13.revised Rate List

Annexure-I
Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011)
01 PROCEDURES
CODE
001
01001001
01001002
01001003
01001004
01001005
01001006
01001007
01001008
01001009
01001010
01001011
01001012
01001013
01001014
01001015
01001016
01001017
01001018
01001019
01001020
01001021
01001022
01001023
01001024
NAME OF TREATMENT
PROCEDURE
General
Consultation by Medical
Officer (OPD)
Consultation by
Specialists (OPD)
Visit/ Revisit/ Consultation
by Specialists (Indoor)
(Maximum two visits per
day admissible)
Consultation by SuperSpecialists (OPD)
Visit/ Revisit/ Consultation
by Super-Specialists
(Indoor)
(Maximum two visits per
day admissible)
Pre-operative Anaesthetic
Consultation
Paramedical Consultation
Special Nursing Charge
(per shift of 12 hrs.)
Aya/ Attendant Charge
(per shift of 12 hrs.)
Delayed primary suture
Dressings Large
Suturing without local
anesthesia
Suturing of wounds with
local anesthesia
Debridement of wounds
Removal of Benign Tumor
Aspiration Plural Effusion Therapeutic
Abdominal Aspiration Therapeutic
Removal of F.B.
Superficial
Bone Marrow Aspiration
Joints Aspiration
Strapping
Removal of Stitches
Venesection
Phimosis Under LA
Maximum
Approved
Rate (INR)
(Rupees)
150/200/-
200/-
CODE
01001025
01001026
01001027
01001028
01001029
01001030
01001031
01001032
01001033
250/-
01001034
01001035
250/-
01001036
002
01002001
01002002
200/75/150/75/1700/160/400/500/1200/1100/1000/-
01002003
01002004
01002005
01002006
01002007
01002008
01002009
01002010
003
01003001
1300/-
01003002
1200/1500/1500/100/60/300/1500/-
01003003
01003004
01003005
01003006
01003007
NAME OF TREATMENT
PROCEDURE
Lumbar puncture
Sternal puncture
Injection for Haemorrhoids
Injection for Varicose
Veins
Catheterisation
Dilatation of Urethra
Incision & Drainage
Intercostal Drainage
Peritoneal dialysis
Removal of soft tissue or
regional block under
general anaesthesia
Dressing Small
Secondary suture of
wounds
Skin
Excision of Moles
Excision of Warts
Excision of Molluscum
contagiosum
Excision of Veneral Warts
Excision of Corns
I/D Injection Keloid of
Acne
Chemical Cautery (per
sittings)
Excision of Sebaceous
Cysts
Excision of Superficial
Liipoma
Excision of Dermoid Cysts
E.N.T.
Speech therapy per
session of 30-40 minutes
Removal of foreign body
From Nose/ Ear/ Throat
(Day care package)
Swallowing Therapy
Syringing
Polyp removal under LA
Peritonsillar abscess
drainage under LA
Tinnitus Retraining
Therapy
Maximum
Approved
Rate (INR)
(Rupees)
700/1500/1000/1300/120/1100/600/1500/1800/-
2400/100/1200/600/600/600/600/550/300/120/1700/2400/2450/-
200/-
1500/250/300/800/1600/250/-
Annexure-I
CODE
01003008
01003009
01003010
01003011
01003012
01003013
01003014
01003015
01003016
01003017
01003018
01003019
01003020
01003021
01003022
01003023
01003024
01003025
01003026
01003027
01003028
01003029
01003030
01003031
01003032
01003033
01003034
01003035
01003036
01003037
01003038
01003039
01003040
01003041
01003042
01003043
01003044
01003045
01003046
NAME OF TREATMENT
PROCEDURE
Myringoplasty
Staepedectomy
Myringotomy with
Grommet insertion
Endoscopic Removal of
Fish Bone
Tympanotomy
Paracentesis
Tympanoplasty
Mastoidectomy
Otoplasty
Labyrinthectomy
Skull Base surgery
Facial Nerve
Decompression
Septoplasty
Submucous Resection
Septo-rhinoplasty
Rhinoplasty (noncosmetic)
Fracture Reduction
Intra Nasal Diathermy
Turbinectomy
Endoscopic DCR
Endoscopic Surgery
Septal Perf. Repair
Antrum Puncture
Lateral Rhinotomy
Cranio-facial resection
Ethamoidectomy
Caldwell Luc Surgery
Angiofibroma Excision
Endoscopic
Hypophysectomy
Endoscopic Optic Nerve
Decompression
Decompression of Orbit
Ranula Excision
Tongue Tie excision
Sub Mandibular Duct
Lithotomy
Adenoidectomy
Palatopharyngoplasty
Cleft Palate repair
Pharyngoplasty
Styloidectomy
Maximum
Approved
Rate (INR)
(Rupees)
10700/12000/6000/1000/8000/4300/14000/15600/16500/15600/50000/20000/10200/10800/15000/12000/9000/6000/9600/13000/15000/15000/3000/1350/28000/17600/12000/18000/25000/-
CODE
01003047
01003048
01003049
01003050
01003051
01003052
01003053
9700/8000/15100/16000/18000/11500/-
Tympanomastoidectomy
01003055
01003056
01003057
01003058
01003059
004
Dacunisation
Tonsillectomy
Adenotonsillectomy
Synichiolysis
Submucosal Diathermy
Nasal Mass ExcisionSimple
Nasal Mass ExcisionEndoscopic Removal
FESS
Anterior Nasal Packing
Post Nasal Packing
Nasal Bone Reduction
Opthalmology
01004001
Cauterisation of
ulcer/subconjuctival
injection - One eye
01003054
01004002
01004003
01004004
01004005
01004006
01004007
01004008
01004009
01004010
01004011
32000/30000/9600/8100/-
NAME OF TREATMENT
PROCEDURE
Uvulo-palatoplasty
01004012
01004013
01004014
01004015
01004016
01004017
01004018
01004019
01004020
Cauterisation of
ulcer/subconjuctival
injection - Both eyes
Retrobular Injection - One
Eye
Retrobular Injection - Both
Eyes
Syringing of Lacrimal Sac
-For one eye
Syringing of Lacrimal Sac
- For both eyes
Paracentesis
Foreign body removal
Refraction/Fundoscopy
Ortho-optic exercises
Plepoptic Exercises
Chalazion operation -One
Eye
Chalazion operation Both Eyes
Dressing (Eye)
Clinical Photography
Pterygium
Orbitotomy
Ptosis correction.
Ectropion Correction
Xenon Arc Laser
Maximum
Approved
Rate (INR)
(Rupees)
20000/15600/7000/11200/13500/4200/4000/11200/13500/11200/4000/5000/6000/-
200/-
300/200/300/200/300/800/300/90/100/100/800/1000/100/100/2200/9000/6500/3600/700/-
Annexure-I
CODE
01004021
01004022
01004023
01004024
01004025
01004026
01004027
01004028
01004029
01004030
01004031
01004032
01004033
01004034
01004035
NAME OF TREATMENT
PROCEDURE
D C R (Dacryo custorhinostomy)
ECCE/ICCE
Epicanthus correction.
Squint Correction (one
eye)
Squint Correction (both
eyes)
Keratoplasty
Trabeculotomy
Iridectomy
Goniotomy
Scleral Bukling (Retinal
Detachment Surgery)
Maximum
Approved
Rate (INR)
(Rupees)
5700/6000/2100/-
01004049
4000/-
01004051
6000/14000/5700/2400/2400/-
01004052
14000/-
Syringing & Probing

Vitrectomy
Enucleation
Eviseration
Entropion correction
Cataract with IOL(Cost of
lens extra)
1100/11000/4000/3800/3000/7500/5700/-
01004038
Fistulectomy
Glucoma surgery with
Glucoma valves
01004039
Caliculoplasty
3000/-
01004040
Dacryocystectomy
Ptosis surgery with LPS
resection
Ptosis surgery with Sling
surgery
3000/-
3000/4000/-
01004045
Ectropion surgery- one lid

Ectropion surgery- both
lids
Cheek rotation flap for lid
tumors
01004046
Telecanthus correction
4000/-
01004047
Fracture orbital repair
9000/-
01004048
Lasik
18000/-
01004036
01004037
01004041
01004042
01004043
01004044
CODE
5000/-
7000/7000/-
8000/-
01004050
NAME OF TREATMENT
PROCEDURE
TTT- Transpupillary
thermal therapy
PTK- Phototherapeutic
keratectomy
Maximum
Approved
Rate (INR)
(Rupees)
4000/9000/-
3000/-
01004053
Iris cyst removal

Lid Abscess incision and
drainage
Orbital Abscess incision
and drainage
01004054
Cyclodiathermy
2000/-
01004055
4000/-
01004059
Perforating injury repair

Phaco + IOL (inclusive of
Foldable & Non-foldable
lens) Package
YAG Laser Capsulotomy
per sitting
YAG Laser Iridectomy per
sitting
Argon Laser
Trabeculoplasty (ALT)
(per sitting)
01004060
HVF
500/-
01004061
Cryopexy
1200/-
01004062
ICG including Medicine

ICG- Double including
Medicine
2000/-
01004056
01004057
01004058
01004063
01004064
1000/-
4000/-
14500/600/600/-
1000/-
3600/-
01004065
Electrolysis (Per sitting)

Cyclocryo/
Cyclodiathermy
150/500/-
01004066
D.C.T. (OPD)
800/-
01004067
Silicone Oil (1000)
4000/-
01004068
Silicone Oil (C5)
4000/-
01004069
Silicone Oil Removal
3500/-
01004070
Pneumo Retinopexy
2400/-
Annexure-I
CODE
NAME OF TREATMENT
PROCEDURE
Maximum
Approved
Rate (INR)
(Rupees)
01004071
FGE/ FAE
1500/-
01004092
Lensectomy
7500/-
01004072
Indirect Laser
1000/-
01004093
16000/-
01004073
Endo Laser
2400/-
01004094
Orbitotomy (Multiple Wall)

ERM (Epi Retinal
Membrane)
01004074
SF6 Gas
2400/-
01004095
2400/-
01004075
C3F8 Gas
2400/-
01004096
01004076
2400/-
01004085
PFCL
Photodynamic Therapy
procedure charges- single
eye
procedure charges- both
eyes
(single eye)
(both eyes)
Intravitreal Avastin
(including cost of injectionsingle)
Intravitreal Lucentis
(excluding cost of
injection-single)
Intravitreal Macugen
(excluding cost of
injection-single)
Intravitreal injections of
antibiotics (cost of
medicines extra)
Retinal Foreign Body
Removal
01004086
PPV/ Victerectomy
6500/-
01004087
Endo Diathermy
1600/-
01004088
Belt Buckle
3200/-
01004089
IVTCA
800/-
01007003
01007004
01004090
Membrane Peeling
2400/-
01007005
01004091
Anterior Vitrectomy
5000/-
01007006
Reti Blue
Corneal Collagen Crosslinking
Biopsies including
Histopathological report
(Package)
Biopsy procedure under
Local Anaesthesia
General Anaesthesia
Endoscopy
FNAC
Strapping (including
Bandage & materials)
Strapping of Finger
Strapping of Toes
Strapping of Wrist
Strapping of Elbow
Strapping of Knee
Strapping of Ankle
Strapping of Chest
Strapping of Shoulder
Nasal bone fracture
Figure of 8 bandage
Colar and cuff sling
Ball bandage
Physiotheraphy &
Traction
Ultrasonic therapy (per
sitting)
S.W. Diathermy (per
sitting)
Electrical stimulation
(therapeutic) (per sitting)
Infra red (per sitting)
U.V. Therapeutic dose
(per sitting)
Electric vibrator (per
sitting)
01004077
01004078
01004079
01004080
01004081
01004082
01004083
01004084
15000/-
CODE
NAME OF TREATMENT
PROCEDURE
Maximum
Approved
Rate (INR)
(Rupees)
005
01005001
01005002
25000/85000/100000/-
6000/-
4000/-
4000/-
2000/4000/-
01005003
01005004
006
01006001
01006002
01006003
01006004
01006005
01006006
01006007
01006008
01006009
01006010
01006011
01006012
007
01007001
01007002
3600/-
15000/-
4000/6000/8000/3500/-
200/200/360/400/400/400/500/450/450/450/450/450/-
70/90/70/90/90/90/-
Annexure-I
CODE
01007007
01007008
01007009
01007010
01007011
01007012
01007013
01007014
NAME OF TREATMENT
PROCEDURE
Vibrator belt massage
(per sitting)
Intra Lumbar Traction
(per sitting)
Intermittent Cervical
traction (per sitting)
Combined Lumbar &
Cervical traction (per
sitting)
Wax bath (per sitting)
Hot pack (per sitting)
Whirl pool bath (per
sitting)
Obesity Exercises (per
sitting)
Maximum
Approved
Rate (INR)
(Rupees)
CODE
NAME OF TREATMENT
PROCEDURE
Maximum
Approved
Rate (INR)
(Rupees)
90/-
01007030
SWD + IFT
100/-
90/-
01007031
US + IFT
100/-
70/-
01007032
200/-
01007033
US + IFT + Stimulation
US + Knee Joint + Spad
Fraction
01007034
US + PWB
100/-
01007035
US + SW + Traction
200/-
01007036
US + Tens
100/-
01007037
US + Stimulation
100/-
70/-
01007038
100/-
90/-
01007039
Knee Joints Spad Fraction

Electronic Tilt TrainingPer Session
70/50/70/90/60/-
60/-
01007040
01007018
Breathing Exercises &

Postural Drainage (per
sitting)
Cerebral Palsy Massage
(per sitting)
Post polio exercise (per
sitting)
Basic Gait Training (Per
Session)
80/-
01007041
01007019
Traction + IFT
150/-
01007042
01007020
Traction + Stimulation
100/-
01007043
01007021
Traction + SWD
100/-
01007044
008
01007022
Traction + SWD + IFT
200/-
01007023
Traction + US
140/-
01007024
Traction + US + IFT
Traction + US + IFT +
Exercises
Traction + US + IFT +
SWD
200/-
01007015
01007016
01007017
01008001
01007025
01007026
260/-
01008002
01008003
01008004
01008005
01008006
260/-
01007027
IFT + PWB
150/-
01008007
01008008
01007028
Exercise- per sitting

PWB + Knee Joint Spad
Fraction
60/-
01008009
01007029
100/-
100/-
01008010
Interferential Therapy
Laser Treatment- Per
Session
Microwave Diathermy- Per
Session
Quadriceps Chair Training
(Per Session)
Tens
Dental
Extraction of tooth
including LA
Complicated Ext. per
Tooth including LA
Flap Operation per Tooth
Gingivectomy per tooth
Cyst under LA (small)
Cyst under LA (large)
Impacted Molar including
LA
Apisectomy including LA
Fracture wiring including
LA
Reduction &
immobilisation of fractureMaxilla under LA
100/100/150/150/100/80/-
120/250/500/300/300/500/800/1000/80/-
1400/-
Annexure-I
CODE
01008011
01008012
01008013
01008014
01008015
01008016
01008017
01008018
01008019
01008020
01008021
01008022
01008023
01008024
01008025
01008026
01008027
01008028
NAME OF TREATMENT
PROCEDURE
Reduction &
immobilisation of fractureMandible under LA
Splints/ Circum
mandibular wiring under
GA
Internal wire fixation/ plate
fixation of Maxilla under
LA
fixation of Maxilla under
GA
fixation of Mandible under
LA/GA
Cyst & Tumour of Maxilla/
mandible by enucleation/
excision (package)
TM joint ankylosis- under
GA (package)
Hemi-mandibulectomy
with graft (package)
Hemi-mandibulectomy
without graft (package)
Segmentalmandibulectomy with graft
(package)
Segmentalmandibulectomy without
graft (package)
Maxillectomy- partial with
graft (package)
Maxillectomy- partial
without graft (package)
Maxillo-facial prosthesis
(sal/ auricular/ orbital/
facial lost part) (package)
Alvelolectomy,
Frenectomy per Quadrant
Alvelolectomy (minor)
Amalgam Filling/tooth
(compound)
Amalgam Filling/tooth
(regular)
Maximum
Approved
Rate (INR)
(Rupees)
6000/-
01008041
NAME OF TREATMENT
PROCEDURE
De Sensitising per sitting
Dento Alveolar Fracture
Reduction & Splinting/l.a.
Denture Repair
(category1)
Dialation of Whartons
Duct under L.A.
Direct/ indirect Pulp
Capping
Drain. of Dento Alveolar
Absce. (ex. Oral)
Enucleation of Cyst of
Oral Cavity
Fibre Post Based Post &
Core
2000/-
01008042
Floride Application (per

sitting)
400/-
01008043
Extraction of Impacted
Tooth By Operation
400/-
3000/-
CODE
01008034
01008035
01008036
2000/01008037
4000/-
6000/-
01008038
01008039
01008040
11000/-
01008033
Apicoectomy Molar Tooth

Arch Bar Removal
Bite Plate/ Retainers
Cast Rpd (per Tooth)
Davis Crown/ radicular
Screw supported
1500/230/1150/230/950/2000/1900/-
7000/-
01008046
Extraction of MISP Tooth

by Operation (Open Meth)
GTR (Guided Tissue
Regeneration)
Gingivectomy per
Quadrant
2000/-
01008047
Glass Ionomer Filling
400/-
5000/-
01008048
01008049
Glass Ionomes Filling

Interdental Wiring
Intra Articular Inj. of
Steroids in TMJ
450/1150/-
Jacket Crown Acrylic

Minor Dento-alveolar
Tracture Reduction &
Splinting/la
Post Core/ tooth (cast
Post) lab Metal Chgs.
Extra
Post Core/ tooth (pin
Retained.comp.core)
Post Core/ tooth
Screw/pin Retain.
amalgm.
Preformed Carbonate
Jacket Crown
1500/-
4000/-
01008044
01008045
6000/-
4000/01008050
5000/-
01008051
1150/380/-
01008052
450/01008053
380/01008054
01008029
01008030
01008031
01008032
Maximum
Approved
Rate (INR)
(Rupees)
200/-
2250/380/1150/380/-
01008055
01008056
1150/1900/750/-
900/-
950/-
1150/750/-
550/750/-
1900/-
Annexure-I
CODE
NAME OF TREATMENT
PROCEDURE
Maximum
Approved
Rate (INR)
(Rupees)
01008057
Preformed Steel Crown
1150/-
01008058
Pulpotomy
Reduction of Dislocation
of Tmj (Under LA.)
Reimplantation (per
Tooth)
Removal Partial Denture
(1st Tooth)
Removable Partial
Denture (Additional Tooth)
Removable Partial
Denture per Tooth (Palatal
Bar)
Repair of Facial Soft
Tissue Laceration
Repair of Facial Soft
Tissue Laceration (minor)
Root Canal Treatment
(Upto 4 Sitting)
(Extra Sitting)
with Filling and Crown
(package) (Lab. Charges
extra)
Scaling per Sitting
Sialolithotomy for Small
Stones
Surgical Extraction or
Surgical Removal of
Impact (package)
Surgical Removal of Benin
Reoplasm of Oral
(package)
Surgical Removal of Soft
Tissue Lesion (package)
Surgical Removal of
Impact Mesiod.tuber
(package)
ITU/CCU CHARGES
(Special Care Cases)
ICU/ITU/CCU/NICU/PICU
(including:- Oxygen;
ECG/SPO2/NIBP/IBP
monitoring; 1:2 Nursing
GNM Nursing; Round the
Clock Doctor (Resident on
spot); Diet; Syringe Pump)
750/-
01012001
01012002
01012003
NAME OF TREATMENT
PROCEDURE
Ventilator charge
(including accessories)
per day
Pneupack Ventilator in
Nursery (per day)
High Definition Unit/ Step
Down (including Oxygen)
Exchange Transfusion
O.T. Charges for
Exchange transfusion
Oxygen Charges
Private/ Semi-private/
General Ward per hour
Burn Cases
upto 30% Burns 1st
Dressing (excluding
dressing materials and
medicines)
upto 30% Burns
Subsequent Dressing
(excluding dressing
materials and medicines)
30% to 50% Burns 1st
Dressing (excluding
dressing materials and
medicines)
30% to 50% Burns
Subsequent Dressing
(excluding dressing
Extensive Burn above
50% Frist Dressing
(excluding dressing
Extensive Burn above
50% Subsequent dressing
(excluding dressing
Burn Unit Bed (including
Oxygen)
Obstetric &
Gynaecology Cases
Normal delivery or with
Episiotomy & P. repair
Low Forceps
Low midcavity forceps
01012004
01012005
Cesarean Section
Cesarean Hysterectomy
CODE
01009002
01008059
01008060
01008061
01008062
01008063
01008064
01008065
01008066
01008067
01008068
01008069
01008070
01008071
01008072
01008073
01008074
009
01009001
01009003
1400/3400/400/-
01009004
01009005
230/-
01009006
010
750/-
01010001
011
1150/750/-
01011001
1150/400/-
01011002
3600/400/-
01011003
115/01011004
1150/01011005
1500/1150/01011006
1150/-
01011007
012
2400/-
Maximum
Approved
Rate (INR)
(Rupees)
1000/800/1500/1200/400/-
60/-
700/-
700/-
700/-
700/-
1500/-
1500/1500/-
12000/12000/14000/20000/22000/-
Annexure-I
Maximum
Approved
Rate (INR)
(Rupees)
Maximum
Approved
Rate (INR)
(Rupees)
CODE
22000/-
01012029
18000/-
01012030
01012031
16000/-
01012032
NAME OF TREATMENT
PROCEDURE
Repair of post-coital tear,
perineal injury
Excision of urethral
caruncle
Laparoscopy (Gynae)
Shirodhkar, Mc. Donalds
stich
6100/-
01012033
Laparotomy
20000/-
01012009
NAME OF TREATMENT
PROCEDURE
Rupture Uterus- closure &
repair with Tubal Ligation
Perforation of Uterus after
D/E Laparotomy &
Closure
Laparotomy-peritonitis
Lavage and Drainage
Laparotomy-failed
laparoscopy to explore
01012010
01012011
Salphingectomy
Salphingo-Oophorectomy
14000/18000/-
01012034
Abdominal Hysterectomy
22000/-
01012012
01012013
18000/15000/-
01012035
Vaginal Hysterectomy
22000/-
01012036
Myomectomy
22000/-
01012014
Ovarean Cystectomy
Oopherctomy
Broad Ligment
Haemotoma Drainage
01012037
01012038
Vaginoplasty
Vulvectomy
(Simple/Radical)
22000/-
01012015
Exploration of perineal
Haematoma & Resuturing
of Episiotomy
25000/-
01012039
RVF Repair
25000/-
01012040
Other Major Operations
25000/-
01012041
Manchester Operations
20000/-
01012042
Perineorrhaphy
14700/-
01012043
Colporraphy
14400/-
2500/3300/-
01012044
Modified Gilliam
16900/-
2500/-
01012045
Shirodkars Operation
10200/-
3700/-
01012046
Diagnostic Curettage
2700/-
2500/-
01012047
Fractional Curettage
3400/-
4200/12000/-
01012048
D & C and Cervical Biopsy
3400/-
01012049
Polypectomy
3600/-
5900/-
01012050
3600/-
4200/-
01012051
Other-Minor Operation
Excision Vaginal
Cyst/Burtholin Cyst
CODE
01012006
01012007
01012008
01012016
01012017
01012018
01012019
01012020
01012021
01012022
01012023
01012024
01012025
01012026
01012027
01012028
Exploration of abdominal
Haematoma (after
laparotomy + LUCS)
Internal podalic version
and extraction
Manual Removal of
Placenta
3rd stage Complication
MRP for outside delivery
etc
Examination under
anaesthesia
Burst-abdomen Repair
Gaping Pareneal Wound
Secondary Suturing
Gaping abdominal wound
Secondary Suturing
Complete perineal tearrepair
Exploration of PPH-tear
repair
Destructive Operation
Suction evacuation
vesicular mole, Missed
abortion D/E
Colpotomy-drainage P/V
needling EUA
4200/4000/6100/3700/-
12000/-
12000/-
12000/12000/3700/-
4900/-
3900/-
Annexure-I
CODE
NAME OF TREATMENT
PROCEDURE
Maximum
Approved
Rate (INR)
(Rupees)
01012052
Excision Vaginal Septum
5900/-
01013005
01012053
Laparoscopy Diagnostic
6000/-
01013006
01012054
Laparoscopy Sterilisation
7300/-
01012055
Laparoscopy Operative
12000/-
01012056
Laparoscopy LAVH
25000/-
01013009
01012057
Drilling of Ovary
10800/-
01013010
01012058
Adhesiolysis
Management of Ectopic
pregnancy
17400/-
01013011
20000/-
01013012
11500/-
01013013
5500/-
01013014
11500/-
01013015
Maximum
Approved
Rate (INR)
(Rupees)
01013018
NAME OF TREATMENT
PROCEDURE
Aspiration of Liver
Abscess
Open Drainage of Liver
Abscess
Drainage of Pelvic
Abscess
Drainage of Ischiorectal
Abscess
Drainage of
Subdiaphragmatic
Abscess
Open Drainage of
Perinepheric Abscess
Drainage of Perigastric
Abscess
Drainage of Perotid
Abscess
Drainage of
Retropharyngeal Abscess
Open Drainage of Psoas
Abscess
Open Drainage of
Perivertebral Abscess
Fissurectomy/
Haemorroidectomy/
Correction of Piles
Haemorroidectomy/
Correction of Piles
with Stapler Gun
(cost of Gun extra)
Excision of Superficial
Neurofibroma
3900/-
01013019
Varicose Veins
25000/-
Abortion- Evacuation
4200/-
01013020
4000/-
01012069
MTP- 1st Trimester
3200/-
014
Excision of Carbuncle
Injury Of Superficial Soft
Tissues
01012070
MTP - 2nd Trimester
4800/-
01012071
013
01013001
01013002
Extended Hysterectomy
General Surgery
Drainage of Abscess
Dressing under G.A.
Aspiration of cold Abscess
of Lymphnode
Aspiration of Empyema
28000/-
015
01015001
01015002
01015003
Interestical (Implant)
Head & Neck
Breast
Soft Tissue Sarcome
016
GASTROENTROLOGY
01016001
Capsule Endoscopy
01012059
01012060
01012061
01012062
01012063
Hysteroscopy TCRE
Hysteroscopy Removal of
IUCD
Hysteroscopy Removal of
Septum
01012064
Hysteroscopy Diagnostic
Werthimas Hystrectomy
for Cancer cervix
30000/-
01012065
Sterilisation Post Pertum
4700/-
01012066
Sterilisation Intravaginal
6000/-
01012067
Abortion- D & C
01012068
01013003
01013004
CODE
01013007
01013008
7300/01013016
2000/2400/3100/2400/-
01013017
3000/10000/10000/8000/-
14000/14000/12000/8000/8000/8000/10000/-
16000/-
16000/2800/-
9700/9600/12000/-
30000/-
Annexure-I
Maximum
Approved
Rate (INR)
(Rupees)
CODE
NAME OF TREATMENT
PROCEDURE
Maximum
Approved
Rate (INR)
(Rupees)
18000/-
01016025
Gastrostomy (PEG)
7000/-
30000/-
01016026
Gastrostomy (PEG) (BS)
11000/-
5000/-
01016027
Glue Injection
4500/-
6500/-
01016028
Glue Injection (BS)
7000/-
2200/-
01016029
Hemosta by Glod Probe
7000/-
3000/-
01016030
Hemostatic Clip
7000/-
01016007
NAME OF TREATMENT
PROCEDURE
Complete Double Baloon
Enteroscopy
Complete Small Bowel
Evaluation
Argan Plasma Coa
(Major)
Argan Plasma Coa
(Major) (BS)
Argan Plasma Coa
(Minor)
Argan Plasma Coa
(Minor) (BS)
01016008
Band Ligation
3500/-
01016031
Hemostatic Clip (BS)
10000/-
01016009
Band Ligation (BS)
5500/-
01016032
Hepatonorm
700/-
01016010
Biliary Brushing
1000/-
01016033
Injection Hemostasis
4000/-
01016011
Biliary Brushing (BS)
1600/-
01016034
Injection Hemostasis (BS)
6000/-
01016012
Biliary Pancreatic (M)
16000/-
01016035
LGI Manometry
4000/-
01016013
Biliary Pancreatic (M) (BS)
23000/-
01016036
LGI Manometry (BS)
6000/-
01016014
Biliary Pancreatic (P)
13300/-
01016037
UGI Manometry
3200/-
01016015
Biliary Pancreatic (P) (BS)
18000/-
01016038
UGI Manometry (BS)
4500/-
01016016
Cre Ballon Dilatation (BS)
15000/-
01016039
Nasobiliary Drainage
12000/-
01016017
Cre Balloon Dilatation
9000/-
01016040
Nasobiliary Drainage (BS)
18000/-
01016018
Dilatation (Stricture)
3000/-
01016041
3000/-
01016019
Dilatation (Stricture) (BS)
4200/-
01016042
Nasojejunal Tube Plac

Nasojejunal Tube Plac
(BS)
4200/-
01016020
EMG Charge (Large)
3500/-
01016043
Papilla Cannu Minor
6500/-
01016021
EMG Charge (Small)
1500/-
01016044
Papilla Cannu Minor (BS)
8200/-
01016022
3000/-
01016045
4200/-
01016046
Pappu Stnt Spingt (M)

Pappu Stnt Spingt (M)
(BS)
12000/-
01016023
Endoscopic Tube Place

Endoscopic Tube Place
(BS)
17500/-
01016024
Oesophageal Transit
1200/-
01016047
Polypectomy (Colonic)
3200/-
CODE
01016002
01016003
01016004
01016005
01016006
10
Annexure-I
CODE
01016048
01016049
NAME OF TREATMENT
PROCEDURE
Polypectomy (Colonic)
(BS)
Maximum
Approved
Rate (INR)
(Rupees)
4800/-
01016050
Polypectomy (Upper GI)

Polypectomy (Upper GI)
(BS)
4500/-
01016051
Pre Cutting
4500/-
01016052
Pre Cutting (BS)
7500/-
01016053
Pseudocyst Drainage
9000/-
01016054
Pseudocyst Drainage (BS)
16000/-
01016055
Sclerotherapy
3000/-
01016056
Sclerotherapy (BS)
3800/-
01016057
Small Bowel Enteroscp
14000/-
01016058
Sphincterotomy
10500/-
01016059
Sphincterotomy (BS)
16000/-
01016060
Stone Extraction
12000/-
01016061
Stone Extraction (BS)
17000/-
01016062
Gastric Emptying
2500/-
01016063
Mechanical Lithotripsy
25000/-
01016064
017
01017001
ERCP (Stenting)
Head & Neck
Ear Lobe Repair one side
10000/-
01017002
01017003
01017004
01017005
Excision of Pinna for

Growth (Squamous/Basal/
Injuries) Skin Only
Excision of Pinna for
Growth (Squamous/Basal/
Injuries) Skin and
Cartilage
Partial Amputation of
Pinna
Total Amputation of Pinna
3000/-
600/-
4500/-
6000/6000/7500/-
CODE
01017006
01017007
01017008
01017009
01017010
01017011
01017012
NAME OF TREATMENT
PROCEDURE
Total Amputation &
Excision of External
Auditory Meatus
Excision of Cystic
Hygroma Minor
Excision of Cystic
Hygroma Major
Excision of Cystic
Hygroma Extensive
Excision of Branchial Cyst
Excision of Branchial
Sinus
Excision of Pharyngeal
Diverticulum
Mandibulectomy
Maximum
Approved
Rate (INR)
(Rupees)
10250/5500/8000/12300/11000/11000/12200/-
01017013
01017014
Operation for Cervical Rib
25000/30000/-
01017015
Pharyngectomy
35000/-
01017016
Stenosis Excision
17000/-
01017017
Commando Operation
Block Dissection of
Cervical Lymph Nodes
Pharyngectomy &
Reconstruction
Operation for Carcinoma
Lip - Wedge Excision
Lip - Vermilionectomy
27000/-
01017018
01017019
01017020
01017021
01017022
01017023
01017024
01017025
01017026
01017027
01017028
01017029
01017030
01017031
01017032

Lip - Wedge Excision and
Vermilonectomy
Estlander Operation
Abbe Operation
Cheek Advancement
Excision of the Maxilla
Excision of the Mandible Segmental
Hemimandibulectomy
Partial Glossectomy
Hemiglossectomy
Total Glossectomy
Parotidectomy Superficial
20300/40000/10000/10000/-
12000/9700/12000/10200/23300/18100/27200/6100/1350025000/24000/-
11
Annexure-I
Maximum
Approved
Rate (INR)
(Rupees)
01017033
NAME OF TREATMENT
PROCEDURE
Parotidectomy Conservative
01017034
Parotidectomy - Radical
22000/-
01017035
Parotidectomy - Total
15000/-
CODE
19700/-
CODE
01018004
01018005
01018006
01018007
01017036
01017037
01017038
01017039
01017040
01017041
01017042
01017043
Repair of Parotid Duct

Removal of
Submandibular Salivary
gland
20400/-
Hemithyroidectomy
Partial Thyroidectomy
Subtotal Thyroidectomy
(Toxic Goitre)
15000/16000/-
01019003
22000/-
01019004
Total Thyroidectomy
Resection Enucleation of
Adenoma
23000/-
01019005
12500/-
01019006
12600/-
01019007
31400/-
020
01020001
10000/-
01017047
Isthmectomy
Total Thyroidectomy and
Block Dissection
Excision of Lingual
Thyroid
Excision of Thyroglossal
Cyst/Fistula
Excision of Parathyroid
Adenoma/Carcinoma
01017048
Laryngectomy
37150/-
01017049
01017050
01017051
01017052
01017053
01017054
01017055
01017056
01017057
01017058
018
01018001
01018002
01018003
Laryngo Pharyngectomy
Sinus & Fistula repair
Lymph Node Excision
Hyoid Suspension
Genioplasty
Direct Laryngoscopy
Phonosurgery
Fibroptic Laryngoscopy
Microlaryngeal Surgery
Laryngofissure
Head & Neck Cancer
Benign Tumour Excisions
Temporal Bone resection
Radical Neck Dissection
43500/14000/8000/12000/12000/5400/15400/3000/11000/17500/-
01017044
01017045
01017046
25650/15000/25600/-
01018008
019
01019001
01019002
01020002
01020003
01020004
01020005
01020006
01020007
01020008
01020009
01020010
01020011
01020012
11000/27600/28500/-
01020013
01020014
NAME OF TREATMENT
PROCEDURE
Carotid Body Excision
(cost of Graft extra)
Total Laryngectomy
Flap Reconstructive
Surgery
Parapharyngeal Tumour
Excision
Total Thyroidectomy
Breast
Drainage of Abscess
Excision of Lumps
Local Mastectomy
(Simple)
Radical Mastectomy
(Formal or Modified)
Excision of Mammary
Fistula
Segmental Resection of
Breast
Breast Cancer (Tumour
excision)
Cardio Respiratory
Procedures
Tracheostomy
Thoracotomy (Penetrating
Wounds)
Intercostal Drainage of
empyema
Decortication
(Pleurectomy)
Thoracoplasty
Pneumonectomy
Lobectomy
Segmental Resection
Hydatid Cyst- Removal
Video-assisted
thoracoscopic lung
Surgeries
Lung volume reduction
surgery (Unilateral/
Bilateral)
Thoracoscopic
Decortication
Thoracoscopic
Pneumonectomy
Thoracoscopic Lobectomy
Maximum
Approved
Rate (INR)
(Rupees)
36000/39050/42800/32000/30000/7000/10000/13500/28000/16000/18300/30000/-
3700/17500/5400/37000/37000/37000/37000/37000/37000/-
37000/-
37000/37000/37000/37000/-
12
Annexure-I
CODE
01020015
01020016
01020017
01020018
01020019
01020020
01020021
01020022
01020023
01020024
01020025
01020026
01020027
01020028
01020029
NAME OF TREATMENT
PROCEDURE
Thoracoscopic Segmental
Resection
Thoracoscopic
Cyst excision
Thoracoscopic
Sympathectomy
Chest Wall Tumor
Excision with
Reconstruction
Repair of Congenital
Chest Wall Defermities
Maximum
Approved
Rate (INR)
(Rupees)
01020039
NAME OF TREATMENT
PROCEDURE
Lung Resection with
Dissection of Lymph Node
Stations
Surgery for Recurrent
Pnemothoraxic
Surgery for Aspergillosis
(Lung Cavities)
37000/-
01020040
Bronchotomy
37000/-
37000/-
01020041
15000/-
Multiple Lobectomy
Decortication +
Thoracoplasty
Decortication + Lung
Resection +
Thoracoplasty
37000/-
021
Open Lung Biopsy
18000/-
Medicistinoscopy(cervical)
15000/-
Video-assisted
thoracoscopy (VATS)
36960/-
Mediostonoscopy
Cardiac / Cardio
Thoracic Procedures
Coronary Bypass Surgery
(including Pre-Surgery
Profile)
Coronary Bypass Surgerypost Angioplasty
Profile)
Coronary Balloon
Angioplasty
(Excluding Cost of Stents)
Profile) (4 days package)
Balloon angioplasty with
Valvotomy (including PreSurgery Profile)
Open Heart Procedures
Profile)
Total Correction of
Tetralogy of Fallot
Profile)
RSUV Correction
Profile)
TAPVC Correction
Profile)
Open ASD VSD (including
Pre-Surgery Profile)
Open Pulmonary
Valvotomy (including PreSurgery Profile)
Open Aortic Valvotomy
Profile)
Blalock Taussig Operation
Thoracotomy for BPF

Surgery for Destroyed
Lung
Sleeve Resection with
Lobectomy
Extrapleural
Pneumonectomy
37000/37000/37000/-
37000/-
CODE
01020037
01020038
01021001
37000/-
37000/-
01021002
01021003
01021004
37000/37000/-
01021005
37000/01021006
01020030
01020032
Tracheal Stenosis Surgery

Repair of Tracheo
Innuminete Fistula
Tracheal Resection for
Tracheal Tumour
37000/-
01020033
Segmentectomy
37000/-
01020034
Wedge Resection
Lung Resection with
Paratracheal L. Node
Resection
Lung Resection with
Chest Wall Invasion
37000/-
01020031
01020035
01020036
Maximum
Approved
Rate (INR)
(Rupees)
37000/37000/-
37000/37000/-
01021007
01021008
01021009
01021010
01021011
01021012
37000/37000/37000/-
150000/-
150000/-
66000/-
90000/-
150000/-
150000/-
150000/-
150000/150000/-
150000/-
150000/72000/-
13
Annexure-I
CODE
01021013
01021014
01021015
01021016
01021017
01021018
01021019
01021020
01021021
01021022
01021023
01021024
01021025
01021026
01021027
01021028
01021029
01021030
NAME OF TREATMENT
PROCEDURE
Profile)
Mitral Valvotomy
Profile)
Mitral Valve Replacement
(Excluding Cost of Valve)
Profile)
Aortic Valve Replacement
(Excluding Cost of Valve)
Profile)
Double Valve
Replacement (Excluding
Cost of Valves) (including
Thoraco-Abdomi Aorta
Replacement (including
Coarctation-Arota Repair
of Block Taussing Shunt
Profile)
Patent Ductus Arteriousus
Profile)
Mitral Valvotomy (Open)
Profile)
Pericardiostomy (including
Pericardiectomy (including
Pericardio Centesis
Permanent Pacemaker
Implantation (Excluding
Cost of Pacemaker)
(4 days package)
Temporary Pacing Lead
Implantation (Including
use of Temporary
Pacemaker)
Embolectomy
Aneurysm- Resection &
Grafting (cost of Graft
extra)
Thoracocentesis
Thorachostomy
Exploratory Thorocotomy
Maximum
Approved
Rate (INR)
(Rupees)
01021031
NAME OF TREATMENT
PROCEDURE
Unifocalization with Shunt
Profile)
01021032
Removal of Foreign Body

from Trachea or
Oesophagus
CODE
72000/-
150000/-
150000/-
160000/-
01021033
01021034
01021035
01021036
01021037
01021038
01021039
01021040
01021041
150000/-
96000/-
72000/-
150000/-
01021042
01021043
01021044
01021045
01021046
01021047
01021048
54000/72000/3900/-
01021049
01021050
01021051
01021052
19400/01021053
01021054
01021055
12600/19800/01021056
96000/2000/5400/37000/-
Rib Resection & Drainage

Mediastinal Tumour
Thymectomy
ASD Device Closure
(Excluding Cost of Device)
PDA Device Closure
(Excluding Cost of Device)
DSA
EP STUDY
3D RF Ablation
Mini EP Study
Coronary Angiography
(1 days package)
Fonten
Gunshot injury
Heart transplant
Intra coronary stenting
Directiol atherectomy
Permanent Pacemaker
Implantation (DDD)
(Pacemaker Cost extra)
(4 days package)
Permanent Pacemaker
Implantation
(Biventricular)
(Pacemaker Cost extra) (4
days package)
Femoral Poplitial Bypass
Iliacfemoral Bypass
Aorto Bifemoral Bypass
Carotid Subclavian
Bypass
PA Banding
BD Glen
Thoracic Aorta/ Arch
Replacement (including
Maximum
Approved
Rate (INR)
(Rupees)
150000/-
6000/11500/35000/35000/40000/32000/5400/8400/40000/5000/11700/170000/52000/277000/58000/98000/-
25000/-
30000/75000/75000/75000/75000/55000/55000/-
150000/-
Note:- CABG if done along with other Heart Surgeries

like Valve Replacement etc. will attract the same rate as
CABG.
022
Oesophagus
14
Annexure-I
CODE
01022001
01022002
01022003
01022004
01022005
01022006
01022007
01022008
01022009
01022010
01022011
01022012
01022013
023
01023001
01023002
01023003
01023004
01023005
01023006
01023007
01023008
01023009
NAME OF TREATMENT
PROCEDURE
Atresia of Oesophagus
and Tracheo
Oesophageal Fistula
Operations for
Replacement of
Oesophagus by Colon
Oesophagectomy for
Carcinoma Easophagus
Oesophageal Intubation
(Mausseau Barbin Tube)
Achalasia Carida
Transthoracic
Achalasia Carida
Abdominal
Oesophago Gastrectomy
for mid 1/3 lesion
Oesophagus Dilatation of
Stricture- per visit
Colon-Inter position or
Replacement of
Oesophagus
Oesophago Gastrectomy
Lower Corringers
procedure
Esophageal Perforation
Surgery
Installation of Ryles Tube
in Ca Esophagus
Esophageal Directiculum
Surgery
Abdomen
Gastroscopy
Gastric & Duodenal
Biopsy (Endoscopic)
Pyleromyotomy
Gastrostomy
Simple Closure of
Perforated peptic Ulcer
Vagotomy Pyleroplasty /
Gastro Jejunostomy
Duodenojejunostomy
Partial/Subtotal
Gastrectomy for
Carcinoma
Partial/Subtotal
Gastrectomy for Ulcer
Maximum
Approved
Rate (INR)
(Rupees)
CODE
01023010
29700/01023011
38000/-
01023012
38000/-
01023013
15500/-
01023014
29700/-
01023015
14600/-
01023016
38000/-
01023017
1500/-
38000/-
01023018
01023019
01023020
01023021
38000/-
01023022
38000/-
01023023
5000/38000/-
01023024
01023025
1300/-
01023026
1700/10000/12000/-
01023027
15000/30000/25000/-
30000/30000/-
01023028
01023029
01023030
01023031
01023032
01023033
01023034
NAME OF TREATMENT
PROCEDURE
Operation for Bleeding
Peptic Ulcer
Gastrojejunostomy &
Vagotomy
Operation for
Gastrojejunal Ulcer
Total Gastrectomy for
Cancer
Highly Selective
Vagotomy
Selective Vagotomy &
Drainage
Congenital Diaphragmatic
Hernia
Hiatus Hernia Repair
Abdominal
Hiatus Hernia Repair
Transthoracic
Exploratory Laparotomy
Epigastric Hernia Repair
Umbilical Hernia Repair
Ventral and Scar Hernia
Repair
Inguinal Hernia
Herniorraphy- unilateral
Inguinal Hernia
Hernioplasty- with meshunilateral
Femoral Hernia Repair
Rare Hernias - Repair
(Spigalion, Obturator,
Lumbar, Sciatic)
Splenectomy - For
Trauma
Splenectomy - For
Hypersplenism
Splenorenal Anastomosis
Portocaval Anastomosis
Direct Operation on
Oesophagus for Portal
Hypertension
Mesentericocaval
Anastomosis
Warren Shunt
Pancerato Duodenectomy
Maximum
Approved
Rate (INR)
(Rupees)
25000/27000/25000/35000/25000/25000/30000/30000/30000/12900/15000/15000/18000/15000/-
22000/22000/-
25000/25000/25000/40000/40000/-
30000/35000/35000/36000/-
15
Annexure-I
CODE
01023035
01023036
01023037
01023038
01023039
01023040
01023041
01023042
01023043
01023044
01023045
01023046
01023047
01023048
01023049
01023050
01023051
01023052
01023053
01023054
01023055
01023056
01023057
01023058
01023059
NAME OF TREATMENT
PROCEDURE
By Pass Procedure for
Inoperable Carcinoma of
Pancreas
Cystojejunostomy or
Cystogastrostomy
Cholecystectomy
Cholecystectomy &
Exploration of CBD
Repair of Common Bile
Duct
Operation for Hydatid Cyst
of Liver
Cholecystostomy
Hepatic Resections
(Lobectomy Hepatectomy)
Operation on Adrenal
Glands - Bilateral
Operation on Adrenal
Glands - Unilateral for
Tumour
Appendicectomy for Acute
Appendicitis
Appendicectomy for
Chronic Appendicitis
Appendicular Abscess
Drainage
Mesenteric Cyst- Excision
Peritonioscopy/
Laparoscopy
Jejunostomy
Ileostomy
Congenital Atresia &
Stenosis of Small Intestine
Muconium ileus
Mal-rotation & Volvulus of
the Midgut
Resection & Anastomosis
of Small Intestine
Excision of Meckles
Deverticulum
Duodenal Diverticulum
Operation for Intestinal
Obstruction
Operation for Intestinal
perforation
Maximum
Approved
Rate (INR)
(Rupees)
CODE
01023060
30000/01023061
30000/18000/-
01023062
22000/20000/-
01023063
25000/14200/28000/35000/-
20000/20000/18000/12000/18000/5100/18000/18000/25000/20000/-
01023064
01023065
01023066
01023067
01023068
01023069
01023070
01023071
01023072
01023073
01023074
01023075
01023076
01023077
01023078
01023079
20000/01023080
22000/01023081
22000/18000/-
01023082
25000/-
01023083
25000/-
01023084
NAME OF TREATMENT
PROCEDURE
Benign Tumours of Small
Intestine
Excision of Small Intestine
Fistula
Operations for
Haemorrhage of the Small
Intestines
Operations of the
Duplication of the
Intestines
Operations for Recurrent
Intestinal Obstruction
(Noble Plication & Other
Operations for the
Adhesions)
Ilieosigmoidostomy
Ilieotransverse Colostomy
Caecostomy
Loop Colostomy
Transverse Sigmoid
Terminal Colostomy
Closure of Colostomy
Right Hemi-Colectomy
Left Hemi-Colectomy
Total Colectomy
Operations for Volvulus of
Large Bowel
Operations for Sigmoid
Diverticulitis
Fissure in Ano - Dilatation
Fissure in Ano Fissurectomy
Rectal Polyp-Excision
Operation of
Haemorrhoids -Lords
procedure
Fistula in Ano - High
Fistulectomy
Fistula in Ano - Low
Fistulectomy
Imperforat Anus Colostomy
Imperforate Anus - Pull
Through Operation
Prolapse Rectum Theirch Wiring
Maximum
Approved
Rate (INR)
(Rupees)
25000/25000/-
25000/-
32000/-
28000/22000/22000/10000/20000/24000/24000/24000/24000/39000/25200/22000/6800/16000/8000/-
10000/20000/12000/16000/22000/15000/-
16
Annexure-I
Maximum
Approved
Rate (INR)
(Rupees)
CODE
10000/-
01024018
22000/-
01024019
01024020
01023092
NAME OF TREATMENT
PROCEDURE
Prolapse Rectum Rectopexy
Prolapse Rectum Grahams Operation
Operations for
Hirschsprungs Disease
Excision of Pilonidal Sinus
Abdomino-Perineal
Excision of Rectum
Anterior Resection of
rectum
Pull Through Abdominal
Resection
Operations for
Neuroblastoma
01023093
Fistula/ Fistulotomy
12000/-
01023094
Hernioctomy
Nephrology /
Genitourinary
Partial Nephrectomy
Nephrolithotomy
Pyelolithotomy
Operations for
Hydronephrosis
Open Drainage of
Perinephric Abscess
Cavernostomy
Operations for Cyst of the
Kidney
Ureterolithotomy
Nephroureterectomy
Operations for Ureter for Double Ureters
Operations for Ureter -for
Ectopia of Single Ureter
Operations for Vesicoureteric Reflux
Ureterostomy - Cutaneous
Uretero-Colic anastomosis
Formation of an Ileal
Conduit
Ureteric Catheterisation
Dormia Extraction of
Calculus
21000/-
CODE
01023085
01023086
01023087
01023088
01023089
01023090
01023091
024
01024001
01024002
01024003
01024004
01024005
01024006
01024007
01024008
01024009
01024010
01024011
01024012
01024013
01024014
01024015
01024016
01024017
22000/12300/26700/26300/-
01024021
01024022
01024023
01024024
22000/01024025
22000/-
25000/25000/25000/-
01024026
01024027
01024028
01024029
01024030
01024031
01024032
25000/15000/20400/25000/20000/20000/-
01024033
01024034
01024035
01024036
01024037
30000/01024038
27000/28000/20000/20000/-
01024039
22000/5000/-
01024041
01024042
01024043
6000/-
01024040
01024044
NAME OF TREATMENT
PROCEDURE
Biopsy of Bladder
(Cystoscopic)
Diathermy Destruction of
Bladder Neoplasm
Litholapexy
Operations for Injuries of
the Bladder
Suprapubic Drainage
(Cystostomy/
Vesicostomy)
Total Cystectomy
Diverticulectomy
Open Resection of the
Bladder Neck
Y-V Plasty of the Bladder
Neck
Cystoplasty
Operations for Extrophy of
the Bladder
Repair of Ureterocoel
Suprapubic Prostatectomy
Retropubic Prostatectomy
Transurethral Resection of
Prostate (TURP)/ TUR
Bladder Tumour
Intravesical BCG
instillation (Cost of BCG
extra)
Operations for Injury to
Urethra
Internal urethrotomy
Urethral Reconstruction
Operation for Congenital
Valves of Urethra
Operations for
Incontinence of Urine Male
Operations for
Incontinence of Urine Female
Reduction of
Paraphimosis
Circumcision (under
General Anaesthesia)
Meatotomy
Meatoplasty
Operations for
Hypospadias - Chordee
Maximum
Approved
Rate (INR)
(Rupees)
6000/15000/15000/30000/-
12000/35000/32000/25000/25000/28000/40000/25000/25000/25000/-
25000/-
500/30000/15000/32000/16000/-
25000/-
25000/2450/6000/3500/6800/15000/-
17
Annexure-I
CODE
01024045
01024046
01024047
01024048
01024049
01024050
01024051
01024052
01024053
01024054
01024055
01024056
01024057
01024058
01024059
01024060
01024061
01024062
01024063
01024064
01024065
01024066
01024067
01024068
NAME OF TREATMENT
PROCEDURE
Correction
Operations for
Hypospadias - Second
Stage or One Stage
Repair
Operations for Epispadias
Partial Amputation of the
Penis
Total amputation of the
Penis
Orchidectomy- Simple
Orchidectomy- Radical
Adreneclectomy
Unilateral/Bilateral for
Tumour/For Carcinoma
Operations for Hydrocele Unilateral
Operations for Hydrocele Bilateral
Operation for Torsion of
Testis
Vasovasostomy
Operations for Varicocele
Block Dissection of
Inguinal Nodes - One Side
Block Dissection of
Inguinal Nodes - Both
Sides
Excision of Filarial
Scrotum
Emergency Dialysis
Femoral Puncture
Emergency Dialysis
Subclavian Puncture
Fistula/Shunt
Dialysis Femoral
Catheterisation Bilateral
Haemo Dialysis (All
Inclusive)
Double Lumen Sub
Clavian Catheter
Continuous Arterio Venus
Haemofiltration (CAVH)/
CAVD
Subclavian Access
Femoral Access
Maximum
Approved
Rate (INR)
(Rupees)
24000/22000/-
CODE
01024069
01024070
01024071
01024072
01024073
01024074
14000/-
01024075
01024076
20000/14000/20000/-
01024077
01024078
30000/8000/-
01024079
01024080
01024081
01024082
01024083
12000/-
01024084
15000/18000/15000/-
01024085
01024086
25000/-
32000/16000/1200/1800/8000/1500/1500/3000/-
17000/1850/1750/-
01024087
01024088
01024089
01024090
01024091
01024092
01024093
01024094
01024095
01024096
01024097
01024098
01024099
01024100
01024101
01024102
NAME OF TREATMENT
PROCEDURE
Plasma Exchange
Donor Nephrectomy
Renal Transplantation
Ureteric Reimplant
Lymphocoel
Transplant Nephrectomy
Nephrouretectomy
Vascular Prosthetic Graft
CAPD (insertion &
removal)
PCNL - Unilateral
PCNL Bilateral/
PCNL-III
Palomos Unilateral
Palomos Bilateral
Endoscopic Teflon Inject
Testicular Biopsy
Gil-Verners Extended
Pyelolithotomy
Radical Nephrectomy
Complicated Tumour or
Adhesions
Anderson Hynes
Pyeloroplasty
Vasico Vaginal Fistula
Repair
Radical Cystectomy
Caeco Cystoplasty
Nephrectomy Simple
Nephrostomy
Ureteric Reimplant
Partial Cystectomy
Epididymectomy
TURP Cystolithotripsy
Open Prostatectomy
Closure of Urethral Fistula
Orchidopexy - Unilateral
Orchidopexy - Bilateral
Cystolithotomy Suprapubic
Endoscopic Removal of
Stone in Bladder
Resection Bladder Neck
Endoscopic
Maximum
Approved
Rate (INR)
(Rupees)
2500/50000/250000/4200/4300/35000/35000/35000/8000/30000/46000/7300/12600/5100/4350/22000/-
50000/25000/30000/44000/26000/25000/22000/25000/28000/12000/30000/28000/28000/15000/20000/15000/18000/18000/-
18
Annexure-I
CODE
01024103
01024104
01024105
01024106
01024107
01024108
01024109
01024110
01024111
01024112
01024113
01024114
01024115
01024116
01024117
01024118
01024119
01024120
01024121
01024122
01024123
01024124
01024125
01024126
NAME OF TREATMENT
PROCEDURE
Ureteroscopic Removalwith LASER
Ureteroscopic Removalwithout LASER
Urethroplasty 1st Stage
Optical Urethrotomy
Exploratory Scrototomy
Perineal Urethrostomy
Dilatation of Stricture
Urethra under G.A.
Dilatation of Stricture
Urethra without
Anesthesia
Retroperitoneoscopy
Nephrectomy
Retroperitoneoscopy
partial Nephrectomy
Retroperitoneoscopic
nephrolithotomy
pyelolithotomy
operation for
Hyderonephrosis
surgery for Renal cyst
ureterolithotomy
Nephroureteroectomy
Laproscopy aassisted
orchidopexy
Laproscopic operation for
varicocele
Cystoscopic Basketing of
Urethra
Lithotripsy/ ESWL
(Complete)
Lithotripsy-1/ SMSL (Day
Care)
Lithotripsy-2/3/ SMSL
(Day Care)
Slow Efficiency Dialysis
(SLED)
Prosthetic Surgery for
urinary incontinence
Maximum
Approved
Rate (INR)
(Rupees)
01025011
NAME OF TREATMENT
PROCEDURE
Hilioum Laser Prostrate
surgery/ Optical Internal
urethrotomy/ C
High Intensity Focus
Ultrasound (HIFU) Robotic
for Carcinoma
CRRT Procedure
TURP with LASER
Lithoclast (Day Care)
Plastic Surgery
Primary Suture of Wound
Injection of Keloids Ganglion
Injection of Keloids Haemangioma
Free Grafts - Wolfe Grafts
Free Grafts - Theirech Small Area 5%
Free Grafts - Large Area
10%
Free Grafts - Very Large
Area 20%
Skin Flaps - Rotation
Flaps
Skin Flaps Advancement Flaps
Skin Flaps - Direct- cross
Leg Flaps- Cross Arm
Flap
Skin Flaps - Cross
Finger
01025012
Skin Flaps - Abdominal
35500/-
01025013
01025014
Skin Flaps - Thoracic

Skin Flaps - Arm Etc.
Subcutaneous Pedicle
Flaps Raising
Flaps Delay
Flaps Transfer
Cartilage Grafting
Reduction of Facial
Fractures of Nose
Reduction of Facial
Fractures of Maxilla
34400/35500/-
CODE
40000/01024127
18000/14000/18000/10000/15000/4000/-
01024128
01024129
01024130
01024131
025
01025001
01025002
2200/40000/-
01025003
01025004
35000/-
01025005
35000/35000/-
01025006
01025007
01025008
35000/-
35000/35000/35000/22000/20000/12000/30000/18000/23000/4000/-
Maximum
Approved
Rate (INR)
(Rupees)
01025009
01025010
01025015
01025016
01025017
01025018
01025019
01025020
30000/-
150000/11000/32000/16000/3200/2700/6100/18000/18500/30000/32400/28750/31650/-
35500/35500/-
28500/27750/28500/29700/9000/13800/-
40000/-
19
Annexure-I
CODE
01025021
01025022
01025023
01025024
01025025
NAME OF TREATMENT
PROCEDURE
Reduction of Fractures of
Mandible & Maxilla - Eye
Let Splinting
Mandible & Maxilla - Cast
Netal Splints
Mandible & Maxilla Gumming Splints
Internal Wire Fixation of
Mandible & Maxilla
Maximum
Approved
Rate (INR)
(Rupees)
27000/-
27000/-
27000/32000/-
01025026
33800/-
01025027
Primary Bone Grafting of

Cleft Lip Palate
34550/-
01025028
Secondary Surgery for

Cleft Lip Deformity
01025030
01025031
01025032
01025033
01025034
01025035
01025036
01025037
026
01026001
Secondary Surgery for

Cleft Palate
Reconstruction of Eyelid
Defects - Minor
Reconstruction of Eyelid
Defects - Major
Plastic Surgery of
Different Regions of the
Ear - Minor
Plastic Surgery of
Different Regions of the
Ear - Major
Plastic Surgery of the
Nose - Minor
Plastic Surgery of the
Nose - Major
Plastic Surgery for Facial
Paralysis (Support with
Reanimation)
Pendulous Breast Mammoplasty
Orthopaedic Surgery
Procedure
Application of P.O.P Casts
for Upper & Lower Limbs
01026002
32400/-
7500/-
01026012
01026013
Tension Band Wirings
6000/-
01026014
18000/28000/-
01026016
Bone Grafting
Excision of Bone Tumours
-Superficial
Excision of Bone Tumours
-Deep
01026017
Excision of Ganglion
10000/-
01026005
01026006
01026007
01026008
01026009
01026010
32600/01026011
31350/17550/-
NAME OF TREATMENT
PROCEDURE
Application of Functional
Cast Brace
Application of Skin
Traction
Application of Skeletal
Tractions
Bandage & Strappings for
Fractures
Aspiration & Intra Articular
Injections
Application of P.O.P
Spices & Jackets
Close Reduction of
Fractures of Limb & P.O.P
Reduction of Compound
Fractures
Open Reduction & Internal
Fixation of Fingurs & Toes
Open Reduction of
fracture of Long Bones of
Upper / Lower Limb Nailing & External Fixation
Open Reduction of
fracture of Long Bones of
Upper / Lower Limb -AO
Procedures
01026003
01026004
Cleft Lip - repair.

Cleft Palate Repair
Severe Degree
01025029
CODE
Maximum
Approved
Rate (INR)
(Rupees)
1650/4450/1150/950/6000/7500/10000/18000/-
28000/-
27000/-
30000/-
10000/-
20000/10000/-
01026015
20000/-
32000/22550/-
01026018
01026019
01026020
7500/-
01026021
Excision or other
Operations for Scaphoid
Fractures
Sequestrectomy &
Saucerizations Superficial
Sequestrectomy &
Saucerizations -Deep
Sequestrectomy &
Saucerizations Arthrotomy
40000/-
25000/-
20000/30000/-
35000/-
20
Annexure-I
CODE
01026022
01026023
01026024
01026025
01026026
01026027
01026028
01026029
01026030
NAME OF TREATMENT
PROCEDURE
S.P.Nailing for Fracture
Neck Femur
Multiple Pinning Fracture
Neck Femur
Nail Plate Fixations for
Fracture Neck Femur
A.O.Compression
Procedures for Fracture
Neck Femur
Open Reduction of
Fracture Neck Femur
Muscle Pedicle Graft and
Internal Fixations
Closed Reduction of
Dislocations
Open Reduction of
Dislocations - Superficial
Open Reduction of
Dislocations - Deep
Open Reduction of
Fracture Dislocation &
Internal Fixation
Maximum
Approved
Rate (INR)
(Rupees)
CODE
35000/-
01026042
35000/-
01026043
35000/-
01026044
35000/-
01026045
10000/-
Amputations - Below
Knee
Rs 25000/-
01026050
Amputations - Below
Elbow
25000/-
01026032
32000/35000/-
01026034
Nerve Repair with Grafting

Tendon with Transplant or
Graft
Tendon
Lengthening/Tendon
Sutures
01026035
Tendon Transfer
35000/-
01026036
Laminectomy, Excision
Disc (Prosthesis extra)
01026052
01026039
01026040
01026041
Costo Transversectomy
Corrective Ostectomy &
Internal Fixation - Minor
25000/40000/32000/-
35000/-
25000/-
01026038
25000/-
30000/-
Neurolysis/Nerve Suture
01026037
30400/-
01026049
20000/-
01026031
Laminectomy, Excision
Disc and Tumours
(Prosthesis extra)
Anterolateral Clearance
for tuberculosis
Antereolateral
Decompression and
Spinal Fusion
15000/-
01026048
01026047
01026051
01026033
30000/-
Soft Tissue Operations for

Polio (instrumentation
extra)
Partial Hip Replacement
(Cost of Prosthesis extra)
Operations for Brachial
Plexus & Cervical Rib
01026046
35000/-
NAME OF TREATMENT
PROCEDURE
Corrective Ostectomy &
Internal Fixation - Major
Arthrodisis of - Minor
Joints
Arthrodisis of - Major
Joints
Soft Tissue Operations for
C.T.E.V.
Maximum
Approved
Rate (INR)
(Rupees)
01026053
01026054
25000/-
01026055
01026056
01026057
40000/-
60000/-
01026058
01026059
01026060
32000/01026061
45000/30000/15000/-
01026062
01026063
01026064
Amputations - Above
Knee
Amputations - Above
Elbow
Amputations Forequarter
Amputations -Hind
Quarter and
Hemipelvectomy
Disarticulations - Major
Disarticulations - Minor
Arthrography &
Osteomedullography
Spinal Ostectomy and
Internal Fixations
Arthroscopy - Operative
Soft Tissue Operation on
Knee
Myocutaneous and
Fasciocutaneous Flat
Procedures for Limbs
Removal of Nails, Wires &
Screw
Removal of Plates
Total Hip ReplacementUnilateral (Excluding
35000/30000/40000/-
44000/30000/20000/10450/40200/24250/24000/-
24000/10000/15000/60000/-
21
Annexure-I
Maximum
Approved
Rate (INR)
(Rupees)
CODE
NAME OF TREATMENT
PROCEDURE
Maximum
Approved
Rate (INR)
(Rupees)
01026083
Above knee full slab
2200/-
01026084
Minerva Jacket
4000/-
01026085
Plaster Jacket
3050/-
01026086
Shoulder spica
3350/-
01026087
Single Hip spica
3100/-
01026088
Double Hip spica
3800/-
01026089
Resection of First Rib
45000/-
01026090
Resection of Cerical Rib
35000/-
01026091
Rib Resection
12500/-
01026092
Ligament Reconstruction
22000/-
027
Neuro-Surgery
Craniotomy and
Evacuation of Haematoma
-Subdural
Craniotomy and
Evacuation of Haematoma
-Extradural
Evacuation of Brain
Abscess
Excision of Lobe (Frontal,
Temporal, Cerebelium
etc.)
Excision of Brain Tumours
-Supratentotial
Excision of Brain Tumours
-Subtentorial
01026071
NAME OF TREATMENT
PROCEDURE
Implants)
Total Finger Joint
Replacement-Unilateral
(Excluding Implants)
Total Knee Joint
Replacement-Unilateral
(Excluding Implants)
Any Other Joint
Replacement (e.g. elbow,
shoulder, etc.)- Unilateral
(Cost of Implants extra)
Multiple fractures repair
(excluding peripheral limb
injuries)-major (above
three fractures) (cost of
implants extra)
Multiple fractures repair
(excluding peripheral limb
injuries)-medium (above
two fractures) (cost of
implants extra)
Sternal Dehisences
Repair
Sternal Dehisences
Reconstruction
01026072
Fingers (post, slab)
300/-
01026073
300/-
01026076
Fingers full plaster

Colles Fracture - Below
elbow
Colles Fracture - Full
plaster
Colles fracture Ant. Or
post. slab
01026077
Above elbow full plaster
1000/-
01026078
Above Knee post-slab
700/-
01026079
Below Knee full plaster
1000/-
01026080
750/-
01027008
01026081
Below Knee post-slab

Tube Plaster (or plaster
cylinder)
1450/-
01027009
01026082
Above knee full plaster
2400/-
01027010
CODE
01026065
01026066
01026067
01026068
01026069
01026070
01026074
01026075
23000/-
55000/-
55000/-
100000/-
60000/25000/55000/-
1200/-
01027001
01027002
01027003
2000/1000/-
01027004
01027005
01027006
01027007
01027011
Surgery of Cord Tumours

Ventriculoatrial
/Ventriculoperitoneal
Shunt
Excision of Cervical InterVertebral Discs
Sympathetectomy Lumbar
Sympathetectomy Cervical
70000/-
70000/80000/-
80000/80000/80000/60000/-
40000/50000/18000/18000/-
22
Annexure-I
CODE
NAME OF TREATMENT
PROCEDURE
Maximum
Approved
Rate (INR)
(Rupees)
01027012
01027013
Twist Drill Craniostomy

Subdural Tapping
30000/15000/-
01027041
01027042
01027014
Ventricular Tapping
12000/-
01027043
01027015
15000/-
01027031
01027032
Abscess Tapping
Placement of ICP Monitor
Urokinase Therepy for
ICH Skull Traction Application
Lumber Pressure
Monitoring
Vascular Malformations
Peritoneal Shunt
Atrial Shunt
Meningo Encephalocoel
Meningomyelocoel
C.S.F. Rhinorrhaea
Cranioplasty
Posterior Cervical
Dissectomy
Anterior Cervical
Dissectomy
Brachial Plexus
Exploration Microsuturing
Median Nerve
Decompression
Peripheral Neurectomy
(Tirgeminal)
Trigeminal Rhiotomy
01027033
Cranial Nerve Astomosis
60000/-
01027034
Meningocoele Excision
Peripheral Nerve Surgery
Major
Peripheral Nerve Surgery
Minor
Ventriculo-Atrial Shunt
(Exclud. Cost of valve)
Nerve Biopsy (Procedure
+ Investigation)
Brain Biopsy (Procedure +
Investigation)
Anterior Cervical Spine
Surgery with fusion
45000/-
01027016
01027017
01027018
01027019
01027020
01027021
01027022
01027023
01027024
01027025
01027026
01027027
01027028
01027029
01027030
15000/15000/3400/10000/100000/15000/15000/52000/42000/55000/55000/50000/-
01027044
01027045
NAME OF TREATMENT
PROCEDURE
Anterior Lateral
Decompression
Brain Mapping
Cervical or Dorsal
Laminectomy
Combined Trans-oral
Surgery & CV Junction
Fusion
C.V. Junction Fusion
01027046
Depressed Fracture
40000/-
01027047
01027048
45000/50000/-
01027062
Discectomy
Endarterectomy
R.F. Lesion for Trigeminal
Neuralgia Spasticity Surgery Spinal Fusion Procedure
Spinal Intra Medullary
Tumours
Spinal Bifida Surgery
Major
Spina/ Bifida Surgery
Minor
Stereotaxic Proceduresbiopsy/ aspiration
Trans Sphenoidal Surgery
Trans Oral Surgery
Implantation of DBS- one
Electrode
Implantation of DBS- two
Electrodes
Endoscopic
Adueductoplasty
Facial nerve
reconstruction
Recanelisation of venous
sinuses
01027063
Carotid stenting
75000/-
01027064
Cervical disc arthroplasty

Lumbar disc arthroplasty
35000/-
CODE
01027049
01027050
01027051
01027052
01027053
01027054
50000/-
01027055
01027056
01027057
40000/-
01027058
45000/35000/-
01027059
50000/-
01027060
01027061
01027035
01027036
01027037
01027038
01027039
01027040
Maximum
Approved
Rate (INR)
(Rupees)
60000/2400/45000/-
110000/80000/-
30000/90000/65000/65000/65000/55000/22000/65000/110000/100000/100000/100000/50000/80000/-
50000/40000/100000/15000/-
01027065
30000/-
01027066
Corpus Callosectomy
60000/-
01027067
Hemishpherectomy
80000/-
18000/60000/-
23
Annexure-I
CODE
01027068
01027069
01027070
01027071
01027072
01027073
01027074
01027075
01027076
01027077
01027078
01027079
01027080
01027081
NAME OF TREATMENT
PROCEDURE
Endoscopic CSF
rhinorrhea repair
Microsurgical excision of
Acoustic tumour
Microsurgical excision of
meningomas
Epilepsy surgery
RF lesion for facet pain
syndrome
Cervical laminoplasty
Lateral mass C1-C2 screw
fixation
Microsurgical
decompression for
Trigemil nerve
Cerebellar stimulation for
hemifacial spasm
Cerebellar stimulation for
other cranial nerve
neuralgia
IC EC bypass procedures
Stereotactic guided
craniotomy
Baclofen pump
implantation lesioning for
movement disorder
including Parkinsonism
Maximum
Approved
Rate (INR)
(Rupees)
50000/-
18000/-
01027101
12000/-
01027102
01027103
Complex Brain Surgery
130000/-
01027104
Complex Spine Surgery
110000/-
01027105
Dorsal Sympathectomy
Neuro rehabilitisationpackage for 25 sittings
(bed charges extra)
Vascular Surgery
50000/-
60000/-
01027090
60000/-
01027091
80000/-
01027092
40000/40000/-
01027093
60000/-
60000/-
80000/70000/70000/-
01027098
60000/-
Endoscopic discectomy
60000/-
01027088
Aneurysm coiling
Endoscopic spil
procedure- aneurysm
80000/-
01027089
01027097
01027099
01027087
01027085
01027095
01027096
60000/-
01027084
01027094
80000/-
01027086
01027083
NAME OF TREATMENT
PROCEDURE
coiling
Surgery for grooving skull
fractures- aneurysm
coiling
Carpel Tunnel
decompression
Clipping of intracranial
aneurysm with use of clip
Endoscopic aspiration of
intracerebellar
haematoma
Stereotactic Radiosurgery
for brain pathology (X
knife/ Gamma)
Foramen magnum
decompression
Foramen magnum
decompression with
syringosubarachnoid
shunt
Dorsal column stimulation
for bachache in failed
back syndrome
Surgery for recurrent disc
prolapse/ epidural fibrosis
Surgery for brain stem
tumours
Decompressive
cranectomy for
hemishpherical acute
subdural
Intra arterial thrombolysis
with RTPA for ischemic
stroket RTPA-acute
Stereotactic aspiration of
intracerebral haematoma
Programmable shunt
Endoscopic
sympathectomy
External ventricular
drainage
Image guided surgery
Excision of tethored
Endoscopic 3rd
ventriculostomy
Endoscopic cranial
surgery/Biopsy/aspiration/
aneurysm coiling
01027082
CODE
Maximum
Approved
Rate (INR)
(Rupees)
40000/-
01027100
80000/40000/90000/-
60000/-
120000/60000/-
60000/-
50000/60000/100000/-
70000/-
100000/50000/-
60000/60000/-
01027106
028
15000/-
80000/-
24
Annexure-I
CODE
NAME OF TREATMENT
PROCEDURE
Maximum
Approved
Rate (INR)
(Rupees)
01028001
Patch Graft Angioplasty
50000/-
01029001
01028002
Operations for Stenosis of

Renal Arteries
50000/-
01029002
01028003
01028004
01028005
Thrombendarterectomy
Operations for Acquired
Arteriovenous Fistula
Congenital Arterio Venous
Fistula
80000/-
01029006
NAME OF TREATMENT
PROCEDURE
Excision of thyroglossal
Duct/Cyst
Diaphragmatic Hernia
Repair (Thoracic or
Abdominal Approach)
Tracheo Oesophageal
Fistula (Correction
Surgery)
Colon Replacement of
Oesophagus
Omphalo Mesenteric Cyst
Excision
Omphalo Mesenteric
Duct- Excision
42500/-
01029007
Meckels Diverticulectomy
50000/-
01029008
CODE
50000/01029003
50000/01029004
27700/01029005
01028009
Surgery for Arterial

Aneursysm -Vertebral
Aneursysm Carotid
Aneursysm Main Arteries
of the Limb
Dissecting Aneurysms +
Implant
150000/-
01028010
Stripping of Short or Long

Sephenous Veins
30000/-
01028006
01028007
01028008
01028011
01028012
Ligation of Ankle
Perforators
Excision and Skin Graft of
Venous Ulcer
17400/15500/-
Maximum
Approved
Rate (INR)
(Rupees)
30000/-
35000/-
40000/40000/30000/30000/30000/-
01029009
Omphalocele 1st Stage

(Hernia Repair)
Omphalocele 2nd Stge
(Hernia Repair)
01029010
Gastrochisis Repair
24000/-
01029011
Inguinal Herniotomy
24000/-
01029012
01029013
Congenital Hydrocele
Hydrocele of Cord
24000/22000/-
01029014
25000/-
28000/30000/-
01028013
Venous Thromoectomy
22100/-
01028014
Lymphatics Excision of
Subcutaneous Tissues In
Lymphoedema
30000/-
01029016
01029017
01029018
30000/-
01029019
16800/-
01029020
Torsion Testis Operation

Congenital Pyloric
Stenosis- operation
Duodenal- Atresia
Operation
Pancreatic Ring Operation
Meconium Ileus Operation
Malrotation of Intestines
Operation
Rectal Biopsy
(Megacolon)
40200/-
01029021
Colostomy Transverse
28000/-
40200/-
01029022
Colostomy Left Iliac

Abdominal Perineal Pull
Through (Hirschaprugis
Disease)
Imperforate Anus Low
28000/-
01028015
01028018
Trendelenburg Operations
Vascular Procedure
Minor
Aneursysm Spleen Artery
Aneursysm Renal Artery
029
Paediatric Surgery
01028016
01028017
01029015
01029023
01029024
27000/35000/45000/30000/32000/25000/-
35000/22000/-
25
Annexure-I
Maximum
Approved
Rate (INR)
(Rupees)
CODE
NAME OF TREATMENT
PROCEDURE
Maximum
Approved
Rate (INR)
(Rupees)
01029041
01029042
Peripheral Long Line

LP
800/300/-
01029043
Peritoneal Tapping
500/-
25000/-
01029044
800/-
21000/35000/-
01029045
Chest Drainage
General Nursery Care
(including Nursing Care
etc.)
01029027
01029028
NAME OF TREATMENT
PROCEDURE
Anomaly -Cut Back
Operation
Imperforate Anus Low
Anomaly - Perineal
Anoplasty
Inperforate Anus High
Anomaly -Sacroabdomino
Perineal Pull Through
Inperforate Anus High
Anomaly - Closure of
Colostomy
Intususception Operation
01029029
Choledochoduodenostom
y for Atresia of Extra
Hepatic Billiary Duct
35000/-
01029030
Operation of Choledochal
Cyst
35000/-
01029031
Nephrectomy for Pyonephrosis
35000/-
01029032
Nephrectomy for Hydronephrosis
CODE
01029025
01029026
01029033
01029034
01029035
Nephrectomy for -Wilms

Tumour
Paraortic
Lymphadenoctomy with
Nephrectomy for Wilms
Tumour
Sacro- Coccygeal
Teratoma Excision
28000/-
01029046
01029047
01029048
030
01030001
35000/-
01030002
01030003
35000/-
01030004
01030005
01029037
01029038
01029039
Neuroblastoma Debulking
Neuroblastoma Total
Excision
Rhabdomyosarcoma wide
Excision
Colon Transplant/ Conduit
Management following
Acid Structure
Oesophagus
01030006
30000/32000/-
01030008
36000/-
01030009
40000/-
01030010
65000/-
01030011
01030012
01029040
Umbilical Line
400/-
600/1600/-
6600/18000/21000/25000/-
24000/-
40000/-
01030007
01029036
Phototherapy per day

Neonate Rooming in with
mother per day (inclusive
of Nursing care)
SNCU (Sick New Born
Care Unit)
Laproscopic/
Endoscopic Operations
In Gen. Surgery /
Gastrohepatic / NephroDiagnostic Laproscopy
Laproscopic
Pyloromyotomy
Laproscopic Gastrostomy
Laproscopic Closure of
Perforated peptic ulcer
Laproscopic Vagotomy
Pyleroplasty/ gastro
jejunostomy
600/-
500/01030013
Laproscopic umbilical
hernia repair
Laproscopic ventral hernia
repair
Laproscopic
cystogastrostomy
Lap. Cholecystectomy &
CBD exploration
Lap. Hydatid of liver
surgery
Lap. Hepatic resection

Lap. Assisted small bowel
resection
Lap. For intestinal
obstruction
20000/25000/30000/26000/28000/-
28000/30000/30000/-
26
Annexure-I
CODE
01030014
01030015
01030016
01030017
01030018
01030019
01030020
01030021
01030022
01030023
01030024
01030025
NAME OF TREATMENT
PROCEDURE
Lap. For intestinal
perforation
Lap. Assisted Right
Hemicolectomy
Lap. Assisted left
Hemicolectomy
Lap. Assisted Total
Colectomy
Laproscopic Rectopexy
Lap. Asisted
Abdominoperineal
Resection of rectum
Lap. Assisted anterior
resection
Laproscopic
Cholecystectomy
Laproscopic
Appendicectomy
Laaproscopic Hernia
Repair
Laproscopic Hiatus Hernia
Repair
Maximum
Approved
Rate (INR)
(Rupees)
CODE
28000/-
01030038
NAME OF TREATMENT
PROCEDURE
Maximum
Approved
Rate (INR)
(Rupees)
37000/-
01030040
32000/-
01030041
Nephrolithotomy
Operations for
HydronephrosisPyeloplasty
Operations for
HydronephrosisEndopyelotomy antegrade
Operations for Cyst of the
Kidney
01030042
URSL
25000/-
01030043
50000/-
01030044
Nephroureterectomy
Operations for Vesicoureteric Reflux
40000/-
01030045
Diverticulectomy
22000/-
01030046
35000/-
01030048
Repair of Ureterocoel
Palomos- Unilateral
Palomos- Bilateral
30000/-
32000/-
01030039
32000/-
35000/-
35000/-
35000/40000/-
37000/37000/25000/21000/21000/30000/-
01030047
20000/-
Laproscopic Adhesiolysis
Laproscopic
Adrenalectomy
Laproscopic
Thyroidectomy
Laproscopic
Spleenectomy
Laproscopic Colectomy
Rs 18000/-
01030049
Nephrostomy
16000/-
32000/-
01030050
Orchidopexy- Unilateral
25000/-
32000/-
01030051
Orchidopexy- Bilateral
30000/-
32000/35000/-
01030052
Prostratectomy
45000/-
40000/-
01030053
Laparoscopic Uro stone
30000/-
01030054
01030036
01030037
Incisional Hernioplasty
Radiotherapy &
Chemotherapy
(packages)
Nuclear MedicinesRadio Isotope Therapy
131- Iodine Therapy <
15mCi
131- Iodine Therapy 15-50
mCi
131- Iodine Therapy 51100 mCi
35000/-
01030035
Laproscopic Nephrectomy
Inguinal Hernia
(Laproscopic)
Laproscopic
Pyelolithotomy
Ureterolithotomy
Lap Ovarian Cystectomy
Laparoscopic
Hysterectomy
01030026
01030027
01030028
01030029
01030030
01030031
01030032
01030033
01030034
20000/30000/22000/22000/-
031
25000/-
01031001
Laparoscopic Ectopic
22000/-
01031002
Foreign body removal
4000/-
01031003
5200/16900/16900/-
27
Annexure-I
01031006
NAME OF TREATMENT
PROCEDURE
131- Iodine Therapy >
100mCi
Strontium therapy for
metastatic bone pain
palliation
Samarium-153 therapy for
metastatic bone pain
palliation
032
Cobalt 60 Therapy
01032001
Radical Therapy
Adjustment TherapyImmobilisation technique
Palliative Therapy (less
than 10 fractions)
Palliative Therapy (10-25
fractions)
Palliative Therapy (single
fraction)
CODE
01031004
01031005
01032002
01032003
01032004
01032005
033
01033001
01033002
01033003
01033004
01033005
Linear Accelerators
3-D Planning (L. Acc. or
Cobalt-60)
2-D Planning (L. Acc. or
Cobalt-60)
Intensity Modulated Radio
Therapy (IMRT)
Image Guided Radio
Therapy (IGRT)
Maximum
Approved
Rate (INR)
(Rupees)
CODE
19500/-
01033013
7200/-
70000/16000/15000/25000/5000/-
5000/105000/150000/-
65000/-
01033007
3D-CRT with IGRT
75000/-
01033008
4D-CRT with IGRT

Stereotactic Radio
Surgery (SRS)
Stereotactic Radio
Therapy (SRT)
90000/-
01033011
01033012
Rapid Arc with IMRT rate

Palliative Radiation
Therapy upto 15 fractions
Pre-radiation profile
034
01034004
Brachy Therapy
Intra Cavitary
Brachytherapy- 1st
insertion
Intra Cavitary/ Intra
Luminal Brachytherapy2nd and subsequent
insertion
Interstitial Brachy
Therapy- 1st insertion
Interstitial Brachy
Therapy- 2nd insertion
035
Chemotherapy
01035001
Neoadjuvant
1000/-
01035002
Adjuvant
1000/-
01035003
1000/20000/-
01035005
Infusional Chemotherapy
Chemotherapy wafers for
malignant brain tumours
Multiple drug therapy per
day
01035006
Targeted therapy
1000/-
01035007
Chemoport facility
1000/-
01033016
01033017
01033018
6000/-
01033006
01033010
01033020
01033014
01034001
IGRT Single Fraction

3D-CRT (Confirmal Radio
Therapy)
01033009
01033019
NAME OF TREATMENT
PROCEDURE
Palliative Radiation
Therapy upto 25 fractions
Palliative Radiation single
fraction
Conventional Radiation
Therapy with CT
Conventional Radiation
Therapy CBCT
SRS/ SRT Neuro
interventional charge/
case
Electron Beam (>10
Fractions)
Electron Beam (<10
Fractions)
01033015
10700/-
7000/-
85000/70000/100000/25000/-
Maximum
Approved
Rate (INR)
(Rupees)
01034002
01034003
01035004
35000/10000/35000/45000/-
10000/40500/9000/2500/-
5500/-
3000/15000/10000/-
900/-
28
Annexure-I
Maximum
Approved
Rate (INR)
(Rupees)
01035008
NAME OF TREATMENT
PROCEDURE
PICC line (Peripherally
Inserted Central
Canulisation)
036
Room Rent
(Per day)
01036001
General Ward
600/-
01036002
Semi-Private Ward
1200/-
01036003
1800/-
037
Private Ward
Day Care/ Minor (OPD)
Surgeries (all categories)
Admissible Blood
Charges
For treatment in
Government Hospitals
01037001
General Beds
50/-
01037002
Paying Beds
100/-
01037003
140/-
038
Cabin
For treatment in
recognised Private
Hospitals/ Nursing
Homes/ Aided
Institurions
01038001
Whole Blood
500/-
01038002
F.F.P.
400/-
01038003
Platelet Concentrate
400/-
01038004
Platelet Rich Plasma
400/-
01038005
Packed Cell
400/-
01038006
Frozen Plasma
350/-
01038007
Crypoprecipitate
300/-
01038008
Washed RBC
400/-
CODE
01036004
1000/-
600/-
29
Annexure-I
RATES OF INVESTIGATIONS :
CODE
NAME OF
INVESTIGATION
Maximum
Approved
Rate (INR)
(Rupees)
02002019
Tympanometry
150/-
02002020
Voice Assest
250/-
02002021
Endo Laryngoscopy
850/-
02002022
ENG
1300/-
02002023
Nasal Endoscopy
600/-
750/-
02002024
Nasopharyngoscopy
600/-
900/-
02002025
003
LV Dyssynchrony Study
Eye
1400/-
02003001
Refraction/Fundoscopy
150/-
02003002
Ortho-optic check up
150/-
02003003
Perimetry/field test
400/-
02003004
Clinical Photography
100/-
02003005
Electrooculogram
500/-
02003006
ERG
400/-
02003007
Flourescein Angioraphy
800/-
02003008
A-Scan
200/-
02003009
Tono Graphy
450/-
02003010
VER
300/-
02003011
Goldmen Perimetry
150/-
250/-
02003012
Specular microsopy
Indo cyaningreen
Angiography of Retina
Indo cyaningreen
Angiography - IRIS
Automated Perimetry
Corneal endothelial cell
count
Corneal topography
200/-
02 INVESTIGATIONS
CODE
001
02001001
NAME OF
INVESTIGATION
Maximum
Approved
Rate (INR)
(Rupees)
02001003
General
Aspiration Plural Effusion Diagnostic
Abdominal Aspiration Diagnostic
Pericardial Aspiration
1200/-
02001004
Bone Marrow Aspiration
800/-
02001005
Joints Aspiration
750/-
02001006
E.C.G.
140/-
02001007
E.E.G.
800/-
02001008
Stress test (TMT)
850/-
02001009
Lumbar puncture
1000/-
02001010
002
Sternal puncture
800/-
02002001
Pure Tone Audiogram
300/-
02002002
300/-
02002003
Impedence & other tests

SISI, Tone Decay &
Difference times
450/-
02003013
02002004
Multiple hearing
assessment test to Adults
02002005
Hearing Aid Selection
100/-
02003014
02002006
400/-
02003015
200/-
02003016
200/-
02003017
02002009
Hearing Aid Analysis

Speech Discrimination
Score
Speech Assessment
Cold Calorie Test for
Vestibular function
02002010
Audiometry (MHC)
250/-
02003019
02002011
ABR (Threshold Est.)
650/-
02003020
02002012
Acoustic Reflex Decay
100/-
02003021
02002013
Eustachian Tube Func
100/-
02003022
02002014
IMP Audiometry
300/-
02002015
Otoacoustic Est. (OAE)
550/-
02002016
PEAD Audio Assessment
200/-
02003024
02002017
SRT & SDS
150/-
02003025
02002018
Swallowing Assest
30/-
02001002
02002007
02002008
E.N.T.
180/-
02003018
02003023
1000/1000/450/200/200/-
Corneal pachymetry
Retinal nerve film analyzer
studies
Auto Refrectemetry
200/-
Biometry
Ultrasound studies - A
Scan
Ultrasound studies -- B
Scan
Retinal/Meter function
studies
PAN ACUITY METER
180/-
100/60/-
600/600/150/200/-
30
Annexure-I
02003026
NAME OF
INVESTIGATION
Laser interferometry
Maximum
Approved
Rate (INR)
(Rupees)
1000/-
02003027
EKG, EOG
500/-
02003028
Dacryocystography (DGC)
500/-
02003029
500/-
02003031
Orbital Angio studies

Digital Biometry Reading
(Single)
Biometry (Both Eye)
350/-
02003032
Biometry-corp (Both)
400/-
02007011
02003033
Biometry-corp-Single
300/-
02007012
02003034
Pachymetry (Both Eye)
400/-
02003035
Pachymetry (Single)
200/-
02003036
Multifocal ERG (One Eye)
800/-
02003037
NCT
160/-
02003038
OCT- NFL Analyser
1600/-
02003039
Schiotz Tonometer
250/-
02003040
TTT
2500/-
02007018
02003041
VEP
Anterior Segment (Fundus)
Photography
600/300/550/-
005
USG
Physiotheraphy
Muscle testing and
diagnostic
Dental
02005001
Intra oral X-ray (Digital)
80/-
02005002
Opg Cephalogram
02005003
02006001
007
Opg Standard View

Radio Visiograph (per
Image)
Genetics
Fragile X Decet & Karyo of
Peri Bld Cell
X-Ray (Digital X Ray)
02007001
Fluroscopy chest
120/-
02007032
02007002
Occlusal
Abdomen AP or Erect (one
film)
Abdomen Lateral view (one
film)
Abdomen for Pregnancy
130/130/-
CODE
02003030
02003042
02003043
004
02004001
02005004
006
02007003
02007004
02007005
Maximum
Approved
Rate (INR)
(Rupees)
130/-
02007014
NAME OF
INVESTIGATION
Chest PA view (one film)
Chest Oblique or Lateral
(One film)
Mastoids (one film)
Extremities, bones & Joints
(one film)
Pelvis (One film)
Paranasal sinuses (One
film)
T.M. Joints (One film)
Abdomen & pelvis for
K.U.B.
Skull A.P. & Lateral
02007015
Spine A.P. & Lateral
250/-
02007016
Barium Swallow
700/-
02007017
750/-
02007019
Sinography/ Sialography
Cystography/
Urethrography
Hystero-Salpaingography
1110/-
02007020
Arthrography
840/-
02007021
1080/-
1160/-
02007025
Retrograde Pyelography
Oral or I.V.
Cholecystography
Barium Enema
Barium Meal Upper or
Lower
Bronchography
210/-
02007026
I.V. Urography/ I.V.P.
1350/-
210/-
02007027
Myelography
1500/-
02007028
Pneumo Encephalography
1120/-
02007029
1230/-
02007033
Barium meal Complete

Cerebral/Femoral
Angiography
Periapical X-Ray
Barium Enema (Double
Cont.)
Barium IC Junction
02007034
Gastro Conray Meal
750/-
02007035
Intravenous Pyelogram
1400/-
130/-
02007036
T-Tube Cholangiogram
700/-
130/-
02007037
PTBD Gram
700/-
02007038
Micturating
750/-
180/-
CODE
02007006
02007007
02007008
02007009
02007010
02007013
02007022
100/-
02007023
02007024
110/-
02007030
3500/-
02007031
130/150/140/140/140/140/250/250/-
1120/-
720/-
960/1260/-
2000/100/1300/750/-
31
Annexure-I
CODE
02007039
02007040
02007041
NAME OF
INVESTIGATION
Cystourethrogram (MCU)
VUR/ Cystourethrography
Small Bowel Enema
Any XRAY using portable
machine-addl handling
charge
Any other XRAY- single
Film (Small)
Maximum
Approved
Rate (INR)
(Rupees)
02008001
I.V. Urography/ I.V.P.
Rs 950/-
02008027
Myelography
Rs 1050/-
02008028
Pneumo Encephalography
780/-
02008029
860/-
02008033
Barium meal Complete

Cerebral/Femoral
Angiography
Periapical X-Ray
Barium Enema (Double
Cont.)
Barium IC Junction
530/-
02008024
300/-
130/-
160/-
02008030
02008031
02007043
008
02008026
02008023
02007042
Film (Large)
02008025
NAME OF
INVESTIGATION
Barium Enema
Barium Meal Upper or
Lower
Bronchography
CODE
2600/1150/-
Conventional X-Ray (70%

of Digital X-Ray rates)
Fluroscopy chest
02008032
90/-
Maximum
Approved
Rate (INR)
(Rupees)
810/670/880/-
1180/70/910/530/-
Occlusal
Abdomen AP or Erect (one
film)
Abdomen Lateral view (one
film)
Abdomen for Pregnancy
90/-
02008034
Gastro Conray Meal
90/-
02008035
Intravenous Pyelogram
980/-
02008036
T-Tube Cholangiogram
490/-
02008037
490/-
90/-
02008014
Chest PA view (one film)

Chest Oblique or Lateral
(One film)
Mastoids (one film)
Extremities, bones & Joints
(one film)
Pelvis (One film)
Paranasal sinuses (One
film)
T.M. Joints (One film)
Abdomen & pelvis for
K.U.B.
Skull A.P. & Lateral
PTBD Gram
Micturating
Cystourethrogram (MCU)
VUR/ Cystourethrography
02008015
Spine A.P. & Lateral
170/-
02008016
Barium Swallow
490/-
02008017
520/780/-
02009003
02008019
Sinography/ Sialography
Cystography/
Urethrography
Hystero-Salpaingography
Rs 780/-
02008020
Arthrography
590/-
02008021
Retrograde Pyelography
Oral or I.V.
Cholecystography
760/-
02008002
02008003
02008004
02008005
02008006
02008007
02008008
02008009
02008010
02008011
02008012
02008013
02008018
02008022
90/90/-
90/-
02008038
02008039
02008040
100/90/-
02008041
90/90/-
160/-
1820/810/300/-
90/-
02008042
Film (Large)
90/170/-
Small Bowel Enema

Any XRAY using portable
machine-addl handling
charge
Film (Small)
530/-
110/-
02008043
800/-
02009004
Ultrasound
Investigations
Obstetric First Scan/
Follow up
USG: Lower Abdomen/
Pelvis
Upper abdomen First
Scan/ Follow up
UltrasoundNeurosonogram
350/-
02009005
USG- NeurosonogramScreening
009
02009001
02009002
500/-
600/900/-
510/-
32
Annexure-I
CODE
NAME OF
INVESTIGATION
02009006
Total Abdominal survey or

Multiple organ study
Maximum
Approved
Rate (INR)
(Rupees)
Maximum
Approved
Rate (INR)
(Rupees)
CODE
NAME OF
INVESTIGATION
Salt
02010004
Urine Urobilinogen
50/-
1230/-
02010005
Urine Ketones
50/-
700/-
02010006
Urine Occult Blood
50/-
950/-
02009008
Special procedures &

Aspiration etc.
Image Intensifiers
02009009
USG: Neck
850/-
02010007
Urine total proteins
100/-
02009010
USG: KUB
800/-
02010008
Urine Sodium
100/-
02009011
950/-
02010009
Urine Chloride
100/-
02010010
Bence Jones protein
90/-
1500/-
02010011
Stool routine
60/-
02009013
USG: Whole Abdomen

USG: Whole Abdomen +
Transrectal
USG: Scrotum
02010012
02009014
600/-
02009015
Ultrasound Bladder
600/-
02010013
02009016
Ultrasound Kidney/ Renal
600/-
02010014
02009017
USG: Pregnancy + Doppler
2200/-
Stool occult blood

Post coital smear
examination
Smear analysis
Body fluid (CSF/Ascitic
Fluid etc.) Chemistry,
Sugar, Protein etc.
Body fluid for Malignant
cells
Urinary Porphobilinogen
60/-
USG: Testis
02009007
02009012
900/-
02010015
02009018
USG: Joint (Unilateral)
900/-
02009019
USG: Joint (Bilateral)
1800/-
02009020
USG: Musculoskeletal
800/-
02009021
USG: Transrectal
800/-
02009022
USG: Breast Unilateral
700/-
02009023
USG: Breast Bilateral
1050/-
02010019
02009024
USG: Thyroid
800/-
02010020
02009025
USG: Chest
700/-
02009026
USG: Prostate
550/-
02009027
USG: Single Organ
550/-
02009028
USG: Follicular Study
1250/-
02009029
USG: Guided Procedure
600/-
02009030
USG: FNAC
900/-
02009031
USG: Follow-up Ovulation

USG: For Congenital
Anomaly
Ultrasound Parotid
600/-
02009032
02009033
1800/800/800/-
02009035
010
Ultrasound Thigh
Any USG using portable
machine- handling charge
Clinical Pathology
02010001
Urine routine
60/-
02010002
Quantitative Albumin/Sugar
50/-
02010003
Urine Bile Pigment and
50/-
02009034
200/-
02010016
02010017
100/100/240/200/110/-
02010022
Urinary Myoglobin
Urine for
Immunoelectrophoresis
Urine for Protein
Electrophoresis
CRK ISO Enzyme
Electrophoresis
Hb Electrophoresis
02010023
Chyle Test
100/-
02010024
Semen Analysis
280/-
02010025
IVF Semen Analysis
250/-
02010026
Stool Reducing Substance
60/-
02010027
Stool for OVA, Parasite
70/-
02010028
Stool for Parasite
60/-
02010029
200/-
02010032
Stool Culture & Sensitivity

Urine for Culture &
Sensitivity
Karyotype Chromosome
Analysis
Genotyping
5000/-
02010033
Glucotyping
5000/-
02010034
Urine for Electrolytes
200/-
02010018
02010021
02010030
02010031
400/3500/2800/5000/600/-
250/2400/-
33
Annexure-I
02010035
NAME OF
INVESTIGATION
Urine Amino-aciduria
Maximum
Approved
Rate (INR)
(Rupees)
150/-
02010036
Urine for Phosphorus
220/-
02010037
Urine for Z-N Stain

Urine Protein/Creatinine
Ratio
Opiates Serum Random
Urine
Opiates Random Urine
Urine Ammino Acid,
Qualitative, 2 Dimensional
Pre/Post-Dialysis
Creatinine
Pre/Post-Dialysis
Potassium
Pre/Post-Dialysis Sodium
60/-
CODE
02010038
02010039
02010040
02010041
02010042
02010043
02010044
250/450/-
100/-
100/-
Pre/Post-Dialysis Urea
02011001
02011004
Haemoglobin (Hb)
Total Leucocytic Count
(TLC)
Differential Leucocytic
Count (DLC)
E.S.R.
02011005
Total Red Cell count
60/-
02011006
Platelet count
80/-
02011007
Reticulocyte count
70/-
02011008
Absolute Eosinophil count
60/-
02011009
50/-
02011011
Packed Cell Volume (PCV)

Peripheral Smear
Examination
Smear for Malaria parasite
02011012
Bleeding & Clotting Time
60/-
02011013
Clot Retraction Time
50/-
02011014
R.B.C. Fragility Test
100/-
02011015
L.E. Cell
120/-
02011016
Foetal Haemoglobin (Hb-F)
250/-
02011017
Prothrombin Time (P.T.)
150/-
02011018
Complete Haemogram
Bone Marrow Smear
Exmination
Partial Thromboplastin
180/-
02011003
02011010
02011019
02011020
NAME OF
INVESTIGATION
220/-
02011021
Glucose 6 Phosphate
Dehydrogenase (G, 6PD)
P.C.V. Haematocrit
50/-
RBC Folate
1350/-
Whole Blood Folate
1350/-
Sickling Test
120/-
Bleeding Time
40/-
Clotting Time
40/-
D-Dimer Semi Quantitative
900/-
Scurose Lysis Test
280/-
Red Cell Osmotic Frag.

with Incubato
280/-
Heinz Body Test
120/-
Fibrinogen
400/-
FDP
150/-
Plasma Haemoglobin
190/-
Factor VIII Studies
1000/-
Factor IX Functional
1200/-
Factor V Functional
2500/-
Factor V Lieden Mutation

Analysis
4000/-
02011022
02011023
02011024
02011025
100/-
02010045
011
02011002
CODE
450/700/-
Maximum
Approved
Rate (INR)
(Rupees)
02011026
80/02011027
Haematology
50/50/50/-
02011028
02011029
50/-
70/-
02011030
02011031
02011032
02011033
70/02011034
02011035
02011036
02011037
400/200/-
02011038
34
Annexure-I
CODE
NAME OF
INVESTIGATION
Maximum
Approved
Rate (INR)
(Rupees)
TC, DC, ESR
120/-
02011039
02011040
Absolute Lymphocytes
Count
80/-
HB, TC, DC
120/-
Bone Marrow [Perls Stain]
750/-
02011060
Cell Type & Cell Count
320/-
02011061
Nasal Smear for

Eosinophils
90/-
02011062
02011043
650/-
AT III Anti Thrombin
650/-
Absolute Neutrophil Count
50/-
Osmotic Fragility
120/-
HLA Typing
10000/-
T-Cell Cross Matching
5000/-
Karyotyping for Bone

Marrow Cancer (REL
6000/-
Sucrose Lysis Test
120/-
APTT (50:50)
200/-
Immunofixation
Electroporesis
7200/-
02011059
CSF Cell Counts [TC/DC]
170/-
02011063
Complete Blood Picture

[CBP]
180/-
02011064
02011045
02011065
MCV MCH MCHC
180/-
02011047
Investigation of ABO/RH
360/-
02011048
02011066
012
Blood Group & RHO Type
140/-
Cross match
Packed Cells- Proc.
Charges
Saline Washed Packed
Cells: Proc. Charges
Coombs Test Direct/
Indirect
Australia Antigen
50/-
400/-
02012002
Blood Parasites
70/-
02012003
02011050
02012004
Malaria Parasite
70/-
02011051
02012005
Malarial Antigen Detection
320/-
02011052
02012006
02012007
Filaria Antigen W. Bancrofti
560/-
Lap Score
400/-
02011053
02011054
02012008
02012009
02012010
BAL Cell Count
100/02012011
02011055
Cold Agglutination
150/-
Blood Bank
02012001
Sinovial Fluid for Analysis
02011049
02011056
AT III
02011058
02011042
02011046
NAME OF
INVESTIGATION
02011057
02011041
02011044
CODE
Maximum
Approved
Rate (INR)
(Rupees)
02012012
02012013
RHO, Antibody titer

Platelet rich Plasma-Proc.
Charges
Whole Human Blood-I.P.Proc. Charges
Fresh frozen Plasma: Proc.
Charges
Cryoprecipitate: Proc.
Charges
Platelet Concent- Proc.
Charges
Therapeutic Phlebotomy:
Proc. Charges
450/450/200/200/250/450/450/450/450/450/450/-
35
Annexure-I
Maximum
Approved
Rate (INR)
(Rupees)
02013033
NAME OF
INVESTIGATION
Cortisol
Maximum
Approved
Rate (INR)
(Rupees)
650/-
CODE
450/-
02013034
HDL Cholestrol
200/-
02013035
VLDL Cholesterol
170/-
02013036
480/-
02013003
NAME OF
INVESTIGATION
Granulocyte Conc.: Proc.
Charges
Bio-Chemistry
Glucose blood- Fasting/
PP/ Random
Blood Urea Nitrogen/ Blood
Urea
Serum Creatinine
02013004
Serum Uric Acid
110/-
02013039
Alkaline Phosphatase
150/-
02013005
Serum Bilirubin total/ direct
130/-
02013040
300/-
02013006
Serum Iron
220/-
02013041
600/-
02013007
Serum Cholesterol
120/-
02013042
Acid Phosphatase
Leucocyte Alkaline
Phosphatase Score
Serum Magnesium
02013008
Total Iron Binding Capacity
300/-
02013043
Serum Copper
500/-
02013009
CK MB
390/-
02013044
Serum Lithium
250/-
02013010
Serum Calcium
120/-
02013045
Serum Lipase
250/-
02013011
Serum Phosphorus
120/-
02013046
150/-
02013012
Total Protein Alb/Glo Ratio
140/-
02013013
S.G.P.T.
120/-
02013014
S.G.O.T.
120/-
02013015
Serum amylase
250/-
02013049
02013016
Serum Electrolyte
250/-
02013050
Serum Chloride
Serum Inorganic
Phosphorous
Serum Ceruloplasmin
Serum
Carbamazepine/Tegretol
Carbamazepine
02013017
220/-
02013051
Serum Calcitonin
1400/-
300/-
02013052
Calcitonin
1200/-
02013019
Triglyceride
Glucose Tolerance Test
(GTT)
C.P.K.
270/-
02013053
Myoglobin Serum
2400/-
L.D.H.
210/-
02013054
Serum C Peptide
800/-
02013020
02013021
L.D.-1
320/-
02013055
Serum C Peptide (PP)
500/-
LDH & LD-1
470/-
02013057
Serum Eption/Phenytoin
700/-
02013022
02013023
T3
300/-
02013058
Albumin (Serum)
120/-
02013024
T4
300/-
02013059
Serum Ferritin
720/-
TSH
300/-
02013060
Serum B12 Level
600/-
02013025
02013026
T3, T4, TSH
700/-
02013061
Serum Sodium
240/-
FSH
420/-
02013062
Serum Folate
720/-
02013027
02013028
LH
410/-
02013063
Folate & Vitamin 12 Serum
1100/-
02013029
FSH & LH
670/-
02013064
Serum Aldolase
400/-
Prolactin
470/-
02013065
Serum Acetaminophen
650/-
02013030
02013031
Blood gas analysis

Blood gas analysis with
electrolytes
400/-
02013066
550/-
500/-
02013067
Serum Growth Hormone

Parathyroid Hormone
(PTH), Intact
Serum Osmolality
CODE
02012014
013
02013001
02013002
02013018
02013032
70/80/-
02013037
ALDL
Lipid Profile
100/-
02013038
LFT [Liver Function Test]
700/750/-
02013047
02013048
02013068
170/-
160/750/1400/600/-
1200/250/-
36
Annexure-I
CODE
02013069
NAME OF
INVESTIGATION
Serum Potassium
Maximum
Approved
Rate (INR)
(Rupees)
150/-
02013074
Serum TIBC
Serum Parathormone
Level
Serum Homocystine/
Homocystine/ Homocystine
Level
Serum Individual
Phospolipids-TLC
Serum/Plasma Bicarbonate
02013075
Serum Haptoglobin
850/-
02013076
Serum Testosterone
500/-
02013077
Serum Thyroglobulin
1360/-
02013078
Lactate Plasma
550/-
02013079
CA-19-9
1000/-
02013080
CA 125
800/-
02013081
160/1050/-
02013083
CA 15.3
CA 72.4 Gastric Cancer
Marker
CSF Sugar
02013084
CSF Protein
100/-
02013085
400/-
2000/-
02013089
Lactate (CSF)
CSF Protein
Electropherisis
CSF-Oligoclinal Band
Analysis
CSF for Biochemical
Analysis
CSF Chloride
02013090
CSF Profile
3200/-
02013091
Sodium Bicarbonate
Mucopolysaccharidoses
(MPS) Screening U
Renin Activity Plasma,
PRA
Plasma Ammonia
100/-
02013070
02013071
02013072
02013073
02013082
02013086
02013087
02013088
02013092
02013093
02013094
280/-
02013101
02013102
750/-
02013103
100/-
450/-
02013108
650/-
02013110
Beta HCG (B-HCG)

Beta HCG Quantitative
Trophoblastic Cancer
Marker
Cardiac Enzymes
02013111
LDH Heat Stable Fraction
640/-
02013112
1430/-
02013113
LDH Isoenzymes
Antiphospolipid Antibody
IGG & IGM
02013114
Antiphospolipid Antibody
IGM
02013109
Estradiol
520/-
02013099
Estradiol (E2)
420/-
450/-
1050/750/-
Cyst Fluid for Analysis
350/-
02013125
Trop-T
820/-
02013126
Troponin T-Qualitative
400/-
02013127
Intracellular Calcium
Pleural/ Peritoneal Fluid for
Sugar
Peritoneal Dialysis Fluid for
Sugar & Urea
120/-
02013120
02013122
02013098
600/-
02013124
02013119
4000/-
120/-
900/-
02013123
02013118
02013121
02013097
800/-
Anti-Sperm Antibody/ ABS

Alpha-Feto Protein (AFP)
Cancer Marker
Carcino Embryonic Antigen
[CEA]
Anti-Thyroid Antibodies
Anti-Thyroid Antibodies-TG
Ab
Bicarbonate
Anti Cardiolipin AntibodyIgG/ IgM
Anti Cardiolipin Antibody
Profile
C_Peptide Assay
02013115
500/-
320/-
550/-
Progesterone
02013117
400/-
650/-
02013107
02013116
150/-
1200/-
02013106
02013105
800/-
280/-
520/-
700/-
450/350/-
NAME OF
INVESTIGATION
Glycosylated Haemoglobin
[HBA1C]
Alpha I Anti Trypsin Assay
Insulin-P.P./ Fasting/
Random
Lactose Tolerance Test
DHEA-S (Sulphate)
Serum Digoxin/ Serum
Digoxin Level
Serum Gastrin
02013104
200/-
02013096
02013100
900/-
Fructosamine
GGT-Gamma Glutamyl
Transaminase
Globulin
02013095
CODE
Maximum
Approved
Rate (INR)
(Rupees)
02013128
02013129
550/650/600/950/900/150/650/1700/350/-
80/220/-
37
Annexure-I
02013130
NAME OF
INVESTIGATION
Apolipo Proteins
Maximum
Approved
Rate (INR)
(Rupees)
500/-
02013131
Free Testosterone
600/-
02013132
Blood Acetone/Ketone
240/-
02013133
Pleural Fluid for Protein
80/-
02013167
02013134
Pleural Fluid for LDH
200/-
02013168
NAME OF
INVESTIGATION
Pericardial Fluid for
Biochemistry
Pericardial Fluid Test
Peritoneal FluidBiochemistry
Aldosterone
02013135
Pleural Fluid for Amylase
180/-
02013169
Galactosemia Profile
1800/-
02013136
Fluid for LDH
160/-
02013170
FISH (NH)
2800/-
02013137
Fluid for Amylase
130/-
02013171
FISH for BCR/ ABL
3200/-
02013138
Fluid for Creatinine
110/-
02013172
Fluid for TVPCR
1400/-
02013139
Fluid for Lipase
130/-
02013173
Serum Cortisone
380/-
02013140
Fluid for Cholesterol
150/-
02013174
Transferrin
780/-
02013141
720/-
02013175
Chromogranin A
5000/-
1700/-
02013176
Cryo Globulin Screening
780/-
02013177
Cocaine Metabolite Screen
500/-
02013178
Cyclosporine CO
1600/-
720/-
02013179
Cytokeratin/ Erythropoietin
1200/-
900/-
02013180
014
Protein C/ S, Functional
2800/-
02013146
Phenytoin Level
24 H Ketosteroid &
Ketogenic Steroid
Angio Tension Converting
Enzyme (ACE)
Phenobarbitone
Anti Thyroid Antibodies
TPO Ab
Anti TG
02013147
ACTH
960/-
02014001
02013148
ACTH Plasma
960/-
02013149
Intact PTH
700/-
02013150
IGFI
350/-
02013151
IGF-I (Somatomedin-C)
2800/-
02013152
B-2 Microglobulin
960/-
02013153
Valproic Acid
520/-
02015003
02013154
Valproate
520/-
02015004
Pap Smear
Histopathology exam per
tissue type
Bactriology & Serology
Smear gram-strain
examination
Sputum smear A.F.B. stain
Vaginal Smear
Examination
V.D.R.L.
02013155
Sex Hormone Binding
1200/-
02015005
Widal test
180/-
02013156
Vitamine B-12 Level
800/-
02015006
300/-
02013157
Vitamin D 25 Hydroxy
1400/-
250/-
02013158
17 Hydroxy Corticostiroids
580/-
02013159
400/-
02015009
C.R.P.
220/-
480/-
02015010
ASO Titer
250/-
02013161
Lipoprotein (a)
Synovial Fluid for
Biochemistry
Plasma Catecholamines
02015008
Rheumatoid Factor test

Culture & Sensitivity (other
specimens)
Urine pregnancy test
5500/-
02015011
Quantitative H.C.G.
400/-
02013162
Serum IgA
220/-
02015012
Blood culture & sensitivity
250/-
02013163
Serum IgG
220/-
02015013
Vibro cholera culture
250/-
02013164
Serum IgM
400/-
02015014
CAPD Fluid for Culture &
350/-
CODE
02013142
02013143
02013144
02013145
02013160
780/-
550/-
CODE
02013165
02013166
02014002
015
02015001
02015002
02015007
Maximum
Approved
Rate (INR)
(Rupees)
360/100/450/1150/-
Histopathology
240/250/-
100/100/100/120/-
200/-
38
Annexure-I
CODE
NAME OF
INVESTIGATION
Sensitivity
Maximum
Approved
Rate (INR)
(Rupees)
CODE
02015044
NAME OF
INVESTIGATION
Maximum
Approved
Rate (INR)
(Rupees)
02015015
CAPD Fluid for Fungal

Stain/ Gram Stain
100/-
02015016
CAPD Fluid-Cytology
200/-
02015017
02015018
Rapid Urease Test

ASO (Antistreptoysin O)
250/360/-
02015019
High Sensitivity-CRP
400/-
02015047
Arterial Line Tip for Culture

& Sensitivity
Ascitic Fluid for Culture &
Sensitivity
AC Tap for Culture &
Sensitivity
Sputum for AFB Culture
02015020
PUS for Fungal Culture
250/-
02015048
Sputum for Fungal Culture
150/-
02015021
PUS for Fungal Stain
100/-
02015049
Sputum for Fungal Stain
100/-
02015022
PUS for Gram Stain
02015050
Sputum for Z-N Stain
100/-
02015023
PUS for Z-N Stain
100/100/-
02015051
100/-
02015024
Culture & Sensitivity [PUS]
250/-
02015025
Culture & Sensitivity [CSF]

Culture & Sensitivity
[Semen]
Culture & Sensitivity [Fluid]
[Sputum]
[Throat Swab]
Culture & Sensitivity for
Vaginal Swab
Culture & Sensitivity for
Aspirated Fluid
[Wound Swab]
Wound Swab for Fungal
Stain
Wound Swab for Gram
Stain
Wound Swab for Z-N Stain
[Rectal Swab]
Nail for Fungal Culture
Nail Clipping for KOH
preparation
Blood Culture & SensitivityAnaerobic
Blood for Culture &
Sensitivity (Paediatric)
Tissue for Culture &
Sensitivity
Mitral Valve Tissue for
Aortic Valve Tissue for
250/-
02015057
Sputum for Grams Stain

Esophageal Smear for
Candida
Urine for AFB Culture
Pleural Fluid for AFB
Culture
Pleural Fluid- TBPCR
Culture AFB Antibiotic
Sensitivity- 5 Drug Panel
Urine for Gram Stain
02015058
Throat Swab for KLB
100/-
02015059
150/-
02015066
Fungus Culture
Clostridium Difficile Toxin A
&B
Yeast Identification and
Susceptibility
Non Fermenter
Identification
Serology for Mumps
IGM/IGG
Torch Profile
Serum Angitens. Conv.
Enzy. Assay
P-ANCA
02015067
C-ANCA
800/-
600/-
02015068
80/-
600/-
02015069
Aldehyde Serum Test

Elisa Test for Ecinococcus
Antibody Detec
Ascitic Fluid Cell Count
Anti HBS (Antibody to
Australia-Antigen)
Hepatitis B Surface
Antibody
02015026
02015027
02015028
02015029
02015030
02015031
02015032
02015033
02015034
02015035
02015036
02015037
02015038
02015039
02015040
02015041
02015042
02015043
250/250/-
02015045
02015046
02015052
02015053
02015054
02015055
250/02015056
250/250/250/250/-
02015060
02015061
100/02015062
100/100/250/200/100/-
02015063
02015064
02015065
02015070
250/250/250/-
02015071
02015072
250/600/250/500/-
150/500/500/1200/3000/100/-
1200/350/300/1000/1500/400/800/-
600/200/400/400/-
39
Annexure-I
Maximum
Approved
Rate (INR)
(Rupees)
02015074
NAME OF
INVESTIGATION
Anti-HBC Core Antibody
IgM
Serum Immunoglobulin
02015075
Immunoglobulin IGE
500/-
02015076
IGE Allergy Individual
600/-
02015077
Immunoglobulin-IGA
600/-
02015078
Immunoglobulin IGM
600/-
02015079
Immunoglobulin IGG
600/-
02015080
Anti-HAV-IGM-Antibody
1000/-
02015081
Compliment C3
350/-
02015082
Compliment C4
350/-
02015083
Toxoplasma- IgG
370/-
02015084
Toxoplasma- IgG
370/-
02015113
02015085
700/-
02015114
600/-
02015115
02015087
Toxoplasma- IgG + IgM

Cysticercosis Antibody/
Antibody IgG
Cytomegalovirus, PCR
2000/-
02015116
02015088
PCR for AFB
1350/-
02015117
02015089
Herpes I(IgG)(HSV Type I)
300/-
02015090
300/-
02015118
300/-
02015119
02015093
Herpes I(IgM)(HSV Type I)

Herpes II (IgG)(HSV Type
II)
Herpes II (IgM)(HSV Type
II)
Herpes I + II (IgG)
02015094
Herpes I + II (IgM)
300/340/-
02015095
TPHA (Treponema
Pallidum Haemagglutinat
02015096
HBsAg
420/-
02015097
600/1000/-
02015099
Hydatid Cyst for IgG Elisa

Aspergillus Antibody
(IGG/IGM)
Anti HCV IgG/IgM
820/-
02015127
Vivax Antigen
Anti Smooth Muscle
Antibody (ASMA)
Anti-Mitochondrial
Antibody-M2 (AMA-M2)
Anti-Nuclear Antibody/
ANF/ ANA
ANA IFA (HEP-2) Method
Anti-Native
Deoxyribonucleic Acid (DsDNA)
Antismith Antibody
02015100
Anti HEV IgG/IgM
840/-
02015128
Rubella IgG/IgM Antibody
360/-
02015101
Allergy Screening- Adult
1200/-
02015129
Rubella IgG & IgM
650/-
02015102
1000/-
02015130
02015105
Screening for C-Pylori
200/-
Rubeola IgG/IgM Antibody

Rubeola Antibodies IgG &
IgM
Leptospira Antibody
IGM/IGG
1000/-
02015104
Dengue Elisa
Dengue Antibodies IgG +
IgM
Dengue NS1 Ag Test
CODE
02015073
02015086
02015091
02015092
02015098
02015103
CODE
550/600/-
300/-
02015106
02015107
02015108
02015109
02015110
02015111
02015112
02015120
02015121
300/-
600/-
02015122
02015123
02015124
02015125
02015126
02015131
600/02015132
NAME OF
INVESTIGATION
[RUT]
Maximum
Approved
Rate (INR)
(Rupees)
Elisa for Tuberculosis

[IGG/IGM/IGA]
Febrile Agglutinins
[Widal.Weli-FEl
HBe Antigen Detection
(HBe Ag)
CMV (Cytomegalo Virus
)Antibody [IGM]
Brucella Antibody
Breast Cancer ERPR and
HER2/NEU
Anti HCV IIIrd Generation
Elisa
Epstein Bar Virus IGM
[VCA Elisa]
HEV IgM Elisa
Legionella PneumophilaElisa
Elisa for Pregnancy
Elisa for Mumps (IgG
Antibody)
Elisa for Measles (IgG
Antibody)
Mumps Elisa (IgM
Antibody)
HIV P24 Antigen
350/400/550/350/420/2400/350/600/700/600/630/450/450/520/600/350/500/750/450/960/700/650/-
1400/840/-
40
Annexure-I
CODE
02015133
02015134
02015135
02015136
02015137
02015138
02015139
02015140
NAME OF
INVESTIGATION
Leptospira Antibody IGG &
IGM
Cryptococcus AntigenLatex Detection (CSF)
Falciparum Antigen
ADA (Adenosine
Deaminase- Body Fluid)
Mantoux Test
Anti HAV-Total (IGG &
IGM)
Cytomegalo Virus (CMV
)Antibody [IGG]
CMV IgM + IgG
1650/1300/360/450/150/-
CODE
02015163
02015164
02015165
02015166
02015167
720/02015168
320/600/-
02015169
NAME OF
INVESTIGATION
Anti LKM-1 (Liver Kidney
Microsomal-1) Antibo
Viable MTB DetectionPCR
HIV Qualitative (Window
Period Detection)
Anti Sclero 70/ SCL 70
Comprehensive CNS
Panel- (Molecular Dia
HIV Proviral DNA Detector
Qualitative
Hepatitis B PCR
Quantitative
Hepatitis B Virus PCR
Qualitative
Anti GBM Antibody+
Maximum
Approved
Rate (INR)
(Rupees)
820/1500/1200/1300/6800/1100/1900/3000/-
100/-
02015170
400/-
02015171
280/-
02015172
HSV DNA PCR
1500/-
02015173
1000/1100/-
02015175
Anti RNP-Sm Antibody

Antibody to Ribonucleo
Protein IgG
NBT Reduction Test
02015176
Anti Jo Antibody
520/-
450/-
02015177
Anti Jo-1 Antibodies
840/-
160/-
02015178
Antibody to SSA/SSB
2000/-
720/-
02015179
720/
02015180
02015151
Anti HBC Antibody (Total)
720/
02015152
Anti HBE
550/-
02015181
02015153
Hepatitis Be Antibody
550/-
02015182
Antibody to SSB/LA
Japanese Encepahilits
Virus PCR (JE Virus P
HIV-1 RNS Quantitative
RT-PCR with CD-3, CD-4,
CD
RNS Study/ Decrement
720/-
02015150
Typhi DOT-M
Hepatitis B-Core, total
(HBC total, IGG + IGM)
Anti HBC Antibody (IgM)
02015154
Hepatitis D Virus Antibody
1450/-
02015183
HIV Viral Load CD4 & CD8
3200/-
02015155
920/-
02015184
1100/-
1500/-
02015185
02015186
Anti RNP- Sm IgG

Anti Endomysial Antibody
IgA
CD-4, CD-8
02015187
CD 10
1200/-
2500/-
02015188
CD 20
920/-
9500/-
02015189
CD 3
920/-
02015190
02015162
Varcilla Zoster IgG & IgM
CD 30
HCV RNA Quantitative/
Viral Load
HBV Quantitative
920/-
02015161
HLA B27 CHN

HLA-B27, Disease
Association, Flow
Cytometry
HLA-ABC & DR Tissue
Crossmatch
HCV RNA PCR Qualitative
Hepatitis C Viral RNA
Genotype, LIPA
Varicella- Zoster Virus IGG
Titres
Varcilla Zoster IgM
02015141
02015142
02015143
02015144
02015145
02015146
02015147
02015148
02015149
02015156
02015157
02015158
02015159
02015160
Chopra Aldehyde Test

Amniotic Fluid-Lecithin
Spingomyl
Amoebiais Antibodies [IHA]
Screening
Amoebic Serology
KOH Mount for Fungal
Elements Detection
Campylobacter Jejieni
Antigen Detection I
HIV Test (1 & 2)
Maximum
Approved
Rate (INR)
(Rupees)
800/100/360/-
2000/-
520/720/1400/-
02015174
02015191
02015192
900/-
720/-
1500/3800/350/-
720/700/-
6000/5500/-
41
Annexure-I
Maximum
Approved
Rate (INR)
(Rupees)
1900/-
02015202
NAME OF
INVESTIGATION
HBV DNA Qualitative
Mycobacterium
IgA/IgG/IgM
Mycobacterium Serology
IgG/IgM
Mycobacterium
Tuberculosis Serology EL
TB PCR (Mycobacterium
tuberculosis PCR)
Treponema Pallidum
Antibody Detection
Treponemal Pallisum,
FTPA-ABF
Autoimmune Hepatitis
Panel
Antinuclear antibody Panel
(14 antibody panel)
Anti CCP Antibody
02015203
Anti Centromere Antibody
800/-
02015204
Serum Procalcitonin
2000/-
019
Cardio Respiratory
Procedures
02015205
Serum Prealbumin
HSV (1+2) IgG/IgM
Antibodies
HSV (1+2) IgG and HSV
(1+2) IgM
Chikungunya Test
550/-
02019001
Direct Laryngoscopy
4380/-
280/-
02019002
Bronchoscopy
2400/-
550/-
02019003
Mediastinoscopy
2880/-
500/-
02019004
Pleural Biopsy
3630/-
ANA/ ANF in Dilution

Bronchial Aspiration for
AFB Culture
Fungal Stain
Gram Stain
TBPCR
CVP Tip for Culture &
Sensitivity
Dialysis Catheter Tip for
C/S
Ear/ Eye/ Nasal/ Tongue
Swab for Culture &
Sensitivity
Prostatic Secretion for
Microscopy
Prostrate Specific Antigen
(PSA)
1000/-
02019005
6600/-
300/-
02019006
Thoracoscopy
Pulmonary function test
BMR
500/-
02019007
Spirometry
700/-
100/-
02019008
CODE
02015193
02015194
02015195
02015196
02015197
02015198
02015199
02015200
02015201
02015206
02015207
02015208
02015209
02015210
02015211
02015212
02015213
02015214
02015215
02015216
02015217
02015218
02015219
600/-
CODE
016
02016001
500/-
02016002
1900/-
02016003
850/300/2000/900/1100/-
017
NAME OF
INVESTIGATION
Obstetric Cases
Examination under
anaesthesia
Laparoscopy (Gynae)
Lap. Dye Test with removal
of adhesions
Biopsies (Specimen
processing per tissue type)
Maximum
Approved
Rate (INR)
(Rupees)
2430/6060/8000/-
02017001
Biopsy [Large]
600/-
02017002
Biopsy [Medium]
500/-
02017003
Biopsy [Small]
350/-
02017004
Biopsy [Extra Large]
800/-
018
Head & Neck Cancer
450/-
100/1400/300/-
02019009
02019010
02019011
300/02019012
300/02019013
150/02019014
Spirometry with Helium

Dilution
Spirometry with Helium
Dilution with diffusion
capacity studies
700/-
1620/1620/-
Pulmonery exercise testing
940/-
Punctal Cautery
100/-
NT Pro BNP
1000/-
Cardioversion
1400/-
Cardiac Troponin I
400/-
500/-
42
Annexure-I
NAME OF
INVESTIGATION
Maximum
Approved
Rate (INR)
(Rupees)
TEE with Anesthesia
2500/-
Testicular
800/-
02019017
Flexible BronchoscopyDiagnostic- TBNA
10000/-
02019018
Flexible BronchoscopyTherapeutic
2500/-
02019019
Flexible BronchoscopyGlue
4000/-
02019020
Flexible BronchoscopyBaloon Tampete
4000/-
02019021
Flexible BronchoscopyToileting
2600/-
02019022
Rigid BronchoscopyDiagnostic
5000/-
02019023
Rigid BronchoscopyMassive Haemoplysis
6200/-
Fibroptic bronchoscopy
2100/-
CODE
02019015
02019016
02019024
02019025
020
02020001
02020002
02020003
02020004
02020005
02020006
02020007
Fibroptic Bronchoscopy
with Washing/Biopsy
Cardiac / Cardio Thoracic
Procedures
3900/-
02020012
Aortogram
Package charges for
Cardiovascular
investigation
02020013
Stress Thallium
3600/-
02020014
Muga (Resting)
1440/-
02020015
Muga (Stress)
Echo Colour Doppler
1800/-
02020017
2500/-
580/-
Stress Myocardial Study

(MBI/ TR)
7200/-
Echo Screening
720/-
Stress Echo/ Dobutamine

Echo
1950/-
Foetal Echocardiography
1320/-
Cardio Tocography
360/-
021
02021001
1320/-
02020009
1470/-
02020010
Cardiac Cath Angiography

(Without Coronary
13200/-
840/-
410/-
1440/Check Angio
Abdomen/
Gastroentrology
Gastroscopy
7000/-
1170/-
Gastric & Duodenal Biopsy

(Endoscopic)
1560/-
02021003
ERCP
4000/-
02021004
ERCP Fluroscopy
2200/-
Upper G.I. Endoscopy
1100/-
Upper G.I. Endoscopy with

Biopsy
1300/-
Sigmoidoscopy (rigid)
1400/-
Sigmoidoscopy (flexible)
1200/-
Oesophagoscopy
1100/-
02021002
02021005
02021006
Trans Oesophaedral Echo

(TEE)
Holter Analysis & Holter
Report (with Prd.
Specification)
02020008
02020011
NAME OF
INVESTIGATION
Angioplasty)
02020016
Test of Pacemaker
2 D Echo with colour

Doppler/ 2D Echo
Cardiography
CODE
Maximum
Approved
Rate (INR)
(Rupees)
02021007
02021008
02021009
43
Annexure-I
CODE
NAME OF
INVESTIGATION
Maximum
Approved
Rate (INR)
(Rupees)
02024003
NAME OF
INVESTIGATION
Nerve Biopsy
Maximum
Approved
Rate (INR)
(Rupees)
8500/-
Colonoscopy
1800/-
02024004
Brain Biopsy
8500/-
02024005
Brain Mapping
3000/-
02024006
Ambulatory Electro Ence
5000/-
02024007
Blink Reflex
500/-
02024008
Decrement Test
650/-
02024009
EMG Four Limbs
900/-
02024010
EMG Two Limbs
480/-
02024011
NCV Four Limbs
900/-
02024012
NCV Two Limbs
500/-
02024013
EMG-Facial
500/-
02024014
NCV-Facial
8000/-
02024015
NCV+EMG-Facial
500/950/-
6000/-
02024016
Spincter-EMG
550/-
500/-
02024017
H Reflex
02024018
SSEP (Lower Limbs)
500/550/-
02024019
SSEP (Upper Limbs)
550/-
02024020
SSEP-UL/LL
02024021
VEP (Flash)
1000/550/-
02024022
VEP (PR)
550/-
02024023
Counsl of INH Patient
200/-
02024024
Spl Edu Assessment
02024025
Baer Study
250/550/-
02024026
Baer/ Threshold
1000/-
02021010
Colonoscopy-Full (GASPKG)
2000/-
02021011
24 H PH Metry
4000/-
02021012
24 H PH Metry (BS)
5500/-
02021013
022
02022001
02022002
Nephrology /
Genitourinary
Biopsy of Bladder
(Cystoscopic)
Urethroscopy
CODE
02022009
Glomerular Filtration Rate

Urethral dialatationDiagnostics
Visually Evoked Potential
Uroflow Study
(Micturometry)
Urodynamic Study
(Cystometry)
Cystoscopy with
Retrograde Catheter
Unilateral
Cystoscopy with
Retrograde Catheter
Bilateral
6000/-
02024027
Councelling & Therapy
200/-
02022010
Cystoscopy Diagnostic
5000/-
02024028
IQ Assessment
300/-
02022011
Cortisol-blood
240/-
02024029
Neuro Psychological T
850/-
02022012
Voiding-cysto-urethrogram
Renal Transplant
Evaluation
Orthopaedic Surgery
Procedure
Arthrography &
Osteomedullography
Arthroscopy - Diagnostic
360/-
02024030
Personality & IQ Child
450/-
02024031
Personality Development T
650/-
02024032
SSR
Lumbar puncture with CSF
Monitoring
HER-2/ NEU
700/1500/-
Breast
Mammography (Single
side)
Mammography (Both
sides)
800/-
02022003
02022004
02022005
02022006
02022007
02022008
02022013
023
02023001
02023002
024
02024001
02024002
1000/500/600/1200/-
4000/-
1500/-
11000/11000/-
Neurology
Placement of ICP Monitor Lumber Pressure
Monitoring
02024033
02024034
025
02025001
6000/6100/-
02025002
1200/-
1500/-
44
Annexure-I
CODE
026
NAME OF
INVESTIGATION
Maximum
Approved
Rate (INR)
(Rupees)
Gynae, Operation
Charges
CODE
NAME OF
INVESTIGATION
Maximum
Approved
Rate (INR)
(Rupees)
02028020
CT Sacrum & Coccyx
3500/-
02028021
C.T. Scan Upper Abdomen
3000/-
02026001
Diagnostic Curettage
3000/-
02026002
Fractional Curettage
3400/-
02028022
C.T. Scan Lower Abdomen
3000/-
02026003
Hysteroscopy Diagnostic
Laproscopic Operations
In Gen. Surgery /
Gastrohepatic / NephroDiagnostic Laproscopy
Specialised Procedures /
Investigations/ C.T. Scan
7500/-
02028023
C.T. Scan Whole Abdomen

C.T. Shoulder Joint/ Knee
Joint/ Elbow Joint/ Any
Other Joint (Plain)
5000/-
027
02027001
028
02028001
02028024
7000/-
02028025
02028026
CT Base of Neck
C.T. Scan Neck (Thyroid
Soft Tissue)
3000/-
02028027
CT Ankle with Foot
2000/-
02028028
3000/-
02028029
C.T. Scan Orbits/Eye

CT Arm/ Humerus/
Forearm/ Radius-Ulna/
Leg/ Tibia-Fibula/ Thigh/
Femur (Single) Plain
02028030
C.T. Scan Limbs
2500/-
02028031
CT Both Thigh
2000/-
02028032
C.T. Scan Whole Body
10000/-
02028033
CT Extremities
C.T. Scan of Para Nasal
Sinus
2000/-
1600/-
02028002
Cat Scan (C.T.) Head

C.T. Head Scan Involv.
Spl. Investigation
02028003
C.T. Scan Brain
1600/-
02028004
HRCT Chest Thorax
6000/-
02028005
C.T. Chest (HRCT)
4000/-
02028006
C.T. Scan Chest

C.T. Spine
(Cervical,Dorsal,
Lumbar,Sacral)
CT Angiogram of Cervical
and Intra
C.T. Cervical C.T. 3D
Reconstruction only --
3500/-
2000/-
02028036
2500/-
02028037
02028013
C.T. Guided Biopsy

C.T. Guided percutaneous
cath drainage
C.T. Myelogram
(Cervical Spine)
C.T. Myelogram
(Lumbar Spine or D/S)
02028014
CT Pelvis with Hip Joints
3000/-
02028015
CT KUB (Plain)
3500/-
02028016
CT Sacro Iliac Joint
2500/-
02028017
CT Pituitary/ Sella
2500/-
02028018
CT Cisternography
1600/-
02028019
CT Petrous Temporal Bone
3000/-
02028007
02028008
02028009
02028010
02028011
02028012
2300/-
3500/-
3500/02028034
2000/-
4500/-
3000/-
7200/1200/-
02028035
3500/3500/02028038
02028039
02028040
02028041
02028042
CT guided FNAC
CT Angiography of Brain/
Carotid/ Thorax/ Neck
CT 64 Coronary
Angiography
CT Angiography of Brain/
Carotid/ Thorax/ Neck/
Abdomen/ Extremities/
Renal area/ Peripheral
area/ Pulmonary area with
Visipaque
CT Renal Angiography
CT Angio Both Lower
Limbs
CT Angiography of Neck
Vessels
CT Angiography of
Abdomen/ Extremities/
Renal area/ Peripheral
2500/5400/10000/-
6500/5000/10000/5000/-
6000/-
45
Annexure-I
CODE
NAME OF
INVESTIGATION
area/ Pulmonary area
Maximum
Approved
Rate (INR)
(Rupees)
CODE
NAME OF
INVESTIGATION
Maximum
Approved
Rate (INR)
(Rupees)
02029014
MRI- Single Joint
5400/-
02029015
MRI- Both Joints
9000/-
02029016
MRI Sacro Iliac Joints

MRI Spine (Cervical/
Dorsal/ Lumbar/ CervicoDorsal/ Dorso-Lumbar/
Lumbo-Sacral)
MRI Lumbar Spine &
Sacroiliac Joint
Double Region Plain (Brain
& Spine)
Tripple Region Plain (Brain
& Spine)
MRI CSF Flow Study
5400/-
02028043
PET CT Scan
(Whole Body)
(including Flurodeoxy
Glucose)
20000/-
02028044
Therapeutic Aspiration- CT
3000/-
02028045
Diagnostic Aspiration- CT
1600/-
02028046
Ionic Contrast (20 C.C.)
270/-
02028047
675/-
02028051
Ionic Contrast (50 C.C.)

Non-ionic Contrast (10
C.C.)
C.C.)
C.C.)
C.C.)
02028052
3D Reconstruction charge
029
02029001
MRI
MRI Brain/ Brain with
Protocol/ CSF Study/
Internal Ear
6000/-
02029002
MRI Base of Skull
5400/-
02029003
MRI Orbits
6000/-
02029004
5400/-
02029005
MRI Face
MRI Nasopharynx and
PNS
02029006
MRI Pharynx
5400/-
02029007
MRI Neck
6000/-
02029034
02029008
5400/-
02029035
5000/6000/-
02029012
MRI Pituitary
MRI Thyroid/ CranioVertebral (C.V.) Junction/
MRI Temporal Bones
(Unilateral)
MRI Venography/
Angiography
MRI Arm/ Fore Arm/ Thigh/
Femur/ Leg/ Foot
02029013
MRI Arm (Humerus) (Left/
02029017
02029018
02028048
02028049
02028050
500/-
02029019
02029020
02029021
1250/2100/1200/-
02029010
02029011
9000/13000/1500/-
02029024
1500/-
02029025
MRI Hip
6000/-
02029026
MRI Urogram
5400/-
02029027
MRI Pelvis
6000/-
02029028
MRCP
5000/-
02029029
MRI Extremities
MRI Upper Abdomen with
MRCP
MRI Temporomandibular
Single Joint
MRI Temporomandibular
Double Joints
6000/-
02029023
02029030
02029031
02029032
1500/1500/-
6000/5000/6000/-
6000/02029033
02029009
6000/-
MRI Spectroscopy
MRI Diffusion Tensor
Imaging (DTI)
MRI SWI (Susceptibility
Weighted Image)
02029022
750/-
5400/-
5400/5400/-
MRI Upper Abdomen

MRI Upper Thigh & Lower
Abdomen
5400/7000/-
02029036
MRI Whole Abdomen

MRI Lower Abdomen/
Pelvis
9000/5400/-
02029037
MRI Breast
6000/-
02029038
MRI Thoracic Outlet
5400/-
02029039
MRI Spine Screening
5400/-
02029040
MRI Brachial Plexus
5400/-
02029041
MRI Chest
5400/-
5400/-
46
Annexure-I
CODE
02029042
02029043
02029044
02029045
02029046
02029047
NAME OF
INVESTIGATION
MRI Brain with
Spectroscopy
MRI Brain with Perfusion
MRI Brain with Orbit/ PNS/
Angio/ Neck Angio
MRI Brain with DTI
(Diffusion Tensor Imaging)/
SWI (Susceptibility
Weighted Image)/ Cranial
Nerve Evaluation
MRI Perfusion Study
Maximum
Approved
Rate (INR)
(Rupees)
6000/-
CODE
02032007
7300/-
02032008
6500/-
02032009
02032010
02032011
6000/-
02032012
3500/02032013
Spect Myocardial Perfusion

Scan (Thalium/ Tetro)
Spect Myo Perfusion Rest
Scan (Thalium/ Tero/ Mie
Nuclear Blood Pool Scan
Radio-Isotope Ureteric
Reflux (Indirect)
Whole Body Tc-V-DMSA
Scan
Brain Spect (Tumour
Imaging)
Tumour Immagery
9000/11000/5500/2000/3000/3500/2500/-
MRI Screening
Screening Single Area with
Films
Screening Double Area
with Films
1500/-
MRI Small Part
4000/-
02032016
5400/-
02032017
02029052
MRI Other Region

Contrast (Ionic/ Non-ionic)
2500/-
02032018
Bone Scan Spect (Single

Region)
Bone Scan- three phase
(Single Region)
Bone Scan Spect (whole
body)
Tc 99m DMSA Renal Scan
030
Other Investigations
033
Profiles
02030001
Fluoroscopic Screening
120/-
02033001
Lipid Profile
700/-
02030002
Oxygen Saturation
Bone Densitometry Single
site
Bone Densitometry Two
sites
Bone Densitometry Three
sites ( Spine , Hip & one
extremity)
Bone Densitometry Whole
body
120/-
02033002
Thyroid Profile
1200/-
02033003
Total Diabetic Profile
1000/-
02033004
Pre Cath Profile
850/-
02033005
Coagulation Profile
02033006
02033007
LFT [Liver Function Test]

Pre Dialysis Serology
550/750/-
2200/-
02033008
Dialysis Profile
500/-
3000/-
02033009
Hepatitis B Profile
3000/-
02033010
Hepatitis Panel
1800/-
02033011
Neuro Profile
2000/-
02033012
Septic Profile
900/-
02033013
Paediatric Septic Profile
1800/-
02029048
02029049
02029050
02029051
02030003
02030004
02030005
02030006
02030007
5400/-
NAME OF
INVESTIGATION
Thallium Scan
Maximum
Approved
Rate (INR)
(Rupees)
02032014
02032015
3000/-
800/1200/-
1600/-
031
A.V. Fistula
Immunology
02031001
Hepatitis B DNA
02031002
6000/-
032
HBV DNA Quantitative/

Viral Load
Nuclear Medicines
02032001
Isotope Venography
3500/-
02033014
02032002
8500/-
02033015
02032003
Gallium-67 Scan/Ghallium
Scan
Thyroid Scan
1800/-
02033016
02032004
Iodine-131 Thyroid Scan
2500/-
02033017
02032005
Thyroid (Tc99m) Scan
1800/-
02032006
Para Thyroid Scan
6000/-
5200/-
Basic Metabolic Panel

(BMP)
Comprehensive Metabolic
Panel (CMP)
Anaemia Screen (HAEM1)
5000/1800/2700/3000/2000/-
600/-
320/500/2800/3400/-
02033018
Thrombocytopenia Screen
(HAEM2)
Mycloma Screen (HAEM3)
02033019
Lymphoma Screen
2000/-
2700/-
47
Annexure-I
CODE
NAME OF
INVESTIGATION
(HAEM4)
02033020
Polycythaemia (HAEM5)
Maximum
Approved
Rate (INR)
(Rupees)
1800/-
02033023
Thallasaemia Patient
Screen (HAEM6)
Thallasaemia Counselling
Serum (HAEM7)
CRBSI
02033024
ACTH Stim
1900/-
02033025
Growth Hormone Stim
2000/-
02033026
Male GnRH Stim
3500/-
02033027
Female GnRH Stim
3300/-
02033028
Bone Marrow Profile
550/-
02033029
EP Screening Profile
1100/-
02033030
Torch Profile
1500/-
02033031
Renal Profile
330/-
02033021
02033022
3000/1200/550/-
48
Annexure-I
RATES FOR IMPLANTS
03- IMPLANTS
CODE
NAME OF THE ITEM
001
Cardiology Implantation Devices
03001001
03001002
Pacemaker (Single Chamber)- Ordinary (SSI Autocapture)

Pacemaker (Single Chamber)- With rate modulation (SSIR)
Pacemaker (Dual Chamber) (DDD/DDDR/VDDR)
03001003
03001004
03001005
03001006
03001007
03001008
03001009
03001010
03001011
03001012
03001013
03001014
03001015
03001016
03001017
03001018
002
03002001
03002002
CRT (Cardiac Resynchronization Therapy)

AICD (Automatic Implantable Cardioverter Defibrillater)
CRT + AICD combination
BMS (Bare Metal Stent)(made of Steel)
BMS (Bare Metal Stent)(made of alloy e.g. Cobalt, Chromium,
etc.)
DES (Drug Eluting Stent)- Sirolimus-eluting e.g. Cypher, etc.
DES (Drug Eluting Stent)- Higher Sirolimus derivatives e.g.
Endeavour, Promus, Xcience, etc.
DES (Drug Eluting Stent)- Paclitaxel-eluting e.g. Taxus, etc.
PDA- closure device
ASD/ VSD- closure device
Mitral Baloon, e.g. Inoue Baloon
Pulmonary Valvoplasty Baloon
Mitral/ Aortic Heart Valve
TTK Chitra (Mitral/ Aortic Heart Valve)
Heart Valves- Annuloplasty Ring
Opthalmology
Hydrophobic Foldable IOL
Silicon Foldable IOL
Maximum Approved Rate (INR)

(Rupees)
45,000/- or the actual cost,

whichever is less
68,000/- + VAT or the actual
cost, whichever is less
1,20,000/- + VAT or the actual
2,50,000/- or the actual cost,
whichever is less
whichever is less
whichever is less
1,05,000/- + VAT or the actual
50,000/- + VAT or the actual cost,
whichever is less
whichever is less
50,000 + VAT or the actual cost,
whichever is less
30,000 + VAT or the actual cost,
whichever is less
whichever is less
5,000/4,000 /-
49
Annexure-I
CODE
03002003
03002004
003
03003001
03003002
03003003
004
NAME OF THE ITEM

(Rupees)
Hydrophilic Acrylic Lens
6,000 /-
PMMA IOL
ENT
One-sided Hearing Aid (Body worn/Pocket/Behind the ear type or
in the canal type (conventional)
500/-
Bilateral Hearing Aid
03004003
03004004
03004005
005
03005001
03005002
03005003
03005004
03005005
03005006
03005007
03005008
03005009
03005010
03005011
03005012
03005013
03005014
03005015
03005016
03005017
20,000/-
Digital Hearing Aid (to be purchased with the permission of the

West Bengal Health Scheme Authority)
Neuro Implants
Type of Neuro-implant
03004001
03004002
10,000/-
Prescribing Authority
Neurologist of a recognised
hospital
Intra-thecal Pumps
Any two specialists of
concerned speciality/ HoD
of Neurology/
Neurosurgery/
Spinal Cord Stimulators
Anaesthesiology of
recognized hospital
CPAP Machine
BIPAP Machine
DBS Implants
Orthopaedic implants
Depuy (TKR) Knee
Zimmer (USA) Knee
Cemented Bipolar Hip (Zimmer)
Uncemented Total Hip (Zimmer)
Cemented Bipolar Hip (Depuy)
Uncemented Total Hip (Depuy)
Cemented Total Hip (Depuy)
DHS Plate Screw
Proximal Femur Nail
Locking Plate & Screw- for Humerous
Locking Plate & Screw- for Distal Tibia
Locking Plate & Screw- for Proximal Tibia
Locking Plate & Screw- for Proximal Femur
Locking Plate & Screw- for Shaft Femur
Locking Plate & Screw- for Radius Ulna
Locking Plate & Screw- for Distal Humerous & Elbow
Joint
Locking Plate & Screw- for Shaft Humerous
30,000/-
Ceiling
Rate
3,60,000/2,62,000/-
2,62,000/-
Life of
Battery
3-5
years
7 years
3-5
years
Cost of
Battery
2,50,000/2,25,000/-
2,00,000/-
50,000/1,00,000/Maximum Ceiling Rates

(Rupees)
75,000/74,880/41,080/69,992/38,500/77,000/46,500/3,500/5,720/5,500/6,500/5,500/6,500/9,000/2,500/4,500/5,500/50
Annexure-I
CODE
03005018
03005019
03005020
03005021
03005022
03005023
03005024
03005025
03005026
03005027
03005028
03005029
03005030
03005031
03005032
03005033
NAME OF THE ITEM

(Rupees)
Locking Plate & Screw- for Buttress Plate & Screw

ISO-Elastic Nail (Per Piece)
Interlocking Nail for Tibia & Femur
PFN Nail for Proximal Femur
DHS Plate Screw for Trochanteric Fracture
Humerous Plate
Humerous locking Plate & Screw
Humerous locking T- Buttress Plates & Screw
Elbow Joint- fixation by locking Plate & Screw
Replacement of Elbow Joint
Radius Ulna- Locking Plates & Screw
Wrist joint with locking Plate & Screw
Soldier Joint- With Jess Fixator
External & ILLIZAROV- Femur
External & ILLIZAROV- Tibia
External & ILLIZAROV- Pelvis
5,500/2,500/3,500/8,000/3,500/3,500/5,500/4,500/3,500/20,000/4,500/2,500/6,500/7,000/7,000/7,000/-
51

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Annexure-I

Syringing & Probing

Ectropion surgery- one lid

Fracture orbital repair

Iris cyst removal

Perforating injury repair

ICG including Medicine

Electrolysis (Per sitting)

Silicone Oil (1000)

Silicone Oil (C5)

Silicone Oil Removal

Orbitotomy (Multiple Wall)

Knee Joints Spad Fraction

Breathing Exercises &

Traction + SWD + IFT

Exercise- per sitting

Floride Application (per

Apicoectomy Molar Tooth

Extraction of MISP Tooth

Glass Ionomer Filling

Glass Ionomes Filling

Jacket Crown Acrylic

Preformed Steel Crown

Other Major Operations

D & C and Cervical Biopsy

Excision Vaginal Septum

MTP- 1st Trimester

MTP - 2nd Trimester

Sterilisation Post Pertum

Gastrostomy (PEG) (BS)

Glue Injection (BS)

Hemosta by Glod Probe

Hemostatic Clip (BS)

Band Ligation (BS)

Biliary Brushing (BS)

Injection Hemostasis (BS)

Biliary Pancreatic (M)

Biliary Pancreatic (M) (BS)

LGI Manometry (BS)

Biliary Pancreatic (P)

Biliary Pancreatic (P) (BS)

UGI Manometry (BS)

Cre Ballon Dilatation (BS)

Cre Balloon Dilatation

Nasobiliary Drainage (BS)

Dilatation (Stricture) (BS)

Nasojejunal Tube Plac

EMG Charge (Large)

Papilla Cannu Minor

EMG Charge (Small)

Papilla Cannu Minor (BS)

Pappu Stnt Spingt (M)

Endoscopic Tube Place

Polypectomy (Upper GI)

Pre Cutting (BS)

Pseudocyst Drainage (BS)

Small Bowel Enteroscp

Stone Extraction (BS)

Excision of Pinna for

Operation for Cervical Rib

Operation for Carcinoma

Repair of Parotid Duct