gangaram rate list.pdf

Sir
Ganga Ram Hospital

Schedule of Charges (2017‐18)
Bed Charges
SNo Bed Category Amount (Rs.)
1 Birthing Suite (LR) 12000

2 Category 1-A (Premium Suite) 19000
3 Category 1-B (Suite) 16000
4 Category 1-C (Deluxe) 12000
5 Category 1-D (Single Room) 9000
6 Category 2 6700
7 Category 3 5000
8 Category 3 ( Paediatric ) 3150
9 Daycare 3000
10 Daycare ( Paediatric ) 1850
11 OT Daycare Over Night Stay 6000
12 Joint Replacement Category 1 10000
13 Joint Replacement Category 3 6000
14 Kidney Transplant 10000
15 Medical Treatment Room 3000
16 Nursery Category 1 5250
Intensive care charges 4 Bedded
All Cat
Cat-1D
Double
Single
Cat-2
Cat-3
SNo Service Area Code
1 CCU / IMCU monitoring charges INTMONCHCCU 13300 11100 8900

2 HDU monitoring charges INTMONCHHDU 11600 9200 7100
3 ICU monitoring charges INTMONCHICU 13300 11100 8900
4 Liver Transplant unit monitoring charges INTMONCHLTU 13300
5 Paediatric ICU monitoring charges INTMONCHPICU 13300 11100 8900
6 Post-operative ICU monitoring charges INTMONCHPOICU 13300 11100 8900
7 Thoracic HDU monitoring charges INTMONCHTHDU 9200 9200 9200
Note: All these charges are for providing intensive care monitoring including the bed charges, which will
be applicable depending upon the category of accommodation at the time of admission or at the time of
shifting i n these areas.
1
Other Special Care Charges
Cat-1C / D
Premium
All Cat
Cat-1A
Cat-1B
Cat-2
Cat-3
Suite
SNo Service Area
1 Labour room charges for delivery 4400 4400 4400 2500 1250
INTMONCHLR
2 NNU charges - level 1 1900

NNULEV1
3 NNU charges - level 2 2900

NNULEV2
4 NNU charges - level 3 4600 4600 4600 4400 4100

NNULEV3
5 Observation nursery charges 720

ONC
* These charges will be charged in addition to bed charges depending on the type of accommodation/ requirement.
INTENSIVE CARE AREAS

Intensive Care monitoring charges include bed to bed nursing care round the clock, critical care consultants cover round the clock,
continuous state of the art monitoring for all vital parameters, CVP monitoring, arterial line monitoring and PA catheter, etc.
LABOUR ROOM
Patients of Category 1D / 2 discharged directly from labour waiting room will be charged according to Category 2 bed charges only.
Rooms/Beds
In case the patient is shifted from lower category to higher category, the charges for the consultant visits, investigations charges and
operation charges from the date of admission will be according to the higher category.
DAY-CARE SURGERY
i) The operation charges for the day care procedures/surgeries will be that of Category 2.
For patients staying for less than 6 hours, day care service charges would be Rs. 3000/- towards bed charges, nursing care and other
miscellaneous services. If patient stays in day care beyond 6 hours, the bed charges will be that of Category 2. However, if patient requires
hospitalization, the professional charges of doctor, investigations & OT Charges, etc. will be according to the category where patient is
admitted or Category 2 whichever is higher.
ii) No bed charges are levied for the procedures done under local anaesthesia/sedation where the doctor fee is upto Rs. 5500/-
1. Checking In / Out

1. If patient is discharged within 24 hrs. of admission, room/bed charges are charged only for one day.
2. Room charges will be billed for full day on the day of admission irrespective of time of checking in (room charges are billed from 10.00 am
and valid upto 10.00 AM next day).

Half ‐day Room Rent ‐ If room is vacated before 01.00 PM
3. If the patient is discharged within 3 hours of admission on the recommendations of consultant, no room rent and consultant visit fee are
charged. However, the investigations/drugs/medical & surgical procedures done during this period will be charged.

2. General Information on Procedure/ Investigation Charges
 Unless otherwise specified, rates for Category 1 / 2 will be same as for Private OPD (POPD), while the rates for Category 3 will be
same as for General OPD (GOPD).
 Daycare patients will be charged at Category 2 rates, unless otherwise specified.
 Rates marked as common will apply to all categories.
General Ward (Free ward). No room rent or any intensive care charges are levied for patients admitted in General Ward.
2
3. General Information regarding operation charges
1. There will be no operation charges for General ward (free ward) patients.
2. In case more than one surgeon performs a single procedure, total operation charges will not exceed those fixed for that particular
surgery except where there is written request and consent from the patient or his relative desiring the presence or participation of
another surgeon. In such event, both surgeons would be entitled to charge their full fees.
3. In case a surgeon feels that in the best interests of the patient, he requires the presence of another doctor in another speciality or
subspeciality then two together are entitled to charge - between themselves equal to 1.5 times of the prescribed operation charge of that
procedure. It is implied that this is conveyed to the patient’s relatives and recorded in the case sheet.
4. If more than one surgeon perform two different procedures at the same time on a particular patient, they shall be entitled to charge their
separate fees in respect of procedure performed.
5. For re-exploratory surgery at different sittings, the operation charges will not exceed 50% of that procedure.
6. Surgeons can charge for visits after the 5th Post Operative day.
7. The operation/procedure charges for patients admitted in Category 1A / B will be double the charges of Category 1C/D.
8. The charges for Category 2 / 3 will be 80% / 60% of Category 1D charges respectively.
9. The charges for Operation theatre will be 65% of Surgeons Fee for patients operated under General Anaesthesia and patients operated
under Regional Blocks.
10. The charges for Operation theatre will be 45% of Surgeons Fee for patients operated under Local Anaesthesia.
11. The charges for Cath lab will be 43% of Consultants Fee for patients undergoing procedure in Cath lab.
12. The Hospital charges for general anaesthesia (consumables) will be 14% of Surgeons Fee.
13. The Hospital charges for local anaesthesia (consumables) will be Rs. 300/- per procedure.
14. The charges for Anaesthetist Fee will be 30% of Surgeons Fee for patients operated under General Anaesthesia.
15. Anaesthetist Fee will be 20% of Surgeons Fee for patients operated under Local Anaesthesia (minor cases) with stand by.
16. The Cardiologist’s charges for monitoring (if required / requested) will be 20% of Surgeons Fee.
17. The Neurologist / Neurosurgeon charges for standby/monitoring (if required / requested) will be 20% of Surgeons Fee.
18. In case, a patient is transferred from lower category to higher category after operation, will be charged according to the charges of
higher category from the date of admission itself.
19. In case one surgeon performs a procedure / operation and another procedure / operation of the same type is also required, the charges of the
higher cost surgery will be charged at actual and the lower cost surgery will be charged at 50% rates.
20. If surgery is assisted by Robotic Surgery, additional Robotic Surgery charges as per Schedule of charges will be payable.
21. All TPA/ Corporate patients will bear all the charges not approved by respective TPAs/ Corporates and will have to be paid at actual at the time
of discharge of the patient.
4. ADVANCE BOOKING CHARGES & ADVANCES AT THE TIME OF ADMISSION
i) Room booking / maternity booking

S.NO. Type of accommodation Amount
1. Category 1A 19000
2. Category 1B 16000
3. Category 1C 12000
4. Category 1D 9000
5. Category - 2 6700
7. Category - 3 5000
Note :
1. Maternity Advance : Non-refundable
2. Room booking advance/cancellation of the booking should be before the date of admission. After the due date advance is non-refundable.
ii) Advance deposit at the time of admission:
S.NO. Type of accommodation Amount
1. Categroy 1A/ 1B 100000

2. Categroy 1C/ 1D 80000
3. Category 2 70000
5. Category 3 50000
3
6. Day Care Cases AS PER OPERATION
7. ICU/PICU/CCU/IMCU/NNU (All Intensive care areas) 120000
In surgical cases (confirmed booking)
S.NO. Department Category 1 Category 2 Category 3
1. GI Surgery 120000 100000 70000
2. General Surgery 50000 40000 30000
3. Neuro Surgery 120000 100000 70000
4. Ortho-Surgery 70000 60000 50000
5. Kidney Transplantation 750000
6. Cardiac Package 100% 100% 100%
7. Liver Transplant (adult) 100% (as per package)

8. Liver Transplant (Paediatrics) 1700000
Blood Transfusion Services
Blood bank crossmatch charges
Cat‐1B Suite
All Category
Cat‐1D NH/
Gen.Ward
Cat‐2 SNH
Cat‐4 Bed
Premium
Gen.OPD
Casualty
Pvt.OPD
Cat‐1A
SNo Description [Code]
1 X‐match brought from outside 150
hospital [CROOUTBLD]
2 BLOOD DONOR SCREENING TESTS
[BLOODDS]
Anti HBc ‐ IgM ( hepatitis B virus serology ) 1720 1040
[ANTIHBC]
HBsAg ( Australia antigen ) [HBSAG] 780 470
Hepatitis C virus serology antibody test [HCV] 1040 620
HIV antibody test [HIV] 780 470
RPR [VDRL] 330 200
3 CROSSMATCH OF BLOOD / RED CELLS
[CMBROS]
ABO & Rh D and Antibody screening of patient's 660
blood ( pre‐transfusion ) WITH X‐MATCH
[ABSCREEN]
BLOOD GROUP ‐ 1 FOR BLOOD / PACKED CELL 150
X‐MATCH (mention quantity) [BG1CM]
BLOOD GROUPING ‐2 FOR X‐MATCH [BG2]
4 CROSSMATCH OF FFP / PLATELETS /
CRYOPRECIPITATE / GRANULOCYTES
[XMATCHBLPR]
[ABSCREEN]
BLOOD GROUPING‐1 FFP / PLATELETS Etc. FOR 150
X‐MATCH (Mention quantity) [BG1]
4
5 CROSSMATCH FOR ALL BLOOD
COMPONENT [XMATCHPAOS]
[ABSCREEN]
BLOOD GROUP ‐ 1 FOR BLOOD / PACKED CELL 150
X‐MATCH (mention quantity) [BG1CM]
BLOOD GROUP ‐ 1 FOR CRYOPRECIPITATE 150
X‐MATCH [BGCRO]
BLOOD GROUP ‐ 1 FOR FFP X‐MATCH [BGFP] 150
BLOOD GROUP ‐ 1 FOR GRANULOCYTES X‐MATCH 150
[BGRAN]
BLOOD GROUP ‐ 1 FOR PLATELET APHERESE 150
X‐MATCH [BGPLP]
BLOOD GROUP ‐ 1 FOR PLATELETS X‐MATCH 150
[BGPLA]
BLOOD BANK ISSUE
Cat‐1B Suite
All Category
Cat‐1D NH/
Gen.Ward
Cat‐2 SNH
Cat‐4 Bed
Premium
Gen.OPD
Casualty
Pvt.OPD
Cat‐1A
1 Issue Fresh Frozen Plasma (FFP)
leukocyte reduced (NAT Tested) +
Additional transfusion Charges
[FFPNATOS]
Additional Transfusion Charges [ATCB] 3100 3100 2550 1600 2350 1350
Issue Fresh Frozen Plasma (FFP) leukocyte reduced 880
(NAT Tested) [FFPNAT]
2 Issue Cryoprecipitate leucocyte reduced
(AHF ‐ factor VIII) per unit + Additional
transfusion Charges [ICRYOLROS]
Issue Cryoprecipitate leucocyte reduced (AHF ‐ 1240
factor VIII) per unit [ICRYOLR]
3 Issue packed red cells (Only for Cardiac
Surgery Packages) + Additional
transfusion Charges [IPRCCSTHDIAOS]
Issue packed red cells (Only for Cardiac Surgery 3680
Packages) [IPRCCSTHDIA]
4 Issue Red Blood Cells leukocytes
depleted ( NAT Tested) excluding X
Match + Additional transfusion charges
[IRCBLDROS]
Issue Red Blood Cells leukocytes depleted ( NAT 3680
Tested) excluding X Match [RBCNAT]
5 Issue red cells (Paed Cardiac Surgery +
Additional transfusion charges)
[IRCPATCOS]
Issue red cells (Paed Cardiac Surgery) [IRCPCS] 3350
6 Issue single donor platelet concentrate
INCLUDING SCREENING TESTS ( platelet
apheresis by cell separator ) +
Additional transfusion Charges
[ISCPLATOS]
5
Issue single donor platelet concentrate INCLUDING 16000
SCREENING TESTS ( platelet apheresis by cell
separator ) [ISCPLAT]
7 Issue Platelets concentrate leukocyte
reduced ( NAT tested) + Additional
transfusion Charges [PCNATOS]
Issue Platelets concentrate leukocyte reduced ( NAT 900
tested) [PCNAT]
Blood bank issue charges
Cat‐1B Suite
All Category
Cat‐1D NH/
Gen.Ward
Cat‐2 SNH
Cat‐4 Bed
Premium
Gen.OPD
Casualty
Pvt.OPD
Cat‐1A
1 Additional Transfusion Charges 3100 3100 2550 1600 2350 1350 0

[ATCB]
2 Infectious marker test ( donor 3850 3850 3630 2750 3300 2750 1650
refused for apheresis ) [IMTDR]
3 Issue Cryoprecipitate leucocyte 1240
reduced (AHF ‐ factor VIII) per unit
[ICRYOLR]
4 Issue Fresh Frozen Plasma (FFP) 880
leukocyte reduced (NAT Tested)
[FFPNAT]
5 Issue packed red cells ( Dialysis ) 1540
[IPRCCSD]
6 Issue packed red cells (Only for 3680
Cardiac Surgery Packages)
[IPRCCSTHDIA]
7 Issue Platelets concentrate leukocyte 900
reduced ( NAT tested) [PCNAT]
8 Issue Red Blood Cells leukocytes 3680
depleted ( NAT Tested) excluding X
Match [RBCNAT]
9 Issue red cells (Paed Cardiac Surgery) 3350
[IRCPCS]
10 Issue single donor platelet 16000
concentrate INCLUDING SCREENING
TESTS ( platelet apheresis by cell
separator ) [ISCPLAT]
11 Issue single donor platelet 11000
concentrate with prior SCREENING
TESTS ( platelet apheresis by cell)
[ISCPLATES]
12 Single Donor Platelet apheresis with 14000
Additive Solution ( PAS )
[PLAAPEASO]

6
Blood bank procedure charges
Cat‐1B Suite
All Category
Cat‐1D NH/
Gen.Ward
Cat‐2 SNH
Cat‐4 Bed
Premium
Gen.OPD
Casualty
Pvt.OPD
Cat‐1A
1 Aphaeresis Collection & Storage 71500 71500 66000 55000 38500

[APRESCOSTO]
2 Cryo preservation of bone marrow 71500 71500 66000 60500 41800
without processing ( Up to one year
in LN2 at ‐80oC ) [CRPBMWP1]
3 Granulocyte apheresis procedure 25650 25650 23450 19710 23450 19710 12450
[GRAPPR]
4 Phlebotomy for polycythemia vera 1450 1450 1450 1260 1640 730 730
[PHEPOLV]
5 Plasma exchange procedure by cell 36300 36300 30250 24200 30250 24200 18150
separator ( Charges of FFP extra )
[PLEXPR]
6 PLASMAPHERESIS WITH ANTIBODY 66000 66000 63000 55000 63000 55000 52000
FILTER [AWANF]
7 Pooling of blood products by sterile 330 330 280 220 280 220 190
connecting device [POPLSTCON]
8 PRP (Platelet Rich Plasma) [PRP] 3000 2300
9 Stem cell harvesting and 78650 78650 72600 60500 40350
preservation at ‐80 C ( upto to 1 Year
) [STEMCELLPR]
10 Stem cells harvesting without 33000 33000 30800 24200 30800 24200 13310
cryopreservation [ASCHWCRYO]
Blood Bank Test Charges
SNo Description Code POPD GOPD
1 ABO / RH New Born ABORH 630 530
2 ABO/RH + DAT New Born ABODAT 770 650
3 Anti body identification ABI 4240 3600
4 Anti body titer ( IgM ) ABTIGM 520 360
5 Anti body titer ( IgM + IgG ) ABTIGMG 1150 820
6 Antibody Screening ANTIS 660 330
7 Antibody Tier ( IgM & IgG ) (Anti A , Anti B ) ATIGMI 1980 1680
8 Antibody Tier ( IgM ) (Anti A , Anti B ) ATIGM 990 840
9 BLOOD GROUP ‐ 1 FOR BLOOD / PACKED CELL BG1CM
X‐MATCH (mention quantity)
10 Blood group ‐ ABO + Rh(D) BGROUP 500 300
11 Compatibility testing with irregular antibody ( One CTI 900 900
Card )
12 Compatibility testing with irregular antibody ( Two CTTWO 1800 1800
Card )
13 DAT Titre DATT 2200 1540
14 Direct Antihuman Globulin Test ( DAT ) DCT 910 720
15 Indirect Antihuman Globulin Test ( IAT ) ICT 1210 940
16 Minor Blood Grouping ( Blood Bank )/Red Cell RCEP 4840 4070
Extended Phenoype
17 Monospecific Coombs Test (IgG, IgM, C3d) MCIGMC 1640 1260
18 Red Cell Rh & Kell Phenotype ( patient ) RCRHK 1160 920
19 Screening of cold antibodies SCAB 610 360
7
20 Subclasses IgG ( IgG1 , IgG2 & IgG3 ) SUBIG 1210 1030
21 Titre of cold antibodies at room temp and 4 degree C TITCART4 1320 990
22 Titre of incomplete antibody by ICT ICTRE 1100 940

Alternative medicine charges
Ayurveda charges
SNo Code Description POPD GOPD All CAT
1 AYURYCC Ayurveda consultation charge 250
2 AYURDHA Ayurveda treatment ‐ Dhara ( per sitting ) 2170
3 AYURELNA Ayurveda treatment ‐ Elakizhi / Navarakazhi ( per sitting ) 500
4 AYURNAS Ayurveda treatment ‐ Nasyam ( per sitting ) 500
5 AYURZL Ayurveda treatment ‐ Pizhichil ( per sitting ) 2040
6 AYURPODI Ayurveda treatment ‐ Podikizhi ( per sitting ) 500
7 AYURTAR Ayurveda treatment ‐ Tarpanam ( per sitting ) 380
8 AYURUPMO Ayurveda treatment ‐ Upanaham ( per sitting ) 330
9 AYURUTV Ayurveda treatment ‐ Uttara Vasti ( per sitting ) 500
10 AYURYTUPS Ayurveda treatment ‐ Uzhichil ( per sitting ) 640
11 AYURVAS Ayurveda treatment ‐ Vasti ( per sitting ) 380
Homeopathy charges
12 HOMMEDCH Homeopathy Medicines charges (1 week) 130 110
13 HOMMEDCH Homeopathy Medicines charges (2 weeks) 250 230
2
3
4
PIP scan charges
16 PIPS PIP scan 700 700
Yoga charges
Cat‐1D Single
Cat‐2 Double
Cat 1B Suite
Cat 1A‐Pre/
All Category
Cat‐4 Bed
SNo Code Description

1 YCRPSS Yoga ‐ cardiac rehabilitation and prevention ( for 9710 4860 3640 2440
six sessions )
2 YCRPSGRS Yoga ‐ cardiac rehabilitation and prevention for 740
SGRH staff ( for six sessions )
3 YGSMSS Yoga ‐ general stress management ( for six 3260 1630 1230 820
sessions )
4 YGSMSGS Yoga ‐ general stress management for SGRH staff ( 740
for six sessions )
5 YTC3S YOGA ‐ Training charges ( 3 sessions ) 1150
6 YTC6S YOGA ‐ Training charges ( 6 sessions ) 2300
8
7 YTCHC YOGA ‐ Training charges for health Checkup 0
patients
8 YTCVC YOGA Visit Charges 100

Anaesthetists PAC charges
Cat‐1D Single/
Cat‐2 Double
OT Day Case
Thalassemia
Cat 1B Suite
Cat 1A‐Pre/
All Category
Cat‐4 Bed/
GOPD
POPD
1 PACCHARGES Anaesthetists charges for PAC 3320 1660 1330 1000
Doctor monitoring charges
2 CSADS Cardiac Surgery Assistance During Chest 27600 22100 16600
Surgery ( Minor ) ‐ Doctors monitoring
charges
3 CCCSC Critical care consultant standby charges 3320 1660 1330 1000
Doctor visit charges
4 CLPSCC Clinical psychologist consultation charges 810
5 DOCVISITCHA Doctor visit charges 3320 1660 1330 1000 300
RGE1
6 DOCVISITCHA Doctor visit charges (category 2 units only) 2640 1320 1060 800
RGE2
7 DOCVISITDEVP Doctor visit charges (development 960 480 380 290
ED paediatrics)
8 LACSTDF Lactation / Stress consultation ( per visit ) ‐ 1960 980 780 590
Neonatology
9 NEPHKTCHRG Nephrologists charges for kidney 88000 44000 44000 44000
transplant patient care
10 PAEDVISITFEE Paediatric / Neonatologists visit charges 3320 1660 1330 1000
for newborns
Remarks :
1. Treating Unit will be allowed to charge two visits per day.
2. Referal Unit will be allowed to charge one visit per day irrespective of the number of visits.
3. Treating Unit in Cardiology, Neonatology and Paediatrics will be allowed to charge 2 ½ visits per day irrespective of the number of
visits from non-packaged patients in CCU, Neonatology and PICU.
4. Category 1A (Premium Suites)/ Category 1B (Suites) : Twice the Category 1D (Single Room) charges i.e. Operation charges and
professional fees will be twice the fee chargeable for Category 1D (Single Room).
5. For new born babies born in the Hospital and shifted to NICU, Consultants will be allowed to charge visit fee.
6. For Post surgery patients, Anasthesia Consultants personally visiting the patients will be allowed to charge visit fees after 24 hours.
7. For patients admitted to the main ICU under Critical Care Unit, the Critical Care Consultants will be allowed to charge 2.5 visits per
day, and for patients admitted in ICU under other Units, Critical Care Consultants will be allowed to charge 1.5 visit per day and
treating unit will be allowed to charge 1.5 visit irrespective of the number of visits.

9
Laboratory and Imaging Charges
CT Scan Charges
SNo Description Code POPD/ GOPD/

CAT 1/CAT2 CAT3
1 CT 3D surface rendering (plain) CTGBI 2240 2240
2 CT abdomen to ankle joint CTABDANK 25400 25400
3 CT angiography (non‐ionic contrast) lower abdomen CTANGLO 19300 19300
& pelvis
4 CT angiography (non‐ionic contrast) upper abdomen CTAN 19300 19300
5 CT angiography abdomen & chest CTAAC 25400 25400
6 CT angiography brain CTANGIOB 13720 13720
7 CT angiography neck CTANGION 13720 13720
8 CT angiography neck & brain CTANGIONB 17880 17880
9 CT angiography thorax and descending/thoracic aorta CTANGIO 17880 17880
10 CT angiography whole abdomen and abdominal aorta CTANGIOA 19300 19300
11 CT ankle joint (non‐ionic contrast) both sides CTANKCTBS 7620 7620
12 CT ankle joint (non‐ionic contrast) left side CTANKCTLS 7620 7620
13 CT ankle joint (non‐ionic contrast) right side CTANKCTRS 7620 7620
14 CT ankle joint (plain) both sides CTANKPLBS 5280 5280
15 CT ankle joint (plain) left side CTANKPLLS 5280 5280
16 CT ankle joint (plain) right side CTANKPLRS 5280 5280
17 CT bronchoscopy CTBRP 8940 8940
18 CT cardiac calcium scoring CTCCSP 6100 6100
19 CT cisternography CTCIST 8330 8330
20 CT colonoscopy CTCP 8940 8940
21 CT coronary angiograpy CTCTAP 13210 13210
22 CT denta scan ( OPG ) CTDSP 8940 8940
23 CT elbow joint (non‐ionic contrast) both sides CTELBCTBS 7620 7620
24 CT elbow joint (non‐ionic contrast) left side CTELBCTLS 7620 7620
25 CT elbow joint (non‐ionic contrast) right side CTELBCTRS 7620 7620
26 CT elbow joint (plain) both sides CTELBPLBS 5280 5280
27 CT elbow joint (plain) left side CTELBPLLS 5280 5280
28 CT elbow joint (plain) right side CTELBPLRS 5280 5280
29 CT extended study for body scan CTES 1880 1880
30 CT extended study for single scan CTESSS 3760 3760
31 CT face (extended) (non‐ ionic contrast) CTFACECE 8640 8640
32 CT face / salivary glands (non‐ionic contrast) CTFACENI 6810 6810
33 CT face / salivary glands (plain) CTFACEP 4570 4570
34 CT face angiography CTFACEANG 13720 13720
35 CT FNAC procedure (scan done from our hospital) CTFNACIN 5280 5280
36 CT FNAC procedure (scan provided from outside CTFNACOUT 7620 7620
hospital)
37 CT foot (non‐ionic contrast) both sides CTFTCTBS 7620 7620
38 CT foot (non‐ionic contrast) left side CTFTCTLS 7620 7620
39 CT foot (non‐ionic contrast) right side CTFTCTRS 7620 7620
40 CT foot (plain) both sides CTFTPLBS 5280 5280
41 CT foot (plain) left side CTFTPLLS 5280 5280
42 CT foot (plain) right side CTFTPLRS 5280 5280
43 CT full abdomen (non‐ionic contrast) CTFANI 9750 9750
44 CT full abdomen (oral contrast only) CTFACT 8130 8130
45 CT full abdomen (plain) CTFAP 7620 7620
46 CT full thorax (non‐ionic contrast) CTFTNI 8640 8640
47 CT full thorax (plain) CTFTP 6100 6100
10
48 CT guided aspiration procedure CTASPIR 5280 5280
49 CT guided drain placement procedure CTDRAIN 5280 5280
50 CT guided pigtail catheter drain placement procedure CTPIG 5280 5280
51 CT hand (non‐ionic contrast) both sides CTHACTBS 7620 7620
52 CT hand (non‐ionic contrast) left side CTHACTLS 7620 7620
53 CT hand (non‐ionic contrast) right side CTHACTRS 7620 7620
54 CT hand (plain) both sides CTHAPLBS 5280 5280
55 CT hand (plain) left side CTHAPLLS 5280 5280
56 CT hand (plain) right side CTHAPLRS 5280 5280
57 CT head (bone window) CTHBW 3050 3050
58 CT head (extended) (non‐ ionic contrast) CTHEADEXTDN 4570 4570
59 CT head (extended) (plain) CTHEADEXTDP 4060 4060
60 CT head (non‐ionic contrast) CTHNI 4170 4170
61 CT head (plain) CTHP 2640 2640
62 CT head (plain) with 3D scan CTHP3D 6100 6100
63 CT high resolution pituitary (non‐ionic contrast) CTHRNI 8330 8330
64 CT high resolution pituitary (plain) CTHRPP 4570 4570
65 CT high resolution pns coronal (plain) CTRPNS 3050 3050
66 CT hip joint (non‐ionic contrast) both sides CTHIPCTBS 7620 7620
67 CT hip joint (plain) both sides CTHIPPLBS 5280 5280
68 CT knee joint (non‐ionic contrast) both sides CTKNCTBS 7620 7620
69 CT knee joint (non‐ionic contrast) left side CTKNCTLS 7620 7620
70 CT knee joint (non‐ionic contrast) right side CTKNCTRS 7620 7620
71 CT knee joint (plain) both sides CTKNPLBS 5280 5280
72 CT knee joint (plain) left side CTKNPLLS 5280 5280
73 CT knee joint (plain) right side CTKNPLRS 5280 5280
74 CT KUB (non‐ionic contrast) CTKUBCT 10670 10670
75 CT KUB (plain) CTKUBPL 7210 7210
76 CT KUB extended (non‐ionic contrast) CTKUBECT 12290 12290
77 CT KUB extended (plain) CTKUBEPL 9040 9040
78 CT Liver donor evaluation CTLIVDONEVAL 20830 20830
79 CT Low Dose Screening Chest CTLDC 2440 2440
80 CT lower abdomen (non‐ionic contrast) CTLANI 7620 7620
81 CT lower abdomen (oral contrast only) CTLACT 4470 4470
82 CT lower abdomen (plain) CTLAP 3810 3810
83 CT lower thorax (non‐ionic contrast) CTLTNI 6100 6100
84 CT lower thorax (plain) CTLTP 3810 3810
85 CT myclo CTMYCLO 8230 8230
86 CT neck (extended) (non‐ ionic contrast) CTNECKCE 10260 10260
87 CT neck / larynx (non‐ionic contrast) CTNECKNI 6810 6810
88 CT neck / larynx (plain) CTNECKP 4570 4570
89 CT orbit (extended) (non‐ ionic contrast) CTOCE 10260 10260
90 CT orbit (non‐ionic contrast) CTONI 6810 6810
91 CT orbit (plain) CTOP 5280 5280
92 CT perfusion studies CTPSP 13720 13720
93 CT peripheral angiography (non‐ionic contrast) CTFACTBS 17880 17880
forearm both sides
94 CT peripheral angiography (non‐ionic contrast) CTFACTLS 17880 17880
forearm left side
95 CT peripheral angiography (non‐ionic contrast) CTFACTRS 17880 17880
forearm right side
96 CT peripheral angiography (non‐ionic contrast) upper CTUACTBS 17880 17880
arm both sides
11
97 CT peripheral angiography (non‐ionic contrast) upper CTUACTLS 17880 17880
arm left side
98 CT peripheral angiography (non‐ionic contrast) upper CTUACTRS 17880 17880
arm right side
99 CT peripheral angiography (non‐ionic contrast) whole CTWULCTBS 17880 17880
upper limb both sides
100 CT peripheral angiography (non‐ionic contrast) whole CTWULCTLS 17880 17880
upper limb left side
101 CT peripheral angiography (non‐ionic contrast) whole CTWULCTRS 17880 17880
upper limb right side
102 CT peripheral angiography hip and thigh both sides CTHATBS 17880 17880
103 CT peripheral angiography hip and thigh left side CTHATLS 17880 17880
104 CT peripheral angiography hip and thigh right side CTHATRS 17880 17880
105 CT peripheral angiography lower leg both sides CTLLBS 17880 17880
106 CT peripheral angiography lower leg left side CTLLLS 17880 17880
107 CT peripheral angiography lower leg right side CTLLRS 17880 17880
108 CT peripheral angiography whole lower limb both CTWLLBS 17880 17880
sides
109 CT peripheral angiography whole lower limb left side CTWLLLS 17880 17880
110 CT peripheral angiography whole lower limb right CTWLLRS 17880 17880
side
111 CT peripheral venography (non‐ionic contrast) CTVFACTBS 17880 17880
forearm both sides
112 CT peripheral venography (non‐ionic contrast) CTVFACTLS 17880 17880
forearm left side
113 CT peripheral venography (non‐ionic contrast) CTVFACTRS 17880 17880
forearm right side
114 CT peripheral venography (non‐ionic contrast) upper CTVUACTBS 17880 17880
arm both sides
115 CT peripheral venography (non‐ionic contrast) upper CTVUACTLS 17880 17880
arm left side
116 CT peripheral venography (non‐ionic contrast) upper CTVUACTRS 17880 17880
arm right side
117 CT peripheral venography (non‐ionic contrast) whole CTVWULCTBS 17880 17880
upper limb both sides
118 CT peripheral venography (non‐ionic contrast) whole CTVWULCTLS 17880 17880
upper limb left side
119 CT peripheral venography (non‐ionic contrast) whole CTVWULCTRS 17880 17880
upper limb right side
120 CT peripheral venography hip and thigh both sides CTVHATBS 17880 17880
121 CT peripheral venography hip and thigh left side CTVHATLS 17880 17880
122 CT peripheral venography hip and thigh right side CTVHATRS 17880 17880
123 CT peripheral venography lower leg both sides CTVLLBS 17880 17880
124 CT peripheral venography lower leg left side CTVLLLS 17880 17880
125 CT peripheral venography lower leg right side CTVLLRS 17880 17880
126 CT peripheral venography whole lower limb both CTVWLLBS 17880 17880
sides
127 CT peripheral venography whole lower limb left side CTVWLLLS 17880 17880
128 CT peripheral venography whole lower limb right side CTVWLLRS 17880 17880
129 CT PNS axial / coronal (non‐ionic contrast) CTACNI 6810 6810
130 CT PNS axial / coronal (plain) CTACP 4570 4570
131 CT PNS axial / coronal / sagittal (non‐ionic contrast) CTACSNI 7620 7620
132 CT PNS axial / coronal / sagittal (plain) CTACSP 5280 5280
133 CT renal angiography CTRENANG 17880 17880
12
134 CT sacro iliac joints (non‐ionic contrast) CTSIJCT 7620 7620
135 CT sacro iliac joints (plain) CTSIJPL 5280 5280
136 CT scan / MRI images on compact disc CTSMCD 510 510
137 CT scanogram (plain) CTSCP 1930 1930
138 CT sella (plain) CTSELLAP 4570 4570
139 CT shoulder joint (non‐ionic contrast) both sides CTSJCTBS 7620 7620
140 CT shoulder joint (non‐ionic contrast) left side CTSJCTLS 7620 7620
141 CT shoulder joint (non‐ionic contrast) right side CTSJCTRS 7620 7620
142 CT shoulder joint (plain) both sides CTSJPLBS 5280 5280
143 CT shoulder joint (plain) left side CTSJPLLS 5280 5280
144 CT shoulder joint (plain) right side CTSJPLRS 5280 5280
145 CT spine (3 vertebral levels) (non‐ionic contrast) CTSNIV 7620 7620
146 CT spine (3 vertebral levels) (plain) CTSPV 5280 5280
147 CT spine extended study CTSES 6810 6810
148 CT spine extended study (with contrast) CTSEC 10260 10260
149 CT sterotactic localization CTSLP 3050 3050
150 CT temporal bone ( package ) CTTBPK 4570 4570
151 CT temporal bone (non‐ionic contrast) CTTBNI 8330 8330
152 CT temporal bone (plain) high resolution CTTBP 6100 6100
153 CT Trucut biopsy procedure (scan done from our CTTBIN 5280 5280
hospital)
154 CT Trucut biopsy procedure (scan provided from CTTBOUT 7620 7620
outside hospital)
155 CT upper abdomen & liver volumetery (non‐ionic CTUALVCT 21340 21340
contrast)
156 CT upper abdomen (dual phase non‐ionic contrast) CTUACT 19300 19300
157 CT upper abdomen (non‐ionic contrast) CTUANI 7620 7620
158 CT upper abdomen (oral contrast only) CTUAOCT 4370 4370
159 CT upper abdomen (plain) CTUAP 3760 3760
160 CT upper abdomen (triple phase non‐ionic contrast) CTUATCT 19300 19300
161 CT upper abdomen (triple phase non‐ionic contrast) ‐ CTUATCTDO 17270 17270
FOR DONOR
162 CT upper thorax (non‐ionic contrast) CTUTNI 6100 6100
163 CT upper thorax (plain) CTUTP 3760 3760
164 CT venography brain CTVBR 13720 13720
165 CT venography neck CTVNE 13720 13720
166 CT venography neck & brain CTVNAB 17880 17880
167 CT venography thorax and descending/thoracic aorta CTVTAD 19300 19300
168 CT venography whole abdomen and abdominal aorta CTVWA 19300 19300
169 CT Visipaque add‐on 30 ml CTVISI30 1490 1490
170 CT Visipaque add‐on 60 ml CTVISI60 2990 2990
171 CT wrist (non‐ionic contrast) both sides CTWRCTBS 7620 7620
172 CT wrist (non‐ionic contrast) left side CTWRCTLS 7620 7620
173 CT wrist (non‐ionic contrast) right side CTWRCTRS 7620 7620
174 CT wrist (plain) both sides CTWRPLBS 5280 5280
175 CT wrist (plain) left side CTWRPLLS 5280 5280
176 CT wrist (plain) right side CTWRPLRS 5280 5280

CT Scan Dye Charges

CAT 1/CAT2 CAT3
1 Additional CT non‐ionic contrast (10 ml) CTADCT10 300 300
13
6 Additional CT rectal contrast CTADCT 300 300
7 Additional film (CT scan) CTADFILM 510 510
8 CT additional oral contrast CTAOC 300 300
9 Pressure injector usage in CT scan CTPI 410 410

Biochemical Genetics Charges

CAT 1/CAT2 CAT3
1 1st Trimester biochemical screen ( PAPP , Fr, Beta BFTS 2300 1800
HCG )
2 2nd Trimester triple test BTR2 2800 2200
3 Alkaptonuria ( Qualitative ) BALK 1200 950
4 Alpha feto protein ‐ AFP ( Serum / Amniotic fluid ) BAFP 800 650
5 Alpha glucosidase enzyme assay ( Pompies disease ) BPOM 5050 4000
6 Amino acid analysis (Quantitative UPLC) BUPLC 5000 4000
7 Amino acid chromatography (Plasma/urine) + Urine BAAM 2200 1750
Metabolic screening tests
8 Anti Leptin Anti Bodies test ALABT 1200 950
9 Anti phospholipid IgG antibodies screening for eight BPG 1200 950
antigens
10 Anti phospholipid IgM antibodies screening for eight BPM 1200 950
antigens
11 Aryl sulphatase ‐ A enzyme assay ( Metachromatic BARA 3800 3000
leukodystrophy )
12 Aryl sulphatase ‐ B enzyme assay ( MPS type VI ) BMP6 5400 4300
13 Beta galactosidase enzyme assay ( GMI gang / MPS BMP7 4050 3200
IVB )
14 Beta glucorinidase enzyme assay ( MPS VII ) BGAC 4050 3200
15 Beta glucosidase enzyme assay ( Gaucher's disease ) BGM1 3800 3000
16 Beta Hexosaminidase A enzyme assay ( Tay Sach's BTAYSACH 5100 4050
disease )
17 Biogenetic Prenatal diagnosis BPND 12500 10000
18 Biogenetic Prenatal diagnosis‐ Non hydrops (any four BPND‐NH 16500 13000
enzymes)
19 Biotinidase enzyme assay BIOTINEA 2500 2000
20 Ceruloplasmin (Serum) BCPL 1250 1000
21 Chitotriosidase enzyme (Gaucher disease) BCHT 2600 2050
22 Dual marker+ Pre‐eclampsia test BFTPE 4000 3200
23 Enzyme Package ‐ (organomegaly) ‐ BEPK 11500 9200
Gaucher+NP+GM1
24 Epimerase Enzyme BGEP 2800 2200
25 Fabry disease‐alpha‐Galactosidase enzyme BFD 4400 3500
26 Fibroblast Growth Factor ( FGF ‐ 21 ) BFGF21 1450 1150
27 Free beta HCG ( Genetics lab ) BFBH 1350 1050
28 Fucosidase enzyme assay ( Fucosidosis ) BFUC 5100 4050
29 G6PD (Quantitative) BG6PD 800 650
14
30 Galactocerebrosidase enzyme assay ( Krabbe disease BKRB 5100 4050
)
31 Galactokinase (Heparin blood) BGK 3650 2900
32 Galactose BGAL1P 3850 3050
33 Galactose ‐ 6 ‐ Sulphatase MPS IV A ( Morquio IV A G6SF 4500 3600
disease ) ‐ Biochemical Genetics
34 Galactose 1 Phosphate BGALP 2800 2200
35 Galactosemia enzyme ( GALT Quantitative ) GALT 3000 2400
36 Galactosemia Panel: Galt+ Epimerase+ Galactose+ BGALEM 10000 8000
Gal‐1‐PO4
37 Genetic Medicine: Thyroid stimulating hormone ( TSH BTT4 660 525
) and T4 estimation ( Filter paper )
38 Genetic Medicine: Thyroid stimulating hormone BTSH 450 350
estimation ( TSH )
39 Genetic Medicine: Thyroid stimulating hormone BTH6 925 750
estimation ( TSH ) , F T4 and F T3
40 Gliadin IgA antibody BGLA 1700 1350
41 I‐Cell disease in plasma (beta_Galactosidase+ BIC 11500 9200
alpha‐Fucosidase + alpha‐mannosidase
42 Iduronate 6 sulphate enzyme assay ( Hunter disease , IDSUEA 6350 5050
MPS II )
43 Iduronidase enzyme assay ( Hurler disease , MPS I ) BHUR 5100 4050
44 Inhibin A BINH 970 750
45 Interleukin ‐2 BIL2 970 750
46 Late Infantile ‐ Tripeptidyl Peptidases BNIL2 4100 3250
47 Mannosidase enzyme assay ( Mannosidosis A & B ) BMAN 6350 5050
48 Mannosidosis (Mannosidase A enzyme) BMANA 3850 3050
49 Mannosidosis (Mannosidase B enzyme) BMANB 3850 3050
50 Methylmalonic acid test BMAT 600 500
51 Minor blood group antigens (Fya+Jka+KCcEe) BMINOR 2400 1920
52 Morquio IVB‐MPS IV‐B‐ beta Galactosidase BMP7G 4100 3250
53 Mps Quantitative + Electrophoresis + 3 enzymes ‐ BQEMPS126 22000 17500
MPS 1+2+6
54 Mps Quantitative + Electrophoresis + 4 enzymes of BQEMPSIII 25000 20000
MPS III
55 Multiple Sulfatase deficiency ( Three enzymes ) BMSD 15000 12000
56 NCL, INFANTILE PALMITOYL PROTEIN THIOESTERASE BNIL1 4100 3250
57 New born screening ( TSH, G6PD, 17 OHP ) ‐ Genetics NBSM 1200 950
lab
58 Nitro blue tetrazolium dye test ‐ Slide ( NBT ) NBT 850 650
59 Organic acid analysis by Gas Choromatography‐Mass BOA 4500 3600
Spectrometry (GC‐MS)
60 PAPP ‐ A assay BPAP 1450 1150
61 PAPP A + DlGF BPAPL 3350 2650
62 Phospholipid 8 pro IgG to identify which of the eight BG8 1700 1350
antigens is positive
63 Phospholipid 8 pro IgM to identify which of the eight BM8 1700 1350
antigens is positive
64 Porphobilinogen ( Qualitative ) BPOR 1200 950
65 Porphobilinogen (Quantitative) BPORQ 1500 1200
66 Porphyria (Qualitative) in blood BPOR BL 1000 800
67 Pre‐ eclampsia Test BPE 2100 1650
68 Quadruple test (Triple markers + Inhibin A) BQAD 3400 2700
69 Quantitative MPS estimation BQMPS 2300 1850
15
70 Sandoff disease‐Hexosaminidase (A+B) enzyme BSD 5100 4050
71 Sanfillipo A disease ( Heparan sulphamidase ) BMP3A 5700 4550
72 Sanfillipo disease‐MPS III B‐alpha‐hexosaminidase BMP3B 5100 4050
(alpha‐N acetyl glucosaminidase)
73 Sanfillipo disease‐MPS III D‐alpha‐hexosaminidase BMP3D 5300 4200
(alpha‐N acetyl glucosaminide 6 ‐ sulfate)
74 Sanfillipo Type C ( Acetye COA ) BMP3C 5100 4050
75 Sanfillippo (A+B) BMP3 (A+B) 10000 8000
76 Sanfillippo (C+D) BMP3 (C+D) 10000 8000
77 Schindler ‐ alpha N ‐ Acetylgalactosaminidase BNAGA 5500 4400
78 Sphingomyelinase enzyme assay ( Niemann Picks BNPD 5100 4050
disease )
79 Succinyl acetone BSA 3500 2800
80 Succinyl acetone in blood + urine succinyl acetone on BSA‐GC 7500 6000
GC‐MS
81 Sugar chromatography BSC 1650 1300
82 Sweat test for cystic fibrosis ‐ lab charges BSWT 1200 950
83 Tay Sach + Sandoff BTSSD 9200 7350
84 TNF‐alpha BTNF 1200 950
85 Transglutaminase antibody ( igA ) BTGM 1350 1050
86 Unconjugated estriol assay ( Serum ) BEST 1100 880
87 Urinary Iodine BUI 1500 1200
88 Urine for MPS screen ( Biochemical genetics ) BURN 400 300
89 Urine Metabolic tests BAMT 600 450
90 Urine MPS Electrophoresis BUME 4000 3200
91 VLCFA Analysis BVLC 8500 6800
92 WOLMAN DISEASE ‐ ACID ESTERASE BWM 5100 4050
Cytogenetics Charges

CAT 1/CAT2 CAT3
1 Abortus Material chromosomal analysis ( Long Term CPOC 7300 5100
Culture )
2 Amniotic fluid chromosomal analysis ( Cell Culture ) CAF 10900 7650
3 Ataxia Telengiectasia chromosomal analysis ( CAT 7300 5100
Bieomycin Assay )
4 Blood chromosome analysis CBLD 3650 2550
5 Bone Marrow chromosomal analysis CBM 5500 3900
6 Chorionic villi chromosomal analysis ( Long Term CVS 10900 7650
Culture )
7 Cord blood prenatal chromosomal analysis CCB 5500 3900
8 Fanconi's syndrome chromosomal analysis ( CFA 7300 5100
Mitomycin Assay )
9 Fibroblast Culture for other tests CFB 4250 3000
10 FISH ‐ 1p & 19q co deletion for oligodendroglial F1P19Q 6050 4250
tumors
11 FISH ‐ 6q21 for CLL F6Q21 6050 4250
12 FISH ‐ 8q24 for Langer‐Giedion syndrome F8Q24 6050 4250
13 FISH ‐ ALK (2p23) FALK 9650 7250
14 Fish ‐ All (8 probe panel) FALL 40000 35000
16
15 FISH ‐ AML ‐ (10 probe panel) FAML 50000 35000
16 FISH ‐ AML/ETO [t8;21)] for AML FETO 6050 4250
17 FISH ‐ BCR/ABL [t(9;22)] for CML FBCRABL 6050 4250
18 FISH ‐ Burkitt's Lymphoma t8;14 FBL 6050 4250
19 FISH ‐ CLL Panel (8 probe panel) FCLL 40000 32000
20 FISH ‐ CML (4 probe panel) FCML 20000 16000
21 FISH ‐ del13q for myeloid malignancies, nonhodgkin F13Q 6050 4250
lymphoma, multiple myloma and CLL
22 FISH ‐ del17p for myeloid malignancies F17Q 6050 4250
23 FISH ‐ del20q myeloid malignancies F20Q 6050 4250
24 FISH ‐ del5q (monosomy 5) for MDS F5Q 6050 4250
25 FISH ‐ del7q (monosomy 7) for AML and MDS F7Q 6050 4250
26 FISH ‐ EGFR (7p12), (7p11.1‐q11.1) FEGFR 9650 7250
27 FISH ‐ HER2/Neu (CEP17) FHER2 9650 7250
28 FISH ‐ inv16 for AML FINV16 6050 4250
29 FISH ‐ MDS (6 probe panel) FMDS 30000 24000
30 FISH ‐ Multiple Myeloma (8 probe panel) FMM 40000 32000
31 FISH ‐ N‐MYC/CEP2 for neuroblastoma FMYC 9650 7250
32 FISH ‐ PML/RARA [t(15;17)] for AML FPMLRARA 6050 4250
33 FISH ‐ RBI for Retinoblastoma (13q14) FRBI 6050 4250
34 FISH ‐ t(11;14) for multiple myeloma F1114 6050 4250
35 FISH ‐ t(11;22) for Ewings Sarcoma F1122 6050 4250
38 FISH ‐ TEL/AML1 [t(12;21)] F1221 6050 4250
39 FISH ‐ Trisomy 8 F8 6050 4250
40 FISH ‐ X,Y Chimerism Screening FCXY 6050 4250
41 Fish 5 probe (13, 18, 21, X, Y) FISH5P 8500 6050
42 FISH ALL Panel FALLP 15000 10500
43 FISH AML Panel FAMLP 15000 10500
44 Fish chromosome 13, 21 FISH1321 6050 4250
45 Fish chromosome 16 FISHC16 6050 4250
46 Fish chromosome 21 FISHC21 6050 4250
47 Fish chromosome X, Y,18 FISHXY18 6050 4250
48 FISH CLL Panel FCLLP 35000 24500
49 FISH CML Panel FCMLP 15000 10500
50 Fish Di George syndrome ‐ N 25 probe FISHDGSN25P 6050 4250
51 Fish Di George syndrome ‐ Tuple 1 probe FISHDGST1P 6050 4250
52 FISH MDS Panel FMDSP 30000 21000
53 Fish microdeletion FISH1P 6050 4250
54 Fish Miller Decker / Lis gene FISHMDLG 6050 4250
55 FISH Multiple myeloma Panel FMMP 30000 21000
56 Fish Prader Willi syndrome FISHPWS 6050 4250
57 Fish Smith ‐ Magenis FISHSM 6050 4250
58 Fish williams syndrome FISHWS 6050 4250
59 Microarray postnatal (180K) CMIC‐POST 30000 30000
60 Microarray‐prenatal(60K) CMIC‐PRE 25000 25000
61 Recurrent Abortion chromosomal analysis ‐ Husband CRACH 0 0
62 Recurrent Abortion chromosomal analysis ‐ Wife CRAC 6050 4250
63 Amniotic fluid chromosomal analysis + Fish 5 probe CAF5P 14300 9900
$$ Fish 5 probe (13, 18, 21, X, Y) FISH5P
Amniotic fluid chromosomal analysis ( Cell Culture ) CAF
Amniotic fluid chromosomal analysis + Fish 5 probe (LABEL ONLY) CAF5POS
17
Genetics Procedures

CAT 1/CAT2 CAT3
1 Genetic counselling ( Doctor fee + Hospital Charges ) PGCDFHC
Genetic counselling ‐ Doctor fee PGCDF 2420 1690
Genetic counselling ‐ Hospital Charges PGCHC 240 170
HLA ‐ Serological & Molecular

CAT 1/CAT2 CAT3
1 SAB+QPRA (HLSAQPRA) SABQPRA 40000 40000
HLA PRA Q‐SCREEN HQPRA
Luminex Single Antigen HLA ‐ Class I HLSA I
Luminex Single Antigen HLA ‐ Class II HLSA II
HLA Serological & Molecular Charges

CAT 1/CAT2 CAT3
1 AB HAB 3850 2640
2 AB + DR ‐ One Person HABR1 13500 9500
3 AB+DR ‐ Additional person (beyond 2 persons) HABR3 10000 7000
4 AB+DR ‐ Two persons HABR2 25000 17500
5 ABC+DR+DQ HBCRQ 17000 12000
6 Antibody Immune Profile (HIMMUNP) HIMMUNP 9000 7000
7 Anti‐paternal Cytotoxic antibodies ‐ APCA HAP 6000 4500
8 DNA ‐ Isolation & storage (HLA Genetics) HDNA 750 500
9 DNA FINGERPRINTING (Additional Person) HDNAFP3 7000 5000
10 DNA FINGERPRINTING STUDY HDNAFP 20000 15000
11 DQ2 / DQ8 Celiac Disease ( High Risk Genotype ) HDCEL 6500 4500
12 DQB1‐06, Narcolepsy HDQ6 2500 1750
13 DR2‐Narcolepsy, M.S. Goodpasture syndrome HDR2 4500 3150
14 DR3‐ , Addison disease, Derm Nerp‐ HDR3 4500 3150
15 DR4‐Pemphigus Rhd A, Giant cell Art ‐ HDR4 4500 3150
16 DR5‐ Pauciart Rhd A, Scleroderma, Hashimotos Thyr, HDR5 4500 3150
17 DR7‐ PS., MCGN, Antiphospholipid AB Sy, Behcets ‐ HDR7 4500 3150
18 HLA ABC DNA HABC 15000 10500
19 HLA B27 HB27 2000 1400
20 HLA DQ Alpha ( HQA ) HLADQA 3500 2400
21 HLA DQ Alpha / Beta ( DNA ) HDRQ 6500 4550
22 HLA DQ Beta ( HQB ) HLADQB 2500 1750
23 HLA DSA ( BY LUMINEX ) HDSA 7000 5500
24 HLA Mitochondrial DNA Polymorphism HMITDNAPOL 0 0
25 HLA PRA % HPRAC1C2 8500 6500
26 HLA PRA Q‐SCREEN HQPRA 4000 2800
27 HLA tissue cross match serology ‐ Donor HCMD 0 0
28 HLA tissue cross match serology ‐ Patient / Recipient HCM 6000 4500
29 HLA Typing ‐ AB ( DNA ) HABM 9500 7000
18
30 HLA Typing ‐ ABC+DR+DQ ( Two Persons) HABCRQ2 30000 21000
31 HLA Typing ‐ C and DQ (DNA) HLACDQ 5500 3850
32 HLA Typing ‐ DR ( DNA ) HDRM 5000 3500
33 HLA Typing ( 2 persons ) and Tissue cross match ( HCRMATD 0 0
serology ) ‐ Donor
34 HLA Typing ( 2 persons ) and Tissue cross match ( HCRMAT 25000 20000
serology ) ‐ Patient / Recipient
35 HLA Y‐STR Polymorphism ( SECOND OF TWO ) HYSTRPOL 7000 5000
36 HLA‐B5, Behcet's disease HLAB5 5500 4000
37 Luminex Single Antigen HLA ‐ Class I HLSA I 22500 20000
38 Luminex Single Antigen HLA ‐ Class II HLSA II 20500 18000
39 Merosin / Dysferlin staining / Alpha dystroglycan HMA 3000 2000
40 Merosin staining ‐ Prenatal diagnosis ( Immunostain HMMP 15000 10500
and DNA Studies )
41 Muscle biopsy ‐ Calpain Staining ( Western Blot ) HMBCSWB 4400 3080
42 Muscle biopsy ‐ Dysferlin staining HMUDF 2970 1980
43 Muscle biopsy ‐ Dystrophin staining HMUDT 3500 2450
44 Muscle biopsy ‐ Merosin staining HMUM 3000 2000
45 Muscle biopsy ‐ Sacrogylcan staining HMUS 6000 4000
46 Muscular dystrophy staining profile ( Muscle biopsy ‐ HMDSP 9000 6300
Dystrophin staining and Sacrogylcan staining )
47 PRA % class 1 HPRA% 9000 6500
48 SKIN BIOPSY ‐ EPIDERMOLYSIS BULLOSA SCREENING HSKINBIO 5000 3500
Molecular Genetics Charges

CAT 1/CAT2 CAT3
1 1p36 MLPA ML1p36 7000 5000
2 Achondroplasia Gene Sequencing FGFR3 MACS 30000 22500
3 Achondroplasia mutation study MACH 5000 3500
4 Achondroplasia with Acantharis Nigricans ‐ SADDAN MSAD 5000 3500
mutation Lys 650 Met in FGFR3 gene
5 ACTN3 GENOTYPING MACTP 3300 2300
6 Acute necrotizing encephalopathy ( ANE ) RANBP2 MANE 5500 4400
gene mutation T585M
7 Adenosine Deaminase Deficiency‐ SCID ? ADA gene MADA 25000 20000
sequencing
8 Adrenoleukodystrophy (X‐linked ALD) sequencing of MXALD 30000 22500
ABCD1 gene
9 ADSpastic paraplegia 4, (SPG4) ‐ SPAST gene targeted MSPASTT 5500 4000
exon 12
10 Aicardi‐Goutieres syndrome 3 (AGS3) ‐ RNASEH2C MRNASEH2CT 5500 4000
gene, targeted exon 2
11 AICARDI‐GOUTIERES SYNDROME ex 2+3 MRNASEH2C 10000 7000
12 Alagille syndrome 1 targeted exon 12 MJAG 1 5500 4000
13 Albinism ‐ common Indian mutation MALB 5000 3500
14 Albinism ‐ OCA1 sequencing tyrosinase gene MAOSTG 20000 16000
15 Albinism ‐ OCA2 P gene‐Common deletion MAOGCD 5000 3500
16 Albinism ‐ OCA2 sequencing P gene MOCA2SQ 30000 27000
17 Albinism ‐ OCA3 sequencing TYRP1 gene MOCA3SQ 20000 16000
18 Albinism (All 3 genes) MACBNGS 40000 35000
19
19 Alkaptonuria gene sequencing (NGS) MALK1 35000 35000
20 Allgrove Syndrome ‐AAAS gene sequencing MAAS 26000 22000
21 Alpha 1 anti‐trypsin ( Z, X & M mutations ) MAAT 35000 30000
22 Alpha Thalassemia ‐ Deletions MATH 6000 4200
23 Androgen Insentivity‐ AR MLPA MLARA 7000 5000
24 Androgen receptor gene sequencing MARC 20000 16000
25 Aneuploidy screening (21, 18, 13,X,Y, chm) ‐ MANU 5000 3500
Additional to other PND
26 Aneuploidy screening by MLPA MLPA 7000 5000
27 Angelman syndrome DNA test ‐ Methylation MANG 6000 4200
28 APC gene analysis for Adenomatous Polyposis MAPCNGS 35000 35000
Syndrome (APC) (By NGS)
29 Apert syndrome mutation study (2 mutation) MAPE 5000 3500
30 Apo E genotyping MAPO 3600 2500
31 Arginosuccinicaciduria ‐ASL gene sequencing MASL 35000 27000
32 ARKPD ARKPD 35000 35000
33 ARKPD‐NGS panel MARNG 3500 35000
34 Atrial Septal Defect + Atrioventricular Block‐ NKX2 MNKX2 15000 12000
gene sequencing
35 Autosomal Dominant Polycystic Kidney Disease ‐ ADPKD 40000 40000
ADPKD 1+2 sequencing‐ NGS
36 Barth syndrome (3‐methylglutaconic aciduria type II) MTAZ 22000 17000
TAZ gene sequencing
37 Bartter syndrome type 2 ‐ KCNJ1 TARGETED MKCNJ1T 5500 4000
MUTATION
38 BASAL CELL NEVUS CARCINOMA, MPTCH1 7000 5000
HOLOPROSENCEPHALY (Exon 20)
39 BCR ‐ ABL Qualitative ( Molecular Genetics ) CBA 3600 2500
40 BCR ‐ ABL Quantitative ( Molecular Genetics ) CBAR 7000 5000
41 Beckwith‐Weidemann / Silver Russel (Chr11 UPD MBWS11 8800 6600
–MLPA)
42 Beta ‐ Ketothiolase sequencing ‐ ACAT1 Gene MBKT 22000 17000
43 BILATERAL FRONTOPARIETAL POLYMICROGYRIA ex6 MGPR56 7000 5000
44 Biotinidase Deficiency‐ BTD gene sequencing MBTD 19000 14500
45 Biotin‐responsive basal ganglia disease (BBGD), MSLC19A3 19800 15000
SLC19A3 gene sequencing
46 Blepharophimosis ?ptosis‐epicanthus inversion MFOXL2 22000 17000
syndrome ( BPES) FOXL2 gene sequencing
47 BPES‐ FOXL2/TWIST1 MLPA MLFOX 7000 5000
48 BRAF exon 15 gene sequencing MBRAF 6000 4200
49 BRANCHIOOTORENAL (BOR) SYNDROME MEYA1 7000 5000
50 BRCA 1 and 2 gene analysis (BY NGS) MBRANGS 36750 31500
51 BRCA 1 and 2 gene analysis (BY NGS) + MLPA MBRANGSD 48000 40000
52 BRCA1 DELETION / DUPLICATION CBRD 7000 5000
53 BRCA2 DELETION / DUPLICATION CBR2D 7000 5000
54 BRCA2 MUTATION ( 27 EXONS BY SEQUENCING ) CBR2 50000 38000
55 Breast cancer‐ BRCA2/CHEK2 MLPA MLBRCH 7000 5000
56 Bruton type X‐linked Agammaglobulinemia (XLA)‐ MBTK 35000 27000
BTK gene sequencing
57 C ‐ KITGene Mutations ( 4 Exons ) MCKIT 10000 7200
58 Calpainopathy ‐ CAPN3 gene sequencing MCAPN 36000 32000
59 Calpainopathy‐ CAPN3 2 common mutations MCAL 8800 6600
60 Calpainopathy‐CAPN3 MLPA MLCAP 7000 5000
61 Camurati‐Engelmann disease ‐ TGFB‐1 gene MTGFB1 22000 17000
sequencing
62 Canavan disease ‐ASPA, MLPA MLCAN 7000 5000
63 Canavan disease gene sequencing MSCG 20000 16000
20
64 Carpenter syndrome‐ RAB23 gene sequencing MRAB23 20000 16000
65 Cataract‐2 congenital Autosomal recessive (FYCO1 MFYO1 33000 26000
gene)
66 Catecholaminergic polymorphic ventricular MTRDN 7000 5000
tachycardia (TRIADIN) (Exon 5)
67 CFTR gene analysis (By NGS) MCFTRNGS 30000 25000
68 CFTR gene analysis (By NGS) + dosage MCFTRNGSD 37000 30000
69 Charcot ‐ Marie tooth Disease‐ EGR2 gene MEGR2 13000 11000
sequencing
70 Charcot ‐ Marie tooth Disease‐ GDAP1 gene MGDAP1 16500 13200
sequencing
71 Charcot ‐ Marie tooth Disease‐ MFN2 gene MMFN2 28000 22000
sequencing
72 Charcot ‐ Marie tooth Disease‐ MPZ gene sequencing MMPZ 16500 13200
73 Charcot ‐ Marie tooth Disease‐ PRX gene sequencing MPRX 25000 20000
74 Charcot ‐ Marie tooth Disease/ HNPP ( PMP 22 gene ) MCMT 7000 5000
dosage
75 Charcot Marie Tooth disease X‐linked ‐GJB1 MLPA MLCMX 7000 5000
76 Charcot‐Marie‐Tooth ‐ X‐Linked GJB1 gene MCMTX 17000 13500
sequencing
77 Charcot‐Marie‐Tooth disease, type 4J targeted MFIG4 11000 7700
mutations exon 16 and IVS7
78 Chicken Pox Infection‐ Varicella PCR (AF) MVA 4000 2700
79 Chicken Pox Infection‐ Varicella PCR (blood) MVB 3000 2100
80 Chimerism analysis (quantitative )per sample MCHIMER 7000 5000
81 Chronic granulomatous disease (CGD) x linked CYBB MCYBB 25000 20000
gene sequencing
82 Chronic granulomatous disease CDG1‐ Targeted MPMM2 9000 7000
PMM2 gene mutation analysis
83 CHRONIC GRANULOMATOUS DISEASE exon 5 MCYBB1 7000 5000
84 Citrullinemia type 1‐ASS1 gene sequencing MASS1 35000 27000
85 Cleidocranial dysplasia ‐ RUNX2 gene sequencing MRUNX2 28000 22000
86 COLD‐INDUCED SWEATING SYNDROME (exon 2) MCRLF 1 7000 5000
87 Colon Cancer (NRAS/KRAS gene Exon 2,3,4 gene MNRAS 13000 10000
sequencing)
88 COMBINED OXIDATIVE PHOSPHORYLATION MMTO1 7000 5000
DEFICIENCY 10 (COXPD10)ex 7
89 COMBINED OXIDATIVE PHOSPHORYLATION MAARS2T 7000 5000
DEFICIENCY 8 (COXPD8),
LEUKOENCEPHALOPATHYWITH OVARIAN FAILURE
(LKENP)exon3
90 Combined pituitary hormone deficiency 3 ‐ LHX3 MLHX3 19800 15000
GENE
91 Complex I, mitochondrial respiratory chain, MNDUFS6 5500 4000
deficiency, NDUFS6 targeted single exon
92 Cong Adernal Hyperplasia CYP ‐ 21A2 Gene MCAS 20000 17000
Sequencing
93 Cong. Adrenal hyperplasia ‐ Deletions by dosage test MCHD 7000 5000
94 Cong. Adrenal hyperplasia ‐CYP21A 1 gene MCAHC 25000 20000
sequecing+ deletion/duplication
95 Congenital adrenal hyperplasia ( Prenatal diagnosis ‐ MCAPF 0 0
linkage analysis ) ‐ family member
96 CONGENITAL GLYCOSYLATION 1Q disorder( KAHRIZI MSRD5A3 7000 5000
SYNDROME)exon1
97 Congenital Insensitivity to Pain with Anhidrosis (CIPA) MCIPA 15000 12000
‐( Prenatal Diagnosis by Linkage )TRKA( NTRK1) gene
98 CONGENITAL MYASTHENIC SYNDROME (exon 14) MCOLQ 7000 5000
21
99 Congenital Myasthenic Syndrome‐RAPSN gene RAPSN 7000 5000
Common mutation(p. N88K)
100 Conradi Hunermann syndrome‐ EBP gene sequencing MEBP 16500 13200
101 Corneal Dystrophy‐CHST gene sequencing MCHST 20000 16000
102 Cortical dysplasia (Exon 24) MKIF5C 7000 5000
103 Craniosynostosis ( non specific ) FGFR3 mutation ‐ MCNS 5000 3500
Pro250Arg
104 Crigler Najjar Syndrome (Sequencing) UGT1A1 gene MCNJS 22000 16000
105 Crouzon Disease : FGFR 2 gene (2 Mutation) MCRZ 10000 7000
106 Cyclical Neutropenia‐ELA2 gene sequencing MELA2 20000 16000
107 CYP2C9 ( 1,2,3 ) VKORC1(1639G>A) GENOTYPING MCYY 5500 4000
108 Cystic fibrosis ‐ CF Diagnosis ( Delta 508 mutation ) MCF1 4000 2500
109 Cystic Fibrosis ‐CFTR MLPA MLCF 7000 5000
110 Cystic Fibrosis, Gene sequencing MCFS 30000 25000
111 Cystic Megalencephaly ‐ MLC1 Gene Sequencing MLCS 22000 17000
112 Cystic Megalencephaly (MLC2) HEPACAM gene MPEPACAM 22000 17000
sequencing
113 Cystic megalencephaly MLC 1 gene mutation MLC1 5000 3500
114 Cystic megalencephaly MLC 1 prenatal diagnosis MLC1‐P 15000 12000
115 Deafness ‐ Connexin 26 ‐ Gene Sequencing MD2S 7000 5500
116 Deafness ‐(Non syndromic X linked Hearing loss gene MXNSHL 15000 12000
sequencing‐POU3F4 gene )
117 Deafness Connexin 30 Gene Deletion MSD 3600 3000
118 Deafness ‐Connexin 30 gene sequencing MDD30 9000 7000
119 Deafness Connexin 31 Gene Sequencing MD31 7000 5000
120 Deafness Dystonia Optic Neuronopathy Syndrome‐ MMTS 16500 13200
Mohr Tranebjaerg syndrome. TIMM8A gene
sequencing
121 Deafness ‐Mondini defect‐KCNJ10 gene sequencing MMD 15000 12000
122 Deafness ‐SLC26A4 Gene Sequencing MSLC26A4 35000 35000
123 Deafness‐Mondini defect‐FOXI1 gene sequencing MFOXI 1 12000 9000
124 Deletion ‐ 22q deletion ‐ ( Conotruncal Heart disease MD22D 12000 9000
)
125 Dengue fever ‐ Molecular diagnosis MDENG 4200 3000
126 DENT DISEASE 2, LOWE SYNDROMEex 22 MOCRL 7000 5000
127 Dentatorubral ‐ Pallidoluysian atrophy ( Triplet repeat MDRPLA 5000 3500
)
128 Desbuquois Dysplasia‐ CANT1 gene sequencing MCANT 16500 13200
129 Desbuquois Dysplasia‐ CHST3 gene sequencing MCHSTT 22000 18000
130 Diabetes Mellitus ‐Type 1 ‐ SIRTI gene sequencing MSIRT 25000 20000
131 Diastrophic Dysplasia‐SLC26A2 gene sequencing MSLC26A2 20000 16000
132 Dilated Cardiomyopathy, Hypertrophic MYBPC3T 5500 4000
cardiomyopathy‐ MYBPC3 targeted 1 exon
133 DMD ‐ Dosage Studies in Females MDDF 9000 7000
134 DMD gene analysis (By NGS) MDMDNGS 30000 25000
135 DNA ‐ Isolation & storage (Molecular Genetics) MDNA 700 500
136 DNA ‐ Isolation & storage for POC MDNAPOC 1200 800
137 DNA isolation and storage of fetal sample MDNAFETAL 1200 800
138 Donnai‐Barrow syndrome‐ LRP2 gene targeted MLRP2 11000 7700
mutation exon 23 & 27
139 Duchenne muscular dystrophy ( DMD ) deletion DMDMLPA 9000 7000
analysis by MLPA ( 79 exons )
140 Duchenne muscular dystrophy ( DMD ) deletion MDD 4200 3000
testing
141 Duchenne muscular dystrophy ( DMD ) prenatal MDP 15000 12000
diagnosis
22
142 Dyschromatosis Symmetrica hereditaria 1 (DSH1) hot MADAR 11000 7700
spot
143 Dystonia ( DYT5 gene sequencing ) MDYT5 15000 11000
144 Dystonia (DYT1 gene sequencing) MDYT1 15000 11000
145 Dystonia (DYT1,6,12,16) MLPA MLDYT 7000 5000
146 Dystrophic Epidermolysis Bullosa (AD)‐COL7A1 MEBAD 15000 11000
‐EXONS72‐75 gene sequencing
147 Ectodermal Dysplasia ‐ hypohidrotic X ‐ linked EDA MEDS 20000 16000
gene
148 EGFR Gene Mutations ( 4 Exons ) MEGFR 10000 7200
149 Emery Driefuss Muscular Dystrophy ‐EMD gene MEMD 15000 11000
sequencing
150 Emery‐Dreifuss muscular dystrophy 2, autosomal MLMNAS 5500 4000
dominant (EDMD2) targeted exon 11
151 Enterovirus PCR (Genetics) MEV 3300 2300
152 Epidermolysis bulllosa simplex ‐ KRT14 (exons1,4 MEBKRT14 15000 11000
and6)
153 Epidermolysis bulllosa simplex ‐ KRT5(exons1,4 and6) MEBKRT5 15000 11000
154 Epidermolysis bullosa dystrophica, autosomal MCOL7A1 11000 7700
dominant (DDEB) hotspot exons 105, 116
155 Epidermolysis Bullosa panel (NGS) MEBPP 35000 35000
156 Epilepsy ‐ SCN1a gene sequencing MSCN 35000 35000
157 Establishment and validation of known mutation MEVKM 19000 14500
158 Establishment and validation of known mutation‐ MEVKMSGRH 13000 10000
sgrh only
159 Ethylmalonic encephalopathy METHE‐1 22000 17000
160 Fabry disease GLA gene sequensing MGLA 22000 17000
161 Factor V Leiden mutation MFVL 2700 1900
162 Factor XIII deficiency (Exon 10) MF13A1 7000 5000
163 Familial Exudative Vitreoretinopathy ‐ FZD4 exon2 MFZD4 5000 3500
mutation
164 FAMILIAL HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS MPRF1 13000 10000
165 Familial Hypercholesteriemia‐APOB gene (exon 26 MFHAPOB 9000 7000
and exon 29)
166 Familial Hypercholesterolemia‐ LDLR gene MFHLDLR 28000 22000
sequencing
167 Familial Hypercholesterolemia‐ PCSK9 gene MFHPCSK9 22000 17000
sequencing
168 Familial Juvenile Nephronophthisis‐ NPHP1 MLPA MLNPH 7000 5000
169 Familial renal glucosuria SLC5A2 gene sequencing MSLC5A2 25000 20000
170 Family Member of Patient MFMD
171 Farber lipogranulomatosis (Exon 6,12) MASAH1 10000 7000

172 FGFR1 +FGFR2+FGFR3 gene analysis (By NGS) MFGFRNGS 40000 35000
173 FGFR2 probemix MLPA MLFGR2 9000 7000
174 FGFR2 sequencing ( Crouzon, Jackson Weiss, Pfeiffer, MFGFR2S 30000 22500
AD craniosynostosis)
175 FGFR3 Gene Sequencing ( Achondroplasia , MFGS 30000 22500
Hypochondroplasia Thonotrophic Dwarfism )
176 Fibrodysplasia ossificans progressiva (FOP), ACVR1 MACVR1 22000 17000
gene sequencing
177 FLT3 mutations(AML) MFLT3 4000 2700
178 Folate polymorphism 3'5 MTHFR ‐ ( 677C>T, 1298A>C MFOL 4200 3000
)
179 Fragile X in Females MSXF 8800 6600
180 Fragile X syndrome ( Methylation test ‐ confirmatory MFXM 6000 4200
)
181 Fragile X syndrome screen MFXS 3300 2300
23
182 Friedreich ataxia ‐ molecular diagnosis MFAMD 5500 4000
183 Frontotemporal lobar dimentia ( MAPT ) exons 9‐13 ) MMAPT 15000 11000
sequencing
184 Fructose intolerance Aldolase B deficiency ? ALDOB MALDOB 19800 15000
gene sequencing
185 Fukutin related protein‐Fukuyama congenital MFKRP 19000 14500
muscular dystrophy‐ FKRP gene sequencing
186 Fukuyama congenital muscular dustrophy‐FKTN gene MFKTN 28000 22000
sequencing
187 G‐6‐ PD ONE MUTATION MGP1 3300 2300
188 G‐6‐PD ( Mediterranean & Orissa types ) ‐ G6PD MG6PD 6000 4200
189 Galactosemia Gene sequencing ( GALT ) GALTSEQ 22000 17000
190 Gaucher disease ‐ GBA gene sequencing MGDSG 30000 22500
191 Gilbert's disease ( UGT1A1 Promoter polymorphism ) MGDP 3600 2500
192 Gilbert's Disease Sequencing ‐ UGT1A1 Gene MGDS 22000 18000
193 GLUTARIC ACIDEMIA TYPE II, exon6 METFB 7000 5000
194 Glutaric acidemia type II‐ETFB gene, targeted exon 6 METFBT 5500 4000
195 Glutaric Aciduria‐GCDH gene sequencing MGCDH 20000 16000
196 Glycogen Storage 1A Gene Sequencing MGSDS 15000 11000
197 Glycogen Storage disease III‐ known targeted MGSD3 7000 5000
mutation AGL gene
198 GM1 Gangliosidosis‐GLB1 gene sequencing MGLB1 28000 22000
199 Goldberg‐Sphrintzen syndrome‐KIAA1279 gene MKIAA1279 28000 22000
sequencing
200 Grebe syndrome‐ GDF5 gene sequencing MGDF5 16500 13200
201 Gyrate Atrophy of Choroid and Retina‐ OAT gene MOAT 28000 22000
sequencing
202 HADDAD syndrome‐ PHOX2B gene sequencing MHADDAD 15000 11000
203 Haemochromatosis ( 2 mutations ) MHACM 5000 3500
204 Hallermann Strieff Syndrome‐GJA1 gene sequencing MHSS 8800 6600
205 Hallervorden Spatz ‐ PANK2 Common mutation MHSC 6600 4500
206 Hallervorden‐Spatz Syndrome ‐ PANK2 gene MHSDSEQ 28000 22000
sequencing
207 Hb D Iran MHBD 3300 2300
208 Hb D Punjab MHBP 3300 2300
209 Hb E MHBE 3300 2300
210 Hb Q India MHBQI 3300 2300
211 Hb Sickle MHBSI 3300 2300
212 Heme oxygenase 1 deficiency HO 1 gene targeted MHO 1 5500 4000
mutation
213 Hemolytic uremic syndrome atypical 1 (AHUS1) ‐ CFH MCFHT 5500 4000
214 Hemophilia A ‐ Gene sequencing MHAS 35000 27000
215 Hemophilia A Inversions 1/22 MHAI 6000 4200
216 Hemophilia B ‐ Gene sequencing MHBS 22000 17000
217 Hemophilia B‐ MLPA MLF9 7000 5000
218 HEPATOCEREBRAL MITOCHONDRIAL DNA DEPLETION MMPV17 10000 7000
SYNDROMEex5+6
219 Herpes virus infection PCR MHER 3300 2300
220 HFI ‐ ALDOB ‐ Agarwal mutaion MHFIA 5500 4000
221 HLA‐B 1502 GENOTYPING, CARBAMAZEPINE, HB1502 3600 2500
PHENYTOIN
222 HLA‐B 5701, GENOTYPING, ABACAVIR HB5701 1800 1200
223 HNPCC ‐ MLH1 / MSH2 DELETION / DUPLIATIONS MID 7000 5000
224 HNPCC ‐ MLH1 Gene Sequencing MMLH1 35000 27000
225 HNPCC ‐ MLH1/ MSH2 MICRO SATELLLTE INSTABILITY MIT 8000 5600
( MSI )
24
226 HNPCC ‐ MSH2 Gene Sequencing MMSH2 26000 22000
227 HNPCC ‐ MSH6 Gene Sequencing MMSH6 19000 14500
228 Holocarboxylase deficiency HLCS full gene MHLCS 25000 20000
229 Human Telomere‐7 (dosage ch9p,10p,11p and MLTEL7 7000 5000
12p)MLPA
230 Huntington disease gene analysis MHD 4200 3000
231 Hyperoxaluria AGXT gene sequencing MHO 22000 17000
232 Hyperoxaluria‐AGXT MLPA MLAGX 7000 5000
233 Hypochondroplasia common mutation MHCM 6000 4200
234 Hypomyelination with Congenital Cataract‐ FAM126A MHCF 26000 22000
gene sequencing
235 IDH1(R132) IDH2 (R172) Mutations in Gliomas MIDH 10000 7000
236 IDUA Full gene (Hurler Syndrome) all 14 exons MIDUA 30000 22500
237 Iminitib Resistance mutation analysis CIR 9000 7000
238 INCONTINENTIA PIGMENTI NEMO GENE COMMON MNEMO 5000 3500
DELETION
239 Infantile neuroaxonal dystrophy ( INAD ) PLA2G6 MPLA2G6 25000 20000
gene sequencing
240 Infection ‐ Cytomegalovirus ( CMV ) PCR ‐ Genetic MCMV 3300 2300
Medicine
241 Infection ‐ PCR for Rubella Virus ( Genetics ) MR41 4200 3000
242 IPEX syndrome (immunodysregulation MFOXP3 6600 4400
polyendocrinopathy enteropathy X‐linked syndrome)
Targeted mutation FOXP3 gene
243 isovaleryl‐CoA dehydrogenase DEFICIENCY (Exon 2) MIVD 7000 5000
244 JAK‐2 mutation ( Molecular Genetics ) MJACK2 3300 2300
245 Jarcho levin syndrome ‐ MESP2 gene sequencing MMESP2 20000 16000
246 Joubert Syndrome ‐21 (exon 19 and 23) MCSPP1 10000 7000
247 JUNCTIONAL EPIDERMOLYSIS BULLOSA, MLAMA3 7000 5000
LARYNGO‐ONYCHO‐CUTANEOUS SYNDROME,
(exon55)
248 Kallman syndrome gene (FGFR1) sequencing MKAL 28000 22000
249 Klippel ‐ Feil syndrome 2 ‐ MEOX1 gene MEOX1 16500 13200
250 Known Mutation ( By Sequencing ) MSQ 5000 3500
251 KRABBE S DISEASE GALC COMMON DELETION MKD 5000 3500
252 Krabbes ‐ GALC gene sequencing MGALC 28000 22000
253 KUFS DISEASE, LATE‐INFANTILE NEURONAL CEROID MCLN6T1 7000 5000
LIPOFUSCINOSIS, exon3
254 Lafora Disease‐EPM2A gene sequencing MLD1 20000 16000
255 Lafora Disease‐NHLRC1 gene sequencing NHLRC1 20000 16000
256 LBSL ‐ DARS 2 gene sequencing MDARS2 33000 26000
257 Leb Hered Optic atrophy ‐ (LHON) 3 mutations MLHO 6000 4200
258 LEBER CONGENITAL AMAUROSIS, CONE‐ROD MGUCY2D 7000 5000
DYSTROPHYex 11
259 LEIGH SYNDROME (LS), MITOCHONDRIAL COMPLEX I MNDUFV1 10000 7000
DEFICIENCY (MT‐C1D)ex8+9
260 Leigh syndrome with cytochrome c oxidase (COX) MLSCOX 20000 16000
deficiency‐SURF1gene sequencing
261 LEPRE1‐Related Osteogenesis Imperfecta ( targeted MLEPRE 11000 7700
mutations exons 13 / 14)
262 Leri‐Weill dyschondrosteosis and Langer mesomelic MSHOX 19800 15000
dysplasia SHOX gene sequencing
263 Lesch Nyhan syndrome HPRT1 gene sequencing MLN 30000 22500
264 LEUKOCYTE ADHESION DEFICIENCY TYPE 1 MITGB2 7000 5000
265 Leukocyte adhesion deficiency type I (LAD1) ‐ ITGB2 MITGB2T 5500 4000
266 Linkage analysis MLA 12000 9000
25
267 Lissencephaly (Exon 35) MDYNC1H1 7000 5000
268 Lissencephaly DCX gene sequencing MDCX 25000 20000
269 Long QT / Cardiomyopathies / Premature CAD by MCQTNGS 40000 40000
NGS
270 Long QT package (KCNQ1, KCNH2, SCN5A) MLQT 35000 35000
271 Long QT2‐ KCNH2 gene sequencing MKCNH2 44000 32000
272 Long QT3‐ SCN5A gene sequencing MSCN5A 65000 45000
273 LOWE SYNDROME LINKAGE STUDIES ‐ FAMILY MLSLF 0 0
MEMBER
274 Lymphedema (Congenital)‐FLT4 gene sequencing MCL 20000 16000
275 Lynch syndrome gene panel (by NGS) MLYNCHNGS 40000 35000
276 Machado ‐ Joseph disease ‐ Spino cerebellar ataxia ( MJD 5000 3500
SCA3 )
277 Mandibuloacral dysplasia‐ LMNA (Lamin A/C) gene MLMNA 6600 4400
targeted mutation
278 Maple Syrup Urine Disease‐ BCKDHA gene MMSUDA 28000 22000
sequencing
279 Maple Syrup Urine Disease‐ BCKDHB gene sequencing MMSUDB 28000 22000
280 Maple Syrup Urine Disease‐ DBT gene sequencing MMSUDDBT 28000 22000
281 Marfan syndrome‐ FBN1 MLPA MLMAR 9000 7000
282 Marfan Syndrome, Loeys‐Deitz Aortic Aneurysm MTGFBR2 7000 5000
Syndrome (Exon8)
283 Maroteaux‐Lamy syndrome‐ MPS VI ASRB gene MASRB 25000 20000
sequencing
284 Maternal cell contamination (MCC) of fetal sample by MMCC 7000 5000
molecular analysis
285 MCAD gene sequencing (ACADM gene) MACADM 25000 20000
286 MCAD mutation ( Medium chain Acyl‐coA MCAD 3300 2300
dehydrogenase )
287 McArdle disease gene sequencing ‐PYGM gene MPYGM 35000 27000
288 Meckel Gruber‐ TMEM67 gene targeted analysis MTMEM67 11000 7700
289 MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS MCFHT1 7000 5000
TYPE II exon 21
290 MEN1 GENE MUTATION ( 7 EXONS BY SEQUENCING ) CMEN 22000 17000
291 Menke?s Disease ‐ ATP7A gene targeted mutations MATP7A 8800 6600
292 MENKES, exon 4+5 MATP7AT 10000 7000
293 Mental Retardation ‐ X Linked ‐ Panel MRX 7000 5000
Deletions/Duplications
294 Mental Retardation Panel1 ‐ Multiple MR1 7000 5000
295 Mental Retardation Panel2 ‐ Multiple MR2 7000 5000
296 Merosin‐deficient congenital muscular dystrophy 1A MLAMA2S 11000 7700
(MDC1A) targeted exons 27 & 56
297 Metachromatic Leukodystrophy gene sequencing MMLD 22000 17000
298 Metaphyseal Dysplasia ‐ COL 10A1 Gene Sequencing MC10S 22000 17000
299 Methyl Malonic Aciduria‐ MMAA gene sequencing MMMAA 17000 13500
300 Methyl Malonic Aciduria‐ MMAB gene sequencing MMMMA 17000 13500
301 Methylmalonic acedimia‐ MUT gene sequencing MMUT 28000 22000
302 Methylmalonic aciduria and homocystinuria type MMACHC 22000 17000
cbIC full gene
303 MGMT Methylation MMGMT 15000 13000
304 Microcephalic Osteodysplastic Primordial Dwarfism MRNU4ATAC 5500 4000
type 1 (MOPD)
305 Microcephaly ‐ASPM gene sequencing MASPM 35000 35000
306 Microcephaly ‐PQBP1 gene sequencing MPQBP1 17000 13500
307 Microdeletion panel MLPA any 1 MMICRO 7000 5000
26
308 Microdeletion panel MLPA any ‐2 MMICRO2 11000 8000
309 Microdeletion‐1 MLPA (Probe‐P245) MLDL1 7000 5000
310 Microdeletion‐5 MLPA (Confirmation P245) MLDL5 7000 5000
311 Microdeletion‐6 MLPA(Confirmation P245) MLDL6 7000 5000
314 Micropthalmia/ Anopthalmia‐ FOXE3 gene MFOXE3 9000 7000
sequencing
315 Mitochindrial DNA Genome sequencing MMITOSQ 40000 40000
316 Mitochondrial / LEIGHS ‐ 3 mutations MLE 8000 6000
317 Mitochondrial / MELAS ‐ 3 mutations MEL 8000 6000
318 Mitochondrial / MERRF ‐ 2 mutations MER 7000 5000
319 Mitochondrial / NARP ‐ 2 mutations MNAR 7000 5000
320 Mitochondrial Deafness‐2 mutations(A1555G, MMDEAF 5500 4000
7445G)
321 Mitochondrial DNA depletion syndrome 6 (MDDS6) ‐ MMDDS6T 11000 7700
MPV17 gene, targeted exons 5 & 6
322 Mitochondrial Genome ‐ Deletion/Duplication MGDD 7000 5000
323 Mitochondrial mutations package ( ALL ) MT4 12000 9000
324 Mowat Wison syndrome /deletion duplication MMWSDD 9000 7000
325 Mowat Wison syndrome‐ZEB2 gene sequencing MMWS 28000 22000
326 MPS II Gene Sequencing MMPSII 28000 22000
327 MPS II Hunter syndrome ( IDS gene deletions ) MHUNTD 7000 5000
328 MPS IIIA Sanfillipo Disease‐SGSH gene sequencing MMPS3A 28000 22000
329 MPS IIIB gene sequencing ( NAGLU gene ) MMPS3B 22000 17000
330 Mucolipidosis II alpha/beta.‐ GNPTAB gene targeted MGNPTAB 6600 4400
mutation analysis (Exon 13, 19)
331 Mucopolysaccharidosis IVA (Morquio A) ‐ GALNS full MGALNSF 35000 27000
gene
332 Multiple endocrine neoplasia‐ MEN1 MLPA MLMEN 7000 5000
333 Multiple epiphyseal dysplasia targeted exon 17 MCOL9A2 5500 4000
334 Multiple epiphyseal dysplasia type 3 targeted exon 5 MCOL9A3 5500 4000
335 Multiple Sulphatases‐ SUMF1 gene sequencing MMS 20000 16000
336 Mutation analysis ( single ) MMAS 5000 3000
337 Myoadenylate Deaminase Deficiency‐AMPD1 exon 2 MAMPD1 7000 5000
&3 gene sequencing
338 Myopathy, centronuclear , X‐linked targeted MMTM1 5500 4000
mutation
339 Myotonic dystrophy ‐ Type 1 ( 19q 13.3 ) MDM 5500 4000
340 Myotonic dystrophy ‐ Type 2 ( 3q 21 ) MMDT2 5500 4000
341 Nail Patella syndrome ‐ex4+5 MLMX1B 10000 7000
342 NBIA Neurodegeneration with brain iron MNBIA 25000 20000
accumulation‐PLA2G gene targeted mutations by
sequencing
343 NBIA‐ PANK2/PLA2G6 MLPA MLPANK 7000 5000
344 NCL ‐ Infantile ( 2 Mutaiton Assay ) ( We advice MNCLH 3300 2300
enzyme assay before this test )
345 NCL ‐ Juvenile ( 1 Mutation ‐ common deletion ) MNCLJ 4000 3000
346 NCL ‐ Late infantile ( 2 Mutations ) MNCLL 4000 3000
347 Neonatal Diabetes Mellitus ABCC8 gene targeted MABCC8 8800 6600
mutation
348 Nephropathic Cystinosis CTNS gene (one mutation) / MCTNST 5500 4000
(exon 10)
349 Nephrotic syndrome (NPHS1 and NPHS2 gene MNPHS 40000 40000
sequcencing)
350 Neurofibromatosis (Exon 16) MNF1 7000 5000
351 Neurofibromatosis type 2 NF2 22q12 MLPA MLNF2 7000 5000
27
352 Neuronal ceriod lipo fucinosis ( NCL ) or Batten MNCLF 9000 7000
disease
353 Neuronal Ceroid Lipofuscinosis(NCL) CLN8 (one MCLN8T 5500 4000
mutation exon 2)
354 Neuronal ceroid‐lipofuscinoses 6‐CLN 6 gene, MCLN6T 5000 4000
targeted exon3
355 Neuronal Ceroid‐Lipofuscinosis 2 (CLN2).‐ TPP1 gene MTPP1 25000 20000
sequencing
356 NGS panel Deafness MDFNG 35000 35000
357 Niemann Pick disease gene sequencing MNP 30000 22500
358 Niemann‐Pick type C disease‐ NPC MLPA MLNPC 7000 5000
359 Non‐ketotic hyperglycinemia (NKH) MGLDC 7000 5000
360 Norrie disease ‐ NDP gene sequencing MNDP 16500 13200
361 NOTCH3 gene sequencing ( cadASIL ) 5 exons MNOT 15000 11000
362 NPM1 gene Mutations(AML) MNPM1 3000 2000
363 Obesity due to leptin deficiency Leptin gene MLEPTIN 13000 11000
sequencing
364 Ocular albinism ( X‐linked), GPR143 gene gene MGPR143 25000 20000
sequencing
365 OSTEOGENESIS IMPERFECTA ex13,14,18 MLEPRE1OI 13000 10000
366 Osteogenesis imperfecta type VIII ‐ targeted exon 14 MLEPRE1T 5500 4000
367 Osteopetrosis TCIRG gene common mutations ( exon MTCIRG 8800 6600
13 & 18)
368 OSTEOPETROSIS,common +14‐15 MTCIRG1 10000 7000
369 OTC deficiency‐ MLPA MLOTC 7000 5000
370 OTC gene sequencing MOTC 30000 22500
371 Otopalato digital syndrome FLNA gene (3 exons) MFLNA 11000 7700
372 Pancreatitis‐ PRSS1 gene sequencing MPRSS 17000 13500
373 Pancreatitis‐ SPINK1 gene sequencing MSPINK 17000 13500
374 Paramyotonia common mutations Arg 1448 His Thr MPM 7000 5000
1313 Met
375 Parvo virus infection ( PCR ) MPAR 3300 2300
376 Pelizaeus Merzbacher Deletion/Duplication MPZD 7000 5000
377 Pelizaeus‐Merzbacher disease‐PLP1 gene sequencing MPMD 20000 16000
378 Permanent neonatal diabetes mellitus ‐ INS gene MINS 8800 6600
targeted mutation
379 PEROXISOME BIOGENESIS DISORDER 5A/5B exon3 MPEX2 7000 5000
380 PFIC1‐Progressive familial intrahepatic cholestasis MATP8B1 35000 35000
type 1 ‐ ATP8B1 gene sequencing
381 PFIC1‐Progressive familial intrahepatic cholestasis MATB123 40000 40000
type 1 +2+3
382 PFIC2‐Progressive familial intrahepatic cholestasis MABCB11 35000 35000
type 2 ‐ABCB11 gene Sequencing
383 PFIC3‐Progressive familial intrahepatic cholestasis MABCB4 35000 35000
type 3 ‐ ABCB4 gene Sequencin
384 PML‐RARA (APML) MPMLRARA 3600 2500
385 POLYCYSTIC KIDNEY AND HEPATIC DISEASE 1 MPKDH1 10000 7000
(AUTOSOMAL RECESSIVE)ex4+61
386 Polycystic kidney disease, autosomal recessive MPKHD‐1 11000 7700
(ARPKD) targeted exon 11 & 19
387 Pompe disease ‐ GAA gene sequencing MGAA 33000 26000
388 Pompe MLPA MLPOM 7000 5000
389 Pontocerebellar hypoplasia‐TSEN54 gene sequencing MTSEN54 40000 40000
390 PORPHYRIA SEQUENCING MPSQ 22000 17000
391 Prader willi syndrome molecular test MPWS 6000 4500
392 preconception screening by NGS‐ six hotspot agarwal M1AGG 22000 18000
mutations
28
393 Preconception screening by NGS‐common genes‐ MPRNG 30000 22000
MAGG+ HBB, DMD ,CF, Gauher,Criggler najjar,
GALT,Deaf,OCA, Wilson disease
394 preconception screening by NGS‐common genes‐ M2PRESCREEN 30000 22000
MAGG+ HBB, DMD ,CF,Gauhcer,CJ, GALT,Deaf,OCA,
wilson
395 preconception screening cmpehensive MPRESCREEN M3SCREEND 44000 38000
by NGS‐+Fx, DOSAGE SMA,DMD,
396 Preconception screening comprehensive Prescreen MSCREN 44000 38000
by NGS‐+Fx, Dosage SMA, DMD
397 Prenatal diagnosis ( Includes test for MCC ) MPND 15000 12000
398 Prenatal diagnosis by gene sequencing MPNDSEQ 20000 16500
399 Primary Congenital Glaucoma/ Buphthalmos‐ CYP1B1 MCYP1B1 15000 11000
gene sequencing
400 PROGRESSIVE PSEUDORHEUMATOID DYSPLASIA MWISP3 7000 5000
(PPRD) ex 2
401 Propionic academia‐ PCCA MLPA MLPCC 7000 5000
402 Propionic aciduria‐ PCCA gene sequencing MPCCA 35000 35000
403 Propionic aciduria‐ PCCA gene sequencing‐ A+B NGS MPCCAB 35000 35000
404 Propionic aciduria‐ PCCB gene sequencing MPCCB 28000 22000
405 Prothrombin gene polymorphism ( G20210A ) MPRO 3300 2300
406 Pseudoachondroplasia ‐ COMP gene sequencing of MCOMP 17000 13500
exons 10‐14, 16
407 PTEN gene sequencing MPTEN 25000 20000
408 Pyknodysostosis‐CTSK sequencing MCTSK 25000 20000
409 Pyruvate Carboxylase deficiency ‐ gene sequencing MPCD 35000 27000
410 Pyruvate Dehydrogenase Deficiency (PDH)X‐linked ‐ MPDH 28000 22000
PDHA1 gene sequencing
411 RAG1 deficiency MRAG1 21000 16500
412 Rapid‐onset dystonia parkinsonism (RDP) (also MATP1A3 33000 26000
known as DYT12)‐ ATP1A3 gene sequencing
413 RB gene analysis (By NGS) MRBNGS 40000 35000
414 Recessive forms of osteogenesis imperfecta (Intron MPPIB 7000 5000
2)
415 Renpenning Syndrome‐PQBP1 gene sequencing MRSPQBP1 21000 16500
416 Respiratory distress syndrome (RDS) due to MRDS 11000 7700
Surfactant Deficiency( three common mutations ‐
SFTPB, SP‐C and ABCA3 gene mutations
417 RET Gene Mutations ( 6 Exons ) MRET 15000 11000
418 Retinoblastoma ‐ Deletion/Duplication MRBDD 7000 5000
419 RETINOBLASTOMA GENE SEQUENCING MRBS 35000 35000
420 Rett syndrome ( MECP2 sequencing and Deletion / MRS 30000 22500
duplication )
421 Rett syndrome atypical ‐CDKL5 MLPA MLCDK 7000 5000
422 RETT Syndrome MECP2 Deletion/Duplication MRTSQ 7000 5000
423 Rett syndrome MECP2 Sequencing MRSS 28000 22000
424 RH genotyping ‐ Both alleles ( +/+ or ‐/‐ ) MRH 6000 4200
425 RH typing ( Rh+ or Rh‐ ) MMRHT 3300 2300
426 Rh Typing On Fetal DNA in Maternal Blood MRHMB 5000 3500
427 RPE65 Gene Sequencing MRPE65 28000 22000
428 Russel Silver ‐ Methylatio H ‐ 19 MRSS19 8800 6600
429 Russel Silver – UPD chr7 MRSS7 8800 6600
430 Saethre‐ Chotzen syndrome ‐ TWIST gene Dosage MTWISTSD 18000 14000
+sequencing
431 Saethre‐ Chotzen syndrome ‐ TWIST gene sequencing MTWISTS 13000 11000
432 Sandhoff disease‐ HEXB gene sequencing MHEXB 25000 20000
29
433 Sanjad Sakati syndrome/common mutation ‐ TBCE MTBCE 7000 5000
gene
434 SCID Radiosensitive ‐ DCLRE1C MLPA MLDCLR 7000 5000
435 Sengers Syndrome (Mitochondrial ) exon 13,14 MAGK 10000 7000
436 Sequencing Parkinson ( Gly19 ser mutation ) SGLY19 5500 4000
437 Sequencing restrictive dermopathy ( specific SRD 5500 4000
mutation )
438 Severe Combined Immunodeficiency (Exon 1) MRFXAP 7000 5000
439 short rib‐polydactyly syndrome type 5 MWDR35 7000 5000
440 Sialidosis (Exon 4) MNEU1 7000 5000
441 Simpson‐Golabi‐Behmel syndrome 1 targeted MGPC3 5500 4000
mutation
442 Sjogren‐Larsson syndrome ‐ ALDH3A2 gene targeted MALDH3A2 6600 4400
mutation
443 SJORGEN‐ LARSSON SYNDROME LINKAGE‐ALDH3A2 MSLS 12000 9000
444 SMA carrier screening by MLPA SMAMLPA 7000 5000
445 SMA with respiratory distress1‐ SMARD1 gene MSMARD 28000 22000
sequencing
446 SPASTIC PARAPLEGIA TYPE 4, exon 12 MSPAST 7000 5000
447 SPG 11 ‐ Q906fs Agrawal mutaion MSPG11A 5500 4000
448 SPINAL BULBAR MUSCULAR ATROPHY CAG REPEATS MSBM 5000 3500
449 Spinal cerebellar ataxia ( SCA ) ‐ one gene MSCA 5000 3500
450 Spinal cerebellar ataxia ( SCA ) ‐ two gene MSCATG 7000 5000
451 Spinal cerebellar ataxia package ( 1, 2, 3, 12 ) MSCA4 12000 9000
452 Spinal cerebellar ataxia package ( 1, 2, 3, 6, 7, 12, 17 ) MSC4 21000 16500
453 Spinal Muscular Atrophy ‐ SMN 1 Gene Sequencing MSMNS 25000 22000
454 Spinal muscular atrophy ( SMA ) ‐ molecular diagnosis MSMA 4000 2700
455 Spinal muscular atrophy ( SMA ) ‐ prenatal diagnosis MSMP 15000 12000
456 Spinal muscular atrophy ‐SMN2 copy number analysis MSMC 7000 5000
457 Spinocerebellar ataxia with peripheral MSCAN 7000 5000
neuropathy‐autosomal recessive‐SCAN1 targeted
mutation analysis
458 Spinocerebellar ataxia with peripheral MTDP1 28000 22000
neuropathy‐autosomal recessive‐TDP1 gene
sequenicng
459 Spondyloepimetaphaseal dysplaisa ‐ KIF22 exon 4 MKIF22 6600 4400
460 Spondyloepiphyseal Dysplasia X‐Linked gene MSEDS 17000 13500
Sequencing
461 Sry + Amxy gene study ( Y chromosome ) MSAGS 5000 3000
462 SSjogren‐Larsson syndrome( Prenatal Diagnosis by MSJOL 15000 12000
Linkage )
463 Subtelomeric Deletions / Duplications ‐ All MTELD 7000 5000
Autosomes
464 Surfactant B gene sequencing MSURFB 28000 22000
465 Surfactant C gene sequencing MSURFC 22000 17000
466 Tay‐Sachs disease (TSD) /GM2 gangliosidosis variant MHEXA 28000 22000
B‐ HEXA gene sequencing
467 TGM1 GENE SEQ A R CONG ICHTH AND LAMELLAR MIGMS 28000 22000
ICHTHYOSIS
468 Thalassemia ‐ XMN, Bcl1 and HBSIL‐ MYB MXM3 8800 6600
polymorphism
469 Thalassemia ALPHA globin gene sequencing MALPHAGS 8500 6000
470 Thalassemia Beta globin gene large deletions (HPFH) MBGLD 8500 6000
471 Thalassemia BETA globin gene sequencing MBETAGS 8500 6000
472 Thalassemia beta mutation study ‐ couple MTHC1 8500 6000
473 Thalassemia beta mutation study ‐child MTHPRO 5000 3500
474 Thalassemia beta mutation study ‐child and parents MTHCP 8500 6000
30
475 Thalassemia beta prenatal diagnosis ( Repeat test ) MTPR 13000 10000
476 Thalassemia Intermedia ‐ Bcl1 and HBSIL‐ MYB MXM2 6600 4400
polymorphism
477 Thalassemia prenatal diagnosis MTHP 15000 12000
478 Thalassemia prenatal diagnosis ( Thalassemia society MTHPTS 12500 10000
patient )
479 Thanatophoric dwarfism ( common mutation ) MTD 5000 3500
480 THROMBOPHILIA DUE TO PROTEIN C DEFICIENCY MPROC 10000 7000
(Exon 7,9)
481 Thrombophilia profile ( DNA ) ‐ 3 polymorphisms MTHR 7000 5000
482 THROSENEMIA ‐ FAH GENE SEQUENCING MTYS 21000 16500
483 Torsion dystonia 1 ( DYT 1 ) deletion analysis MDYT 3600 2500
484 Toxoplasmosis infection PCR ( Genetics ) MTOX 3300 2300
485 TP53 DELETION/ DUPLICATION C53D 7000 5000
486 TP53 SEQUENCING CP53 15000 11000
487 TPMT ( 1,2,3A,3B,3C ) GENOTYPING, AZA, MTP5 5500 4000
6MP,6‐THIOGUANINE
488 TPMT ( 1,2,3C ) GENOTYPING, MTP3 3300 2300
AZA,6MP,6‐THIOGUANINE
489 Tricho hepatoenteric syndrome‐ TTC37 exon 28 MTTC 5000 3500
common mutation
490 TSC1 and TSC2 gene analysis( By NGS)+ dosage MTCSNGSD 40000 37000
491 Tuberculosis mycobacterium infection ( PCR )‐ MTBINF 4200 3000
qualitative
492 Tuberous sclerosis ( TSC1 ) deletion / duplication MDTS1 7000 5000
493 Tuberous sclerosis ( TSC1+2)‐ NGS TUBES 35000 35000
494 Tuberous sclerosis ( TSC2 ) deletion / duplication MDTS2 7000 5000
495 UGT1A1 28 GENOTYPING IRINOTECAN MUGG 3300 2300
496 Unverricht?Lundborg disease MEPM1 8800 6600
497 Usher syndrome and nonsyndromic AR deafness MCDH23 7000 5000
(Exon 58)
498 Usher syndrome type IIa and retinitis pigmentosa MUSH2A 11000 7700
targeted exons 38 & 53
499 validation of NGS mutation‐ SGRH only MVALSGRH 7000 5000
500 Very Long Chain Fatty Acid Dehydrogenase MACADVL 28000 22000
Deficiency‐ACADVL gene
501 VGT1A1 28 ( (TA) ) GENOTYPING, IRINOTECAN MUGT 2500 1750
502 VHL GENE DELETION/ DUPLICATION CVHL 7000 5000
503 VHL GENE MUTATION ( 3 EXONS BY SEQUENCING, CVHS 15000 11000
MLPA )
504 Waardenburg Syndrome ‐ PA X 3 Gene Sequencing MWSS 22000 17000
505 Waardenburg syndrome type 2 (Hirschsprung ) EDN3 MEDN3 19800 15000
gene sequencing
506 WILMS TUMOR 1, ex 9+7 MWT 1 10000 7000
507 Wilson Disease ‐ ATP7B Gene Sequencing MWDS 30000 22500
508 Winchester Syndrome ‐ MMP2 gene targeted MMMP2 6600 4400
mutations
509 Wiskott Aldrich gene sequencing‐ WAS gene MWAS 28000 22000
510 X ‐ L Chondrodysplasia punctata Arse gene MXLCDP 22000 17000
511 X ‐ linked ichthyosis ( deletion in Steroid sulfatase MXIC 5000 3500
gene )
512 X ‐ linked ichthyosis ‐carrier screening by dosage MXICD 7000 5000
analysis of STS gene
513 X ‐ linked ichthyosis ‐extent of deletion MXICEXT 7000 5000
514 X‐ severe combined immunodeficiency MXSCID 28000 22000
(X‐SCID)‐IL2RG gene sequencing
515 Xeroderma pigmentosum ‐ XPC gene sequencing MXPC 35000 27000
31
516 XERODERMA PIGMENTOSUM,exon3 MXPA 7000 5000
517 X‐linked congenital adrenal hypoplasia‐ DAX gene MDAX 17000 13500
sequencing
518 X‐linked dyserythropoietic anemia and MGATA‐1 5500 4000
thrombocytopenia GATA 1 hotspot
519 X‐Linked Hydrocephalus ‐ L1CAM gene sequencing ML1CAM 35000 35000
520 X‐LINKED MYOTUBULAR MYOPATHY3,12,13 MMTMX 13000 10000
521 XMN polymorphism Gr gene ( thalassemia child ) MXM1 4000 2700
522 Y ‐ chromosome deletions ( DNA ) ‐ 10 MYDL 6000 4200
IVF Investigations Charges

CAT 1/CAT2 CAT3
1 Anti Mullarian Hormone ( AMH ) AMH 1280 1000
2 Hormone estimation of TSH (IVF Lab) IVFTSH 400 240
3 Post Coital Test PCT 170 100
4 Semen Analysis SANAL 400 240
5 Semen Fructose Test SFRUCK 80 80
6 Semen Processing for IUI / AIH SPFAIH 2100 1280
7 Semen Pus Cells Test (IVF Lab) PUSIVF 80 80
8 Serum Beta hCG (IVF Lab) SHCG 650 400
9 Serum FSH ( Baseline ‐ Day 1 / 2 / 3 of menses ) SFSHBDM 700 420
10 Serum FSH ( Random ) FSH 700 420
11 Serum LH ( Baseline ‐ Day 1 / 2 / 3 of menses ) SLHBDM 700 420
12 Serum LH ( Random ) LH 700 420
13 Serum Oestradiol ( E2 ) ‐ Random OESTR 700 420
14 Serum Oestradiol ( E2 ) ( Baseline ‐ Day 1 / 2 / 3 of SOBDM 700 420
menses )
15 Serum Progesterone PROGEST 700 420
16 Serum Prolactin SPROLAC 700 420
IVF Procedures

CAT 1/CAT2 CAT3
1 CULTURE AND EMBRYO TRANSFER CHARGES ( AFTER CETCPDCHOS
CRYOPRESERVATION ) (EMBRYOLOGIST FEE + HOSPITAL
CHARGES)
Culture and embryo transfer charges ( after cryopreservation ) ‐ Clinical CETCDFCL 9800 9800
doctor fees
Culture and embryo transfer charges ( after cryopreservation ) ‐ CETCDFEMBR 3300 3300
Embryologist fee
Culture and embryo transfer charges ( after cryopreservation ) ‐ hospital CETCDFAHC 17000 17000
service charges
2 DIAGNOSTIC SPERM EXTRACTION ( TESA / PESA ) DSEPCADCHOS

(PACKAGE CHARGES + ALL DOCTOR FEES)
Diagnostic sperm extraction ( TESA / PESA ) ‐ Embryologist's fee DSEEF 2050 2050
Diagnostic sperm extraction ( TESA / PESA ) ‐ Hospital service charges DSEHC 1550 1550
Diagnostic sperm extraction ( TESA / PESA ) ‐ Surgeon fee DSEUF 6200 6200
3 Embryo Biopsy 3‐4 Embryos (Embryologists fee + Hospital EMBOS
charges + Clinician Charges)
32
Embryo Biopsy (3‐4 Embryos) ‐ Clinician Charges EMBRYOCL 10000 10000
Embryo Biopsy (3‐4 Embryos) ‐ Embryologist fee EMBRY 5100 5100
Embryo Biopsy (3‐4 Embryos) ‐ Hospital Charges EMBRYO 15300 15000
4 Embryo Biopsy 1‐2 Embryos (Embryologists fee + Hospital EMBROS
Embryo Biopsy (1‐2 Embryos) ‐ Clinician Charges EMBRCF 5100 5100
Embryo Biopsy (1‐2 Embryos) ‐ Embryologist fee EMBRF 2550 2550
Embryo Biopsy (1‐2 Embryos) ‐ Hospital Charges EMBRHC 7600 7600
5 Embryo Biopsy 5‐8 Embryos (Embryologists fee + Hospital EMBRYOS
Embryo Biopsy (5‐8 Embryos) ‐ Clinician Charges EMBCLIN 10000 10000
Embryo Biopsy (5‐8 Embryos) ‐ Embryologist fee EMBYOEF 7600 7600
Embryo Biopsy (5‐8 Embryos) ‐ Hospital Charges EMBRYOHC 23000 23000
6 Freezing of semen (Embryologists fee + Hospital charges) FRESEMOS
Freezing of semen ‐ Embryologists fee FSEMEEMBR 440 440
Freezing of semen ‐ hospital charges FSEME 1300 1300
Semen Cryo Preservation SCP
7 Intra‐cytoplasmic sperm injection ( ICSI ) ‐ (Embryologists ICSIOS

fee + Hospital charges)
Intra‐cytoplasmic sperm injection ( ICSI ) ‐ Embryologists fee ICSIEMB 5000 5000
Intra‐cytoplasmic sperm injection ( ICSI ) ‐ hospital charges ICSINJ 15000 15000
8 IVF PROCEDURE ( 1ST CYCLE ) ‐ PACKAGE + ALL DOCTOR IVF1OS
FEES + HOSPITAL CHARGES
IVF procedure ( 1st Cycle ) ‐ Anaesthetists Charges IVF1SCAC 4700 4100
IVF procedure ( 1st Cycle ) ‐ Clinician Charges IVFSC1CL 24500 19500
IVF procedure ( 1st cycle ) ‐ Embryologists Fee IVFSC1EMBF 11500 9000
IVF procedure ( 1st Cycle ) ‐ Hospital Charges IVF1SCHC 37800 30400
IVF procedure ( 1st cycle ) ‐ package charges IVF1PC 81000 65000
IVF procedure ( 1st Cycle ) ‐ Ultasound Charges IVF1SCUC 2500 2000
9 Inpatients Only ‐ IVF package procedure 2nd installment ‐ IVF2IN
all charges
IVF procedure ( 2nd installment ) ‐ Anaesthetists fees IVF2NDAF 4500 3600
IVF procedure ( 2nd installment ) ‐ clinical doctor fee IVF2NDDFCL 17500 14000
IVF procedure ( 2nd installment ) ‐ embryologists fee IVF2NDEMBRY 5800 4600
IVF procedure ( 2nd installment ) ‐ hospital amount IVF2NDHA 24000 19500
IVF procedure ( 2nd installment ) ‐ PAC charges IVF2PAC 620 620
IVF procedure ( 2nd installment ) ‐ ultrasound charges IVF2NDUC 2600 2100
10 IVF PROCEDURE ( 2ND CYCLE ) ‐ PACKAGE + ALL DOCTOR IVF2OS
FEES + HOSPITAL CHARGES
IVF procedure ( 2nd Cycle ) ‐ Anaesthetists Charges IVF2SCAC 3600 3400
IVF procedure ( 2nd Cycle ) ‐ Clinician Charges IVFSC2CL 17000 15500
IVF procedure ( 2nd cycle ) ‐ Embryologists Fee IVFSC2EMBF 8100 7300
IVF procedure ( 2nd Cycle ) ‐ Hospital Charges IVF2SCHC 26300 24500
IVF procedure ( 2nd cycle ) ‐ package charges IVF2PC 57500 53000
IVF procedure ( 2nd Cycle ) ‐ Ultasound Charges IVF2SCUC 2500 2300
11 Egg Freezing (Every additional 9 oocytes) IVFEF
Egg Freezing (Every additional 9 oocytes) ‐ Embryologist Fee EFEF 2500 2500
Egg Freezing (Every additional 9 oocytes) ‐ Hospital Charges EFHC 7600 7600
12 Egg Freezing (Non Fertility Preservation :upto 9 oocytes) IVFEN
Egg Freezing (Non Fertility Preservation :upto 9 oocytes) ‐ Embryologists EFDCN 6400 6400
Charges
Egg Freezing (Non Fertility Preservation :upto 9 oocytes) ‐ Hospital EFHCN 19000 19000
Charges
13 Oocyte Cryopreservation cycle (upto 9 oocytes) IVFOC9O

Oocyte Cryopreservation cycle (upto 9 oocytes) ‐ Anaesthetist pool OCAP 4500 4500
Oocyte Cryopreservation cycle (upto 9 oocytes) ‐ Consultant Fee OCCF 19500 19500
Oocyte Cryopreservation cycle (upto 9 oocytes) ‐ Embryologist Fee OCEF 11500 11500
Oocyte Cryopreservation cycle (upto 9 oocytes) ‐ Hospital Charges OCHC 30000 30000
Oocyte Cryopreservation cycle (upto 9 oocytes) ‐ PAC Charges OCPAC 1000 1000
33
Oocyte Cryopreservation cycle (upto 9 oocytes) ‐ Ultrasound Charges OCUC 2650 2650
14 Egg Freezing (Renewal Charges per year) IVFRC
Egg Freezing (Renewal Charges per year) ‐ Embryologist Charges EFRDC 3800 3800
Egg Freezing (Renewal Charges per year) ‐ Hospital Charges EFRHC 11500 11500
15 IVF procedure ( Registration ) IVFROS
IVF procedure ( Registration ) ‐ Packages Charges IVFRPC 10000 10000
IVF procedure ( Registration) ‐ Clinician Charges IVFRC 1100 1100
IVF procedure ( Registration) ‐ Embryologists Fee IVDEM 370 370
IVF procedure ( Registration) ‐ Hospital Charges IVFHC 7300 7300
IVF procedure ( Registration) ‐ Ultasound Charges IVFULT 1600 1600
16 Oocyte aspiration (no oocytes retrieved and further IVF OOCYTEASPOS
suspended) (Package charges + all doctor fees + Hospital
charges)
Oocyte aspiration (no oocytes retrieved and further IVF suspended) ‐ OAAF 3700 3000
Anaesthetist fee
Oocyte aspiration (no oocytes retrieved and further IVF suspended) ‐ OAHA 8500 8000
Hospital amount
Oocyte aspiration (no oocytes retrieved and further IVF suspended) ‐ OAUC 2200 1750
Ultrasound charges
Oocyte aspiration (no oocytes retrieved and further IVF suspended) Clinical OACF 10500 8700
Doctor fee
17 Renewal charges for embryo cryopreservation (for every RENCRYOOS

six months) ‐ (Embryologist fee + Hospital charges)
Renewal charges for embryo cryopreservation (for every six months) ‐ RCSCRYOEMBR 1250 1250
embryologists fee
Renewal charges for embryo cryopreservation (for every six months) ‐ RCSCRYO 3700 3700
hospital charges
18 Re‐Vitrification (Embryologists fee + Hospital charges) REVITEOS

Re‐Vitrification ‐ Embryologist fee REVITEMB 2760 2760
Re‐Vitrification ‐ Hospital Charges REVITEHC 7875 7875
19 Embryo cryopreservation for 1‐3 bactes (Embryologist fee SPERMCRYO
+ hospital charges)
Embryo cryopreservation ( freezing ) charges (Embryologists fee) SCRYCEMB 5400 5400
Embryo cryopreservation ( freezing ) charges (Hospital amount) SCRYC 16000 16000
20 Embryo cryopreservation for 4‐6 bactes (Embryologist fee SPERMCRYO46
+ hospital charges)
21 Embryo cryopreservation for 7‐9 bactes (Embryologist fee SPERMCRYO79
+ hospital charges)
22 REPEAT DIAGNOSTIC SPERM EXTRACTION ( TESA / PESA ) TESADHCHCOS
(PACKAGE CHARGES + ALL DOCTOR FEES + HOSPITAL
CHARGES)
Repeat diagnostic sperm extraction ( TESA / PESA ) ‐ Anasthesia fee RDTPA 1750 1750
Repeat diagnostic sperm extraction ( TESA / PESA ) ‐ Embryologist's fee RDSEEF 680 680
Repeat diagnostic sperm extraction ( TESA / PESA ) ‐ Hospital charges RDSEHC 620 620
Repeat diagnostic sperm extraction ( TESA / PESA ) ‐ Surgeon fee RDSEUF 2000 2000
IVF PACKAGE
All Category
Cat 1B Suite
4 Beddded
Cat 1A‐Pre
Single Bed
2 Bedded
Cat‐1D
GOPD
POPD
Cat‐2
Cat‐3

1 FETALRED Fetal reduction in IVF lab (All
OS charges)
FETALREDAC Fetal reduction in IVF lab ‐ Anaesthetist fee 2580
FETALREDDF Fetal reduction in IVF lab ‐ Surgeon fee 9240
FETALREDUL Fetal reduction in IVF lab ‐ Ultrasound 3770
charges
34
2 IVFR2OS IVF procedure ( Registration 2)
IVFREG2 IVF procedure ( Registration 2) ‐ Clinician 2180 2180
Charges
IVFEMB2 IVF procedure ( Registration 2) ‐ 720 720
Embryologists Fee
IVFREGHC2 IVF procedure ( Registration 2) ‐ Hospital 14500 14500
Charges
IVFR2PC IVF procedure ( Registration 2) ‐ Packages 20000 20000
Charges
CDS Ultrasound colour doppler follicle 640 390
monitoring (single day)
Biochemistry Laboratory Charges
S No Description Code POPD/ GOPD/

CAT 1/CAT2 CAT3
1 24 Hours Urine ( Calcium, Phosphorus ) 24CPU 400 260
2 24 Hours Urine Calcium 24C 200 130
3 24 Hours Urine Chloride 24CHLO 200 130
4 24 Hours Urine Creatinine 24UCR 190 120
5 24 Hours Urine Micro Albumin 24URINALB 400 250
6 24 Hours Urine Phosphorous 24P 200 120
7 24 Hours Urine Potassium 24UP 200 120
8 24 Hours Urine Protein (Excludes Albumin) 24URINPROT 300 180
9 24 Hours Urine Protein (Excludes Albumin) ‐ ( Kidney KT‐24URINPROT 150 90
Transplant )
10 24 Hours Urine Protein (Excludes Albumin) ‐ ( Liver LT‐24URINPROT 150 90
Transplant )
11 24 Hours Urine Sodium 24US 200 120
12 24 Hours Urine Uric Acid 24U 200 120
13 Active B12 ACTIVEB12 1200 900
14 Acute Cardiac Profile CPA 3150 1890
15 Adenosine Deaminase ( ADA ) ‐ CSF ADAC 550 330
16 Adenosine Deaminase ( ADA ) ‐ Fluid ( Enter ADA 550 330
Specimen in Processing Notes )
17 Adenosine Deaminase ( ADA ) ‐ Serum ADAS 550 330
18 Alkaline Phosphatase ( ALP ) ALKP 200 130
19 Alphafetoprotein (AFP) AFP 800 700
20 ALT / SGPT SGPT 200 130
21 ALT / SGPT ( Kidney Transplant ) KT‐SGPT 100 100
22 ALT / SGPT ( Liver Transplant ) LT‐SGPT 100 100
23 Amikacin levels AMICA 2000 1200
24 Ammonia SEA 900 540
25 Amylase AMYL 400 250
26 Anaemia Profile ( Biochemical ) ENP 2500 1500
27 Angiotensin Converting Enzyme ( ACE ) ACE 950 680
28 Animal Allergen Mix ANIM 1100 660
29 Anti Mullerian Hormone BAMH 1800 1570
30 Apolipoprotein A1 APA1 1000 600
31 Apolipoprotein B APAB 1000 600
32 AST / SGOT SGOT 200 130
33 AST / SGOT ( Kidney Transplant ) KT‐SGOT 100 100
34 AST / SGOT ( Liver Transplant ) LT‐SGOT 100 100
35 Bence Jones Proteins ( Urine ) BJP 300 180
36 Beta 2 Microglobulin (Serum) B2MICROS 1300 800
37 Bicarbonate BCAR 300 180
38 Bilirubin ( Total & Direct ) BILL 300 180
39 Bilirubin ( Total & Direct ) ‐ ( Kidney Transplant ) KT‐BILL 150 150
35
40 Bilirubin ( Total & Direct ) ‐ ( Liver Transplant ) LT‐BILL 150 150
41 Blood Glucose 1 Hour After 50gm Glucose ( Glucose BLGL1 120 75
Spot Test )
42 Blood Lead Test BLT 700 475
43 BUN BUN 160 100
44 BUN ( Dialysis ) D‐BUN 80 80
45 BUN ( Kidney Transplant ) KT‐BUN 80 80
46 BUN ( Liver Transplant ) LT‐BUN 80 80
47 CA 125 CA125 1200 750
48 CA 15‐3 CA153 1200 750
49 CA 19‐9 CA199 1200 750
50 Calcium CALC 200 130
51 Calcium ( Dialysis) D‐CALC 100 100
52 CAPD Fluids ( 24 Hrs Protein ) C‐UPRO 300 180
53 Carbamazepine ( CPZ ) / Tegretol Assay CPZA 1160 700
54 Cardiac Checkup Extended Profile CCUE 5000 3000
55 Cardiac Profile CPC 2000 1200
56 CCR ‐ Creatinine Clearance CCR 420 250
57 CCR ‐ Creatinine Clearance ( Liver Transplant ) LT‐CCR 350 210
58 CEA ( Carcino‐Embryonic Antigen ) CEA 750 450
59 Chloride CHLO 185 110
60 CK ( CPK ) CPK 400 250
61 CKMB ( Activity ) CKMB ( ACTIVITY ) 450 270
62 CKMB ( MASS ) CKMBM 475 290
63 Comprehensive Allergy Panel Mixes ( CAPMIX ) ALLERGYP 12500 7600
64 Comprehensive Individual Allergy Panel ( COMPALL ) EXTENSIVE 32000 19300
65 Creatinine Clearance including serum creatinine, KT‐CCR 300 300
proteins & CCR ( Kidney Transplant )
66 CRP ( HS ) High Sensitivity C‐Reactive Protein HS 500 300
67 CSF ( Glucose/Protein/Chloride ) BCSF 500 300
68 CSF Albumin CSFALB 400 250
69 CSF Chloride CSFC 185 110
70 CSF Glucose CSFS 120 75
71 CSF IgA ( Immunoglobulin ) CSFIGA 800 480
72 CSF LDH CSFLDF 300 180
73 CSF Methotrexate Level METHOCSF 1800 1100
74 CSF Protein CSFP 300 180
75 Cystatin C CYSTC 750 600
76 Dehydroepiandrosterone Sulfate ( DHEA‐S ) DHEAS 950 650
77 Diabetes Monitoring Profile (Glu F,PP Insulin F,PP DIAMP 1500 1200
HbA1c)
78 Diabetes Screening Profile (Glu F,PP Insulin F,PP) DIASP 1200 1000
79 Diabetic Profile DP 850 510
80 Digoxin Level (SGRH Bioch.) DIGO 900 600
81 Drug Panel DRUGP 4600 2800
82 D‐Xylose Excretion Test ‐ 25 grams (5 hours sample) DXYL25 750 450
83 D‐Xylose Excretion Test ‐ 5 grams (5 hours sample) DXYL 750 450
84 Eczema Mini Panel ECZEMAM 6600 4000
85 Eczema Panel Extensive ( EXZEMA EX ) ECZEMA 15000 9000
86 Extended Lipid Profile ELIPP 3500 2100
87 Extended Metabolic Profile (Diabetic Profile, Insulin EMETP 6500 6500
F+PP, C Peptide F+PP, Renal Function, Liver Function,
Lipid Profile, Homocystine, Magnesium, hsCRP, Bile
Acids, Anemia Profile, Vitamin D, TSH, fT3, fT4)
88 Ferritin FERI 900 540
89 Fluid Alkaline Phosphatase ( ALP ) ALKPF 200 130
90 Fluid Amylase FLUAMY 400 250
36
91 Fluid Bilirubin ( Total & Direct ) FLUBIL 300 180
92 Fluid Bilirubin ( Total & Direct ) ‐ for Kidney KT‐FLUBIL 150 150
Transplant
93 Fluid Bilirubin ( Total & Direct ) ‐ for Liver Transplant LT‐FLUBIL 150 150
94 Fluid Bun FLUMIS 160 100
95 Fluid Calcium FLUCAL 200 130
96 Fluid Chloride FLUCHL 185 110
97 Fluid Cholesterol FLUCHOL 190 120
98 Fluid Creatinine FLUCREAT 180 110
99 Fluid Glucose FLUGLU 120 75
100 Fluid LDH PFLDH 300 180
101 Fluid Lipase FLULIP 360 220
102 Fluid Lipid Profile FLIPP 1200 720
103 Fluid Osmolality FLUOSM 600 360
104 Fluid Potassium FLUPOT 185 110
105 Fluid Protein & albumin PFPROT 420 250
106 Fluid Sodium FLUIDSOD 185 110
107 Fluid Triglycerides FLUTRIG 310 190
108 Fluid Uric Acid FLUUA 180 110
109 Folic Acid FACID 820 490
110 Food Allergen Mix FOOD 1100 660
111 Food Intolerance Test FIT 5500 5500
112 Food Panel Extensive ( FPEX ) ASTHMA 10300 6200
113 Free/Total PSA Ratio FTPA 850 510
114 FRUCTOSAMINE FRUCT 750 450
115 Galactosemia ‐ Galactitol estimation in urine by BGLTT 2000 1600
GC‐MS
116 Galactosemia ‐ GALT enzyme (Quantitative) + Urine BGGLT 4500 3600
Galactitol (GC‐MS) urine by GC‐M5
117 Gamma GT GAMMA GT 275 165
118 Gentamicin Level ( Gentamycin ) GENTA 950 570
119 Glucose F GLUF 120 80
120 Glucose F ( Dialysis ) D‐GLUF 60 60
121 Glucose F ( Kidney Transplant ) KT‐GLUF 60 60
122 Glucose F ( Liver Transplant ) LT‐GLUF 60 60
123 Glucose F + Glucose PP ( 75 g Glucose ) GTT6 250 150
124 Glucose PP GLUP 120 80
125 Glucose PP ( Dialysis ) D‐GLUP 60 60
126 Glucose PP ( Kidney Transplant ) KT‐GLUP 60 60
127 Glucose PP ( Liver Transplant ) LT‐GLUP 60 60
128 Glucose Random GLUR 120 80
129 Glucose Random ( Dialysis ) D‐GLUR 60 60
130 Glucose Random ( Kidney Transplant ) KT‐GLUR 60 60
131 Glucose Random ( Liver Transplant ) LT‐GLUR 60 60
132 Glucose Tolerance Test ( 100 g ) ‐ ½ hrly x 3 hrs GTT8 700 420
133 Glucose Tolerance Test ( 100 g ) ‐ 1 hrly x 3 hrs GTT3 450 280
134 Glucose Tolerance Test ( 75 g ) ‐ ½ hrly x 2½ hrs GTT4 700 420
135 Glucose Tolerance Test ( 75 g ) ‐ ½ hrly x 3 hrs GTT5 750 450
138 Glucose Tolerance Test ( Standard GTT ) ( 75 g ) ‐ ½ GTT1 650 390
hrly x 2 hrs
139 Glycosylated Haemoglobin ( HbA1c ) GLYCOHA 650 390
140 Grass Allergen Mix GRASS 1100 660
141 HDL Cholesterol HDL 310 190
142 HE ‐ 4 HE4 3500 3500
143 HE ‐ 4 And CA 125 HE4CA 4000 4000
37
144 Homocysteine HMYT 1100 660
145 hS Troponin I TROP 1100 660
146 Immunoglobulin A ( IgA ) IGA 780 470
147 Immunoglobulin E ( IgE ) IGE 700 420
148 Immunoglobulin G ( IgG ) IGG 780 470
149 Immunoglobulin M ( IgM ) IGM 780 470
150 Immunological profile ( IgA, IgG, IgM ) IMMPROF 1980 1190
151 Immunological profile ( IgA, IgG, IgM, IgE ) IMMPROF‐I 2200 1320
152 Individual Allergen INDIVIDUALA 1100 660
153 Interleukin 6 ( IL6 ) INTER 1100 660
154 Lactate SLACTALI 450 270
155 LACTATE (FLUID) LACFLU 450 270
156 LDH LDH 300 180
157 LDL Cholesterol LDL 430 260
158 Legume Allergen Mix LEGUM 1100 660
159 LFT ‐ Liver Function Test ( Hepatic Profile ) HEPA 1150 690
160 LFT ‐ Liver Function Test ( Hepatic Profile ) ‐ ( Liver LT‐HEPA 575 575
Transplant )
161 Lipase SLIPASE 400 250
162 Lipid Profile LIPP 1200 720
163 Lipoprotein ( a ) LP 1000 600
164 Magnesium SMAG 275 165
165 Metabolic Profile (Ca,Phos, ALP, Lipid Profile, Vitamin METAPRO 4000 2500
B12, Glu F,PP, HbA1C, TSH, Uric Acid, Insulin F)
166 Mold Allergen Mix MOLD 1100 660
167 NAGL ( Urine ) ‐ Thesis Paed NAGLPRO
168 NGAL (Plasma) NGALP 1840 1100

169 NGAL (Urine) NGALU 1840 1100
170 NT‐ proBNP ( Biochemistry Lab ) NTPRO 1550 930
171 Ostase (Bone Alkaline Phosphatase) OSTASE 1800 1800
172 Phadiatop Atopic Screening Test ATOPIC 1100 660
173 Phenytoin / Dilantin Assay PHEN 1200 720
174 Phosphorus PHOS 185 110
175 Phosphorus ( Dialysis ) D‐PHOS 90 90
176 Porphyria ‐ Porphobilinogen in urine & plasma ( BPORUPL 1800 1450
Qualitative )
177 Porphyria ‐ Porphobilinogen in urine ( Qualitative + BPORQNQL 2500 2000
Quantitative )
178 Potassium POTA 185 110
179 Potassium ( Dialysis ) D‐POTA 90 90
180 Potassium ( Kidney Transplant ) KT‐POTA 90 90
181 Potassium ( Liver Transplant ) LT‐POTA 90 90
182 Prostatic Specific Antigen ( PSA ) PROST 700 450
183 Renal Anaemia Profile ( Biochemical ) ARENP 1250 750
(Fe,TIBC,Transferrin,Ferretin)
184 Renal Biochemical Profile ‐ Basic RENPI 1200 720
(BUN,Creat,Ca,PO,4,Na,K,Bicarbonate)
185 Renal Biochemical Profile ‐ Complete RENPP 1600 960
(BUN,Creat,Ca,PO4,Na,K,RBS,Uric,Prot,AlkPo4,Choles
t,Bicarbonate)
186 Respiratory Panel Extensive ( RESPEX ) WHEEZE 14000 8500
187 Respiratory Panel‐Mini (RESPMINI) WHEEZERM 8000 5000
188 Serum Cortisol SRC 550 330
189 Serum Creatinine CREA 180 110
190 Serum Creatinine ( Dialysis ) D‐CREA 95 95
191 Serum Creatinine ( Kidney Transplant ) KT‐CREA 95 95
192 Serum Creatinine ( Liver Transplant ) LT‐CREA 95 95
38
193 Serum Iron IRON 375 225
194 Serum Iron Binding Capacity ( TIBC ) TIBC 450 270
195 Serum Methotrexate Level METHO 1500 900
196 Serum Osmolality SEROSM 600 360
197 Serum Pre ‐ albumin level SPAL 1200 720
198 Serum procalcitonin SPROC 2200 1320
199 Serum total bile acids STBA 1000 600
200 Sodium SODI 185 110
201 Sodium ( Dialysis ) D‐SODI 90 90
202 Sodium ( Kidney Transplant ) KT‐SODI 90 90
203 Sodium ( Liver Transplant ) LT‐SODI 90 90
204 Sodium + Potassium + Chlorides + Bicarbonate SPC 700 420
205 Soluble Transferrin Receptor STRAREC 2500 2500
206 Stone Qualitative Analysis STON 700 420
207 Tacrolimus test TACRO 1800 1800
208 Tandem Mass Screening in newborn ‐ High Risk BTMSH 3000 3000
209 Tandem Mass Screening in newborn ( Outsourced ) BTMSN 2000 2000
210 Tandem Mass Screening in newborn ( Outsourced ) + BTMSNBNBSG 3000 2700
NBS (SGRH)
211 Theophylline THEO 1000 800
212 Thesis_Ferritin FERITHESIS 0 0
213 Total Antioxidant Status ( TAS ) TAS 1000 600
214 Total Beta‐ hCG ( Biochemistry ) BHC 640 380
215 Total Cholesterol CHOL 190 120
216 Total Proteins TPRO 300 180
217 Total Proteins ( Dialysis ) D‐TPRO 150 150
218 Transferrin TF 700 420
219 Tree Allergen Mix ‐ Juniperus TREEJ 1100 660
220 Tree Allergen Mix ‐ Pines TREEP 1100 660
221 Triglycerides TRIG 310 190
222 Tumor Necrosis Factor Alpha ( TNF Alpha ) TUFA 1200 720
223 Uric Acid URIA 180 110
224 Urinary ( Urine ) VMA (24 hours) UVMA 2000 1200
225 Urinary Albumin creatinine ratio UACR 350 210
226 Urine Osmolality OSMLU 600 360
227 Urine Spot Calcium : Creatinine Ratio SPOTCC 350 210
228 Urine Spot Test for Calcium USCA 200 130
229 URINE SPOT TEST FOR CHLORIDE CHLOSP 185 110
230 Urine Spot Test for Creatinine USCREAT 180 110
231 Urine Spot Test for Microalbumin ( Biochemistry ) MA 375 230
232 Urine Spot Test for Phosphorus USPOTPH 185 110
233 Urine Spot Test for Potassium UK 185 110
234 Urine Spot Test for Protein & Creatinine ( PC Ratio ) USPRCR 375 230
235 Urine Spot Test for Protein ( Excludes Albumin ) USPROT 300 180
236 Urine Spot Test for Sodium UNA 185 110
237 Urine Spot Test for Uric Acid USUR 180 110
238 Vancomycin Level VANCO 1000 800
239 Veg. Food Panel ( VEGFP ) ASTHMAR 8000 5000
240 Vegetable Allergen Mix VEGE 1100 660
241 Vitamin B 12 ( B12 ) VB12 900 540
242 VLDL Cholesterol VLDL 900 540
243 Weed Allergen Mix WEED 1100 660
244 Zinc Serum ZINCZN 800 500
245 Zinc Urine ZINCU 800 500
246 Glucose F + Glucose PP GLUCP 180 90
Glucose F GLUF
Glucose PP GLUP
39
247 Obesity Screening Package for Bariatric Surgery OSPBS 3000 3000
CBC ‐ Complete blood count CBC
Glucose F GLUF
Glycosylated Haemoglobin ( HbA1c ) GLYCOHA
Insulin Level ‐ Fasting INSULINLF
Lipid Profile LIPP
Thyroid Profile ( T3, T4, TSH ) T3T4TSH
248 Urine spot test for sodium & potassium URINSODPOTOS

Urine Spot Test for Potassium UK 185 110
Urine Spot Test for Sodium UNA 185 110
Blood gas analysis charges

CAT 1/CAT2 CAT3
1 Blood Gas + S.Elect Analysis BGAPLUS 600 360
2 Blood Gas Analysis BGA 450 270

Cardiac Laboratory

CAT 1/CAT2 CAT3
1 Screening Echo Cardiology SECAROS 1660

CAT 1/CAT2 CAT3
1 Diagnosis of Acute Myocardial Infarcation ( AMI ) CARAMI 1360 1100
Cardiac Dept
2 Diagnosis of Pulmonary Embolisation ( Cardiac Dept ) CARPE 950 680
3 Panel for diagnosis of breathlessness ( Cardiac Dept. ) CARBL 1950 1630
4 Prothrombin Time INR ( Cardiac Dept ) CARPT 400 270
5 Triage cardio profiler panel (Cardiac Dept.) CATCPP 1630 1300
Clinical Pathology Charges

CAT 1/CAT2 CAT3
1 Urine examination ( Routine / Microscopy ) URINERE 250 150
2 Urine for Acetone UROK 200 120
3 Urine for albumin / protein UROP 200 120
4 Urine for Bile pigment / salt BPIG 250 150
5 Urine for chyle URC 250 150
6 Urine for Dysmorphic RBCs UDYRBC 250 150
7 Urine for haemoglobin URHEM 280 170
8 Urine for myoglobin URMYO 280 170
9 Urine for porphobilinogen URP 360 220
10 Urine for sugar / reducing substance UROG 250 150
11 Urine for urobilinogen UROB 360 220
12 Urine pH URINEPH 160 100
13 Urine specific gravity URINESPGR 160 100
Diabetology Laboratory Charges

40
CAT 1/CAT2 CAT3
1 Blood Ketone Test BKT 370 320
2 Lipid Profile (Endocrinology) TCTT 1070 800
3 Spot Finger Prick Blood Glucose ( Endocrinology ) BGLU 120 90
4 Spot HbA1c ( Endocrinology ) HB‐1C 750 540
5 Spot Urine Micro‐Albuminuria ( Endocrinology ) UMA 750 540

Haematology Laboratory Charges

CAT 1/CAT2 CAT3
1 Absolute eosinophil count ( AEC ) AEC 300 180
2 Absolute Lymphocyte Count ( ALC ) ALC 300 180
3 Absolute neutrophil count ( ANC ) ANC 300 180
4 Acid phosphatase cytochemistry ( AP ) with/without CYTOAP 1800 1100
tartrate
5 AJAY AJAY 20 10
6 ANA Profile 3 ANA 2800 1700
7 Antibodies to ds ‐ DNA ( Enzyme Immuno Assay ) DNA 1300 800
8 Anti‐c ANCA ( anti ‐ PR3 ) AANCA‐AP 1850 1100
9 Anticardiolipin antibodies ( ACA ) ‐ IgG ACLG 1300 800
10 Anticardiolipin antibodies ( ACA ) ‐ IgM ACLM 1300 800
11 Anti‐p ANCA ( anti ‐ MPO ) AANCA‐AM 1850 1100
12 Antithrombin functional assay (Haematology) ANTITHROH 4000 2400
13 APT test APTS 320 200
14 APTT ( Activated partial thromboplastin time ) APTT 650 400
15 APTT based inhibitor screen APPTIN 1200 720
16 APTT mixing experiment APTTMIX 1100 720
17 Ascitic fluid cell counts ASF 520 310
18 B2 Glycoprotein 1 ( GPI ) IgG ELISA B2IGG 1700 1000
19 B2 Glycoprotein 1 ( GPI ) IgM ELISA B2IGM 1700 1000
20 Bethesda Assay BETH 16000 9500
21 Bone marrow and peripheral smear examination BMARROW1 2650 1600
22 Bone marrow slides for issue to patient ( 1 slide ) BMSFITP1S 340 200
23 CAPD fluid cell counts CAPD 520 310
24 CBC ‐ Complete blood count CBC 420 250
25 CBC , DLC with Peripheral smear CBCDLCPBF 700 420
26 CD 19 / CD 20 / CD45 by flowcytometry CD1945 3200 1900
27 Cell count CELLC 520 310
28 Cerebrospinal fluid ( CSF ) cell count CSF 520 310
29 Clot retraction test CRT 300 200
30 Clot solubility test ( Factor‐XIII ) CST 600 360
31 Coagulation factor IX assay COAGF9 2700 1600
32 Coagulation factor VIII assay COAGF8 2700 1600
33 Coagulation profile screening (PT / APTT/ TT / CBC / CPST 3700 2200
PS )
34 Complete blood count ( CBC ) ‐ ( Dialysis ) DCBC 320 250
35 Complete blood count ( CBC ) ‐ ( Kidney Transplant ) KT‐CBC 320 250
36 Complete blood count ( CBC ) ‐ ( Liver Transplant ) LT‐CBC 320 250
37 Complete blood count ( CBC ) with Differential CBCDLC 550 350
leukocyte count ( DLC )
38 Complete blood count ( CBC ) with Differential DCBCDLC 400 360
leukocyte count ( DLC ) ‐ ( Dialysis )
41
39 Complete blood count ( CBC ) with Differential KT‐CBCDLC 400 360
leukocyte count ( DLC ) ‐ ( Kidney Transplant )
40 Complete blood count ( CBC ) with Differential LT‐CBCDLC 400 360
leukocyte count ( DLC ) ‐ ( Liver Transplant )
41 D‐dimer D‐DIMER 1800 1100
42 Differential leukocyte count ( DLC ) DLC 350 210
43 Dihydrorhodamine Assay by Flow Cytometry DAFC 2400 1440
44 dRVVT screen dRVVT confirm LACC 2500 1500
45 Erythrocyte sedimentation rate ( ESR ) ESR 350 220
46 Factor II assay FACTOR2 3700 2600
47 Factor V assay FACTOR5 3200 2100
48 Factor V Leiden ( APC‐R) FVLEDN 4200 2500
49 Factor VII assay FACTOR7 3600 2600
50 Factor X assay FACTOR10 3200 2100
51 Factor Xa Heparin for Enoxaparin FXAENO 4200 2500
52 Factor XI assay FACTOR11 3700 2600
53 Factor XII assay FACTOR12 3700 2600
54 Factor XIII assay FACTOR13 10000 8000
55 Fibrinogen (Quantitative) FIBEST 1350 800
56 FLOW CYTOMETRIC FOR ANY SINGLE PANEL OF FCSLL 3600 2300
LEUKEMIA / LYMPHOMA
57 Flow Cytometry for Leucocyte adhesion defect type 1 FCFL 3200 2100
58 Flowcytometery ( CD 19 and CD 45 ) FLOWCD1945 2000 1250
59 Flowcytometery ( CD 20 and CD 45 ) FLOWCD2045 2000 1250
60 Flowcytometric DHR Assay and NBT slide Test DHRNBT 3100 2200
61 FLOWCYTOMETRIC HLA ‐ CROSS MATCH FCXM 12000 7200
62 Flowcytometric MDS Panel FMYMDS 8200 6100
63 Flowcytometry for Myeloma FMY 6000 4000
64 G‐6‐PD screening ( G6PD ) G6PD 530 320
65 Gastric aspirate for neutrophilis GAS 300 200
66 Haemoglobin ( Hb ) HB 240 140
67 Haemoglobin ( Hb ) ‐ Dialysis DHB 130 120
68 Haemoglobin ( Hb ) ‐ Transplant KT‐HB 130 120
69 Haemoglobin electrophoresis ‐ acid pH ( 6.0 ) HBELECACI 1000 600
70 Haemoglobin electrophoresis ‐ alkaline pH ( 8.6 ) HBELECALK 1000 600
71 Haemoglobin electrophoresis ( alkaline & acid pH ) HBELEC 2000 1200
72 Haemoglobin F cytochemistry ( Kleihauer test ) HBFCYTO 700 420
73 HB / PCV HBPCV 350 220
74 HbH Inclusion HBHI 470 280
75 Heinz bodies HZB 300 180
76 Hemosiderin in urine HSU 470 300
77 Heparin induced thrombocytopenia (gel card) HITA 2200 1600
78 Immature Platelet Fraction IPF 650 400
79 Immunodeficiency / HIV panel ( CD3 / CD4 / CD8 HIVIMM 3300 1950
counts )
80 Immunodeficiency / Non HIV panel BTCELL 3300 1950
81 Immunofixation electrophoresis ‐ 24 hrs urine IMMUNOU 10000 6000
82 Immunofixation electrophoresis ‐ serum IMMUNOS 9000 5400
83 Immunophenotyping ( flow cytometry ) ‐ Acute ACLP 17000 14000
leukemia panel (cMPO, cCD79a, c3, CD45, 19, 10, 5,
7, 3, 14, 13, 34, 33)
84 Immunophenotyping ( flow cytometry ) ‐ Chronic CLLPANEL 17000 14000
lymphocytic leukemia panel ( CLL ) ‐
k,l,CD45,19,5,10,FMC7,23,103,11c,38,56
85 Immunophenotyping ( flow cytometry ) ‐ Lymphoma LYMPHPANEL 17000 14200
panel (CD45, 19, 10, 5, 7, 3, 4, 8, k, l)
42
86 Immunophenotyping ( flow cytometry ) ‐ NK / NKCELL 5100 3050
Obstetric Panel
87 Immunophenotyping ( flow cytometry ) ‐ PNH panel PNHPAN 7500 4500
88 Incubation osmotic fragility ( CBC / PS / Retic) IOFT 1600 950
89 Iron Stain Bone Marrow ISBM 700 420
90 Leukocyte alkaline phosphatase ( LAP ) score CYTOLAP 1700 1000
91 Malaria antigen test ‐ Plasmodium falciparum / P. PLAS 870 520
vivax ( Immunochromatography )
92 Methaemoglobin estimation MHB 470 280
93 Microfilaria ( Peripheral smear ) MF 420 250
94 Myeloperoxidase ( MPO ) CYTOMPO 650 390
95 Myositis Profile 3 MSA 3200 1900
96 Nonspecific esterase ( NSE ) ‐ CAE CYTONSE 1800 1080
97 Osmotic fragility test ( CBC / PS / Retic) OST 1600 950
98 Pericardial fluid cell count PESF 520 310
99 Periodic acid schiff ( PAS ) CYTOPAS 1600 960
100 Peripheral smear for malaria ( MP ) MP 550 330
101 Platelet aggregation test for HIT (confirmatory PAT 1100 900
functional Assay)
102 Platelet count PLT 150 90
103 Platelet function test for bleeding disorders PFTFBD 8500 6000
104 Platelet function test for drug monitoring PFTFDM 6200 3900
105 Platelet function test for von Willebrand disease PFTFVWD 8500 6000
106 Pleural fluid cell count PLSF 520 310
107 Protein C functional assay PROTEINC 4200 2500
108 Protein S functional assay PROTEINS 4200 2500
109 Prothrombin time ( PT ) Haematology Lab PT 400 240
110 PT mixing experiment PTMIX 550 350
111 Renal/BMT Reticulocyte Count RBRC 600 360
112 Reticulocyte count RTIC 540 320
113 Review of stained bone biopsy section received from HBBS 1350 800
outside ( Hematology )
114 Screening for beta thalassemia / BTHAL 1500 900
haemoglobinopathies ( CBC / HbF / HbA2 )
115 Serum Freelight Chain Assay SFLCA 5000 3000
116 Serum protein electrophoresis ( SPE ) PROELECT 2000 1200
117 Sickling test SLT 400 250
118 Specific esterase ( SE ) ‐ ANAE / ANBE CYTOSE 1800 1080
119 STEM CELL ENUMERATION ( CD34 + CELL COUNT ) SCEN34 7600 4550
120 Synovial fluid cell count SYSF 520 310
121 Synovial fluid for crystals by Polarizer SYFLD 580 350
122 T‐B‐NK with CD4 & CD8 counts TBNK 6600 4100
123 Test for HbH Inclusion HBH 550 330
124 Thrombin time ( TT ) TT 770 460
125 Total leukocyte count ( TLC ) TC 250 150
126 Total leukocyte count ( TLC ) ‐ Transplant KT‐TLC 180 150
127 Urine For Eosinophils UFE 420 250
128 Urine protein electrophoresis URIELECTRO 3150 1900
129 Von Willebrand factor VONWILL 6400 3830
130 Von Willebrand Ristocetin Cofactor activity VWRCA 8200 6600
131 Complete blood count ( CBC ) with Erythrocyte CBCESR 650 400
sedimentation rate ( ESR )
CBC ‐ Complete blood count CBC
Erythrocyte sedimentation rate ( ESR ) ESR
132 Thromobophilia Panel ( Molecular + Coagulant assays ) ( THROMMH 18500 16000

Mutations of Factor V ( leiden ), Prothrombin, MTHFR
genes, Proteins C, Protein S, AT III, APCR, Lupus
Anticoagulant, Anti phospholipid antibody )
43
Anticardiolipin antibodies ( ACA ) ‐ IgG ACLG
Anticardiolipin antibodies ( ACA ) ‐ IgM ACLM
Antithrombin functional assay (Haematology) ANTITHROH
B2 Glycoprotein 1 ( GPI ) IgG ELISA B2IGG
B2 Glycoprotein 1 ( GPI ) IgM ELISA B2IGM
dRVVT screen dRVVT confirm LACC
Factor V ( Leiden ) Gene mutations ‐ Molecular Haematology FVLGMMH
Factor V Leiden ( APC‐R) FVLEDN
MTHFR ( C677T ) Gene Polymorphism ‐ Molecular Haematology MTHFRGMMH
Protein C functional assay PROTEINC
Protein S functional assay PROTEINS
Prothrombin ( G20210A ) Gene Mutation ‐ Molecular Haematology PGMMH
Thromobophilia Panel ( Molecular + Coagulant assays ) ( Mutations of THROMMHLO
Factor V ( leiden ), Prothrombin, MTHFR genes, Proteins C, Protein S, AT III,
APCR, Lupus Anticoagulant, Anti phospholipid antibody ) ‐ Label Only
133 Von Willebrand factor & Von Willebrand Ristocetin VONWOS 13000 9000

Cofactor activity
Von Willebrand factor VONWILL
Von Willebrand Ristocetin Cofactor activity VWRCA
Histopathology Laboratory Charges

CAT 1/CAT2 CAT3
1 1 pathology slide for issue to patient ‐ NO Barcode FPSR 280 280
2 1 pathology slide for issue to patient (2nd time) ‐ NO PSIP21 430 430
Barcode
3 2 pathology slides for issue to patient ‐ NO Barcode FPSR2 430 430
4 2 pathology slides for issue to patient (2nd time) ‐ NO PSIP22 700 700
Barcode
5 3 pathology slides for issue to patient ‐ NO Barcode PSIP3 600 600
Barcode
Barcode
Barcode
Barcode
13 ANA , ASMA , ALKMA and AMA ‐ WITH Barcode ANASMALKMA 4960 2970
14 ANA , ASMA and ALKMA ‐ WITH Barcode ANASMALK 4150 2490
15 ANA with titration ANAWTIT 3850 2310
16 ANCA ‐ WITH Barcode ANCA 1100 660
17 Anti liver & kidney microsomal antibody ( ALKMA ) ‐ ALKMA 1530 920
WITH Barcode
18 Anti mitochondrial antibody ( AMA ) ‐ WITH Barcode AMA 1310 780
19 Anti nuclear antibodies ( ANA ) ‐ WITH Barcode HANA 1310 780
20 Anti nuclear antibodies ( ANA ) and Anti parietal cell ANAAPOA 2020 1210
antibody ( APCA ) ‐ WITH Barcode
21 Anti nuclear antibodies ( ANA ) and Anti smooth ANASMA 2020 1210
muscle antibody ( ASMA ) ‐ WITH Barcode
22 Anti nuclear antibodies ( ANA ) and Anti thyroid ANAATA 1740 1050
antibodies ( ATA ) ‐ WITH Barcode
23 Anti parietal cell antibody ( APCA ) ‐ WITH Barcode APOA 1310 780
44
24 Anti PLA2R antibody by indrect immunofluorescene PLA2R 6550 3930
25 Anti smooth muscle antibody ( ASMA ) ‐ WITH ASMA 1310 780
Barcode
26 Anti thyroid antibodies ( ATA )‐ WITH Barcode ATA 1310 780
(Histopathology)
27 ASMA , ALKMA and AMA ‐ WITH Barcode SMALKMA 2730 1640
28 Bile Duct Brushing for malignant cells ‐ Cytology MCBILE 970 590
29 Biopsy ( Extra large ) ‐ WITH Barcode BIOX 3930 2350
30 Biopsy ( Large ) ‐ WITH Barcode BIOL 2730 1640
31 Biopsy ( Medium ) ‐ WITH Barcode BIOM 2080 1240
32 Biopsy ( Small ) ‐ WITH Barcode BIOS 1370 820
33 Biopsy medium with IF study with 7 IF markers with BIOIMM7 6550 3930
barcodes
34 Biopsy Medium with Immuno fluroscent study ‐ WITH BIOIMM 5460 3270
Barcode
35 Block For Patient BFP 960 960
36 Bronchial washing/BAL/ET secretions for malignant MCBRO 1220 760
cells ‐ Cytology
37 CSF for malignant cells ‐ Cytology MCCSF 800 480
38 Cyst Fluid for malignant cells ‐ Cytology MCCYST 800 480
39 Cytology of aspirate /any smear for cytology WITH FNACN 1100 660
Barcode
40 DSDNA ‐ WITH Barcode DSDNA 1100 660
41 Enzyme Histochemistry ‐ Each additional enzyme ENZHISE 1370 820
stain ‐ Histopathology
42 Enzyme Histochemistry ‐ One enzyme stain ‐ ENZHIS 2430 1460
Histopathology
43 FNAC Cytology of aspirate (DONE IN PATHOLOGY ASFNAC 1940 1170
LAB) WITH Barcode
44 FNAC for Endoscopic ultrasound specimen ( EUSFNAC MCEUS 3320 1990
) ‐ Cytology
45 Frozen section (including subsequent paraffin FSECTPS 2080 1240
processing) ( 1 to 2 samples)‐ WITH Barcode
46 Frozen section (including subsequent paraffin FSECTPSB 2940 1770
47 Frozen section (including subsequent paraffin FSECTPSC 4580 2750
48 Frozen section (including subsequent paraffin FSECTPSC7 6760 4060
processing) ( 7 or more samples) ‐ WITH barcode
49 HPV‐DNA ( High Risk ) Cervical Sample HPVDNAH 3190 1940
50 IHC 10 markers and above / ADD ON without barcode IHS10H 15280 9170
51 IHC 10 markers and above with barcode IHS10 15280 9170
52 IHC 7 markers / ADD ON without barcode IHS7H 11570 6940
53 IHC 7 markers with barcode IHS7 11570 6940
54 IHC 8 Markers ‐ With Barcode IHC8 11340 6810
55 IHC 8 markers ‐ Without Barcode IHC8H 11340 6810
56 IHC 9 markers / ADD ON without barcode IHS9H 12880 7730
57 IHC 9 markers with barcode IHS9 12880 7730
58 Immuno fluroscent staining ( 1 stain ) ‐ WITH Barcode IFS1 1090 650
59 Immuno fluroscent staining ( 2 stains ) ‐ WITH IFS2 1850 1480
Barcode
Barcode
Barcode
Barcode
45
63 Immuno histochemistry ADD ON staining ( IHISTCHEM1C 1680 1010
Cytopathology ) ‐ 1 stain NO Barcode
Cytopathology ) ‐ 2 stains NO Barcode
66 Immuno histochemistry ADD ON staining ( IHS4C 6080 3650
67 Immuno histochemistry ADD ON staining ( IHISTCHEM1H 2080 1240
Histopathology ) ‐ 1 stain ‐ NO Barcode
Histopathology ) ‐ 2 stains ‐ NO Barcode
70 Immuno histochemistry ADD ON staining ( IHS4H 6390 3830
71 Immuno histochemistry staining ( 1 stain ) WITH IHISTCHEM 1970 1180
barcode
72 Immuno histochemistry staining ( 2 stain ) ‐ WITH IHISTCHEM2 3930 2350
Barcode
73 Immuno histochemistry staining ( 3 stain ) ‐ WITH IHISTCHEM3 5560 3340
Barcode
74 Immuno histochemistry staining ( 4 stains ) WITH IHS4 6330 3800
barcode
75 Immuno histochemistry staining ( 5 stain ) WITH IHS5 8950 5370
barcode
76 Immuno histochemistry staining ( 5 stain ) WITHOUT IHS5H 7640 4580
barcode
77 Microwave processing for rapid diagnosis (small MPRD 4370 2620
biopsies)
78 One to two stained histopathology slide(s) from FPS1 820 820
outside for opinion ‐ WITH Barcode
79 PAP smear / Hormonal smear / Vault smear / Cervical PAPS 590 350
smear WITH Barcode
80 Paraffin Blocks / Unstained slides received from PBUSM3 2080 1240
outside (more than 3) ‐ WITH Barcode
81 Paraffin Blocks / Unstained slides received from PBUS 1640 980
outside (up to 3) ‐ WITH Barcode
82 Pleural / Ascitic / Pericardial / Peritoneal wash /any MCPLE 970 590
other fluid for malignant cells ‐ Cytology
83 Remaining of frozen tissue ( Extra Large ) ‐ NO REMXLARGE 4150 2490
Barcode
84 Remaining of frozen tissue ( Large ) ‐ NO Barcode REMLARGE 2730 1970
85 Remaining of frozen tissue ( Medium ) ‐ NO Barcode REMMEDIUM 2080 1240
86 Remaining of frozen tissue ( Small ) ‐ NO Barcode REMSMALL 1370 820
87 Six and more stained histopathology slide(s) from FPS6 1640 1640
88 Sputum for malignant cells ‐ Cytology MCSPU 800 480
89 Stained pathology slide (s) from outside for opinion ( STPHCY3 830 830
Cytopathology ) ‐ More than 2 WITH Barcode
90 Stained pathology slide (s) from outside for opinion ( STPHCY2 490 490
Cytopathology ) ‐ Up to 2 WITH Barcode
91 Three to five stained histopathology slide(s) from FPS3‐5 1090 1090
92 Trans bronchial needle aspiration ( TBNA ) Reporting MCTBNA 1220 760
for malignant cells ‐ Cytology
46
93 Ultrasound/CT guided FNAC Reporting for malignant MCFNAC 1660 1000
cells ‐ Cytology
94 Urine for malignant cells ( 1 sample ) ‐ Cytology MCURI 800 480
95 Urine for malignant cells ( 3 samples ) ‐ Cytology MCURI3 2200 1330
96 Vaginal / cervical cytology by liquid base cytology ( LBC 1240 750
LBC )
Microbiology Laboratory Charges

CAT 1/CAT2 CAT3
1 (OPD case only) AFB culture and sensitivity ‐ LJ AFBCULTASP 1970 1180
Method ( Aspirate )
2 (OPD case only) AFB culture and sensitivity ‐ LJ AFBCULTASPF 1970 1180
Method ( Aspiration fluid )
3 (OPD case only) AFB culture and sensitivity ‐ LJ AFBCULTBLF 1970 1180
Method ( Blister fluid )
4 (OPD case only) AFB culture and sensitivity ‐ LJ AFBCULTBRW 1970 1180
Method ( Bronchial washing )
5 (OPD case only) AFB culture and sensitivity ‐ LJ AFBCULTBRL 1970 1180
Method ( Bronchoalveolar lavage )
6 (OPD case only) AFB culture and sensitivity ‐ LJ AFBCULTCIF 1970 1180
Method ( Chest irrigation fluid )
7 (OPD case only) AFB culture and sensitivity ‐ LJ AFBCULTCSF 1970 1180
Method ( CSF )
8 (OPD case only) AFB culture and sensitivity ‐ LJ AFBCULTDRF 1970 1180
Method ( Drainage fluid )
9 (OPD case only) AFB culture and sensitivity ‐ LJ AFBCULET 1970 1180
Method ( ET Secretion )
10 (OPD case only) AFB culture and sensitivity ‐ LJ AFBCULTGTA 1970 1180
Method ( Gastric aspirate )
11 (OPD case only) AFB culture and sensitivity ‐ LJ AFBCULT 1970 1180
Method ( Miscellaneous )
12 (OPD case only) AFB culture and sensitivity ‐ LJ AFBCULTMTV 1970 1180
Method ( Mitral valve )
13 (OPD case only) AFB culture and sensitivity ‐ LJ AFBCULTPDF 1970 1180
Method ( P.D. fluid )
14 (OPD case only) AFB culture and sensitivity ‐ LJ AFBCULTPCF 1970 1180
Method ( Pericardial fluid )
15 (OPD case only) AFB culture and sensitivity ‐ LJ AFBCULTPNF 1970 1180
Method ( Peritoneal fluid )
16 (OPD case only) AFB culture and sensitivity ‐ LJ AFBCULTPLF 1970 1180
Method ( Pleural fluid )
17 (OPD case only) AFB culture and sensitivity ‐ LJ AFBCULTPUS 1970 1180
Method ( Pus )
18 (OPD case only) AFB culture and sensitivity ‐ LJ AFBCULTRVF 1970 1180
Method ( Romovac fluid )
19 (OPD case only) AFB culture and sensitivity ‐ LJ AFBCULTSPM 1970 1180
Method ( Sputum )
20 (OPD case only) AFB culture and sensitivity ‐ LJ AFPCULTSTL 1970 1180
Method ( Stool )
21 (OPD case only) AFB culture and sensitivity ‐ LJ AFBCULTSYF 1970 1180
Method ( Synovial fluid )
22 (OPD case only) AFB culture and sensitivity ‐ LJ AFBCULTTIS 1970 1180
Method ( Tissue )
47
23 (OPD case only) AFB culture and sensitivity ‐ LJ AFBCULTURI 1970 1180
Method ( Urine )
24 Active Hepatitis B profile AHBP 6560 3940
25 Adenovirus Quantitative real time PCR (BAL) AVQBAL 6970 4180
26 Adenovirus Quantitative real time PCR (BLOOD) AVQBLD 6970 4180
27 Adenovirus Quantitative real time PCR (MIS) AVQMIS 6970 4180
28 Adenovirus Quantitative real time PCR (NASAL SWAB) AVQNALS 6970 4180
29 Adenovirus Quantitative real time PCR (THROAT AVQTHS 6970 4180
SWAB)
30 Aerobic blood culture and sensitivity AEROBLD 870 520
31 Albert staining ( C. diphtheria ) ALBSTCDT 470 280
32 Anaerobic culture ( Aspiration fluid ) ANAECULTASPF 1970 1180
33 Anaerobic culture ( CSF ) ANAECULTCSF 1970 1180
34 Anaerobic culture ( Drainage fluid ) ANAECULTDRF 1970 1180
35 Anaerobic culture ( Miscellaneous ) ANAECULT 1970 1180
36 Anaerobic culture ( Mitral valve ) ANAECULTMIV 1970 1180
37 Anaerobic culture ( P. D. fluid ) ANAECULTPDF 1970 1180
38 Anaerobic culture ( Pericardial fluid ) ANAECULTPEF 1970 1180
39 Anaerobic culture ( Peritoneal fluid ) ANAECULTPRF 1970 1180
40 Anaerobic culture ( Pleural fluid ) ANAECULTPLF 1970 1180
41 Anaerobic culture ( PUS ) ANAECULTPUS 1970 1180
42 Anaerobic culture ( Synovial Fluid ) ACSSF 1970 1180
43 Anaerobic culture ( Tissue ) ANAECULTTIS 1970 1180
44 Anaerobic culture ( Urine ) ANAECULTURN 1970 1180
45 Anaerobic culture and sensitivity ( Aspirate ) ANAECULTASP 1970 1180
46 Anti CCP ( Immunoscan R A ) ANTICPP 2210 1330
47 Anti HAV ‐ IgM ( hepatitis A virus serology ) HAVT 1550 930
48 Anti HBc ‐ IgM ( hepatitis B virus serology ) ANTIHBC 1720 1040
49 Anti HBeAg serology ANTIHBE 1880 1130
50 Anti HEV ‐ IgM ( hepatitis E virus serology ) HEVT 2210 1330
51 Anti yeast sensitivity ( Blood ) CANDIFBLD 1430 860
52 Anti yeast sensitivity ( Bone marrow ) CANDIFBOM 1430 860
53 Anti yeast sensitivity ( Bronchial washing ) CANDIFBRW 1430 860
54 Anti yeast sensitivity ( Bronchoalveolar lavage ) CANDIFBRL 1430 860
55 Anti yeast sensitivity ( CSF ) CANDIFCSF 1430 860
56 Anti yeast sensitivity ( Drain Fluid ) CANDIDRA 1430 860
57 Anti yeast sensitivity ( E. T. secretion ) CANDIFETS 1430 860
58 Anti yeast sensitivity ( Miscellaneous ) CANDIF 1430 860
59 Anti yeast sensitivity ( P.D. fluid ) CANDIFPDF 1430 860
60 Anti yeast sensitivity ( Pericardial fluid ) CANDIFPEF 1430 860
61 Anti yeast sensitivity ( Peritoneal fluid ) CANDIFPRF 1430 860
62 Anti yeast sensitivity ( Pleural fluid ) CANDIFPLF 1430 860
63 Anti yeast sensitivity ( Pus ) CANDIFPUS 1430 860
64 Anti yeast sensitivity ( Sputum ) CANDIFSPU 1430 860
65 Anti yeast sensitivity ( Tissue ) CANDIFTIS 1430 860
66 Anti yeast sensitivity ( Urine ) CANDIFURN 1430 860
67 Antibody titre serology for HBsAg ANTIHBSAG 780 470
68 Antistreptolyson O titre ASO 1240 750
69 BacT/Alert aerobic culture ( Aspirate ) AERBTA+B‐ASP 2200 1330
70 BacT/Alert aerobic culture ( Blood ) AERBTA+B‐BLD 2200 1330
71 BacT/Alert aerobic culture ( Bone Marrow ) AERBTA+B‐BM 2200 1330
72 BacT/Alert aerobic culture ( Bronchial washing ) AERBTA+B‐BRO 2200 1330
73 BacT/Alert aerobic culture ( CSF ) AERBTACSF 2200 1330
74 BacT/Alert aerobic culture ( Drainage fluid ) AERBTA+B‐DRA 2200 1330
75 BacT/Alert aerobic culture ( Miscellaneous ) AERBTA+B 2200 1330
76 BacT/Alert aerobic culture ( P.D. fluid ) AERBTA+B‐PDF 2200 1330
77 BacT/Alert aerobic culture ( Pericardial fluid ) AERBTA+B‐PEC 2200 1330
48
78 BacT/Alert aerobic culture ( Peritoneal fluid ) AERBTA+B‐PET 2200 1330
79 BacT/Alert aerobic culture ( Pleural fluid ) AERBTA+B‐PLE 2200 1330
80 BacT/Alert aerobic culture ( Pus ) AERBTA+B‐PUS 2200 1330
81 BacT/Alert aerobic culture ( Synovial fluid ) AERBTA+B‐SYN 2200 1330
82 BacT/Alert anaerobic culture ( Aspirate ) ANABTA+BASP 2200 1330
83 BacT/Alert anaerobic culture ( Aspiration fluid ) ANABTA+BASF 2200 1330
84 BacT/Alert anaerobic culture ( Blood ) ANABTA+BBLD 2200 1330
85 BacT/Alert anaerobic culture ( Bone Marrow) ANABTA+BBON 2200 1330
86 BacT/Alert anaerobic culture ( CSF ) ANABTA+BCSF 2200 1330
87 BacT/Alert anaerobic culture ( Miscellaneous ) ANABTA+B 2200 1330
88 BacT/Alert anaerobic culture ( P. D. fluid ) ANABTA+BPDF 2200 1330
89 BacT/Alert anaerobic culture ( Pericardial fluid ) ANABTA+BPER 2200 1330
90 BacT/Alert anaerobic culture ( Peritoneal fluid ) ANABTA+BPEF 2200 1330
91 BacT/Alert anaerobic culture ( Pleural fluid ) ANABTA+BPLE 2200 1330
92 BacT/Alert anaerobic culture ( Pus ) ANABTA+BPUS 2200 1330
93 BacT/Alert anaerobic culture ( Tissue ) ANABTA+BTIS 2200 1330
94 BacT/Alert anaerobic culture ( Urine ) ANABTA+BURI 2200 1330
95 BK Polyomavirus Quantitative real time PCR (BLOOD) BKPQBLD 6970 4180
96 BK Polyomavirus Quantitative real time PCR (CSF) BKPQCSF 6970 4180
97 BK Polyomavirus Quantitative real time PCR (MISC) BKPQMIS 6970 4180
98 BK Polyomavirus Quantitative real time PCR (URINE) BKPQURI 6970 4180
99 Brucella antibody assay BAS 890 540
100 C ‐ Reactive protein ( CRP ) CRP 890 540
101 CAPD Fluid Microscopy ( Cell count + Gram Stain + CAPDFCUL 620 370
KOH )
102 Charges for screening tests for blood donor BLOODDS 4560 2740
103 Chikungunya & Dengue Real Time Qualitative PCR CDRTPCQ 3210 3210
104 Chikungunya IgM spot assay (Microbiology dept) CHGUIGMSPOT 640 640
105 Chikungunya Real Time Qualitative PCR CRTQPCR 1610 1610
106 Clostridium Difficile toxin A & B CDTAB 2010 1210
107 CMV antibody IgG CMVAG 780 470
108 CMV antibody IgM CMVAM 730 440
109 CMV avidity IgG CMVAVIGG 1440 870
110 CMV Quantitative Real Time PCR ‐ Microbiology CMVQRTP 6970 4990
111 Cryptococcus antigen test ( Cryptola ) ‐ Blood CDT 2210 1330
112 Cryptococcus antigen test ( Cryptola ) ‐ CSF CDTCSF 2210 1330
113 CSF bacterial antigen test for meningitis causing CSFBATM 2900 1740
organsims
114 CSF VDRL VDRLCSF 330 200
115 Cysticercosis antibody test ( ELISA ) CYSTICER 1880 1130
116 Dengue antibody serology (IgM) DENGU 640 640
117 Dengue Duo spot plus test ( IgG / IgM / NS ‐ 1 ) DDSTPLIGGIGM 3010 1810
118 Dengue Duo spot test ( IgG / IgM ) DDSTIGGIGM 2420 1460
119 Dengue NS 1 Antigen Assay DENGUNS1 640 640
120 Dengue Real Time PCR DENREATPC 1610 1610
121 Direct Fluorescent staining for AFB ( Aspirate ) FLUOREAFBASP 1130 680
122 Direct Fluorescent staining for AFB ( Aspirate ) FLUOREAFBASPN
Northern Railway
123 Direct Fluorescent staining for AFB ( Aspiration fluid ) FLUOREAFBASPF 1130 680
124 Direct Fluorescent staining for AFB ( Aspiration FLUOREAFBASPS 1130 680
smears )
125 Direct Fluorescent staining for AFB ( Bone marrow ) FLUOREAFBBOM 1130 680
126 Direct Fluorescent staining for AFB ( Bronchial FLUOREAFBBRW 1130 680
washing )
127 Direct Fluorescent staining for AFB ( Bronchoalveolar FLUOREAFBBRL 1130 680
lavage )
49
128 Direct Fluorescent staining for AFB ( Chest irrigatin FLUOREAFBCIF 1130 680
fluid )
129 Direct Fluorescent staining for AFB ( CSF ) FLUOREAFBCSF 1130 680
130 Direct Fluorescent staining for AFB ( Drainage fluid ) FLUOREAFBDRF 1130 680
131 Direct Fluorescent staining for AFB ( E. T. secretion ) FLUOREAFBETS 1130 680
132 Direct Fluorescent Staining for AFB ( Gastrtric FLUOREAFBGAS 1130 680
aspirate )
133 Direct Fluorescent staining for AFB ( Miscellaneous ) FLUOREAFB 1130 680
134 Direct Fluorescent staining for AFB ( P. D. fluid ) FLUOREAFBPDF 1130 680
135 Direct Fluorescent staining for AFB ( Pericardial fluid ) FLUOREAFBPEF 1130 680
136 Direct Fluorescent staining for AFB ( Peritoneal fluid ) FLUOREAFBPRF 1130 680
137 Direct Fluorescent staining for AFB ( Pleural fluid ) FLUOREAFBPLF 1130 680
138 Direct Fluorescent staining for AFB ( PUS ) FLUOREAFBPUS 1130 680
139 Direct Fluorescent staining for AFB ( Sputum ) FLUOREAFBSPU 1130 680
140 Direct Fluorescent staining for AFB ( Stool ) FLUOREAFBSTO 1130 680
141 Direct Fluorescent staining for AFB ( Synovial fluid ) FLUOREAFBSYF 1130 680
142 Direct Fluorescent staining for AFB ( Tissue ) FLUOREAFBTIS 1130 680
143 Direct Fluorescent staining for AFB ( Urine ) FLUOREAFBURN 1130 680
144 E histolytica antibody test (IgG) ‐ Amoebic serology IGGEHIST 1410 850
145 EBV Quantitative Real Time PCR EBQRTP 6970 4990
146 Echinococcus antibody test ( ELISA ) ‐ Hydatid ECHINOIGG 1270 760
serology
147 ELISA for Chikungunya IgM EFCI 640 640
148 Enterovirus real time PCR (Microbiology) ERTN 7450 4470
149 Fungal culture ( Aspiration fluid ) FUNGCULTAPF 1130 680
150 Fungal culture ( Blister fluid ) FUNGCULTBTF 1130 680
151 Fungal culture ( Bronchial washing ) FUNGCULTBRW 1130 680
152 Fungal culture ( Bronchoalveolar lavage ) FUNGCULTBRL 1130 680
153 Fungal culture ( CSF ) FUNGCULTCSF 1130 680
154 Fungal culture ( Drainage fluid ) FUNGCULTDRF 1130 680
155 Fungal culture ( E. T. secretion ) FUNGCULTETS 1130 680
156 Fungal culture ( Faecal fluid ) FUNGCULTFLF 1130 680
157 Fungal culture ( Hair ) FUNGCULTHAIR 1130 680
158 Fungal culture ( Miscellaneous ) FUNGCULT 1130 680
159 Fungal culture ( Nail ) FUNGCULTNAIL 1130 680
160 Fungal culture ( P. D. fluid ) FUNGCULTPDF 1130 680
161 Fungal culture ( Percardial fluid ) FUNGCULTPCF 1130 680
162 Fungal culture ( Peritoneal fluid ) FUNGCULTPTF 1130 680
163 Fungal culture ( Pleural fluid ) FUNGCULTPLF 1130 680
164 Fungal culture ( PUS ) FUNGCULTPUS 1130 680
165 Fungal culture ( Skin scrapings ) FUNGCULTSKIN 1130 680
166 Fungal culture ( Sputum ) FUNGCULTSPU 1130 680
167 Fungal culture ( Stool ) FUNGCULTSTL 1130 680
168 Fungal culture ( Synovial fluid ) FUNGCULTSYF 1130 680
169 Fungal culture ( Tissue ) FUNGCULTTIS 1130 680
170 Fungal culture ( Urine ) FUNGCULTURN 1130 680
171 Fungal culture by Bact Alert ( Blood ) FUNGCULBLD 2200 1330
172 Fungal culture by Bact Alert ( Bone Marrow ) FUNGCULBONE 2200 1330
173 Fungal smear ‐ India ink preparation for cryptococcus INDINK 300 180
174 Fungal smear ‐ KOH preparation ( Ascitic fluid ) KOHMEFATF 270 160
175 Fungal smear ‐ KOH preparation for fungus ( Aspirate KOHMEFASP 270 160
)
176 Fungal smear ‐ KOH preparation for fungus ( KOHMEFAPS 270 160
Aspiration fluid )
177 Fungal smear ‐ KOH preparation for fungus ( Blister KOHMEFBLF 270 160
fluid )
50
178 Fungal smear ‐ KOH preparation for fungus ( Bone KOHMEFBMW 270 160
marrow )
179 Fungal smear ‐ KOH preparation for fungus ( KOHMEFBRW 270 160
Bronchial washing )
180 Fungal smear ‐ KOH preparation for fungus ( KOHMEFBRL 270 160
Bronchoalveolar lavage )
181 Fungal smear ‐ KOH preparation for fungus ( Chest KOHMEFCIF 270 160
irrigation fluid )
182 Fungal smear ‐ KOH preparation for fungus ( Chest KOHMEFCWS 270 160
wound swab )
183 Fungal smear ‐ KOH preparation for fungus ( Drainage KOHMEFDRF 270 160
fluid )
184 Fungal smear ‐ KOH preparation for fungus ( E.T. KOHMEFETS 270 160
secretion )
185 Fungal smear ‐ KOH preparation for fungus ( Ear swab KOHMEFERS 270 160
)
186 Fungal smear ‐ KOH preparation for fungus ( Eye KOHMEFEYS 270 160
swab )
187 Fungal smear ‐ KOH preparation for fungus ( Gastric KOHMEFGTS 270 160
aspirate )
188 Fungal smear ‐ KOH preparation for fungus ( Hair ) KOHMEFHAIR 270 160
189 Fungal smear ‐ KOH preparation for fungus ( KOHMEFLYS 270 160
Laryngeal swab )
190 Fungal smear ‐ KOH preparation for fungus ( KOHMEF 270
Miscellaneous )
191 Fungal smear ‐ KOH preparation for fungus ( Nail ) KOHMEFNAIL 270 160
192 Fungal smear ‐ KOH preparation for fungus ( P.D. fluid KOHMEFPDF 270 160
)
193 Fungal smear ‐ KOH preparation for fungus ( KOHMEFPCF 270 160
Pericardial fluid )
194 Fungal smear ‐ KOH preparation for fungus ( KOHMEFPTF 270 160
Peritoneal fluid )
195 Fungal smear ‐ KOH preparation for fungus ( Pleural KOHMEFPLF 270 160
fluid )
196 Fungal smear ‐ KOH preparation for fungus ( Pus ) KOHMEFPUS 270 160
197 Fungal smear ‐ KOH preparation for fungus ( KOHMEFRVF 270 160
Romovac fluid )
198 Fungal smear ‐ KOH preparation for fungus ( Skin KOHMEFSKIN 270 160
scrapings )
199 Fungal smear ‐ KOH preparation for fungus ( Sputum ) KOHMEFSPU 270 160
200 Fungal smear ‐ KOH preparation for fungus ( Stool ) KOHMEFSTOOL 270 160
201 Fungal smear ‐ KOH preparation for fungus ( Synovial KOHMEFSYF 270 160
fluid )
202 Fungal smear ‐ KOH preparation for fungus ( Tissue ) KOHMEFTIS 270 160
203 Fungal smear ‐ KOH preparation for fungus ( Urine ) KOHMEFURN 270 160
204 Fungal smear ‐ KOH preparation for fungus ( Vaginal KOHMEFVGS 270 160
swab )
205 Galactomannam test for aspergillus PAG 2080 1240
206 Gen Probe for T.B. TBGENPROBE 4390 3570
207 Giemsa stain ( Aspiration smears ) ‐ Inclusion bodies GIEMSAASP 300 180
in CMV or herpes
208 Giemsa stain ( Blister fluid ) ‐ Inclusion bodies in CMV GIEMSABLF 300 180
or herpes
209 Giemsa stain ( Bronchial washing ) ‐ PCP / Inclusion GIEMSABRW 300 180
bodies in CMV or herpes
210 Giemsa stain ( E.T. secretion ) ‐ PCP GIEMSAETS 300 180
51
211 Giemsa stain ( Miscellaneous ) ‐ Inclusion bodies in GIEMSA 300 180
CMV or herpes
212 Giemsa stain ( Sputum ) ‐ PCP GIEMSASPU 300 180
213 Giemsa stain ( Tissue ) ‐ Inclusion bodies in CMV or GIEMSATIS 300 180
herpes
214 Gram stain ( Aortic valve ) GRMSTAINAOV 300 180
215 Gram stain ( Ascitic fluid) GRMSTAINASC 300 180
216 Gram stain ( Aspirate) GRMSTAINASE 300 180
217 Gram stain ( Aspiration fluid ) GRMSTAINASF 300 180
218 Gram stain ( Aspiration smears) GRMSTAINASP 300 180
219 Gram stain ( Blister fluid ) GRMSTAINBLF 300 180
220 Gram stain ( Bronchial washing ) GRMSTAINBRW 300 180
221 Gram stain ( Bronchoalveolar lavage ) GRMSTAINBVL 300 180
222 Gram stain ( Chest irrigation fluid ) GRMSTAINCIF 300 180
223 Gram stain ( CSF ) GRMSTAINCSF 300 180
224 Gram stain ( CT guided aspirate ) GRMSTAINCTGA 300 180
225 Gram stain ( Drainage fluid ) GRMSTAINDRF 300 180
226 Gram stain ( E.T. secretion ) RCULTUREETS 300 180
227 Gram stain ( Laryngeal swab ) GRMSTAINLAS 300 180
228 Gram stain ( Miscellaneous ) GRMSTAIN 300 180
229 Gram stain ( P.D. fluid ) GRMSTAINPDF 300 180
230 Gram stain ( Pericardial fluid ) GRMSTAINPEF 300 180
231 Gram stain ( Peritoneal fluid ) GRMSTAINPER 300 180
232 Gram stain ( Pleural fluid ) GRMSTAINPLF 300 180
233 Gram stain ( Pus ) GRMSTAINPUS 300 180
234 Gram stain ( Romovac fluid ) GRMSTAINROF 300 180
235 Gram stain ( Semen ) GRMSTAINSEM 300 180
236 Gram stain ( Sputum ) GRMSTAINSPU 300 180
237 Gram stain ( Stool ) GRMSTAINSTO 300 180
238 Gram stain ( Throat swab ) GRMSTAINTHS 300 180
239 Gram stain ( Tissue ) GRMSTAINTIS 300 180
240 Gram stain ( Urine ) GRMSTAINURN 300 180
241 Gram stain ( Vaginal swab / High vaginal swab ) GRMSTAINVAS 300 180
242 Gram stain ( Venticular fluid ) GRMSTAINVEF 300 180
243 Gram stain ( Wound swab ) GRMSTAINWOS 300 180
244 Group B Streptococci Screening GBSS 1060 630
245 H1N1 / 09 SWINE FLU Qualitative Real Time PCR H1N1 5300 3730
246 Hanging Drop examination ( Stool ) HDROP 260 150
247 HBeAg for hepatitis B HBE 1860 1110
248 HBsAg ( Australia antigen ) HBSAG 780 470
249 HBsAg ( Australia antigen ) ( Dialysis ) DHBSAG 390 390
250 HBsAG SPOT HBSAGSPOT 1340 800
251 HBV Monitor ( Quantitative ) HBVM 11910 7150
252 HBV Qualitative HBVQ 7040 4230
253 HCV Monitor ( Quantitative ) HCVM 12950 7770
254 HCV Qualitative HCVQ 6470 3880
255 HCV Spot test HCVSPOT 1550 930
256 Hepatitis B core specific antibody ( total ) HEPBCSAT 1340 800
257 Hepatitis C virus serology antibody test HCV 1040 620
258 Hepatitis C virus serology antibody test ( Dialysis ) DHCV 510 510
259 Hepatitis E Virus Quantitative Real Time PCR HENRNA 5410
260 Herpes antibody ( IgG ) ‐ Blood HERPAN 1440 870
261 Herpes antibody ( IgG ) ‐ CSF HERPANCSF 1440 870
262 Herpes antibody ( IgM ) ‐ Blood HERPA 1440 870
263 Herpes antibody ( IgM ) ‐ CSF HERPACSF 1440 870
264 HIC Screen Blood Culture Aerobic HICBCA 2210 1330
265 HIC Screen Endotracheal secretion culture HICESC 1240 750
52
266 HIC Screen Stool Culture HICST 1240 750
267 HIC Screen Urine Culture HICUC 1130 680
268 HIV antibody test HIV 780 470
269 HIV antibody test ( Dialysis ) DHIV 390 390
270 HIV Qualitative HIVQ 7770 4670
271 HIV Spot test HIVSPOT 1030 620
272 HSV 1 & 2 and VZV real time PCR (CSF) HSVCSF 9020 5410
273 HSV 1 & 2 real time PCR (BLOOD) HSVBLD 9020 5410
274 HSV 1 & 2 real time PCR (MIS) HSVMIS 9020 5410
275 IgG4 Serum Levels IGG4 3210 2140
276 Influenza A and B Qualitative PCR INABQL 7380 4430
277 JC Polyomavirus Qualitative real time PCR (BLOOD) JCVQBLD 6970 4180
278 JC Polyomavirus Qualitative real time PCR (CSF) JCVQCSF 6970 4180
279 JC Polyomavirus Qualitative real time PCR (MIS) JCVQMIS 6970 4180
280 JC Polyomavirus Qualitative real time PCR (URINE) JCVQURI 6970 4180
281 Kidney Transplant Urine Routine Microscopy KTURMCRO 50 30
282 Kinyoun Stain ( Nocardia / Cryptospordium ) ‐ KINYOUNBRW 430 260
Bronchial washing
283 Kinyoun Stain ( Nocardia / Cryptospordium ) ‐ KINYOUNBRO 430 260
Bronchoalvcolar lavage
284 Kinyoun Stain ( Nocardia / Cryptospordium ) ‐ E.T. KINYOUNETS 430 260
Secretion
285 Kinyoun Stain ( Nocardia / Cryptospordium ) ‐ Other KINYOUN 430 260
fluids (NOT FOR CSF)
286 Kinyoun Stain ( Nocardia / Cryptospordium ) ‐ Pleural KINYOUNPLF 430 260
fluid
287 Kinyoun Stain ( Nocardia / Cryptospordium ) ‐ Pus KINYOUNPUS 430 260
288 Kinyoun Stain ( Nocardia / Cryptospordium ) ‐ Sputum KINYOUNSPU 430 260
289 Kinyoun Stain ( Nocardia / Cryptospordium ) ‐ Stool KINYOUNSTO 430 260
290 Legionella urinary antigen test LUAT 2460 1480
291 Leptospira IgM LEPTOIGM 1610 960
292 Mantoux test MONTOUX 200 120
293 Modified ZN stain ( M. leprae ) ‐ Slit smears nasal ZNMLEPNASAL 420 250
septum
294 Modified ZN stain ( M. leprae ) ‐ Slit smears skin ZNMLEPSKIN 420 250
295 Monospot test MSPOT 660 400
296 Nasba HIV QT (Quantitative) HIVQT 8200 5490
297 Pneumocystis carinii Immunoflourescent PCI 2210 1330
298 Quantiferon Gold QUQNGOLD 5490 4390
299 Rapid AFB culture ‐ (BacT/ALERT 3D) + Accuprobe AFB4DRUGBLD 7930 5550
identification and sensitivity 4 drugs BLOOD ‐
Streptomycin, Isoniazid, Rifampicin and Ethambutol
(SIRE)
300 Rapid AFB culture ( BacT/Alert 3D ) with accuprobe RAPIDWITHOUTSEN 2010 1410
identification without sensitivity
301 Rapid AFB culture ( BacT/Alert 3D ) with accuprobe RAPIDWITHOUTSEN
identification without sensitivity Northern Railway
302 Rapid AFB culture (BacT/ALERT 3D) + Accuprobe AFB10DRUGBLD 17850 13880
identification and sensitivity 10 drugs BLOOD ‐ SIRE ,
Ofloxacin, Amikacin, kanamycin, Capreomycin, PAS
and D‐ Cycloserine
303 Rapid anti mycobacteria sensitivity 2nd line , Single MTBSINGLE 3390 3010
drug sensitivity ( MTB )
304 Rapid anti mycobacterial sensitivity 2nd line, 6 drugs ‐ RAP6DRUG 7060 5300
Ofloxacin, Amikacin, kanamycin, Capreomycin, PAS
and D‐ Cycloserine
305 Rapid antimycobacterial sensitivity to 4 drugs (SIRE) RAS4D 5650 4710
53
306 Rapid Biofire Gastrointestinal Panel RBGP 16000 13000
307 Rapid Biofire Meningitis / Encephalitis Panel RBFM 16000 13000
308 Rapid Biofire Positive Blood Culture Panel RBFP 13940 11760
309 Rapid Biofire Respiratory Panel RBFR 16000 13000
310 Respiratory ‐ panel (Real Time Qualitative PCR) RESPIRATORY 22 12500 10000
311 Rheumatoid factor ‐ RF ( blood ) RF 780 470
312 Rheumatoid factor ‐ RF ( Synovial fluid ) RFSF 780 470
313 Rota Virus Antigen Test RVAT 1290 780
314 Routine culture and sensitivity ( Ascitic fluid ) RCULTUREASF 1240 750
315 Routine culture and sensitivity ( Aspiration fluid ) RCULTUREASP 1240 750
316 Routine culture and sensitivity ( Blister fluid ) RCULTUREBLF 1240 750
317 Routine culture and sensitivity ( Bone marrow ) RCULTUREBOM 1240 750
318 Routine culture and sensitivity ( Bronchial washing ) RCULTUREBRW 1240 750
319 Routine culture and sensitivity ( Bronchoalveolar RCULTUREBRL 1240 750
lavage )
320 Routine culture and sensitivity ( Chest irrigation fluid RCULTURECIF 1240 750
)
321 Routine culture and sensitivity ( CSF ) RCULTURECSF 1240 750
322 Routine culture and sensitivity ( CT guided aspirate ) RCULTURECTG 1240 750
323 Routine culture and sensitivity ( Drain tip ) RCULTUREDRT 1240 750
324 Routine culture and sensitivity ( Drainage fluid ) RCULTUREDRF 1240 750
325 Routine culture and sensitivity ( Ear swab ) RCULTUREESW 1240 750
326 Routine Culture and Sensitivity ( Endotracheal RCULTUREES 1240 750
Secretion )
327 Routine culture and sensitivity ( Eye swab ) RCULTUREEYS 1240 750
328 Routine culture and sensitivity ( Faecal fluid ) RCULTUREFAF 1240 750
329 Routine culture and sensitivity ( Line tip ) RCULTURELIT 1240 750
330 Routine culture and sensitivity ( Miscellaneous ) RCULTURE 1240 750
331 Routine culture and sensitivity ( Nail ) RCULTURENAIL 1240 750
332 Routine culture and sensitivity ( P.D. fluid ) RCULTUREPDF 1240 750
333 Routine culture and sensitivity ( Pericardial fluid ) RCULTUREPEF 1240 750
334 Routine culture and sensitivity ( Peritoneal fluid ) RCULTUREPER 1240 750
335 Routine culture and sensitivity ( Pleural fluid ) RCULTUREPLF 1240 750
336 Routine culture and sensitivity ( Pus ) RCULTUREPUS 1240 750
337 Routine culture and sensitivity ( Romovac fluid ) RCULTUREROF 1240 750
338 Routine culture and sensitivity ( Semen ) RCULTURESEM 1240 750
339 Routine culture and sensitivity ( Skin scraping swab ) RCULTURESKS 1240 750
340 Routine culture and sensitivity ( Sputum ) RCULTURESPU 1240 750
341 Routine culture and sensitivity ( Stool ) RCULTURESTO 1240 750
342 Routine culture and sensitivity ( Throat swab ) RCULTURETHS 1240 750
343 Routine culture and sensitivity ( Tissue ) RCULTURETIS 1240 750
344 Routine culture and sensitivity ( Vaginal swab ) RCULTUREVAS 1240 750
345 Routine culture and sensitivity ( Venticular fluid ) RCULTUREVEF 1240 750
346 Routine culture and sensitivity ( Wound swab ) RCULTUREWOS 1240 750
347 RPR VDRL 330 200
348 RSV Qualitative NASBA RSVQL 7450 4470
349 Rubella antibody serology ( IgG ) ‐ Blood RUBVAG 1440 870
350 Rubella antibody serology ( IgG ) ‐ CSF RUBVAGCSF 1440 870
351 Rubella antibody serology ( IgM ) ‐ Blood RUBVAM 1440 870
352 Rubella antibody serology ( IgM ) ‐ CSF RUBVAMCSF 1440 870
353 Rubella IgG Avidity Test RUBEAV 2010 1410
354 Scrub Typhus IgM Elisa STIGM 2620 1570
355 Serum complement C‐3 (Nephelometric method) C3 1060 630
356 Serum complement C‐4 (Nephelometric method) C4 1060 630
357 Stool examination ( Routine / Microscopy ) STOOLRE 140 100
358 Stool Examination for Parasites ( Conc. Method ) SEFP 240 140
359 Stool fat globules STOOLFG 140 100
54
360 Stool Occult blood STOB 200 120
361 Stool pH STPH 130 90
362 Stool reducing substance STRED 140 100
363 SUPPLEMENTARY Direct Fluorescent staining for AFB FLUREAF 0 0
( Bronchoalveolar lavage )
364 TB ‐ Xpert MTB / Rif TBXPERT 3880 3240
365 TB‐HAINS Genotypic test MTB/INH,Rif TBHAINS 3240 2590
366 TORCH complex IgG serology ( Blood ) TORCHPROG 2210 1330
367 TORCH complex IgG serology ( CSF ) TORCHPROGCSF 2210 1330
368 TORCH complex IgM serology ( Blood ) TORCHPROM 2210 1330
369 TORCH complex IgM serology ( CSF ) TORCHPROMCSF 2210 1330
370 Toxoplasma antibody serology ( IgG ) TOXOPLAG 1240 750
371 Toxoplasma antibody serology ( IgM ) TOXOPLAM 1240 750
372 Toxoplasma avidity ( IgG ) TOXOAVIGG 1240 750
373 Treponema pallidum haemagglutination test ( TPHA ) TPHA 660 400
‐ Blood
374 Treponema pallidum haemagglutination test ( TPHA ) TPHACSF 660 400
‐ CSF
375 Typhi Dot Assay ( IgG ) TDAIGG 650 400
376 Typhi Dot Assay ( IgM ) TDAIGM 650 400
377 Urine culture URNCULT 1170 700
378 Urine culture ( Kidney Transplant ) KT‐URNCULT 560 560
379 Urine culture ( Liver Transplant ) LT‐URNCU 560 560
380 Urine Pregnancy test ( Beta HCG ) ‐ Microbiology PREG.TST 480 290
381 VZV IgG VZVIGG 1880 1130
382 VZV Real time PCR VZV 9020 5410
383 Weil ‐ felix Test WFELIX 820 490
384 Wet mount examination ( Ameobic liver abcess ) WETMEALA 280 170
385 Wet mount examination ( Aspirate for scolicls / WETMEASH 280 170
hooklets )
386 Wet mount examination ( Miscellaneous ) WETMEMIS 280 170
387 Wet mount examination ( Stool / faecal fluid ) WETME 280 170
388 Widal test for Typhoid WIDAL 480 290
389 ZN staining for A.F.B. ( Aortic Valve ) AFBSNAVE 420 250
390 ZN staining for A.F.B. ( Aspirate ) AFBSNASP 420 250
391 ZN staining for A.F.B. ( Aspiration Fluid ) AFBSNASF 420 250
392 ZN staining for A.F.B. ( Body Fluid ) AFBSNBFD 420 250
393 ZN staining for A.F.B. ( Bronchial Washing ) AFBSNBRW 420 250
394 ZN staining for A.F.B. ( Bronchoalveolar Lavage ) AFBSNBRO 420 250
395 ZN staining for A.F.B. ( CAPD Fluid ) AFBSNCAP 420 250
396 ZN staining for A.F.B. ( Chest Irrigation Fluid ) AFBSNCHE 420 250
397 ZN staining for A.F.B. ( CSF ) AFBSNCSF 420 250
398 ZN staining for A.F.B. ( Drainage Fluid ) AFBSNDRA 420 250
399 ZN staining for A.F.B. ( E.T. Secretion ) AFBSNETS 420 250
400 ZN staining for A.F.B. ( Gastric Aspirate ) AFBSNGAS 420 250
401 ZN staining for A.F.B. ( Miscellaneous ) AFBSN 420 250
402 ZN staining for A.F.B. ( Mitral Valve ) AFBSNMIT 420 250
403 ZN staining for A.F.B. ( P.D. Fluid ) AFBSNPDF 420 250
404 ZN staining for A.F.B. ( Pericardial Fluid ) AFBSNPER 420 250
405 ZN staining for A.F.B. ( Peritoneal Fluid ) AFBSNPEF 420 250
406 ZN staining for A.F.B. ( Pleural Fluid ) AFBSNPLE 420 250
407 ZN staining for A.F.B. ( Pus ) AFBSNPUS 420 250
408 ZN staining for A.F.B. ( Sputum ) AFBSNSPU 420 250
409 ZN staining for A.F.B. ( Synovial Fluid ) AFBSNSYN 420 250
410 ZN staining for A.F.B. ( Tissue ) AFBSNTIS 420 250
411 ZN staining for A.F.B. ( Urine ) AFBSNURI 420 250
55
412 Rapid AFB culture ( BacT/ALERT 3D) + Accuprobe AFB10DRUGOS 17850 13880
identification and sensitivity 10 drugs + DF ‐ SIRE ,
Ofloxacin, Amikacin, kanamycin, Capreomycin, PAS and
D‐ Cycloserine
Direct Fluorscence Staining for AFB DIRFLU
Rapid AFB culture (BacT/ALERT 3D) + Accuprobe identification and AFB10DRUG
sensitivity 10 drugs ‐ SIRE , Ofloxacin, Amikacin, kanamycin, Capreomycin,
PAS and D‐ Cycloserine
413 Rapid AFB culture ( BacT/ALERT 3D) + Accuprobe AFB4DRUG 7930 5550

identification and sensitivity 4 drugs + DF ‐ Streptomycin,
Isoniazid, Rifampicin and Ethambutol (SIRE)
Direct Fluorscence Staining for AFB DIRFLU
Rapid AFB culture (BacT/ALERT 3D) + Accuprobe identification and AFB4DRUG
sensitivity 4 drugs ‐ Streptomycin, Isoniazid, Rifampicin and Ethambutol
(SIRE)
414 CAPD Fluid Package ( Cell count + Gram Stain + KOH + CAPDFCUL 3990 2400

Culture Senstivity )
CAPD fluid culture/ABST RCULTURECAPD
CAPD Fluid Microscopy ( Cell count + Gram Stain + KOH ) CAPDFCUL
415 CMV antibody IgG & IgM CMVAGAM 2620 1570

CMV antibody IgG CMVAG
CMV antibody IgM CMVAM
416 Enterically transmitted hepatitis profile ( IgM HAV, IgM ENTHEP 3010 1810

HEV )
Anti HAV ‐ IgM ( hepatitis A virus serology ) HAVT
Anti HEV ‐ IgM ( hepatitis E virus serology ) HEVT
417 Herpes antibody ( IgG & IgM ) ‐ Blood HERPANGM 2620 1570

Herpes antibody ( IgG ) ‐ Blood HERPAN
Herpes antibody ( IgM ) ‐ Blood HERPA
418 Herpes antibody ( IgG & IgM ) ‐ CSF HERPANGMCSF 2620 1570

Herpes antibody ( IgG ) ‐ CSF HERPANCSF
Herpes antibody ( IgM ) ‐ CSF HERPACSF
419 Rubella antibody serology ( IgG & IgM) ‐ Blood RUBVAGM 2620 1570

Rubella antibody serology ( IgG ) ‐ Blood RUBVAG
Rubella antibody serology ( IgM ) ‐ Blood RUBVAM
420 Rubella antibody serology ( IgG & IgM) ‐ CSF RUBVAGMCSF 2620 1570

Rubella antibody serology ( IgG ) ‐ CSF RUBVAGCSF
Rubella antibody serology ( IgM ) ‐ CSF RUBVAMCSF
421 Stool microbiology workup ( Culture, Wetmount, Kinyoun STWORK 1210 730

)
Kinyoun Stain ( Nocardia / Cryptospordium ) ‐ Stool KINYOUNSTO
Routine culture and sensitivity ( Stool ) RCULTURESTO
Wet mount examination ( Stool / faecal fluid ) WETME
422 TORCH complex IgG & IgM serology ( CSF ) TORCHPRCSF

TORCH complex IgG serology ( CSF ) TORCHPROGCSF 2210 1330
TORCH complex IgM serology ( CSF ) TORCHPROMCSF 2210 1330
423 TORCH complex IgG & IgM serology ( Blood ) TORCHPROGM 5960 3570
TORCH complex IgG serology ( Blood ) TORCHPROG
TORCH complex IgM serology ( Blood ) TORCHPROM
424 Toxoplasma antibody serology ( IgG & IgM ) TOXOPLAGM 2010 1210

Toxoplasma antibody serology ( IgG ) TOXOPLAG
Toxoplasma antibody serology ( IgM ) TOXOPLAM
425 VIRAL MARKER ( ACUTE HEPATITIS PANEL) VIRAHEP 3400 2040

Anti HAV ‐ IgM ( hepatitis A virus serology ) HAVT
HBsAg ( Australia antigen ) HBSAG
Hepatitis E Virus Quantitative Real Time PCR HENRNA
426 VIRAL MARKER (CHRONIC HEPATITIS SCREEN PANEL) VIRCHGAS 1370 820

Hepatitis C virus serology antibody test HCV
427 VIRAL MARKER (DIALYSIS) VIRDIA 1290 1290
56
HBsAg ( Australia antigen ) ( Dialysis ) DHBSAG
Hepatitis C virus serology antibody test ( Dialysis ) DHCV
HIV antibody test ( Dialysis ) DHIV
428 VIRAL MARKER ‐ HBV PANEL (HBSAG PROFILE) VIRHBSAG 11750 7050

Anti HBc ‐ IgM ( hepatitis B virus serology ) ANTIHBC
HBeAg for hepatitis B HBE
HBV Qualitative HBVQ
429 VIRAL MARKER(NON PREGNANT / GASTRO) VIRNONP 1950 1170

HIV antibody test HIV
430 VIRAL MARKER (PREGNANT PANEL) VIRP 4370 2620

RPR VDRL
Rubella antibody serology ( IgG ) ‐ Blood RUBVAG
Rubella antibody serology ( IgM ) ‐ Blood RUBVAM
431 VIRAL MARKER (PAED. THAL ASSEEMIA) VIRPTHAL 1950 1170

432 Viral marker profile (Transplant) VMP 2080 2080

CMV antibody IgG CMVAG
CMV antibody IgM CMVAM
Molecular Haematology Laboratory Charges

CAT 1/CAT2 CAT3
1 ALL Translocation Panel ATPMH 6700 5700
2 AML PCR Panel (Any 4) AMLMH 8800 7500
3 AML1 ‐ ETO Translocation ( Molecular Haematogy ) AML1 7000 4500
4 BCR ‐ ABL Qualitative ( Molecular Haematology ) MMBCRABL 6500 4000
5 BCR ‐ ABL Quantitative ( Molecular Haematology ) BCRABL 8500 7500
6 CALR Mutation (Type 1 and Type2) CALRMH 6080 4600
7 Composite Thrombophilia Mutation Panel CTMPMH 7700 5800
8 Factor V ( Leiden ) Gene mutations ‐ Molecular FVLGMMH 5200 3400
Haematology
9 FLT3 Mutation ( D835 & IDT ) ( Molecular FLTMH 6000 4000
Haemtology )
10 Inversion 16 translocation ( Molecular Haemtology ) INVERSIONMH 7000 4500
11 JAK‐2 mutation ( Molecular Haematology ) MMPCR 6500 4500
12 MPL mutation MPLMMH 4000 3000
13 MPN Reflex Panel MPNMH 8500 7500
14 MTHFR ( C677T ) Gene Polymorphism ‐ Molecular MTHFRGMMH 3800 2200
Haematology
15 Prothrombin ( G20210A ) Gene Mutation ‐ Molecular PGMMH 3800 2200
Haematology
16 Qualitative Reverse Transcriptase PCR (RT‐PCR) for MMPMLRARA 6500 4000
PML‐RARA ( Molecular Haematology Laboratory )
17 Qualitative Reverse Transcriptase PCR (RT‐PCR) for MMTELAML1 6500 4000
TEL‐AML1 ( Molecular Haematology Laboratory )
18 TPMT Genotyping ( Molecular Hematology ) TGMH 5500 4200
57
Research Lab Charges

CAT 1/CAT2 CAT3
1 Soluble interleukin‐2 receptor (SIL2R) SIL2R 4820 3530
Special Order Sets

CAT 1/CAT2 CAT3
1 Liver recipient preoperative workup LIVRECPOWU
$$ Alpha feto protein ‐ AFP ( Serum / Amniotic fluid ) BAFP 800 650
24 Hours Urine Protein (Excludes Albumin) 24URINPROT 300 180
24 Hours Urine Sodium 24US 200 120
Anti mitochondrial antibody ( AMA ) ‐ WITH Barcode AMA 1310 780
Anti nuclear antibodies ( ANA ) and Anti smooth muscle antibody ( ASMA ) ANASMA 2020 1210
‐ WITH Barcode
Anti‐p ANCA ( anti ‐ MPO ) AANCA‐AM 1850 1100
APTT ( Activated partial thromboplastin time ) APTT 650 400
BacT/Alert aerobic culture ( Blood ) AERBTA+B‐BLD 2200 1330
Blood group ‐ ABO + Rh(D) BGROUP 500 300
BUN BUN 160 100
CA 19‐9 CA199 1200 750
Calcium CALC 200 130
CBC ‐ Complete blood count CBC 420 250
CCR ‐ Creatinine Clearance CCR 420 250
CEA ( Carcino‐Embryonic Antigen ) CEA 750 450
Ceruloplasmin (Serum) BCPL 1250 1000
CMV antibody IgG CMVAG 780 470
CMV antibody IgM CMVAM 730 440
Electrocardiogram ( ECG ) ECG 350 250
Ferritin FERI 900 540
Fibrinogen (Quantitative) FIBEST 1350 800
Glucose Random GLUR 120 80
HBsAg ( Australia antigen ) HBSAG 780 470
Hepatitis C virus serology antibody test HCV 1040 620
HIV antibody test HIV 780 470
LFT ‐ Liver Function Test ( Hepatic Profile ) HEPA 1150 690
Magnesium SMAG 275 165
Prothrombin time ( PT ) Haematology Lab PT 400 240
RPR VDRL 330 200
Serum Creatinine CREA 180 110
Serum Iron IRON 375 225
Serum Iron Binding Capacity ( TIBC ) TIBC 450 270
Sodium + Potassium + Chlorides + Bicarbonate SPC 700 420
Spirometery SPIROM 1800 1100
Thyroid Profile ( T3, T4, TSH ) T3T4TSH 1250 1250
Transferrin TF 700 420
Ultrasound lower abdomen / pelvis LA 1460 880
Ultrasound upper abdomen & doppler study ABDO 3800 2280
Urine culture URNCULT 1170 700
Urine examination ( Routine / Microscopy ) URINERE 250 150
Xray chest PA ( CXR ) CHPA 520 310
58
MRI Charges

CAT 1/CAT2 CAT3
1 Ankylosing Spondylosis Screening Package ‐ for 2 ASSP2 6970 6970
parts
2 Ankylosing Spondylosis Screening Package ‐ for 3 ASSP3 9750 9750
parts
3 Breast MRI ‐ MRI Dept.Charges BRMRI 12120 12120
4 Contrast enhanced MRI brain MRICEMRIB 14510 14510
5 MR Venography Neck ( Plain ) MRIMRVNP 8860 8860
6 MR Venography Neck with contrast ( double dose ) MRIMRVNCDD 20000 20000
7 MR Venography Neck with contrast ( single dose ) MRIMRVNCSD 14510 14510
8 MRI 3D ( Extra ) MRI3D 9750 9750
9 MRI add on anaesthesia MRIADDANAES 4450 4450
10 MRI add on charges for CD MRICD 640 640
11 MRI add on double dose contrast MRISODDC 11300 11300
12 MRI add on extended study MRIAOES 5360 5360
13 MRI add on extra film charges MRIEXTFILM 460 460
14 MRI add on scout both ankles MRIAOSBA 8890 8890
15 MRI add on scout both arms MRIAOSBF 8890 8890
16 MRI add on scout both feet MRIAOSFO 8890 8890
17 MRI add on scout both knee joints MRIAOSBKJ 8890 8890
18 MRI add on scout both lower legs MRIAOSLLB 8890 8890
19 MRI add on scout both shoulders MRIAOSSBS 8890 8890
20 MRI add on scout both thighs MRIAOSTB 8890 8890
21 MRI add on scout brain MRIAOSB 4850 4850
22 MRI add on scout cervical spine MRIAOSCS 4850 4850
23 MRI add on scout dorsal/thoracic spine MRIAOSDTS 4850 4850
24 MRI add on scout hip joints MRIAOSHJ 4850 4850
25 MRI add on scout left ankle MRIAOSLA 4850 4850
26 MRI add on scout left arm MRIAOSRUA 4850 4850
27 MRI add on scout left feet MRIAOSF 4850 4850
28 MRI add on scout left knee joint MRIAOSLKJ 4850 4850
29 MRI add on scout left lower leg MRIAOSLL 4850 4850
30 MRI add on scout left shoulder MRIAOSLS 4850 4850
31 MRI add on scout left thigh MRIAOST 4850 4850
32 MRI add on scout lumbo‐sacral spine MRIAOSLSS 4850 4850
33 MRI add on scout of neck MRISNK 4850 4850
34 MRI add on scout of wrist MRISWR 4850 4850
35 MRI add on scout orbit MRIAOSO 4850 4850
36 MRI add on scout right ankle MRIAOSRA 4850 4850
37 MRI add on scout right arm MRIAOSRF 4850 4850
38 MRI add on scout right feet MRIAOSFR 4850 4850
39 MRI add on scout right knee joint MRIAOSRKJ 4850 4850
40 MRI add on scout right lower leg MRIAOSLLR 4850 4850
41 MRI add on scout right shoulder MRIAOSRS 4850 4850
42 MRI add on scout right thigh MRIAOSTR 4850 4850
43 MRI add on scout sacro‐iliac joints MRIAOSSIJ 4850 4850
44 MRI add on single dose contrast MRIAOSDC 5570 5570
45 MRI angiography both forearms MRASFB 19500 19500
46 MRI angiography both forearms (double dose MRASFDDCB 31930 31930
contrast)
47 MRI angiography both lower legs MRABLL 15960 15960
48 MRI angiography both lower legs (double dose MRABLLDDC 15960 15960
contrast)
49 MRI angiography both thighs MRABT 31930 31930
59
50 MRI angiography both thighs (double dose contrast) MRABTDDC 15960 15960
51 MRI angiography both upper arms MRASUAB 15960 15960
52 MRI angiography both upper arms (double dose MRASUADDCB 31930 31930
contrast)
53 MRI angiography left forearm MRASFL 9750 9750
54 MRI angiography left forearm (double dose contrast) MRASFDDCL 15960 15960
55 MRI angiography left upper arm MRASUA 15960 15960
56 MRI angiography left upper arm (double dose MRASUADDC 15960 15960
contrast)
57 MRI angiography lower abdomen / pelvis MRALAP 15960 15960
58 MRI angiography lower abdomen / pelvis (double MRALAPDDC 15960 15960
dose contrast)
59 MRI angiography lower thorax MRALT 9750 9750
60 MRI angiography lower thorax (double dose contrast) MRALTDDC 15960 15960
61 MRI Angiography Peripheral With Contrast ( Single MRIANGIO 15960 15960
Part )
62 MRI angiography right forearm MRASFR 19500 19500
63 MRI angiography right forearm (double dose MRASFDDCR 15960 15960
contrast)
64 MRI angiography right upper arm MRASUAR 25680 25680
65 MRI angiography right upper arm (double dose MRASUADDCR 15960 15960
contrast)
66 MRI angiography upper abdomen MRAUA 9750 9750
67 MRI angiography upper abdomen (double dose MRAUADDC 15960 15960
contrast)
68 MRI angiography upper thorax MRAUT 9750 9750
69 MRI angiography upper thorax (double dose contrast) MRAUTDDC 15960 15960
70 MRI Arthrography MRIARTH 19500 19500
71 MRI both ankles MRIA 19500 19500
72 MRI both ankles (contrast) MRBAC 25680 25680
73 MRI both elbows MRIESB 19500 19500
74 MRI both elbows (contrast) MRSECB 25680 25680
75 MRI both forearm (contrast) MRSCFCB 25680 25680
76 MRI both forearms MRFB 19500 19500
77 MRI both hand MRSHB 19500 19500
78 MRI both hand (contrast) MRSHCB 25680 25680
79 MRI both knee joints MRBNJ 19500 19500
80 MRI both knee joints (contrast) MRBNJC 25680 25680
81 MRI both shoulders MRISBS 19500 19500
82 MRI both shoulders (contrast) MRSSCB 25680 25680
83 MRI both wrist MRIWB 19500 19500
84 MRI both wrist (contrast) MRIWBC 25680 25680
85 MRI brachial plexus MRBP 9750 9750
86 MRI brachial plexus (contrast) MRBPC 15960 15960
87 MRI Brachial Plexus + Cervical Spine MRIBRCER 15960 15960
88 MRI brain MRIBRAIN 8860 8860
89 MRI brain (angiography) MRIBANGIO 8850 8850
90 MRI brain (venography) MRIBVEN 8850 8850
91 MRI Brain + Diffusion MRIBRDIF 13680 13680
92 MRI Brain + Diffusion + Perfusion + Contrast MRIBRDIPECON 28290 28290
93 MRI Brain + Dynamic CSF Flow Studies MRIBRDY 12870 12870
94 MRI Brain + Functional MRIBRFUN 14500 14500
95 MRI Brain + Orbits MRIBRORB 13680 13680
96 MRI Brain + Perfusion + Contrast MRIBRPERCON 19320 19320
97 MRI Brain + Sella MRIBRSELLA 13680 13680
98 MRI Brain + Spectroscopy MRIBRSP 13680 13680
99 MRI Brain Cisternography MRIBRCIS 13680 13680
60
100 MRI brain epilepsy protocol MRIBEP 11280 11280
101 MRI Cardiac Package Plain MRICARPKPL 15960 15960
102 MRI cervical spine MRICS 8860 8860
103 MRI cervical spine (contrast) MRCSC 15960 15960
104 MRI Contrast For Cardiac MRICONCAR 8850 8850
105 MRI Diffusion Weighted MRIDFW 4680 4680
106 MRI dorsal / thoracic spine MRIDS 8850 8850
107 MRI dorsal / thoracic spine (contrast) MRDTSC 15960 15960
108 MRI Dynamic CSF study MRIDCSF 8560 8560
109 MRI ear MRIEAR 9750 9750
110 MRI face MRIFACE 9750 9750
111 MRI feet MRBF 19500 19500
112 MRI feet (contrast) MRBFC 25680 25680
113 MRI Foetus MRIFOETUS 9750 9750
114 MRI foot MRF 9750 9750
115 MRI foot (contrast) MRFC 15960 15960
116 MRI hip joints MRIHJ 9750 9750
117 MRI hip joints (contrast) MRHJC 15960 15960
118 MRI left ankle MRSAL 9750 9750
119 MRI left ankle (contrast) MRSACL 15960 15960
120 MRI left elbow MRIESL 9750 9750
121 MRI left elbow (contrast) MRSECL 15960 15960
122 MRI left forearm MRFL 9750 9750
123 MRI left forearm (contrast) MRSCFCL 15960 15960
124 MRI left hand MRSHL 9750 9750
125 MRI left hand (contrast) MRSHCL 15960 15960
126 MRI left knee joint MRIKJSL 9750 9750
127 MRI left knee joint (contrast) MRSKJCL 15960 15960
128 MRI left shoulder MRISL 9750 9750
129 MRI left shoulder (contrast) MRSSCL 15960 15960
130 MRI left upper arm MRSUAL 9750 9750
131 MRI left upper arm (contrast) MRSUACL 15960 15960
132 MRI left wrist MRIWL 9750 9750
133 MRI left wrist (contrast) MRSWCL 15960 15960
134 MRI Liver Transplant Package MRILIVPK 23920 23920
135 MRI lower abdomen / pelvis MRLAP 9750 9750
136 MRI lower abdomen / pelvis (contrast) MRLAPC 15960 15960
137 MRI lower legs MRLL 9750 9750
138 MRI lower legs (contrast) MRLLC 15960 15960
139 MRI lumbar plexus MRLP 9750 9750
140 MRI lumbar plexus (contrast) MRLPC 15960 15960
141 MRI lumbo‐sacral spine MRILSS 8860 8860
142 MRI lumbo‐sacral spine (contrast) MRLSSC 15960 15960
143 MRI mammogram both breasts MRMBB 14200 14200
144 MRI mammogram both breasts (contrast) MRMBBC 20410 20410
145 MRI MRCP MRIMRCP 9750 9750
146 MRI neck MRINECK 9750 9750
147 MRI neck carotid angiography MRIENCKANGIO 8850 8850
148 MRI neck carotid angiography (double dose contrast) MRINADD 14500 14500
149 MRI neck with contrast MRINECKC 15960 15960
150 MRI Oncology Package MRIONCOPK 34450 34450
151 MRI orbit MRIORBIT 9750 9750
152 MRI orbit with (contrast) MRIORBITWC 15960 15960
153 MRI para nasal sinuses ( PNS ) MRPNS 9750 9750
154 MRI para nasal sinuses ( PNS with contrast) MRPNSWC 15960 15960
155 MRI Parametric Map MRIPARA 3210 3210
156 MRI pelvis MRIP 9750 9750
61
157 MRI pelvis with contrast MRIPWC 15960 15960
158 MRI perineum MRP 9750 9750
159 MRI perineum (contrast) MRPC 15960 15960
160 MRI pituitary fossa/sella MRIPFS 8850 8850
161 MRI pituitary fossa/sella contrast MRIPFSC 15960 15960
162 MRI Prostate Package ( Contrast ) MRIPROSPK 34450 34450
163 MRI Pyelography MRIPYE 4450 4450
164 MRI renal angiography MRIRA(CE‐S) 9750 9750
165 MRI renal angiography (double dose contrast) MRIRA(CE‐D) 15960 15960
166 MRI right ankle MRSAR 9750 9750
167 MRI right ankle (contrast) MRSACR 15960 15960
168 MRI right elbow MRIESR 9750 9750
169 MRI right elbow (contrast) MRSECR 15960 15960
170 MRI right forearm MRFR 9750 9750
171 MRI right forearm (contrast) MRSCFCR 15960 15960
172 MRI right hand MRSHR 9750 9750
173 MRI right hand (contrast) MRSHCR 15960 15960
174 MRI right knee joint MRIKJSR 9750 9750
175 MRI right knee joint (contrast) MRSKJCR 15960 15960
176 MRI right shoulder MRISR 9750 9750
177 MRI right shoulder (contrast) MRSSCR 15960 15960
178 MRI right upper arm MRSUAR 9750 9750
179 MRI right upper arm (contrast) MRSUACR 15960 15960
180 MRI right wrist MRIWR 9750 9750
181 MRI right wrist (contrast) MRSWCRL 15960 15960
182 MRI sacro‐iliac joints MRISIJ 9750 9750
183 MRI sacro‐iliac joints (contrast) MRSIJC 15960 15960
184 MRI screening of brain & MRA MRISB 12080 12080
185 MRI Screening of Lower abdomen MRISLAB 4450 4450
186 MRI Screening of upper abdomen MRISUAB 4450 4450
187 MRI screening with contrast MRISC 9750 9750
188 MRI screening without contrast MRISWC 4450 4450
189 MRI Spectroscopy MRISPE 9750 9750
190 MRI Spine screening MRISPSC 4450 4450
191 MRI Thalassemia Package MRITHALPK 0 0
192 MRI Thalassemia Protocol MRITHALPR 5560 5560
193 MRI thigh MRT 9750 9750
194 MRI thigh (contrast) MRTC 15960 15960
195 MRI thorax MRITHORAX 9750 9750
196 MRI thorax (contrast) MRTHOC 15960 15960
197 MRI TM joint/temporo‐mandibular joint MRITMJTMJ 9750 9750
198 MRI TM joint/temporo‐mandibular joint contrast MRITMJTMJC 15960 15960
199 MRI Tractography MRITRAC 3540 3540
200 MRI upper abdomen MRIUA 9750 9750
201 MRI upper abdomen (contrast) MRUAC 15960 15960
202 MRI upper abdomen with MRCP MRUAMRCP 15960 15960
203 MRI venography both forearm MRVSFB 19500 19500
204 MRI venography both forearm (double dose contrast) MRVSFDDCB 31930 31930
205 MRI venography both lower legs MRVBLL 9750 9750
206 MRI venography both lower legs (double dose MRVBLLDDC 15960 15960
contrast)
207 MRI venography both thighs MRVBT 9750 9750
208 MRI venography both thighs (double dose contrast) MRVBTDDC 15960 15960
209 MRI venography both upper arm MRVSUAB 19500 19500
210 MRI venography both upper arm (double dose MRVSUADDCB 31930 31930
contrast)
211 MRI venography left forearm MRVSFL 9750 9750
62
212 MRI venography left forearm (double dose contrast) MRVSFDDCL 15960 15960
213 MRI venography left upper arm MRVSUAL 9750 9750
214 MRI venography left upper arm (double dose MRVSUADDCL 15960 15960
contrast)
215 MRI venography lower abdomen / pelvis MRVLAP 9750 9750
216 MRI venography lower abdomen / pelvis (double MRVLAPDDC 15960 15960
dose contrast)
217 MRI venography lower thorax MRVLT 9750 9750
218 MRI venography lower thorax (double dose contrast) MRVLTDDC 15960 15960
219 MRI venography right forearm MRVSFR 9750 9750
220 MRI venography right forearm (double dose contrast) MRVSFDDCR 15960 15960
221 MRI venography right upper arm MRVSUAR 9750 9750
222 MRI venography right upper arm (double dose MRVSUADDCR 15960 15960
contrast)
223 MRI venography upper abdomen MRVUA 9750 9750
224 MRI venography upper abdomen (double dose MRVUADDC 15960 15960
contrast)
225 MRI venography upper thorax MRVUTHO 9750 9750
226 MRI venography upper thorax (double dose contrast) MRVUTHODDC 15960 15960
227 MRI whole abdomen MRIWHAB 19500 19500
228 MRI whole abdomen with contrast MRIWAWC 25660 25660
229 MRI Whole Body MRIWHBD 26520 26520
230 MRI Whole Body Angio ( Plain ) MRIWHBDANGIO 26520 26520
231 MRI Whole Body Diffusion MRIWHBDIF 13340 13340

CAT 1/CAT2 CAT3
1 MRI BRAIN + MRA BRAIN MRIMRA 10890 10890
MRI brain MRIBRAIN
MRI brain (angiography) MRIBANGIO
2 MRI BRAIN + MRA BRAIN + MRV BRAIN MRIMRAMRV 14520 14520

MRI brain MRIBRAIN
MRI brain (angiography) MRIBANGIO
MRI brain (venography) MRIBVEN
3 MRI NECK + MRA NECK MRIMRANECK 10290 10290

MRI neck MRINECK
MRI neck carotid angiography MRIENCKANGIO
4 MRI UPPER ABDOMEN + MRCP MRIMRCP 10290 10290

MRI MRCP MRIMRCP
MRI upper abdomen MRIUA
5 MRI BRAIN + MRV BRAIN MRIMRV 10290 10290

MRI brain MRIBRAIN
MRI brain (venography) MRIBVEN
1 Total Intra Venous Sedation ( TIVS ) ‐ MRI/CT TIVSOPDOS
Anaeshesia consumables used in MRI/CT for TIVS TIVSMC 1500 1500
Total Intra Venous Sedation ( TIVS ) ‐ MRI/CT TIVSOPD 2670 2670

Neonatology Test

CAT 1/CAT2 CAT3
1 NEONATOLOGY FUNCTIONAL ECHO ( TEST + DOCTOR FEE ) NEOFEOS 2850 1790
2 NEONATOLOGY ULTRASOUND (TEST+DOCTOR FEE) NEOULTRAOS 2140 1070
63
Nephrology Procedures
All Category
Cat 1B Suite
4 Beddded
Cat 1A‐Pre
Single Bed
2 Bedded
Cat‐1D
GOPD
POPD
Cat‐2
Cat‐3
Code Description
AVADDH ACUTE VASCULAR ACCESS FOR
OS DIALYSIS (DOCTOR FEE +
HOSPITAL CHARGES)
ACADAHC Acute vascular access for dialysis ‐ 1850 1850 920 740 550
Additional hospital charges
AVADDF Acute vascular access for dialysis ‐ Doctor 18480 18480 9240 7390 5540
fees
CADKIDD Cadaveric Kidney Donation
OS (Bench Surgery) ‐ Doctor fee +
Hospital charges
CADKDHC Cadaveric kidney donation (Bench Surgery) ‐ 2670
Additional hospital charges
CADKDF Cadaveric kidney donation (Bench Surgery) ‐ 26670
Doctor fee
CAPD1WD CAPD 1 week daycase training
COS (Doctor fee + Hospital charges)
CAPD1WDCDF CAPD 1 week daycase training ‐ doctor fee 16520
CAPD1WDCHC CAPD 1 week daycase training ‐ hospital 1650
charges
CAPDTDH CAPD training (doctor charges
COS + hospital service charges)
CAPDAHC CAPD training ‐ Additional hospital charges 1890 1510 1130
CAPDDF CAPD training ‐ Doctor fees 18900 15120 11340
CRRTPPD CRRT ‐ PLANNING AND
CHOS MONITORING (DOCTOR FEE +
HOSPITAL CHARGES)
CRRTPMDF CRRT ‐ planning and monitoring ‐ Doctor fee 13860 13860 7620 6090 4570
CRRTPMAHC CRRT ‐ planning and monitoring ‐ hospital 1390 1390 760 610 460
charges
HAEM48S Haemodialysis charges for
OS Daycare patients (Doctor +
Hospital + Kit charges) 4008S
HEMODIALDO Haemodialysis ‐ amount given to doctor 735
CCH
HEMODIALKIT Haemodialysis ‐ kit charges 295
CH
HAEPC48S Haemodialysis package charges 4008S 2450
HAEHOS4SN Haemodialysis procedure (4008S) ‐ Hospital 1715
charges
HAEMDH Haemodialysis charges for
OS INPATIENTS 4008S ( Doctor +
Hospital )
CCH
HAEHOS4SN Haemodialysis procedure (4008S) ‐ Hospital 1715
charges
HAEMIPD Haemodialysis charges for
HOS INPATIENTS 5008S ( Doctor +
Hospital )
CCH
HAEHC8S Haemodialysis procedure (5008S) ‐ hospital 2215
charges
HAEMPAC Haemodialysis charges for
8SOS Daycare patients (Doctor +
Hospital + Kit charges) 5008S
BLBINAV $$BLOODLINE AV SET (TUBING) 5008S 238
DIAFLSL $$DIALYSER FX60 HIGH FLUX SINGLE USE 467
64
CCH
CH
HAEOCHS Haemodialysis package charges 5008S 2950
HAEHC8S Haemodialysis procedure (5008S) ‐ hospital 2215
charges
HEMODIA Haemodialysis ( emergency )
LEORDSET charges for daycare patient (all
charges)
CH
HEMODIALEP Haemodialysis (emergency) package 4500
C charges
HEMOEDF Haemodialysis Emergency ‐ amount given to 1300 1300
doctor
HEEHC Haemodialysis procedure emergency ‐ 3200 3200
hospital charges
IJCSBOS Internal jugular ( IJ ) catheter /
subclavion catheter insertion
in Dialysis Room (Doctor fee +
Hospital Charges)
IJCATHC Internal jugular ( IJ ) catheter / subclavion 1390 1390 760 610 460
catheter insertion in Dialysis Room ‐
Hospital Charges
IJCSCATDF Internal jugular ( IJ ) catheter / subclavion 13860 13860 7620 6090 4570
catheter insertion in Dialysis Room ( Doctor
Fee )
INJOS Charges for giving injection
(I/V infusion ‐ Vancomycin,
Solumedrol, Endoxan ) in
Dialysis Room ( Doctor Fee +
Hospital charges)
CHINJHC Charges for giving injection (I/V infusion ‐ 260
Vancomycin, Solumedrol, Endoxan ) in
Dialysis Room ‐ Hospital Charges
INJDF Charges for giving injection (I/V infusion ‐ 530
Vancomycin, Solumedrol, Endoxan ) in
Dialysis Room ( Doctor Fee )
IPDDHCH PERITONEAL DIALYSIS ‐
OS INTERMITTENT (DOCTOR FEE +
HOSPITAL CHARGES)
IPDAHC Intermittent peritoneal dialysis ‐ Additional 1390 1390 770 610 460
hospital charges
IPDDF Intermittent peritoneal dialysis ‐ Doctor fees 13860 13860 7670 6130 4600
KTPSOS KTP Surcharge ( Surgeon +
Hospital + Anastheist )
KTPSA KTP Surcharge ‐ Anasthesist fee 2650
KTPSH KTP Surcharge ‐ Hospital charges 5290
KTPSS KTP Surcharge ‐ Surgeon Fee 5290
ONHOS Online Haemodialysis (Doctor
fee + Hospital Charges + kit
charges)
AVSET $$ AV SET ONLINE 530
BIBAG $$ Bibag 960 gm 215
CH
HEDFON Online Haemodialysis ‐ amount given to 650
doctor
HHCON Online Haemodialysis ‐ Hospital Charges 1710
HEPPCON Online Haemodialysis package charges 2360
PLPEROS Pleural / Peritoneal tapping in
Dialysis Room ( Doctor Fee +
Hospital charges)
PLEPERHC Pleural / Peritoneal tapping in Dialysis Room 530
‐ Hospital Charges
65
PTAPPERDF Pleural / Peritoneal tapping in Dialysis Room 2630 2630 2630 2630
( Doctor Fee )
SLEEDDHC SLEDD ‐ PLANNING AND
HOS MONITORING CHARGES
(DOCTOR FEE + HOSPITAL
CHARGES)
SLEDDAHC SLEDD ‐ Planning and monitoring charges by 1530 1530 760 610 380
nephrologist ‐ Additional hospital charges
SLEDDNDF SLEDD ‐ Planning and monitoring charges 15250 15250 7620 6090 3810
for Nephrologist ‐ Doctor fee
KBDHCHO KIDNEY BIOPSY (DOCTOR FEE +
S HOSPITAL CHARGES)
KBHC Kidney biopsy ‐ Additional hospital charges 1680 1680 840 670 500
KBDF Kidney biopsy ‐ Doctor fees 16800 16800 8400 6720 5040
UGRBOD Ultrasound guided renal biopsy
OS
UGRBDC Ultrasound guided renal biopsy ‐ Dept. 1760 1410 1060 1760 1650
charges
UGRBDF Ultrasound guided renal biopsy ‐ Doctor fee 1760 1410 1060 1760
UGRBOS Ultrasound guided renal biopsy
(Outside dept.)
UGRBODDC Ultrasound guided renal biopsy (Outside 2040 2040 1010 2040 2040
dept.) ‐ Dept. charges
UGRBODDF Ultrasound guided renal biopsy (Outside 2040 2040 1010 2040
dept.) ‐ Doctor fee
Ultrasound transplant ( graft ) kidney (without doppler) TK 660 400
KBSET Kidney biopsy set usage charges 390
Dialysis package charges
All Category
Cat 1B Suite
4 Beddded
Cat 1A‐Pre
Single Bed
2 Bedded
Cat‐1D
GOPD
POPD
Cat‐2
Cat‐3

267 HEMOFRE5 Online Hemodiafiltration 4000
(Fresenius5008‐5)
AV Fistula package
All Category
Cat 1B Suite
4 Beddded
Cat 1A‐Pre
Single Bed
2 Bedded
Cat‐1D
GOPD
POPD
Cat‐2
Cat‐3
Code Description
AV Fistula AV Fistula 20000

Package Includes :
 Day Care Bed charges
 Medicines & Consumables upto Rs. 1688/‐
 Anaesthesia Charges & OT Charges
 Professional Fees of Consultant

Package Excludes :
 Cross references other than Nephrologist.
 All investigations, medicines, and consumables over & above included in the package

66
Dialysis machine usage charges
All Category
Cat 1B Suite
Cat 1A‐Pre/
Single Bed
2 Bedded
4 Bedded
Casualty
Cat‐1D
GOPD
POPD
Cat‐2
Cat‐3
1 CRRTMPD CRRT ‐ use of machine (per day) 5780

2 SLEDDMPD SLEDD ‐ Use of machine (per day) 5780
Access Procedures For Dialysis
OT Day Care
Single Bed
Premium/
2 Bedded
4 Bedded
Cat‐1D
Cat‐2
Cat‐3
Suite
1 OP2911 Acute vascular access for dialysis ( in OT ) 20330 10160 8140 6100
2 AVFISSF AV Fistula ‐ Surgen Fee
3 OP3397 Basilic vein transposition in OT 60980 30490 24400 18290
4 OP0240 Brachio ‐ basilic loop AV graft for haemodialysis 40610 20310 16250 12180
5 OP0242 Brachio ‐ basilic straight ( above elbow ) AV graft for 40610 20310 16250 12180
haemodialysis
6 OP0239 Brachio ‐ cephalic loop AV graft for haemodialysis 40610 20310 16250 12180
7 OP0241 Brachio ‐ cephalic straight ( above elbow ) AV graft for 40610 20310 16250 12180
haemodialysis
8 OP0245 Brachio AV fistula at elbow for haemodialysis 29230 14620 11700 8770
9 OP0443 CAPD placement ( laparosopic ) 24650 12330 9870 7390
10 OP1080 CAPD placement ( open ) 24650 12330 9400 7390
11 OP0448 CAPD removal & placement ( laparosopic ) 32340 16170 12320 9700
12 OP0445 CAPD removal & placement ( open ) 32340 16170 12940 9700
13 OP0447 CAPD removal ( laparosopic ) 15460 7730 6180 4640
14 OP0444 CAPD removal ( open ) 15460 7730 6180 4640
15 OP0446 CAPD revision ( laparosopic ) 12350 6170 4950 3710
16 OP0449 CAPD revision ( open ) 12350 6170 4710 3710
17 OP0437 Conversion of arteriovenous ( AV ) shunt to 29230 14620 11700 8770
arteriovenous ( AV ) fistula
18 OP0440 Creation of arteriovenous ( AV ) fistula at axillary 36960 18480 14780 11090
artery
19 OP0433 Creation of arteriovenous ( AV ) fistula at elbow ( 35200 18480 14780 11090
brachial artery )
20 OP1077 Creation of arteriovenous ( AV ) fistula at wrist ( radial 36960 18480 14780 11090
artery )
21 OP4205 GSV translocation for AV access 60980 30490 24400 18290
22 OP0320 Ligation of ruptured AV fistula 15460 7730 6180 4640
23 OP0319 Ligation of ruptured AV graft 20330 10160 8140 6100
24 OP0436 Placement of arteriovenous ( AV ) shunt at ankle ( 20330 10160 8140 6100
posterior tibial artery )
25 OP1078 Placement of arteriovenous ( AV ) shunt at wrist ( 20330 10160 8140 6100
radial artery )
26 OP0243 Radio ‐ basilic straight ( below elbow ) AV graft for 40610 20310 16250 12180
haemodialysis
27 OP0244 Radio ‐ cephalic straight ( below elbow ) AV graft for 40610 20310 16250 12180
haemodialysis
28 OP4204 Repair of A.V.Fistula aneurysm 41580 20790 16630 12470
29 OP0441 Revision of arteriovenous ( AV ) fistula at axillary 15460 7730 6180 4640
artery
30 OP0435 Revision of arteriovenous ( AV ) fistula at elbow ( 15460 7730 6180 4640
brachial artery )
67
31 OP0434 Revision of arteriovenous ( AV ) fistula at wrist ( radial 15490 7730 6180 4640
artery )
32 OP0439 Revision of arteriovenous ( AV ) shunt at ankle ( 10160 5080 4070 3050
33 OP0438 Revision of arteriovenous ( AV ) shunt at wrist ( radial 10160 5080 3880 3050
artery )
34 OP1083 Vascular prosthetic graft in forearm 46200 23100 18480 13860
35 OP0526 Vascular prosthetic graft in thigh 46200 23100 18480 13860
36 OP0525 Vascular prosthetic graft in upper arm 46200 23100 18480 13860
ECG Charges

CAT 1/CAT2 CAT3
1 Electrocardiogram ( ECG ) ECG 350 250
Echo Lab Charges

CAT 1/CAT2 CAT3
1 Ambulatory B.P. Monitoring for 24 Hrs. ( Echo ) AMBPMONIT 3300 2200
2 Carotid doppler (ECHO ROOM) CARODOP 3500 2400
3 Dobutamine stress echo (Echo Department) DECHO 5830 4400
4 Echocardiogram with Doppler ( Echo ) ECHODOP 3300 2400
5 Fetal cardiac assessment ( Echo ) FECHO 4030 2050
6 Holter test (cardiac lab) ( Echo ) HOLTER 3300 2400
7 Portable Echo Additional Charges ECHO_BS 1100 660
8 Stress Echo (Echo Deparment) SECHOOS 5400 3850
9 Tilt table test ( Cardiology ) ( Echo ) TILT 5600 3600
10 Transoeophageal ‐ Echocardiography / Multiplane TEE 6050 3300
TEE ( Echo )
11 Treadmill test ( TMT) TMT 3100 2400
12 V‐Scan Screening Echo SCRECHO 770 770
13 Dobutamine Stress Echo with Contrast DOBUSECHOWD
Contrast for Echocardiography COFOEC 1100 1100
Dobutamine stress echo (Echo Department) DECHO 5830 4400
14 Echocardiogram with Doppler ( with Contrast ) ECHODOPWD
Contrast for Echocardiography COFOEC 1100 1100
Echocardiogram with Doppler ( Contrast charged extra) ECHODOPWD 3300 2420
15 Stress Echo with Contrast SECHOSETWD 6500 5000
Contrast for Echocardiography COFOEC
Stress Echo (Echo Deparment) SECHOOS

Echo Lab Contrast Charges

CAT 1/CAT2 CAT3
1 Contrast for Echocardiography COFOEC 1100 1100
68
EEG/EMG lab charges

CAT 1/CAT2 CAT3
1 Bedside EEG (less than 1 hr) EEG_BS 3510 2100
2 Bedside EMG EMG_BS 5080 3050
3 Bedside EMG & NCV EMGNCV_BS 8200 4920
4 Bedside Evoked Potential ‐ Auditory ( AEP / BAER / AUDIT_BS 3910 2340
BERA )
5 Bedside Evoked Potential ‐ Somatosensory ( SSEP ) EVOPOTSSEP_BS 3910 2340
6 Bedside Evoked Potential ‐ Visual ( VEP / VER ) VISUAL_BS 3910 2340
7 Bedside NCV / NCS ( Nerve conduction velocity / NCV_BS 4280 2560
study )
8 Bedside Repetitive nerve stimulation / Decremental REPNERSTI_BS 3910 2340
response ( RNST )
9 Botox injection under EMG control BIEMGC 1000 610
10 EEG EEG 2340 1410
11 Electroretinography ERG 2940 1760
12 EMG EMG 3510 2100
13 EMG / NCV EMGNCV 6630 3980
14 Evoked Potential ‐ Auditory ( AEP / BAER / BERA ) AUDIT 2930 1760
15 Evoked potential ‐ P300 EVOPOTP300 2660 1600
16 Evoked Potential ‐ Somatosensory EVOPOTSSEP 3140 1880
17 Evoked Potential ‐ Visual ( VEP / VER ) VISUAL 2930 1760
18 Long term bedside EEG ( 6 ‐ 24 hrs ) LTEEG24H 8060 4840
19 Long term video EEG (6 to 24 hrs) ‐ charges for video LTVEEG 9670 5800
recording
20 NCV / NCS ( Nerve conduction velocity / study ) NCV 3330 2000
21 Overnight Video EEG for 12 hour ‐ Lab Charges ONVEEG12LAB 8800 5280
22 Repetitive nerve stimulation / Decremental response REPNERSTI 2930 1760
( RNST )
23 Short term bedside EEG ( 1 ‐ 6 hrs ) STEEG6H 4830 2890
24 Short term video EEG monitoring (less than 6 hrs) VMT 4830 2890
25 Sleep deprivation EEG SDEEG 3140 1880
26 DIAGNOSTIC SLEEP STUDIES WITH OVERNIGHT VIDEO DSSWONVEEGOS
EEG(LABORATRY CHARGES + DOCTOR CHARGES)
Diagnostic sleep studies with overnight video EEG ‐ Doctor fee DSSWONVEEGDF 10500 6350
Diagnostic sleep studies with overnight video EEG ‐ Test charges DSSWONVEEG 8470 5080
27 Electrocorticography ECOGOS
Electrocorticography ‐ charges for procedure ECOGPC 16100 9660
Electrocorticography ‐ Doctor Fee ECOGDF 8060 4840
28 Intraoperative Neurophysiology monitoring INOPMONOS
Intraoperative Neurophysiology monitoring ‐ Charges for procedure INOPMONPC 16100 9660
Intraoperative Neurophysiology monitoring ‐ Doctor Fee INOPMONDF 8060 4840
29 Overnight Video EEG for 12 hours ‐(LABORATORY ONVEEG12OS
CHARGES + DOCTOR CHARGES)
Overnight Video EEG for 12 hour ‐ Lab Charges ONVEEG12LAB 8800 5280
Overnight Video EEG for 12 hours ‐ Doctor Fee ONVEEG12D 2200 1320
Note: for EMG procedures Rs. 250/‐ will be charged in addition to EMG charges for disposable needles.

69
Paediatric cardiac sciences lab charges

CAT 1/CAT2 CAT3
1 Ambulatory B.P. Monitoring for 24 Hrs. ( Paediatric AMBPMONITPS 2640 1840
Cardiac Sciences )
2 Echocardiogram with Doppler ( Paedtriatric Cardiac ECHODOPPS 2660 1670
Sciences )
3 Electrocardiogram ECG ( Paedtriatric Cardiac Sciences ECGPS 310 190
)
4 Fetal Cardiac Assessment ( Paedtriatric Cardiac FECHOPS 3660 2420
Sciences )
5 Holter Test ( Paedtriatric Cardiac Sciences ) HOLTERPS 2640 1840
6 Review Echo for LV Function RELVF 1000 600
7 Review Follow up Fetal Echo RFEH 2000 1200
8 Tilt Table Test ( Paediatric Cardiac Sciences ) TILTPS 5570 3340
9 Transoeophageal Echocardiography / Multiplane TEE TEEPSD 5570 3340
( Paedtriatric Cardiac Sciences )
Nuclear Imaging Charges

CAT 1/CAT2 CAT3
1 99m Tc Thyroid Scan TH1 5000 5000
2 Blood Pool Study For GI Bleed GT1 8000 8000
3 Bone Scan SS 6000 6000
4 Brain SPECT ( Epilepsy Protocol ) SPECT 17000 17000
5 Captopril DTPA Study For Screening of Renal HT GS4 11000 11000
6 DEXA bone densitometry with IVA BD5 2610 2610
7 DEXA Hip And Spine bone densitometry BD1 3500 3500
8 DEXA Single Site bone densitometry BD4 2250 2250
9 DEXA Three Site bone densitometry BD2 4000 4000
10 DEXA Three Sites ( Thalassemia Patient ) BD2TP 2250 2250
11 DEXA Whole Body BD3 4500 4500
12 DEXA Whole Body Fat Assessment BD6 4700 4700
13 Direct Radionucleotide Cystogram with uroflometery GS6 5500 5500
( DRCG )
14 DMSA renal scan GS5 6000 6000
15 DTPA Scan GS1 6000 6000
16 Dynamic Sailo Scintigrapgy DSCIN 10000 10000
17 ECD Brain SPECT ECDB 10500 10500
18 Gallium Scan TI1 14370 14370
19 Gastric Emptying ( Liquid ) GEL 6000 6000
20 Gastric Emptying ( Solid ) GES 6000 6000
21 Gastric Emptying ( Solid and Liquid ) GESL 8000 8000
22 Gastro Esophageal Reflux Study ( GER ) GT2 5000 5000
23 Gated Stress Myocardial Perusion Study CVS1 13000 13000
24 GER and swallow GT4 5500 5500
25 Hepatobiliary Scan GT5 7500 7500
26 Hepatosplenic Scan HTSS 5000 5000
27 HMPAO Brain SPECT B1 11500 11500
28 I‐131 MIBG Scan (MIBG isotope charges extra) TI2 11000 11000
29 I‐131 Uptake and Scan TH2 5000 5000
30 I‐131 Whole Body Scan TH3 6500 6500
31 Infection ( Ciprofloxacin ) Scan for Infection ICSI 12650 12650
32 Leukocyte scan for Infection II1 22000 22000
70
33 Lung Perfusion RES3 5000 5000
34 Lung Ventilation RES2 5000 5000
35 Lung Ventilation & Perfusion RES1 9000 9000
36 Lung Ventilation, Perfusion and Venography VQ 11500 11500
37 Lymphagiography CVS3 7500 7500
38 Meckel Study GT6 5000 5000
39 Parathyroid Scan TI4 9000 9000
40 Radionuclide cisternnography for CSF Leak ‐ Scan B2 8500 8500
charges
41 Radionuclide Peritoneography RNPG 6500 6500
42 RBC Scan ( Heat Denatured ) RBCSC 6500 6500
43 Renal transplant evaluation GS7 5000 5000
44 Rest Myocardial Perfusion Imaging ( MPI ) RMPI 6500 6500
45 Resting MUGA CVS5 5250 5250
46 Scintimammography SMGPY 8000 8000
47 Sentinel Node SENN 5000 5000
48 SPECT Bone Scan SS2 4600 4600
49 Spect for Brain Tumor recurrence GHA B4 9000 9000
50 Spect for Brain Tumor recurrence MIBI B5 9500 9500
51 Stress MUGA CVS4 6000 6000
52 Swallow Study SWAS 2500 2500
53 Tecktroyd Scan (technetium octreotide scan) TECKTROYD 57480 57480
54 Testicular Scan GS8 5000 5000
55 Trodat + FDG PET Brain TROPS 15680 15680
56 TRODAT BRAIN TRODAT2 21000 21000
57 TRODAT BRAIN PET TRODAT1 15680 15680
58 Venography CVS2 5500 5500
59 Yttrium (Medicine Cost Only) RS1 16720 16720
Nuclear Medicine Laboratory Charges

CAT 1/CAT2 CAT3
1 17‐OHP (Progesterone) (Nuclear RIA) ‐ 1 Sample 17OHP 840 840
2 17‐OHP (Progesterone) (Nuclear RIA) ‐ 2 Samples 17OHP2 1640 1640
3 25‐OH VIT D Level (Nuclear RIA) 25OHVIT 1900 1900
4 Anti ‐ TG ( Thyroid Antibody ) ‐ Nuclear Medicine TG 700 700
5 Anti ‐ TPO ( Thyroid Antibody ) ‐ Nuclear Medicine TPO 700 700
6 C ‐ Peptide Test PEPTIDE 700 700
7 Chromogranin A NCA 7470 7470
8 Cyclosporin Level ( C0 and C2 ) CYCLOSPORINC 2240 2240
9 Cyclosporin Level ( C2 ) CYCLOSPC2 1390 1390
10 Cyclosporin Level ( CO ) CYCLOSPCO 1390 1390
11 Free T3 T3 500 500
12 Free T3 / Free T4 T3T4 980 980
13 Free T4 T4 500 500
14 Free T4 / TSH T4TSH 980 980
15 Growth Hormone (HGH) ( Nuclear RIA ) GHORMONE 840 840
16 Growth Hormone Stimulation Test ( Clonidine ) ( GHORMONES 3490 3490
Nuclear RIA )
17 IGF 1 (Nuclear Medicine) IGF1 3200 3200
18 IGF BP3 (Nuclear Medicine) IGFBP3 3200 3200
19 Insulin Estimation (5 Samples) INSULINC 2090 2090
20 Insulin Level ‐ Fasting INSULINLF 450 450
21 Insulin Level ‐ PP INSULIPP 450 450
22 Insulin Level ‐ Random INSULINLR 450 450
71
23 Insulin Level ( Fasting + PP ) INSULINFPP 880 880
24 Insulin Level ( Fasting, 1 hourly and 2 hourly ) INSULINF12 1330 1330
25 Neonatal TSH TSHN 320 320
26 PTH Level PTH 1340 1340
27 Renin Levels RENIN 4430 4430
28 Testesterone (Free) TESTF 1770 1770
29 Testesterone (Total) TESTT 760 760
30 Thyroglobulin assay THGLOA 4430 4430
31 Thyroid Antibodies ‐ Nuclear Medicine TANTIBODIES 1260 1260
32 Thyroid Profile ( T3, T4, TSH ) T3T4TSH 1250 1250
33 TSH (Nuclear) TSH 450 450
34 Thyroid profile ( T3 , T4 , TSH ) with Anti ‐ TPO THYTPO
Anti ‐ TPO ( Thyroid Antibody ) ‐ Nuclear Medicine TPO 700 700
Thyroid Profile ( T3, T4, TSH ) T3T4TSH 1250 1250
Nuclear Medicine Therapy Charges

CAT 1/CAT2 CAT3
1 10‐20 mCi TH5 12000 12000
2 High Dose I‐131 Therapy TH6 16000 16000
3 I‐131 Theraphy for thyrotoxicosis upto 10mCi TH4 9000 9000
4 P‐32 Therapy for Bone Metastasis SS5 5750 5750
5 Samarium Therapy for Bone Pain Palliation STFBPP 13790 13790
6 Strontium 89 Therapy Bone Metastasis SS6 89660 89660
7 Theraspheres/Sirspheres THENUC 783750 783750
Nuclear Imaging

CAT 1/CAT2 CAT3
1 FDG PET CT Cardiac plain ( FOR COMPANY PATIENTS ) CPCTPOS
FDG isotope charges F18FDGISO 10500 10500
FDG PET CT Cardiac plain (FDG isotope charges extra) CPCTP 6500 6500
2 FDG PET CT Angiography Whole Body with Contrast ( FOR PCTAWBCOS
COMPANY PATIENTS )
FDG PET CT Angiography Whole Body with Contrast (FDG isotope charges PCTAWBC 18500 18500
extra)
3 FDG PET CT Brain plain ( FOR COMPANY PATIENTS ) PCTBPos
FDG PET CT Brain plain (FDG isotope charges extra) PCTBP 3500 3500
4 FDG PET CT Brain plain with Contrast ( FOR COMPANY PCTBWCOS
PATIENTS )
FDG PET CT Brain plain with Contrast (FDG isotope charges extra) PCTBWC 5500 5500
5 Whole body PET CT scan with TRODAT brain (With PCTTROBROS
Contrast)
Whole body PET CT Scan with TRODAT brain (With Contrast) PCTTROBR 28500 28500
6 Whole body PET CT Scan with TRODAT brain (Plain) PCTTROBRPOS
Whole body PET CT Scan with TRODAT brain (Plain) PCTTROBRP 24500 24500
7 FDG PET CT Whole Body Plain ( FOR COMPANY PATIENTS) PCTWBPOS
FDG PET CT Whole Body Plain (FDG isotope charges extra) PCTWBP 10500 10500
72
8 FDG PET CT Whole Body with Contrast ( FOR COMPANY PETCTWBOS
PATIENTS)
FDG PET CT Whole Body with Contrast (FDG isotope charges extra) PCTWBC 13500 13500
PET CT scan

CAT 1/CAT2 CAT3
1 DOTONOC isotope charges DOTONOC 31350 31350
2 Extra additional CD ( Nuclear ) EADDCDNU 420 420
3 Extra additional color film ( Nuclear ) EADDCFNU 420 420
4 Extra additional film ( Nuclear ) EADDNU 420 420
5 F‐18 isotope charges F18ISO 5621 5621
6 F‐18 PET Bone scan with whole body contrast HRFBSWEC 13500 13500
enhanced CT (F‐18 isotope charges extra)
7 FDG isotope charges F18FDGISO 10500 10500
8 FDG PET CT Angiography Brain with Contrast (FDG PCTABWC 8998 8998
isotope charges extra)
9 FDG PET CT Angiography Whole Body with Contrast PCTAWBC 18500 18500
(FDG isotope charges extra)
10 FDG PET CT Brain plain (FDG isotope charges extra) PCTBP 3500 3500
11 FDG PET CT Brain plain with Contrast (FDG isotope PCTBWC 5500 5500
charges extra)
12 FDG PET CT Cardiac plain (FDG isotope charges extra) CPCTP 6500 6500
13 FDG PET CT Myocardial Viability and Perfusion study CPCTMVPSP 10120 10120
plain (FDG isotope charges extra)
14 FDG PET CT Myocardial viability and Perfusion with PCTMVPAWC 16874 16874
CT Coronary Angiography with Contrast (FDG isotope
charges extra)
15 FDG PET CT Whole Body Plain (FDG isotope charges PCTWBP 10500 10500
extra)
16 FDG PET CT Whole Body with Contrast (FDG isotope PCTWBC 13500 13500
charges extra)
17 Gallium Whole body PET scan GWBPET 30000 30000
18 Human Serum Albumin (HSA) HSA 11000 11000
19 MIBG isotope charges MIBGC 22000 22000
20 MIBG isotope charges ( Routine ) MIBGPET 10450 10450
21 PET CT ‐ Regional somatostatin ( DOTANOC ) receptor DOTANOC 8180 8180
imaging ( regional )
22 PET CT ‐ Whole body somatostatin receptor imaging ( PCTSRI 15340 15340
DOTONOC isotope charges extra)
23 PET CT BRAIN AND DAT SCAN PTBDS 25000 25000
24 PET CT guided procedure PETBIOPSY 9200 9200
25 Pet CT Scan whole body (Sarcoidosis) PCWB 28000 28000
26 PET Whole Body Sweep PWBS 3070 3070
27 PSMA PET CT Whole Body Plain PSMAPET 22000 22000
28 PSMA PET CT Whole Body with Contrast PSMPETC 25560 25560
29 Urgent PET CT Brain scan with TRODAT Brain PCTBWT 38000 38000
30 Visipaque contrast charges for PET CT PETVC 1050 1050
31 Whole body PET CT Scan with TRODAT brain (With PCTTROBR 28500 28500
Contrast)
73
Allergy Tests

CAT 1/CAT2 CAT3
1 Aeroallergen ( Respiratory ) Common Panel AERESCOMOS
Aeroallergen ( Respiratory ) Common Panel AERESCOM 4820 2890
Aeroallergen ( Respiratory ) Common Panel ‐ Hospital Charges AERESCOMH 1600 960
2 Aeroallergen ( Respiratory ) Comprehensive Panel AERESCPOS
Aeroallergen ( Respiratory ) Comprehensive Panel AERESCP 8025 4810
Aeroallergen ( Respiratory ) Comprehensive Panel ‐ Hospital Charges AERESCPH 2670 1605
3 Food Allergy Common Panel ALLCOMOS
Food Allergy Common Panel ALLCOM 3200 1930
Food Allergy Common Panel ‐ Hospital Charges ALLCOMHOSP 1070 640
4 Food Allergy Comprehensive Panel ALLCOMPOS
Food Allergey Comprehensive Panel ALLCOMPR 7220 4330
Food Allergy Comprehnsive Panel ‐ Hospital Charges ALLCOMPHOSP 2400 1450

Fetal Medicine Charges

CAT 1/CAT2 CAT3
1 Portable ultrasound hospital service charges ( Fetal FETAL_BS 900 550
Medicine )
2 Ultrasound 3 D Reconstruction of face 3DRF 5500 3300
3 Ultrasound Amino infusion AMINOINF 4700 3000
4 Ultrasound AVI & Doppler only UAVID 1700 1120
5 Ultrasound bio‐physical scoring BPSC 900 550
6 Ultrasound BPS with doppler + AVI BPSDOP 1800 1100
7 Ultrasound colour doppler Fetal echo with 4 D UFED4 3850 2310
8 Ultrasound colour doppler Fetal echo with doppler UFED 3300 1980
9 Ultrasound colour doppler Twins UTDS 3700 2200
10 Ultrasound colour doppler Twins with growth scan UCDTGS 5000 3000
11 Ultrasound CVS chorionic villus sampling UCVS 10000 7500
12 Ultrasound CVS chorionic villus sampling ( UCVSTS 6000 4500
Thalassemia society patient )
13 Ultrasound Evaluation of AVI / Scar thickness / UEAVI 800 480
presentation / placental localisation
14 Ultrasound fetal blood sampling UFBS 13000 8200
15 Ultrasound fetal For cardiac activity UFCA 800 500
16 Ultrasound fetal Portable charges for fetal medicine UFPCH 950 600
17 Ultrasound fetal reduction in Fetal Medicine Dept FRED 16500 9900
18 Ultrasound fetal skin sampling (Fetal medicine FETALSKIN 4300 2600
charges)
19 Ultrasound fetal Triplet BPS UFTRBPS 1500 900
20 Ultrasound fetal Triplet BPS ‐ colour Doppler UFTRBPSCD 4600 2760
21 Ultrasound fetal Triplet Growth scan UFTRGS 3700 2220
22 Ultrasound fetal Triplet Growth scan Doppler flows UFTRGSDF 5800 3500
23 Ultrasound fetal Triplet Level II ‐ Doppler flows UFTRLII 5800 3500
24 Ultrasound fetal Triplet MCA / UA / Umblical / UFTRMCA 2000 1200
uterine artery
25 Ultrasound fetal Twin anamoly scan ‐ doppler flows UFTACDF 5500 3300
26 Ultrasound fetal Twin biophysical score UFTBPS 1500 900
27 Ultrasound fetal Twin Genetic sonogram UFTGS 3800 2300
28 Ultrasound fetal Twin MCA/UA/Umblical/uterine UFTMCA 1500 900
artery‐Doppler
74
29 Ultrasound fetal urine sampling FETALURI 6000 3600
30 Ultrasound for Genetic Sonogram (16‐18 weeks) UANEU 2500 1500
31 Ultrasound guided Aminocentesis (Twins) FETAMINOTWIN 9000 6000
32 Ultrasound guided amniocentesis UGAMINO 6000 4000
33 Ultrasound guided Amniocentesis and UGAAF 8000 4800
Amnioinfusiuon
34 Ultrasound guided CVS (Twins) FETCVSTWIN 12000 8000
35 Ultrasound Intrauterine transfusion INTRATRA 19000 12000
36 Ultrasound obstetric growth scan + colour doppler OBSTDOP 4200 2600
flow study + AVI
37 Ultrasound Obstetric Intervention OBSINTER 7000 4200
38 Ultrasound obstetrics ‐ MCA / UA / Umblical / Uterine FETOBSMCAUA 1500 900
artery ‐ Doppler
39 Ultrasound obstetrics ‐ Mid trimester anomaly scan FETMTAS 4000 2400
(MTAS / Level II / TIFFA) with Doppler
40 Ultrasound obstetrics ‐ Miscellaneous FETOBSMIS 1300 800
41 ULTRASOUND OBSTETRICS ‐ NUCHAL SCAN WITH UONSUAD 3000 1800
UTERINE ARTERY DOPPLER
42 Ultrasound obstetrics ‐ viability / dating scan ( upto UO10 1500 900
10 weeks )
43 Ultrasound obstetrics ( Twins ) ( After 18 weeks UOT 3000 1800
without Level II )
44 Ultrasound obstetrics (Triplets) ‐ Level II / MTAS / FETOBSTRI 5200 3150
TIFFA
45 Ultrasound obstetrics Dating + cervical length UTDCL 1200 750
46 Ultrasound obstetrics growth scan ( 26 weeks till UOGS26 2000 1200
term )
47 Ultrasound obstetrics Quadruplets NT Scan UTQTMT 4700 2820
48 Ultrasound obstetrics Triplet Dating cardiac activity UTTRIDCA 2100 1260
49 Ultrasound obstetrics Triplet extended screening UTTRIEX 4200 2600
50 Ultrasound obstetrics Twins AVI Doppler UTTWAVID 2100 1300
51 Ultrasound obstetrics Twins Dating cardiac activity UTTWDCA 1750 1050
52 Ultrasound obstetrics Twins extended screening UTTWEX 3800 2300
53 ULTRASOUND OBSTETRICS WITH DETAILED STUDY OF UODFKS 3700 2350
FETAL KUB (KIDNEYS‐SIZES, PELVICALYCED
DILATATION, CORTICAL THICKNESS, URETERS AND
URINARY BLADDER) SINGLETON
54 ULTRASOUND OBSTETRICS WITH MATERNAL KIDNEYS UOWMK 2000 1200
55 Ultrasound placental biopsy ULPLABIO 10000 7000
56 AMNIO DRAINAGE AMNIODR 5000 3000
57 FETAL REDUCTION QUADRUPLETS FETALRED 25000 15000
58 DOCTORS VISIT CHARGES FOR IUT FETALIUT 1500 1500

75
Ultrasound Charges

CAT 1/CAT2 CAT3
1 Breasr FNAC under ultrasound guidance ‐ Ultrasound UFNACULC 1650 990
Department Charges
2 IVF procedure ( Registration 2) ‐ Ultasound Charges IVFREGUC2 3190 3190
3 IVF procedure ( Registration) ‐ Ultasound Charges IVFULT 1600 1600
4 LIVER TRANSPLANT PACKAGE ‐ Ultrasound charges LTRULT
5 Portable ultrasound hospital service charges ULTRA_BS 1110 670

(Ultrasound Dept)
6 Ultrasound Extra Film Charges ULTEF 500 500
7 Ultrasound & colour doppler of transplanted kidney KT 1820 1090
8 Ultrasound 3D / 4D upper abdomen lower abdomen U3DUA 4200 2520
9 Ultrasound breast SPB 2200 1320
10 Ultrasound carotid doppler UCARODOP 3220 1940
11 Ultrasound colour doppler eye UEYE 1680 1010
12 Ultrasound colour doppler follicle monitoring (single CDS 640 390
day)
13 Ultrasound colour doppler orthosonography UOSONO 2090 1250
14 Ultrasound colour doppler renal artery RENAL 3500 2100
15 Ultrasound colour doppler thyroid THYROID 1960 1180
16 Ultrasound colour doppler vessel / vein mapping / VLM 1210 730
marking
17 Ultrasound Elastography ‐ Breast ULELASB 2040 1220
18 Ultrasound Elastography ‐ Liver ULELASLIV 2790 1670
19 Ultrasound Elastography ‐ Prostate ULELASPRRO 2040 1220
20 Ultrasound Elastography ‐ Scrotum ULELASSCR 2040 1220
21 Ultrasound Elastography ‐ Thyroid ULELASTTHY 2040 1220
22 Ultrasound follicle monitoring ( single day ) UFMSD 480 290
23 Ultrasound follicle study full FSF 2240 1340
24 Ultrasound for detection of ascitis UFDA 560 340
25 Ultrasound for detection of pleural effusion ULDPE 560 340
26 Ultrasound for residual urine RU 430 250
27 Ultrasound for undescended testis UUT 1890 1130
28 Ultrasound guidance charges for Ascites / Effusion UASCUINT 1210 730
tapping ( interventional)
29 Ultrasound guidance charges for FNAC / Biopsy ( UFNACINT 1210 730
interventional)
30 Ultrasound gynae with colour doppler UGCD 2090 1250
31 Ultrasound joints UJTS 2240 1340
32 Ultrasound KUB KUB 1540 920
33 Ultrasound KUB + doppler scrotum ( without TRS ) UKUBDS 2790 1670
34 Ultrasound KUB + pelvis ( Female ) UKUBPF 2040 1220
35 Ultrasound KUB + prostate ( TRUS ) KUBP 2040 1220
36 Ultrasound KUB + prostate + scrotum (without KUBPROSC 2520 1510
doppler)
37 Ultrasound KUB + prostate + TRS + doppler scrotum UKUBPTRS 3500 2100
38 Ultrasound KUB + residual urine KUBRU 1540 920
39 Ultrasound lower abdomen / pelvis LA 1460 880
40 Ultrasound monitoring ( PICU / ICU / OT ) UMBOT 380 380
41 Ultrasound musculoskeletal system UMUSCU 2420 1450
42 Ultrasound Neck UNECK 1650 990
43 Ultrasound neurosonography ( cranial ultrasound in SPN 1330 800
babies )
44 Ultrasound of a focal swelling FOCALSW 840 510
45 Ultrasound pelvis with colour doppler GCD 2240 1340
76
46 Ultrasound penile colour doppler PLD 3070 1840
47 Ultrasound peripheral arterial colour doppler both PBLU 5870 3520
arms
48 Ultrasound peripheral arterial colour doppler both PBLL 5870 3520
legs
49 Ultrasound peripheral arterial colour doppler left arm PLA 3770 2270
50 Ultrasound peripheral arterial colour doppler left leg PLL 3770 2270
51 Ultrasound peripheral arterial colour doppler right PRA 3770 2270
arm
52 Ultrasound peripheral arterial colour doppler right leg PRL 3770 2270
53 Ultrasound scrotum ULTRASCROT 1540 920
54 Ultrasound scrotum with colour doppler OSONO 2380 1430
55 Ultrasound small parts ULSMP 1410 850
56 Ultrasound thorax SPCH 1110 670
57 Ultrasound thyroid SPT 1450 870
58 Ultrasound transplant ( graft ) kidney (without TK 660 400
doppler)
59 Ultrasound Transplant kidney with scrotum (with ULKWISCR 3070 1840
colour doppler)
60 Ultrasound Transplant kidney with scrotum (without ULKWSCR 2090 1250
colour doppler)
61 Ultrasound transrectal + pelvis ultrasound (Male) TRUS 1470 880
62 Ultrasound upper abdomen UA 1540 920
63 Ultrasound upper abdomen & doppler study ABDO 3800 2280
64 Ultrasound venous colour doppler both arms PBLUV 6290 3770
65 Ultrasound venous colour doppler both legs PBLLV 6290 3770
66 Ultrasound venous colour doppler left arm PLAV 3770 2270
67 Ultrasound venous colour doppler left leg PLLV 3770 2270
68 Ultrasound venous colour doppler neck PNV 2450 1470
69 Ultrasound venous colour doppler right arm PRAV 3770 2270
70 Ultrasound venous colour doppler right leg PRLV 3770 2270
71 Ultrasound whole abdomen & pelvis ( Adult ) WA 2420 1450
72 Ultrasound whole abdomen & pelvis (age less than 12 WA12 1540 920
years)
73 Ultrasound whole abdomen with scrotum ULWBWSCR 3500 2100
74 Ultrasound whole abdomen with TRUS UWAWTRUS 2790 1670
Ultrasound Procedures All Category
Cat 1B Suite
4 Beddded
Cat 1A‐Pre
Single Bed
2 Bedded
Cat‐1D
GOPD
POPD
Cat‐2
Cat‐3

1 ABRFNAC Ultrasound guided Breast
ODOS FNAC outside the department
ABRFNACODD Ultrasound guided Breast FNAC outside the 2090 2090 1060 2090 910
F department ‐ Doctor fee
AFNACOD Ultrasound guided FNAC outside the 2090 2090 1060 2090 2090
department ( Ultrasound dept charges )
2 ABRFNAC Ultrasound guided Breast
OS FNAC in the department
ABRFNACDF Ultrasound guided Breast FNAC in the 1530 1530 760 1650 990
department ‐ Doctor fee
AFNAC Ultrasound guided FNAC in the department ( 1530 1530 760 1650 990
Ultrasound dept charges )
3 AFNACOD Ultrasound guided FNAC
OS outside the department
AFNACODDF Ultrasound guided FNAC outside the 2090 2090 1060 2090
department ‐ ultrasonologist fee
77
AFNACOD Ultrasound guided FNAC outside the 2090 2090 1060 2090 2090
4 AFNACOS Ultrasound guided FNAC in the
department
AFNACDF Ultrasound guided FNAC in the department ‐ 1530 1530 760 1530
ultrasonologist fee
AFNAC Ultrasound guided FNAC in the department ( 1530 1530 760 1650 990
5 BIOCTMRI Biopsy under guidance of
OS ultrasound / CT / MRI fusion
UBUGCTMRID Biopsy under guidance of ultrasound / CT / 2090 2090 1250 2090
F MRI fusion ‐ Ultrasonologist fee
UBUGCTMRID Biopsy under guidance of ultrasound / CT / 2090 2090 1250 2090 2090
C MRI fusion ‐ Ultrasound dept. charges
6 BRMRIOS Breast MRI + Tomosynthesis
Charges
BRMRI Breast MRI ‐ MRI Dept.Charges 12120 12120 12120 12120 12120 12120 12120
TOMOMAM Tomosynthesis Charges ‐ Mammography 5000 5000 5000 5000 5000 3000
Dept.Charges
7 CUBTAOS Contrast Ultrasound for Blunt
Trauma abdomen
CUBTADC Contrast Ultrasound for Blunt Trauma 7000 7000 4200 7000 3180
abdomen ‐ U/S dept. charges
CUBTADF Contrast Ultrasound for Blunt Trauma 1410 1410 850 1410 850
abdomen ‐ Ultrasonologist fee
8 ENDOBRO ENDOBRONCHIAL
ULOS ULTRASOUND ‐ (DOCTOR FEE +
HOSPITAL CHARGES +
DISPOSABLES CHARGES +
CYTOLOGY CHARGES)
ENDOBROULD Endobronchial Ultrasound ‐ Doctor Fee 22140 22140 11070 8860 6640 11070 6640
F
ENDOBROPAC Endobronchial Ultrasound ‐ For PACS ‐ NOT
S FOR BILLING PURPOSE
ENDOBROULH Endobronchial Ultrasound ‐ Hospital charges 8840 8840 4420 3540 2650 4420 2650
C
ENDOBRONUL Endobronchial Ultrasound ‐ Package 46840 46840 23420 18740 14050 23420 14050
TAPC charges
9 FRUOS Fetal Reduction by Ultrasound
Dept
FRUDF Fetal Reduction by Ultrasound Dept ‐ Doctor 8800 8800 4750
Fee
FRUUD Fetal Reduction by Ultrasound Dept ‐ 8800 8800 4750
Ultrasound Deptt. Charges
10 SALSONO Salpingo sonography
OS
USALSODF Salpingo sonography ‐ Ultrasonologist fee 1390 1390 690 1390
USALSODC Salpingo sonography ‐ Ultrasound dept. 1390 1390 690 1390 1390
charges
11 SKINMAR Ultrasound skin marking for
KOS lesion
SKINMARKDF Ultrasound skin marking for lesion ‐ 1100 1100 660 1100 660
ultrasonologist fee
SKINMARK Ultrasound skin marking for lesion ( 1100 1100 660 1100 660
12 UADOS Ultrasound diagnostic needle
aspiration for Ascitis
UADDF Ultrasound diagnostic needle aspiration for 910 910 610 910
Ascitis ‐ ultrasonologist fee
UAD Ultrasound diagnostic needle aspiration for 910 910 610 910 910
Ascitis ( Ultrasound dept charges )
13 UAEOS Ultrasound guided aspiration
in the department
UAEDF Ultrasound guided aspiration in the 1530 1530 760 1530
department ‐ ultrasonologist fee
UAE Ultrasound guided aspiration in the 1530 1530 760 1530 1530
78
14 UAODOS Ultrasound guided aspiration
outside the U/S department
UAODDF Ultrasound guided aspiration outside the 2090 2090 1060 2090
U/S department ‐ ultrasonologist fee
UAOD Ultrasound guided aspiration outside the 2090 2090 1060 2090 2090
U/S department ( Ultrasound dept charges )
15 UGBHWP Ultrasound guided breast hook
OS wire placement
UGBHWPDC Ultrasound guided breast hook wire 5000 3000
placement ‐ Dept. charges
UGBHWPDF Ultrasound guided breast hook wire 2500 1500
placement ‐ Doctor fee
16 UGLAAOD Ultrasound guided liver
OS abscess aspiration (outside
dept.)
UGLAAODDC Ultrasound guided liver abscess aspiration 2240 2240 1330 2240 2240
(outside dept.) ‐ Dept. charges
UGLAAODDF Ultrasound guided liver abscess aspiration 2240 2240 1330 2240
(outside dept.) ‐ Doctor fee
17 UGLAAOS Ultrasound guided liver
abscess aspiration
UGLAADC Ultrasound guided liver abscess aspiration ‐ 1820 1820 920 1820 1820
Dept. charges
UGLAADF Ultrasound guided liver abscess aspiration ‐ 1820 1820 920 1820
Doctor fee
18 UGLBODO Ultrasound guided liver biopsy
S (outside the dept.)
UGLBODDC Ultrasound guided liver biopsy (outside the 2240 2240 1110 2240 2240
UGLBODDF Ultrasound guided liver biopsy (outside the 2240 2240 1110 2240
19 UGLBOS Ultrasound guided liver biopsy
UGLBDC Ultrasound guided liver biopsy ‐ Dept. 1820 1820 1210 1820 1820
charges
UGLBDF Ultrasound guided liver biopsy ‐ Doctor fee 1820 1820 1210 1820
20 UGMTPOS Ultrasound guided MTP
UGMTPDF Ultrasound guided MTP ‐ ultrasonologist fee 2090 2090 1210 2090
UGMTP Ultrasound guided MTP ( Ultrasound dept 2090 2090 1210 2090 2090
charges )
21 UGOCAOS Ultrasound guided ovarian cyst
aspiration
UGOCADC Ultrasound guided ovarian cyst aspiration ‐ 2090 2090 1210 2090 2090
Dept. charges
UGOCADF Ultrasound guided ovarian cyst aspiration ‐ 2090 2090 1210 2090 1000
Doctor fee
22 UGPAOD Ultrasound guided perigraft
OS aspiration (outside the dept.)
UGPAODDC Ultrasound guided perigraft aspiration 1410 1410 970 1410 1410
(outside the dept.) ‐ Dept. charges
UGPAODDF Ultrasound guided perigraft aspiration 1410 1410 970 1410
(outside the dept.) ‐ Doctor fee
23 UGPAOS Ultrasound guided perigraft
aspiration
UGPADC Ultrasound guided perigraft aspiration ‐ 1060 1060 520 1060 1060 1060
Dept. charges
UGPADF Ultrasound guided perigraft aspiration ‐ 1060 1060 520 1060
Doctor fee
24 UGPBOS Ultrasound guided transrectal
prostatic aspiration / biopsy
UGPBDF Ultrasound guided transrectal prostatic 2420 2420 1210 2420
aspiration / biopsy ‐ ultrasonologist fee
UGPB Ultrasound guided transrectal prostatic 2420 2420 1210 2420 2420
aspiration / biopsy ( Ultrasound dept
charges )
25 UGRBOD Ultrasound guided renal biopsy
OS
UGRBDC Ultrasound guided renal biopsy ‐ Dept. 1760 1410 1060 1760 1650
charges
UGRBDF Ultrasound guided renal biopsy ‐ Doctor fee 1760 1410 1060 1760
79
26 UGRBOS Ultrasound guided renal biopsy
(Outside dept.)
UGRBODDC Ultrasound guided renal biopsy (Outside 2040 2040 1010 2040 2040
UGRBODDF Ultrasound guided renal biopsy (Outside 2040 2040 1010 2040
27 UGTAFAO Ultrasound guided therapeutic
S aspiration for ascitis
UGTAFADC Ultrasound guided therapeutic aspiration 1820 1820 920 1820 1820
for ascitis ‐ Dept. charges
UGTAFADF Ultrasound guided therapeutic aspiration 1820 1820 920 1820
for ascitis ‐ Doctor fee
28 UGTAFPF Ultrasound guided therapeutic
OS aspiration for pleural fluid
UGTAFPFDC Ultrasound guided therapeutic aspiration 1820 1820 920 1820 1820
for pleural fluid ‐ Dept. charges
UGTAFPFDF Ultrasound guided therapeutic aspiration 1820 1820 920 1820
for pleural fluid ‐ Doctor fee
29 ULBRCBO Breast core biopsy under
S Ultrasound guidance
ULBRSCB Breast core biopsy under Ultrasound 2500 1500
guidance ‐ Ultrasonologist fee
ULBRCBDF Breast core biopsy under Ultrasound 2500 1500
guidance ‐ Ultrasound Deptt. Charges
30 ULCON Contrast ultrasound
CULTRA Contrast Ultrasound ‐ Ultrasonologist fee 1410 1410 850 1410
CONULHC Contrast ultrasound ‐ Ultrasound dept. 7000 7000 4200 7000 4200
charges
31 ULGYNOS Contrast ultrasound Gynae
ULGYNDF Contrast Ultrasound Gynae ‐ Ultrasonologist 1410 1410 850 1410
fee
ULGYNDC Contrast Ultrasound Gynae ‐ Ultrasound 7000 7000 4200 7000 4200
dept. charges
32 ULHEPLTO Contrast Ultrasound Hepatic
S artery for liver transplant
ULHALIVDF Contrast Ultrasound Hepatic artery for liver 1410 1410 850 1410
transplant ‐ Ultrasonologist fee
ULHALIVDC Contrast Ultrasound hepatic artery for liver 7000 7000 4200 7000 4200
transplant ‐ Ultrasound dept. charges
33 ULKIDOS Contrast ultrasound Kidney
ULKIDDF Contrast ultrasound Kidney ‐ Ultrasonologist 1410 1410 850 1410
fee
ULKIDDC Contrast ultrasound Kidney ‐ Ultrasound 7000 7000 4200 7000 4200
dept. charges
34 ULLIVOS Contrast ultrasound Liver
ULLIVDF Contrast Ultrasound Liver ‐ Ultrasonologist 1410 1410 850 1410
fee
ULLIVDC Contrast ultrasound Liver ‐ Ultrasound dept. 7000 7000 4200 7000 4200
charges
35 ULOESOS Contrast ultrasound
Oesophagus
ULOESDF Contrast Ultrasound Oesophagus ‐ 1410 1410 850 1410
Ultrasonologist fee
ULOESDC Contrast ultrasound Oesophagus ‐ 3500 3500 2100 3500 2100
Ultrasound dept. charges
36 ULPROOS Contrast ultrasound Prostate
ULPRODF Contrast Ultrasound Prostate ‐ 1410 1410 850 1410
Ultrasonologist fee
ULPRODC Contrast ultrasound Prostate ‐ Ultrasound 7000 7000 4200 7000 4200
dept. charges
37 ULRFAOS Contrast ultrasound charges
for Radio frequency ablation
ULRFADF Contrast ultrasound charges for Radio 3500 3500 2100 3500
frequency ablation ‐ Ultrasonologist fee
ULRFADC Contrast ultrasound charges for Radio 13980 13980 8390 13980 8390
frequency ablation ‐ Ultrasound dept.
charges
38 ULSPLOS Contrast ultrasound Spleen
ULSPLDF Contrast Ultrasound Spleen ‐ Ultrasonologist 1410 1410 850 1410
fee
80
ULSPLDC Contrast Ultrasound Spleen ‐ Ultrasound 7000 7000 4200 7000 4200
dept. charges
39 ULTHYOS Contrast ultrasound Thyoid
ULTHYDF Contrast Ultrasound Thyroid ‐ 1410 1410 850 1410 850
Ultrasonologist fee
ULTHYDC Contrast ultrasound Thyroid ‐ Ultrasound 7000 7000 4200 7000 4200
dept. charges
40 ULUVROS Contrast Ultrasound for U V
Reflux
ULUVRDF Contrast Ultrasound for UV reflux ‐ 1410 1410 850 1410
Ultrasonologist fee
ULUVRDC Contrast Ultrasound for UV reflux ‐ 3500 3500 2100 3500 2100
Ultrasound dept. charges
41 USAVFC Ultrasound guided venous
mapping for I/J catheter
insertion and A.V Fistula
creation
USAVFDF Ultrasound guided venous mapping for I/J 600
catheter insertion and A.V Fistula creation ‐
Doctor Fee
USAVFHS Ultrasound guided venous mapping for I/J 600
catheter insertion and A.V Fistula creation ‐
Machine Charges
42 USBRSTBP Ultrasound guided breast
SYOS biopsy
USBRSTBPSYD Ultrasound guided breast biopsy ‐ 1680 1680 840 1680
F ultrasonologist fee
USBRSTBPSY Ultrasound guided breast biopsy ( 1680 1680 840 1680 1680
43 USSKBRO Ultrasound skin marking for
T lesion in OT
SKINMARKOT Ultrasound skin marking for lesion in OT ‐ 2200 2200 1320 2200 1320
Ultrasonologist fee
SKINMARKOT Ultrasound skin marking for lesion in OT ‐ 2200 2200 1320 2200 1320
US Ultrasound dept charges

81
X‐Ray Charges

CAT 1/CAT2 CAT3
1 Additional charge for BEDSIDE portable X‐ray done in XRAY_BS 580 350
WARD/Recovery
2 Additional Xray Contrast AXCONTRAST 150 150
3 Additional Xray film charges for vascular / neuro lab XFCVAS
4 Additional Xray gastrographin contrast (100 ml) AXGC100 1300 1300

7 Additional Xray ionic contrast (20 ml) AXIC20 320 320
8 Additional Xray non‐ionic contrast (10 ml) AXNIC10 480 480
12 B/L Ankle Mortice View ‐ Xray XRAYAMV 520 310
13 B/L Femur Oblique view‐ Xray XRAYBLFOV 1010 610
14 B/L Forearm Oblique view ‐ Xray XRAYBLFROV 1010 610
15 B/L Hip Joint Outlet & Inlet views‐ Xray XRAYHINV 2000 1200
16 B/L Humerus Oblique view ‐ Xray XRAYBLHOV 1010 610
17 B/L Knees Merchant View ‐ Xray XRAYBL 520 310
18 B/L Knees Tunnel View ‐ Xray XRAYBLT 520 310
19 B/L Legs Oblique view‐ Xray XRAYBLOV 1010 610
20 B/L Shoulder True AP View ‐ Xray XRAYBLSTAPV 520 310
21 Base of Skull ‐ Xray XRAYBSK 520 310
22 Both lower limb length measurement by Xray LOWLIMB 2660 2660
23 Breast ductography / galactography ( excluding dye BDG 3910 3910
charges )
24 Clinch fist view (AP) XRAYFV 520 310
25 Clinch fist view (B/L) XRAYFVBL 520 310
26 Clinch fist View (Lat.) XRAYFVLT 520 310
27 Digital image in CD XRAYCD 220 130
28 Duplicate film (each film) XRAYDF 330 200
29 Enface view of scapula (B/L) XRAYSCBL 1010 610
30 Enface view of scapula (Lt.) XRAYSCLT 520 310
31 Enface view of scapula (Rt.) XRAYSCR 520 310
32 Foetogram AP / Lat. ‐ Xray XRAYFOAPL 1010 610
33 For OT ONLY ‐ Additional charge for portable X‐ray BOTPX 2500 1500
done in OT
34 Frog Leg View XRAYLV 520 310
35 Intra oral Xray IORAL 240 140
36 Lt. Ankle Mortice View‐ Xray XRAYLTAMV 520 310
37 Lt. Femur Oblique view Xray XRAYLFV 520 310
38 Lt. Forearm Oblique view ‐ Xray XRAYLFROV 520 310
39 Lt. Hip Joint Outlet & Inlet views‐ Xray XRAYHLINV 1010 610
40 Lt. Humerus Oblique view ‐ Xray XRAYLTHOV 520 310
41 Lt. Knee Merchant View ‐ Xray XRAYLTFNEE 520 310
42 Lt. Knee Tunnel View ‐ Xray XRAYLFTV 520 310
43 Lt. Legs Oblique view‐ Xray XRAYLFOV 520 310
44 Lt. Shoulder True AP View ‐ Xray XRAYLFTSTAPV 520 310
45 Lumbosacral Spine ‐ Lateral view in lying down LUMSLD 520 310
position
46 Lumbosacral Spine ‐ Lateral view in sitting position LUMST 520 310
47 Lumbosacral spine AP in sitting position ‐ XRAY XRAYAP 520 310
48 Lumbosacral spine AP/ Lat. In sitting position ‐ Xray XRAYAPLAT 1010 610
49 Lumbosacral spine Lat. In sitting position ‐ Xray XRAYLAT 520 310
82
50 OPG Xray OPG 720 430
51 Pericatheteric RGU ‐ Dye charges XRAYRGUDY 320 320
52 Rt. Ankle Mortice View ‐ Xray XRAYRTAMV 520 310
53 Rt. Femur Oblique view ‐ Xray XRAYRFV 520 310
54 Rt. Forearm Oblique view ‐ Xray XRAYRTOV 520 310
55 Rt. Hip Joint Outlet & Inlet views‐ Xray XRAYHRINV 1010 610
56 Rt. Humerus Oblique view‐ Xray XRAYRTHOV 520 310
57 Rt. Knee Merchant View ‐ Xray XRAYRTKNEE 520 310
58 Rt. Knee Tunnel View ‐ Xray XRAYRTV 520 310
59 Rt. Legs Oblique view‐ Xray XRAYRFOV 520 310
60 Rt. Shoulder True AP View‐ Xray XRAYRSTAP 520 310
61 Stentogram Dye charges ‐ Xray XRAYDYE 320 320
62 Xray abdomen AP erect AMENAPE 520 310
63 Xray abdomen AP erect & supine AMENAPES 1010 610
64 Xray abdomen AP supine AMENAPS 520 310
65 Xray abdomen AP view for pancreatic calcification AMENAPPC 520 310
66 Xray abdomen for foreign body localisation AMENFBL 520 310
67 Xray abdomen lateral (bilateral) AMENLB 1010 610
68 Xray abdomen lateral (L) AMENLL 520 310
69 Xray abdomen lateral (R) AMENLR 520 310
70 Xray abdomen left lateral decubitus AMENDB 520 310
71 Xray abdomen oblique for GB area AMENPOGB 520 310
72 Xray abdomen renal area (bilateral) AMENRAB 520 310
73 Xray abdomen renal area (L) AMENRAL 520 310
74 Xray abdomen renal area (R) AMENRAR 520 310
75 Xray abdomen right lateral decubitus AMENDBRT 520 310
76 Xray abdomen urinary bladder area erect AMENUBER 520 310
77 Xray abdomen urinary bladder area supine (AP) AMENUBSP 520 310
78 Xray acromio clavicular joint (bilateral) ACJAPRB 1010 610
79 Xray acromio clavicular joint (L) ACJAPL 520 310
80 Xray acromio clavicular joint (R) ACJAPR 520 310
81 Xray ankle AP & lateral (bilateral) ANKAPLTRB 1010 610
82 Xray ankle AP & lateral (L) ANKAPLTL 520 310
83 Xray ankle AP & lateral (R) ANKAPLTR 520 310
84 Xray ankle AP & stress view (bilateral) ANKAPSVB 1010 610
85 Xray ankle AP & stress view (L) ANKAPSVL 520 310
86 Xray ankle AP & stress view (R) ANKAPSVR 520 310
87 Xray ankle AP (bilateral) ANKAPB 520 310
88 Xray ankle AP (L) ANKAPL 520 310
89 Xray ankle AP (R) ANKAPR 520 310
90 Xray ankle lateral (bilateral) ANKLB 520 310
91 Xray ankle lateral (L) ANKLL 520 310
92 Xray ankle lateral (R) ANKLR 520 310
93 Xray ankle oblique (bilateral) ANKOBB 520 310
94 Xray ankle oblique (L) ANKOBL 520 310
95 Xray ankle oblique (R) ANKOBR 520 310
96 Xray ankle stress view (bilateral) ANKSVB 520 310
97 Xray ankle stress view (L) ANKSVL 520 310
98 Xray ankle stress view (R) ANKSVR 520 310
99 Xray arm / humerus AP & lateral (bilateral) ARAPLTB 2000 1200
100 Xray arm / humerus AP & lateral (L) ARAPLTL 1010 610
101 Xray arm / humerus AP & lateral (R) ARAPLTR 1010 610
102 Xray arm / humerus AP & lateral with elbow ARAPLEB 2000 1200
(bilateral)
103 Xray arm / humerus AP & lateral with elbow (L) ARAPLEL 1010 610
104 Xray arm / humerus AP & lateral with elbow (R) ARAPLER 1010 610
83
105 Xray arm / humerus AP & lateral with shoulder ARAPLSB 2000 1200
(bilateral)
106 Xray arm / humerus AP & lateral with shoulder (L) ARAPLSL 1010 610
107 Xray arm / humerus AP & lateral with shoulder (R) ARAPLSR 1010 610
108 Xray arm / humerus AP (bilateral) ARAPB 1010 610
109 Xray arm / humerus AP (L) ARAPL 520 310
110 Xray arm / humerus AP (R) ARAPR 520 310
111 Xray arm / humerus AP with elbow (bilateral) ARAPELB 1010 610
112 Xray arm / humerus AP with elbow (L) ARAPELL 520 310
113 Xray arm / humerus AP with elbow (R) ARAPELR 520 310
114 Xray arm / humerus AP with shoulder (bilateral) ARAPSHB 1010 610
115 Xray arm / humerus AP with shoulder (L) ARAPSHL 520 310
116 Xray arm / humerus AP with shoulder (R) ARAPSHR 520 310
117 Xray arm / humerus lateral (bilateral) ARLTB 1010 610
118 Xray arm / humerus lateral (L) ARLTL 520 310
119 Xray arm / humerus lateral (R) ARLTR 520 310
120 Xray arm / humerus lateral with elbow (bilateral) ARLTELB 1010 610
121 Xray arm / humerus lateral with elbow (L) ARLTELL 520 310
122 Xray arm / humerus lateral with elbow (R) ARLTELR 520 310
123 Xray arm / humerus lateral with shoulder (bilateral) ARLTSHB 1010 610
124 Xray arm / humerus lateral with shoulder (L) ARLTSHL 520 310
125 Xray arm / humerus lateral with shoulder (R) ARLTSHR 520 310
126 Xray arm for foreign body localisation (bilateral) ARFBLB 1010 610
127 Xray arm for foreign body localisation (L) ARFBLL 520 310
128 Xray arm for foreign body localisation (R) ARFBLR 520 310
129 Xray aspiration biopsy under image intensifier ABUIIF 3910 2340
130 Xray barium swallow + barium meal (upper GI) BSBMUGI 4870 2930
131 Xray Bilateral lower limb length AP & Lateral (Digital) XBLLLAPLD 2660 2660
132 Xray Bilateral lower limb length AP (Digital) XBLLLAPD 1770 1770
133 Xray Bilateral lower limb length Lateral (Digital) XBLLLLD 1770 1770
134 Xray both lower limbs complete (bilateral) ‐ children BLLBC 520 310
135 Xray breast specimen radiography BRSRAD 1180 700
136 Xray bronchogram (bilateral) BRONCBS 7280 4540
137 Xray bronchogram (L) BRONCSSL 4800 2830
138 Xray bronchogram (R) BRONCSSR 4800 2830
139 Xray calcaneum axial & lateral (bilateral) CALAXLB 1010 610
140 Xray calcaneum axial & lateral (L) CALAXLL 520 310
141 Xray calcaneum axial & lateral (R) CALAXLR 520 310
142 Xray calcaneum axial (bilateral) CALAXB 520 310
143 Xray calcaneum axial (L) CALAXL 520 310
144 Xray calcaneum axial (R) CALAXR 520 310
145 Xray calcaneum lateral (bilateral) CALLTB 520 310
146 Xray calcaneum lateral (L) CALLTL 520 310
147 Xray calcaneum lateral (R) CALLTR 520 310
148 Xray cephalogram CEPGRAM 720 430
149 Xray cervical spine (lateral) in extension CSPRE 520 310
150 Xray cervical spine (lateral) in flexion CSPLF 520 310
151 Xray cervical spine AP & lateral view CSAPLTV 1010 610
152 Xray cervical spine AP view CSPAP 520 310
153 Xray cervical spine in flexion, extension & neutral CSPFEFC 1490 890
154 Xray cervical spine lateral for cranio‐vertebrae CSPLCV 520 310
junction
155 Xray cervical spine lateral view CSPL 520 310
156 Xray cervical spine oblique (bilateral) CSPOB 1010 610
157 Xray cervical spine oblique (L) CSPOL 520 310
158 Xray cervical spine oblique (R) CSPOR 520 310
159 Xray cervical spine open mouth for CV junction CSPOM 520 310
84
160 Xray cervico‐dorsal spine AP & lateral view CDSAPLV 1010 610
161 Xray cervico‐dorsal spine AP & swimmers view CDSAPSV 520 310
162 Xray cervico‐dorsal spine AP view CDSPAP 520 310
163 Xray cervico‐dorsal spine lateral view CDSPL 520 310
164 Xray cervico‐dorsal spine swimmers view CDSPSW 520 310
165 Xray check procedure post biliary dilatation CPPBDIL 5310 5310
166 Xray chest AP CHAP 520 310
167 Xray chest AP for ribs bucky film CHAPR 520 310
168 Xray chest apicogram CHAPGM 520 310
169 Xray chest decubitus (L) CHDBL 520 310
170 Xray chest decubitus (R) CHDBR 520 310
171 Xray chest fluroscopy CHFL 1070 640
172 Xray chest for foreign body localisation CHFBL 1070 640
173 Xray chest lateral (L) CHLATL 520 310
174 Xray chest lateral (R) CHLATR 520 310
175 Xray chest oblique (L) CHOBQL 520 310
176 Xray chest oblique (R) CHOBQR 520 310
177 Xray chest PA & lateral (L) CHPALTL 1010 610
178 Xray chest PA & lateral (R) CHPALTR 1010 610
179 Xray chest PA ( CXR ) CHPA 520 310
180 Xray chest PA penetrating CHPAPL 520 310
181 Xray clavicle AP view (bilateral) CLALAPB 1010 610
182 Xray clavicle AP view (L) CLALAPL 520 310
183 Xray clavicle AP view (R) CLALAPR 520 310
184 Xray coccyx AP COAP 520 310
185 Xray coccyx AP & lateral COAPLT 1010 610
186 Xray coccyx lateral COL 520 310
187 Xray dental Xray each film DTXRAYF 240 140
188 Xray dorsal lumbar spine AP & lateral view DLSAPLTV 1010 610
189 Xray dorsal lumbar spine AP view DLSLAPV 520 310
190 Xray dorsal lumbar spine lateral view DLSLTV 520 310
191 Xray dorsal spine AP & lateral view DSAPLTV 1010 610
192 Xray dorsal spine AP view DSPAP 520 310
193 Xray dorsal spine lateral view DSPL 520 310
194 Xray dorsal spine oblique view (L) DSOBLL 520 310
195 Xray dorsal spine oblique view (R) DROBLR 520 310
196 Xray ear pinna ‐ soft tissue (bilateral) EARPSTB 1010 610
197 Xray ear pinna ‐ soft tissue (L) EARPSTL 520 310
198 Xray ear pinna ‐ soft tissue (R) EARPSTR 520 310
199 Xray elbow AP & lateral (bilateral) ELBAPLB 1010 610
200 Xray elbow AP & lateral (L) ELBAPLL 520 310
201 Xray elbow AP & lateral (R) ELBAPLR 520 310
202 Xray elbow AP (bilateral) ELBAPBIL 520 310
203 Xray elbow AP (L) ELBAPL 520 310
204 Xray elbow AP (R) ELBAPR 520 310
205 Xray elbow lateral (bilateral) ELBLTB 520 310
206 Xray elbow lateral (L) ELBLTL 520 310
207 Xray elbow lateral (R) ELBLTR 520 310
208 Xray ERCP ERCP 3540 2120
209 Xray ERCP with papillotomy (includes one ampoule ERCPWPT 4620 2770
ionic contrast)
210 Xray ERCP with papilotomy & dormia basketing of ERCPPDB 4620 2770
stone
211 Xray ERCP with stenting ERCPST 4250 2550
212 Xray ethmoid sinus (bilateral) ETHSB 520 310
213 Xray ethmoid sinus (L) ETHSL 520 310
214 Xray ethmoid sinus (R) ETHSR 520 310
85
215 Xray feet (bilateral) AP FTAP 520 310
216 Xray feet (bilateral) AP & lateral FTBAPLT 1010 610
217 Xray feet (bilateral) AP & oblique FTBAPOB 1010 610
218 Xray feet (bilateral) lateral FTLAT 520 310
219 Xray feet (bilateral) oblique FTBOBL 520 310
220 Xray feet for arch lateral (bilateral) FTALTB 520 310
221 Xray femur (including hip joint) AP & lateral (bilateral) FRHJAPLTB 2000 1200
222 Xray femur (including hip joint) AP & lateral (L) FRHJAPLTL 1010 610
223 Xray femur (including hip joint) AP & lateral (R) FRHJAPLTR 1010 610
224 Xray femur (including hip joint) AP (bilateral) FRHJAPBIL 1010 610
225 Xray femur (including hip joint) AP (L) FRHJAPL 520 310
226 Xray femur (including hip joint) AP (R) FRHJAPR 520 310
227 Xray femur (including hip joint) lateral (bilateral) FRHJLTBIL 1010 610
228 Xray femur (including hip joint) lateral (L) FRHJLTL 520 310
229 Xray femur (including hip joint) lateral (R) FRHJLTR 520 310
230 Xray femur (including knee joint) AP & lateral FRKJAPLTB 2000 1200
(bilateral)
231 Xray femur (including knee joint) AP & lateral (L) FRKJAPLTL 1010 610
232 Xray femur (including knee joint) AP & lateral (R) FRKJAPLTR 1010 610
233 Xray femur (including knee joint) AP (bilateral) FRKJAPBIL 1010 610
234 Xray femur (including knee joint) AP (L) FRKJAPL 520 310
235 Xray femur (including knee joint) AP (R) FRKJAPR 520 310
236 Xray femur (including knee joint) lateral (bilateral) FRKJLTB 1010 610
237 Xray femur (including knee joint) lateral (L) FRKJLTL 520 310
238 Xray femur (including knee joint) lateral (R) FRKJLTR 520 310
239 Xray femur AP & lateral (bilateral) THAPLFB 2000 1200
240 Xray femur AP & lateral (L) THAPLFL 1010 610
241 Xray femur AP & lateral (R) THAPLFR 1010 610
242 Xray femur AP (bilateral) FEAPB 1010 610
243 Xray femur AP (L) FEAPLT 520 310
244 Xray femur AP (R) FEAPRT 520 310
245 Xray femur lateral (bilateral) FELAB 1010 610
246 Xray femur lateral (L) FELALT 520 310
247 Xray femur lateral (R) FELART 520 310
248 Xray first carpo metacarpal joint (bilateral) FTCMJB 520 310
249 Xray first carpo metacarpal joint (L) FTCMJL 520 310
250 Xray first carpo metacarpal joint (R) FTCMJR 520 310
251 Xray floor of orbit (bilateral) FLORBB 520 310
252 Xray floor of orbit (L) FLORBL 520 310
253 Xray floor of orbit (R) FLORBR 520 310
254 Xray Foetogram INTOGRMF 520 310
255 Xray foot AP & lateral (L) FTAPLL 520 310
256 Xray foot AP & lateral (R) FTAPLR 520 310
257 Xray foot AP & oblique (L) FTAPOBL 520 310
258 Xray foot AP & oblique (R) FTAPOBR 520 310
259 Xray foot AP (L) FOOTAPL 520 310
260 Xray foot AP (R) FOOTAPR 520 310
261 Xray foot AP , Lateral & oblique (Bilateral) FAPLTOBB 1490 890
262 Xray foot AP , Lateral & oblique (L) FAPLTOBL 1010 610
263 Xray foot AP , Lateral & oblique (R) FAPLTOBR 1010 610
264 Xray foot for arch lateral (L) FTAHLTL 520 310
265 Xray foot for arch lateral (R) FTAHLTR 520 310
266 Xray foot for foreign body localisation (bilateral) FOTFBLB 520 310
267 Xray foot for foreign body localisation (L) FOTFBLL 520 310
268 Xray foot for foreign body localisation (R) FOTFBLR 520 310
269 Xray foot lateral (L) FOTLTL 520 310
270 Xray foot lateral (R) FOTLTR 520 310
86
271 Xray foot oblique (L) FOTOBL 520 310
272 Xray foot oblique (R) FOTOBR 520 310
273 Xray for foreign body in orbit (bilateral) FFBORBB 520 310
274 Xray for foreign body in orbit (L) FFBORBL 520 310
275 Xray for foreign body in orbit (R) FFBORBR 520 310
276 Xray forearm AP & lateral (bilateral) FAPLB 1010 610
277 Xray forearm AP & lateral (L) FAPLL 520 310
278 Xray forearm AP & lateral (R) FAPLR 520 310
279 Xray forearm AP (bilateral) FARMAPB 520 310
280 Xray forearm AP (L) FARMAPL 520 310
281 Xray forearm AP (R) FARMAPR 520 310
282 Xray forearm for foreign body localisation (bilateral) FARMFBLB 520 310
283 Xray forearm for foreign body localisation (L) FARMFBLL 520 310
284 Xray forearm for foreign body localisation (R) FARMFBLR 520 310
285 Xray forearm for soft tissue AP & lateral (bilateral) FSTAPB 1010 610
286 Xray forearm for soft tissue AP & lateral (L) FSTAPL 520 310
287 Xray forearm for soft tissue AP & lateral (R) FSTAPR 520 310
288 Xray forearm with elbow AP & lateral (bilateral) FAEALB 1010 610
289 Xray forearm with elbow AP & lateral (L) FAEALL 520 310
290 Xray forearm with elbow AP & lateral (R) FAEALR 520 310
291 Xray forearm with wrist AP & lateral (bilateral) FWAPLB 1010 610
292 Xray forearm with wrist AP & lateral (L) FWAPLL 520 310
293 Xray forearm with wrist AP & lateral (R) FWAPLR 520 310
294 Xray hand ‐ soft tissue AP view (bilateral) HDSTAPB 520 310
295 Xray hand ‐ soft tissue AP view (L) HDSTAPL 520 310
296 Xray hand ‐ soft tissue AP view (R) HDSTAPR 520 310
297 Xray hand ( ball catcher view ) HBRA 520 310
298 Xray hand AP & Lateral (bilateral) HAPLTB 1010 610
299 Xray hand AP & Lateral (L) HAPLTL 520 310
300 Xray hand AP & Lateral (R) HAPLTR 520 310
301 Xray hand AP & oblique (bilateral) HLOBLB 1010 610
302 Xray hand AP & oblique (L) HLOBLL 520 310
303 Xray hand AP & oblique (R) HLOBLR 520 310
304 Xray hand AP (bilateral) HPOBL 520 310
305 Xray hand AP (L) HPA 520 310
306 Xray hand AP (R) HPAL 520 310
307 Xray hand AP , Lateral & oblique (bilateral) HAPLTOBB 1010 610
308 Xray hand AP , Lateral & oblique (L) HAPLTOBL 1010 610
309 Xray hand AP , Lateral & oblique (R) HAPLTOBR 1010 610
310 Xray hand for foreign body localisation (bilateral) HDFBLB 520 310
311 Xray hand for foreign body localisation (L) HDFBLL 520 310
312 Xray hand for foreign body localisation (R) HDFBLR 520 310
313 Xray hand lateral (bilateral) HDLTB 520 310
314 Xray hand lateral (L) HLATL 520 310
315 Xray hand lateral (R) HLATR 520 310
316 Xray hand oblique (bilateral) HOBLB 520 310
317 Xray hand oblique (L) HOBLL 520 310
318 Xray hand oblique (R) HOBLR 520 310
319 Xray hand ulnar deviation (for scaphoid) (bilateral) HDUDSB 520 310
320 Xray hand ulnar deviation (for scaphoid) (L) HDUDSL 520 310
321 Xray hand ulnar deviation (for scaphoid) (R) HDUDSR 520 310
322 Xray heel axial (bilateral) HLAXB 520 310
323 Xray heel axial (L) HLAXL 520 310
324 Xray heel axial (R) HLAXR 520 310
325 Xray heel lateral & axial (bilateral) HLLAXB 1010 610
326 Xray heel lateral & axial (L) HLLAXL 520 310
327 Xray heel lateral & axial (R) HLLAXR 520 310
87
328 Xray heel lateral (bilateral) HLLTB 520 310
329 Xray heel lateral (L) HLLTL 520 310
330 Xray heel lateral (R) HLLTR 520 310
331 Xray heel pads lateral view (bilateral) HLPLTBIL 520 310
332 Xray hip AP & lateral (bilateral) HIPAPLTB 2000 1200
333 Xray hip AP & lateral (L) HIPAPLTL 1010 610
334 Xray hip AP & lateral (R) HIPAPLTR 1010 610
335 Xray hip AP (L) HIPAPL 520 310
336 Xray hip AP (R) HIPAPR 520 310
337 Xray hip for acetabulum AP view (L) HIPAAPL 520 310
338 Xray hip for acetabulum AP view (R) HIPAAPR 520 310
339 Xray hip lateral (bilateral) HIPLTB 1010 610
340 Xray hip lateral (L) HIPLTL 520 310
341 Xray hip lateral (R) HIPLTR 520 310
342 Xray hips for acetabulum AP view (bilateral) HIPAAPB 1010 610
343 Xray hips including thighs (AP view for hip HIPITHB 1010 610
dislocation) ‐ bilateral
344 Xray iliac crest for bone age ( pelvis AP view ) ILCBPAP 520 310
345 Xray index finger AP & lateral (L) IXFRAPLTL 520 310
346 Xray index finger AP & lateral (R) IXFRAPLTR 520 310
347 Xray infantogram INTOGRM 520 310
348 Xray inferior orbital fissure (bilateral) INFORBFB 520 310
349 Xray inferior orbital fissure (L) INFORBFL 520 310
350 Xray inferior orbital fissure (R) INFORBFR 520 310
351 Xray invertogram INVTOGRM 1010 610
352 Xray IVP non‐ionic contrast with lasix challenge XNILC 4430 2660
353 Xray knee AP & lateral (bilateral) KNAPLTB 1010 610
354 Xray knee AP & lateral (L) KNAPLTL 520 310
355 Xray knee AP & lateral (R) KNAPLTR 520 310
356 Xray knee AP (bilateral) KNAPBIL 520 310
357 Xray knee AP (erect) (bilateral) BTKAP 520 310
358 Xray knee AP (erect) (L) LTKAP 520 310
359 Xray knee AP (erect) (R) RTKAP 520 310
360 Xray knee AP (L) KNEEAPL 520 310
361 Xray knee AP (R) KNAPR 520 310
362 Xray knee lateral (bilateral) KNLTBL 520 310
363 Xray knee lateral (L) KNLTL 520 310
364 Xray knee lateral (R) KNLTR 520 310
365 Xray knee skyline (bilateral) KNSKYB 1010 610
366 Xray knee skyline (L) KNSKYL 520 310
367 Xray knee skyline (R) KNSKYR 520 310
368 Xray knee tunnel / axial view (bilateral) KNTAXB 520 310
369 Xray knee tunnel / axial view (L) KNAXL 520 310
370 Xray knee tunnel / axial view (R) KNAXR 520 310
371 Xray KUB AMENKUB 1010 610
372 Xray KUB ( single film ) AMENKUBS 520 310
373 Xray left elbow for bone age (AP & lateral view) LELBAPLTV 520 310
374 Xray left hand for bone age (PA view) LTHDBAPA 520 310
375 Xray Left lower limb length AP & Lateral (Digital) XLLLLAPLD 1770 1770
376 Xray Left lower limb length AP (Digital) XLLLLAPD 1070 1070
377 Xray Left lower limb length Lateral (Digital) XLLLLLD 1070 1070
378 Xray leg AP & lateral (bilateral) LEGAPLTB 1010 610
379 Xray leg AP & lateral (L) LEGAPLL 520 310
380 Xray leg AP & lateral (R) LEGAPLR 520 310
381 Xray leg AP & lateral with ankle (bilateral) LEGAPAB 1010 610
382 Xray leg AP & lateral with ankle (L) LEGAPAL 520 310
383 Xray leg AP & lateral with ankle (R) LEGAPAR 520 310
88
384 Xray leg AP & lateral with knee (bilateral) LEGAPKB 1010 610
385 Xray leg AP & lateral with knee (L) LEGAPKL 520 310
386 Xray leg AP & lateral with knee (R) LEGAPKR 520 310
387 Xray leg AP (bilateral) LEGAPB 520 310
388 Xray leg AP (L) LEGAPL 520 310
389 Xray leg AP (R) LEGAPR 520 310
390 Xray leg AP with ankle (bilateral) LEGAPANKB 520 310
391 Xray leg AP with ankle (L) LEGAPANKL 520 310
392 Xray leg AP with ankle (R) LEGAPANKR 520 310
393 Xray leg AP with knee (bilateral) LEGAPKNEB 520 310
394 Xray leg AP with knee (L) LEGAPKNEL 520 310
395 Xray leg AP with knee (R) LEGAPKNER 520 310
396 Xray leg lateral (bilateral) LEGLTB 520 310
397 Xray leg lateral (L) LEGLTL 520 310
398 Xray leg lateral (R) LEGLTR 520 310
399 Xray leg lateral with ankle (bilateral) LEGLANKB 520 310
400 Xray leg lateral with ankle (L) LEGLANKL 520 310
401 Xray leg lateral with ankle (R) LEGLANKR 520 310
402 Xray leg lateral with knee (bilateral) LEGLKNEB 520 310
403 Xray leg lateral with knee (L) LEGLKNEL 520 310
404 Xray leg lateral with knee (R) LEGLKNER 520 310
405 Xray little finger AP & lateral (L) LITFRAPLTL 520 310
406 Xray little finger AP & lateral (R) LITFRAPLTR 520 310
407 Xray lower leg for foreign body localisation (bilateral) LLEGFBLB 520 310
408 Xray lower leg for foreign body localisation (L) LLEGFBLL 520 310
409 Xray lower leg for foreign body localisation (R) LLEGFBLR 520 310
410 Xray lumbar spine AP & lateral view LRSAPLT 1010 610
411 Xray lumbar spine AP erect (Lt & Rt bending) LRSAPLTRT 1010 610
412 Xray lumbar spine AP erect (Lt bending) LSAPELB 520 310
413 Xray lumbar spine AP erect (Rt bending) LSAPERB 520 310
414 Xray lumbar spine AP view LSPAP 520 310
415 Xray lumbar spine lateral erect extension LSPLEPE 520 310
416 Xray lumbar spine lateral erect flexion LSPLEPF 520 310
417 Xray lumbar spine lateral erect flexion & extension LSPLEFE 1010 610
418 Xray lumbar spine lateral view LSPL 520 310
419 Xray lumbar spine oblique (bilateral) LSPOB 1010 610
420 Xray lumbar spine oblique (L) LSPOL 520 310
421 Xray lumbar spine oblique (R) LSPOR 520 310
422 Xray lumbosacral spine AP & lateral view LLSAPLT 1010 610
423 Xray lumbosacral spine AP erect (Lt & Rt bending) LLSAPRT 1010 610
424 Xray lumbosacral spine AP erect (Lt bending) LLSAPLTB 520 310
425 Xray lumbosacral spine AP erect (Rt bending) LLSAPRTB 520 310
426 Xray lumbosacral spine AP view including SI joints LLSAPV 520 310
427 Xray lumbosacral spine lateral erect extension LLSAEEXT 520 310
428 Xray lumbosacral spine lateral erect flexion LLSLTEF 520 310
429 Xray lumbosacral spine lateral erect flexion & LLSLTEFE 1010 610
extension
430 Xray lumbosacral spine lateral view LTSLTV 520 310
431 Xray lumbosacral spine oblique (bilateral) LTSOBLB 1010 610
432 Xray lumbosacral spine oblique (L) LTSOBLL 520 310
433 Xray lumbosacral spine oblique (R) LTSOBLR 520 310
434 Xray lunate (bilateral) LUNB 520 310
435 Xray lunate (L) LUNL 520 310
436 Xray lunate (R) LUNR 520 310
437 Xray mandible AP MABAPPA 520 310
438 Xray mandible oblique (bilateral) MABOBB 1010 610
439 Xray mandible oblique (L) MABOBL 520 310
89
440 Xray mandible oblique (R) MABOBR 520 310
441 Xray mastoid lateral oblique (bilateral) MASLOB 1010 610
442 Xray mastoid lateral oblique (L) MASLOL 520 310
443 Xray mastoid lateral oblique (R) MASLOR 520 310
444 Xray mastoid stenvers view (bilateral) MASSVB 1010 610
445 Xray mastoid stenvers view (L) MASSTEN 520 310
446 Xray mastoid stenvers view (R) MASSVR 520 310
447 Xray mastoid townes view MASTOW 520 310
448 Xray mastoid view schuller (bilateral) MASVSB 1010 610
449 Xray mastoid view schuller (L) MASVSC 520 310
450 Xray mastoid view schuller (R) MASVSR 520 310
451 Xray middle finger AP & lateral (L) MIDFAPLTL 520 310
452 Xray middle finger AP & lateral (R) MIDFAPLTR 520 310
453 Xray modified stenvers view for cochlear implant ) (L) MODSCIMPL 520 310
454 Xray modified stenvers view for cochlear implant ) (R) MODSCIMPR 520 310
455 Xray myelogram ( cervical ) MYELOC 8500 5100
456 Xray myelogram ( lumbar ) MYELOL 7460 4480
457 Xray nasal bone lateral (bilateral) NASBLTB 520 310
458 Xray nasal bone lateral (L) NASBLL 520 310
459 Xray nasal bone lateral (R) NASBLR 520 310
460 Xray nasopharynx lateral for adenoids NASADE 520 310
461 Xray neck for foreign body localisation NKFBL 520 310
462 Xray oesophageal dilatation under fluoroscopy ODUTVC 3540 2120
463 Xray oesophageal dilatation under fluoroscopy + ODUTVEI 3540 2120
endo prosthesis insertion
464 Xray oesophagus for foreign body localisation OFBL 520 310
465 Xray optic foramen (bilateral) OPTFORB 1010 610
466 Xray optic foramen (L) OPTFORL 520 310
467 Xray optic foramen (R) OPTFORR 520 310
468 Xray orbit AP & lateral (bilateral) OBITAPLTB 1490 890
469 Xray orbit AP & lateral (L) ORLTAP 1010 610
470 Xray orbit AP & lateral (R) OBITAPLTR 1010 610
471 Xray orbit AP (bilateral) OBITAPB 520 310
472 Xray orbit AP (L) OBITAPL 520 310
473 Xray orbit AP (R) ORRTAP 520 310
474 Xray orbit caldwel (bilateral) ORBITCB 520 310
475 Xray orbit caldwel (L) ORBITCL 520 310
476 Xray orbit caldwel (R) ORBITCR 520 310
477 Xray orbit for foreign body localisation (bilateral) ORBITFBLB 520 310
478 Xray orbit for foreign body localisation (L) ORBITFBLL 520 310
479 Xray orbit for foreign body localisation (R) ORBITFBLR 520 310
480 Xray orbit lateral (bilateral) ORBITLTB 1010 610
481 Xray orbit lateral (L) ORLTLA 520 310
482 Xray orbit lateral (R) ORRTLA 520 310
483 Xray orbit PA (bilateral) OBITPAB 520 310
484 Xray orbit PA (L) OBITPAL 520 310
485 Xray orbit PA (R) OBITPAR 520 310
486 Xray pacemaking (any procedure under fluoroscopy) PMAPTVF 5850 3510
487 Xray paranasal sinus Waters view PNSWAT 520 310
488 Xray patella PA & lateral (bilateral) PATPALB 1010 610
489 Xray patella PA & lateral (L) PATPALL 520 310
490 Xray patella PA & lateral (R) PATPALR 520 310
491 Xray patella tangential (bilateral) PATTANB 520 310
492 Xray patella tangential (L) PATTANL 520 310
493 Xray patella tangential (R) PATTANR 520 310
494 Xray pelvis AP (including both hips) PELAP 520 310
495 Xray penis ( soft tissue ) PEN 520 310
90
496 Xray percutaneous biliary baloon dilatation POUSBBD 17710 10630
497 Xray pisiform (bilateral) PISIB 520 310
498 Xray pisiform (L) PISIL 520 310
499 Xray pisiform (R) PISIR 520 310
500 Xray PTC PTC 6200 3720
501 Xray right hypochondrium for gall bladder RHYPOGB 520 310
502 Xray Right lower limb length AP & Lateral (Digital) XRLLLAPLD 1770 1770
503 Xray Right lower limb length AP (Digital) XRLLLAD 1070 1070
504 Xray Right lower limb length Lateral (Digital) XRLLLLD 1070 1070
505 Xray ring finger AP & lateral (L) RGFRAPLTL 520 310
506 Xray ring finger AP & lateral (R) RGFRAPLTR 520 310
507 Xray roof of orbit (bilateral) ROOFOB 520 310
508 Xray roof of orbit (L) ROOFOL 520 310
509 Xray roof of orbit (R) ROOFOR 520 310
510 Xray sacro coccyx spine / junction ‐ AP & Lateral SCSAL 1010 610
511 Xray sacro coccyx spine / junction ‐ lateral SCSL 520 310
512 Xray sacroiliac joint AP (bilateral) SIJTAPB 520 310
513 Xray sacroiliac joint AP (L) SIJTAPL 520 310
514 Xray sacroiliac joint AP (R) SIJTAPR 520 310
515 Xray sacroiliac joint oblique (bilateral) SIJTOBB 1010 610
516 Xray sacroiliac joint oblique (L) SIJTOBL 520 310
517 Xray sacroiliac joint oblique (R) SIJTOBR 520 310
518 Xray sacrum AP SSPAP 520 310
519 Xray sacrum AP & lateral SSAPLT 1010 610
520 Xray sacrum lateral SSPL 520 310
521 Xray scapula AP & lateral (bilateral) SCPLAPLB 2000 1200
522 Xray scapula AP & lateral (L) SCPLAPLL 1010 610
523 Xray scapula AP & lateral (R) SCPLAPLR 1010 610
524 Xray scapula AP (bilateral) SCPLAPB 1010 610
525 Xray scapula AP (L) SCPLAPL 520 310
526 Xray scapula AP (R) SCPLAPR 520 310
527 Xray scapula axial (bilateral) SCPAB 1010 610
528 Xray scapula axial (L) SCPAL 520 310
529 Xray scapula axial (R) SCPAR 520 310
530 Xray scapula lateral (bilateral) SCPLB 1010 610
531 Xray scapula lateral (L) SCPLL 520 310
532 Xray scapula lateral (R) SCPLR 520 310
533 Xray scapula Y ‐ view (bilateral) SCPYB 1010 610
534 Xray scapula Y ‐ view (L) SCPYL 520 310
535 Xray scapula Y ‐ view (R) SCPYR 520 310
536 Xray screening fluoroscopy SFLURO 1070 640
537 Xray shoulder AP & lateral (bilateral) SHOAPLTB 2000 1200
538 Xray shoulder AP & lateral (L) SHOAPLTL 1010 610
539 Xray shoulder AP & lateral (R) SHOAPLTR 1010 610
540 Xray shoulder AP (bilateral) SHAPB 1010 610
541 Xray shoulder AP (L) SHAPL 520 310
542 Xray shoulder AP (R) SHAPR 520 310
543 Xray shoulder axial (axillary) (bilateral) SHAXB 1010 610
544 Xray shoulder axial (axillary) (L) SHAXL 520 310
545 Xray shoulder axial (axillary) (R) SHAXR 520 310
546 Xray shoulder lateral (bilateral) SHLATB 1010 610
547 Xray shoulder lateral (L) SHLATL 520 310
548 Xray shoulder lateral (R) SHLATR 520 310
549 Xray shoulder lateral transthoracic (bilateral) SHLTTHB 1010 610
550 Xray shoulder lateral transthoracic (L) SHLTTHL 520 310
551 Xray shoulder lateral transthoracic (R) SHLTTHR 520 310
552 Xray skeletal survey ( extended ‐ 11 films) SKELSE11 5510 3310
91
553 Xray skeletal survey ( standard ‐ 5 films ) SKELSS5 2500 1500
554 Xray skull AP SKUAP/PA 520 310
555 Xray skull AP & lateral SKUAPLT 1010 610
556 Xray skull AP for styloid process SKUAPSP 520 310
557 Xray skull base / basal view / submento‐vertebral SKUBAS 520 310
view
558 Xray skull cone down lateral for sella ( pitutary fossa ) SKUCDS 520 310
559 Xray skull for jugular foramen SKJF 520 310
560 Xray skull lateral (bilateral) SKULB 1010 610
561 Xray skull lateral (L) SKULL 520 310
562 Xray skull lateral (R) SKULR 520 310
563 Xray skull maxilla SKUMAX 520 310
564 Xray skull oblique for optic foramina (bilateral) SKUOOFB 1010 610
565 Xray skull oblique for optic foramina (L) SKUOOFL 520 310
566 Xray skull oblique for optic foramina (R) SKUOOFR 520 310
567 Xray skull occipito‐frontal view SKOCCF 520 310
568 Xray skull perorbital view SKUPERIV 520 310
569 Xray skull tangential view SKTGV 520 310
570 Xray skull Towne's / fronto‐occipital 15 deg SKUTOW 520 310
571 Xray skull Townes / fronto‐occipital 20 deg SKUTOW20 520 310
572 Xray skull Townes / fronto‐occipital 30 deg SKUTOW30 520 310
573 Xray soft tissue neck AP NAP 520 310
574 Xray soft tissue neck AP & lateral NAPL 1010 610
575 Xray soft tissue neck lateral NLA 520 310
576 Xray soft tissue neck lateral ( adenoids / nasopharynx NLAA 520 310
)
577 Xray sphenoid sinus (lateral) SSINLT 520 310
578 Xray sterno clacicular joint AP (bilateral) STCJAPB 520 310
579 Xray sterno clavicular joint AP (L) STCJAPL 520 310
580 Xray sterno clavicular joint AP (R) STCJAPR 520 310
581 Xray sterno clavicular joint oblique (bilateral) STCJOBB 1010 610
582 Xray sterno clavicular joint oblique (L) STCJOBL 520 310
583 Xray sterno clavicular joint oblique (R) STCJOBR 520 310
584 Xray sternum AP STERAP 520 310
585 Xray sternum lateral STERLT 520 310
586 Xray sternum oblique (L) STEROBL 520 310
587 Xray sternum oblique (R) STEROBR 520 310
588 Xray styloid processes AP STLPAP 520 310
589 Xray submandibular gland area (L) SMABGOL 520 310
590 Xray submandibular gland area (R) SMABGOR 520 310
591 Xray subtalar joint (bilateral) SJB 1010 610
592 Xray subtalar joint (L) SJL 520 310
593 Xray subtalar joint (R) SJR 520 310
594 Xray superior orbital fissure (bilateral) SOFISB 520 310
595 Xray superior orbital fissure (L) SOFISL 520 310
596 Xray superior orbital fissure (R) SOFISR 520 310
597 Xray temporo mandibular joints (closed mouth) TMJCMB 1010 610
(bilateral)
598 Xray temporo mandibular joints (closed mouth) (L) TMJCML 520 310
599 Xray temporo mandibular joints (closed mouth) (R) TMJCMR 520 310
600 Xray temporo mandibular joints (open & closed TMJOCMB 2000 1200
mouth) (bilateral)
601 Xray temporo mandibular joints (open & closed TMJOCML 1010 610
mouth) (L)
602 Xray temporo mandibular joints (open & closed TMJOCMR 1010 610
mouth) (R)
92
603 Xray temporo mandibular joints (open mouth) TMJOMB 1010 610
(bilateral)
604 Xray temporo mandibular joints (open mouth) (L) TMJOML 520 310
605 Xray temporo mandibular joints (open mouth) (R) TMJOMR 520 310
606 Xray thigh for foreign body localisation (bilateral) THFBLB 1010 610
607 Xray thigh for foreign body localisation (L) THFBLL 520 310
608 Xray thigh for foreign body localisation (R) THFBLR 520 310
609 Xray thigh for soft tissue AP & lateral (bilateral) THSTAPLTB 2000 1200
610 Xray thigh for soft tissue AP & lateral (L) THSTAPLTL 1010 610
611 Xray thigh for soft tissue AP & lateral (R) THSTAPLTR 1010 610
612 Xray thigh for soft tissue AP (bilateral) THSTAPB 1010 610
613 Xray thigh for soft tissue AP (L) THSTAPL 520 310
614 Xray thigh for soft tissue AP (R) THSTAPR 520 310
615 Xray thoracic inlet view THIAP 520 310
616 Xray thumb AP & lateral (L) THUAPLTL 520 310
617 Xray thumb AP & lateral (R) THUAPLTR 520 310
618 Xray Thumb AP (bilateral) THUALB 520 310
619 Xray trapezium (bilateral) TZIUB 520 310
620 Xray trapezium (L) TZIUL 520 310
621 Xray trapezium (R) TZIUR 520 310
622 Xray venogram lower limb (bilateral) VENOLLB 8870 5320
623 Xray venogram lower limb (L) VENOLLL 5310 3190
624 Xray venogram lower limb (R) VENOLLR 5310 3190
625 Xray venogram upper limb (bilateral) VENOULB 8870 5320
626 Xray venogram upper limb (L) VENOULL 5310 3190
627 Xray venogram upper limb (R) VENOULR 5310 3190
628 Xray Whole spine digital film AP XWSDAP 1070 1070
629 Xray Whole spine digital film AP & Lateral XWSDAPL 1770 1770
630 Xray Whole spine digital film AP & Lateral (Left XWSDFAPLLB 1770 1770
Bending)
631 Xray Whole spine digital film AP & Lateral (Right XWSDFAPLRB 1770 1770
Bending)
632 Xray Whole spine digital film AP ( Right & Left XWSDFAPLRLB 2660 2660
Bending )
633 Xray Whole spine digital film AP (Left Bending) XWSDFAPLB 1070 1070
634 Xray Whole spine digital film AP (Right Bending) XWSDFAPRB 1070 1070
635 Xray Whole spine digital film Lateral XWSDL 1070 1070
636 Xray wrist and hand for bone age WRHBA 520 310
637 Xray wrist AP & lateral (bilateral) WRPALB 1010 610
638 Xray wrist AP & lateral (L) WRPALL 520 310
639 Xray wrist AP & lateral (R) WRPALR 520 310
640 Xray wrist AP & oblique (bilateral) WRAPLATB 520 310
641 Xray wrist AP & oblique (L) WRAPLATL 520 310
642 Xray wrist AP & oblique (R) WRAPLATR 520 310
643 Xray wrist AP (bilateral) WRPAB 520 310
644 Xray wrist AP (L) WRPAL 520 310
645 Xray wrist AP (R) WRPAR 520 310
646 Xray wrist AP, lateral & oblique (bilateral) WRAPLOBB 1490 890
647 Xray wrist AP, lateral & oblique (L) WRAPLOBL 1010 610
648 Xray wrist AP, lateral & oblique (R) WRAPLOBR 1010 610
649 Xray wrist carpal tunnel (bilateral) WRCTNLB 520 310
650 Xray wrist carpal tunnel (L) WRCTNLL 520 310
651 Xray wrist carpal tunnel (R) WRCTNLR 520 310
652 Xray wrist lateral (bilateral) WRLATB 520 310
653 Xray wrist lateral (L) WRLATL 520 310
654 Xray wrist lateral (R) WRLATR 520 310
655 Xray zygomatic arch base ZYGABAS 520 310
93
656 Xray zygomatic arch oblique tangential ZYGAOBLT 520 310
657 Xray zygomatic arch Townes ZYGATOW 520 310
658 Xray barium enema (double contrast) BEDCON
Xray barium dye Charges ( Rs. 320 ) BEDCONDYE 320 320
Xray barium enema (double contrast) BEDCON 5510 3310
659 Xray barium enema BELBOW
Xray barium dye Charges ( Rs. 320 ) BEDCONDYE 320 320
Xray barium enema BELBOW 4260 2550
660 Xray barium meal follow through BHFT
Xray barium dye Charges BHFTDYE 150 150
Xray barium meal follow through BHFT 3740 2240
661 Xray barium meal upper GI BMUGIT
Xray barium meal upper GI BMUGIT 3110 1870
662 Xray barium swallow for foreign body localisation BSFBL
Xray barium swallow for foreign body localisation BSFBL 2150 1290
663 Xray barium swallow (for heart) with fluoroscopy BSHFLS
Xray barium swallow (for heart) with fluoroscopy BSHFLS 2150 1290
664 Xray barium distal cologram COLOD
Xray barium distal cologram COLOD 2150 1290
Xray barium distal cologram ( dye Charges ) COLODDYE 150 150
665 Xray gastrografin cologram COLOG
Xray gastrografin cologram COLOG 2830 1690
Xray gastrografin dye Charges ‐ 3 Ampoules ( Rs. 970 ) COLOGDYE 970 970
666 Xray Colonic transit time COLOTTOS
Xray Colonic transit time COLTT 3910 2340
667 Xray penile cavernosogram CONG
Xray gastrografin dye Charges ‐ Vial ( Rs. 640 ) GAST2DYE 640 640
Xray penile cavernosogram CONG 4260 2550
668 Xray barium upper GI and follow through CUGITAF
Xray barium upper GI and follow through CUGITAF 5510 3310
669 Xray cystouretherogram ( MCU ) CYSTOMCU
Xray cystouretherogram ( MCU ) CYSTOMCU 4430 2830
Xray gastrografin dye Charges ( Rs. 1130) CYSTOMCVDYE 1130 1130
670 Xray cystogram ( MCU ) CYSTOMCV
Xray cystogram ( MCU ) CYSTOMCV 4430 2830
Xray gastrografin dye Charges ( Rs. 1130) CYSTOMCVDYE 1130 1130
671 Xray Dacrocystogram DACROOS
Xray Dacrocystogram DACROCYS 2500 1500
Xray gastrografin dye charges ‐ Ampoule ( Rs. 320 ) BDGDYE 320 320
672 Xray Defaecography DAFGRAOS
Xray Barium paste charges ( Rs. 250 ) BARPAST 250 250
Xray Defaecography DEFAGRA 6740 4050
673 Xray Distal cologram with RGU ( Barium + Gastrografin ) DISRGUBGOS
Xray Distal cologram with RGU ( Barium + Gastrografin ) DISCOLORGU 3540 2120
674 Xray Distal cologram with RGU ( Gastrografin ) DISRGUGASOS
Xray Distal cologram with RGU ( Gastrografin ) DISCOLORGUGAS 3540 2120
675 Xray gastric band adjustment under image intensifier GASBANDOS
Xray Gastric band adjustment under image intensifier GASBAND 1960 1180
94
676 Xray gastrografin upper GI GAST
Xray gastrografin upper GI GAST 3990 2400
677 Xray gastrografin swallow GAST2
Xray gastrografin swallow GAST2 1960 1170
678 Xray gastrografin follow through GAST3
Xray gastrografin follow through GAST3 3740 2240
679 Xray gastrografin upper GI & follow through GAST4
Xray gastrografin upper GI & follow through GAST4 5850 3510
680 Xray gastrografin enema GASTENE
Xray gastrografin enema GASTENE 4260 2550
681 Xray genitogram GENT
Xray genitogram GENT 3740 2240
682 Xray hysterosalpingogram ( HSG ) HSG
Xray hysterosalpingogram ( HSG ) HSG 3540 2150
683 Xray Ileostogram with barium ILEOBAROS
Xray Ileostogram with barium ILEOBAR 2220 1330
684 Xray Ileostogram with gastrografin ILEOGASOS
Xray Ileostogram with gastrografin ILEOGAS 3910 2340
685 Xray IVP (non‐ionic contrast) IVPA
Xray IVP (non‐ionic contrast) IVPA 3910 2340
Xray IVP (non‐ionic contrast) ( dye Charges ) IVPADYE 2090 2090
686 Xray IVP (non‐ionic contrast) child IVPC2
Xray IVP (non‐ionic contrast) child IVPC2 4620 2770
Xray IVP (non‐ionic contrast) child ( dye Charges ) IVPC2DYE 810 810
687 Xray Loopogram with barium LOOPOBAROS
Xray Loopogram with Barium LOOPOGRAM 2220 1330
688 Xray Loopogram with gastrografin LOOPOGASOS
Xray Loopogram with Gastrografin LOOPOGAS 3540 2120
689 Lumbosacral Spine ‐ Sitting & Lying Position LUMSTOS
Lumbosacral Spine ‐ Lateral view in lying down position LUMSLD 520 310
Lumbosacral Spine ‐ Lateral view in sitting position LUMST 520 310
690 Xray nephrostogram (bilateral) NEPB
Xray nephrostogram (bilateral) NEPB 5150 3090
691 Xray nephrostogram (L) NEPL
Xray nephrostogram (L) NEPL 3740 2240
692 Xray nephrostogram (R) NEPR
Xray nephrostogram (R) NEPR 3740 2240
693 Xray barium swallow OPBSLOW
Xray barium swallow OPBSLOW 2150 1290
694 Xray pouchogram (with barium) POUWBAR
Xray pouchogram (with barium) POUWBAR 2150 1290
95
695 Xray pouchogram (with gastrografin) POUWGAS
Xray pouchogram (with gastrografin) POUWGAS 2150 1290
696 Xray PTBD gram PTBDGRAM
Xray PTBD gram PTBDGRAM 3540 2120
697 Xray RGP in Xray department RGPIDM
Xray RGP in Xray department RGPIDM 3540 2120
698 Xray RGP in OT RGPIOT
Xray RGP in OT RGPIOT 4620 2770
699 Xray RGU RGU
Xray RGU RGU 3740 2240
700 Xray small bowel barium enema ( enteroclysis ) SBBEMA
Xray small bowel barium enema ( enteroclysis ) SBBEMA 7280 4370
701 Xray parotid sialogram (bilateral) SIALBS
Xray parotid sialogram (bilateral) SIALBS 3100 1860
702 Xray parotid sialogram (R) SIALOR
Xray parotid sialogram (R) SIALOR 1770 1070
703 Xray parotid sialogram (L) SIALOS
Xray parotid sialogram (L) SIALOS 1770 1070
704 Xray sinogram / fistulogram SINOG
Xray sinogram / fistulogram SINOG 2310 1390
705 Xray submandibular sialogram (bilateral) SMABSB
Xray submandibular sialogram (bilateral) SMABSB 3100 1860
706 Xray submandibular sialogram (L) SMABSL
Xray submandibular sialogram (L) SMABSL 1770 1070
707 Xray submandibular sialogram (R) SMABSR
Xray submandibular sialogram (R) SMABSR 1770 1070
708 Xray T ‐ tube cholangiogram TTCG
Xray T ‐ tube cholangiogram TTCG 2940 1760
709 Xray VP shuntogram VENOVPS
Xray VP shuntogram VENOVPS 3300 1980
710 Pericatheteric RGU( including dye charges ) ‐ XRAY XRAYRGOS
Pericatheteric RGU ‐ Dye charges XRAYRGUDY 320 320
Pericatheteric RGU ‐ Xray XRAYRGU 3740 2240
711 Stentogram ( including dye charges ) XRAYSCOS
Stentogram charges ‐ Xray XRAYSC 2940 1760
Stentogram Dye charges ‐ Xray XRAYDYE 320 320

96
X‐Ray Mammography Charges

CAT 1/CAT2 CAT3
1 ADD ON 3D MAMMOGRAPHY CHARGES ADDMAMOG 2500 1500
2 Breast FNAC under Radiological guidance ‐ Radiology BFNACDF 1500
Dept. Charges
3 Breast Ultrasound ( Radiology ) BRERAD 2000 1200
4 Hook wire localisation under radiological guidance ‐ HKWLHC 0 3000
Radiology Dept. fee
5 Mammographic hook wire localisation HWLOCAL 7500 2000
6 Mammographic hook wire localizatio ( Hook wire and MAHWL 2000
film charges only)
7 Radiological evaluation of collection REVACOL 510 510
8 Radiological evaluation of stent patency REVASTPT 510 510
9 Radiological guidance charges for FNAC / Biopsy ( RDFNACINT 600 600
interventional) ‐ Dept Charges
10 Tomosynthesis Charges ‐ Mammography TOMOMAM 5000 3000
Dept.Charges
11 Breast FNAC under Radiological guidance BFNACOS
Breast FNAC under Radiological guidance ‐ Radiologist fee BFNACRF 1580
Breast FNAC under Radiological guidance ‐ Radiology Dept. Charges BFNACDF 1500
12 Breast core biopsy under radiological guidance BRBIOS
Breast core biopsy under radiological guidance ‐ Radiologist fee BRBIORF 2500
Breast core biopsy under radiological guidance ‐ Radiology Dept. Charges BRBIOHC 2500 1500
13 Hook wire localisation under radiological guidance HKWLOS
Hook wire localisation under radiological guidance ‐ Radiologist fee HKWLRF 2500 1500
Hook wire localisation under radiological guidance ‐ Radiology Dept. fee HKWLHC 3000
14 Breast Tomosynthesis (3D Mammography) ‐ Left Breast MAMMBT3DLOS
only
Breast Tomosynthesis (3D Mammography) ‐ Left Breast only MAMMBT3DL 3000 1800
Breast Ultrasound ( Mammography ) BRULTMAM
15 Breast Tomosynthesis ( 3D Mammography ) ‐ Bilateral MAMMBT3DOS

Breast Tomosynthesis (3D Mammography) MAMMBT3D 6000 3600
16 Breast Tomosynthesis (3D Mammography) ‐ Right Breast MAMMBT3DROS

only
Breast Tomosynthesis (3D Mammography) ‐ Right Breast only MAMMBT3DR 3000 1800
17 Mammography ‐ Bilateral MAMMOBL

Mammography (bilateral) ( Xray dept charges ) MAMMOP 3500 2100

18 Mammography ( Left ) MAMMOLTOS
Mammography ( Left ) ( Xray dept charges ) MAMMOPL 1750 1050

19 Mammography ( Right ) MAMMORTOS
Mammography (R) ( Xray dept charges ) MAMMOPR 1750 1050

20 Comprehensive Left breast imaging package bilateral (2D MM2D3DLMOS
+ 3D Left Mammogram + Breast MRI)
Comprehensive Left breast imaging package bilateral (2D + 3D Left MM2D3DRM 12000 12000

Mammogram + Breast MRI) ‐ MRI Department Charges
Comprehensive Left breast imaging package bilateral (2D + 3D Left MM2D3DLM 2500 1500
Mammogram + Breast MRI) ‐ X‐Ray Department Charges
21 Comprehensive breast imaging package bilateral (2D + 3D MMCOBR2D3DOS

Mammography + Breast MRI)
Comprehensive breast imaging package bilateral (2D + 3D Mammography MMCOBR2D3DMRI 12000 12000

+ Breast MRI) ‐ MRI Department Charges
97
Comprehensive breast imaging package bilateral (2D + 3D Mammography MMCOBR2D3D 5000 3000
+ Breast MRI) ‐ X‐Ray Department Charges
22 Comprehensive Right breast imaging package bilateral MMCOBR2D3DRO

(2D + 3D Right Mammogram + Breast MRI)
Comprehensive Right breast imaging package bilateral (2D + 3D Right MM2D3DRMRI 12000 1500

Mammogram + Breast MRI) ‐ MRI Department Charges
Comprehensive Right breast imaging package bilateral (2D + 3D Right MMCOBR2D3DR 2500 1500
Mammogram + Breast MRI) ‐ X‐Ray Department Charges
23 Radiological skin marking for lesion RAFSMAROS

Radiological skin marking for lesion ‐ Radiologist fee RAFSMARDF 1000 600
Radiological skin marking for lesion ‐ Radiology Dept. Charges RAFSMARHC 1000 600
24 Radiological skin marking for lesion in OT RAFSMOTOS
Radiological skin marking for lesion in OT ‐ Radiologist fee RAFSMOTDF 2000 1200
Radiological skin marking for lesion in OT ‐ Radiology Dept. Charges RAFSMOTHC 2000 1200
25 Radiological guidance charges for Ascites / Effusion RASCUINTOS
tapping / Drainage ( interventional)
Radiological guidance charges for Ascites / Effusion tapping / Drainage ( RASCUINT 600 600
interventional) ‐ Dept. Charges
Radiological guidance charges for Ascites / Effusion tapping / Drainage ( RASCUINTRF 500 500
interventional) ‐ Radiologist fee
26 Radiological guidance charges for FNAC / Biopsy ( RDFNACINTOS

interventional)
Radiological guidance charges for FNAC / Biopsy ( interventional) ‐ Dept RDFNACINT 600 600
Charges
Radiological guidance charges for FNAC / Biopsy ( interventional) ‐ RDFNACINTRF 500 500
Radiologist Fee

Respiratory & Chest Medicine Lab Charges

CAT 1/CAT2 CAT3
1 Pulmonary rehabilitation program PULREHP 1400 1400
2 Spirometery SPIROM 1800 1100
3 Spirometery + Diffusion studies DIFSTUD 2540 1530
4 Spirometery + Lung Volume + Diffusion studies SPIRLD 2540 1530
5 Spirometry with Reversibility ( Drugs ) SPIROMD 1800 1100
Respiratory medicine package charges
All Category
Cat 1B Suite
4 Beddded
Cat 1A‐Pre
Single Bed
2 Bedded
Cat‐1D
GOPD
POPD
Cat‐2
Cat‐3

1 ENDOBRON Endobronchial Ultrasound ‐ 46840 46840 23420 18740 14050 23420 14050
ULTAPC Package charges

98
Urodynamic test charges
SNo Description Code POPD/ CAT GOPD/

1/CAT2 CAT3
1 Complete Urodynamic Study ( Uroflowmetery , UROCOMPLETE 2800 1680
Cystometrography and UPP )
2 Electromyography ( EMG ) urinary sphincter EMGU 400 240
3 Urethral profile pressure ( UPP ) UPP 490 300
4 Uroflowmetery ( UFM ) UFM 800 480
5 Voiding cystometery VOIDCYST 1340 800
6 Water cystometrography ( CMG ) CMG 2000 1200
7 Water cystometrography ( CMG ) with WATCYST 2800 1680
Electrmyography ( EMG )
URODYNAMICS PROCEDURES (OPD)
All Category
Cat 1B Suite
4 Beddded
Cat 1A‐Pre
Single Bed
2 Bedded
Cat‐1D
GOPD
POPD
Cat‐2
Cat‐3
1 CATHMOS Catheterization with
instillation with any medicine ‐
Urodynamics ( OPD )
CATHMHC Catheterization with instillation with any 240 1330
medicine ‐ Hospital Charges
CATHMDF Catheterization with instillation with any 2430
medicine ‐ Procedure Charges
2 CATHOS Catheterization ‐ Urodynamics
( OPD )
CATHHC Catheterization ‐ Hospital Charges 190 1000
CATHDF Catheterization ‐ Procedure Charges ( OPD ) 1820
3 CESOS Cyst Excision ‐ Urodynamics (
OPD )
CESHC Cyst Excision ‐ Hospital Charges 370 2000
CESDF Cyst Excision ‐ Procedure Charges 3640
4 DMAJOS Dressing Major ‐ Urodynamics
( OPD )
DMAJHC Dressing Major ‐ Hospital Charges 130 670
DMAJDF Dressing Major ‐ Procedure Charges (OPD) 1220
5 DMOS Dressing Minor ‐ Urodynamics
( OPD )
DMINHC Dressing Minor ‐ Hospital Charges 60 340
DMDF Dressing Minor ‐ Procedure Charges (OPD) 610
6 FREOS Frenuloplasty ‐ Urodynamics (
OPD )
FREHC Frenuloplasty ‐ Hospital Charges 320 1730
FREDF Frenuloplasty ‐ Procedure Charges 3150
7 NSBWOS Bladder wash with catheter
removal ‐ Urodynamics (OPD)
BWHC Bladder wash with catheter removal ‐ 130 670
Hospital Charges
NSBWDF Bladder wash with catheter removal ‐ 1220
Procedure Charges
8 PBIOOS Prostatic Biopsy ‐ Urodynamics
(OPD)
PBIOHC Prostatic Biopsy ‐ Hospital Charges 370 2010
PBIODF Prostatic Biopsy ‐ Procedure Charges (OPD) 3580
99
9 SUPBIOOS Superficial Biopsy ‐
Urodynamics ( OPD )
SUPBIOHC Superficial Biopsy ‐ Hospital Charges 230 1270
SUPBIODF Superficial Biopsy ‐ Procedure Charges 2430
10 TBIOOS Testicular Biopsy ‐
Urodynamics ( OPD )
TBIOHC Testicular Biopsy ‐ Hospital Charges 440 2420
TBIODF Testicular Biopsy ‐ Procedure Charges 4390
11 UDILOS Uretheral Dilatation ‐
Urodynamics ( OPD )
UDILHC Urethral Dilatation ‐ Hospital Charges 340 1790
UDILDF Urethral Dilatation ‐ Procedure Charges 3240
(OPD)
Other Special Care Charges
Premium/
2 Bedded
4 Bedded
Cat‐1D
POPD/
All Cat
Single
GOPD
Cat‐2
Cat‐3
Suite
1 ATEBJMOTAC All teeth extractions (both jaws) For Minor OT ( 3700
Anaesthetists Charges )
2 ABJMOTAC Alveolectomy (Both jaws) For Minor OT ( 2310
3 ASJNMOTAC Alveolectomy (one jaws) For Minor OT ( 1160
4 ALPMOTAC Alveoloplasty For Minor OT ( Anaesthetists Charges 690
)
5 ALPDMANCH Anaesthetists charges for Argon laser 690
photocoagulation ( single sitting ) for diabetic
maculopathy ‐ Doctor fees
6 CRDFICGANCH Anaesthetists charges for Combined retinal digital 670
fluorescein & indocyanine green ( ICG ) imaging
angiography
7 ANADENTAL Anaesthetists charges for dental procedures 2910
8 RDFIANCH Anaesthetists charges for Retinal digital 320
flurorescein imaging angiography
9 RDICGANCH Anaesthetists charges for Retinal digital 440
indocyanine green ( ICG ) imaging angiography
10 YAGANCH Anaesthetists charges for YAG laser 700
photocoagulation ‐ Doctor fees
11 ANDLANA Anal Dilatation For Minor OT ( Anaesthetists 830
Charges )
12 ABLDAF Angiography of B/L Dorsolumbar Spinal Radicular 13200 6600 5280 3960
Arteries ‐ Anasthetist fee
13 ARCTAC Apexification + Root canal treatment (RCT) For 1160
Minor OT ( Anaesthetists Charges )
14 AULAC Apicectomy (Under LA) For Minor OT ( 1850
15 AFDFAC Archbar fixation dentoalveolar fracture segment 1390
For Minor OT ( Anaesthetists Charges )
16 BASCAN Balloon Angioplasty & Stenting in Cervical 39600 19800 15840 11880
ICA/Vertebral ‐ Anasthetist Fee
17 BACEDAN Balloon Assisted Coil Embolization of a 44000 22000 17600 13200
Direct/Indirect Cavernous Fistula ‐ Anasthetist fee
18 BAVAC Brachio AV fistula at elbow for hemodialysis ‐ 2300
Anaesthetists Charges
19 CSTLACSMF Cataract Surgery MULTIFOCAL TORIC LENS ‐ 2880
Anaesthetist Charges
100
20 CSTLACSY Cataract Surgery SYMFONY LENS ‐ Anaesthetist 3600
Charges
21 CSTLACSYT Cataract Surgery SYMFONY TORIC LENS ‐ 3960
Anaesthetist Charges
22 CTZANA Catheterization For Minor OT ( Anaesthetists 490
Charges )
23 CIRETDAC Caval Interruption using retrievable device ‐ Doctor 15960 7980 6380 3990
Anaesthesia Charges
24 CCMANA Circumcision For Minor OT ( Anaesthetists Charges 1490
)
25 CARAVFAC Conversion of arteriovenous (AV) shunt to 2300
arteriovenous (AV) fistula ‐ Anaesthetists Charges
26 CAREVFAC Creation of arteriovenous (AV) Fistula at axillary 2910
artery ‐ Anaesthetists Charges
27 CAREVFBAC Creation of arteriovenous (AV) Fistula at elbow ( 2910
Brachial artery ) ‐ Anaesthetists Charges
28 CAREVFWBAC Creation of arteriovenous (AV) Fistula at wrist ( 2910
Radial Artery ) ‐ Anaesthetists Charges
29 DENIMPAC Dental Implant (first stage) For Minor OT ( 9220
30 DBFMNA Diagnostic Bronchoscopy For Minor OT ( 1840
31 DBWBNA Diagnostic Bronchoscopy with Biopsy ( 2240
32 TESAAN Diagnostic sperm extraction ( TESA / PESA ) ‐ 1700
Anesthesist fee
33 DISTMJAC Dislocation of TMJ For Minor OT ( Anaesthetists 1160
Charges )
34 DOSANA Dorsal Slit For Minor OT ( Anaesthetists Charges ) 1180
35 DREMA Dressing (minor) For Minor OT ( Anaesthetists 490
Charges )
36 DCDRA Dressing change/drain removal For Minor OT 410
(Anaesthetists Charges)
37 ELRBA Ear lobe repair BL For Minor OT ( Anaesthetists 1000
Charges )
38 ELRUA Ear lobe repair UL For Minor OT ( Anaesthetists 660
Charges )
39 ESPFDNA Embolization of Spinal Pial/dural Fistula ‐ 44000 22000 17600 13200
Anasthetist fee
40 ENDOBYAC Endoluminal bypass ‐ Doctor Anaesthesia Charges 15960 7980 6380 3990
41 ANAANAF Endoscopy submucosal dissection ‐ Anaesthetists 53550 26780 21420 16070
Fee
42 EXPFAC Excision of pericoronal flap For Minor OT ( 460
43 EXBIMAC Excisional biospy For Minor OT ( Anaesthetists 1390
Charges )
44 FLDIMTAC Flap Division and Inset For Minor OT ( Anaesthetists 2840
Charges)
45 FLMTAC Flap Large For Minor OT ( Anaesthetists Charges ) 4730
46 FSMTAC Flap Small For Minor OT ( Anaesthetists Charge) 3940
47 FSBQAC Flap surgery with bone graft (per quadrant) For 1850
48 FDPIANA Flow Divertor Placement for Intracranial Aneurysm 52800 26400 21120 15840
‐ Anasthetist fee
49 FOASA Foam Sclerotherapy For Minor OT ( Anaesthetists 3310
Charges )
50 FLAMOTAC Fracture mandible open reduction under LA (Cost 6920
of plates & screws etc.) For Minor OT (
51 FRMOTAC Frenectomy For Minor OT ( Anaesthetists Charges ) 690
52 FNPANA Frenuloplasty For Minor OT ( Anaesthetists Charges 750
)
101
53 GASPROPOEM Gastroenterology Procedures Poem ‐ Anasthetist 53550 26780 21420 16070
Fee
54 GINPMOTAC Gingivoplasty For Minor OT ( Anaesthetists Charges 1390
)
55 HYBAC Hybrid Procedure‐ Anaesthetist Charge 23480 22730 19000 15270
56 ICCPLNA ICD insertion for complex effusion/pneumothorax 1840
57 ICDSMNA ICD insertion for simple effusion/pneumothorax 790
58 IBSMOTAC Impaction (Bony/soft tissue) For Minor OT ( 2310
59 ICVADPAC Implantable Central Venous Access Device 5000 2500 2010 1250
Placement ‐ Doctor Anaesthesia Charges
60 INADMA Incision and drainage (major) For Minor OT ( 1320
61 INADA Incision and drainage (Minor) For Minor OT ( 660
62 INDMOTAC Incision and drainage For Minor OT( Anaesthetists 920
Charges )
63 IDLANA Incision and Drainage of Multiple/ Large Superficial 1320
Abscess For Minor OT ( Anaesthetists Charges )
64 IDSANA Incision And Drainage of Small/Superficial Abscess 660
65 IMFMOTAC Inter ‐ Maxillary fixation with archbar For Minor 3230
OT( Anaesthetists Charges )
66 IAVDNA Intracranial Angioplasty for Vasaspasm ‐ 26400 13200 10560 7920
Anasthetist fee
67 IVMECNA Intracranial AVM Embolization (Complex) ‐ 52800 26400 21120 15840
Anasthetist fee
68 IAELNA Intracranial AVM Embolization using Liquid Embolic 44000 22000 17600 13200
material ‐ Anasthetist fee
69 ISRNA Intracranial Stenting in Stroke Revascularization ‐ 44000 22000 17600 13200
Anasthetist fee
70 JFMOTAC Jaw fracture closed reduction For Minor OT( 3700
71 KTPSA KTP Surcharge ‐ Anasthesist fee 2650
72 LIVHIAF Liver Transplant High ‐ Anaesthetist Charges 105000
73 LIVTANF Liver Transplant Low ‐ Anaesthetist Charges 75000
74 LINNRAF Liver Transplant Normal Risk ‐ Anaesthetist Charges 90000
75 LNBMN Lymph Node Biopsy For Minor OT ( Anaesthetists 790
Charges )
76 MADMANA Major Debridement For Minor OT ( Anaesthetists 1660
Charges )
77 MTANA Meatotomy For Minor OT ( Anaesthetists Charges ) 690
78 MINIMPAC Mini implant for anchorage (per implant) For Minor 2770
OT( Anaesthetists Charges )
79 MINDA Minor debridement For Minor OT ( Anaesthetists 830
Charges )
80 NEDLAA Needle aspiration For Minor OT (Anaesthetists 410
Charges )
81 NERBLAC Nerve block in Neuralgias For Minor OT ( 1390
82 ORANCAC Oro antral communication closure For Minor OT ( 6460
83 PTBANA Prostatic Trucut Biopsy For Minor OT ( 660
84 RFCHTVOAC Recanalization for Chronic Total Vascular Occlusion 13970 6990 5590 3500
‐ Doctor Anaesthesia Charges
85 RIOHAN Reduction of Irreducible Obstructed Hernia For 4140
86 RSPANA Reduction of Stomal Prolapsed For Minor OT ( 2480
102
87 RATMOTAC Reimplantation of avulsed tooth For Minor OT( 920
88 RCIDAC Removal of Caval Interruption Device ‐ Doctor 5990 3000 2400 1500
Anaesthesia Charges
89 RPMLAAC Removal of plates of mandible and maxilla (Under 3700
LA) For Minor OT( Anaesthetists Charges )
90 MINPAC Root canal with Apicectomy For Minor OT ( 2310
91 SCMOTAC Scaling full mouth For Minor OT ( Anaesthetists 690
Charges )
92 SSFTNA Secondary Suturing For Minor OT ( Anaesthetists 1050
Charges )
93 SVCAAC Six Vessel Cerabral Angiogram ‐ Anasthetist Fee 11000 5500 4400 3300
94 SKGMTAC Skin Grafting For Minor OT ( Anaesthetists Charges 3150
)
95 SMSKGRAA Small Skin Grafting For Minor OT ( Anaesthetists 3150
Charges )
96 STSEA Soft tissue swelling excision for Minor OT 2320
(Anaesthetists Charges )
97 SPTCANA SPC (Suprapubic Trocar Cystostomy) For Minor OT ( 1980
98 SPREMOTAC Splint Removal For Minor OT ( Anaesthetists 460
Charges )
99 SACEAN Stent Assisted Coil Embolization of Intracranial ICA 44000 22000 17600 13200
Aneurysm ‐ Anasthetist fee
100 SUBCURAC Subgingival scaling & curretage full mouth For 1390
Minor OT (Anaesthetists Charges)
101 SUEXTAC Surgical extraction of tooth For Minor OT 920
(Anaesthetists Charges)
102 SUTREA Suture removal For Minor OT (Anaesthetists 410
Charges)
103 SMLANA Suturing of Medium Lacerations (Large) For Minor 2320
OT ( Anaesthetists Charges )
104 SSLANA Suturing of Small Lacerations For Minor OT ( 1320
105 TCBANA Teslicular Biopsy For Minor OT ( Anaesthetists 1000
Charges )
106 THHYD Therapeutic Hypothermia for 24‐48 hrs ‐ Doctor 20000 10000 8000 6000
Fee
108 TUEXAC Tumour Excision For Minor OT (Anaesthetists 4610
Charges)
109 URCANA Uretheral Catheterization For Minor OT ( 490
110 UCADANA Urethral Calibration and Dilatation For Minor OT ( 660
111 URDLA Urethral dilatation For Minor OT (Anaesthetists 830
Charges)
112 VAMSNA VAC Application For Minor OT ( Anaesthetists 530
Charges )
113 VENSAPBAC Venography guided laser assisted saphenous vein 17460 8740 6990 4370

closure (B/L) ‐ Doctor Anaesthesia Charges
114 VENSAPAC Venography guided laser assisted saphenous vein 13970 6990 5590 3500
closure (U/L) ‐ Doctor Anaesthesia Charges
115 WDMTN Wound Debridement For Minor OT ( Anaesthetists 530
Charges )
116 YSBAN Y‐Stenting in a Basilar Top Aneurysm ‐ Anasthetist 52800 26400 21120 15840
fee
103
Dental Charges
SNo Code Description POPD GOPD

1 BASIDT Bar Supported Implant Dentures 550000 550000
2 BASLDSJ Bar Supported Implant Dentures / Single Jaw 300000 300000
3 DATEXT‐1 Cat‐ 1 ‐ All teeth extractions (both jaws) 11720 8790
4 DABJAW‐1 Cat‐ 1 ‐ Alveolectomy (both jaws) 7330 5850
5 DAOJAW‐1 Cat‐ 1 ‐ Alveolectomy (one jaws) 3660 2930
6 DALVPLS1 Cat‐ 1 ‐ Alveoloplasty 2200 1460
7 DARCT‐1 Cat‐ 1 ‐ Apexification + Root canal treatment ( RCT ) 3660 3330
8 DAULA‐1 Cat‐ 1 ‐ Apicectomy ( Under LA ) 5850 4390
9 DAPICE‐1 Cat‐ 1 ‐ Apicectomy (Endodontics) 5850 3990
10 DAPAT‐1 Cat‐ 1 ‐ Apicectomy per additional tooth 2200
11 DAFDDS‐1 Cat‐ 1 ‐ Archbar fixation dentoalveolar fracture segment 4390 2930
12 DARTMJ‐1 Cat‐ 1 ‐ Arthocentesis of TMJ 7330 5450
13 DBP‐1 Cat‐ 1 ‐ Bite plate 4400 2940
14 DBT‐1 Cat‐ 1 ‐ Bleaching of teeth 7330 7330
15 DCPD‐1 Cat‐ 1 ‐ Cast partial dentures (metal casting) 8790 6600
16 CSPT‐1 Cat‐ 1 ‐ Cavity sealant (per tooth) 940 940
17 DCERLAM1 Cat‐ 1 ‐ Ceramic laminate 5860 5140
18 CCPV‐1 Cat‐ 1 ‐ Chemical cauterisation (per visit) 750 590
19 DCULAR‐1 Cat‐ 1 ‐ Closure of upper & lower anterior spaces + 27820 17580
retainers
20 DENCDUL‐1 Cat‐ 1 ‐ Complete denture upper and lower (both) 17580 13180
21 DENCDUOL‐1 Cat‐ 1 ‐ Complete denture upper or lower (either one) 8790 7330
22 DCFILL‐1 Cat‐ 1 ‐ Composite filling 2200 2000
23 DCOMPVEN1 Cat‐ 1 ‐ Composite veneers 2210 2210
24 DCOVUCST1 Cat‐ 1 ‐ Core build up ( casting ) 2210 2210
25 DCOVUPREF1 Cat‐ 1 ‐ Core build up ( prefab ) 1470 750
26 DCBC‐1 Cat‐ 1 ‐ Crown / Bridge per unit (ceramic) 6600 5140
27 DCBM‐1 Cat‐ 1 ‐ Crown / Bridge per unit (metal) 4400 2940
28 DCBP‐1 Cat‐ 1 ‐ Crown / Bridge per unit (Procera) 19970
29 DCURRE‐1 Cat‐ 1 ‐ Curettage (per quadrant) 3660 1330
30 DCYSTMAR‐1 Cat‐ 1 ‐ Cyst Enucleation / Marsupialisation 11720 5850
31 DDIFS‐1‐C Cat‐ 1 ‐ Dental implant ( complete ) 66550 48400
32 DDIFS‐1 Cat‐ 1 ‐ Dental implant (first stage) 29280 11720
33 DDIMP2‐1 Cat‐ 1 ‐ Dental implant (second stage) 14640 10250
34 DIWC Cat‐ 1 ‐ Dental Implant with Crown 66550
35 DDTMJ‐1 Cat‐ 1 ‐ Dislocation of TMJ 3660 3030
36 DEPF‐1 Cat‐ 1 ‐ Excision of pericoronal flap 1460 1460
37 DEB‐1 Cat‐ 1 ‐ Excisional biopsy 4390 2340
38 DRPTO‐1 Cat‐ 1 ‐ Extraction (per tooth) 740 590
39 DEFDTO‐1 Cat‐ 1 ‐ Extraction of fractured / decayed tooth 1460 880
40 DFCS‐1 Cat‐ 1 ‐ Fabrication of Circummandibular splint 5860 4840
41 DFMASK‐1 Cat‐ 1 ‐ Face mask 10250 9530
42 DFAGI‐1 Cat‐ 1 ‐ Filling amalgam / Glass ionomer 2240 1600
43 DFFOCJ‐1 Cat‐ 1 ‐ Fixed Functional Appliance for Orthopedic 43920
correction of JAW
44 DFOCERN‐1 Cat‐ 1 ‐ Fixed Orthodontics ( Ceramic Braces ) ‐ First 21970 14640
installment
45 DFOCERS‐1 Cat‐ 1 ‐ Fixed Orthodontics ( Ceramic Braces ) ‐ 2940 2570
Subsequent installment
46 DFOCER‐1 Cat‐ 1 ‐ Fixed orthodontics (ceramic braces) ‐ Full amount 51250 49670
47 DFOSSN‐1 Cat‐ 1 ‐ Fixed orthodontics (steel braces) ‐ First installment 14640 14640
48 DFOSS‐1 Cat‐ 1 ‐ Fixed orthodontics (steel braces) ‐ Full amount 39930 36610
104
49 DFOSSS‐1 Cat‐ 1 ‐ Fixed orthodontics (steel braces) ‐ Subsequent 2570 2210
installment
50 DFRLB‐1 Cat‐ 1 ‐ Fixed Retainers ( Lingual Bonded ) 7330
51 DFOPFM‐1 Cat‐ 1 ‐ Flap operation (full mouth) 14640 13180
52 DFOPQ‐1 Cat‐ 1 ‐ Flap operation (per quadrant) 4390 3660
53 DFSBG‐1 Cat‐ 1 ‐ Flap surgery with bone graft (per quadrant) 5850 5850
54 DFAPP‐1 Cat‐ 1 ‐ Fluoride application 1180 1180
55 DFMORLA‐1 Cat‐ 1 ‐ Fracture mandible open reduction under LA ( Cost 21970 18150
of Plates & screws etc. )
56 DFRENE‐1 Cat‐ 1 ‐ Frenectomy 2200 1180
57 DGTOMY‐1 Cat‐ 1 ‐ Gingivectomy (per quadrant) 3660 2930
58 DGPLASTY‐1 Cat‐ 1 ‐ Gingivoplasty (per quadrant) 4390 3660
59 DHBA‐1 Cat‐ 1 ‐ Habit Breaking appliance 8790
60 DIMPACT‐1 Cat‐ 1 ‐ Impaction (Bony / soft tissue) 7330 6660
61 DIPW‐1 Cat‐ 1 ‐ Implant Prosthetic work up Stage 2 and Stage 3 35000 25000
62 DIDRAIN‐1 Cat‐ 1 ‐ Incision and drainage 2930 2340
63 DIBIOP‐1 Cat‐ 1 ‐ Incisional biopsy 2200 1180
64 DIMFA‐1 Cat‐ 1 ‐ Inter ‐ maxillary fixation with archbar 10250 8790
65 DIWSPIL‐1 Cat‐ 1 ‐ Interdental wiring + splinting (per quadrant) 4390 4390
66 DIAINJ‐1 Cat‐ 1 ‐ Intra articular injection 1180 1180
67 DIFF‐1 Cat‐ 1 ‐ Iodoform Dressing for CYST 590 530
68 DJFCR‐1 Cat‐ 1 ‐ Jaw fracture closed reduction 11720 10990
69 DLFREN‐1 Cat‐ 1 ‐ Lingual frenectomy 2200 1770
70 DENCDULL‐1 Cat‐ 1 ‐ Lucitone Denture 24630 24630
71 DMFCC‐1 Cat‐ 1 ‐ Metal free ceramic crown 10250 8790
72 DMIA‐1 Cat‐ 1 ‐ Mini ‐ implant for anchorage (per implant) 8790 7330
73 DMFA‐1 Cat‐ 1 ‐ Myfunctional Appliance ‐ Twin Block 9080 7260
74 DNBN‐1 Cat‐ 1 ‐ Nerve block in Neuralgias 4390 3630
75 DOBTU‐1 Cat‐ 1 ‐ Obturators 11720 10990
76 DOPER‐1 Cat‐ 1 ‐ Operculectomy 1460 1460
77 DOACC‐1 Cat‐ 1 ‐ Oro antral communication closure 20490
78 DPDAC‐1 Cat‐ 1 ‐ Partial dentures (acrylic) 2940 2660
79 DATD‐1 Cat‐ 1 ‐ per additional tooth in denture 750 590
80 DPIOSMF‐1 Cat‐ 1 ‐ Placentrax Inj for OSMF 1180
81 DPOS‐1 Cat‐ 1 ‐ Planning Orthognathic Surgery 7870 7260
82 DPLCENE‐1 Cat‐ 1 ‐ Porcelain laminate veneers 5860 5140
83 DPPSOCPN‐1 Cat‐ 1 ‐ Pre & post surgical orthodontics for cleft palate ‐ 17580 14640
First installment
84 DPPSOCP‐1 Cat‐ 1 ‐ Pre & post surgical orthodontics for cleft palate ‐ 32220 29280
Full amount
85 DPPSOCPS‐1 Cat‐ 1 ‐ Pre & post surgical orthodontics for cleft palate ‐ 1470 3670
86 DPSOSN‐1 Cat‐ 1 ‐ Pre & post surgical orthodontics for orthognathic 23430 20500
surgery ‐ First installment
87 DPSOS‐1 Cat‐ 1 ‐ Pre & post surgical orthodontics for orthognathic 36610 41000
surgery ‐ Full amount
88 DPSOSS‐1 Cat‐ 1 ‐ Pre & post surgical orthodontics for orthognathic 2210 2570
surgery ‐ Subsequent installment
89 DPUCAP‐1 Cat‐ 1 ‐ Pulp capping 2240 1330
90 DPULPO‐1 Cat‐ 1 ‐ Pulpotomy 1460 1460
91 DRME‐1 Cat‐ 1 ‐ Rapid maxillary expansion ( RME ) 10250 9530
92 DRCB‐1 Cat‐ 1 ‐ Recementation of crown / bridge 890 590
93 DRAT‐1 Cat‐ 1 ‐ Reimplantation of avulsed tooth 2930 2930
94 DREDENT‐1 Cat‐ 1 ‐ Relining of denture 890 890
95 DRORTHON‐1 Cat‐ 1 ‐ Removable orthodontics ‐ First installment 14640 14640
105
96 DRORTHO‐1 Cat‐ 1 ‐ Removable orthodontics ‐ Full amount 23430 23430
97 DRORTHOS‐1 Cat‐ 1 ‐ Removable orthodontics ‐ Subsequent installment 1470 1470
98 DRFW‐1 Cat‐ 1 ‐ Removal of Frontosuspension wiring 5850
99 DROCBU‐1 Cat‐ 1 ‐ Removal of old crown/bridge/unit 740
100 DRPMMLA‐1 Cat‐ 1 ‐ Removal of plates of mandible and maxilla ( Under 11720
LA )
101 DRDENT‐1 Cat‐ 1 ‐ Repair of dentures 890 530
102 DRRBA‐1 Cat‐ 1 ‐ Retainers replacement (both arches) 2940 2210
103 DRRPA‐1 Cat‐ 1 ‐ Retainers replacement (per arch) 1470 1110
104 DRCTANT‐1 Cat‐ 1 ‐ Root canal treatment ( RCT ) ‐ anterior 3660 2930
105 DRCTPOS‐1 Cat‐ 1 ‐ Root canal treatment ( RCT ) ‐ posterior 5850 3990
106 DRCAPIC‐1 Cat‐ 1 ‐ Root canal with Apicectomy 7330 5850
107 DSFMOU‐1 Cat‐ 1 ‐ Scaling full mouth 2200 2000
108 DSMEA‐1 Cat‐ 1 ‐ Slow Maxillary Expansion Appliance 7330
109 DSMAINT‐1 Cat‐ 1 ‐ Space maintainers 3670 3670
110 DSPREMO1 Cat‐ 1 ‐ Splint Removal 1460 1460
111 DSMODEL‐1 Cat‐ 1 ‐ Study model 450 390
112 DSSCFM‐1 Cat‐ 1 ‐ Subgingival scaling & curretage full mouth 4390 3660
113 DSETO‐1 Cat‐ 1 ‐ Surgical extraction of tooth 2930 2930
114 DSREMO‐1 Cat‐ 1 ‐ Suture removal 1460 1030
115 DTMJP‐1 Cat‐ 1 ‐ TMJ Physiotherapy 750
116 DTINLY‐1 Cat‐ 1 ‐ Tooth inlay 2210 2210
117 DTEXCI‐1 Cat‐ 1 ‐ Tumour excision 14640 8790
118 DVOSPL‐1 Cat‐ 1 ‐ Vacuum formed occlusal splint 4400 3670
119 FPD6 Cat‐ 1 ‐ Velaplast (Flexible Partial Dentures) ‐ Upto 6 15000 12000
missing teeth to be replaced
120 FPD9 Cat‐ 1 ‐ Velaplast (Flexible Partial Dentures) ‐ Upto or 18000 15000
more than 9 missing teeth to be replaced
121 FPD3 Cat‐ 1 ‐ Velaplast (Flexible Partial Dentures)‐ Upto 3 10000 7000
122 DZCFULA‐1 Cat‐ 1 ‐ Zygonatic Complex Fracture under LA 14640
123 CLEGNESD Clear Aligners Double 150000
124 CLEGNES Clear Aligners Single 120000
125 CULHIDR Complete ( U / L ) Hybrid Implant Dentures 750000 750000
126 CDWPLA Complete Denture With Implant Location 225000 225000
127 DLOSJA Denture with Implant Locators / Single Jaw 130000 130000
128 DSLLPA Direct Sinus Lift For Implant Placement 25000 25000
129 DRVGRAD DRVG ‐ Dental Radiovision Graphy 250 150
130 GRAPC Graft ( Per CC ) 7000 7000
131 HYIDRS Hybrid Implant Dentures / Single Jaw 375000 375000
132 IMCTDISG Impaction ( Distoangular ) 10000 10000
133 ISLFTP Indirect Sinus Lift For Implant Placement 10000 10000
134 LACLASRE LANAP (Laser Assisted New Attachment Procedure) ‐ per 7500 4500
quadrant
135 LACAEX Laser Canine Exposure 5000 3500
136 LACROQUA Laser Crown Lengthening (per Quadrant) 7500 5000
137 LACROLE Laser Crown Lengthening (per Tooth) 2000 2000
138 LASDISMO Laser Disinfection ( Full Mouth ) 10000 7500
139 LAFRETO Laser Frenectomy 7500 5000
140 LAGITOMX Laser Gingivectomy (per Quadrant) 7500 5000
141 LAGINTH Laser Gingivectomy (per Tooth) 2000 1500
142 LAGUMBLE Laser Gum Bleaching (per Quadrant) 10000 6000
143 LAPHRA Laser Physiotherapy 6 Sittings 5000 3000
144 LASERMAJ Laser Surgery Major 10000 7500
145 LASESUR Laser Surgery Minor 5000 3500
106
146 LASEFULL Laser Whitening ( Full Mouth ) 20000 15000
147 LASEWHI Laser Whitening (per Tooth) 2000 2000
148 LADC1 Local Anaesthesia Category 1 ‐ Dental 200 150
149 MEFOT Metal Free ONLAY / Tooth 15000 15000
150 PITFISRE Pit and Fissure Sealants (per Tooth) 1800 1500
151 RETNTCT Retreatment RCT 8000 8000
152 SEALICEBA Self Ligating Ceramic Braces 80000 70000
153 SELIBRAS Self Ligating Metal Braces 65000 55000
154 SIRCT Single Sitting RCT 10000 10000
155 SUTREMO Suture Removal For Dental 1000 1000
156 VSTDESJ Valplast Denture / Single Jaw 18000 18000
157 NGA Night Guard Appliance ( Dental )
NGA Cat‐ 1 ‐ Dental Night Guard Appliance 3670
DENLAB150 Dental Lab Charges Rs ‐ 210 210 210
158 DATEXT‐2 Cat‐ 2 ‐ All teeth extractions (both jaws) 6160
159 DABJAW‐2 Cat‐ 2 ‐ Alveolectomy (both jaws) 4100
160 DAOJAW‐2 Cat‐ 2 ‐ Alveolectomy (one jaws) 2060
161 DARCT‐2 Cat‐ 2 ‐ Apexification + Root canal treatment ( RCT ) 2060
162 DAULA‐2 Cat‐ 2 ‐ Apicectomy ( Under LA ) 3090
163 DAPICE‐2 Cat‐ 2 ‐ Apicectomy (Endodontics) 2570
164 DAPAT‐2 Cat‐ 2 ‐ Apicectomy per additional tooth 1030
165 DAFDDS‐2 Cat‐ 2 ‐ Archbar fixation dentoalveolar fracture segment 2060
166 DBP‐2 Cat‐ 2 ‐ Bite plate 2060
167 DBT‐2 Cat‐ 2 ‐ Bleaching of teeth 5140
168 DCPD‐2 Cat‐ 2 ‐ Cast partial dentures (metal casting) 4630
169 CSPT‐2 Cat‐ 2 ‐ Cavity sealant (per tooth) 530
170 DCERLAM2 Cat‐ 2 ‐ Ceramic laminate 3600
171 CCPV‐2 Cat‐ 2 ‐ Chemical cauterisation (per visit) 430
172 DCULAR‐2 Cat‐ 2 ‐ Closure of upper & lower anterior spaces + 12310
retainers
173 DENCDUL‐2 Cat‐ 2 ‐ Complete denture upper and lower (both) 9240
174 DENCDUOL‐2 Cat‐ 2 ‐ Complete denture upper or lower (either one) 5140
175 DCFILL‐2 Cat‐ 2 ‐ Composite filling 1030
176 DCOMPVEN2 Cat‐ 2 ‐ Composite veneers 1550
177 DCOVUCST2 Cat‐ 2 ‐ Core build up ( casting ) 1550
178 DCOVUPREF2 Cat‐ 2 ‐ Core build up ( prefab ) 530
179 DCBC‐2 Cat‐ 2 ‐ Crown / Bridge per unit (ceramic) 3600
180 DCBM‐2 Cat‐ 2 ‐ Crown / Bridge per unit (metal) 2060
181 DCURRE‐2 Cat‐ 2 ‐ Curettage (per quadrant) 530
182 DCYSTMAR‐2 Cat‐ 2 ‐ Cyst Enucleation / Marsupialisation 4100
183 DDIFS‐2‐C Cat‐ 2 ‐ Dental implant ( complete ) 24200
184 DDIFS‐2 Cat‐ 2 ‐ Dental implant (first stage) 8210
185 DDIMP3‐2 Cat‐ 2 ‐ Dental implant (second stage) 7190
186 NGA‐2 Cat‐ 2 ‐ Dental Night Guard Appliance 2570
187 DEPF‐2 Cat‐ 2 ‐ Excision of pericoronal flap 1030
188 DEB‐2 Cat‐ 2 ‐ Excisional biopsy 1650
189 DRPTO‐2 Cat‐ 2 ‐ Extraction (per tooth) 430
190 DEFDTO‐2 Cat‐ 2 ‐ Extraction of fractured / decayed tooth 630
191 DFMASK‐2 Cat‐ 2 ‐ Face mask 6680
192 DFAGI‐2 Cat‐ 2 ‐ Filling amalgam / Glass ionomer 530
193 DFOCERN‐2 Cat‐ 2 ‐ Fixed Orthodontics ( Ceramic Braces ) ‐ First 11430
installment
194 DFOCERS‐2 Cat‐ 2 ‐ Fixed Orthodontics ( Ceramic Braces ) ‐ 590
107
195 DFOCER‐2 Cat‐ 2 ‐ Fixed orthodontics (ceramic braces) ‐ Full amount 35820
196 DFOSSN‐2 Cat‐ 2 ‐ Fixed orthodontics (steel braces) ‐ First installment 11430
197 DFOSS‐2 Cat‐ 2 ‐ Fixed orthodontics (steel braces) ‐ Full amount 24610
198 DFOSSS‐2 Cat‐ 2 ‐ Fixed orthodontics (steel braces) ‐ Subsequent 1660
installment
199 DFOPFM‐2 Cat‐ 2 ‐ Flap operation (full mouth) 9240
200 DFOPQ‐2 Cat‐ 2 ‐ Flap operation (per quadrant) 2570
201 DFSBG‐2 Cat‐ 2 ‐ Flap surgery with bone graft (per quadrant) 4100
202 DFAPP‐2 Cat‐ 2 ‐ Fluoride application 830
203 DFRENE‐2 Cat‐ 2 ‐ Frenectomy 830
204 DGTOMY‐2 Cat‐ 2 ‐ Gingivectomy (per quadrant) 2060
205 DGPLASTY‐2 Cat‐ 2 ‐ Gingivoplasty (per quadrant) 2570
206 DIMPACT‐2 Cat‐ 2 ‐ Impaction (Bony / soft tissue) 3090
207 DIDRAIN‐2 Cat‐ 2 ‐ Incision and drainage 1650
208 DIBIOP‐2 Cat‐ 2 ‐ Incisional biopsy 830
209 DIMFA‐2 Cat‐ 2 ‐ Inter ‐ maxillary fixation with archbar 6160
210 DIWSPIL‐2 Cat‐ 2 ‐ Interdental wiring + splinting (per quadrant) 3090
211 DIAINJ‐2 Cat‐ 2 ‐ Intra articular injection 830
212 DJFCR‐2 Cat‐ 2 ‐ Jaw fracture closed reduction 7700
213 DLFREN‐2 Cat‐ 2 ‐ Lingual frenectomy 1240
214 DMFCC‐2 Cat‐ 2 ‐ Metal free ceramic crown 6160
215 DMIA‐2 Cat‐ 2 ‐ Mini ‐ implant for anchorage (per implant) 5140
216 DMFA‐2 Cat‐ 2 ‐ Myfunctional Appliance ‐ Twin Block 5450
217 DOBTU‐2 Cat‐ 2 ‐ Obturators 7700
218 DOPER‐2 Cat‐ 2 ‐ Operculectomy 1030
219 DPDAC‐2 Cat‐ 2 ‐ Partial dentures (acrylic) 1550
220 DATD‐2 Cat‐ 2 ‐ per additional tooth in denture 430
221 DPOS‐2 Cat‐ 2 ‐ Planning Orthognathic Surgery 4840
222 DPLCENE‐2 Cat‐ 2 ‐ Porcelain laminate veneers 3600
223 DPPSOCPN‐2 Cat‐ 2 ‐ Pre & post surgical orthodontics for cleft palate ‐ 10250
First installment
224 DPPSOCP‐2 Cat‐ 2 ‐ Pre & post surgical orthodontics for cleft palate ‐ 20500
Full amount
225 DPPSOCPS‐2 Cat‐ 2 ‐ Pre & post surgical orthodontics for cleft palate ‐ 2570
226 DPSOSN‐2 Cat‐ 2 ‐ Pre & post surgical orthodontics for orthognathic 15530
227 DPSOS‐2 Cat‐ 2 ‐ Pre & post surgical orthodontics for orthognathic 28710
228 DPSOSS‐2 Cat‐ 2 ‐ Pre & post surgical orthodontics for orthognathic 1660
229 DPUCAP‐2 Cat‐ 2 ‐ Pulp capping 530
230 DPULPO‐2 Cat‐ 2 ‐ Pulpotomy 1030
231 DRME‐2 Cat‐ 2 ‐ Rapid maxillary expansion ( RME ) 6680
232 DRCB‐2 Cat‐ 2 ‐ Recementation of crown / bridge 430
233 DRAT‐2 Cat‐ 2 ‐ Reimplantation of avulsed tooth 2060
234 DREDENT‐2 Cat‐ 2 ‐ Relining of denture 630
235 DRORTHON‐2 Cat‐ 2 ‐ Removable orthodontics ‐ First installment 9820
236 DRORTHO‐2 Cat‐ 2 ‐ Removable orthodontics ‐ Full amount 16410
237 DRORTHOS‐2 Cat‐ 2 ‐ Removable orthodontics ‐ Subsequent installment 1110
238 DRDENT‐2 Cat‐ 2 ‐ Repair of dentures 360
239 DRRBA‐2 Cat‐ 2 ‐ Retainers replacement (both arches) 1550
240 DRRPA‐2 Cat‐ 2 ‐ Retainers replacement (per arch) 780
241 DRCTANT‐2 Cat‐ 2 ‐ Root canal treatment ( RCT ) ‐ anterior 1860
242 DRCTPOS‐2 Cat‐ 2 ‐ Root canal treatment ( RCT ) ‐ posterior 2570
108
243 DRCAPIC‐2 Cat‐ 2 ‐ Root canal with Apicectomy 4100
244 DSFMOU‐2 Cat‐ 2 ‐ Scaling full mouth 530
246 DSMAINT‐2 Cat‐ 2 ‐ Space maintainers 2570
247 DSPREMO2 Cat‐ 2 ‐ Splint Removal 1030
248 DSMODEL‐2 Cat‐ 2 ‐ Study model 280
249 DSSCFM‐2 Cat‐ 2 ‐ Subgingival scaling & curretage full mouth 2570
250 DSETO‐2 Cat‐ 2 ‐ Surgical extraction of tooth 2060
251 DSREMO‐2 Cat‐ 2 ‐ Suture removal 750
252 DTINLY‐2 Cat‐ 2 ‐ Tooth inlay 1550
253 DTEXCI‐2 Cat‐ 2 ‐ Tumour excision 6160
254 DVOSPL‐2 Cat‐ 2 ‐ Vacuum formed occlusal splint 2570
255 FPD6‐2 Cat‐ 2 ‐ Velaplast (Flexible Partial Dentures) ‐ Upto 6 8400
256 FPD9‐2 Cat‐ 2 ‐ Velaplast (Flexible Partial Dentures) ‐ Upto or 10500
257 FPD3‐2 Cat‐ 2 ‐ Velaplast (Flexible Partial Dentures)‐ Upto 3 4900
258 DALVPLS2 Cat‐ 2‐ Alveoloplasty 1030
259 LADC2 Local Anaesthesia Category 2 ‐ Dental 100
260 DBP‐3 Cat‐ 3 ‐ Bite plate 890
261 DBT‐3 Cat‐ 3 ‐ Bleaching of teeth 2210
262 DCPD‐3 Cat‐ 3 ‐ Cast partial dentures (metal casting) 1990
263 DCERLAM3 Cat‐ 3 ‐ Ceramic laminate 1550
264 DCULAR‐3 Cat‐ 3 ‐ Closure of upper & lower anterior spaces + 5280
retainers
265 DENCDUL‐3 Cat‐ 3 ‐ Complete denture upper and lower (both) 3960
266 DENCDUOL‐3 Cat‐ 3 ‐ Complete denture upper or lower (either one) 2210
267 DCOMPVEN3 Cat‐ 3 ‐ Composite veneers 670
268 DCBC‐3 Cat‐ 3 ‐ Crown / Bridge per unit (ceramic) 1550
269 DCBM‐3 Cat‐ 3 ‐ Crown / Bridge per unit (metal) 890
270 DDIFS‐3 Cat‐ 3 ‐ Dental implant (first stage) 3510
271 DDIMP4‐3 Cat‐ 3 ‐ Dental implant (second stage) 3090
272 NGA‐3 Cat‐ 3 ‐ Dental Night Guard Appliance 1110
273 DFMASK‐3 Cat‐ 3 ‐ Face mask 2860
274 DFOCERN‐3 Cat‐ 3 ‐ Fixed Orthodontics ( Ceramic Braces ) ‐ First 5860
installment
275 DFOCER‐3 Cat‐ 3 ‐ Fixed orthodontics (ceramic braces) ‐ Full amount 15370
276 DFOSSN‐3 Cat‐ 3 ‐ Fixed orthodontics (steel braces) ‐ First installment 5860
277 DFOSS‐3 Cat‐ 3 ‐ Fixed orthodontics (steel braces) ‐ Full amount 10560
278 DFOSSS‐3 Cat‐ 3 ‐ Fixed orthodontics (steel braces) ‐ Subsequent 590
installment
279 DMFCC‐3 Cat‐ 3 ‐ Metal free ceramic crown 2640
280 DMIA‐3 Cat‐ 3 ‐ Mini ‐ implant for anchorage (per implant) 2210
281 DMFA‐3 Cat‐ 3 ‐ Myfunctional Appliance ‐ Twin Block 3030
282 DOBTU‐3 Cat‐ 3 ‐ Obturators 3310
283 DPDAC‐3 Cat‐ 3 ‐ Partial dentures (acrylic) 670
284 DATD‐3 Cat‐ 3 ‐ per additional tooth in denture 190
285 DPLCENE‐3 Cat‐ 3 ‐ Porcelain laminate veneers 1550
286 DPPSOCPN‐3 Cat‐ 3 ‐ Pre & post surgical orthodontics for cleft palate ‐ 5860
First installment
287 DPPSOCP‐3 Cat‐ 3 ‐ Pre & post surgical orthodontics for cleft palate ‐ 8790
Full amount
288 DPPSOCPS‐3 Cat‐ 3 ‐ Pre & post surgical orthodontics for cleft palate ‐ 750
109
289 DPSOSN‐3 Cat‐ 3 ‐ Pre & post surgical orthodontics for orthognathic 7620
290 DPSOS‐3 Cat‐ 3 ‐ Pre & post surgical orthodontics for orthognathic 12310
291 DPSOSS‐3 Cat‐ 3 ‐ Pre & post surgical orthodontics for orthognathic 590
292 DRME‐3 Cat‐ 3 ‐ Rapid maxillary expansion ( RME ) 2860
293 DRCB‐3 Cat‐ 3 ‐ Recementation of crown / bridge 190
294 DREDENT‐3 Cat‐ 3 ‐ Relining of denture 280
295 DRORTHON‐3 Cat‐ 3 ‐ Removable orthodontics ‐ First installment 4400
296 DRORTHO‐3 Cat‐ 3 ‐ Removable orthodontics ‐ Full amount 7040
297 DRORTHOS‐3 Cat‐ 3 ‐ Removable orthodontics ‐ Subsequent installment 450
298 DRDENT‐3 Cat‐ 3 ‐ Repair of dentures 170
299 DRRBA‐3 Cat‐ 3 ‐ Retainers replacement (both arches) 670
300 DRRPA‐3 Cat‐ 3 ‐ Retainers replacement (per arch) 340
302 DSMAINT‐3 Cat‐ 3 ‐ Space maintainers 1110
303 DSMODEL‐3 Cat‐ 3 ‐ Study model 120
304 DVOSPL‐3 Cat‐ 3 ‐ Vacuum formed occlusal splint 1110
305 FPD6‐3 Cat‐ 3 ‐ Velaplast (Flexible Partial Dentures) ‐ Upto 6 3600
306 FPD9‐3 Cat‐ 3 ‐ Velaplast (Flexible Partial Dentures) ‐ Upto or 4500
307 FPD3‐3 Cat‐ 3 ‐ Velaplast (Flexible Partial Dentures)‐ Upto 3 2100
308 LADC3 Local Anaesthesia Category 3 ‐ Dental 70
309 CERBR7000 Ceramic Braces Rs ‐ 10250 10250
310 DENLAB1000 Dental Lab Charges Rs ‐ 1330 1330 1330
316 DENLAB2000 Dental Lab Charges Velaplast Rs ‐ 2300 2300 2300
Dental Procedures All Category
Cat 1B Suite
4 Beddded
Cat 1A‐Pre
Single Bed
2 Bedded
Cat‐1D
GOPD
POPD
Cat‐2
Cat‐3
Code Description
BMSDHC BILIARY MICROLITH STUDY
OS (DOCTOR FEE + HOSPITAL
CHARGES)
BMSHC Biliary microlith study ‐ Additional hospital 6200 6200 3100 2490 1860
charges
BMSDF Biliary microlith study ‐ Doctor fee 17730 17730 8870 7100 5320
BMSHCPACS Biliary microlith study ‐ For PACS ‐ NOT FOR
BILLING PURPOSE
BTDFHCO BEHAVIOUR THERAPY ( 50
S MINUTE SESSION ) (DOCTOR
FEE + HOSPITAL CHARGES)
BET Behaviour therapy ( 50 minute session ) ‐ 1610 1610 800 640 480 800 410
Doctor Fee
BETPSC Behaviour therapy ( 50 minute session ) ‐ 420 420 210 170 130 210 110
hospital charges
CSPTOS Dental ‐ Cavity sealant (per
tooth)‐ INPATIENT Doctor &
Hospital charges
110
CSPTHC Dental ‐ Cavity sealant (per tooth) ‐ Hospital 180 180 90 70 50
Charges
CSPT‐1 Dental Category 1 ‐ Cavity sealant (per 940 940
tooth)
DABJOS Dental ‐ Alveolectomy (both
jaws)‐ INPATIENT Doctor &
Hospital charges
DABJHC Dental ‐ Alveolectomy (both jaws) ‐ Hospital 1470 1470 740 590 440
Charges
DABJAW‐1 Dental Category 1 ‐ Alveolectomy (both 7330 5850
jaws)
DAFDOS Dental ‐ Archbar fixation
dentoalveolar fracture
segment‐ INPATIENT Doctor &
Hospital charges
DAFDHC Dental ‐ Archbar fixation dentoalveolar 900 900 450 360 270
fracture segment ‐ Hospital Charges
DAFDDS‐1 Dental Category 1 ‐ Archbar fixation 4390 2930
dentoalveolar fracture segment
DALVOS Dental ‐ Alveoloplasty‐
INPATIENT Doctor & Hospital
charges
DALVHC Dental ‐ Alveoloplasty ‐ Hospital Charges 460 460 230 190 140
DALVPLS1 Dental Category 1 ‐ Alveoloplasty 2200 1460
DAOJOS Dental ‐ Alveolectomy (one
jaws)‐ INPATIENT Doctor &
Hospital charges
DAOJHC Dental ‐ Alveolectomy (one jaws) ‐ Hospital 750 750 370 300 220
Charges
DAOJAW‐1 Dental Category 1 ‐ Alveolectomy (one jaws) 3660 2930
DAPAOS Dental ‐ Apicectomy per
additional tooth‐ INPATIENT
Doctor & Hospital charges
DAPAHC Dental ‐ Apicectomy per additional tooth ‐ 460 460 230 190 140
Hospital Charges
DAPAT‐1 Dental Category 1 ‐ Apicectomy per 2200
additional tooth
DAPIOS Dental ‐ Apicectomy
(Endodontics)‐ INPATIENT
DAPIHC Dental ‐ Apicectomy (Endodontics) ‐ Hospital 1190 1190 590 470 350
Charges
DAPICE‐1 Dental Category 1 ‐ Apicectomy 5850 3990
(Endodontics)
DARCOS Dental ‐ Apexification + Root
canal treatment ( RCT )‐
charges
DARCHC Dental ‐ Apexification + Root canal 750 750 370 300 220
treatment ( RCT ) ‐ Hospital Charges
DARCT‐1 Dental Category 1 ‐ Apexification + Root 3660 3330
canal treatment ( RCT )
DARTOS Dental ‐ Arthocentesis of TMJ‐
charges
DARTHC Dental ‐ Arthocentesis of TMJ ‐ Hospital 1470 1470 740 590 440
Charges
DARTMJ‐1 Dental Category 1 ‐ Arthocentesis of TMJ 7330 5450
DATEOS Dental ‐ All teeth extractions
(both jaws)‐ INPATIENT Doctor
& Hospital charges
DATEHC Dental ‐ All teeth extractions (both jaws) ‐ 2350 2350 1180 950 710
Hospital Charges
DATEXT‐1 Dental OPD Category 1 ‐ All teeth 11720 8790
extractions (both jaws)
111
DAULOS Dental ‐ Apicectomy ( Under LA
)‐ INPATIENT Doctor & Hospital
charges
DAULHC Dental ‐ Apicectomy ( Under LA ) ‐ Hospital 1190 1190 590 470 350
Charges
DAULA‐1 Dental Category 1 ‐ Apicectomy ( Under LA ) 5850 4390
DCFIOS Dental ‐ Composite filling‐
charges
DCFIHC Dental ‐ Composite filling ‐ Hospital Charges 460 460 230 190 140
DCFILL‐1 Dental Category 1 ‐ Composite filling 2200 2000
DCUROS Dental ‐ Curettage (per
quadrant)‐ INPATIENT Doctor
& Hospital charges
DCURHC Dental ‐ Curettage (per quadrant) ‐ Hospital 750 750 370 300 220
Charges
DCURRE‐1 Dental Category 1 ‐ Curettage (per 3660 1330
quadrant)
DCYSOS Dental ‐ Cyst Enucleation /
Marsupialisation‐ INPATIENT
DCYSTMAR‐1 Dental OPD Category 1 ‐ Cyst Enucleation / 11720 5850
Marsupialisation
DDIFCOS Dental ‐ Dental implant (
complete )‐ INPATIENT Doctor
& Hospital charges
DDIFCHC Dental ‐ Dental implant ( complete ) ‐ 8780 8780 4390 3510 2630
Hospital Charges
DDIFS‐1‐C Dental OPD Category 1 ‐ Dental implant ( 66550 48400
complete )
DDIFOS Dental ‐ Dental implant (first
stage)‐ INPATIENT Doctor &
Hospital charges
DDIFHC Dental ‐ Dental implant (first stage) ‐ 5850 5850 2930 2340 1760
Hospital Charges
DDIFS‐1 Dental OPD Category 1 ‐ Dental implant 29280 11720
(first stage)
DDIMOS Dental ‐ Dental implant
(second stage)‐ INPATIENT
DDIMHC Dental ‐ Dental implant (second stage) ‐ 2930 2930 1460 1170 880
Hospital Charges
DDIMP2‐1 Dental OPD Category 1 ‐ Dental implant 14640 10250
(second stage)
DDTMOS Dental ‐ Dislocation of TMJ‐
charges
DDTMHC Dental ‐ Dislocation of TMJ ‐ Hospital 750 750 370 300 220
Charges
DDTMJ‐1 Dental Category 1 ‐ Dislocation of TMJ 3660 3030
DEB‐OS Dental ‐ Excisional biopsy‐
charges
DEB‐HC Dental ‐ Excisional biopsy ‐ Hospital Charges 900 900 450 360 270
DEB‐1 Dental OPD Category 1 ‐ Excisional biopsy 4390 2340
DEFDOS Dental ‐ Extraction of fractured
/ decayed tooth‐ INPATIENT
DEFDHC Dental ‐ Extraction of fractured / decayed 310 310 150 120 90
tooth ‐ Hospital Charges
DEFDTO‐1 Dental OPD Category 1 ‐ Extraction of 1460 880
fractured / decayed tooth
112
DEIPDHC DENTAL EXTRACTION (
OS INPATIENT ) (DOCTOR FEE +
HOSPITAL CHARGES)
DEAHC Dental extraction ( inpatient ) ‐ Additional 130 130 70 60 40
hospital charges
DEDF Dental extraction ( inpatient ) ‐ Doctor fee 1190 1190 590 470 350
DEPFOS Dental ‐ Excision of pericoronal
flap‐ INPATIENT Doctor &
Hospital charges
DEPFHC Dental ‐ Excision of pericoronal flap ‐ 310 310 150 120 90
Hospital Charges
DEPF‐1 Dental OPD Category 1 ‐ Excision of 1460 1460
pericoronal flap
DFAGOS Dental ‐ Filling amalgam /
Glass ionomer‐ INPATIENT
DFAGHC Dental ‐ Filling amalgam / Glass ionomer ‐ 220 220 110 90 70
Hospital Charges
DFAGI‐1 Dental Category 1 ‐ Filling amalgam / Glass 2240 1600
ionomer
DFAPOS Dental ‐ Fluoride application‐
charges
DFAPHC Dental ‐ Fluoride application ‐ Hospital 240 240 120 100 70
Charges
DFAPP‐1 Dental Category 1 ‐ Fluoride application 1180 1180
DFMOOS Dental ‐ Fracture mandible
open reduction under LA‐
charges
DFMOHC Dental ‐ Fracture mandible open reduction 4400 4400 2200 1760 1320
under LA ‐ Hospital Charges
DFMORLA‐1 Dental Category 1 ‐ Fracture mandible open 21970 18150
reduction under LA ( Cost of Plates & screws
etc. )
DFOPFOS Dental ‐ Flap operation (full
mouth)‐ INPATIENT Doctor &
Hospital charges
DFOPFHC Dental ‐ Flap operation (full mouth) ‐ 2930 2930 1460 1170 880
Hospital Charges
DFOPFM‐1 Dental OPD Category 1 ‐ Flap operation (full 14640 13180
mouth)
DFOPOS Dental ‐ Flap operation (per
& Hospital charges
DFOPHC Dental ‐ Flap operation (per quadrant) ‐ 900 900 450 360 270
Hospital Charges
DFOPQ‐1 Dental OPD Category 1 ‐ Flap operation (per 4390 3660
quadrant)
DFREOS Dental ‐ Frenectomy‐
charges
DFREHC Dental ‐ Frenectomy ‐ Hospital Charges 460 460 230 190 140
DFRENE‐1 Dental OPD Category 1 ‐ Frenectomy 2200 1180
DFSBOS Dental ‐ Flap surgery with bone
graft (per quadrant)‐
charges
DFSBHC Dental ‐ Flap surgery with bone graft (per 1190 1190 590 470 350
quadrant) ‐ Hospital Charges
DFSBG‐1 Dental OPD Category 1 ‐ Flap surgery with 5850 5850
bone graft (per quadrant)
DGPLOS Dental ‐ Gingivoplasty (per
& Hospital charges
113
DGPLHC Dental ‐ Gingivoplasty (per quadrant) ‐ 900 900 450 360 270
Hospital Charges
DGPLASTY‐1 Dental OPD Category 1 ‐ Gingivoplasty (per 4390 3660
quadrant)
DGTOOS Dental ‐ Gingivectomy (per
& Hospital charges
DGTOHC Dental ‐ Gingivectomy (per quadrant) ‐ 750 750 370 300 220
Hospital Charges
DGTOMY‐1 Dental OPD Category 1 ‐ Gingivectomy (per 3660 2930
quadrant)
DIAIOS Dental ‐ Intra articular
injection‐ INPATIENT Doctor &
Hospital charges
DIAIHC Dental ‐ Intra articular injection ‐ Hospital 240 240 120 100 70
Charges
DIAINJ‐1 Dental OPD Category 1 ‐ Intra articular 1180 1180
injection
DIBIOS Dental ‐ Incisional biopsy‐
charges
DIBIHC Dental ‐ Incisional biopsy ‐ Hospital Charges 460 460 230 190 140
DIBIOP‐1 Dental OPD Category 1 ‐ Incisional biopsy 2200 1180
DIDROS Dental ‐ Incision and drainage‐
charges
DIDRHC Dental ‐ Incision and drainage ‐ Hospital 620 620 310 240 190
Charges
DIDRAIN‐1 Dental OPD Category 1 ‐ Incision and 2930 2340
drainage
DIFFOS Dental ‐ Iodoform Dressing for
CYST‐ INPATIENT Doctor &
Hospital charges
DIFFHC Dental ‐ Iodoform Dressing for CYST ‐ 130 130 70 60 40
Hospital Charges
DIFF‐1 Dental Category 1 ‐ Iodoform Dressing for 590 530
CYST
DIMFOS Dental ‐ Inter ‐ maxillary
fixation with archbar‐
charges
DIMFHC Dental ‐ Inter ‐ maxillary fixation with 2070 2070 1030 830 620
archbar ‐ Hospital Charges
DIMFA‐1 Dental Category 1 ‐ Inter ‐ maxillary fixation 10250 8790
with archbar
DIMPOS Dental ‐ Impaction (Bony / soft
tissue)‐ INPATIENT Doctor &
Hospital charges
DIMPHC Dental ‐ Impaction (Bony / soft tissue) ‐ 1470 1470 740 590 440
Hospital Charges
DIMPACT‐1 Dental OPD Category 1 ‐ Impaction (Bony / 7330 6660
soft tissue)
DIWSOS Dental ‐ Interdental wiring +
splinting (per quadrant)‐
charges
DIWSHC Dental ‐ Interdental wiring + splinting (per 900 900 450 360 270
quadrant) ‐ Hospital Charges
DIWSPIL‐1 Dental OPD Category 1 ‐ Interdental wiring 4390 4390
+ splinting (per quadrant)
DJFCOS Dental ‐ Jaw fracture closed
reduction‐ INPATIENT Doctor &
Hospital charges
DJFCHC Dental ‐ Jaw fracture closed reduction ‐ 2350 2350 1180 950 710
Hospital Charges
DJFCR‐1 Dental OPD Category 1 ‐ Jaw fracture closed 11720 10990
reduction
114
DLFROS Dental ‐ Lingual frenectomy‐
charges
DLFRHC Dental ‐ Lingual frenectomy ‐ Hospital 460 460 230 190 140
Charges
DLFREN‐1 Dental OPD Category 1 ‐ Lingual frenectomy 2200 1770
DMIAOS Dental ‐ Mini ‐ implant for
anchorage (per implant)‐
charges
DMIAHC Dental ‐ Mini ‐ implant for anchorage (per 1760 1760 880 700 530
implant) ‐ Hospital Charges
DMIA‐1 Dental OPD Category 1 ‐ Mini ‐ implant for 8790 7330
anchorage (per implant)
DNBNOS Dental ‐ Nerve block in
Neuralgias‐ INPATIENT Doctor
& Hospital charges
DNBNHC Dental ‐ Nerve block in Neuralgias ‐ Hospital 900 900 450 360 270
Charges
DNBN‐1 Dental Category 1 ‐ Nerve block in 4390 3630
Neuralgias
DOACOS Dental ‐ Oro antral
communication closure ‐
charges
DOACHC Dental ‐ Oro antral communication closure ‐ 4110 4110 2060 1650 1240
Hospital Charges
DOACC‐1 Dental Category 1 ‐ Oro antral 20490
communication closure
DOBTOS Dental ‐ Obturators‐
charges
DOBTHC Dental ‐ Obturators ‐ Hospital Charges 2350 2350 1180 950 710
DOBTU‐1 Dental Category 1 ‐ Obturators 11720 10990
DOPEOS Dental ‐ Operculectomy‐
charges
DOPEHC Dental ‐ Operculectomy ‐ Hospital Charges 310 310 150 120 90
DOPER‐1 Dental Category 1 ‐ Operculectomy 1460 1460
DPIOOS Dental ‐ Placentrax Inj for
OSMF‐ INPATIENT Doctor &
Hospital charges
DPIOHC Dental ‐ Placentrax Inj for OSMF ‐ Hospital 240 240 120 100 70
Charges
DPIOSMF‐1 Dental Category 1 ‐ Placentrax Inj for OSMF 1180
DPUCOS Dental ‐ Pulp capping‐
charges
DPUCHC Dental ‐ Pulp capping ‐ Hospital Charges 220 220 110 90 70
DPUCAP‐1 Dental Category 1 ‐ Pulp capping 2240 1330
DPULOS Dental ‐ Pulpotomy‐
charges
DPULHC Dental ‐ Pulpotomy ‐ Hospital Charges 310 310 150 120 90
DPULPO‐1 Dental Category 1 ‐ Pulpotomy 1460 1460
DRATOS Dental ‐ Reimplantation of
avulsed tooth‐ INPATIENT
DRATHC Dental ‐ Reimplantation of avulsed tooth ‐ 620 620 310 240 190
Hospital Charges
DRAT‐1 Dental OPD Category 1 ‐ Reimplantation of 2930 2930
avulsed tooth
115
DRCAOS Dental ‐ Root canal with
Apicectomy‐ INPATIENT Doctor
& Hospital charges
DRCAHC Dental ‐ Root canal with Apicectomy ‐ 1470 1470 740 590 440
Hospital Charges
DRCAPIC‐1 Dental Category 1 ‐ Root canal with 7330 5850
Apicectomy
DRCTFOS Dental ‐ Root canal treatment (
RCT ) ‐ anterior‐ INPATIENT
DRCTFHC Dental ‐ Root canal treatment ( RCT ) ‐ 750 750 370 300 220
anterior ‐ Hospital Charges
DRCTANT‐1 Dental Category 1 ‐ Root canal treatment ( 3660 2930
RCT ) ‐ anterior
DRCTOS Dental ‐ Root canal treatment (
RCT ) ‐ posterior‐ INPATIENT
DRCTHC Dental ‐ Root canal treatment ( RCT ) ‐ 1190 1190 590 470 350
posterior ‐ Hospital Charges
DRCTPOS‐1 Dental Category 1 ‐ Root canal treatment ( 5850 3990
RCT ) ‐ posterior
DRFWOS Dental ‐ Removal of
Frontosuspension wiring‐
charges
DRFWHC Dental ‐ Removal of Frontosuspension 1190 1190 590 470 350
wiring ‐ Hospital Charges
DRFW‐1 Dental Category 1 ‐ Removal of 5850
Frontosuspension wiring
DROCOS Dental ‐ Removal of old
crown/bridge/unit‐ INPATIENT
DROCHC Dental ‐ Removal of old crown/bridge/unit ‐ 180 180 90 70 50
Hospital Charges
DROCBU‐1 Dental Category 1 ‐ Removal of old 740
crown/bridge/unit
DRPMOS Dental ‐ Removal of plates of
mandible and maxilla ( Under
LA )‐ INPATIENT Doctor &
Hospital charges
DRPMHC Dental ‐ Removal of plates of mandible and 2350 2350 1180 950 590
maxilla ( Under LA ) ‐ Hospital Charges
DRPMMLA‐1 Dental Category 1 ‐ Removal of plates of 11720
mandible and maxilla ( Under LA )
DRPTOS Dental ‐ Extraction (per tooth)‐
charges
DRPTHC Dental ‐ Extraction (per tooth) ‐ Hospital 180 180 90 70 50
Charges
DRPTO‐1 Dental OPD Category 1 ‐ Extraction (per 740 590
tooth)
DSETOS Dental ‐ Surgical extraction of
tooth‐ INPATIENT Doctor &
Hospital charges
DSETHC Dental ‐ Surgical extraction of tooth ‐ 620 620 310 240 190
Hospital Charges
DSETO‐1 Dental OPD Category 1 ‐ Surgical extraction 2930 2930
of tooth
DSFMOS Dental ‐ Scaling full mouth‐
charges
DSFMHC Dental ‐ Scaling full mouth ‐ Hospital 460 460 230 190 140
Charges
DSFMOU‐1 Dental Category 1 ‐ Scaling full mouth 2200 2000
116
DSPROS Dental ‐ Splint Removal‐
charges
DSPRHC Dental ‐ Splint Removal ‐ Hospital Charges 310 310 150 120 90
DSPREMO1 Dental Category 1 ‐ Splint Removal 1460 1460
DSREOS Dental ‐ Suture removal‐
charges
DSREHC Dental ‐ Suture removal ‐ Hospital Charges 180 180 90 70 50
DSREMO‐1 Dental OPD Category 1 ‐ Suture removal 1460 1030
DSSCOS Dental ‐ Subgingival scaling &
curretage full mouth‐
charges
DSSCHC Dental ‐ Subgingival scaling & curretage full 900 900 450 360 270
mouth ‐ Hospital Charges
DSSCFM‐1 Dental Category 1 ‐ Subgingival scaling & 4390 3660
curretage full mouth
DTEXOS Dental ‐ Tumour excision‐
charges
DTEXHC Dental ‐ Tumour excision ‐ Hospital Charges 2930 2930 1460 1170 880
DTEXCI‐1 Dental OPD Category 1 ‐ Tumour excision 14640 8790
DZCFOS Dental ‐ Zygonatic Complex
Fracture under LA‐ INPATIENT
DZCFHC Dental ‐ Zygonatic Complex Fracture under 2930 2930 1460 1170 880
LA ‐ Hospital Charges
DZCFULA‐1 Dental Category 1 ‐ Zygonatic Complex 14640
Fracture under LA

Dermatology Procedure Charges

1 SKINCP Skin ‐ Corn paring 670 400
2 SKINCML Skin Cauterisation ‐ Multiple lesions 2270 1370
3 SKINCSL Skin Cauterisation ‐ Single lesion 810 480
4 SKINCTL Skin Cauterisation ‐ Two lesions 1330 800
5 SKINCRML Skin Cryosurgery ‐ Multiple Lesions 3480 2090
6 SKINCRSL Skin Cryosurgery ‐ Single Lesion 1600 960
7 SKINCRTL Skin Cryosurgery ‐ Two Lesions 2400 1440
8 SKINGSP Skin OPD ‐ Gram Stain procedure 480 290
9 SKINIIP Skin OPD ‐ Intralesional injection procedure 670 400
10 SKINKPP Skin OPD ‐ KOH preparation procedure 480 290
11 SKINPUVA Skin OPD ‐ PUVA Therapy 400 240
12 SKINBP Skin OPD ‐ Skin biopsy procedure 2440 1460
13 SKINSPTP Skin OPD ‐ Skin patch testing procedure 1730 1040
14 SKINSPTPAC Skin OPD ‐ Skin patch testing procedure ‐ charges for 80 50
additional antigen
15 SKINSMAFB Skin OPD ‐ Slit smear for AFB procedure 480 290
16 SKINTACML Skin OPD ‐ Trichloacetia acid cauterisation ‐ Multiple 1330 800
lesions
17 SKINTACSL Skin OPD ‐ Trichloacetia acid cauterisation ‐ Single lesion 400 240
18 SKINTACTL Skin OPD ‐ Trichloacetia acid cauterisation ‐ Two lesions 810 480
19 SKINSFP Skin OPD scraping for fungus procedure 260 160
117
ENT Procedure Charges

20 IMPED Impedance Audiometry 620 370
21 NASENDO Nasal Endoscopy 1860 1110
22 PTDHS Position Testing ( Dix ‐ Hallpike / Head ‐ Shaking ) GOPD 350
23 AUDIOM Pure tone audiometry ( PTA ) 550 330
24 RPEM Re‐Position ( Epley's ) Manouvere GOPD 580
ENT Therapy Charges
Cat‐1D Single/
Cat‐2 Beded
Premium/
4 Bedded
GOPD
POPD
Cat‐3
Suite
1 STHER Speech Therapy (per sitting) 550 530 320 530 320

2 SPEECHC Speech Therapy per 10 Session ‐ Hospital 4730 2840 4730 2840
Charges
3 SPSINHC Speech Therapy specialised for singers ‐ 1580 950 1580 950
Hospital Charges
4 ENTINHC Tinnitus retraining therapy ‐ Hospital Charges 530 320 530 320
ENT charges
SNo Code Description POPD GOPD ALL CAT

1 DCHFENT Dressing charges for ENT 260
2 EUMCH Examination under microscope charges 280
3 TTCCH Tracheostomy tube change charges 680
4 ENGHC Videonystagmography (VNG)(Hospital Fee) 3150 3150
ENT Procedures
All Category
Cat 1B Suite
4 Beddded
Cat 1A‐Pre
Single Bed
2 Bedded
Cat‐1D
GOPD
POPD
Cat‐2
Cat‐3

1 ASEHOS Speech Assessment (
Endoscopic Laryngology &
Stroboscopy ) ‐ ( Doctor fee +
Hospital Share )
ASEDF Speech Assessment ( Endoscopic 3150
Laryngology & Stroboscopy ) ‐ Doctor fee
ASEHC Speech Assessment ( Endoscopic 2100 2630
Laryngology & Stroboscopy ) ‐ Hospital
Share
2 ASSRDH Auditory Steady State
Response( ASSR )(DOCTOR FEE
+ HOSPITAL CHARGES)
ASSR Auditory Steady State Response ( ASSR ) ‐ 4120 2050
Doctor fee
ASSRHA Auditory Steady State Response ( ASSR ) ‐ 830 410
hospital amount
3 DBHLDH Detailed BERA for hearing
loss(DOCTOR FEE + HOSPITAL
CHARGES)
DBHL Detailed BERA for hearing loss ‐ Doctor fee 2650 1590
DBHLHA Detailed BERA for hearing loss‐ hospital 530 320
amount
118
4 DPOAEDH Distortion Product Otoacoustic
Emisssion( DPOAE )(DOCTOR
FEE + HOSPITAL CHARGES)
DPOAE Distortion Product Otoacoustic Emisssion ( 1180 590
DPOAE ) ‐ Doctor fee
DPOAEHA Distortion Product Otoacoustic Emisssion ( 240 130
DPOAE ) ‐ hospital amount
5 ELDHOS Endoscopic Laryngology
(Doctor fee + Hospital Share)
ELDF Endoscopic Laryngology ‐ Doctor fee 2100
SAELSH Endoscopic Laryngology ‐ Hospital Share 1050 1580
6 ENGOS Videonystagmography (VNG)
(Doctor fee + Hospital fee)
ENGDF Videonystagmography (VNG) (Doctor Fee) 4730 4730 3940 3150 2360 3150
ENGHC Videonystagmography (VNG)(Hospital Fee) 4730 4730 3940 3150 2360 3150 3150
7 OTOESDH OTO‐ACOUSTIC EMISSION TEST
CHOS FOR NEWBORN BABIES
(DOCTOR FEE + HOSPITAL
CHARGES)
OETNBDF OTO‐acoustic emission test for newborn 900 900 450 360 270
babies ‐ Doctor fee
OETNBHC OTO‐acoustic emission test for newborn 480 480 240 190 140
babies ‐ Hospital charges
8 VAOS VOICE ANALYSIS
VACDC Voice analysis ‐ Clinical doctor charges 2760 1370
VAHC Voice analysis ‐ Hospital Charges 5500 2760
VASPC Voice analysis ‐ Speech pathologists charges 2760 1370
Hospital Charges
Bedside procedure charges
All Category
Cat 1B Suite
Cat 1A‐Pre/
Single Bed
2 Bedded
Casualty
Cat‐1D
4 Bed
Cat‐2
Cat‐3
Code Description
ALTEST Allergy testing in casualty / Prick testing for ant 90 80
ANINFCH Antibiotic infusion charges 320 260
BCCHC Baby care charges ( while baby is with mother i 970 970 720 480
DRESSCAS Dressing in casualty 230 210
HIDORFEOS HIGH DOSE CHEMOTHERAPY AND RESCUE ‐ Ho 21300 10660 8530 6390
ICPHC ICP Monitoring Charges (Hospital charges) 1790 1190 880 600
INJADMCH Injection administration charges 110 110
RYLETI Ryle's tube insertion in casualty 240 210
STSUTREM Stitch / Suture removal 240 210
STREMDRESS Suture removal / Dressings / Stent removal in D 170
TRACH Tracheostomy tube changing charges in casual 320 260
URCATH Urinary Foley's catheterisation in casualty 260
KTP Charges
KTPCHA KTP Service Charges 10680 5340 4010 2680 4850
Resuscitation charges
NEWBRNRESCES Resuscitation charges of newborn baby following caeserian 5070 2540 1910 1280
section
NEWBRNRESCH Resuscitation charges of newborn baby following normal 4010 2020 1520 1010

delivery
119
Bedside procedure charges (Glucometry)
Code Description POPD GOPD ALL CAT

GLUCH Glucometry test charges ( Also order stock item with this ) 80 40
Dressing set charges

ASPSER Aspiration set usage charges 360
BGAMJEER Big Gamjee Roll 110
BMSET Bone marrow set usage charges 380
DRESSET Dressing set usage charges 190
EYESET Eye set usage charges 400
GAMJEEP Gamjee Pad 20
GAMJEER Gamjee Roll 80
GAUZEP Gauze Pack ( packet of 5) 30
ICDBOTTLE Intercostal chest tube ( ICD ) bottle charges 380
KBSET Kidney biopsy set usage charges 390
LBSET Liver biopsy set usage charges 380
LPSET Lumbar puncture set usage charges 380
MAJDSET Major dressing set usage charges 280
MYELOSET Myelogram set usage charges 380
PEXTRSET Paediatric exchange transfusion set usage charges 380
PDSET Peritoneal dialysis ( PD ) set usage charges 380
TROCSET Trocar and cannula set usage charges 1790
CATHSET Urinary catheteristion set 380
Dressing set charges (CVP line)
COSET Cut open ( venesection ) / suturing set usage charges 380
Dressing set charges (in package)

ANGIOSET Angiogram set usage charges 360
Dressing set charges (Tracheostomy)

TRACSET Tracheostomy set usage charges 380
Hospital charges
ALPTRA ALPHA TRACELL CHARGES 240
ALPTRDL ALPHA TRACELL DELUX CHARGES 430
ALPXC ALPHA XCELL CHARGES 430
APAC Angiography Pool Account 2000
ACAC Angioplasty combo a/c 3000
AULG AUTOLOGIC CHARGES 490
ECMOHC ECMO ‐ Maintenance Charges Per Day (Cardiac surgery) 11030
INTERCH Interpreter charges 1320
KTPSH KTP Surcharge ‐ Hospital charges 5290
LCLL Laser Charges for Lesion ( Large ) 4850
LCLS Laser Charges for Lesion ( Small Size ) 2430
LCLM Laser Charges for Lesions ( Midium Size ) 3640
NIM NIMBUS CHARGES 610
SECARHC Screening Echo Cardiology ‐ Hospital Charges 1020
SUPAR SUPAR TEST CHARGES 610
120
LAVDMC Temporary LVAD ‐ Maintenance Charges Per Day 11030
USAVFHS Ultrasound guided venous mapping for I/J catheter insertion 600
and A.V Fistula creation ‐ Machine Charges
Hospital Charges CIC

HCCIC Home Collection Sample Charges 110
Hospital charges for Diabetic Foot Clinic
BIOTHES Biothesiometery 240 240 240
DIFOMIPOP Diabetic foot ‐ minor outpatient procedure (hospital charges) 1240 1240 1240
RHC
TOEBRAIND Toe Brachial Index 240 240
Hospital charges for haemodialysis

HDFHC Online Hemodiafiltration (HDF) (5008S) ‐ Hospital Charges 3680 3680
Hospital service charges for thalassemia patient

IPRTH Hospital service charges for thalassemia patients 700
MRD Charges
MRDCHG MRD Charges 500 (IP)/
200 (Day care)
Stoma care charges

STOMCARE Stoma care charge 210
CHRG
STOMAC3 Stoma care charges ( Complex ) 390
STOMAC1 Stoma care charges ( Easy ) 170
STOMAC4 Stoma care charges ( Extra Complex ) 560
STOMAC2 Stoma care charges ( Normal ) 320

121
Operations

Access Procedures For Dialysis
OT Day Care
Single Bed
Premium/
2 Bedded
4 Bedded
Cat‐1D
Cat‐2
Cat‐3
Suite
1 OP2911 Acute vascular access for dialysis ( in OT ) 20330 10160 8140 6100
2 AVFISSF AV Fistula ‐ Surgen Fee
3 OP3397 Basilic vein transposition in OT 60980 30490 24400 18290
4 OP0240 Brachio ‐ basilic loop AV graft for haemodialysis 40610 20310 16250 12180
5 OP0242 Brachio ‐ basilic straight ( above elbow ) AV graft for 40610 20310 16250 12180
haemodialysis
6 OP0239 Brachio ‐ cephalic loop AV graft for haemodialysis 40610 20310 16250 12180
7 OP0241 Brachio ‐ cephalic straight ( above elbow ) AV graft for 40610 20310 16250 12180
haemodialysis
8 OP0245 Brachio AV fistula at elbow for haemodialysis 29230 14620 11700 8770
9 OP0443 CAPD placement ( laparosopic ) 24650 12330 9870 7390
10 OP1080 CAPD placement ( open ) 24650 12330 9400 7390
11 OP0448 CAPD removal & placement ( laparosopic ) 32340 16170 12320 9700
12 OP0445 CAPD removal & placement ( open ) 32340 16170 12940 9700
13 OP0447 CAPD removal ( laparosopic ) 15460 7730 6180 4640
14 OP0444 CAPD removal ( open ) 15460 7730 6180 4640
15 OP0446 CAPD revision ( laparosopic ) 12350 6170 4950 3710
16 OP0449 CAPD revision ( open ) 12350 6170 4710 3710
17 OP0437 Conversion of arteriovenous ( AV ) shunt to 29230 14620 11700 8770
arteriovenous ( AV ) fistula
18 OP0440 Creation of arteriovenous ( AV ) fistula at axillary 36960 18480 14780 11090
artery
19 OP0433 Creation of arteriovenous ( AV ) fistula at elbow ( 35200 18480 14780 11090
brachial artery )
20 OP1077 Creation of arteriovenous ( AV ) fistula at wrist ( radial 36960 18480 14780 11090
artery )
21 OP4205 GSV translocation for AV access 60980 30490 24400 18290
22 OP0320 Ligation of ruptured AV fistula 15460 7730 6180 4640
23 OP0319 Ligation of ruptured AV graft 20330 10160 8140 6100
24 OP0436 Placement of arteriovenous ( AV ) shunt at ankle ( 20330 10160 8140 6100
25 OP1078 Placement of arteriovenous ( AV ) shunt at wrist ( 20330 10160 8140 6100
radial artery )
26 OP0243 Radio ‐ basilic straight ( below elbow ) AV graft for 40610 20310 16250 12180
haemodialysis
27 OP0244 Radio ‐ cephalic straight ( below elbow ) AV graft for 40610 20310 16250 12180
haemodialysis
28 OP4204 Repair of A.V.Fistula aneurysm 41580 20790 16630 12470
29 OP0441 Revision of arteriovenous ( AV ) fistula at axillary 15460 7730 6180 4640
artery
30 OP0435 Revision of arteriovenous ( AV ) fistula at elbow ( 15460 7730 6180 4640
brachial artery )
31 OP0434 Revision of arteriovenous ( AV ) fistula at wrist ( radial 15490 7730 6180 4640
artery )
32 OP0439 Revision of arteriovenous ( AV ) shunt at ankle ( 10160 5080 4070 3050
33 OP0438 Revision of arteriovenous ( AV ) shunt at wrist ( radial 10160 5080 3880 3050
artery )
34 OP1083 Vascular prosthetic graft in forearm 46200 23100 18480 13860
35 OP0526 Vascular prosthetic graft in thigh 46200 23100 18480 13860
36 OP0525 Vascular prosthetic graft in upper arm 46200 23100 18480 13860

122
Aesthetic Surgery
OT Day Care
Single Bed
Premium/
2 Bedded
4 Bedded
Cat‐1D
Cat‐2
Cat‐3
Suite
37 OP1305 Abdominoplasty 115500 57750 46200 34650
38 OP1303 Abdominoplasty with limited incision 92400 46200 36960 27720
39 OP1304 Abdominoplasty with liposuction 138600 69300 55440 41580
40 OP2996 Belt Lipectomy 175140 87570 70060 52540
41 OP3082 Bilateral face dimple construction ( dimploplasty ) 80850 40430 32340 24260
42 OP3007 Botox / Fillers 32150 16080 12870 9650
43 OP1803 Brachioplasty / arm lift 107120 53560 42860 32130
44 OP0842 Brow / forehead lift 141310 70650 56530 42390
45 OP1804 Buttock implant 111340 55670 44540 33410
46 OP4383 Buttock Lift 127050 63530 50820 38120
47 OP1802 Calf implant 102750 51370 41100 30820
48 OP0840 Centralisation of chin 94180 47090 37680 28250
49 OP0083 Chemical peel of face 80370 40180 32140 24100
50 OP0060 Chin augmentation ‐ multiple sliding osteotomies ( 80850 40430 32340 24260
Genioplasty )
51 OP0061 Chin augmentation ‐ osteotomy with bone graft ( 111340 55670 44540 33410
Genioplasty )
52 OP1320 Chin augmentation ‐ prosthetic / allograft ( 94180 47090 37680 28250
Genioplasty )
53 OP0059 Chin augmentation ‐ single sliding osteotomy ( 102750 51370 41100 30820
Genioplasty )
54 OP0826 Chin reduction 107120 53560 42860 32130
55 OP4382 Circumferential Body Lift 190580 95290 76230 57180
56 OP3423 Contouring of bones of the face ‐ multiple Bones 92400 46200 36960 27720
57 OP3422 Contouring of bones of the face ‐ single Bone 57750 28880 23100 17330
58 OP1365 Correction / revision of face scars ‐ multiple 59970 29990 23990 18000
59 OP1364 Correction / revision of face scars ‐ single 46270 23130 18500 13880
60 OP3060 Correction / revision of two face scars 62330 31160 24930 18700
61 OP3431 Correction of complex scar ‐ large 96450 48220 38580 28930
62 OP3430 Correction of complex scar ‐ medium 64280 32140 25710 19290
63 OP3429 Correction of complex scar ‐ small 48240 24110 19290 14480
64 OP1798 Correction of congenital ear lobule deformity 64280 32140 25710 19290
65 OP4368 Correction of Contour Deformity Face (Fat, Implant, 60980 30490 24400 18290
Flap) ‐ Minor
66 OP4369 Correction of Contour Deformity Face (Fat, Implant, 101640 50820 40660 30490
Flap)‐Majorlip
67 OP3005 Correction of multiple facial scars 77910 38960 31160 23380
68 OP1588 Corrective rhinoplasty ‐ augmentation with bone graft 96450 48220 38580 28930
69 OP1587 Corrective rhinoplasty ‐ augmentation with cartilage 96450 48220 38580 28930
70 OP1586 Corrective rhinoplasty ‐ augmentation with implant 73940 36970 29580 22190
71 OP1589 Corrective rhinoplasty ‐ augmentation with other 100630 50310 40250 30200
material
72 OP3310 Corrective rhinoplasty ‐ complete 151580 75790 60640 45470
73 OP1584 Corrective rhinoplasty ‐ nasal tip 64280 32140 25710 19290
74 OP1593 Corrective rhinoplasty ‐ reduction 100630 50310 40250 30200
75 OP1580 Corrective rhinoplasty ‐ with septoplasty 112520 56270 45010 33760
76 OP1594 Corrective rhinoplasty for crooked / deviated nose 128580 64280 51440 38580
77 OP1315 Cosmetic blepharoplasty ( four lids ) 96450 48220 38580 28930
78 OP0135 Cosmetic blepharoplasty ( one lid ) 42920 21460 17160 12880
79 OP0136 Cosmetic blepharoplasty ( three lids ) 62330 31160 24930 18700
80 OP0058 Cosmetic blepharoplasty ( two lids ) 64280 32140 25710 19290
81 OP1095 Dermabrasion 85680 42830 34270 25700
82 OP1336 Dermabrasion full face 85680 42830 34270 25700
123
83 OP1337 Dermabrasion partial face 59970 29990 23990 18000
84 OP1345 Ear lobule repair ‐ bilateral 17330 8670 6930 5200
85 OP1344 Ear lobule repair ‐ unilateral 11550 5780 4620 3470
86 OP3077 Ear lobule repair with cartilage graft 70140 35070 28050 21040
87 OP1350 Endoscopic brow / forehead lift 141310 70650 56530 42390
88 OP1349 Endoscopic face lift 192650 96330 77070 57790
89 OP1363 Eyebrow graft 70710 35350 28280 21220
90 OP0138 Eyelash graft 70710 35350 28280 21220
91 OP0841 Face lift ‐ classic operations 128580 64280 51440 38580
92 OP1767 Face lift ‐ facial suspension 85680 42830 34270 25700
93 OP1789 Face lift ‐ mid face 96450 48220 38580 28930
94 OP1766 Face lift ‐ minimum scar

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Sir

Ganga Ram Hospital

1 Birthing Suite (LR) 12000

Intensive care charges 4 Bedded

SNo Service Area Code

1 CCU / IMCU monitoring charges INTMONCHCCU 13300 11100 8900

2 NNU charges - level 1 1900

3 NNU charges - level 2 2900

4 NNU charges - level 3 4600 4600 4600 4400 4100

5 Observation nursery charges 720

INTENSIVE CARE AREAS

2. General Information on Procedure/ Investigation Charges

4. ADVANCE BOOKING CHARGES & ADVANCES AT THE TIME OF ADMISSION

i) Room booking / maternity booking

ii) Advance deposit at the time of admission:

S.NO. Type of accommodation Amount

1. Categroy 1A/ 1B 100000

In surgical cases (confirmed booking)

S.NO. Department Category 1 Category 2 Category 3

1. GI Surgery 120000 100000 70000

2. General Surgery 50000 40000 30000

3. Neuro Surgery 120000 100000 70000

4. Ortho-Surgery 70000 60000 50000

5. Kidney Transplantation 750000

6. Cardiac Package 100% 100% 100%

7. Liver Transplant (adult) 100% (as per package)

Hepatitis C virus serology antibody test [HCV] 1040 620

HIV antibody test [HIV] 780 470

RPR [VDRL] 330 200

1 Additional Transfusion Charges 3100 3100 2550 1600 2350 1350 0

1 Aphaeresis Collection & Storage 71500 71500 66000 55000 38500

SNo Code Description

SNo Description Code POPD/ GOPD/

SNo Description Code POPD/ GOPD/

SNo Description Code POPD/ GOPD/

SNo Description Code POPD/ GOPD/

SNo Description Code POPD/ GOPD/

SNo Description Code POPD/ GOPD/

HLA Serological & Molecular Charges

SNo Description Code POPD/ GOPD/

Molecular Genetics Charges

SNo Description Code POPD/ GOPD/

171 Farber lipogranulomatosis (Exon 6,12) MASAH1 10000 7000

SNo Description Code POPD/ GOPD/

SNo Description Code POPD/ GOPD/

2 DIAGNOSTIC SPERM EXTRACTION ( TESA / PESA ) DSEPCADCHOS

7 Intra‐cytoplasmic sperm injection ( ICSI ) ‐ (Embryologists ICSIOS

13 Oocyte Cryopreservation cycle (upto 9 oocytes) IVFOC9O

17 Renewal charges for embryo cryopreservation (for every RENCRYOOS

18 Re‐Vitrification (Embryologists fee + Hospital charges) REVITEOS

SNo Code Description

Biochemistry Laboratory Charges

S No Description Code POPD/ GOPD/

168 NGAL (Plasma) NGALP 1840 1100

248 Urine spot test for sodium & potassium URINSODPOTOS

SNo Description Code POPD/ GOPD/

SNo Description Code POPD/ GOPD/

SNo Description Code POPD/ GOPD/