (antids DNA Anti Smith
728 169 ********* 595 700 ******* ********
ANCA)
729 170 Vit.D3 assay ********* 723 850 ******* ********
Serum Protein electrophoresis with
730 171 immunofixationelectro phoresis ********* 425 500 ******* ********
(IFE)
731 172 BETA-2 Microglobulin assay ********* 128 150 ******* ********
Anti cycliocitrullinated peptide
732 173 ********* 595 700 ******* ********
(Anti CCP)
Anti-tissue Transglutaminase
733 174 ********* 595 700 ******* ********
Antibody
734 175 Serum Erythropoetin ********* 595 700 ******* ********
735 176 ACTH ********* 680 800 ******* ********
736 177 HARMONES ********* 0 ******* ********
737 178 T3, T4, TSH ********* 298 350 ******* ********
738 179 T3 ********* 128 150 ******* ********
739 180 T4 ********* 128 150 ******* ********
740 181 TSH ********* 213 250 ******* ********
741 182 LH ********* 213 250 ******* ********
742 183 FSH ********* 213 250 ******* ********
743 184 Prolactin ********* 213 250 ******* ********
744 185 Cortisol ********* 340 400 ******* ********
745 186 PTH(Paratharmone) ********* 680 800 ******* ********
746 187 C-Peptide. ********* 425 500 ******* ********
747 188 Insulin. ********* 213 250 ******* ********
748 189 Progesterone. ********* 340 400 ******* ********
749 190 17-DH Progesterone. ********* 595 700 ******* ********
750 191 DHEAS. ********* 595 700 ******* ********
751 192 Androstendione. ********* 765 900 ******* ********
752 193 Growth Hormone. ********* 510 600 ******* ********
753 194 TPO. ********* 425 500 ******* ********
754 195 Throglobulin. ********* 425 500 ******* ********
755 196 Hydatic Serology. ********* 425 500 ******* ********
756 197 Anti Sperm Antibodies. ********* 510 600 ******* ********
757 198 HBV DNA Qualitative ********* 2550 3000 ******* ********
758 199 HBV DNA Quantitative. ********* 2975 3500 ******* ********
759 200 HCV RNA Qualitative. ********* 2550 3000 ******* ********
760 201 HPV serology ********* 298 350 ******* ********
761 202 Rota Virus serology ********* 170 200 ******* ********
762 203 PCR for TB ********* 1190 1400 ******* ********
763 204 PCR for HIV ********* 765 900 ******* ********
764 205 Chlamydae antigen ********* 1275 1500 ******* ********
765 206 chlamydae antibody ********* 1275 1500 ******* ********
766 207 Brucella serology ********* 298 350 ******* ********
767 208 Influenza A serology ********* 1190 1400 ******* ********
Dexa Scan Bone Densitometry-
768 209 ********* 1913 2250 ******* ********
Two sites
Dexa Scan Bone Densitometry-
769 210 ********* 2550 3000 ******* ********
Three sites (Spine, Hip & extremity)
Dexa Scan Bone Densitometry
770 211 ********* 2550 3000 ******* ********
Whole body
771 212 EEG/Video EEG ********* 383 450 ******* ********
772 213 EMG (Electro myography) ********* 850 1000 ******* ********
Nerve condition velocity (at least 2
773 214 ********* 850 1000 ******* ********
limbs)
Decremental response (before and
774 215 ********* 808 950 ******* ********
after Neostigmine)
775 216 Incremental response ********* 808 950 ******* ********
SSEP (Somato sensory evoked
776 217 ********* 850 1000 ******* ********
potentials)
777 218 Poly somnography ********* 850 1000 ******* ********

778 219 Brachial plexus study ********* 850 1000 ******* ********
779 220 Muscle biopsy ********* 510 600 ******* ********
780 221 ACHR anti body titre ********* 2380 2800 ******* ********
781 222 Anti MUSK body titre ********* 2975 3500 ******* ********
782 223 Serum COPPER ********* 680 800 ******* ********
783 224 Serum ceruloplasmin ********* 595 700 ******* ********
784 225 Urinary copper ********* 680 800 ******* ********
785 226 Serum homocystine ********* 595 700 ******* ********
786 227 Serum valproate level ********* 425 500 ******* ********
787 228 Serum phenolbarbitone level ********* 468 550 ******* ********
788 229 Coagulation profile ********* 765 900 ******* ********
789 230 Protein C, S anti thrombine -III ********* 3060 3600 ******* ********
790 231 Serum lactate level ********* 595 700 ******* ********

Basic studies including cell count,

791 232 protein, sugar, gram stain, India ********* 340 400 ******* ********
Ink preparation and smear for AFP
792 233 Special studies ********* 1275 1500 ******* ********
PCR for tuberculosis/Herpes
793 234 ********* 1530 1800 ******* ********
simplex
794 235 Bacterial culture and sensitivity ********* 255 300 ******* ********
Mycobacterial culture and
795 236 ********* 255 300 ******* ********
sensitivity
796 237 Fungal culture ********* 170 200 ******* ********
797 238 Malignant cells ********* 85 100 ******* ********
Anti measlesantibodytitre (with
798 239 ********* 1190 1400 ******* ********
serum antibodytitre)
799 240 Viral culture ********* 340 400 ******* ********
Antibody titre (Herpes simplex,
800 241 cytomegalo virus, flavivirus, zoster ********* 1020 1200 ******* ********
varicella virus)
801 242 Oligoclonal band ********* 1530 1800 ******* ********
802 243 Myelin Basic protein ********* 2550 3000 ******* ********
803 244 Lactate ********* 425 500 ******* ********
804 245 Crypto coccal antigen ********* 1445 1700 ******* ********
805 246 D-xylase test ********* 1105 1300 ******* ********
Fecal fat test/ fecal chymotrypsin/
806 247 ********* 1105 1300 ******* ********
fecal elastase
807 248 Breath tests ********* 1652 1943 ******* ********
H pylori serology for ciliac
808 249 ********* 801 942 ******* ********
disease
809 250 HBV genotyping ********* 3176 3737 ******* ********
810 251 HCV genotyping ********* 6194 7287 ******* ********
811 252 Urinary VMA ********* 1955 2300 ******* ********
Urinary metanephrine/
812 253 ********* 1445 1700 ******* ********
Normetanephrine
813 254 Urinary free catecholamine ********* 2125 2500 ******* ********
814 255 Serum catecholamine ********* 4250 5000 ******* ********
815 256 Serum aldosterone ********* 1445 1700 ******* ********
816 257 24 Hr urinary aldosterone ********* 1190 1400 ******* ********
817 258 Plasma renin activity ********* 1275 1500 ******* ********
818 259 Serum aldosterone/renin ratio ********* 1530 1800 ******* ********
819 260 Osmolality urine ********* 170 200 ******* ********
820 261 Osmolality serum ********* 170 200 ******* ********
821 262 Urinary sodium ********* 106 125 ******* ********
822 263 Urinary Chloride ********* 60 70 ******* ********
823 264 Urinary potassium ********* 106 125 ******* ********
824 265 Urinary calcium ********* 106 125 ******* ********
825 266 Thyroid binding globulin ********* 680 800 ******* ********
826 267 24 hrs. urinary free cortisole ********* 255 300 ******* ********
827 268 Islet cell antebody ********* 935 1100 ******* ********
828 269 GAD antibody ********* 1700 2000 ******* ********
829 270 Insulin associated antibody ********* 595 700 ******* ********
830 271 IGF-1 ********* 1955 2300 ******* ********
831 272 IGF-BP3 ********* 2125 2500 ******* ********
832 273 Sex hormone binding globulin ********* 1700 2000 ******* ********
833 274 USG guided FNAC thyroid gland ********* 510 600 ******* ********
834 275 E2 ********* 298 350 ******* ********
835 276 Thyro globulin antibody ********* 765 900 ******* ********
RADIOLOGY (Investigations/Diagnostics)
836 1 Dental IOPA X-ray ****** 85 100 ****** ******
837 2 Occlusal X-ray ****** 170 200 ****** ******
838 3 OPG X-ray ****** 298 350 ****** ******
839 4 FDG Whole body PET / CT Scan ****** 21250 25000 ****** ******
840 5 Brain I Heart FDG PET / CTScan, ****** 15300 18000 ****** ******
Gallium-68 Peptide PET / CT
841 6 ****** 16150 19000 ****** ******
imaging for Neuroendocrine Tumor

842 7 USG for Obstetrics- Anomalies scan ****** 850 1000 ****** ******

843 8 Abdomen USG ****** 340 400 ****** ******

Pelvic USG (Prostate, Gynae,
844 9 ****** 340 400 ****** ******
Infertility, etc.)
Small parts USG (scrotum, thyroid,
845 10 ****** 425 500 ****** ******
parathyroid, etc)
846 11 Neonatal head (Tranfontanellar) ****** 425 500 ****** ******
847 12 Neonatal spine ****** 425 500 ****** ******
848 13 Contrast enhanced USG ****** 935 1100 ****** ******
849 14 USG Breast ****** 425 500 ****** ******
USG Hystero-Salpaingography
850 15 ****** 425 500 ****** ******
(HSG)
851 16 Carotid Doppler ****** 850 1000 ****** ******
852 17 Arterial Colour Doppler ****** 850 1000 ****** ******
853 18 Venous Colour Doppler ****** 850 1000 ****** ******
Colour Doppler, renal arteries/any
854 19 ****** 850 1000 ****** ******
other organ
855 20 USG guided intervention- FNAC ****** 510 600 ****** ******
856 21 USG guided intervention- biopsy ****** 850 1000 ****** ******
USG guided intervention-
857 22 ****** 850 1000 ****** ******
nephrostomy
Abdomen AP Supine or Erect (One
858 23 ****** 128 150 ****** ******
film)
859 24 Abdomen Lateral view (one film) ****** 128 150 ****** ******
860 25 Chest PA view (one film) ****** 128 150 ****** ******

861 26 Chest Lateral (one film) ****** 128 150 ****** ******
Mastoids: Towne view, oblique
862 27 ****** 383 450 ****** ******
views (3 films)
Extremities, bones & Joints AP &
863 28 ****** 255 300 ****** ******
Lateral views (Two films)
864 29 Pelvis A.P (one film) ****** 128 150 ****** ******
865 30 T. M. Joints (one film) ****** 128 150 ****** ******
866 31 Abdomen & Pelvis for K. U. B. ****** 128 150 ****** ******
867 32 Skull A. P. & Lateral (2 films) ****** 255 300 ****** ******
868 33 Spine A. P. & Lateral (2 films) ****** 255 300 ****** ******
869 34 PNS view (1 film) ****** 128 150 ****** ******
870 35 Barium Swallow ****** 680 800 ****** ******
871 36 Barium Upper GI study ****** 1020 1200 ****** ******
Barium Upper GI study (Double
872 37 ****** 1275 1500 ****** ******
contrast)
873 38 Barium Meal follow through ****** 1700 2000 ****** ******
Barium Enema (Single
874 39 ****** 1275 1500 ****** ******
contrast/double contrast)
875 40 Small bowel enteroclysis ****** 1275 1500 ****** ******
ERCP (Endoscopic Retrograde
876 41 ****** 2975 3500 ****** ******
Cholangio-Pancreatography)
General: Fistulography/
Sinography/ Sialography/
877 42 ****** 850 1000 ****** ******
Dacrocystography/ T-Tube
cholangiogram/Nephrostogram
Percutaneous transhepatic
878 43 ****** 1700 2000 ****** ******
cholangiography (PTC)
879 44 Intravenous Pyelography (IVP) ****** 1700 2000 ****** ******
Micturating Cystourethrography
880 45 ****** 1020 1200 ****** ******
(MCU)
881 46 Retrograde Urethrography (RGU) ****** 1020 1200 ****** ******
Contrast Hystero-Salpingography
882 47 ****** 1275 1500 ****** ******
(HSG)
883 48 X ray - Arthrography ****** 850 1000 ****** ******
884 49 Cephalography ****** 170 200 ****** ******
885 50 Myelography ****** 2975 3500 ****** ******
Diagnostic Digital Subtraction
886 51 ****** 2550 3000 ****** ******
Angiography (DSA)
887 52 X-ray Mammography ****** 425 500 ****** ******
888 53 MRI Mammography ****** 2550 3000 ****** ******
889 54 CT Head-Without Contrast ****** 880 1035 ****** ******
CT Head- with Contrast (+/- CT
890 55 ****** 1320 1553 ****** ******
Angiography)
C. T. Chest- without contrast (for
891 56 ****** 1700 2000 ****** ******
lungs)
C. T. Scan Lower Abdomen (incl.
892 57 ****** 1662 1955 ****** ******
Pelvis) with Contrast
C. T. Scan Lower Abdomen (Incl.
893 58 ****** 1466 1725 ****** ******
Pelvis) Without Contrast
C. T. Scan Whole Abdomen
894 59 ****** 2933 3450 ****** ******
Without Contrast
C. T. Scan Whole Abdomen with
895 60 ****** 4399 5175 ****** ******
Contrast
896 61 Triple Phase CT abdomen ****** 4399 5175 ****** ******
897 62 CT angiography abdomen/ Chest ****** 4399 5175 ****** ******
898 63 CT Enteroclysis ****** 5865 6900 ****** ******

899 64 C. T. Scan Neck - Without Contrast ****** 1466 1725 ****** ******
900 65 C. T. Scan Neck - With Contrast ****** 1870 2200 ****** ******
901 66 C. T. Scan Orbits - Without Contrast ****** 1190 1400 ****** ******
902 67 C. T. Scan Orbits - With Contrast ****** 1615 1900 ****** ******
C. T. Scan of Para Nasal Sinuses-
903 68 ****** 880 1035 ****** ******
Without Contrast
C. T. Scan of Para Nasal Sinuses -
904 69 ****** 1564 1840 ****** ******
With Contrast
C. T. Spine (Cervical, Dorsal,
905 70 ****** 1466 1725 ****** ******
Lumbar, Sacral)- without Contrast
CT Temporal bone - without
906 71 ****** 893 1050 ****** ******
contrast
907 72 CT - Dental ****** 1275 1500 ****** ******
908 73 C. T. Scan Limbs - Without Contrast ****** 1700 2000 ****** ******

C. T. Scan Limbs - With Contrast

909 74 ****** 2253 2650 ****** ******
including CT Angiography
910 75 C.T. Guided intervention -FNAC ****** 1173 1380 ****** ******
911 76 C.T. Guided Trucut Biopsy ****** 1173 1380 ****** ******
C. T. Guided intervention -
912 77 percutaneous catheter drainage / ****** 1305 1535 ****** ******
tube placement
913 78 MRI Head - Without Contrast ****** 1998 2350 ****** ******
914 79 MRI Head - With Contrast ****** 2848 3350 ****** ******
915 80 MRI Orbits - Without Contrast ****** 1445 1700 ****** ******
916 81 MRI Orbits - With Contrast ****** 1955 2300 ****** ******
MRI Nasopharynx and PNS -
917 82 ****** 2395 2818 ****** ******
Without Contrast
MRI Nasopharynx and PNS - With
918 83 ****** 3421 4025 ****** ******
Contrast
MR for Salivary Glands with
919 84 ****** 2933 3450 ****** ******
Sialography
920 85 MRI Neck - Without Contrast ****** 2933 3450 ****** ******
921 86 MRI Neck- with contrast ****** 4888 5750 ****** ******
922 87 MRI Shoulder - Without contrast ****** 1955 2300 ****** ******
923 88 MRI Shoulder - With conntrast ****** 2550 3000 ****** ******
MRI shoulder both Joints - Without
924 89 ****** 2933 3450 ****** ******
contrast
MRI Shoulder both joints - with
925 90 ****** 3910 4600 ****** ******
contrast
MRI Wrist Single joint - without
926 91 ****** 2125 2500 ****** ******
contrast
MRI Wrist Single joint - With
927 92 ****** 3910 4600 ****** ******
contrast
MRI Wrist both joints- Without
928 93 ****** 2125 2500 ****** ******
contrast
MRI Wrist Both joints - With
929 94 ****** 4888 5750 ****** ******
contrast
MRI knee Single joint- Without
930 95 ****** 2125 2500 ****** ******
contrast
MRI knee Single joint- With
931 96 ****** 4888 5750 ****** ******
contrast
MRI knee both joints- Without
932 97 ****** 2125 2500 ****** ******
contrast
933 98 MRI knee both joints- With contrast ****** 4888 5750 ****** ******
MRI Ankle Single joint - Without
934 99 ****** 2125 2500 ****** ******
contrast
MRI Ankle single joint - With
935 100 ****** 4888 5750 ****** ******
contrast
MRI Ankle both joints - With
936 101 ****** 4888 5750 ****** ******
contrast
MRI Ankle both joints - Without
937 102 ****** 2444 2875 ****** ******
contrast
938 103 MRI Hip - With contrast ****** 2444 2875 ****** ******
939 104 MRI Hip - without contrast ****** 2125 2500 ****** ******
940 105 MRI Pelvis - Without Contrast ****** 2125 2500 ****** ******
941 106 MRI Pelvis - with contrast ****** 4888 5750 ****** ******
942 107 MRI Extremities - With contrast ****** 4888 5750 ****** ******
943 108 MRI Extremities - Without contrast ****** 2125 2500 ****** ******
MRI Temporomandibular- B/L -
944 109 ****** 3910 4600 ****** ******
With contrast
MRI Temporomandibular- B/L -
945 110 ****** 2125 2500 ****** ******
Without contrast
MR Temporal Bone/ Inner ear with
946 111 ****** 3910 4600 ****** ******
contrast
 MR Temporal Bone/ Inner ear
947 112 ****** 2444 2875 ****** ******
without contrast
948 113 MRI Abdomen - Without Contrast ****** 2125 2500 ****** ******
949 114 MRI Abdomen - With Contrast ****** 4888 5750 ****** ******

950 115 MRI Breast - With Contrast ****** 4250 5000 ****** ******

951 116 MRI Breast - Without Contrast ****** 2125 2500 ****** ******
MRI Spine Screening- Without
952 117 ****** 978 1150 ****** ******
Contrast
953 118 MRI Chest - Without Contrast ****** 2125 2500 ****** ******

954 119 MRI Chest - With Contrast ****** 3910 4600 ****** ******
MRI Cervical/Cervico Dorsal Spine -
955 120 ****** 2125 2500 ****** ******
Without Contrast
MRI Cervical/ Cervico Dorsal Spine-
956 121 ****** 3910 4600 ****** ******
With Contrast
MRI Dorsal/ Dorso Lumbar Spine -
957 122 ****** 2125 2500 ****** ******
Without Contrast
MRI Dorsal/ Dorso Lumbar Spine -
958 123 ****** 3910 4600 ****** ******
With Contrast
MRI Lumbar/ Lumbo-Sacral Spine-
959 124 ****** 2125 2500 ****** ******
Without Contrast
MRILumbar/ Lumbo-Sacral Spine-
960 125 ****** 4888 5750 ****** ******
With Contrast
Whole body MRI (For oncological
961 126 ****** 5100 6000 ****** ******
workup)
962 127 MR cholecysto- pancreatography. ****** 5376 6325 ****** ******
963 128 MRI Angiography- with contrast ****** 4888 5750 ****** ******
964 129 MR Enteroclysis ****** 2125 2500 ****** ******
SURGERY
Drainage of abscess under
965 1 4 11900 14000 extra
General/Spinal Anaesthesia
Excision of lumps under General/
966 2 4 12750 15000 extra
Spinal Anesthesia
Local mastectomy- simple under
967 3 4 21250 25000 extra
General Anesthesia
Radical mastectomy- formal or
968 4 4 27200 32000 extra
modified.
Excision of mammary fistula under
969 5 4 17000 20000 extra
General Anesthesia
970 6 Segmental resection of breast 4 17000 20000 extra
Secondary suture of wounds under
971 7 Day Care 8925 10500 extra
General Anesthesia
8925 10500
(Small) (Small)
Debridement of wounds under 11900 14000
972 8 Day Care extra
General Anesthesia (Medium) (Medium)
14875 17500
(Large) (Large)
Removal of Foreign Bodies under
973 9 General/ Spinal/ Brachial Day Care 10413 12250 extra
Anesthesia
Excision of Cervical Lymph Node
974 10 Day Care 8925 10500 extra
under General Anesthesia
Excision of Axillary Lymph Node
975 11 Day Care 8925 10500 extra
under General Anesthesia
Excision of Inguinal Lymph Node
976 12 Day Care 8925 10500 extra
under General Anesthesia
Excision Biopsy of Ulcers under
977 13 Day Care 8925 10500 extra
General / Spinal Anesthesia
Excision Biopsy of Superficial
978 14 Lumps under General / Spinal Day Care 8925 10500 extra
Anesthesia
Incision Biopsy of Growths/ Ulcers
979 15 Day Care 8925 10500 extra
under General/ Spinal Anesthesia
980 16 Trucut Needle Biopsy Day Care 4250 5000 extra
981 17 Percutaneous Kidney Biopsy Day Care 8925 10500 extra
982 18 Marrow Biopsy (Open) Day Care 10625 12500 extra
Haemorrhoidectomy under
983 19 4 19550 23000 extra
General/ Spinal Anesthesia
984 20 Stappler Haemorrhoidectomy 7 21250 25000 Stapler PPH extra
Large keloid excision under
985 21 Day Care 8925 10500 extra
General / Spinal Anesthesia
Vericose vein surgery;
986 22 Tendelenburg operation with 4 19550 23000 extra
suturing or ligation.
987 23 Gastroscopy Day Care 21250 25000 extra
Gastric & Duodenal Biopsy
988 24 Day Care 2338 2750 extra
(Endoscopic)
989 25 Pyloromyotomy 1 14875 17500 extra
Gastrostomy under General
990 26 4 6375 7500 extra
Anesthesia
Simple Closure of Perforated peptic
991 27 4 23375 27500 extra
Ulcer
Vagotomy Pyleroplasty/ Gastro
992 28 4 23375 27500 extra
Jejunostomy
993 29 Duodenojejunostomy 4 23375 27500 extra
Partial/ Subtotal Gastrectomy for
994 30 4 38250 45000 Stapler extra
Carcinoma
Partial/ Subtotal Gastrectomy for
995 31 4 38250 45000 Stapler extra
Ulcer
996 32 Operation for Bleeding Peptic Ulcer 4 34000 40000 extra
997 33 Operation for Gastrojejunal Ulcer 4 34000 40000 extra
998 34 Total Gastrectomy for Cancer 4 42500 50000 Stapler extra
999 35 Highly Selective Vagotomy 4 29750 35000 extra
1000 36 Selective Vagotomy & Drainage 4 29750 35000 extra
1001 37 Congenital Diaphragmatic Hernia 4 34000 40000 extra
1002 38 Hiatus Hernia Repair- Abdominal 4 25500 30000 extra
Lap. Hiatus Hernia Repair
1003 39 4 38250 45000 extra
Abdominal
1004 40 Hiatus Hernia Repair- Transthoracic 4 25500 30000 extra
1005 41 Exploratory Laparotomy 4 21250 25000 extra
1006 42 Epigastric Hernia Repair 4 21250 25000 Mesh extra
1007 43 Lap- Epigastric Hernia Repair 4 25500 30000 Mesh Tracker extra
1008 44 Umbilical Hernia Repair 4 21250 25000 Mesh extra
1009 45 Lap- Umbilical Hernia Repair 4 25500 30000 Mesh Tracker extra
1010 46 Ventral /incisional Hernia Repair 4 21250 25000 Mesh extra
Lap- Ventral/ incisional Hernia
1011 47 4 25500 30000 Mesh with Tracker extra
Repair
1012 48 Inguinal Hernia Herniorraphy 4 17000 20000 extra
1013 49 Inguinal Hernia - Hernioplasty 4 21250 25000 Mesh extra
1014 50 Lap-Inguinal Hernia- Hernioplasty 4 25500 30000 Mesh with Tracker extra
1015 51 Femoral Hernia Repair 4 17000 20000 Mesh extra
1016 52 Lap-Femoral Hernia Repair 4 21250 25000 Mesh with Tracker extra
Rare Hernias Repair (Spigalion,
1017 53 4 25500 30000 extra
Obturator, Lumbar, Sciatic)
Lap- Rare Hernias Repair
1018 54 (Spigalion, Obturator, Lumbar, 4 29750 35000 Mesh with Tracker extra
Sciatic)
1019 55 Splenectomy - For Trauma 4 29750 35000 extra
1020 56 Splenectomy - For Hypersplenism 4 25500 30000 extra
Lap- Splenectomy - For
1021 57 4 34000 40000 extra
Hypersplenism
1022 58 Splenorenal Anastomosis 4 51000 60000 extra
1023 59 Portocaval Anastomosis 4 51000 60000 extra
Direct Operation on Oesophagus
1024 60 4 51000 60000 extra
for Portal Hypertension
1025 61 Mesentericocaval Anastomosis 4 51000 60000 extra
1026 62 Warren Shunt 4 51000 60000 extra
1027 63 Pancerato Duodenectomy 4 51000 60000 extra
1028 64 Lap-Pancerato Duodenectomy 4 68000 80000 Stapler extra
By Pass Procedure for Inoperable
1029 65 4 51000 60000 extra
Carcinoma of Pancreas
Lap- By Pass Procedure for
1030 66 4 68000 80000 Stapler extra
Inoperable Carcinoma of Pancreas
Cystojejunostomy or
1031 67 4 29750 35000 extra
Cystogastrostomy
Lap-Cystojejunostomy or
1032 68 4 38250 45000 Stapler extra
Cystogastrostomy
1033 69 Open- Cholecystectomy 4 21250 25000 extra
1034 70 Lap- Cholecystectomy 4 25500 30000 extra
Open- Cholecystectomy &
1035 71 4 25500 30000 extra
Exploration of CBD
Lap- Cholecystectomy &
1036 72 4 29750 35000 extra
Exploration of CBD
1037 73 Repair of CBD 4 25500 30000 extra
1038 74 Lap- Repair of CBD 4 29750 35000 extra
1039 75 Operation for Hydatid Cyst of Liver 4 29750 35000 extra
Lap-Operation for Hydatid Cyst of
1040 76 4 34000 40000 extra
Liver
Hepatic Resections (Lobectomy/
1041 77 4 59500 70000 extra
Hepatectomy)
Operation on Adrenal Glands -
1042 78 4 59500 70000 extra
Bilateral
Lap- Operation on Adrenal Glands -
1043 79 4 68000 80000 extra
Bilateral
Operation on Adrenal Glands -
1044 80 4 51000 60000 extra
Unilateral
Lap-Operation on Adrenal Glands -
1045 81 4 59500 70000 extra
Unilateral
1046 82 Appendicectomy 4 21250 25000 extra
1047 83 Lap-Appendicectomy 4 25500 30000 extra
1048 84 Appendicular Abscess- Drainage 4 21250 25000 extra
Lap-Appendicular Abscess -
1049 85 4 25500 30000 extra
Drainage
1050 86 Mesenteric Cyst- Excision 4 21250 25000 extra
1051 87 Lap- Mesenteric Cyst- Excision 4 25500 30000 extra
Peritonioscopy/ Laparoscopy under
1052 88 4 17000 20000 extra
General Anesthesia
1053 89 Jejunostomy 4 23800 28000 extra
1054 90 Lap- Jejunostomy 4 25500 30000 Stapler extra
1055 91 Ileostomy 4 21250 25000 extra
1056 92 Lap-Ileostomy 4 25500 30000 Stapler extra
Resection & Anastomosis of Small
1057 93 4 29750 35000 extra
Intestine
Lap- Resection & Anastomosis of
1058 94 4 34000 40000 Stapler extra
Small Intestine
1059 95 Duodenal Diverticulum 4 25500 30000 extra
1060 96 Lap- Duodenal Diverticulum 4 29750 35000 Stapler extra
1061 97 Operation for Intestinal Obstruction 4 25500 30000 extra

1062 98 Operation for Intestinal perforation 7 23375 27500 extra

1063 99 Benign Tumours of Small Intestine 7 25500 30000 extra

1064 100 Excision of Small Intestine Fistula 7 25500 30000 extra
Operations of the Duplication of
1065 101 4 51000 60000 extra
the Intestines
Lap- Operations of the Duplication
1066 102 4 59500 70000 Stapler extra
of the Intestines
Operations for Recurrent Intestinal
1067 103 Obstruction (Noble Plication & 7 29750 35000 extra
Other Operations for Adhesions)
 Lap- Operations for
RecurrentIntestinal Obstruction
1068 104 7 34000 40000 Stapler extra
(Noble Plication & Other
Operations for Adhesions)
Ilieosigmoidostomy and related
1069 105 7 38250 45000 extra
resection
Lap- Ilieosigmoidostomy and
1070 106 7 42500 50000 Stapler extra
related resection
Ilieotransverse Colostomy and
1071 107 7 38250 45000 extra
related resection
1072 108 Caecostomy 1 21250 25000 extra
1073 109 Loop Colostomy Transverse Sigmoid 7 21250 25000 Stapler extra
1074 110 Terminal Colostomy 7 21250 25000 extra
1075 111 Closure of Colostomy 7 21250 25000 extra
1076 112 Right Hemi-Colectomy 7 34000 40000 extra
1077 113 Lap- Right Hemi-Colectomy 7 42500 50000 Stapler extra
1078 114 Left Hemi-Colectomy 7 34000 40000 extra
1079 115 Lap- Left Hemi-Colectomy 7 42500 50000 Stapler extra
1080 116 Total Colectomy 7 42500 50000 extra
1081 117 Lap- Total Colectomy 7 51000 60000 Stapler extra
Operations for Volvulus of Large
1082 118 7 42500 50000 extra
Bowel
1083 119 Operations for Sigmoid Diverticulitis 7 25500 30000 extra

Fissure-in-Ano with Internal

1084 120 7 19550 23000 extra
sphinctrectomy with fissurectomy.
1085 121 Fissure-in-Ano: Fissurectomy 7 19550 23000 extra
1086 122 Rectal Polyp-Excision 7 19550 23000 extra
1087 123 Fistula-in-Ano: High Fistulectomy 7 29750 35000 extra
1088 124 Fistula-in-Ano: Low Fistulectomy 7 25500 30000 extra
1089 125 Prolapse Rectum- Theirch Wiring 7 25500 30000 extra
1090 126 Prolapse Rectum- Rectopexy 7 25500 30000 extra
1091 127 Lap- Prolapse Rectum - Rectopexy 7 34000 40000 Mesh with Tracker extra
Operations for Hirschsprungs
1092 128 7 29750 35000 extra
Disease
1093 129 Excision of Pilonidal Sinus (open) 7 19550 23000 extra
Excision of Pilonidal Sinus with
1094 130 7 19550 23000 extra
closure
Abdomino-Perineal Excision of
1095 131 7 38250 45000 extra
Rectum
Lap-Abdomino- Perineal Excision of
1096 132 7 51000 60000 Stapler extra
Rectum
1097 133 Anterior Resection of rectum 7 34000 40000 extra
1098 134 Lap-Anterior Resection of rectum 7 42500 50000 Stapler extra
1099 135 Pull Through Abdominal Resection 7 34000 40000 extra
1100 136 Retro Peritoneal Tumor Removal 7 42500 50000 extra
Lap- Retro Peritoneal Tumor
1101 137 7 51000 60000 extra
Removal
1102 138 Radio ablation of varicose veins 1 42500 50000 extra
1103 139 Laser ablation of varicose veins 7 51000 60000 extra
Laproscopic treatment of Pseudo
1104 140 4 34000 40000 Stapler extra
Pancreatic cyst
1105 141 Laproscopic Whipple's operation 4 68000 80000 Stapler extra
1106 142 Laproscopic GI bypass operation 4 68000 80000 Stapler extra
1107 143 Nephrectomy 4 34000 40000 extra
1108 144 Laproscopic Nephrectomy 3 38250 45000 extra
NEPHROLOGY and UROLOGY
Cost of Inj.
Renal Transplant without Donor Simulect is fully
1109 1 10 days 172000 197800 extra
Charges reimbursable, if
used
1110 2 Partial Nephrectomy- open 7 76500 90000 extra
Partial Nephrectomy- laproscopic/
1111 3 3 110500 130000 extra
endoscopic
1112 4 Pyelolithotomy-open 7 46750 55000 Cost of Implant extra
Pyelolithotomy - laproscopic/
1113 5 3 55250 65000 Cost of Implant extra
endoscopic
Operations for Hydronephrosis-
1114 6 3 63750 75000 Cost of Implant extra
ureterocalicostomy
1115 7 Open Drainage of Perinephric
7 34000 40000 extra
Abscess
Percutaneous Drainage of
1116 8 Perinephric Abscess-Ultrasound 3 21250 25000 extra
guided
Operations for Cyst of the Kidney -
1117 9 7 42500 50000 extra
open
1118 10 Ureterolithotomy– open 7 42500 50000 Cost of Implant extra
1119 11 Ureterolithotomy- Lap/Endoscopic 3 51000 60000 Cost of Implant extra
1120 12 Nephroureterectomy open 7 59500 70000 Cost of Implant extra
1121 13 Nephroureterectomy-
3 76500 90000 Cost of Implant extra
Lap/Endoscopic
Operations for Ureter- for Ectopia
1122 14 7 55250 65000 Cost of Implant extra
of Single Ureter
Operations for Vesico- ureteric
1123 15 Reflux/ Urinary incontinence with 7 68000 80000 Cost of Implant extra
bulking agents
1124 16 Ureterostomy- Cutaneous 3 42500 50000 extra
1125 17 Ureteric Catheterisation Day care 3400 4000 Cost of Implant extra
1126 18 Biopsy of Bladder (Cystoscopic) Day care 8500 10000 extra
1127 19 Operations for Injuries of the
3 42500 50000 extra
Bladder
Suprapubic Drainage (Cystostomy/
1128 20 Day Care 3400 4000 Cost of Implant extra
vesicostomy)
1129 21 Repair of Ureterocoel -Open 5 59500 70000 Cost of Implant extra
1130 22 Repair of Ureterocoel -Lap/
3 42500 50000 Cost of Implant extra
Endoscopic
1131 23 Open Retropubic Prostatectomy 5 76500 90000 extra
 Transurethral Resection of Prostate
1132 24 3 68000 80000 extra
(TURP)
1133 25 Urethral Reconstruction- End to
Day care 25500 30000 extra
end ansatamosis
1134 26 Abdomino Perineal urethroplasty 3 85000 100000 extra
Operations for Incontinence of
1135 27 5 55250 65000 Cost of Implant extra
Urine - Male -Sling
1136 28 Operations for Incontinence of
5 68000 80000 Cost of Implant extra
Urine - Female-Bulking agent
1137 29 Circumcision Day care 8500 10000 extra
1138 30 Meatotomy Day care 8500 10000 extra
1139 31 Meatoplasty Day care 12750 15000 extra
Operations for Hypospadias +
1140 32 3 76500 90000 extra
Chordee Correction
1141 33 Partial Amputation of the Penis 3 42500 50000 extra
1142 34 Total amputation of the Penis 3 51000 60000 extra
1143 35 Orchidectomy- Simple 3 34000 40000 extra
1144 36 Orchidectomy - Radical 3 42500 50000 extra
1145 37
Adreneclectomy Unilateral/Bilateral
5 76500 90000 extra
for Tumour/Carcinoma- Open

Adreneclectomy Unilateral/Bilateral
1146 38 for Tumour/Carcinoma - 3 102000 120000 extra
Lap/Endoscopic
Operations for Hydrocele -
1147 39 3 17000 20000 extra
Unilateral
1148 40
Operations for Hydrocele - Bilateral 3 25500 30000 extra
1149 41 Operation for Torsion of Testis 3 42500 50000 extra
Micro-surgical Vasovasostomy/
1150 42 3 59500 70000 extra
Vasoepidedymal ansatamosis.
1151 43 Operations for Varicocele Palomo's
3 59500 70000 extra
Unilateral - Lap
Operations for Varicocele Bilateral-
1152 44 3 102000 120000 extra
Lap/Palomo
1153 45 Endoscopic Bulking agent Inject 1 17000 20000 Cost of Implant extra
1154 46 Radical Nephrectomy -Open 5 68000 80000 extra
Radical Nephrectomy -
1155 47 3 85000 100000 extra
Lap/Endoscopic
Radical Nephrectomy plus IV
1156 48 3 153000 180000 Cost of Implant extra
thrombus
1157 49 Vesico Vaginal Fistula Repair
7 59500 70000 extra
(Open)
Vesico Vaginal Fistula Repair
1158 50 3 76500 90000 extra
(Laproscopic)
Radical Cystectomy - continent
1159 51 3 127500 150000 extra
diversion.
1160 52 Radical Cystectomy- Neo bladder 3 170000 200000 extra
1161 53 TURP with Cystolithotripsy 3 38250 45000 extra
1162 54 Closure of Urethral Fistula 3 42500 50000 extra
1163 55 Orchidopexy- Unilateral- Open 3 34000 40000 extra
Orchidopexy- Unilateral-
1164 56 3 42500 50000 extra
Lap/Endoscopic
1165 57 Orchidopexy - Bilateral -Open 3 42500 50000 extra
1166 58 Orchidopexy - Bilateral -
3 51000 60000 extra
Lap/Endoscopic
Resection Bladder Neck
Endoscopic/Bladder neck
1167 59 5 25500 30000 extra
incision/transurethral incision on
prostrate
1168 60 Urethroplasty 1st Stage 5 42500 50000 extra
1169 61 Perineal Urethrostomy 3 25500 30000 extra
Dilatation of Stricture Urethra
1170 62 1 8500 10000 extra
under G.A.
1171 63 Laproscopic Pyeloplasty 3 76500 90000 extra
1172 64
Laproscopic surgery for Renal cyst 3 42500 50000 extra
1173 65 Laproscopic Ureterolithotomy 3 51000 60000 Cost of Implant extra
1174 66 Uroflow Study (Uroflometry) OPD 1700 2000 *****
1175 67 Cystoscopy with Retrograde
1 17000 20000 extra
Catheter-Unilateral/ RGP
Cystoscopy with Retrograde
1176 68 1 25500 30000 extra
Catheter- Bilateral /RGP
AV FISTULA- RADIOCEPHALIC
1177 69 1 8500 10000 extra
PACKAGE
1178 70 BIPOLAR TURP 4 34000 40000 extra
1179 71 DJ REMOVAL U/L Day care 4250 5000 extra
1180 72 DJ REMOVAL B/L Day care 4250 5000 extra
1181 73 DJ STENTING 1 4250 5000 Cost of Implant extra
1182 74 RIRS PKG B/L 3 68000 80000 Cost of Implant extra
1183 75 RIRS PKG U/L 3 42500 50000 Cost of Implant extra
1184 76
SUPRAPUBIC CYSTOSTOMY- OPEN 5 4250 5000 extra
TRANSURETHRAL RESECTION OF
1185 77 4 30600 36000 extra
PROSTATE (TURP)
1186 78 TURBT 4 30600 36000 extra
1187 79 TURP+OIU 4 38250 45000 extra
1188 80 URETEROLITHOTOMY 5 23800 28000 extra
1189 81 LAP- URETEROLITHOTOMY 5 29750 35000 extra
1190 82 URSL WITH DJ(S) PLACEMENT -
3 29750 35000 extra
HARYANA GOVT.
VARICOSE VEINS UNILATERAL
1191 83 3 25500 30000 extra
LIMB (LASER)- HARYANA GOVT.
1192 84 A.V. FISTULA INSERTION 2 25500 30000 extra
1193 85 ANEURYSM AT RADIAL SITE-
2 17000 20000 extra
EXCISION
1194 86 BLADDER WASH Day Care 4250 5000 extra
1195 87 CARE THROUGH OIU 1 23800 28000 extra
1196 88 CATHERRIZATION BY UROLOGIST Day Care 1275 1500 extra
FEMORAL ACCESS- SINGLE
1197 89 2 850 1000 extra
SURGERY
 PROSTATE BIOPSY- FINGER
1198 90 Day Care 4250 5000 extra
GUIDED
1199 91 ANEURYSM AT BRACHIAL SITE-
2 27200 32000 extra
EXCISION
ANTERIOR URETHRAL STRICTURE-
1200 92 7 23800 28000 extra
SINGLE STAGE REPAIRS
ARTERIO VENOUS FISTULA-
1201 93 2 12750 15000 extra
BRACHIOCEPHALIC
1202 94 ARTERIO VENOUS FISTULA: RE-
2 6375 7500 extra
EXPLORATION
1203 95 ARTIFICIAL URINARY SPHINCTER 5 106250 125000 extra
1204 96 AVF RE-EXPLORATION 2 25500 30000 extra
1205 97
BASKETING OF STONE IN URETER 2 12750 15000 extra
BILATERAL NEPHROURETECTOMY
1206 98 2 51000 60000 extra
(TIVE)
BIPOLAR ENCUCLEATION OF
1207 99 3 42500 50000 extra
PROSTATE
1208 100 BLADDER NECK RESECTION/
3 22100 26000 extra
BLADDER NECK INCISION

1209 101 BLADDER STONE REMOVAL- OPEN 5 1700 2000 extra

BLADDER STONE REMOVAL- Trans
1210 102 2 25500 30000 extra
Urethral
1211 103 BLOCK DISSECTION OF INGUINAL
NODES - SUPERFICIAL AND DEEP 7 34000 40000 extra
U/L
1212 104 BURCH COLPOSUSPENCOSIS- LAP 5 46750 55000 extra

1213 105 BURCH COLPOSUSPENCOSIS- OPEN 7 29750 35000 extra

1214 106 CALIBRATION OF URETHRA 1 4250 5000 extra
1215 107 CAPD - UROLOGY 12750 15000 extra

1216 108 CIC 1 5525 6500 extra

1217 109 CYSTOSCOPY Day Care 4250 5000 extra
CSTECTOMY- PARTIAL WITH
1218 110 10 59500 70000 extra
BOWEL AUGMENTATION
CYSTECTOMY RADICAL AND
1219 111 3 170000 200000 extra
ORTHOTOPIC NEOBLADDER-LAP
1220 112 CYSTOSCOPY with BLADDER WASH
and REFULGRATION of OPERATIVE 2 5950 7000 extra
SITE
DETORSION OF TESTICULAR
1221 113 2 4250 5000 extra
TORSION MANUAL
DIATHERMY DESTRUCTION OF
1222 114 2 17000 20000 extra
BLADDER NEOPLASM
1223 115 DORSAL SLITTING OF PREPUCE 2 4250 5000 extra
1224 116 DRAINAGE FOR PRIAPISM 2 6800 8000 extra
DRAINAGE OF PROSTATIC ABCESS-
1225 117 2 12750 15000 extra
TRANSRECTAL
1226 118 DRAINAGE OF PROSTATIC ABCESS-
2 15300 18000 extra
TRANSURETHRAL
ENDOSCOPIC INJECTION FOR VUR-
1227 119 1 8500 10000 extra
U/L
ENDOSCOPIC INJECTION FOR VUR-
1228 120 1 12750 15000 extra
B/L
1229 121 EPIDIDYMAL CYST EXCISION 3 8500 10000 extra

1230 122 EPISPADIAS/ EXYSTOPHY REPAIR 7 38250 45000 extra

EXCISION OF MULTIPLE
1231 123 SEBACEOUS CYSTS UNDER 2 8500 10000 extra
General/ Spinal Anaesthesia
1232 124 EXCISION OF SCROTAL SINUS 3 5950 7000 extra

1233 125 FRENUPLASTY 2 12750 15000 extra

1234 126 LAP.ORCIHDOPEXY 3 21250 25000 extra

1235 127 LAP. RADICAL PROSTATECTOMY 7 59500 70000 extra
LAP. URETHROLITHOTOMY FOR
1236 128 5 21250 25000 Cost of Implant extra
LARGE STONES
1237 129 LAP. VARICICELECTOMY 3 21250 25000 extra
1238 130 LAY OPEN OF URETHRA WITH
5 42500 50000 Cost of Implant extra
BUCCAL GRAFTS
LAY OPEN OF URETHRA WITH
1239 131 5 42500 50000 extra
PERINEAL URETHROSTOMY
1240 132 ILEO CAECO CYSTECTOMY 7 34000 40000 Cost of Implant extra
1241 133 LUMBAR PUNCTURE Day Care 2975 3500 extra
NEPHRECTOMY COMPLICATED -
1242 134 7 51000 60000 extra
ADHESIONS
1243 135 NEPHRECTOMY FOR RENAL TRAUMA 5 51000 60000 extra
1244 136 NEPHRECTOMY RADICAL WITH IVC
10 85000 100000 Cost of Implant extra
THROMBUS LEVEL 1
NEPHRECTOMY RADICAL WITH IVC
1245 137 10 106250 125000 Cost of Implant extra
THROMBUS LEVEL 2
NEPHRECTOMY RADICAL WITH
1246 138 7 102000 120000 extra
LYMPHADENECTOMY- LAP
1247 139 NEPHRECTOMY RADICAL WITH
7 85000 100000 extra
LYMPHADENECTOMY- OPEN
NEPHROURETERECTO MY WITH
1248 140 BLADDER CUFF-LAP 7 127500 150000 extra
RETROPERITONEAL
NEPHROURETERECTO MY WITH
1249 141 BLADDER CUFF-LAP 7 127500 150000 extra
TRANSPERITONEAL
1250 142 OPEN PROSTATECTOMY -
7 18700 22000 extra
TRANSPUBIC
1251 143 OPEN STRICTURE SURGERY 7 27200 32000 extra
OPTICAL INTERNAL URETHROTOMY
1252 144 2 21250 25000 extra
(OIU)
1253 145 ORCHIDECTOMY-SIMPLE(B/L) 3 12750 15000 extra
ORCHIDECTOMY - B/L FOR CA
1254 146 3 21250 25000 extra
PROSTATE
1255 147 PCN- NEPHROSTOMY-OPEN B/L 2 21250 25000 Cost of Implant extra
1256 148 PCN (NEPHROSTOMY)- USG
2 29750 35000 Cost of Implant extra
GUIDED/ENDO B/L
PCN (NEPHROSTOMY)- USG
1257 149 2 25500 30000 Cost of Implant extra
GUIDED/ENDO U/L
PENECETOMY TOTAL WITH
1258 150 5 34000 40000 extra
URETHEROSTOMY
1259 151 PENILE CYST EXCISION 2 8500 10000 extra
1260 152 PENILE FRACTURE REPAIR 5 17000 20000 extra
PENILE PROSTHESIS INSERTION-
1261 153 5 29750 35000 Cost of Implant extra
SEMIRIGID
1262 154 PENILE PROSTHESIS INSERTION -
5 127500 150000 Cost of Implant extra
3 PIECE INFLATABLE
1263 155 PENILE WEDGE BX 3 3400 4000 extra
PERINEPHRIC ABCESS DRAINAGE-
1264 156 5 25500 30000 extra
LAP
1265 157 PLACMENT OF GRAFT FOR
42500 50000 extra
VASCULAR ACCESS
POST ORCHIDECTOMY LYMPH
1266 158 7 29750 35000 extra
NODE DISSECTION
POST TRANSPLANT lymphocele-
1267 159 7 17000 20000 extra
Laparoscopic drainage
1268 160 POST TRANSPLANT lymphocele-
7 8500 10000 extra
Percutaneous Drainage
POSTERIOR URETHAL VALVE
1269 161 3 17000 20000 extra
FULGURATION
1270 162 PYELOLITHOTOMY- OPEN 5 17000 20000 extra
1271 163 PYELOLYMPHATIC DISSEMINATION-
5 42500 50000 extra
LAP
PYELOLYMPHATIC DISSEMINATIO-
1272 164 5 34000 40000 extra
OPEN
PYELOPLASTY- LAP
1273 165 6 38250 45000 extra
TRANSPERITONEAL
1274 166 PYELOPLASTY - OPEN
7 21250 25000 extra
(ANDERSOMHYNES)
1275 167 RADICAL PROSTATECTOMY - OPEN 7 34000 40000 extra
1276 168 RENAL BIOPSY -OPEN Day Care 17000 20000 extra
1277 169 RENAL BIOPSY - USG GUIDED 1 12750 15000 extra
1278 170 RENAL BIOPSY -LAP 2 21250 25000 extra
1279 171 RENAL CYST EXCISION –OPEN 5 17000 20000 extra
1280 172 REPAIR OF RENAL LACERATION 7 34000 40000 extra
RETROGRAGE PYELOGRAPHY WITH
1281 173 1 8500 10000 extra
STENTING -U/L
RETROGRAGE PYELOGRAPHY WITH
1282 174 1 8500 10000 extra
STENTING -B/L
1283 175 RETROPERITONEOSC OPIC
SURGERY FOR RETROPERITONEAL 7 47600 56000 extra
TUMOURS
1284 176 RGU/MCU 1 4250 5000 extra
1285 177 RIRS-B/L 2 68000 80000 Cost of Implant extra
1286 178 RIRS-U/L 2 42500 50000 Cost of Implant extra
1287 179 SITAL SHUNT FOR PRIAPISM 2 34000 40000 extra
SLING PROCEDURE
1288 180 INCONTINENCE- 3 46750 55000 Cost of Implant extra
TRANSVAGINL(TVT)
1289 181 SOROTOPLASTY 4 17000 20000 extra
1290 182 TESTICULAR BIOPSY-OPEN 2 4250 5000 extra
1291 183 TOT 3 25500 30000 Cost of Implant extra
1292 184 TURP BIPOLAR with PCLT 3 38250 45000 extra
1293 185 TURP WITH CYSTOLITHOTRIPSY 3 38250 45000 extra
1294 186 URACHAL MASS- EXCISION 7 34000 40000 extra
1295 187 URETHERAL DILATION 1 2975 3500 extra
URETERONEOCYSTO STOMY-
1296 188 7 63750 75000 extra
LAPROSCOPIC
URETERONEOCYSTOSTOMY-
1297 189 (URETERIC REIMPLANTATION)- 7 47600 56000 extra
OPEN B/L
1298 190 URETERONEOCYSTOSTOMY-
7 38250 45000 Cost of Implant extra
COMMON SHIETH RE-IMPLANT
1299 191 URETERIC BALLOON DILATION 2 6800 8000 extra
1300 192 URETERIC CATHETERISATION-B/L 1 5950 7000 Cost of Implant extra
1301 193 URETERIC EXCISION and End to
7 63750 75000 Cost of Implant extra
End ANASTOMOSIS- LAP
URETERIC EXCISION and End to
1302 194 7 34000 40000 Cost of Implant extra
End ANASTOMOSIS-OPEN
URETERIC MEATOTOMY WITH
1303 195 3 15725 18500 extra
STONE EXTRACATION
1304 196 URETERIC STRICTURE SURGERY-
3 29750 35000 Cost of Implant extra
ENDOSCOPIC
SLING PROCEDURE
1305 197 INCONTINENCE- TRANSVAGINL 3 46750 55000 Cost of Implant extra
(TVT)
URETERIC STRICTURE SURGERY-
1306 198 5 55250 65000 Cost of Implant extra
LAP
1307 199 URETERIC STRICTURE SURGERY-
5 21250 25000 Cost of Implant extra
OPEN
1308 200 URETERIC SIGMOID DIVERSION 7 34000 40000 extra
1309 201 URETERO URETEROSTOMY- OPEN 7 38250 45000 Cost of Implant extra
1310 202 URETEROCALICOST OMY-OPEN 7 55250 65000 Cost of Implant extra
1311 203 URETEROLITHOTOM Y-OPEN B/L 7 29750 35000 Cost of Implant extra
1312 204 UTEROLYRES OMENTAL B/L (OPEN) 5 29750 35000 extra
1313 205 URETEROLYRES WITH OMENTAL
5 63750 75000 extra
WRAP
 URETERORENOSCO PY (URS) -
1314 206 3 28475 33500 Cost of Implant extra
UPPER ½
URETERORENOSCOPY (URS)-
1315 207 3 25500 30000 Cost of Implant extra
BILATERAL
1316 208 URETERORENOSCOPY (URS) WITH
3 17000 20000 Cost of Implant extra
BIOPSY
URETERORENOSCOPY (URS) -
1317 209 3 16575 19500 Cost of Implant extra
LOWER 1/3
URETHERAL TRANSPLANTATION-
1318 210 5 25500 30000 extra
BILATERAL
1319 211 URETHERAL TRANSPLANTATION-
5 17000 20000 extra
UNILATERAL
URETHROPLASTY- SUBSTITUTION
1320 212 with BUCCAL MUCOSA (DORSAL 7 46750 55000 Cost of Implant extra
ONLY)
1321 213 URETHROPLASTY -OTHERS 7 46750 55000 Cost of Implant extra
1322 214 URETHROPLASTY - SECOND STAGE
7 28475 33500 Cost of Implant extra
CLOSURE
1323 215 URETHROPLASTY - SKIN FLAP 7 47600 56000 Cost of Implant extra
1324 216 URETHROPLASTY- SKIN TUBE 7 47600 56000 Cost of Implant extra
1325 217
URETHROSCOPY WITH BIOPSY 3 8500 10000 extra
URETERIC REPLACEMENT WITH
1326 218 7 85000 100000 Cost of Implant extra
ILEAL URETER
URETERIC STRICTURE SURGERY-
1327 219 5 14025 16500 Cost of Implant extra
ENDOSCOPIC
1328 220 VARICOCELECTOMY- PALMOS
3 25500 30000 extra
OPEN (B/L)
VARICOCELECTOMY- PALMOS
1329 221 3 17000 20000 extra
OPEN (U/L)
VARICOCELECTOMY-
1330 222 3 29750 35000 extra
MICROSURGICAL INGUINAL B/L
1331 223 ARICOCELECTOMY -
3 20400 24000 extra
MICROSURGICAL INGUINAL U/L
VARICOCELECTOMY-
1332 224 3 42500 50000 extra
MICROSURGICAL SUBINGUINAL B/L

VARICOCELECTOMY-
1333 225 3 28900 34000 extra
MICROSURGICAL SUBINGUINAL U/L
1334 226 VASECTOMY (NSV) 1 6800 8000 extra
1335 227 VASO VASOSTOMY 2 29750 35000 extra
1336 228 VACILOSTOMY CLOSURE 4 25500 30000 extra
1337 229 VESICOSTOMY 1 16150 19000 extra
Cost of dialyzer is
1338 230 Dialysis Day care 1000 1150 extra
fully reimbursable
Cost of dialyzer is
1339 231 Dialysis OPD 1000 1150 ******
fully reimbursable
Additional Package
cost of medicines is
1340 1 Chemotherapy Day care 1500 1725 extra
fully reimbursable

NOTE : ICU/CCU inclusive of ventilator charges as per para 2 (b) ii) & 2 (c) vii) of Guidelines, is not to be charged extra.
 ANNEXURE –II Dated: 14.07.2020
AMENDED RATE LIST OF VARIOUS IMPLANTS
S.No. Item Maximum Ceiling Rate
A. REIMBURSEMENT OF CARDIOLOGICAL IMPLANTATION DEVICES AND CORONARY STENTS
1 Rotablator Rs.50,000/- or the actual cost, whichever is less.
2 Pacemaker (Single Chamber) -
i. Without rate response. Rs.37,000/- or the actual cost, whichever is less.
ii. With rate response. Rs.65,000/- or the actual cost, whichever is less.
3 Pacemaker (Dual Chamber) Rs.1,15,000/- or the actual cost, whichever is less.
4 Permanent Pace Maker Rs.3,00,000/- or the actual cost, whichever is less.
Biventricular (CRT)
5 AICD Implant Single Chamber Rs.3,00,000/- or the actual cost, whichever is less.
6 AICD Implant Dual Chamber Rs.4,50,000/- or the actual cost, whichever is less.
7 Combo Device (CRTD) Rs.5,50,000/- or the actual cost, whichever is less.
8 Coronary Stents a) The cost of implants as fixed by Govt. of India, Ministry of
Chemicals and Fertilizers Department of Pharmaceuticals
Pricing Authority dated 13.02.2017 and amended from time to
time.
b) Other implants for which the rates have not fixed by Govt. of
India shall be charged as per the rates fixed by Govt of
Haryana, Health Department Annexure-II dated 21.05.2015
and amended from time to time or whichever is less.
c) Wherever the cost is not fixed, the actual cost of implant shall
be given.
B. REIMBURSEMENT OF COST OF INTRA OCULAR LENS (IOL)/VALVE FOR GLAUCOMA
9 Hydrophobic Mono Focal Foldable Rs.7,000/-
IOL (USFDA Approved)
10 Toric IOL (Pre existing Astigmatism Rs.17,500/-
should be more than 2 Diopter)
11 Hydrophilic Acrylic Lens (US FDA Rs.1000/-
Approved)
12 PMMA IOL Rs. 200/-
13 Valve For Glaucoma Surgery Rs.10,000/-
C. REIMBURSEMENT OF COST OF TOTAL KNEE AND TOTAL HIP IMPLANTS
14 Total Knee Implant a) The cost of implants as fixed by Govt. of India, Ministry of
Chemicals and Fertilizers Department of Pharmaceuticals
Pricing Authority dated 16.08.2017 and amended from time to
time.
b) Other implants for which the rates have not fixed by Govt. of
India shall be charged as per the rates fixed by Govt. of
Haryana, Health Department Annexure-II dated 21.05.2015
and amended from time to time or whichever is less.
c) Wherever the cost is not fixed, the actual cost of implant shall
be given.
15 Total Hip Implant 1. Hip implant cemented (unilateral) = Rs.35,000/- + cost of Bone
Cement Rs.5,000/-
2. Hybrid Hip Implant One component cemented and other un
cemented (Unilateral) = Rs.45,000/- + Cost of Bone Cement
i.e. Rs.5,000/-
3. Hip Implant Un-cemented (Unilateral) = Rs.60,000/-
4. Surface replacement Hip Implant (Unilateral) = Rs.1,20,000/-
5. Bipolar Modular Cemented Implant = Rs.30,000/- + the cost of
Bone Cement Rs.5,000/-
6. Bipolar Modular Un-cemented Implant = Rs.45,000/-
D. REIMBURSEMENT OF COST OF COCHLEAR IMPLANTS
16 Cochlear Implant Rs.5,35,000/- (for implant with 12 channels/24 electrodes with
behind the ear speech processor). Reimbursement shall be
allowed @ 100% in case of children between 1 to 5 years, @ 80%
in case of children between 5 to 10 years and @ 50% in case of
children between 10 to 16 years. 50% of the cost of wearable
components e.g. Speech Processor, Microphone, etc. (excluding
cords, batteries) for the purpose of upgradation and/or
replacement every 3 years, on the advice of two ENT surgeons of
Government/ Approved Private Hospitals.
E. REIMBURSEMENT OF COST OF CPAP/BIPAP MACHINES
17 CPAP Machine Rs.50,000/- on the advice of concerned specialist of Government/
Approved Private Hospitals.
18 BIPAP Machine Rs.1,00,000/- on the advice of concerned specialists of
Government/ Approved Private Hospitals.
F. REIMBURSEMENT OF COST OF NEURO-IMPLANT
Item Ceiling Rate Life of battery Cost of battery
19 DBS Implants Rs.3,60,000/- 3-5 years Rs.2,50,000/-
20 Intra-thecal Pumps Rs.2,62,000/- 7 years Rs.2,25,000/-
21 Spinal Cord Stimulators Rs.2,62,000/- 3-5 years Rs.2,00,000/-
a. On prescribing by the Neurologist of the Govt./ Approved Hospitals.
b. Replacement of battery before 4 years may be permitted in exceptional cases on the basis of justification by
the treating specialist and shall be considered on a case to case basis by Department of Health & Family
Welfare, Haryana.
G. OTHER ITEMS
22 Stapler Rs.12,000/-