Revised Rate List

Annexure-I
Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011)
Maximum
01 – PROCEDURES Approved
NAME OF TREATMENT Rate (INR)
CODE PROCEDURE (Rupees)
Maximum
Approved 01001025 Lumbar puncture 700/-
NAME OF TREATMENT Rate (INR) 01001026 Sternal puncture 1500/-
CODE PROCEDURE (Rupees) 01001027 Injection for Haemorrhoids 1000/-
Injection for Varicose
001 General 01001028 Veins 1300/-
01001001 Consultation by Medical 01001029 Catheterisation 120/-
Officer (OPD) 150/- 01001030 Dilatation of Urethra 1100/-
Consultation by 01001031 Incision & Drainage 600/-
01001002 Specialists (OPD) 200/- 01001032 Intercostal Drainage 1500/-
Visit/ Revisit/ Consultation
01001033 Peritoneal dialysis 1800/-
by Specialists (Indoor)
Removal of soft tissue or
(Maximum two visits per
regional block under
01001003 day admissible) 200/-
01001034 general anaesthesia 2400/-
Consultation by Super-
01001004 Specialists (OPD) 250/- 01001035 Dressing Small 100/-
Visit/ Revisit/ Consultation Secondary suture of
by Super-Specialists 01001036 wounds 1200/-
(Indoor) 002 Skin
(Maximum two visits per 01002001 Excision of Moles 600/-
01001005 day admissible) 250/- 01002002 Excision of Warts 600/-
Pre-operative Anaesthetic Excision of Molluscum
01001006 Consultation 200/- 01002003 contagiosum 600/-
01001007 Paramedical Consultation 75/- 01002004 Excision of Veneral Warts 600/-
Special Nursing Charge 01002005 Excision of Corns 550/-
01001008 (per shift of 12 hrs.) 150/-
I/D Injection Keloid of
Aya/ Attendant Charge
01002006 Acne 300/-
01001009 (per shift of 12 hrs.) 75/-
Chemical Cautery (per
01002007 sittings) 120/-
01001010 Delayed primary suture 1700/-
Excision of Sebaceous
01001011 Dressings Large 160/-
01002008 Cysts 1700/-
Suturing without local
Excision of Superficial
01001012 anesthesia 400/-
01002009 Liipoma 2400/-
Suturing of wounds with
01001013 local anesthesia 500/-
01002010 Excision of Dermoid Cysts 2450/-
01001014 Debridement of wounds 1200/-
003 E.N.T.
01001015 Removal of Benign Tumor 1100/-
Speech therapy per
Aspiration Plural Effusion - 01003001 session of 30-40 minutes 200/-
01001016 Therapeutic 1000/-
Removal of foreign body
Abdominal Aspiration - From Nose/ Ear/ Throat
01001017 Therapeutic 1300/- 01003002 (Day care package) 1500/-
Removal of F.B.
01001018 Superficial 1200/- 01003003 Swallowing Therapy 250/-
01001019 Bone Marrow Aspiration 1500/- 01003004 Syringing 300/-
01001020 Joints Aspiration 1500/- 01003005 Polyp removal under LA 800/-
01001021 Strapping 100/-
Peritonsillar abscess
01001022 Removal of Stitches 60/- 01003006 drainage under LA 1600/-
01001023 Venesection 300/- Tinnitus Retraining
01001024 Phimosis Under LA 1500/- 01003007 Therapy 250/-
1
Annexure-I
Maximum Maximum
Approved Approved
NAME OF TREATMENT Rate (INR) NAME OF TREATMENT Rate (INR)
CODE PROCEDURE (Rupees) CODE PROCEDURE (Rupees)
01003008 Myringoplasty 10700/- 01003047 Uvulo-palatoplasty 20000/-
01003009 Staepedectomy 12000/- 01003048 Tympanomastoidectomy 15600/-
Myringotomy with 01003049 Dacunisation 7000/-
01003010 Grommet insertion 6000/- 01003050 Tonsillectomy 11200/-
Endoscopic Removal of 01003051 Adenotonsillectomy 13500/-
01003011 Fish Bone 1000/-
01003052 Synichiolysis 4200/-
01003012 Tympanotomy 8000/-
01003053 Submucosal Diathermy 4000/-
01003013 Paracentesis 4300/- Nasal Mass Excision-
01003014 Tympanoplasty 14000/- 01003054 Simple 11200/-
01003015 Mastoidectomy 15600/- Nasal Mass Excision-
01003016 Otoplasty 16500/- 01003055 Endoscopic Removal 13500/-
01003017 Labyrinthectomy 15600/- 01003056 FESS 11200/-
01003018 Skull Base surgery 50000/- 01003057 Anterior Nasal Packing 4000/-
Facial Nerve 01003058 Post Nasal Packing 5000/-
01003019 Decompression 20000/- 01003059 Nasal Bone Reduction 6000/-
01003020 Septoplasty 10200/- Excision of Lesion
01003021 Submucous Resection 10800/- Base of Tongue-
01003022 Septo-rhinoplasty 15000/- 01003060 per Oral Approach 6400/-
Rhinoplasty (non- 004 Opthalmology
01003023 cosmetic) 12000/- Cauterisation of
01003024 Fracture Reduction 9000/- ulcer/subconjuctival
01003025 Intra Nasal Diathermy 6000/- 01004001 injection - One eye 200/-
01003026 Turbinectomy 9600/- Cauterisation of
01003027 Endoscopic DCR 13000/- ulcer/subconjuctival
01003028 Endoscopic Surgery 15000/- 01004002 injection - Both eyes 300/-
01003029 Septal Perf. Repair 15000/- Retrobular Injection - One
01003030 Antrum Puncture 3000/- 01004003 Eye 200/-
01003031 Lateral Rhinotomy 1350/- Retrobular Injection - Both
01003032 Cranio-facial resection 28000/- 01004004 Eyes 300/-
01003033 Ethamoidectomy 17600/- Syringing of Lacrimal Sac
01003034 Caldwell Luc Surgery 12000/- 01004005 -For one eye 200/-
01003035 Angiofibroma Excision 18000/- Syringing of Lacrimal Sac
Endoscopic 01004006 - For both eyes 300/-
01003036 Hypophysectomy 25000/- 01004007 Paracentesis 800/-
Endoscopic Optic Nerve 01004008 Foreign body removal 300/-
01003037 Decompression 32000/- 01004009 Refraction/Fundoscopy 90/-
01004010 Ortho-optic exercises 100/-
01003038 Decompression of Orbit 30000/-
01004011 Plepoptic Exercises 100/-
01003039 Ranula Excision 9600/-
Chalazion operation -One
01003040 Tongue Tie excision 8100/-
01004012 Eye 800/-
Sub Mandibular Duct
01003041 9700/- Chalazion operation -
Lithotomy
01004013 Both Eyes 1000/-
01003042 Adenoidectomy 8000/-
01004014 Dressing (Eye) 100/-
01003043 Palatopharyngoplasty 15100/-
01004015 Clinical Photography 100/-
01003044 Cleft Palate repair 16000/-
01004016 Pterygium 2200/-
01003045 Pharyngoplasty 18000/-
01004017 Orbitotomy 9000/-
01003046 Styloidectomy 11500/-
2
Annexure-I
Maximum Maximum
Approved Approved
01004018 Ptosis correction. 6500/-
01004019 Ectropion Correction 3600/- 01004048 Lasik 18000/-
01004020 Xenon Arc Laser 700/- TTT- Transpupillary
D C R (Dacryo custo- 01004049 thermal therapy 4000/-
01004021 rhinostomy) 5700/- PTK- Phototherapeutic
01004022 ECCE/ICCE 6000/- 01004050 keratectomy 9000/-
01004023 Epicanthus correction. 2100/-
Squint Correction (one 01004051 Iris cyst removal 1000/-
01004024 eye) 4000/- Lid Abscess incision and
Squint Correction (both 01004052 drainage 3000/-
01004025 eyes) 6000/-
Orbital Abscess incision
01004026 Keratoplasty 14000/- 01004053 and drainage 4000/-
01004027 Trabeculotomy 5700/-
01004028 Iridectomy 2400/- 01004054 Cyclodiathermy 2000/-
01004029 Goniotomy 2400/-
Scleral Bukling (Retinal 01004055 Perforating injury repair 4000/-
01004030 Detachment Surgery) 14000/- Phaco + IOL (inclusive of
Foldable & Non-foldable
01004031 Syringing & Probing 1100/- 01004056 lens) Package 14500/-
01004032 Vitrectomy 11000/- YAG Laser Capsulotomy
01004033 Enucleation 4000/- 01004057 per sitting 600/-
01004034 Eviseration 3800/- YAG Laser Iridectomy per
01004035 Entropion correction 3000/- 01004058 sitting 600/-
Cataract with IOL(Cost of 7500/- Argon Laser
01004036 lens extra) Trabeculoplasty (ALT)
01004037 Fistulectomy 5700/- 01004059 (per sitting) 1000/-
Glucoma surgery with
01004038 Glucoma valves 5000/- 01004060 HVF 500/-
01004039 Caliculoplasty 3000/- 01004061 Cryopexy 1200/-
01004040 Dacryocystectomy 3000/- 01004062 ICG including Medicine 2000/-

Ptosis surgery with LPS ICG- Double including
01004041 resection 7000/- 01004063 Medicine 3600/-
Ptosis surgery with Sling
01004042 surgery 7000/- 01004064 Electrolysis (Per sitting) 150/-
Cyclocryo/
01004043 Ectropion surgery- one lid 3000/- 01004065 Cyclodiathermy 500/-
Ectropion surgery- both
01004044 lids 4000/- 01004066 D.C.T. (OPD) 800/-
Cheek rotation flap for lid
01004045 tumors 8000/- 01004067 Silicone Oil (1000) 4000/-
01004046 Telecanthus correction 4000/- 01004068 Silicone Oil (C5) 4000/-
01004047 Fracture orbital repair 9000/- 01004069 Silicone Oil Removal 3500/-
3
Annexure-I
Maximum Maximum
Approved Approved
01004070 Pneumo Retinopexy 2400/- 01004091 Anterior Vitrectomy 5000/-
01004071 FGE/ FAE 1500/- 01004092 Lensectomy 7500/-
01004072 Indirect Laser 1000/- 01004093 Orbitotomy (Multiple Wall) 16000/-

ERM (Epi Retinal
01004073 Endo Laser 2400/- 01004094 Membrane) 3600/-
01004074 SF6 Gas 2400/- 01004095 Reti Blue 2400/-

Corneal Collagen Cross-
01004075 C3F8 Gas 2400/- 01004096 linking 15000/-
Biopsies including
01004076 PFCL 2400/- Histopathological report
Photodynamic Therapy 005 (Package)
procedure charges- single Biopsy procedure under
4000/-
01004077 eye 15000/- 01005001 Local Anaesthesia
Photodynamic Therapy Biopsy procedure under
6000/-
procedure charges- both 01005002 General Anaesthesia
01004078 eyes 25000/- Biopsy procedure under
8000/-
Photodynamic Therapy 01005003 Endoscopy
01004079 (single eye) 85000/- 01005004 FNAC 3500/-
Photodynamic Therapy Strapping (including
01004080 (both eyes) 100000/- 006 Bandage & materials)
Intravitreal Avastin 01006001 Strapping of Finger 200/-
(including cost of injection- 01006002 Strapping of Toes 200/-
01004081 single) 6000/- 01006003 Strapping of Wrist 360/-
Intravitreal Lucentis 01006004 Strapping of Elbow 400/-
(excluding cost of
01004082 injection-single) 4000/- 01006005 Strapping of Knee 400/-
Intravitreal Macugen 01006006 Strapping of Ankle 400/-
(excluding cost of 01006007 Strapping of Chest 500/-
01004083 injection-single) 4000/- 01006008 Strapping of Shoulder 450/-
Intravitreal injections of 01006009 Nasal bone fracture 450/-
antibiotics (cost of 01006010 Figure of 8 bandage 450/-
01004084 medicines extra) 2000/- 01006011 Colar and cuff sling 450/-
Retinal Foreign Body 01006012 Ball bandage 450/-
01004085 Removal 4000/- Physiotheraphy &
007 Traction
01004086 PPV/ Victerectomy 6500/- Ultrasonic therapy (per
01007001 sitting) 70/-
01004087 Endo Diathermy 1600/- S.W. Diathermy (per
01007002 sitting) 90/-
01004088 Belt Buckle 3200/- Electrical stimulation
01007003 (therapeutic) (per sitting) 70/-
01004089 IVTCA 800/- 01007004 Infra red (per sitting) 90/-
U.V. Therapeutic dose
01004090 Membrane Peeling 2400/- 01007005 (per sitting) 90/-
4
Annexure-I
Maximum Maximum
Approved Approved
Electric vibrator (per PWB + Knee Joint Spad
01007006 sitting) 90/- 01007029 Fraction 100/-
Vibrator belt massage
01007007 (per sitting) 90/- 01007030 SWD + IFT 100/-
Intra Lumbar Traction
01007008 (per sitting) 90/- 01007031 US + IFT 100/-
Intermittent Cervical
01007009 traction (per sitting) 70/- 01007032 US + IFT + Stimulation 200/-
Combined Lumbar & US + Knee Joint + Spad
Cervical traction (per 01007033 Fraction 100/-
01007010 sitting) 70/-
01007011 Wax bath (per sitting) 50/- 01007034 US + PWB 100/-
01007012 Hot pack (per sitting) 70/-
Whirl pool bath (per 01007035 US + SW + Traction 200/-
01007013 sitting) 90/-
Obesity Exercises (per 01007036 US + Tens 100/-
01007014 sitting) 60/-
Breathing Exercises & 01007037 US + Stimulation 100/-
Postural Drainage (per
01007015 sitting) 70/- 01007038 Knee Joints Spad Fraction 100/-
Cerebral Palsy – Massage Electronic Tilt Training-
01007016 (per sitting) 90/- 01007039 Per Session 100/-
Post – polio exercise (per
01007017 sitting) 60/- 01007040 Interferential Therapy 100/-
Basic Gait Training (Per Laser Treatment- Per
01007018 Session) 80/- 01007041 Session 150/-
Microwave Diathermy- Per
01007019 Traction + IFT 150/- 01007042 Session 150/-
Quadriceps Chair Training
01007020 Traction + Stimulation 100/- 01007043 (Per Session) 100/-
01007021 Traction + SWD 100/- 01007044 Tens 80/-

008 Dental
01007022 Traction + SWD + IFT 200/- Extraction of tooth
01008001 including LA 120/-
01007023 Traction + US 140/- Complicated Ext. per
01008002 Tooth including LA 250/-
01007024 Traction + US + IFT 200/- 01008003 Flap Operation per Tooth 500/-
Traction + US + IFT + 01008004 Gingivectomy per tooth 300/-
01007025 Exercises 260/- 01008005 Cyst under LA (small) 300/-
Traction + US + IFT + 01008006 Cyst under LA (large) 500/-
01007026 SWD 260/- Impacted Molar including
01008007 LA 800/-
01007027 IFT + PWB 150/- 01008008 Apisectomy including LA 1000/-
Fracture wiring including
01007028 Exercise- per sitting 60/- 01008009 LA 80/-
5
Annexure-I
Maximum Maximum
Approved Approved
Reduction & 01008032 Cast Rpd (per Tooth) 380/-
immobilisation of fracture- Davis Crown/ radicular
01008010 Maxilla under LA 1400/- 01008033 Screw supported 1900/-
Reduction & 01008034 De Sensitising per sitting 200/-
immobilisation of fracture- Dento Alveolar Fracture
01008011 Mandible under LA 3000/- 01008035 Reduction & Splinting/l.a. 1500/-
Splints/ Circum Denture Repair
mandibular wiring under 01008036 (category1) 230/-
01008012 GA 2000/- Dialation of Whartons
Internal wire fixation/ plate 01008037 Duct under L.A. 1150/-
fixation of Maxilla under Direct/ indirect Pulp
01008013 LA 4000/- 01008038 Capping 230/-
Internal wire fixation/ plate Drain. of Dento Alveolar
fixation of Maxilla under 01008039 Absce. (ex. Oral) 950/-
01008014 GA 6000/- Enucleation of Cyst of
Internal wire fixation/ plate 01008040 Oral Cavity 2000/-
fixation of Mandible under Fibre Post Based Post &
01008015 LA/GA 6000/- 01008041 Core 1900/-
Cyst & Tumour of Maxilla/
mandible by enucleation/ Floride Application (per
01008016 excision (package) 2000/- 01008042 sitting) 400/-
TM joint ankylosis- under
01008017 GA (package) 11000/- Extraction of Impacted
Hemi-mandibulectomy 01008043 Tooth By Operation 400/-
01008018 with graft (package) 7000/-
Hemi-mandibulectomy Extraction of MISP Tooth
01008019 without graft (package) 4000/- 01008044 by Operation (Open Meth) 1150/-
Segmental- GTR (Guided Tissue
mandibulectomy with graft 01008045 Regeneration) 1900/-
01008020 (package) 6000/- Gingivectomy per
Segmental- 01008046 Quadrant 750/-
mandibulectomy without
01008021 graft (package) 2000/- 01008047 Glass Ionomer Filling 400/-
Maxillectomy- partial with
01008022 graft (package) 5000/- 01008048 Glass Ionomes Filling 450/-
Maxillectomy- partial 01008049 Interdental Wiring 1150/-
01008023 without graft (package) 4000/- Intra Articular Inj. of
Maxillo-facial prosthesis 01008050 Steroids in TMJ 900/-
(sal/ auricular/ orbital/
01008024 facial lost part) (package) 5000/- 01008051 Jacket Crown Acrylic 1500/-
Alvelolectomy, Minor Dento-alveolar
01008025 Frenectomy per Quadrant 1150/- Tracture Reduction &
01008026 Alvelolectomy (minor) 380/- 01008052 Splinting/la 950/-
Amalgam Filling/tooth Post Core/ tooth (cast
01008027 (compound) 450/- Post) lab Metal Chgs.
Amalgam Filling/tooth 01008053 Extra 1150/-
01008028 (regular) 380/- Post Core/ tooth (pin
01008054 Retained.comp.core) 750/-
01008029 Apicoectomy Molar Tooth 2250/- Post Core/ tooth
01008030 Arch Bar Removal 380/- Screw/pin Retain.
01008031 Bite Plate/ Retainers 1150/- 01008055 amalgm. 550/-
6
Annexure-I
Maximum Maximum
Approved Approved
Preformed Carbonate spot); Diet; Syringe Pump)
01008056 Jacket Crown 750/- Ventilator charge
01008057 Preformed Steel Crown 1150/- (including accessories)
01009002 per day 1000/-
Pneupack Ventilator in
01008058 Pulpotomy 750/-
01009003 Nursery (per day) 800/-
Reduction of Dislocation
01008059 of Tmj (Under LA.) 1400/- High Definition Unit/ Step
Reimplantation (per 01009004 Down (including Oxygen) 1500/-
01008060 Tooth) 3400/- 01009005 Exchange Transfusion 1200/-
Removal Partial Denture O.T. Charges for
01008061 (1st Tooth) 400/- 01009006 Exchange transfusion 400/-
Removable Partial 010 Oxygen Charges
01008062 Denture (Additional Tooth) 230/-
Private/ Semi-private/
Removable Partial
01010001 General Ward per hour 60/-
Denture per Tooth (Palatal
011 Burn Cases
01008063 Bar) 750/-
Repair of Facial Soft upto 30% Burns 1st
01008064 Tissue Laceration 1150/- Dressing (excluding
dressing materials and
Repair of Facial Soft
01011001 medicines) 700/-
01008065 Tissue Laceration (minor) 750/-
upto 30% Burns
Root Canal Treatment
Subsequent Dressing
01008066 (Upto 4 Sitting) 1150/-
(excluding dressing
01011002 materials and medicines) 700/-
01008067 (Extra Sitting) 400/-
30% to 50% Burns 1st
Dressing (excluding
with Filling and Crown
dressing materials and
(package) (Lab. Charges
01011003 medicines) 700/-
01008068 extra) 3600/-
30% to 50% Burns
01008069 Scaling per Sitting 400/- Subsequent Dressing
Sialolithotomy for Small (excluding dressing
01008070 Stones 115/- 01011004 materials and medicines) 700/-
Surgical Extraction or Extensive Burn above
Surgical Removal of 50% Frist Dressing
01008071 Impact (package) 1150/- (excluding dressing
Surgical Removal of Benin 01011005 materials and medicines) 1500/-
Reoplasm of Oral Extensive Burn above
01008072 (package) 1500/- 50% Subsequent dressing
Surgical Removal of Soft (excluding dressing
01008073 Tissue Lesion (package) 1150/- 01011006 materials and medicines) 1500/-
Surgical Removal of Burn Unit Bed (including
Impact Mesiod.tuber 01011007 1500/-
Oxygen)
01008074 (package) 1150/-
Obstetric &
ITU/CCU CHARGES 012 Gynaecology Cases
009 (Special Care Cases)
ICU/ITU/CCU/NICU/PICU Normal delivery or with
(including:- Oxygen; 01012001 Episiotomy & P. repair 12000/-
ECG/SPO2/NIBP/IBP 01012002 Low Forceps 12000/-
monitoring; 1:2 Nursing ċ 01012003 Low midcavity forceps 14000/-
GNM Nursing; Round the
01009001 Clock Doctor (Resident on 2400/- 01012004 Cesarean Section 20000/-
7
Annexure-I
Maximum Maximum
Approved Approved
01012005 Cesarean Hysterectomy 22000/- Repair of post-coital tear,
Rupture Uterus- closure & 01012029 perineal injury 4200/-
01012006 repair with Tubal Ligation 22000/- Excision of urethral
Perforation of Uterus after 01012030 caruncle 4000/-
D/E Laparotomy & 01012031 Laparoscopy (Gynae) 6100/-
01012007 Closure 18000/- Shirodhkar, Mc. Donalds
Laparotomy-peritonitis 01012032 stich 3700/-
01012008 Lavage and Drainage 16000/-
Laparotomy-failed 01012033 Laparotomy 20000/-
01012009 laparoscopy to explore 6100/-
01012010 Salphingectomy 14000/- 01012034 Abdominal Hysterectomy 22000/-
01012011 Salphingo-Oophorectomy 18000/-
01012035 Vaginal Hysterectomy 22000/-
01012012 Ovarean Cystectomy 18000/-
01012013 Oopherctomy 15000/- 01012036 Myomectomy 22000/-
Broad Ligment
01012014 Haemotoma Drainage 12000/- 01012037 Vaginoplasty 22000/-
Exploration of perineal Vulvectomy
Haematoma & Resuturing 01012038 (Simple/Radical) 25000/-
01012015 of Episiotomy 12000/-
Exploration of abdominal 01012039 RVF Repair 25000/-
Haematoma (after
01012016 laparotomy + LUCS) 12000/- 01012040 Other Major Operations 25000/-
Internal podalic version
01012017 and extraction 12000/- 01012041 Manchester Operations 20000/-
Manual Removal of
01012018 Placenta 3700/- 01012042 Perineorrhaphy 14700/-
3rd stage Complication
MRP for outside delivery
01012019 etc 4900/- 01012043 Colporraphy 14400/-
Examination under
01012020 anaesthesia 2500/- 01012044 Modified Gilliam 16900/-
01012021 Burst-abdomen Repair 3300/-
01012045 Shirodkar’s Operation 10200/-
Gaping Pareneal Wound
01012022 Secondary Suturing 2500/-
01012046 Diagnostic Curettage 2700/-
Gaping abdominal wound
01012023 Secondary Suturing 3700/-
Complete perineal tear- 01012047 Fractional Curettage 3400/-
01012024 repair 2500/-
Exploration of PPH-tear 01012048 D & C and Cervical Biopsy 3400/-
01012025 repair 4200/-
01012026 Destructive Operation 12000/- 01012049 Polypectomy 3600/-
Suction evacuation
vesicular mole, Missed 01012050 Other-Minor Operation 3600/-
01012027 abortion D/E 5900/- Excision Vaginal
Colpotomy-drainage P/V 01012051 Cyst/Burtholin Cyst 3900/-
01012028 needling EUA 4200/-
8
Annexure-I
Maximum Maximum
Approved Approved
Aspiration of Liver
01012052 Excision Vaginal Septum 5900/- 01013005 Abscess 3000/-
Open Drainage of Liver
01012053 Laparoscopy Diagnostic 6000/- 01013006 Abscess 10000/-
Drainage of Pelvic
01013007 Abscess 10000/-
01012054 Laparoscopy Sterilisation 7300/-
Drainage of Ischiorectal
01013008 Abscess 8000/-
01012055 Laparoscopy Operative 12000/-
Drainage of
Subdiaphragmatic
01012056 Laparoscopy LAVH 25000/- 01013009 Abscess 14000/-
Open Drainage of
01012057 Drilling of Ovary 10800/- 01013010 Perinepheric Abscess 14000/-
Drainage of Perigastric
01012058 Adhesiolysis 17400/- 01013011 Abscess 12000/-
Management of Ectopic Drainage of Perotid
01012059 pregnancy 20000/- 01013012 Abscess 8000/-
Drainage of
01012060 Hysteroscopy TCRE 11500/- 01013013 Retropharyngeal Abscess 8000/-
Hysteroscopy Removal of Open Drainage of Psoas
01012061 IUCD 5500/- 01013014 Abscess 8000/-
Hysteroscopy Removal of Open Drainage of
01012062 Septum 11500/- 01013015 Perivertebral Abscess 10000/-
Fissurectomy/
01012063 Hysteroscopy Diagnostic 7300/- Haemorroidectomy/
Werthimas Hystrectomy 01013016 Correction of Piles 16000/-
01012064 for Cancer cervix 30000/- Haemorroidectomy/
Correction of Piles
with Stapler Gun
01012065 Sterilisation Post Pertum 4700/-
01013017 (cost of Gun extra) 16000/-
Excision of Superficial
01012066 Sterilisation Intravaginal 6000/- 01013018 2800/-
Neurofibroma
01012067 Abortion- D & C 3900/- 01013019 Varicose Veins 25000/-
01012068 Abortion- Evacuation 4200/- 01013020 Excision of Carbuncle 4000/-

Injury Of Superficial Soft
01012069 MTP- 1st Trimester 3200/- 014 Tissues
01012070 MTP - 2nd Trimester 4800/-

015 Interestical (Implant)
01015001 Head & Neck 9700/-
01012071 Extended Hysterectomy 28000/-
01015002 Breast 9600/-
013 General Surgery
01015003 Soft Tissue Sarcome 12000/-
01013001 Drainage of Abscess 2000/-
01013002 Dressing under G.A. 2400/-
016 GASTROENTROLOGY
Aspiration of cold Abscess
01013003 of Lymphnode 3100/-
01016001 Capsule Endoscopy 30000/-
01013004 Aspiration of Empyema 2400/-
9
Annexure-I
Maximum Maximum
Approved Approved
Complete Double Baloon
01016002 Enteroscopy 18000/- 01016025 Gastrostomy (PEG) 7000/-
Complete Small Bowel
01016003 Evaluation 30000/- 01016026 Gastrostomy (PEG) (BS) 11000/-
Argan Plasma Coa
01016004 (Major) 5000/- 01016027 Glue Injection 4500/-
Argan Plasma Coa
01016005 (Major) (BS) 6500/- 01016028 Glue Injection (BS) 7000/-
Argan Plasma Coa
01016006 (Minor) 2200/- 01016029 Hemosta by Glod Probe 7000/-
Argan Plasma Coa
01016007 (Minor) (BS) 3000/- 01016030 Hemostatic Clip 7000/-
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 Nasojejunal Tube Plac 3000/-

Nasojejunal Tube Plac
01016019 Dilatation (Stricture) (BS) 4200/- 01016042 (BS) 4200/-
01016020 EMG Charge (Large) 3500/- 01016043 Papilla Cannu Minor 6500/-
01016021 EMG Charge (Small) 1500/- 01016044 Papilla Cannu Minor (BS) 8200/-
01016022 Endoscopic Tube Place 3000/- 01016045 Pappu Stnt Spingt (M) 12000/-
Endoscopic Tube Place Pappu Stnt Spingt (M)
01016023 (BS) 4200/- 01016046 (BS) 17500/-
01016024 Oesophageal Transit 1200/- 01016047 Polypectomy (Colonic) 3200/-
10
Annexure-I
Maximum Maximum
Approved Approved
Polypectomy (Colonic) Total Amputation &
01016048 (BS) 4800/- Excision of External
01017006 Auditory Meatus 10250/-
01016049 Polypectomy (Upper GI) 3000/- Excision of Cystic
01017007 Hygroma Minor 5500/-
Polypectomy (Upper GI)
01016050 (BS) 4500/- Excision of Cystic
01017008 Hygroma Major 8000/-
01016051 Pre Cutting 4500/- Excision of Cystic
01017009 Hygroma Extensive 12300/-
01016052 Pre Cutting (BS) 7500/- 01017010 Excision of Branchial Cyst 11000/-
Excision of Branchial
01017011 Sinus 11000/-
01016053 Pseudocyst Drainage 9000/-
Excision of Pharyngeal
01017012 Diverticulum 12200/-
01016054 Pseudocyst Drainage (BS) 16000/-
Mandibulectomy
01017013 25000/-
01016055 Sclerotherapy 3000/-
01017014 Operation for Cervical Rib 30000/-
01016056 Sclerotherapy (BS) 3800/-
01017015 Pharyngectomy 35000/-
01016057 Small Bowel Enteroscp 14000/-
01017016 Stenosis Excision 17000/-
01016058 Sphincterotomy 10500/-
01017017 Commando Operation 27000/-
01016059 Sphincterotomy (BS) 16000/- Block Dissection of
01017018 Cervical Lymph Nodes 20300/-
01016060 Stone Extraction 12000/- Pharyngectomy &
01017019 Reconstruction 40000/-
01016061 Stone Extraction (BS) 17000/- Operation for Carcinoma
01017020 Lip - Wedge Excision 10000/-
01016062 Gastric Emptying 2500/- Operation for Carcinoma
01017021 Lip - Vermilionectomy 10000/-
01016063 Mechanical Lithotripsy 25000/- Operation for Carcinoma
Lip - Wedge Excision and
01017022 Vermilonectomy 12000/-
01016064 ERCP (Stenting) 10000/-
01017023 Estlander Operation 9700/-
017 Head & Neck
01017024 Abbe Operation 12000/-
01017001 Ear Lobe Repair one side 600/-
01017025 Cheek Advancement 10200/-
Excision of Pinna for 01017026 Excision of the Maxilla 23300/-
Growth (Squamous/Basal/
01017002 Injuries) Skin Only 4500/- Excision of the Mandible -
Excision of Pinna for 01017027 Segmental 18100/-
Growth (Squamous/Basal/ 01017028 Hemimandibulectomy 27200/-
Injuries) Skin and 01017029 Partial Glossectomy 6100/-
01017003 Cartilage 6000/- 01017030 Hemiglossectomy 13500-
Partial Amputation of 01017031 Total Glossectomy 25000/-
01017004 Pinna 6000/- Parotidectomy -
01017005 Total Amputation of Pinna 7500/- 01017032 Superficial 24000/-
11
Annexure-I
Maximum Maximum
Approved Approved
Parotidectomy - Carotid Body Excision
01017033 Conservative 19700/- 01018004 (cost of Graft extra) 36000/-
01018005 Total Laryngectomy 39050/-
01017034 Parotidectomy - Radical 22000/- Flap Reconstructive
01018006 Surgery 42800/-
01017035 Parotidectomy - Total 15000/- Parapharyngeal Tumour
01018007 Excision 32000/-
01017036 Repair of Parotid Duct 20400/-
Removal of 01018008 Total Thyroidectomy 30000/-
Submandibular Salivary 019 Breast
01017037 gland 10000/- 01019001 Drainage of Abscess 7000/-
01019002 Excision of Lumps 10000/-
01017038 Hemithyroidectomy 15000/- Local Mastectomy
01017039 Partial Thyroidectomy 16000/- 01019003 (Simple) 13500/-
Subtotal Thyroidectomy Radical Mastectomy
01017040 (Toxic Goitre) 22000/- 01019004 (Formal or Modified) 28000/-
Excision of Mammary
01017041 Total Thyroidectomy 23000/- 01019005 Fistula 16000/-
Resection Enucleation of Segmental Resection of
01017042 Adenoma 12500/- 01019006 Breast 18300/-
Breast Cancer (Tumour
01017043 Isthmectomy 12600/- 01019007 excision) 30000/-
Total Thyroidectomy and Cardio Respiratory
01017044 Block Dissection 31400/- 020 Procedures
Excision of Lingual 01020001 Tracheostomy 3700/-
01017045 Thyroid 25650/-
Thoracotomy (Penetrating
Excision of Thyroglossal
01020002 Wounds) 17500/-
01017046 Cyst/Fistula 15000/-
Intercostal Drainage of
Excision of Parathyroid
01020003 empyema 5400/-
01017047 Adenoma/Carcinoma 25600/-
Decortication
01020004 (Pleurectomy) 37000/-
01017048 Laryngectomy 37150/-
01020005 Thoracoplasty 37000/-
01020006 Pneumonectomy 37000/-
01017049 Laryngo Pharyngectomy 43500/-
01020007 Lobectomy 37000/-
01017050 Sinus & Fistula repair 14000/-
01020008 Segmental Resection 37000/-
01017051 Lymph Node Excision 8000/-
01020009 Hydatid Cyst- Removal 37000/-
01017052 Hyoid Suspension 12000/-
01017053 Genioplasty 12000/- Video-assisted
thoracoscopic lung
01017054 Direct Laryngoscopy 5400/- 01020010 Surgeries 37000/-
01017055 Phonosurgery 15400/- Lung volume reduction
01017056 Fibroptic Laryngoscopy 3000/- surgery (Unilateral/
01017057 Microlaryngeal Surgery 11000/- 01020011 Bilateral) 37000/-
01017058 Laryngofissure 17500/- Thoracoscopic
018 Head & Neck Cancer 01020012 Decortication 37000/-
01018001 Benign Tumour Excisions 11000/- Thoracoscopic
01018002 Temporal Bone resection 27600/- 01020013 Pneumonectomy 37000/-
01018003 Radical Neck Dissection 28500/- 01020014 Thoracoscopic Lobectomy 37000/-
12
Annexure-I
Maximum Maximum
Approved Approved
Thoracoscopic Segmental Lung Resection with
01020015 Resection 37000/- Dissection of Lymph Node
01020037 Stations 37000/-
Thoracoscopic
01020016 Cyst excision 37000/- Surgery for Recurrent
01020038 Pnemothoraxic 37000/-
Thoracoscopic
01020017 Sympathectomy 37000/- Surgery for Aspergillosis
Chest Wall Tumor 01020039 (Lung Cavities) 37000/-
Excision with 01020040 Bronchotomy 37000/-
01020018 Reconstruction 37000/-
01020041 Mediostonoscopy 15000/-
Repair of Congenital
01020019 Chest Wall Defermities 37000/- Cardiac / Cardio
021 Thoracic Procedures
Coronary Bypass Surgery
01020020 Multiple Lobectomy 37000/-
(including Pre-Surgery
Decortication + 01021001 Profile) 150000/-
01020021 Thoracoplasty 37000/- Coronary Bypass Surgery-
Decortication + Lung post Angioplasty
Resection + (including Pre-Surgery
01020022 Thoracoplasty 37000/- 01021002 Profile) 150000/-
Open Lung Biopsy 18000/- Coronary Balloon
01020023 Angioplasty
(Excluding Cost of Stents)
Medicistinoscopy(cervical) 15000/- (including Pre-Surgery
01020024
Video-assisted 01021003 Profile) (4 days’ package) 66000/-
36960/- Balloon angioplasty with
01020025 thoracoscopy (VATS)
Valvotomy (including Pre-
01021004 Surgery Profile) 90000/-
01020026 Thoracotomy for BPF 37000/- Open Heart Procedures
Surgery for Destroyed (including Pre-Surgery
01020027 Lung 37000/- 01021005 Profile) 150000/-
Sleeve Resection with Total Correction of
01020028 Lobectomy 37000/- Tetralogy of Fallot
Extrapleural
01021006 Profile) 150000/-
01020029 Pneumonectomy 37000/-
RSUV Correction
01020030 Tracheal Stenosis Surgery 37000/- 01021007 Profile) 150000/-
Repair of Tracheo TAPVC Correction
01020031 Innuminete Fistula 37000/- (including Pre-Surgery
Tracheal Resection for 01021008 Profile) 150000/-
01020032 Tracheal Tumour 37000/- Open ASD VSD (including
01020033 Segmentectomy 37000/- 01021009 Pre-Surgery Profile) 150000/-
Open Pulmonary
01020034 Wedge Resection 37000/- Valvotomy (including Pre-
Lung Resection with 01021010 Surgery Profile) 150000/-
Paratracheal L. Node Open Aortic Valvotomy
01020035 Resection 37000/- (including Pre-Surgery
Lung Resection with 01021011 Profile) 150000/-
01020036 Chest Wall Invasion 37000/- Blalock Taussig Operation
01021012 Profile) 72000/-
13
Annexure-I
Maximum Maximum
Approved Approved
Mitral Valvotomy Unifocalization with Shunt
(including Pre-Surgery (including Pre-Surgery
01021013 Profile) 72000/- 01021031 Profile) 150000/-
Mitral Valve Replacement Removal of Foreign Body
(Excluding Cost of Valve) from Trachea or
(including Pre-Surgery 01021032 Oesophagus 6000/-
01021014 Profile) 150000/-
Aortic Valve Replacement 01021033 Rib Resection & Drainage 11500/-
(Excluding Cost of Valve) 01021034 Mediastinal Tumour 35000/-
(including Pre-Surgery 01021035 Thymectomy 35000/-
01021015 Profile) 150000/- ASD Device Closure
Double Valve 01021036 (Excluding Cost of Device) 40000/-
Replacement (Excluding
PDA Device Closure
Cost of Valves) (including
01021037 (Excluding Cost of Device) 32000/-
01021016 Pre-Surgery Profile) 160000/-
Thoraco-Abdomi Aorta 01021038 DSA 5400/-
Replacement (including 01021039 EP STUDY 8400/-
01021017 Pre-Surgery Profile) 150000/- 01021040 3D RF Ablation 40000/-
Coarctation-Arota Repair 01021041 Mini EP Study 5000/-
of Block Taussing Shunt Coronary Angiography
(including Pre-Surgery 01021042 (1 day’s package) 11700/-
01021018 Profile) 96000/- 01021043 Fonten 170000/-
Patent Ductus Arteriousus 01021044 Gunshot injury 52000/-
01021045 Heart transplant 277000/-
01021019 Profile) 72000/-
Mitral Valvotomy (Open) 01021046 Intra coronary stenting 58000/-
(including Pre-Surgery 01021047 Directiol atherectomy 98000/-
01021020 Profile) 150000/- Permanent Pacemaker
Implantation (DDD)
Pericardiostomy (including (Pacemaker Cost extra)
01021021 Pre-Surgery Profile) 54000/- 01021048 (4 days’ package) 25000/-
Pericardiectomy (including Permanent Pacemaker
01021022 Pre-Surgery Profile) 72000/- Implantation
01021023 Pericardio Centesis 3900/- (Biventricular)
Permanent Pacemaker (Pacemaker Cost extra) (4
Implantation (Excluding 01021049 days’ package) 30000/-
Cost of Pacemaker) 01021050 Femoral Poplitial Bypass 75000/-
01021024 (4 days’ package) 19400/-
01021051 Iliacfemoral Bypass 75000/-
Temporary Pacing Lead
Implantation (Including 01021052 Aorto Bifemoral Bypass 75000/-
use of Temporary Carotid Subclavian
01021025 Pacemaker) 12600/- 01021053 Bypass 75000/-
01021054 PA Banding 55000/-
01021026 Embolectomy 19800/- 01021055 BD Glen 55000/-
Aneurysm- Resection & Thoracic Aorta/ Arch
Grafting (cost of Graft Replacement (including
01021027 extra) 96000/- 01021056 Pre-Surgery Profile) 150000/-
AICD/ICD Implantation
01021028 Thoracocentesis 2000/- procedure charges (cost
01021057 of implants extra) 60000/-
01021029 Thorachostomy 5400/-
01021030 Exploratory Thorocotomy 37000/-
14
Annexure-I
Maximum Maximum
Approved Approved
Note:- CABG if done along with other Heart Surgeries Partial/Subtotal
like Valve Replacement etc. will attract the same rate as Gastrectomy for
CABG. 01023008 Carcinoma 30000/-
Partial/Subtotal
01023009 Gastrectomy for Ulcer 30000/-
022 Oesophagus
Operation for Bleeding
Atresia of Oesophagus 01023010 Peptic Ulcer 25000/-
and Tracheo Gastrojejunostomy &
01022001 Oesophageal Fistula 29700/- 01023011 Vagotomy 27000/-
Operations for
Operation for
Replacement of
01023012 Gastrojejunal Ulcer 25000/-
01022002 Oesophagus by Colon 38000/-
Total Gastrectomy for
Oesophagectomy for
01023013 Cancer 35000/-
01022003 Carcinoma Easophagus 38000/-
Highly Selective
Oesophageal Intubation 01023014 Vagotomy 25000/-
01022004 (Mausseau Barbin Tube) 15500/-
Selective Vagotomy &
Achalasia Carida 01023015 Drainage 25000/-
01022005 Transthoracic 29700/-
Congenital Diaphragmatic
Achalasia Carida
01023016 Hernia 30000/-
01022006 Abdominal 14600/-
Hiatus Hernia Repair
Oesophago Gastrectomy
01023017 Abdominal 30000/-
01022007 for mid 1/3 lesion 38000/-
Oesophagus Dilatation of Hiatus Hernia Repair
01022008 Stricture- per visit 1500/- 01023018 Transthoracic 30000/-
01023019 Exploratory Laparotomy 12900/-
Colon-Inter position or
Replacement of 01023020 Epigastric Hernia Repair 15000/-
01022009 Oesophagus 38000/- 01023021 Umbilical Hernia Repair 15000/-
Oesophago Gastrectomy Ventral and Scar Hernia
– Lower Corringers 01023022 Repair 18000/-
01022010 procedure 38000/- Inguinal Hernia
Esophageal Perforation 01023023 Herniorraphy- unilateral 15000/-
01022011 Surgery 38000/- Inguinal Hernia –
Installation of Ryles Tube Hernioplasty- with mesh-
01022012 in Ca Esophagus 5000/- 01023024 unilateral 22000/-
01023025 Femoral Hernia Repair 22000/-
Esophageal Directiculum
01022013 Surgery 38000/- Rare Hernias - Repair
023 Abdomen (Spigalion, Obturator,
01023001 Gastroscopy 1300/- 01023026 Lumbar, Sciatic) 25000/-
Splenectomy - For
Gastric & Duodenal 01023027 Trauma 25000/-
01023002 Biopsy (Endoscopic) 1700/-
Splenectomy - For
01023003 Pyleromyotomy 10000/-
01023028 Hypersplenism 25000/-
01023004 Gastrostomy 12000/-
01023029 Splenorenal Anastomosis 40000/-
Simple Closure of 01023030 Portocaval Anastomosis 40000/-
01023005 Perforated peptic Ulcer 15000/-
Direct Operation on
Vagotomy Pyleroplasty /
Oesophagus for Portal
01023006 Gastro Jejunostomy 30000/-
01023031 Hypertension 30000/-
01023007 Duodenojejunostomy 25000/-
15
Annexure-I
Maximum Maximum
Approved Approved
Mesentericocaval Operation for Intestinal
01023032 Anastomosis 35000/- 01023058 Obstruction 25000/-
01023033 Warren Shunt 35000/- Operation for Intestinal
01023034 Pancerato Duodenectomy 36000/- 01023059 perforation 25000/-
By Pass Procedure for Benign Tumours of Small
Inoperable Carcinoma of 01023060 Intestine 25000/-
01023035 Pancreas 30000/- Excision of Small Intestine
Cystojejunostomy or 01023061 Fistula 25000/-
01023036 Cystogastrostomy 30000/- Operations for
01023037 Cholecystectomy 18000/- Haemorrhage of the Small
01023062 Intestines 25000/-
Cholecystectomy &
Operations of the
01023038 Exploration of CBD 22000/-
Duplication of the
Repair of Common Bile
01023063 Intestines 32000/-
01023039 Duct 20000/-
Operations for Recurrent
Operation for Hydatid Cyst Intestinal Obstruction
01023040 of Liver 25000/- (Noble Plication & Other
01023041 Cholecystostomy 14200/- Operations for the
Hepatic Resections 01023064 Adhesions) 28000/-
01023042 (Lobectomy Hepatectomy) 28000/- 01023065 Ilieosigmoidostomy 22000/-
Operation on Adrenal 01023066 Ilieotransverse Colostomy 22000/-
01023043 Glands - Bilateral 35000/- 01023067 Caecostomy 10000/-
Operation on Adrenal Loop Colostomy
Glands - Unilateral for 01023068 Transverse Sigmoid 20000/-
01023044 Tumour 20000/- 01023069 Terminal Colostomy 24000/-
Appendicectomy for Acute 01023070 Closure of Colostomy 24000/-
01023045 Appendicitis 20000/- 01023071 Right Hemi-Colectomy 24000/-
Appendicectomy for 01023072 Left Hemi-Colectomy 24000/-
01023046 Chronic Appendicitis 18000/- 01023073 Total Colectomy 39000/-
Appendicular Abscess – Operations for Volvulus of
01023047 Drainage 12000/- 01023074 Large Bowel 25200/-
01023048 Mesenteric Cyst- Excision 18000/- Operations for Sigmoid
Peritonioscopy/ 01023075 Diverticulitis 22000/-
01023049 Laparoscopy 5100/- 01023076 Fissure in Ano - Dilatation 6800/-
01023050 Jejunostomy 18000/-
Fissure in Ano -
01023051 Ileostomy 18000/- 01023077 Fissurectomy 16000/-
Congenital Atresia & 01023078 Rectal Polyp-Excision 8000/-
01023052 Stenosis of Small Intestine 25000/- Operation of
01023053 Muconium ileus 20000/- Haemorrhoids -Lords
Mal-rotation & Volvulus of 01023079 procedure 10000/-
01023054 the Midgut 20000/- Fistula in Ano - High
Resection & Anastomosis 01023080 Fistulectomy 20000/-
01023055 of Small Intestine 22000/- Fistula in Ano - Low
Excision of Meckle’s 01023081 Fistulectomy 12000/-
01023056 Deverticulum 22000/- Imperforat Anus -
01023057 Duodenal Diverticulum 18000/- 01023082 Colostomy 16000/-
16
Annexure-I
Maximum Maximum
Approved Approved
Imperforate Anus - Pull Conduit
01023083 Through Operation 22000/- 01024016 Ureteric Catheterisation 5000/-
Prolapse Rectum - Dormia Extraction of
01023084 Theirch Wiring 15000/- 01024017 Calculus 6000/-
Prolapse Rectum - Biopsy of Bladder
01023085 Rectopexy 10000/- 01024018 (Cystoscopic) 6000/-
Prolapse Rectum - Diathermy Destruction of
01023086 Grahams Operation 22000/- 01024019 Bladder Neoplasm 15000/-
Operations for 01024020 Litholapexy 15000/-
01023087 Hirschsprungs Disease 22000/- Operations for Injuries of
01023088 Excision of Pilonidal Sinus 12300/- 01024021 the Bladder 30000/-
Abdomino-Perineal Suprapubic Drainage
01023089 Excision of Rectum 26700/- (Cystostomy/
Anterior Resection of 01024022 Vesicostomy) 12000/-
01023090 rectum 26300/- 01024023 Total Cystectomy 35000/-
Pull Through Abdominal 01024024 Diverticulectomy 32000/-
01023091 Resection 22000/- Open Resection of the
Operations for 01024025 Bladder Neck 25000/-
01023092 Neuroblastoma 22000/- Y-V Plasty of the Bladder
01024026 Neck 25000/-
01023093 Fistula/ Fistulotomy 12000/- 01024027 Cystoplasty 28000/-
Operations for Extrophy of
01023094 Hernioctomy 21000/- 01024028 the Bladder 40000/-
Nephrology / 01024029 Repair of Ureterocoel 25000/-
024 Genitourinary 01024030 Suprapubic Prostatectomy 25000/-
01024001 Partial Nephrectomy 25000/- 01024031 Retropubic Prostatectomy 25000/-
01024002 Nephrolithotomy 25000/- Transurethral Resection of
01024003 Pyelolithotomy 25000/- Prostate (TURP)/ TUR
Operations for 01024032 Bladder Tumour 25000/-
01024004 Hydronephrosis 25000/- Intravesical BCG
instillation (Cost of BCG
Open Drainage of
01024033 extra) 500/-
01024005 Perinephric Abscess 15000/-
01024006 Cavernostomy 20400/- Operations for Injury to
01024034 Urethra 30000/-
Operations for Cyst of the
01024035 Internal urethrotomy 15000/-
01024007 Kidney 25000/-
01024036 Urethral Reconstruction 32000/-
01024008 Ureterolithotomy 20000/-
01024009 Nephroureterectomy 20000/- Operation for Congenital
01024037 Valves of Urethra 16000/-
Operations for Ureter for - Operations for
01024010 Double Ureters 30000/- Incontinence of Urine -
Operations for Ureter -for 01024038 Male 25000/-
01024011 Ectopia of Single Ureter 27000/- Operations for
Operations for Vesico- Incontinence of Urine -
01024012 ureteric Reflux 28000/- 01024039 Female 25000/-
01024013 Ureterostomy - Cutaneous 20000/- Reduction of
01024014 Uretero-Colic anastomosis 20000/- 01024040 Paraphimosis 2450/-
Circumcision (under
01024015 Formation of an Ileal 22000/-
01024041 General Anaesthesia) 6000/-
17
Annexure-I
Maximum Maximum
Approved Approved
01024042 Meatotomy 3500/- CAVD
01024043 Meatoplasty 6800/-
Operations for 01024067 Subclavian Access 1850/-
Hypospadias - Chordee 01024068 Femoral Access 1750/-
01024044 Correction 15000/- 01024069 Plasma Exchange 2500/-
Operations for 01024070 Donor Nephrectomy 50000/-
Hypospadias - Second 01024071 Renal Transplantation 250000/-
Stage or One Stage 01024072 Ureteric Reimplant 4200/-
01024045 Repair 24000/-
01024073 Lymphocoel 4300/-
01024046 Operations for Epispadias 22000/-
01024074 Transplant Nephrectomy 35000/-
Partial Amputation of the
01024047 Penis 14000/-
01024075 Nephrouretectomy 35000/-
Total amputation of the
01024076 Vascular Prosthetic Graft 35000/-
01024048 Penis 20000/-
CAPD (insertion &
01024049 Orchidectomy- Simple 14000/- 01024077 removal) 8000/-
01024050 Orchidectomy- Radical 20000/- 01024078 PCNL - Unilateral 30000/-
Adreneclectomy PCNL – Bilateral/
Unilateral/Bilateral for 01024079 PCNL-III 46000/-
01024051 Tumour/For Carcinoma 30000/- 01024080 Palomo’s Unilateral 7300/-
Operations for Hydrocele - 01024081 Palomo’s Bilateral 12600/-
01024052 Unilateral 8000/- 01024082 Endoscopic Teflon Inject 5100/-
Operations for Hydrocele - 01024083 Testicular Biopsy 4350/-
01024053 Bilateral 12000/- Gil-Verner’s Extended
Operation for Torsion of 01024084 Pyelolithotomy 22000/-
01024054 Testis 15000/- Radical Nephrectomy
01024055 Vasovasostomy 18000/- Complicated Tumour or
01024056 Operations for Varicocele 15000/- 01024085 Adhesions 50000/-
Block Dissection of Anderson Hynes
01024057 Inguinal Nodes - One Side 25000/- 01024086 Pyeloroplasty 25000/-
Block Dissection of Vasico Vaginal Fistula
Inguinal Nodes - Both 01024087 Repair 30000/-
01024058 Sides 32000/- 01024088 Radical Cystectomy 44000/-
Excision of Filarial 01024089 Caeco Cystoplasty 26000/-
01024059 Scrotum 16000/-
01024090 Nephrectomy Simple 25000/-
Emergency Dialysis 01024091 Nephrostomy 22000/-
01024060 Femoral Puncture 1200/-
01024092 Ureteric Reimplant 25000/-
Emergency Dialysis 01024093 Partial Cystectomy 28000/-
01024061 Subclavian Puncture 1800/-
01024062 Fistula/Shunt 8000/-
01024094 Epididymectomy 12000/-
Dialysis Femoral 01024095 TURP Cystolithotripsy 30000/-
01024063 Catheterisation Bilateral 1500/-
Haemo Dialysis (All 01024096 Open Prostatectomy 28000/-
01024064 Inclusive) 1500/- 01024097 Closure of Urethral Fistula 28000/-
Double Lumen Sub 01024098 Orchidopexy - Unilateral 15000/-
01024065 Clavian Catheter 3000/- 01024099 Orchidopexy - Bilateral 20000/-
Cystolithotomy -
Continuous Arterio Venus
01024100 Suprapubic 15000/-
01024066 Haemofiltration (CAVH)/ 17000/-
18
Annexure-I
Maximum Maximum
Approved Approved
Endoscopic Removal of Slow Efficiency Dialysis
01024101 Stone in Bladder 18000/- 01024125 (SLED) 4000/-
Resection Bladder Neck Prosthetic Surgery for
01024102 Endoscopic 18000/- 01024126 urinary incontinence 40000/-
Ureteroscopic Removal- Helium Laser Prostrate
surgery/ Optical Internal
01024103 with LASER 40000/-
01024127 urethrotomy 30000/-
Ureteroscopic Removal-
without LASER High Intensity Focus
01024104 18000/-
Ultrasound (HIFU) Robotic
01024128 for Carcinoma 150000/-
01024105 Urethroplasty 1st Stage 14000/-
01024129 CRRT Procedure 11000/-
01024106 Optical Urethrotomy 18000/-
01024130 TURP with LASER 32000/-
01024107 Exploratory Scrototomy 10000/-
01024131 Lithoclast (Day Care) 16000/-
01024108 Perineal Urethrostomy 15000/- 025 Plastic Surgery
Dilatation of Stricture
01025001 Primary Suture of Wound 3200/-
01024109 Urethra under G.A. 4000/-
Injection of Keloids -
Dilatation of Stricture
01025002 Ganglion 2700/-
Urethra without
01024110 Anesthesia 2200/- Injection of Keloids -
01025003 Haemangioma 6100/-
Retroperitoneoscopy
01025004 Free Grafts - Wolfe Grafts 18000/-
01024111 Nephrectomy 40000/-
Free Grafts - Theirech -
Retroperitoneoscopy 01025005 Small Area 5% 18500/-
01024112 partial Nephrectomy 35000/- Free Grafts - Large Area
Retroperitoneoscopic 01025006 10% 30000/-
01024113 nephrolithotomy 35000/- Free Grafts - Very Large
Retroperitoneoscopic 01025007 Area 20% 32400/-
01024114 pyelolithotomy 35000/- Skin Flaps - Rotation
Retroperitoneoscopic 01025008 Flaps 28750/-
operation for Skin Flaps -
01024115 Hyderonephrosis 35000/- 01025009 Advancement Flaps 31650/-
Skin Flaps - Direct- cross
Retroperitoneoscopic Leg Flaps- Cross Arm
01024116 surgery for Renal cyst 35000/- 01025010 Flap 35500/-
Retroperitoneoscopic Skin Flaps - Cross
01024117 ureterolithotomy 35000/- 01025011 Finger 35500/-
Retroperitoneoscopic
01024118 Nephroureteroectomy 35000/- 01025012 Skin Flaps - Abdominal 35500/-
Laproscopy aassisted
01024119 orchidopexy 22000/- 01025013 Skin Flaps - Thoracic 34400/-
Laproscopic operation for 01025014 Skin Flaps - Arm Etc. 35500/-
01024120 varicocele 20000/- Subcutaneous Pedicle
Cystoscopic Basketing of 01025015 Flaps Raising 28500/-
01024121 Urethra 12000/- Subcutaneous Pedicle
Lithotripsy/ ESWL 01025016 Flaps Delay 27750/-
01024122 (Complete) 30000/- Subcutaneous Pedicle
Lithotripsy-1/ SMSL (Day 01025017 Flaps Transfer 28500/-
01024123 Care) 18000/- 01025018 Cartilage Grafting 29700/-
Lithotripsy-2/3/ SMSL 01025019 Reduction of Facial 9000/-
01024124 (Day Care) 23000/-
19
Annexure-I
Maximum Maximum
Approved Approved
Fractures of Nose
Reduction of Facial Orthopaedic Surgery
01025020 Fractures of Maxilla 13800/- 026 Procedure
Reduction of Fractures of Application of P.O.P Casts
Mandible & Maxilla - Eye 01026001 for Upper & Lower Limbs 7500/-
01025021 Let Splinting 27000/-
Reduction of Fractures of Application of Functional
Mandible & Maxilla - Cast 01026002 Cast Brace 7500/-
01025022 Netal Splints 27000/-
Reduction of Fractures of Application of Skin
Mandible & Maxilla - 01026003 Traction 1650/-
01025023 Gumming Splints 27000/- Application of Skeletal
Internal Wire Fixation of 01026004 Tractions 4450/-
01025024 Mandible & Maxilla 32000/- Bandage & Strappings for
01026005 Fractures 1150/-
01025025 Cleft Lip - repair. 32400/- Aspiration & Intra Articular
Cleft Palate Repair 01026006 Injections 950/-
01025026 Severe Degree 33800/- Application of P.O.P
01026007 Spices & Jackets 6000/-
Primary Bone Grafting of Close Reduction of
01025027 Cleft Lip Palate 34550/- 01026008 Fractures of Limb & P.O.P 7500/-
Reduction of Compound
01026009 Fractures 10000/-
Secondary Surgery for
01025028 Cleft Lip Deformity 32600/- Open Reduction & Internal
01026010 Fixation of Fingurs & Toes 18000/-
Open Reduction of
Secondary Surgery for
fracture of Long Bones of
01025029 Cleft Palate 31350/-
Upper / Lower Limb -
Reconstruction of Eyelid 01026011 Nailing & External Fixation 28000/-
01025030 Defects - Minor 17550/- Open Reduction of
Reconstruction of Eyelid fracture of Long Bones of
01025031 Defects - Major 30000/- Upper / Lower Limb -AO
Plastic Surgery of 01026012 Procedures 27000/-
Different Regions of the
01025032 Ear - Minor 10000/- 01026013 Tension Band Wirings 6000/-
Plastic Surgery of
Different Regions of the
01025033 Ear - Major 20000/- 01026014 Bone Grafting 18000/-
Plastic Surgery of the Excision of Bone Tumours
01025034 Nose - Minor 10000/- 01026015 -Superficial 28000/-
Plastic Surgery of the Excision of Bone Tumours
01025035 Nose - Major 20000/- 01026016 -Deep 40000/-
Plastic Surgery for Facial 01026017 Excision of Ganglion 10000/-
Paralysis (Support with
01025036 Reanimation) 32000/- Excision or other
Operations for Scaphoid
Pendulous Breast -
01026018 Fractures 25000/-
01025037 Mammoplasty 22550/-
Sequestrectomy &
Saucerizations -
01026019 Superficial 20000/-
20
Annexure-I
Maximum Maximum
Approved Approved
Sequestrectomy & Spinal Fusion
01026020 Saucerizations -Deep 30000/-
Sequestrectomy & 01026040 Costo Transversectomy 30000/-
Saucerizations -
01026021 Arthrotomy 35000/- Corrective Ostectomy &
01026041 Internal Fixation - Minor 15000/-
S.P.Nailing for Fracture Corrective Ostectomy &
01026022 Neck Femur 35000/- 01026042 Internal Fixation - Major 30000/-
Multiple Pinning Fracture
01026023 Neck Femur 35000/- Arthrodisis of - Minor
01026043 Joints 15000/-
Nail Plate Fixations for
01026024 Fracture Neck Femur 35000/- Arthrodisis of - Major
01026044 Joints 30400/-
A.O.Compression
Procedures for Fracture Soft Tissue Operations for
01026025 Neck Femur 35000/- 01026045 C.T.E.V. 25000/-
Open Reduction of Soft Tissue Operations for
Fracture Neck Femur Polio (instrumentation
Muscle Pedicle Graft and 01026046 extra) 25000/-
01026026 Internal Fixations 35000/- Partial Hip Replacement
Closed Reduction of 01026047 (Cost of Prosthesis extra) 40000/-
01026027 Dislocations 10000/- Operations for Brachial
Open Reduction of 01026048 Plexus & Cervical Rib 32000/-
01026028 Dislocations - Superficial 20000/- Amputations - Below
Open Reduction of 01026049 Knee Rs 25000/-
01026029 Dislocations - Deep 30000/-
Open Reduction of Amputations - Below
Fracture Dislocation & 01026050 Elbow 25000/-
01026030 Internal Fixation 35000/-
Amputations - Above
01026051 Knee 35000/-
01026031 Neurolysis/Nerve Suture 25000/- Amputations - Above
01026052 Elbow 30000/-
01026032 Nerve Repair with Grafting 32000/- Amputations -
01026053 Forequarter 40000/-
Tendon with Transplant or
01026033 Graft 35000/- Amputations -Hind
Tendon Quarter and
Lengthening/Tendon 01026054 Hemipelvectomy 44000/-
01026034 Sutures 25000/- 01026055 Disarticulations - Major 30000/-
01026056 Disarticulations - Minor 20000/-
01026035 Tendon Transfer 35000/- Arthrography &
01026057 Osteomedullography 10450/-
Laminectomy, Excision Spinal Ostectomy and
01026036 Disc (Prosthesis extra) 40000/- 01026058 Internal Fixations 40200/-
Laminectomy, Excision 01026059 Arthroscopy - Operative 24250/-
Disc and Tumours Soft Tissue Operation on
01026037 (Prosthesis extra) 60000/- 01026060 Knee 24000/-
Anterolateral Clearance Myocutaneous and
01026038 for tuberculosis 32000/- Fasciocutaneous Flat
Antereolateral 01026061 Procedures for Limbs 24000/-
01026039 Decompression and 45000/- 01026062 Removal of Nails, Wires & 10000/-
21
Annexure-I
Maximum Maximum
Approved Approved
Screw Tube Plaster (or plaster
01026063 Removal of Plates 15000/- 01026081 cylinder) 1450/-
Total Hip Replacement-
Unilateral (Excluding 01026082 Above knee full plaster 2400/-
01026064 Implants) 60000/-
Total Finger Joint 01026083 Above knee full slab 2200/-
Replacement-Unilateral
01026065 (Excluding Implants) 23000/- 01026084 Minerva Jacket 4000/-
Total Knee Joint
Replacement-Unilateral
01026066 (Excluding Implants) 55000/- 01026085 Plaster Jacket 3050/-
Any Other Joint
Replacement (e.g. elbow, 01026086 Shoulder spica 3350/-
shoulder, etc.)- Unilateral
01026067 (Cost of Implants extra) 55000/- 01026087 Single Hip spica 3100/-
Multiple fractures repair
(excluding peripheral limb 01026088 Double Hip spica 3800/-
injuries)-major (above
three fractures) (cost of
01026068 implants extra) 100000/- 01026089 Resection of First Rib 45000/-
Multiple fractures repair
(excluding peripheral limb 01026090 Resection of Cerical Rib 35000/-
injuries)-medium (above
two fractures) (cost of 01026091 Rib Resection 12500/-
01026069 implants extra) 60000/-
Sternal Dehisences 01026092 Ligament Reconstruction 22000/-
01026070 Repair 25000/-
Sternal Dehisences 027 Neuro-Surgery
01026071 Reconstruction 55000/- Craniotomy and
Evacuation of Haematoma
01026072 Fingers (post, slab) 300/- 01027001 -Subdural 70000/-
Craniotomy and
01026073 Fingers full plaster 300/- Evacuation of Haematoma
Colles Fracture - Below 01027002 -Extradural 70000/-
01026074 elbow 1200/- Evacuation of Brain
Colles Fracture - Full 01027003 Abscess 80000/-
01026075 plaster 2000/- Excision of Lobe (Frontal,
Temporal, Cerebelium
Colles fracture Ant. Or 01027004 etc.) 80000/-
01026076 post. slab 1000/-
Excision of Brain Tumours
01027005 -Supratentotial 80000/-
01026077 Above elbow full plaster 1000/- Excision of Brain Tumours
01027006 -Subtentorial 80000/-
01026078 Above Knee post-slab 700/-
01027007 Surgery of Cord Tumours 60000/-
01026079 Below Knee full plaster 1000/- Ventriculoatrial
/Ventriculoperitoneal
01026080 Below Knee post-slab 750/- 01027008 Shunt 40000/-
Excision of Cervical Inter-
01027009 Vertebral Discs 50000/-
22
Annexure-I
Maximum Maximum
Approved Approved
Sympathetectomy - + Investigation)
01027010 Lumbar 18000/- Brain Biopsy (Procedure +
Sympathetectomy - 01027039 Investigation) 18000/-
01027011 Cervical 18000/- Anterior Cervical Spine
01027040 Surgery with fusion 60000/-
01027012 Twist Drill Craniostomy 30000/- Anterior Lateral
01027013 Subdural Tapping 15000/- 01027041 Decompression 60000/-
01027042 Brain Mapping 2400/-
01027014 Ventricular Tapping 12000/- Cervical or Dorsal
01027043 Laminectomy 45000/-
Combined Trans-oral
01027015 Abscess Tapping 15000/-
Surgery & CV Junction
Placement of ICP Monitor
01027044 Fusion 110000/-
01027016 - 15000/-
01027045 C.V. Junction Fusion 80000/-
Urokinase Therepy for
01027017 ICH - 15000/- 01027046 Depressed Fracture 40000/-
01027018 Skull Traction Application 3400/- 01027047 Discectomy 45000/-
Lumber Pressure 01027048 Endarterectomy 50000/-
01027019 Monitoring 10000/-
R.F. Lesion for Trigeminal
01027020 Vascular Malformations 100000/- 01027049 Neuralgia - 30000/-
01027021 Peritoneal Shunt 15000/-
01027050 Spasticity Surgery - 90000/-
01027022 Atrial Shunt 15000/-
01027051 Spinal Fusion Procedure 65000/-
01027023 Meningo Encephalocoel 52000/- Spinal Intra Medullary
01027024 Meningomyelocoel 42000/- 01027052 Tumours 65000/-
01027025 C.S.F. Rhinorrhaea 55000/- Spinal Bifida Surgery
01027026 Cranioplasty 55000/- 01027053 Major 65000/-
Posterior Cervical Spina/ Bifida Surgery
01027027 Dissectomy 50000/- 01027054 Minor 55000/-
Anterior Cervical Stereotaxic Procedures-
01027028 Dissectomy 50000/- 01027055 biopsy/ aspiration 22000/-
Brachial Plexus 01027056 Trans Sphenoidal Surgery 65000/-
01027029 Exploration Microsuturing 50000/-
01027057 Trans Oral Surgery 110000/-
Median Nerve
01027030 Decompression 40000/- Implantation of DBS- one
Peripheral Neurectomy 01027058 Electrode 100000/-
01027031 (Tirgeminal) 45000/- Implantation of DBS- two
01027032 Trigeminal Rhiotomy 35000/- 01027059 Electrodes 100000/-
Endoscopic
01027033 Cranial Nerve Astomosis 60000/- 01027060 Adueductoplasty 100000/-
Facial nerve
01027034 Meningocoele Excision 45000/- 01027061 reconstruction 50000/-
Peripheral Nerve Surgery Recanelisation of venous
01027035 – Major 50000/- 01027062 sinuses 80000/-
Peripheral Nerve Surgery
01027036 Minor 40000/- 01027063 Carotid stenting 75000/-
Ventriculo-Atrial Shunt
01027037 (Exclud. Cost of valve) 100000/- 01027064 Cervical disc arthroplasty 35000/-
01027038 Nerve Biopsy (Procedure 15000/-
23
Annexure-I
Maximum Maximum
Approved Approved
Lumbar disc arthroplasty
01027065 30000/- 01027087 Endoscopic discectomy 60000/-
01027066 Corpus Callosectomy 60000/-
01027088 Aneurysm coiling 80000/-
Endoscopic spil
01027067 Hemishpherectomy 80000/- procedure- aneurysm
Endoscopic CSF 01027089 coiling 80000/-
01027068 rhinorrhea repair 50000/- Surgery for grooving skull
Microsurgical excision of fractures- aneurysm
01027069 Acoustic tumour 60000/- 01027090 coiling 80000/-
Microsurgical excision of Carpel Tunnel
01027070 meningomas 60000/- 01027091 decompression 40000/-
01027071 Epilepsy surgery 80000/- Clipping of intracranial
01027092 aneurysm with use of clip 90000/-
RF lesion for facet pain
01027072 syndrome 40000/- Endoscopic aspiration of
intracerebellar
01027073 Cervical laminoplasty 40000/-
01027093 haematoma 60000/-
Lateral mass C1-C2 screw Stereotactic Radiosurgery
01027074 fixation 60000/- for brain pathology (X
Microsurgical 01027094 knife/ Gamma) 120000/-
decompression for
Foramen magnum
01027075 Trigemil nerve 60000/-
01027095 decompression 60000/-
Cerebellar stimulation for Foramen magnum
01027076 hemifacial spasm 80000/- decompression with
Cerebellar stimulation for syringosubarachnoid
other cranial nerve 01027096 shunt 60000/-
01027077 neuralgia 80000/- Dorsal column stimulation
01027078 IC EC bypass procedures 70000/- for bachache in failed
01027097 back syndrome 50000/-
Stereotactic guided
Surgery for recurrent disc
01027079 craniotomy 70000/-
01027098 prolapse/ epidural fibrosis 60000/-
Baclofen pump
implantation lesioning for Surgery for brain stem
movement disorder 01027099 tumours 100000/-
01027080 including Parkinsonism 60000/- Decompressive
cranectomy for
01027081 Programmable shunt 40000/- hemishpherical acute
01027100 subdural 70000/-
Endoscopic Intra arterial thrombolysis
01027082 sympathectomy 18000/- with RTPA for ischemic
External ventricular 01027101 stroket RTPA-acute 100000/-
01027083 drainage 12000/-
Stereotactic aspiration of
Image guided surgery 01027102 intracerebral haematoma 50000/-
01027084 Excision of tethored 60000/-
Endoscopic 3rd 01027103 Complex Brain Surgery 130000/-
01027085 ventriculostomy 60000/-
Endoscopic cranial 01027104 Complex Spine Surgery 110000/-
surgery/Biopsy/aspiration/
01027086 aneurysm coiling 60000/- 01027105 Dorsal Sympathectomy 50000/-
24
Annexure-I
Maximum Maximum
Approved Approved
Neuro rehabilitisation-
package for 25 sittings
01027106 (bed charges extra) 15000/- 029 Paediatric Surgery
028 Vascular Surgery
Excision of thyroglossal
01029001 Duct/Cyst 30000/-
01028001 Patch Graft Angioplasty 50000/- Diaphragmatic Hernia
Operations for Stenosis of Repair (Thoracic or
01028002 Renal Arteries 50000/- 01029002 Abdominal Approach) 35000/-
Tracheo Oesophageal
Fistula (Correction
01028003 Thrombendarterectomy 50000/- 01029003 Surgery) 40000/-
Operations for Acquired Colon Replacement of
01028004 Arteriovenous Fistula 50000/- 01029004 Oesophagus 40000/-
Congenital Arterio Venous Omphalo Mesenteric Cyst
01028005 Fistula 27700/- 01029005 Excision 30000/-
Omphalo Mesenteric
Surgery for Arterial 01029006 Duct- Excision 30000/-
01028006 Aneursysm -Vertebral 80000/-
Surgery for Arterial 01029007 Meckels Diverticulectomy 30000/-
01028007 Aneursysm Carotid 42500/-
Surgery for Arterial Omphalocele 1st Stage
Aneursysm Main Arteries 01029008 (Hernia Repair) 28000/-
01028008 of the Limb 50000/-
Dissecting Aneurysms + Omphalocele 2nd Stge
01028009 Implant 150000/- 01029009 (Hernia Repair) 30000/-
01029010 Gastrochisis Repair 24000/-

Stripping of Short or Long
01028010 Sephenous Veins 30000/-
01029011 Inguinal Herniotomy 24000/-
Ligation of Ankle
01028011 Perforators 17400/- 01029012 Congenital Hydrocele 24000/-
01029013 Hydrocele of Cord 22000/-
Excision and Skin Graft of
01028012 Venous Ulcer 15500/-
01029014 Torsion Testis Operation 25000/-
Congenital Pyloric
01028013 Venous Thromoectomy 22100/- 01029015 Stenosis- operation 27000/-
Duodenal- Atresia
Lymphatics Excision of 01029016 Operation 35000/-
Subcutaneous Tissues In
01029017 Pancreatic Ring Operation 45000/-
01028014 Lymphoedema 30000/-
01029018 Meconium Ileus Operation 30000/-
Malrotation of Intestines
01029019 Operation 32000/-
01028015 Trendelenburg Operations 30000/- Rectal Biopsy
Vascular Procedure – 01029020 (Megacolon) 25000/-
01028016 Minor 16800/-
Surgery for Arterial 01029021 Colostomy Transverse 28000/-
01028017 Aneursysm Spleen Artery 40200/-
Surgery for Arterial
01028018 Aneursysm Renal Artery 40200/- 01029022 Colostomy Left Iliac 28000/-
01029023 Abdominal Perineal Pull 35000/-
25
Annexure-I
Maximum Maximum
Approved Approved
Through (Hirschaprugis
Disease)
Imperforate Anus Low 01029040 Umbilical Line 500/-
Anomaly -Cut Back
01029024 Operation 22000/-
01029041 Peripheral Long Line 800/-
Imperforate Anus Low
Anomaly - Perineal 01029042 LP 300/-
01029025 Anoplasty 28000/-
Inperforate Anus High 01029043 Peritoneal Tapping 500/-
Anomaly -Sacroabdomino
01029026 Perineal Pull Through 25000/- 01029044 Chest Drainage 800/-
Inperforate Anus High General Nursery Care
Anomaly - Closure of (including Nursing Care
01029027 Colostomy 21000/- 01029045 etc.) 600/-
01029028 Intususception Operation 35000/-
Choledochoduodenostom 01029046 Phototherapy per day 400/-
y for Atresia of Extra Neonate Rooming in with
01029029 Hepatic Billiary Duct 35000/- mother per day (inclusive
01029047 of Nursing care) 600/-
Operation of Choledochal SNCU (Sick New Born
01029030 Cyst 35000/- 01029048 Care Unit) 1600/-
Laproscopic/
Endoscopic Operations
Nephrectomy for -
In Gen. Surgery /
01029031 Pyonephrosis 35000/-
030 Gastrohepatic / Nephro-
01030001 Diagnostic Laproscopy 6600/-
Nephrectomy for - Laproscopic
01029032 Hydronephrosis 35000/- 01030002 Pyloromyotomy 18000/-
01030003 Laproscopic Gastrostomy 21000/-
Nephrectomy for -Wilms Laproscopic Closure of
01029033 Tumour 35000/- 01030004 Perforated peptic ulcer 25000/-
Paraortic Laproscopic Vagotomy
Lymphadenoctomy with Pyleroplasty/ gastro
Nephrectomy for Wilms 01030005 jejunostomy 24000/-
01029034 Tumour 40000/-
Laproscopic umbilical
Sacro- Coccygeal 01030006 hernia repair 20000/-
01029035 Teratoma Excision 30000/- Laproscopic ventral hernia
01030007 repair 25000/-
01029036 Neuroblastoma Debulking 32000/- Laproscopic
Neuroblastoma Total 01030008 cystogastrostomy 30000/-
01029037 Excision 36000/- Lap. Cholecystectomy &
01030009 CBD exploration 26000/-
Rhabdomyosarcoma wide
01029038 Excision 40000/- Lap. Hydatid of liver
Colon Transplant/ Conduit 01030010 surgery 28000/-
Management following
Acid Structure
01029039 Oesophagus 65000/- 01030011 Lap. Hepatic resection 28000/-
26
Annexure-I
Maximum Maximum
Approved Approved
Lap. Assisted small bowel
01030012 resection 30000/- 01030036 Laparoscopic Ectopic 22000/-
Lap. For intestinal
01030013 obstruction 30000/- 01030037 Foreign body removal 4000/-
Lap. For intestinal
01030014 perforation 28000/- 01030038 Nephrolithotomy 35000/-
Lap. Assisted Right Operations for
01030015 Hemicolectomy 32000/- Hydronephrosis-
Lap. Assisted left 01030039 Pyeloplasty 35000/-
01030016 Hemicolectomy 32000/- Operations for
Lap. Assisted Total Hydronephrosis-
01030017 Colectomy 37000/- 01030040 Endopyelotomy antegrade 35000/-
Operations for Cyst of the
01030018 Laproscopic Rectopexy 32000/- 01030041 Kidney 40000/-
Lap. Asisted
Abdominoperineal 01030042 URSL 25000/-
01030019 Resection of rectum 37000/-
Lap. Assisted anterior 01030043 Nephroureterectomy 50000/-
01030020 resection 37000/- Operations for Vesico-
Laproscopic 01030044 ureteric Reflux 40000/-
01030021 Cholecystectomy 25000/-
Laproscopic 01030045 Diverticulectomy 22000/-
01030022 Appendicectomy 21000/-
Laaproscopic Hernia 01030046 Repair of Ureterocoel 35000/-
01030023 Repair 21000/- Operations for Varicocele
Laproscopic Hiatus Hernia 01030047 Palomo’s- Unilateral 20000/-
01030024 Repair 30000/-
Operations for Varicocele
01030048 Palomo’s- Bilateral 30000/-
01030025 Laproscopic Adhesiolysis Rs 18000/- 01030049 Nephrostomy 16000/-

Laproscopic
01030026 Adrenalectomy 32000/- 01030050 Orchidopexy- Unilateral 25000/-
Laproscopic
01030027 Thyroidectomy 32000/- 01030051 Orchidopexy- Bilateral 30000/-
Laproscopic
01030028 Spleenectomy 32000/- 01030052 Prostratectomy 45000/-
01030029 Laproscopic Colectomy 35000/-
01030053 Laparoscopic Uro stone 30000/-
01030030 Laproscopic Nephrectomy 40000/-
Inguinal Hernia 01030054 Incisional Hernioplasty 35000/-
01030031 (Laproscopic) 20000/- Radiotherapy &
Laproscopic Chemotherapy
01030032 Pyelolithotomy 30000/- (packages)
01030033 Ureterolithotomy 22000/-
Nuclear Medicines-
01030034 Lap Ovarian Cystectomy 22000/- 031 Radio Isotope Therapy
Laparoscopic 131- Iodine Therapy <
01030035 Hysterectomy 25000/- 01031001 15mCi 5200/-
27
Annexure-I
Maximum Maximum
Approved Approved
131- Iodine Therapy 15-50
01031002 mCi 16900/- 01033011 Rapid Arc with IMRT rate 100000/-
131- Iodine Therapy 51- Palliative Radiation
01031003 100 mCi 16900/- 01033012 Therapy upto 15 fractions 25000/-
131- Iodine Therapy > Palliative Radiation
01031004 100mCi 19500/- 01033013 Therapy upto 25 fractions 35000/-
Strontium therapy for Palliative Radiation single
metastatic bone pain 01033014 fraction 10000/-
01031005 palliation 7200/-
Conventional Radiation
Samarium-153 therapy for 01033015 Therapy with CT 35000/-
metastatic bone pain
01031006 palliation 10700/- Conventional Radiation
01033016 Therapy CBCT 45000/-
SRS/ SRT Neuro
032 Cobalt 60 Therapy
interventional charge/
01033017 case 10000/-
01032001 Radical Therapy 70000/-
Electron Beam (>10
Adjustment Therapy- 01033018 Fractions) 40500/-
01032002 Immobilisation technique 16000/-
Electron Beam (<10
Palliative Therapy (less 01033019 Fractions) 9000/-
01032003 than 10 fractions) 15000/-
Palliative Therapy (10-25 01033020 Pre-radiation profile 2500/-
01032004 fractions) 25000/-
Palliative Therapy (single 034 Brachy Therapy
01032005 fraction) 5000/- Intra Cavitary
Brachytherapy- 1st
033 Linear Accelerators 01034001 insertion 5500/-
3-D Planning (L. Acc. or Intra Cavitary/ Intra
01033001 Cobalt-60) 6000/- Luminal Brachytherapy-
2nd and subsequent
2-D Planning (L. Acc. or
01034002 insertion 3000/-
01033002 Cobalt-60) 5000/-
Interstitial Brachy
Intensity Modulated Radio
01034003 Therapy- 1st insertion 15000/-
01033003 Therapy (IMRT) 105000/-
Interstitial Brachy
Image Guided Radio
01034004 Therapy- 2nd insertion 10000/-
01033004 Therapy (IGRT) 150000/-
035 Chemotherapy
01033005 IGRT Single Fraction 7000/-
3D-CRT (Confirmal Radio
01035001 Neoadjuvant 1000/-
01033006 Therapy) 65000/-
01035002 Adjuvant 1000/-

01033007 3D-CRT with IGRT 75000/-
01035003 Infusional Chemotherapy 1000/-

01033008 4D-CRT with IGRT 90000/-
Chemotherapy wafers for
Stereotactic Radio
01035004 malignant brain tumours 20000/-
01033009 Surgery (SRS) 85000/-
Multiple drug therapy per
Stereotactic Radio
01035005 day 900/-
01033010 Therapy (SRT) 70000/-
28
Annexure-I
Maximum Maximum
Approved Approved
01035006 Targeted therapy 1000/- 01038008 Washed RBC 400/-
01035007 Chemoport facility 1000/-

PICC line (Peripherally
Inserted Central
01035008 Canulisation) 1000/-
036 Room Rent (Per day)
01036001 General Ward 600/-
01036002 Semi-Private Ward 1200/-
01036003 Private Ward 1800/-

Day Care/ Minor (OPD)
01036004 Surgeries (all categories) 600/-
Admissible Blood
Charges
For treatment in
037 Government Hospitals
01037001 General Beds 50/-
01037002 Paying Beds 100/-
01037003 Cabin 140/-

For treatment in
recognised Private
Hospitals/ Nursing
Homes/ Aided
038 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/-
29
Annexure-I
RATES OF INVESTIGATIONS : Maximum

Approved
02 – INVESTIGATIONS NAME OF Rate (INR)
CODE INVESTIGATION (Rupees)
Maximum 02002019 Tympanometry 150/-

Approved 02002020 Voice Assest 250/-
NAME OF Rate (INR)
02002021 Endo Laryngoscopy 850/-
02002022 ENG 1300/-
001 General 02002023 Nasal Endoscopy 600/-
02001001 Aspiration Plural Effusion -
Diagnostic 750/- 02002024 Nasopharyngoscopy 600/-
Abdominal Aspiration - 02002025 LV Dyssynchrony Study 1400/-
900/-
02001002 Diagnostic 02002026 Stroboscopy 700/-
02001003 Pericardial Aspiration 1200/- 003 Eye
02001004 Bone Marrow Aspiration 800/- Refraction/Fundoscopy 150/-
02003001
02001005 Joints Aspiration 750/- Ortho-optic check up 150/-
02003002
02001006 E.C.G. 140/- Perimetry/field test 400/-
02003003
02001007 E.E.G. 800/- Clinical Photography 100/-
02003004
02001008 Stress test (TMT) 850/- Electrooculogram 500/-
02003005
02001009 Lumbar puncture 1000/- ERG 400/-
02003006
02001010 Sternal puncture 800/- Flourescein Angioraphy 800/-
02003007
002 E.N.T. A-Scan 200/-
02003008
02002001 Pure Tone Audiogram 300/- Tono Graphy 450/-
02003009
02002002 Impedence & other tests 300/- VER 300/-
02003010
SISI, Tone Decay &
250/- 02003011 Goldmen Perimetry 150/-
02002003 Difference times
Multiple hearing 02003012 Specular microsopy 200/-
450/- Indo cyaningreen
02002004 assessment test to Adults 1000/-
02003013 Angiography of Retina
02002005 Hearing Aid Selection 100/- Indo cyaningreen
1000/-
02002006 Hearing Aid Analysis 400/- 02003014 Angiography - IRIS
Speech Discrimination 02003015 Automated Perimetry 450/-
200/-
02002007 Score Corneal endothelial cell
200/-
02002008 Speech Assessment 200/- 02003016 count
Cold Calorie Test for 02003017 Corneal topography 200/-
180/-
02002009 Vestibular function 02003018 Corneal pachymetry 200/-
02002010 Audiometry (MHC) 250/- Retinal nerve film analyzer
100/-
02002011 ABR (Threshold Est.) 650/- 02003019 studies
02003020 Auto Refrectemetry 60/-
02002012 Acoustic Reflex Decay 100/-
02003021 Biometry 180/-
02002013 Eustachian Tube Func 100/-
Ultrasound studies - A
02002014 IMP Audiometry 300/- 600/-
02003022 Scan
02002015 Otoacoustic Est. (OAE) 550/- Ultrasound studies -- B
600/-
02003023 Scan
02002016 PEAD Audio Assessment 200/-
Retinal/Meter function
02002017 SRT & SDS 150/- 150/-
02003024 studies
02002018 Swallowing Assest 30/-
30
Annexure-I
Maximum Maximum
Approved Approved
NAME OF Rate (INR) NAME OF Rate (INR)
CODE INVESTIGATION (Rupees) CODE INVESTIGATION (Rupees)
02003025 PAN ACUITY METER 200/- 02007005 Abdomen for Pregnancy 130/-
02003026 Laser interferometry 1000/- 02007006 Chest PA view (one film) 130/-
02003027 EKG, EOG 500/- Chest Oblique or Lateral
130/-
02007007 (One film)
02003028 Dacryocystography (DGC) 500/-
02007008 Mastoids (one film) 150/-
02003029 Orbital Angio studies 500/- Extremities, bones & Joints
Digital Biometry Reading 140/-
180/- 02007009 (one film)
02003030 (Single)
02007010 Pelvis (One film) 140/-
02003031 Biometry (Both Eye) 350/- Paranasal sinuses (One
140/-
02003032 Biometry-corp (Both) 400/- 02007011 film)
02003033 Biometry-corp-Single 300/- 02007012 T.M. Joints (One film) 140/-
Pachymetry (Both Eye) 400/- Abdomen & pelvis for
02003034 250/-
02007013 K.U.B.
02003035 Pachymetry (Single) 200/-
02007014 Skull A.P. & Lateral 250/-
02003036 Multifocal ERG (One Eye) 800/-
02007015 Spine A.P. & Lateral 250/-
02003037 NCT 160/-
02007016 Barium Swallow 700/-
02003038 OCT- NFL Analyser 1600/-
02007017 Sinography/ Sialography 750/-
02003039 Schiotz Tonometer 250/- Cystography/
1120/-
02003040 TTT 2500/- 02007018 Urethrography
VEP 600/- 02007019 Hystero-Salpaingography 1110/-
02003041
Anterior Segment (Fundus) 02007020 Arthrography 840/-
300/-
02003042 Photography Retrograde Pyelography 1080/-
02007021
02003043 USG 550/- Oral or I.V.
720/-
004 Physiotheraphy 02007022 Cholecystography
Muscle testing and 02007023 Barium Enema 1160/-
02004001 100/-
diagnostic Barium Meal Upper or
960/-
005 Dental 02007024 Lower
02005001 Intra oral X-ray (Digital) 80/- 02007025 Bronchography 1260/-
02005002 Opg Cephalogram 210/- 02007026 I.V. Urography/ I.V.P. 1350/-
02005003 Opg Standard View 210/- 02007027 Myelography 1500/-
Radio Visiograph (per 02007028 Pneumo Encephalography 1120/-
02005004 110/-
Image) Barium meal Complete 1230/-
02007029
006 Genetics Cerebral/Femoral
Fragile X Decet & Karyo of 2000/-
02007030 Angiography
02006001 Peri Bld Cell 3500/- Periapical X-Ray 100/-
02007031
007 X-Ray (Digital X Ray) Barium Enema (Double
1300/-
02007001 Fluroscopy chest 120/- 02007032 Cont.)
02007002 Occlusal 130/- 02007033 Barium IC Junction 750/-
Abdomen AP or Erect (one 02007034 Gastro Conray Meal 750/-
130/-
02007003 film)
Abdomen Lateral view (one 02007035 Intravenous Pyelogram 1400/-
130/-
02007004 film) 02007036 T-Tube Cholangiogram 700/-
31
Annexure-I
Maximum Maximum
Approved Approved
02007037 PTBD Gram 700/- Oral or I.V.
510/-
Micturating 02008022 Cholecystography
750/- Barium Enema 810/-
02007038 Cystourethrogram (MCU) 02008023
2600/- Barium Meal Upper or
VUR/ Cystourethrography 670/-
02007039 02008024 Lower
02007040 Small Bowel Enema 1150/- 02008025 Bronchography 880/-
Any XRAY using portable 02008026 I.V. Urography/ I.V.P. 950/-
machine-addl handling 300/-
02007041 charge 02008027 Myelography 1050/-
Any other XRAY- single 02008028 Pneumo Encephalography 780/-
Film (Small) 130/- Barium meal Complete 860/-
02007042 02008029
Cerebral/Femoral
Any other XRAY- single 1180/-
160/- 02008030 Angiography
02007043 Film (Large)
Conventional X-Ray (70% 02008031 Periapical X-Ray 70/-
008
of Digital X-Ray rates) Barium Enema (Double
02008001 Fluroscopy chest 90/- 02008032 Cont.) 910/-
02008033 Barium IC Junction 530/-
02008002 Occlusal 90/-
Abdomen AP or Erect (one 02008034 Gastro Conray Meal 530/-
90/-
02008003 film) 02008035 Intravenous Pyelogram 980/-
Abdomen Lateral view (one
90/- 02008036 T-Tube Cholangiogram 490/-
02008004 film)
Abdomen for Pregnancy 90/- 02008037 PTBD Gram 490/-
02008005
Micturating
02008006 Chest PA view (one film) 90/-
02008038 Cystourethrogram (MCU) 530/-
Chest Oblique or Lateral
90/- 02008039 VUR/ Cystourethrography 1820/-
02008007 (One film)
Mastoids (one film) 100/- 02008040 Small Bowel Enema 810/-
02008008
Extremities, bones & Joints Any XRAY using portable
90/- machine-addl handling 300/-
02008009 (one film)
02008041 charge
02008010 Pelvis (One film) 90/-
Any other XRAY- single
Paranasal sinuses (One Film (Small) 90/-
90/-
02008011 film) 02008042
02008012 T.M. Joints (One film) 90/- Any other XRAY- single
Abdomen & pelvis for Film (Large) 110/-
170/- 02008043
02008013 K.U.B.
Skull A.P. & Lateral 160/- Ultrasound
02008014 009
Investigations
02008015 Spine A.P. & Lateral 170/- Obstetric First Scan/
500/-
02008016 Barium Swallow 490/- 02009001 Follow up
Sinography/ Sialography 520/- USG: Lower Abdomen/
02008017 800/-
02009002 Pelvis
Cystography/ Upper abdomen First
780/- 600/-
02008018 Urethrography 02009003 Scan/ Follow up
02008019 Hystero-Salpaingography Rs 780/- Ultrasound-
900/-
02008020 Arthrography 590/- 02009004 Neurosonogram
02008021 Retrograde Pyelography 760/- USG- Neurosonogram-

350/-
02009005 Screening
32
Annexure-I
Maximum Maximum
Approved Approved
Total Abdominal survey or Urine Bile Pigment and
950/- 50/-
Multiple organ study 02010003 Salt
02009006
02010004 Urine Urobilinogen 50/-
Special procedures &
1230/- Urine Ketones 50/-
02009007 Aspiration etc. 02010005
02009008 Image Intensifiers 700/- 02010006 Urine Occult Blood 50/-
02009009 USG: Neck 850/- 02010007 Urine total proteins 100/-
02009010 USG: KUB 800/- 02010008 Urine Sodium 100/-
02009011 USG: Whole Abdomen 950/- 02010009 Urine Chloride 100/-
USG: Whole Abdomen + 02010010 Bence Jones protein 90/-
1500/-
02009012 Transrectal
02010011 Stool routine 60/-
02009013 USG: Scrotum 900/-
02010012 Stool occult blood 60/-
02009014 USG: Testis 600/-
Post coital smear
Ultrasound Bladder 600/- 100/-
02009015 02010013 examination
02009016 Ultrasound Kidney/ Renal 600/- 02010014 Smear analysis 100/-
02009017 USG: Pregnancy + Doppler 2200/- Body fluid (CSF/Ascitic
Fluid etc.) Chemistry, 240/-
02009018 USG: Joint (Unilateral) 900/-
02010015 Sugar, Protein etc.
02009019 USG: Joint (Bilateral) 1800/- Body fluid for Malignant
200/-
USG: Musculoskeletal 800/- 02010016 cells
02009020
02010017 Urinary Porphobilinogen 110/-
02009021 USG: Transrectal 800/-
02010018 Urinary Myoglobin 400/-
02009022 USG: Breast Unilateral 700/-
Urine for
02009023 USG: Breast Bilateral 1050/- 3500/-
02010019 Immunoelectrophoresis
02009024 USG: Thyroid 800/- Urine for Protein
2800/-
02010020 Electrophoresis
02009025 USG: Chest 700/-
CRK ISO Enzyme
USG: Prostate 550/- 5000/-
02009026 02010021 Electrophoresis
02009027 USG: Single Organ 550/- 02010022 Hb Electrophoresis 600/-
02009028 USG: Follicular Study 1250/- 02010023 Chyle Test 100/-
02009029 USG: Guided Procedure 600/- 02010024 Semen Analysis 280/-
02009030 USG: FNAC 900/- 02010025 IVF Semen Analysis 250/-
02009031 USG: Follow-up Ovulation 600/- 02010026 Stool Reducing Substance 60/-
USG: For Congenital 02010027 Stool for OVA, Parasite 70/-
1800/-
02009032 Anomaly
02010028 Stool for Parasite 60/-
02009033 Ultrasound Parotid 800/-
02010029 Stool Culture & Sensitivity 200/-
Ultrasound Thigh 800/- Urine for Culture &
02009034 250/-
Any USG using portable 02010030 Sensitivity
200/- Karyotype Chromosome
02009035 machine- handling charge 2400/-
010 Clinical Pathology 02010031 Analysis
02010032 Genotyping 5000/-
02010001 Urine routine 60/-
02010033 Glucotyping 5000/-
02010002 Quantitative Albumin/Sugar 50/- Urine for Electrolytes 200/-
02010034
33
Annexure-I
Maximum Maximum
Approved Approved
02010035 Urine Amino-aciduria 150/- Glucose 6 Phosphate
220/-
02010036 Urine for Phosphorus 220/- 02011021 Dehydrogenase (G, 6PD)
02010037 Urine for Z-N Stain 60/-

P.C.V. Haematocrit 50/-
Urine Protein/Creatinine 02011022
250/-
02010038 Ratio
Opiates Serum Random RBC Folate 1350/-
450/-
02010039 Urine 02011023
02010040 Opiates Random Urine 450/-
Whole Blood Folate 1350/-
Urine Ammino Acid, 02011024
700/-
02010041 Qualitative, 2 Dimensional
Pre/Post-Dialysis Sickling Test 120/-
100/-
02010042 Creatinine 02011025
Pre/Post-Dialysis
100/- Bleeding Time 40/-
02010043 Potassium
Pre/Post-Dialysis Sodium 100/- 02011026
02010044
02010045 Pre/Post-Dialysis Urea 80/- Clotting Time 40/-
02011027
011 Haematology
02011001 Haemoglobin (Hb) 50/- D-Dimer Semi Quantitative 900/-
Total Leucocytic Count 02011028
50/-
02011002 (TLC)
Scurose Lysis Test 280/-
Differential Leucocytic
50/- 02011029
02011003 Count (DLC)
E.S.R. 50/- Red Cell Osmotic Frag.
02011004 280/-
02011030 with Incubato
02011005 Total Red Cell count 60/-
02011006 Platelet count 80/- Heinz Body Test 120/-
02011031
02011007 Reticulocyte count 70/-
02011008 Absolute Eosinophil count 60/- Fibrinogen 400/-
02011032
02011009 Packed Cell Volume (PCV) 50/-
Peripheral Smear FDP 150/-
70/-
02011010 Examination 02011033
02011011 Smear for Malaria parasite 70/-
Plasma Haemoglobin 190/-
02011012 Bleeding & Clotting Time 60/- 02011034
02011013 Clot Retraction Time 50/-
Factor VIII Studies 1000/-
02011014 R.B.C. Fragility Test 100/- 02011035
02011015 L.E. Cell 120/-
Factor IX Functional 1200/-
02011016 Foetal Haemoglobin (Hb-F) 250/- 02011036
02011017 Prothrombin Time (P.T.) 150/-
Factor V Functional 2500/-
02011018 Complete Haemogram 180/- 02011037
Bone Marrow Smear Factor V Lieden Mutation
400/- 4000/-
02011019 Exmination Analysis
02011038
02011020 Partial Thromboplastin 200/-
34
Annexure-I
Maximum Maximum
Approved Approved
TC, DC, ESR 120/- AT III 650/-

02011039 02011057
Absolute Lymphocytes
80/- AT III Anti Thrombin 650/-
02011040 Count 02011058
HB, TC, DC 120/- Absolute Neutrophil Count 50/-

02011059
02011041
Osmotic Fragility 120/-
Bone Marrow [Perls Stain] 750/- 02011060
02011042
HLA Typing 10000/-
Cell Type & Cell Count 320/- 02011061
02011043
Nasal Smear for T-Cell Cross Matching 5000/-
90/- 02011062
02011044 Eosinophils
Karyotyping for Bone
6000/-
CSF Cell Counts [TC/DC] 170/- 02011063 Marrow Cancer (REL
02011045
Complete Blood Picture Sucrose Lysis Test 120/-
180/- 02011064
02011046 [CBP]
02011065 APTT (50:50) 200/-
MCV MCH MCHC 180/- Immunofixation
02011047 7200/-
02011066 Electroporesis
Investigation of ABO/RH 360/- 012 Blood Bank
02011048
02012001 Blood Group & RHO Type 140/-
Sinovial Fluid for Analysis 400/- 02012002 Cross match 50/-
02011049
Packed Cells- Proc.
450/-
Blood Parasites 70/- 02012003 Charges
02011050 Saline Washed Packed
450/-
02012004 Cells: Proc. Charges
Malaria Parasite 70/- Coomb’s Test Direct/
02011051 200/-
02012005 Indirect
02012006 Australia Antigen 200/-
Malarial Antigen Detection 320/-
02011052 02012007 RHO, Antibody titer 250/-
Platelet rich Plasma-Proc.
Filaria Antigen W. Bancrofti 560/- 450/-
02012008 Charges
02011053
Whole Human Blood-I.P.-
450/-
02012009 Proc. Charges
Lap Score 400/-
02011054 Fresh frozen Plasma: Proc.
450/-
02012010 Charges
BAL Cell Count 100/- Cryoprecipitate: Proc.
450/-
02011055 02012011 Charges
Platelet Concent- Proc.
Cold Agglutination 150/- 450/-
02012012 Charges
02011056 Therapeutic Phlebotomy:
450/-
02012013 Proc. Charges
35
Annexure-I
Maximum Maximum
Approved Approved
Granulocyte Conc.: Proc. 02013033 Cortisol 650/-
450/-
02012014 Charges
02013034 HDL Cholestrol 200/-
013 Bio-Chemistry
Glucose blood- Fasting/ 02013035 VLDL Cholesterol 170/-
70/-
02013001 PP/ Random 02013036 ALDL 480/-
Blood Urea Nitrogen/ Blood Lipid Profile
80/- 02013037 700/-
02013002 Urea
02013038 LFT [Liver Function Test] 750/-
02013003 Serum Creatinine 100/-
02013039 Alkaline Phosphatase 150/-
02013004 Serum Uric Acid 110/-
02013040 Acid Phosphatase 300/-
02013005 Serum Bilirubin total/ direct 130/-
Leucocyte Alkaline
02013006 Serum Iron 220/- 600/-
02013041 Phosphatase Score
02013007 Serum Cholesterol 120/- 02013042 Serum Magnesium 170/-
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 Serum Chloride 150/-
02013012 Total Protein Alb/Glo Ratio 140/- Serum Inorganic
160/-
02013047 Phosphorous
02013013 S.G.P.T. 120/-
02013048 Serum Ceruloplasmin 750/-
02013014 S.G.O.T. 120/-
Serum
Serum amylase 250/- 1400/-
02013015 02013049 Carbamazepine/Tegretol
02013016 Serum Electrolyte 250/- 02013050 Carbamazepine 600/-
02013017 Triglyceride 220/- 02013051 Serum Calcitonin 1400/-
Glucose Tolerance Test 02013052 Calcitonin 1200/-
300/-
02013018 (GTT)
02013053 Myoglobin Serum 2400/-
02013019 C.P.K. 270/-
02013054 Serum C Peptide 800/-
02013020 L.D.H. 210/-
02013055 Serum C Peptide (PP) 500/-
02013021 L.D.-1 320/-
02013057 Serum Eption/Phenytoin 700/-
02013022 LDH & LD-1 470/-
02013058 Albumin (Serum) 120/-
02013023 T3 300/-
02013059 Serum Ferritin 720/-
02013024 T4 300/-
02013060 Serum B12 Level 600/-
02013025 TSH 300/-
02013061 Serum Sodium 240/-
02013026 T3, T4, TSH 700/-
02013062 Serum Folate 720/-
02013027 FSH 420/-
02013063 Folate & Vitamin 12 Serum 1100/-
02013028 LH 410/-
02013064 Serum Aldolase 400/-
02013029 FSH & LH 670/-
02013065 Serum Acetaminophen 650/-
02013030 Prolactin 470/-
02013066 Serum Growth Hormone 550/-
02013031 Blood gas analysis 400/-
Parathyroid Hormone
Blood gas analysis with 1200/-
500/- 02013067 (PTH), Intact
02013032 electrolytes
02013068 Serum Osmolality 250/-
36
Annexure-I
Maximum Maximum
Approved Approved
02013069 Serum Potassium 150/- Glycosylated Haemoglobin
520/-
02013100 [HBA1C]
02013070 Serum TIBC 280/-
02013101 Alpha I Anti Trypsin Assay 1200/-
Serum Parathormone
900/- Insulin-P.P./ Fasting/
02013071 Level 650/-
Serum Homocystine/ 02013102 Random
Homocystine/ Homocystine 750/- 02013103 Lactose Tolerance Test 550/-
02013072 Level 02013104 DHEA-S (Sulphate) 800/-
Serum Individual Serum Digoxin/ Serum
450/- 700/-
02013073 Phospolipids-TLC 02013105 Digoxin Level
02013074 Serum/Plasma Bicarbonate 350/- Serum Gastrin 900/-
02013106
02013075 Serum Haptoglobin 850/- Progesterone 450/-
02013107
02013076 Serum Testosterone 500/- Beta HCG (B-HCG) 650/-
02013108
02013077 Serum Thyroglobulin 1360/- Beta HCG Quantitative
02013078 Lactate Plasma 550/- Trophoblastic Cancer 600/-
02013109 Marker
02013079 CA-19-9 1000/-
02013110 Cardiac Enzymes 450/-
02013080 CA 125 800/-
02013111 LDH Heat Stable Fraction 640/-
02013081 CA 15.3 160/-
02013112 LDH Isoenzymes 1430/-
CA 72.4 Gastric Cancer
1050/- Antiphospolipid Antibody
02013082 Marker 1050/-
02013113 IGG & IGM
02013083 CSF Sugar 100/-
Antiphospolipid Antibody
02013084 CSF Protein 100/- 750/-
02013114 IGM
02013085 Lactate (CSF) 400/-
02013115 Anti-Sperm Antibody/ ABS 550/-
CSF Protein
800/- Alpha-Feto Protein (AFP)
02013086 Electropherisis 650/-
CSF-Oligoclinal Band 02013116 Cancer Marker
2000/- Carcino Embryonic Antigen
02013087 Analysis 600/-
CSF for Biochemical 02013117 [CEA]
280/- Anti-Thyroid Antibodies 950/-
02013088 Analysis 02013118
02013089 CSF Chloride 150/- Anti-Thyroid Antibodies-TG
900/-
02013119 Ab
02013090 CSF Profile 3200/-
02013120 Bicarbonate 150/-
02013091 Sodium Bicarbonate 100/-
Anti Cardiolipin Antibody-
Mucopolysaccharidoses 650/-
500/- 02013121 IgG/ IgM
02013092 (MPS) Screening U Anti Cardiolipin Antibody
Renin Activity Plasma, 1700/-
4000/- 02013122 Profile
02013093 PRA C_Peptide Assay 350/-
02013123
02013094 Plasma Ammonia 400/-
02013124 Cyst Fluid for Analysis 350/-
02013095 Fructosamine 200/-
02013125 Trop-T 820/-
GGT-Gamma Glutamyl
320/- Troponin T-Qualitative 400/-
02013096 Transaminase 02013126
02013097 Globulin 120/- 02013127 Intracellular Calcium 120/-
02013098 Estradiol 520/- Pleural/ Peritoneal Fluid for
80/-
02013128 Sugar
02013099 Estradiol (E2) 420/- Peritoneal Dialysis Fluid for
220/-
02013129 Sugar & Urea
37
Annexure-I
Maximum Maximum
Approved Approved
02013130 Apolipo Proteins 500/- Pericardial Fluid for
360/-
02013165 Biochemistry
02013131 Free Testosterone 600/-
02013166 Pericardial Fluid Test 100/-
02013132 Blood Acetone/Ketone 240/- Peritoneal Fluid-
450/-
02013133 Pleural Fluid for Protein 80/- 02013167 Biochemistry
02013134 Pleural Fluid for LDH 200/- 02013168 Aldosterone 1150/-
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 Phenytoin Level 720/- 02013175 Chromogranin A 5000/-
24 H Ketosteroid & 02013176 Cryo Globulin Screening 780/-
1700/-
02013142 Ketogenic Steroid
02013177 Cocaine Metabolite Screen 500/-
Angio Tension Converting
780/- Cyclosporine CO 1600/-
02013143 Enzyme (ACE) 02013178
02013144 Phenobarbitone 720/- 02013179 Cytokeratin/ Erythropoietin 1200/-
Anti Thyroid Antibodies 02013180 Protein C/ S, Functional 2800/-
900/-
02013145 TPO Ab
014 Histopathology
02013146 Anti TG 550/-
02014001 Pap Smear 240/-
02013147 ACTH 960/-
Histopathology exam per
ACTH Plasma 960/- 250/-
02013148 02014002 tissue type
02013149 Intact PTH 700/- 015 Bactriology & Serology
02013150 IGFI 350/- Smear gram-strain
100/-
02015001 examination
02013151 IGF-I (Somatomedin-C) 2800/-
02015002 Sputum smear A.F.B. stain 100/-
02013152 B-2 Microglobulin 960/-
Vaginal Smear
100/-
02013153 Valproic Acid 520/- 02015003 Examination
02013154 Valproate 520/- 02015004 V.D.R.L. 120/-
02013155 Sex Hormone Binding 1200/- Widal test 180/-

02015005
02013156 Vitamine B-12 Level 800/-
02015006 Rheumatoid Factor test 300/-
02013157 Vitamin D 25 Hydroxy 1400/-
Culture & Sensitivity (other
17 Hydroxy Corticostiroids 580/- 250/-
02013158 02015007 specimens)
02013159 Lipoprotein (a) 400/- 02015008 Urine pregnancy test 200/-
Synovial Fluid for 02015009 C.R.P. 220/-
480/-
02013160 Biochemistry
02015010 ASO Titer 250/-
02013161 Plasma Catecholamines 5500/-
02015011 Quantitative H.C.G. 400/-
02013162 Serum IgA 220/-
02015012 Blood culture & sensitivity 250/-
02013163 Serum IgG 220/-
Serum IgM 400/- 02015013 Vibro cholera culture 250/-
02013164
38
Annexure-I
Maximum Maximum
Approved Approved
CAPD Fluid for Culture & Aortic Valve Tissue for
02015014 Sensitivity 350/- 02015043 Culture & Sensitivity 250/-
CAPD Fluid for Fungal Arterial Line Tip for Culture
02015015 Stain/ Gram Stain 100/- 02015044 & Sensitivity 250/-
02015016 CAPD Fluid-Cytology 200/- Ascitic Fluid for Culture &
600/-
02015045 Sensitivity
02015017 Rapid Urease Test 250/- AC Tap for Culture &
02015018 ASO (Antistreptoysin “O”) 360/- 02015046 Sensitivity 250/-
02015019 High Sensitivity-CRP 400/- 02015047 Sputum for AFB Culture 500/-
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 100/- 02015050 Sputum for Z-N Stain 100/-
02015023 PUS for Z-N Stain 100/- 02015051 Sputum for Grams Stain 100/-
Culture & Sensitivity [PUS] Esophageal Smear for
02015024 250/- 150/-
02015052 Candida
02015025 Culture & Sensitivity [CSF] 250/-
02015053 Urine for AFB Culture 500/-
Culture & Sensitivity
Pleural Fluid for AFB
02015026 [Semen] 250/- 500/-
02015054 Culture
02015027 Culture & Sensitivity [Fluid] 250/-
02015055 Pleural Fluid- TBPCR 1200/-
250/- Culture AFB Antibiotic
02015028 [Sputum] 3000/-
02015056 Sensitivity- 5 Drug Panel
02015029 [Throat Swab] 250/- 02015057 Urine for Gram Stain 100/-
Culture & Sensitivity for 02015058 Throat Swab for KLB 100/-
02015030 Vaginal Swab 250/-
02015059 Fungus Culture 150/-
Culture & Sensitivity for
02015031 Aspirated Fluid 250/- Clostridium Difficile Toxin A
1200/-
Culture & Sensitivity 02015060 &B
02015032 [Wound Swab] 250/- Yeast Identification and
350/-
Wound Swab for Fungal 02015061 Susceptibility
100/- Non Fermenter
02015033 Stain
Wound Swab for Gram 02015062 Identification 300/-
100/- Serology for Mumps
02015034 Stain 1000/-
02015063 IGM/IGG
02015035 Wound Swab for Z-N Stain 100/-
02015064 Torch Profile 1500/-
02015036 [Rectal Swab] 250/- Serum Angitens. Conv.
400/-
02015065 Enzy. Assay
02015037 Nail for Fungal Culture 200/-
02015066 P-ANCA 800/-
Nail Clipping for KOH
100/- C-ANCA 800/-
02015038 preparation 02015067
Blood Culture & Sensitivity- 02015068 Aldehyde Serum Test 80/-
600/-
02015039 Anaerobic Elisa Test for Ecinococcus
Blood for Culture & 600/-
600/- 02015069 Antibody Detec
02015040 Sensitivity (Paediatric)
Tissue for Culture & 02015070 Ascitic Fluid Cell Count 200/-
02015041 Sensitivity 250/- Anti HBS (Antibody to
400/-
Mitral Valve Tissue for 02015071 Australia-Antigen)
02015042 Culture & Sensitivity 250/- Hepatitis B Surface
400/-
02015072 Antibody
39
Annexure-I
Maximum Maximum
Approved Approved
Anti-HBC Core Antibody Screening for C-Pylori
550/- 200/-
02015073 IgM 02015105 [RUT]
02015074 Serum Immunoglobulin 600/- Elisa for Tuberculosis
350/-
02015106 [IGG/IGM/IGA]
02015075 Immunoglobulin IGE 500/- Febrile Agglutinins
400/-
02015076 IGE Allergy Individual 600/- 02015107 [Widal.Weli-FEl
Immunoglobulin-IGA 600/- HBe Antigen Detection
02015077 550/-
02015108 (HBe Ag)
02015078 Immunoglobulin IGM 600/- CMV (Cytomegalo Virus
350/-
02015079 Immunoglobulin IGG 600/- 02015109 )Antibody [IGM]
Anti-HAV-IGM-Antibody 1000/- 02015110 Brucella Antibody 420/-
02015080
Breast Cancer ERPR and
02015081 Compliment C3 350/- 2400/-
02015111 HER2/NEU
02015082 Compliment C4 350/- Anti HCV IIIrd Generation
350/-
Toxoplasma- IgG 370/- 02015112 Elisa
02015083
Epstein Bar Virus IGM
02015084 Toxoplasma- IgG 370/- 600/-
02015113 [VCA Elisa]
02015085 Toxoplasma- IgG + IgM 700/- 02015114 HEV IgM Elisa 700/-
Cysticercosis Antibody/ Legionella Pneumophila-
600/- 600/-
02015086 Antibody IgG 02015115 Elisa
02015087 Cytomegalovirus, PCR 2000/- 02015116 Elisa for Pregnancy 630/-
Elisa for Mumps (IgG
02015088 PCR for AFB 1350/- 450/-
02015117 Antibody)
02015089 Herpes I(IgG)(HSV Type I) 300/- Elisa for Measles (IgG
450/-
02015090 Herpes I(IgM)(HSV Type I) 300/- 02015118 Antibody)
Herpes II (IgG)(HSV Type Mumps Elisa (IgM
300/- 520/-
02015091 II) 02015119 Antibody)
Herpes II (IgM)(HSV Type 02015120 HIV P24 Antigen 600/-
300/-
02015092 II) 02015121 Vivax Antigen 350/-
Herpes I + II (IgG) 300/- Anti Smooth Muscle
02015093 500/-
02015122 Antibody (ASMA)
02015094 Herpes I + II (IgM) 300/- Anti-Mitochondrial
750/-
TPHA (Treponema 02015123 Antibody-M2 (AMA-M2)
340/- Anti-Nuclear Antibody/
02015095 Pallidum Haemagglutinat 450/-
02015124 ANF/ ANA
02015096 HBsAg 420/- ANA IFA (HEP-2) Method 960/-
02015125
02015097 Hydatid Cyst for IgG Elisa 600/- Anti-Native
Aspergillus Antibody Deoxyribonucleic Acid (Ds- 700/-
1000/- 02015126 DNA)
02015098 (IGG/IGM)
02015099 Anti HCV IgG/IgM 820/- 02015127 Antismith Antibody 650/-
02015100 Anti HEV IgG/IgM 840/- 02015128 Rubella IgG/IgM Antibody 360/-
02015101 Allergy Screening- Adult 1200/- 02015129 Rubella IgG & IgM 650/-
02015102 Dengue Elisa 1000/- 02015130 Rubeola IgG/IgM Antibody 1000/-
Dengue Antibodies IgG + Rubeola Antibodies IgG &
600/- 1400/-
02015103 IgM 02015131 IgM
02015104 Dengue NS1 Ag Test 600/- Leptospira Antibody
840/-
02015132 IGM/IGG
40
Annexure-I
Maximum Maximum
Approved Approved
Leptospira Antibody IGG & Anti LKM-1 (Liver Kidney
1650/- 820/-
02015133 IGM 02015163 Microsomal-1) Antibo
Cryptococcus Antigen- Viable MTB Detection-
1300/- 1500/-
02015134 Latex Detection (CSF) 02015164 PCR
02015135 Falciparum Antigen 360/- HIV Qualitative (Window
1200/-
ADA (Adenosine 02015165 Period Detection)
450/- Anti Sclero 70/ SCL 70 1300/-
02015136 Deaminase- Body Fluid) 02015166
02015137 Mantoux Test 150/- Comprehensive CNS
6800/-
Anti HAV-Total (IGG & 02015167 Panel- (Molecular Dia
720/- HIV Proviral DNA Detector
02015138 IGM) 1100/-
Cytomegalo Virus (CMV 02015168 Qualitative
320/- Hepatitis B PCR
02015139 )Antibody [IGG] 1900/-
02015169 Quantitative
02015140 CMV IgM + IgG 600/-
Hepatitis B Virus PCR
3000/-
02015141 Chopra Aldehyde Test 100/- 02015170 Qualitative
Amniotic Fluid-Lecithin Anti GBM Antibody+
400/- 900/-
02015142 Spingomyl 02015171
Amoebiais Antibodies [IHA] 02015172 HSV DNA PCR 1500/-
280/-
02015143 Screening
02015173 Anti RNP-Sm Antibody 1000/-
02015144 Amoebic Serology 800/-
Antibody to Ribonucleo
KOH Mount for Fungal 1100/-
100/- 02015174 Protein IgG
02015145 Elements Detection NBT Reduction Test 720/-
Campylobacter Jejieni 02015175
360/- Anti Jo Antibody 520/-
02015146 Antigen Detection I 02015176
02015147 HIV Test (1 & 2) 450/- 02015177 Anti Jo-1 Antibodies 840/-
02015148 Typhi DOT-M 160/- 02015178 Antibody to SSA/SSB 2000/-
Hepatitis B-Core, total 02015179 Antibody to SSB/LA 720/-
720/-
02015149 (HBC total, IGG + IGM) Japanese Encepahilits
Anti HBC Antibody (IgM) 720/ 1500/-
02015150 02015180 Virus PCR (JE Virus P
02015151 Anti HBC Antibody (Total) 720/ HIV-1 RNS Quantitative
RT-PCR with CD-3, CD-4, 3800/-
02015152 Anti HBE 550/- 02015181 CD
02015153 Hepatitis Be Antibody 550/- 02015182 RNS Study/ Decrement 350/-
02015154 Hepatitis D Virus Antibody 1450/- 02015183 HIV Viral Load CD4 & CD8 3200/-
02015155 HLA B27 CHN 920/- 02015184 Anti RNP- Sm IgG 1100/-
HLA-B27, Disease Anti Endomysial Antibody
Association, Flow 1500/- 720/-
02015185 IgA
02015156 Cytometry
02015186 CD-4, CD-8 700/-
HLA-ABC & DR Tissue
2000/- CD 10 1200/-
02015157 Crossmatch 02015187
02015158 HCV RNA PCR Qualitative 2500/- 02015188 CD 20 920/-
Hepatitis C Viral RNA 02015189 CD 3 920/-
9500/-
02015159 Genotype, LIPA
Varicella- Zoster Virus IGG 02015190 CD 30 920/-
520/- HCV RNA Quantitative/
02015160 Titres 6000/-
02015191 Viral Load
02015161 Varcilla Zoster IgM 720/-
02015192 HBV Quantitative 5500/-
02015162 Varcilla Zoster IgG & IgM 1400/-
41
Annexure-I
Maximum Maximum
Approved Approved
02015193 HBV DNA Qualitative 1900/- 016 Obstetric Cases
Mycobacterium Examination under
600/- 2430/-
02015194 IgA/IgG/IgM 02016001 anaesthesia
Mycobacterium Serology 02016002 Laparoscopy (Gynae) 6060/-
500/-
02015195 IgG/IgM Lap. Dye Test with removal
Mycobacterium 8000/-
1900/- 02016003 of adhesions
02015196 Tuberculosis Serology EL Biopsies (Specimen
TB PCR (Mycobacterium 017
850/- processing per tissue type)
02015197 tuberculosis PCR)
Treponema Pallidum 02017001 Biopsy [Large] 600/-
300/-
02015198 Antibody Detection
Treponemal Pallisum, 02017002 Biopsy [Medium] 500/-
2000/-
02015199 FTPA-ABF
02017003 Biopsy [Small] 350/-
Autoimmune Hepatitis
900/-
02015200 Panel Biopsy [Extra Large] 800/-
Antinuclear antibody Panel 02017004
1100/-
02015201 (14 antibody panel) 018 Head & Neck Cancer
02015202 Anti CCP Antibody 450/-
02015203 Anti Centromere Antibody 800/-
Cardio Respiratory
Serum Procalcitonin 2000/- 019
02015204 Procedures
02015205 Serum Prealbumin 550/- Direct Laryngoscopy 4380/-
02019001
HSV (1+2) IgG/IgM
280/- 02019002 Bronchoscopy 2400/-
02015206 Antibodies
HSV (1+2) IgG and HSV Mediastinoscopy 2880/-
550/- 02019003
02015207 (1+2) IgM
02015208 Chikungunya Test 500/- 02019004 Pleural Biopsy 3630/-
02015209 ANA/ ANF in Dilution 1000/- 02019005 Thoracoscopy 6600/-
Bronchial Aspiration for Pulmonary function test
300/- 700/-
02015210 Culture & Sensitivity 02019006 BMR
Bronchial Aspiration for Spirometry 700/-
500/- 02019007
02015211 AFB Culture
Bronchial Aspiration for Spirometry with Helium
100/- 1620/-
02015212 Fungal Stain 02019008 Dilution
Bronchial Aspiration for Spirometry with Helium
100/- Dilution with diffusion 1620/-
02015213 Gram Stain
Bronchial Aspiration for 02019009 capacity studies
1400/-
02015214 TBPCR Pulmonery exercise testing 940/-
CVP Tip for Culture & 02019010
300/-
02015215 Sensitivity Punctal Cautery 100/-
Dialysis Catheter Tip for 02019011
300/-
02015216 C/S NT Pro BNP 1000/-
Ear/ Eye/ Nasal/ Tongue 02019012
Swab for Culture & 300/- Cardioversion 1400/-
02015217 Sensitivity 02019013
Prostatic Secretion for
150/- Cardiac Troponin I 400/-
02015218 Microscopy 02019014
Prostrate Specific Antigen
02015219 (PSA) 500/- 02019015 TEE with Anesthesia 2500/-
42
Annexure-I
Maximum Maximum
Approved Approved
Testicular 800/-
02019016 02020011 Aortogram 3900/-
Flexible Bronchoscopy- Package charges for
10000/- Cardiovascular
02019017 Diagnostic- TBNA
02020012 investigation 410/-
Flexible Bronchoscopy-
2500/-
02019018 Therapeutic
02020013 Stress Thallium 3600/-
4000/-
02019019 Glue
02020014 Muga (Resting) 1440/-
4000/-
02019020 Baloon Tampete
02020015 Muga (Stress) 1800/-
2600/- Echo Colour Doppler
02019021 Toileting
02020016 1440/-
Rigid Bronchoscopy-
5000/-
02019022 Diagnostic
02020017 Check Angio 7000/-
Rigid Bronchoscopy-
6200/- Abdomen/
02019023 Massive Haemoplysis 021
Gastroentrology
Fibroptic bronchoscopy 2100/- 02021001 Gastroscopy 1170/-
02019024
Fibroptic Bronchoscopy Gastric & Duodenal Biopsy
1560/-
02019025 with Washing/Biopsy 2500/- (Endoscopic)
Cardiac / Cardio Thoracic 02021002
020
Procedures
Test of Pacemaker 580/-
02020001 02021003 ERCP 4000/-
Stress Myocardial Study
02020002 (MBI/ TR) 7200/-
Echo Screening 720/- 02021004 ERCP Fluroscopy 2200/-
02020003
Stress Echo/ Dobutamine
1950/-
02020004 Echo Upper G.I. Endoscopy 1100/-
Foetal Echocardiography 1320/- 02021005
02020005
Upper G.I. Endoscopy with
Cardio Tocography 360/- 1300/-
02020006 Biopsy
02021006
2 D Echo with colour
Doppler/ 2D Echo Sigmoidoscopy (rigid) 1400/-
02021007
02020007 Cardiography 1320/-
Trans Oesophaedral Echo Sigmoidoscopy (flexible) 1200/-
02020008 (TEE) 840/-
Holter Analysis & Holter 02021008
Report (with Prd.
02020009 Specification) 1470/- Oesophagoscopy 1100/-
Cardiac Cath Angiography 02021009
(Without Coronary
02020010 Angioplasty) 13200/-
Colonoscopy 1800/-
02021010
43
Annexure-I
Maximum Maximum
Approved Approved
02024005 Brain Mapping 3000/-
Colonoscopy-Full (GAS-
2000/-
PKG) 02024006 Ambulatory Electro Ence 5000/-
02021011
02024007 Blink Reflex 500/-
24 H PH Metry 4000/- 02024008 Decrement Test 650/-

02021012 02024009 EMG Four Limbs 900/-
02024010 EMG Two Limbs 480/-
24 H PH Metry (BS) 5500/- 02024011 NCV Four Limbs 900/-
02021013 02024012 NCV Two Limbs 500/-
Nephrology /
022 02024013 EMG-Facial 500/-
Genitourinary
Biopsy of Bladder 02024014 NCV-Facial 500/-
8000/-
02022001 (Cystoscopic) 02024015 NCV+EMG-Facial 950/-
02022002 Urethroscopy 6000/- 550/-
02024016 Spincter-EMG
02022003 Glomerular Filtration Rate 500/-
02024017 H Reflex 500/-
Urethral dialatation- 550/-
1000/- 02024018 SSEP (Lower Limbs)
02022004 Diagnostics
02024019 SSEP (Upper Limbs) 550/-
02022005 Visually Evoked Potential 500/-
Uroflow Study 02024020 SSEP-UL/LL 1000/-
02022006 (Micturometry) 600/- 550/-
02024021 VEP (Flash)
Urodynamic Study
02024022 VEP (PR) 550/-
02022007 (Cystometry) 1200/-
Cystoscopy with 02024023 Counsl of INH Patient 200/-
Retrograde Catheter
02022008 Unilateral 4000/- 02024024 Spl Edu Assessment 250/-
Cystoscopy with 02024025 Baer Study 550/-
Retrograde Catheter
02024026 Baer/ Threshold 1000/-
02022009 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 360/-
Renal Transplant 02024030 Personality & IQ Child 450/-
02022013 Evaluation 1500/- 02024031 Personality Development T 650/-
Orthopaedic Surgery
023 02024032 SSR 700/-
Procedure
Arthrography & Lumbar puncture with CSF
11000/- 1500/-
02023001 Osteomedullography 02024033 Monitoring
02023002 Arthroscopy - Diagnostic 11000/- HER-2/ NEU 1200/-
02024034
024 Neurology 025 Breast
02024001 Placement of ICP Monitor - 6000/- Mammography (Single
02025001
Lumber Pressure side) 800/-
6100/-
02024002 Monitoring Mammography (Both
02025002
02024003 Nerve Biopsy 8500/- sides) 1500/-
02024004 Brain Biopsy 8500/-
44
Annexure-I
Maximum Maximum
Approved Approved
Gynae, Operation 02028020 CT Sacrum & Coccyx 3500/-

026
Charges
02028021 C.T. Scan Upper Abdomen 3000/-
02026001 Diagnostic Curettage 3000/-
Fractional Curettage 3400/- 02028022 C.T. Scan Lower Abdomen 3000/-
02026002
Hysteroscopy Diagnostic 7500/- 02028023 C.T. Scan Whole Abdomen 5000/-
02026003 C.T. Shoulder Joint/ Knee
Laproscopic Operations Joint/ Elbow Joint/ Any
027 In Gen. Surgery /
02028024 Other Joint (Plain) 3500/-
Gastrohepatic / Nephro-
02027001 Diagnostic Laproscopy 7000/- 02028025 CT Base of Neck 2000/-
Specialised Procedures / C.T. Scan Neck (Thyroid
028 02028026 Soft Tissue) 3000/-
Investigations/ C.T. Scan
02028001 Cat Scan (C.T.) Head 1600/-
02028027 CT Ankle with Foot 2000/-
C.T. Head Scan Involv.
02028002 Spl. Investigation 2300/- 02028028 C.T. Scan Orbits/Eye 3000/-
CT Arm/ Humerus/
02028003 C.T. Scan Brain 1600/- Forearm/ Radius-Ulna/
Leg/ Tibia-Fibula/ Thigh/
02028029 Femur (Single) Plain 4500/-
02028004 HRCT Chest Thorax 6000/-
02028030 C.T. Scan Limbs 2500/-
02028005 C.T. Chest (HRCT) 4000/-
02028031 CT Both Thigh 2000/-
02028006 C.T. Scan Chest 3500/-
C.T. Spine 02028032 C.T. Scan Whole Body 10000/-
(Cervical,Dorsal, 02028033 CT Extremities 2000/-
02028007 Lumbar,Sacral) 3500/- C.T. Scan of Para Nasal
CT Angiogram of Cervical 02028034 Sinus 3000/-
02028008 and Intra 7200/-
C.T. Cervical C.T. 3D 02028035 CT guided FNAC 2500/-
02028009 Reconstruction only -- 1200/- CT Angiography of Brain/
02028036 Carotid/ Thorax/ Neck 5400/-
02028010 C.T. Guided Biopsy 2000/-
C.T. Guided percutaneous CT 64 Coronary
02028011 cath drainage 2500/- 02028037 Angiography 10000/-
CT Angiography of Brain/
C.T. Myelogram
02028012 (Cervical Spine) 3500/- Carotid/ Thorax/ Neck/
Abdomen/ Extremities/
C.T. Myelogram Renal area/ Peripheral
02028013 (Lumbar Spine or D/S) 3500/- area/ Pulmonary area with
02028038 Visipaque 6500/-
02028014 CT Pelvis with Hip Joints 3000/- 02028039 CT Renal Angiography 5000/-
CT Angio Both Lower
02028015 CT KUB (Plain) 3500/- 02028040 10000/-
Limbs
02028016 CT Sacro Iliac Joint 2500/- CT Angiography of Neck
02028017 CT Pituitary/ Sella 2500/- 02028041 Vessels 5000/-
CT Angiography of
02028018 CT Cisternography 1600/-
Abdomen/ Extremities/
02028019 CT Petrous Temporal Bone 3000/- Renal area/ Peripheral
02028042 area/ Pulmonary area 6000/-
45
Annexure-I
Maximum Maximum
Approved Approved
PET CT Scan 02029015 MRI- Both Joints 9000/-
(Whole Body)
(including Flurodeoxy 02029016 MRI Sacro Iliac Joints 5400/-
02028043 Glucose) 20000/- MRI Spine (Cervical/
Dorsal/ Lumbar/ Cervico-
02028044 Therapeutic Aspiration- CT 3000/- Dorsal/ Dorso-Lumbar/
02029017 Lumbo-Sacral) 5400/-
MRI Lumbar Spine &
02028045 Diagnostic Aspiration- CT 1600/- 02029018 Sacroiliac Joint 6000/-
Double Region Plain (Brain
02028046 Ionic Contrast (20 C.C.) 270/- 02029019 & Spine) 9000/-
Tripple Region Plain (Brain
02028047 Ionic Contrast (50 C.C.) 675/- 02029020 & Spine) 13000/-
Non-ionic Contrast (10 02029021 MRI CSF Flow Study 1500/-
02028048 C.C.) 500/- MRI Spectroscopy
02029022 1500/-
Non-ionic Contrast (25 MRI Diffusion Tensor
02028049 C.C.) 750/- 02029023 Imaging (DTI) 1500/-
Non-ionic Contrast (50 MRI SWI (Susceptibility
02028050 C.C.) 1250/- 02029024 Weighted Image) 1500/-
Non-ionic Contrast (100 02029025 MRI Hip 6000/-
02028051 C.C.) 2100/-
02029026 MRI Urogram 5400/-
02028052 3D Reconstruction charge 1200/- 02029027 MRI Pelvis 6000/-
029 MRI 02029028 MRCP 5000/-
MRI Brain/ Brain with 02029029 MRI Extremities 6000/-
Protocol/ CSF Study/ MRI Upper Abdomen with
02029001 Internal Ear 6000/- 02029030 MRCP 6000/-
02029002 MRI Base of Skull 5400/- MRI Temporomandibular
02029003 MRI Orbits 6000/- 02029031 Single Joint 5000/-
MRI Temporomandibular
02029004 MRI Face 5400/-
02029032 Double Joints 6000/-
MRI Nasopharynx and
02029005 PNS 6000/- 02029033 MRI Upper Abdomen 5400/-
MRI Upper Thigh & Lower
02029006 MRI Pharynx 5400/-
02029034 Abdomen 7000/-
02029007 MRI Neck 6000/-
02029035 MRI Whole Abdomen 9000/-
02029008 MRI Pituitary 5400/- MRI Lower Abdomen/
MRI Thyroid/ Cranio- 02029036 Pelvis 5400/-
02029009 Vertebral (C.V.) Junction/ 5000/-
02029037 MRI Breast 6000/-
MRI Temporal Bones 6000/-
02029010 (Unilateral) 02029038 MRI Thoracic Outlet 5400/-
MRI Venography/ 02029039 MRI Spine Screening 5400/-
02029011 Angiography 5400/-
MRI Arm/ Fore Arm/ Thigh/ 02029040 MRI Brachial Plexus 5400/-
02029012 Femur/ Leg/ Foot 5400/- 02029041 MRI Chest 5400/-
MRI Arm (Humerus) (Left/ MRI Brain with
02029013 Right) 5400/- 02029042 Spectroscopy 6000/-
02029014 MRI- Single Joint 5400/- 02029043 MRI Brain with Perfusion 7300/-
46
Annexure-I
Maximum Maximum
Approved Approved
MRI Brain with Orbit/ PNS/ Spect Myo Perfusion Rest
02029044 Angio/ Neck Angio 6500/- 02032009 Scan (Thalium/ Tero/ Mie 5500/-
MRI Brain with DTI 02032010 Nuclear Blood Pool Scan 2000/-
(Diffusion Tensor Imaging)/ Radio-Isotope Ureteric
SWI (Susceptibility 02032011 Reflux (Indirect) 3000/-
Weighted Image)/ Cranial
Whole Body Tc-V-DMSA
02029045 Nerve Evaluation 6000/-
02032012 Scan 3500/-
02029046 MRI Perfusion Study 3500/- Brain Spect (Tumour
02029047 MRI Screening 5400/- 02032013 Imaging) 2500/-
Screening Single Area with 02032014 Tumour Immagery 5000/-
02029048 Films 1500/- Bone Scan Spect (Single
Screening Double Area 02032015 Region) 1800/-
02029049 with Films 3000/- Bone Scan- three phase
02029050 MRI Small Part 4000/- 02032016 (Single Region) 2700/-
Bone Scan Spect (whole
02029051 MRI Other Region 5400/- 02032017 body) 3000/-
02029052 Contrast (Ionic/ Non-ionic) 2500/- Tc 99m DMSA Renal Scan
02032018 2000/-
030 Other Investigations 033 Profiles
02030001 Fluoroscopic Screening 120/- 02033001 Lipid Profile 700/-
02030002 Oxygen Saturation 120/- 02033002 Thyroid Profile 1200/-
Bone Densitometry Single Total Diabetic Profile
02030003 site 800/- 02033003 1000/-
Bone Densitometry Two 02033004 Pre Cath Profile 850/-
02030004 sites 1200/- Coagulation Profile
02033005 550/-
Bone Densitometry Three
sites ( Spine , Hip & one 02033006 LFT [Liver Function Test] 750/-
02030005 extremity) 1600/- 02033007 Pre Dialysis Serology 600/-
Bone Densitometry Whole Dialysis Profile
02030006 body 2200/- 02033008 500/-
02033009 Hepatitis B Profile 3000/-
02030007 A.V. Fistula 3000/-
Immunology 02033010 Hepatitis Panel 1800/-
031
Hepatitis B DNA 02033011 Neuro Profile 2000/-
02031001 5200/-
HBV DNA Quantitative/ 02033012 Septic Profile 900/-
02031002 Viral Load 6000/- 02033013 Paediatric Septic Profile 1800/-
032 Nuclear Medicines Basic Metabolic Panel
02032001 Isotope Venography 3500/- 02033014 (BMP) 320/-
Gallium-67 Scan/Ghallium Comprehensive Metabolic
02032002 Scan 8500/- 02033015 Panel (CMP) 500/-
Thyroid Scan 02033016 Anaemia Screen (HAEM1) 2800/-
02032003 1800/-
Iodine-131 Thyroid Scan Thrombocytopenia Screen
02032004 2500/- 02033017 (HAEM2) 3400/-
02032005 Thyroid (Tc99m) Scan 1800/- Mycloma Screen (HAEM3)
Para Thyroid Scan 02033018 2700/-
02032006 6000/-
Lymphoma Screen
02032007 Thallium Scan 9000/- 02033019 (HAEM4) 2000/-
Spect Myocardial Perfusion Polycythaemia (HAEM5)
02033020 1800/-
02032008 Scan (Thalium/ Tetro) 11000/-
47
Annexure-I
Maximum
Approved
NAME OF Rate (INR)
Thallasaemia Patient
02033021 Screen (HAEM6) 3000/-
Thallasaemia Counselling
02033022 Serum (HAEM7) 1200/-
02033023 CRBSI 550/-
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/-
48
Annexure-I
RATES FOR IMPLANTS
03- IMPLANTS
Maximum Approved Rate (INR)

CODE NAME OF THE ITEM (Rupees)
001 Cardiology Implantation Devices

45,000/- or the actual cost,
Pacemaker (Single Chamber)- Ordinary (SSI Autocapture)
03001001 whichever is less
68,000/- + VAT or the actual
Pacemaker (Single Chamber)- With rate modulation (SSIR)
03001002 cost, whichever is less
1,20,000/- + VAT or the actual
Pacemaker (Dual Chamber) (DDD/DDDR/VDDR)
cost, whichever is less
03001003
2,50,000/- or the actual cost,
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, 40,000/- + VAT or the actual
03001008 etc.) cost, whichever is less
DES (Drug Eluting Stent)- Sirolimus-eluting e.g. Cypher, etc.
DES (Drug Eluting Stent)- Higher Sirolimus derivatives e.g. 1,05,000/- + VAT or the actual
03001010 Endeavour, Promus, Xcience, etc. cost, whichever is less
DES (Drug Eluting Stent)- Paclitaxel-eluting e.g. Taxus, etc.
50,000/- + VAT or the actual cost,
PDA- closure device
ASD/ VSD- closure device
Mitral Baloon, e.g. Inoue Baloon
Pulmonary Valvoplasty Baloon
50,000 + VAT or the actual cost,
Mitral/ Aortic Heart Valve
30,000 + VAT or the actual cost,
TTK Chitra (Mitral/ Aortic Heart Valve)
Heart Valves- Annuloplasty Ring
002 Opthalmology
03002001 Hydrophobic Foldable IOL 5,000/-
03002002 Silicon Foldable IOL 4,000 /-
49
Annexure-I

Hydrophilic Acrylic Lens 6,000 /-
03002003
03002004 PMMA IOL 500/-
003 ENT
One-sided Hearing Aid (Body worn/Pocket/Behind the ear type or
10,000/-
03003001 in the canal type (conventional)
Bilateral Hearing Aid 20,000/-

03003002
Digital Hearing Aid (to be purchased with the permission of the
30,000/-
03003003 West Bengal Health Scheme Authority)
004 Neuro Implants
Ceiling
Life of Cost of
Type of Neuro-implant Prescribing Authority Rate
Battery Battery
Neurologist of a recognised 3-5
DBS Implants 3,60,000/- 2,50,000/-
03004001 hospital years
03004002 Intra-thecal Pumps Any two specialists of 2,62,000/- 7 years 2,25,000/-
concerned speciality/ HoD
of Neurology/
3-5
03004003 Spinal Cord Stimulators Neurosurgery/ 2,62,000/- 2,00,000/-
years
Anaesthesiology of
recognized hospital
03004004 CPAP Machine 50,000/-
03004005 BIPAP Machine 1,00,000/-
Maximum Ceiling Rates
Orthopaedic implants
005 (Rupees)
03005001 Depuy (TKR) Knee 75,000/-
03005002 Zimmer (USA) Knee 74,880/-
03005003 Cemented Bipolar Hip (Zimmer) 41,080/-
03005004 Uncemented Total Hip (Zimmer) 69,992/-
03005005 Cemented Bipolar Hip (Depuy) 38,500/-
03005006 Uncemented Total Hip (Depuy) 77,000/-
03005007 Cemented Total Hip (Depuy) 46,500/-
03005008 DHS Plate Screw 3,500/-
03005009 Proximal Femur Nail 5,720/-
03005010 Locking Plate & Screw- for Humerous 5,500/-
03005011 Locking Plate & Screw- for Distal Tibia 6,500/-
03005012 Locking Plate & Screw- for Proximal Tibia 5,500/-
03005013 Locking Plate & Screw- for Proximal Femur 6,500/-
03005014 Locking Plate & Screw- for Shaft Femur 9,000/-
03005015 Locking Plate & Screw- for Radius Ulna 2,500/-
Locking Plate & Screw- for Distal Humerous & Elbow
4,500/-
03005016 Joint
03005017 Locking Plate & Screw- for Shaft Humerous 5,500/-
50
Annexure-I

03005018 Locking Plate & Screw- for Buttress Plate & Screw 5,500/-
03005019 ISO-Elastic Nail (Per Piece) 2,500/-
03005020 Interlocking Nail for Tibia & Femur 3,500/-
03005021 PFN Nail for Proximal Femur 8,000/-
03005022 DHS Plate Screw for Trochanteric Fracture 3,500/-
03005023 Humerous Plate 3,500/-
03005024 Humerous locking Plate & Screw 5,500/-
03005025 Humerous locking T- Buttress Plates & Screw 4,500/-
03005026 Elbow Joint- fixation by locking Plate & Screw 3,500/-
03005027 Replacement of Elbow Joint 20,000/-
03005028 Radius Ulna- Locking Plates & Screw 4,500/-
03005029 Wrist joint with locking Plate & Screw 2,500/-
03005030 Soldier Joint- With Jess Fixator 6,500/-
03005031 External & ILLIZAROV- Femur 7,000/-
03005032 External & ILLIZAROV- Tibia 7,000/-
03005033 External & ILLIZAROV- Pelvis 7,000/-
51

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Annexure-I

01004039 Caliculoplasty 3000/- 01004061 Cryopexy 1200/-

01004040 Dacryocystectomy 3000/- 01004062 ICG including Medicine 2000/-

01004046 Telecanthus correction 4000/- 01004068 Silicone Oil (C5) 4000/-

01004070 Pneumo Retinopexy 2400/- 01004091 Anterior Vitrectomy 5000/-

01004071 FGE/ FAE 1500/- 01004092 Lensectomy 7500/-

01004072 Indirect Laser 1000/- 01004093 Orbitotomy (Multiple Wall) 16000/-

01004074 SF6 Gas 2400/- 01004095 Reti Blue 2400/-

01007021 Traction + SWD 100/- 01007044 Tens 80/-

01012067 Abortion- D & C 3900/- 01013019 Varicose Veins 25000/-

01012068 Abortion- Evacuation 4200/- 01013020 Excision of Carbuncle 4000/-

01012070 MTP - 2nd Trimester 4800/-

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/-

01016012 Biliary Pancreatic (M) 16000/- 01016035 LGI Manometry 4000/-

01016014 Biliary Pancreatic (P) 13300/- 01016037 UGI Manometry 3200/-

01016018 Dilatation (Stricture) 3000/- 01016041 Nasojejunal Tube Plac 3000/-

01016024 Oesophageal Transit 1200/- 01016047 Polypectomy (Colonic) 3200/-

01029010 Gastrochisis Repair 24000/-

01030025 Laproscopic Adhesiolysis Rs 18000/- 01030049 Nephrostomy 16000/-

01035002 Adjuvant 1000/-

01035003 Infusional Chemotherapy 1000/-

01035006 Targeted therapy 1000/- 01038008 Washed RBC 400/-

01035007 Chemoport facility 1000/-

036 Room Rent (Per day)

01036001 General Ward 600/-

01036002 Semi-Private Ward 1200/-

01036003 Private Ward 1800/-

01037001 General Beds 50/-

01037002 Paying Beds 100/-

01037003 Cabin 140/-

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/-

RATES OF INVESTIGATIONS : Maximum

Maximum 02002019 Tympanometry 150/-

02008021 Retrograde Pyelography 760/- USG- Neurosonogram-

02010037 Urine for Z-N Stain 60/-

TC, DC, ESR 120/- AT III 650/-

HB, TC, DC 120/- Absolute Neutrophil Count 50/-

02013139 Fluid for Lipase 130/- 02013173 Serum Cortisone 380/-

02013140 Fluid for Cholesterol 150/- 02013174 Transferrin 780/-

02013155 Sex Hormone Binding 1200/- Widal test 180/-

24 H PH Metry 4000/- 02024008 Decrement Test 650/-

02024004 Brain Biopsy 8500/-

Gynae, Operation 02028020 CT Sacrum & Coccyx 3500/-

RATES FOR IMPLANTS

Maximum Approved Rate (INR)

001 Cardiology Implantation Devices

Maximum Approved Rate (INR)

Bilateral Hearing Aid 20,000/-

Maximum Approved Rate (INR)

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