Charges - St.Stephen`s Hospital
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ST. STEPHEN'S HOSPITAL TIS HAZARI, DELHI - 110 054 SCHEDULE OF CHARGES W.E.F 01-04-2016 INDEX SL. No. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 25 26 27 28 29 30 31 32 33 34 Particulars O.P.D. SERVICES : - Registration …………………………………….…. - Clinics ……………………………………………… - Comprehensive Check-up………………….……. ADMISSION FEE ............................................................................... ACCOMMODATION CHARGES ………………………………………… ICU, CCU …………………………………………………………………… CONSULTATION CHARGES ……………………………….…………… THERAPEUTIC DIET SERVICES ……………………………………… PROCEDURE & DRESSING - Dressing, Injection, etc… …………… LABORATORY SERVICES - Haematology ……………………….. - Microbiology ................................... - Serology ......................................... - Blood Bank . ................................... - Biochemistry . ................................. - Clinical Pathology ........................... - Immuno Assay ............................... - Histopathology & Cytology ............ RADIOLOGY SERVICES - X-Ray ………………………………... - CT Scan..... …………………….……. - Ultrasound……………………………. - MRI......………………….................... - Interventional Radiology…… ………. PHYSIOTHERAPY SERVICES ……………………………………….. OCCUPATIONAL SERVICES .......................................................... A.L.C. SERVICES .......................................................................... CARDIOLOGY SERVICES ………………………................................ PACKAGE CHARGES FOR C T S ……………………………………… ENDOCRINOLOGY SERVICES ………………………………………… GASTROENTROLOGY SERVICES ................................................. DERMATOLOGY SERVICES .......................................................... RESPIRATORY MEDICINE SERVICES ......................................... PSYCHIATRIC SERVICES .............................................................. ONCOLOGY SERVICES ……………………………………………….. NEUROLOGY SERVICES …………………………………………….. NEPHROLOGY SERVICES ............................................................. PEADIATRIC SERVICES .............................................................. OPHTHALMOLOGY SERVICES………………………………………… E.N.T. & AUDIOLOGY SERVICES……………………………………… PACKAGE CHARGES FOR ENT SURGERY…………………………. DENTAL SERVICES ………………………………………………….. MATERNITY SERVICES ………………………………………………. REPRODUCTIVE AND FOETAL MEDICINE UNIT (RFM UNIT) ….. MINOR OT PROCEDURES ............................................................. PAIN CLINIC CHARGES ………………………..…….…………….. OXYGEN CHARGES …………………………………………………… OPERATION CHARGES ................................................................ IN PATIENT PACKAGE CHARGES FOR GENERAL SURGERY ... MISCELLANEOUS CHARGES - Certificate Fee ……………………. - Mortuary Services ………………. Page No. 4 4 4 5 5 5 5 5 6 7 8 8 9 9 10 10 11 12 13 13 14 15 17 18 18 21 23 23 23 24 25 25 26 26 27 28 28 29 30 32 34 35 37 38 39 39 40 41 41 GENERAL INFORMATIONS: 1. This schedule will apply to all patients including those belonging to the Institutions who have St. Stephen's Hospital on their panel for treatment of their referred patients. 2. a) For O.P.D. Services there are two categories of charges only i.e. GENERAL and PRIVATE. For private OPD, the charges @ private rates would be applicable. b) For in-patients, the charges are determined with reference to the type of accommodation chosen by the patients as given below: GENERAL,CUBICLE, SEMI-PVT NON A.C., SEMI-PVT A.C., SEMI-PVT. (DELUXE), PRIVATE NON A.C., PRIVATE A.C., SPECIAL ROOMS AND DELUXE Rooms. 3. Change of Accommodation: a) If a higher type of accommodation is desired by a patient during the hospital stay, ie. if a general ward patient wishes to be transferred to a private/semi - Pvt. Ward, he/she will pay general ward charges for all services up to the time of transfer and private ward charges as per category chosen for all services from the date of transfer to higher accommodation. However, in the case of a person operated or who has undergone a delivery who subsequently desires a higher category of accommodation, the operation fees/delivery charges will be as per the highest category of accommodation availed. b) If a patient wishes to change to lower accommodation (from private/semi private to general ward) the decision to transfer will depend on the availability of bed and evaluation by Medical Social worker as to his/her eligibility to go to a subsidized bed. If transfer is effect, the patient will pay all the charges up to the date of transfer as per private charges and at the general ward charges from the date of transfer. 4. a) ICU/CCU etc. are treatment areas and not the accommodation areas. Any patient admitted directly in these areas will decide about the type of accommodation at the time of admission in these areas and charges will be made accordingly irrespective of whether or not they have actually utilized such an accommodation for whatever reason. b) Labour charges will apply fully irrespective of the duration of stay in the Labour Room. 2 c) Accommodation Charges: Duration of stay for 24 hours will be counted as one full day. For fractions thereof additional charges will be calculated as follows: a) Wards 1. 4 hours of stay – No charges 2. 4 hours to 12 hours of stay – Half day charges 3. More than 12 hours of stay – Full day charges b) I C U and High Dependency Unit (Medicine/Paediatric) 1. Up to 4 hours of stay – 25% charges 2. 4 hours to 12 hours of stay – Half day charges 3. More than 12 hours of stay – Full day charges c) Post Operative Care units 5. 1. Up to 4 hours of stay – 25% charges 2. 4 hours to 12 hours of stay – Half day charges 3. More than 12 hours of stay – Full day charges Service Charges: The patient will be charged for all services provided from the time of admission till the time of discharge. 6. VAT, Service Tax etc. will be applicable wherever it applies. 7. Checkout Time is within 6 hours from the time of billing and if not settled such bills will be modified accordingly. 8. An attendant is allowed to stay with the patient free of charge in Cubicle/ Semi- Private/ Private Non A.C./Private A.C, Special and Deluxe rooms. No attendant is permitted to stay with the patient in General Ward. 9. Visitors should strictly adhere to the visiting hours of the hospital. Dr. Sudhir C. Joseph DIRECTOR 3 ST STEPHEN'S HOSPITAL, TIS HAZARI, DELHI – 110 054. SCHEDULE OF CHARGES FOR O.P.D. W.E.F. 01.04.2016 New Registration I. 130 110 2. Registration - Private O.P.D. 650 600 3. Registration- Private O P D (Evening) 650 600 4. Registration- Private O P D (Psychiatry) 850 700 5. Casualty 250 6. Child Health Card II. Revisit OPD CONSULTATION 1. Registration - General O.P.D. 50 7. Gurgaon -General OPD 200 180 8. Gurgaon - Private OPD 650 600 1. Well Baby Clinic-General 110 110 2. All sub-specialties and super- specialty Clinic-General 130 130 3. Psychiatry Clinic 270 270 CLINICS (GENERAL) NOTE : No Registration fee will be charged for the Cards issued to the New Born Babies III. ANTE NATAL CLINIC (GENERAL) New Registration Revisit 1. Pregnancy Clinic (Per Visit) 300 250 2. High Risk Pregnancy Clinic ( per Visit) 650 330 3. For entire duration of Pregnancy (Unlimited Visit) 2000 - 4. Special Scheme for entire duration of Pregnancy (Unlimited Visit) 3800* - * Rs.2000/- rebate will be given on delivery in St. Stephen’s Hospital IV. COMPREHENSIVE CHECK-UP: Delhi Gurgaon 950 1400 b) Executive Health check-up 2200 3000 c) Preventive Heart check-up 3800 3800 d) Whole Body check-up 4800 - e) Well woman check-up 2200 - 1. Comprehensive check-up a) Basic Preventive Health check-up 4 SCHEDULE OF CHARGES FOR INPATIENTS W.E.F. 01.04.2016 General 350 Admission Fee Private 700 ACCOMMODATION CHARGES (Per day) SL. No. 1 2 3 4 Category of Accommodation General Ward Cubicle Semi Private Non A.C. Semi Private A.C. Room Amount 1600 2200 2450 2850 5 Semi Private A.C. Room (Deluxe) 3500 6 7 8 Non A.C. Single Room A.C. Single Room (Small) A.C. Single Room- Special Room 3850 4300 5300 9 Deluxe Room 5800 I.C.U. & C.C.U. CHARGES (per day for all Categories) SL. No. 1 2 3 4 5 Amount 5500 3500 3500 4500 2200 I C U care (with Cardiac Monitor) High Dependency Unit (Medicine/ Paediatric) with Monitor Post Operative Care with Monitor Ventilator Charges Non Invasive Ventilation-Bippapp machine CONSULTATION FEE & VISITING CHARGES Consultation charges per day Rs. 600 500 400 200 100 Category of Accommodation 1 2 3 4 5 A.C. Rooms Non A.C. Rooms and A.C. Semi Private Rooms Semi-Private (non-A.C. Rooms) Cubicle General Note: 1. The charges as noted above will also apply when the specialist visit the patients in the ICU/CCU and Nursery. 2. Surgeon's fees include visiting charges for the first five days starting from and including day of operation. THERAPEUTIC DIET CHARGES I. THERAPEUTIC DIET CO01 DT03 DIET COUNSELING CHARGES DIETICIANS VISIT General 80 - 5 Cubicle 80 50 Private 200 200 PROCEDURE & DRESSING/ TREATMENT CHARGES I. ICU05 PD01 PD02 PD03 PD04 PD05 PD06 PD07 PD08 PD09 PD10 PD11 PD12 PD13 PD14 PD15 PD16 PD17 PD18 PD19 PD20 PD21 PD22 PT01 PT02 PT03 PT04 PT05 PT06 PT07 PT08 PT09 PT10 PT11 PT12 PT13 PT14 PT15 PT16 PT17 PT18 PT19 PT20 PT21 PT23 PT25 PT26 PT27 PT28 PT29 PT30 PROCEDURES& DRESSING/TREATMENT MONITOR CHARGES IN WARDS DRESSING SMALL DRESSING LARGE SPECIAL DRESSING (PLASTIC SURGERY) CHEMOTHERAPY (I V INJECTION) INJECTION INOCULATION 15% TO 30% BURNS FIRST DRESSING SUBSEQUENT DRESSING (15-30 %) 30% TO 50% BURNS FIRST DRESSING SUBSEQUENT DRESSING (30-50%) EXTENSIVE BURN ABOVE 50% SUBSEQUENT DRESSING (ABOVE 50%) NEBULIZATION THERAPY D.C. SHOCK RBS (BY GLUCOMETERS) BLOOD GAS ANALYSER BLOOD GAS ANALYSER WITH ELECTROLYTE INFUSION PUMPS (per Pump) SYRINGE PUMPS (per Pump) SUTURE REMOVAL OT DRESSING NEBULIZATION THERAPY (24 HOURS) TUBE FEEDING LUMBAR PUNCTURE CUT DOWN CHEST ASPIRATION INTER COSTAL DRAINAGE LIVER BIOPSY KIDNEY BIOPSY LIVER ASPIRATION BONE MARROW SUBDURAL TAP TAP THERAPEUTIC (ASCITIC) TAP DIAGNOSTIC (ASCITIC) VENTRICULAR TAP UMBILICAL CANULATION EXCHANGE TRANSFUSION BLOOD TRANSFUSION PULSE OXIMETER IMAGE INTENSIFIER PLASTER APPLICATION CHARGES FLOW RATE (UROLOGY) URODYNAMICS CATHETERISATION URINE ALBUMIN INTUBATION FLUID/BLOOD WARMER BODY WARMER OPERATING MICROSCOPE ARGON COAGULATOR INVASIVE MONITORING 6 General. 540 170 320 370 1000 10 860 750 1350 1150 1800 1400 80 250 120 370 490 240 240 270 190 370 160 1000 940 1000 1300 1400 3000 1400 1400 800 860 750 860 1100 2050 380 240 950 320 500 1000 230 80 620 1300 1300 900 900 1300 Private 540 260 480 540 1900 10 1300 1100 2000 1700 2700 2100 120 390 140 550 680 480 480 320 290 540 210 1500 1400 1500 1900 2100 4000 2100 2100 1200 1300 1100 1300 1600 3100 570 360 1400 480 750 1500 350 120 940 1700 1700 1300 1300 1700 PT32 PT33 PT36 PT37 PT38 PT39 PT41 PT42 PT43 PT45 PT46 PT47 PT48 PT49 PT50 PT51 PT52 PT53 PT54 PT55 PT56 PT57 PT58 PT59 PT60 ISOFLURIN SERVO FLURANE JOINT ASPIRATION CHARGES TRACHEOSTOMY IN ICU/WARDS HARMONIC SCALPEL CATEGORY III A & III B HARMONIC SCALPEL CATEGORY IV A & IV B EQP. CHG. FOR ALL THERAPEUTIC ARTHROSCOPY PROC. EQP. CHG. FOR ALL DIAGNOSTIC ARTHROSCOPY PROC. BAND LIGATION CENTRAL LINE- SUBCLAVINE/FEMORAL CHARGES NEURO DRILL CHARGES (SUMEX DRILL) DVT PUMPS BELOW KNEE CUFF ABOVE KNEE CUFF LAPAROSCOPE EQP. CHARGES UPTO 1 HOUR LAPAROSCOPE EQP. CHARGES- SUBSEQUENT ½ HOUR LAPAROSCOPE PROCEDURE CONVERTED TO OPEN LAPAROSCOPIC CHOLECYSTCTOMY EXCEEDING 1.5 Hr upto 2Hr LAPAROSCOPIC CHOLECYSTCTOMY EXCEEDING 2 HOURS HARMONIC SCALPEL CATEGORY V HARMONIC SCALPEL CATEGORY VI HARMONIC SCALPEL LAPAROSCOPIC CASES NEURO DRILL (SPECIAL) C PAP PER DAY BI PAP MACHINE HANDLING CHARGES 600 700 550 5400 3200 3700 4800 1900 550 1100 3200 270 800 1400 5400 1600 1600 1600 3200 4300 4800 16100 12800 110 500 600 700 1100 13900 3500 4100 7500 2600 1100 1600 4800 370 800 1400 5400 1600 1600 1600 3200 4700 5300 16100 12800 160 500 General 100 350 120 250 150 120 130 110 400 430 4820 1870 6000 1870 2500 1070 550 500 110 430 100 900 500 900 Private 100 350 120 250 150 120 130 110 400 430 4820 1870 6000 1870 2500 1070 550 500 110 430 100 900 500 900 LABORATORY SERVICE CHARGES I. HM01 HM02 HM03 HM04 HM05 HM06 HM07 HM08 HM09 HM10 HM11 HM12 HM13 HM14 HM15 HM16 HM17 HM18 HM19 HM20 HM21 HM22 HM23 HM24 HAEMATOLOGY Hb (HAEMOGLOBIN) CBC (HB,TC,DC,PLTS,Cell Indi PS) ESR RETICULOCYTE COUNT ABSOLUTE EOSINOPHIL COUNT MP (MALARIA PARASITE SMEAR) MICROFILARIA BT PT/INR APTT COAGULATION WORK UP FACTOR ASSAY BETHESDA ASSAY INHIBITOR SCREENING LUPUS ANTICOAGULANT PANEL FDP/D-DIMER FIBRINOGEN HAMS TEST H PREPARATION G6 PD SCREENING SICKLE CELL PREPARATION Hb A2 AND Hb F (THAL SCREENING TEST) OSMOTIC FRAGILITY TEST BONE MARROW WITH IRON 7 HM26 HM27 HM28 HM29 HM32 HM33 HM34 HM35 HM36 HM37 HM38 HM39 HM40 HM41 HM42 HM43 HM44 HM45 HM46 HM47 HM48 LE CELLS RAPID TEST FOR MALARIA TEG – ANALYSIS SPLENIC ASPIRATE FOR L.D. BODIES PLATELETS COUNT With SMEAR FACTOR VIII FACTOR IX FACTOR X FACTOR XI FACTOR XII FACTOR XIII SCREENING VON WILLEBRAND FACTOR AG RISTOCETIN CO FACTOR ACTIVITY FACTOR II KLEIHAUR TEST FOR HbF TEST FOR UNSTABLE HEMOGLOBIN HEINZ BODY PREPARATION FACTOR V FACTOR VII THROMBIN TIME IRON STAIN FOR HAEMOSIDERIN 210 600 1610 160 150 3210 2680 3750 2140 3750 430 2140 2500 2140 350 250 210 2680 3210 500 250 210 600 1610 160 150 3210 2680 3750 2140 3750 430 2140 2500 2140 350 250 210 2680 3210 500 250 II. MB01 MB02 MB03 MB08 MB10 MB11 MB12 MB27 MB28 MB29 MB25 MB26 MICROBIOLOGY GRAMS STAIN AFB STAIN ALBERTS STAIN FUNGAL CULTURE INDIA INK PREPARATION KOH PREPARATION HANGING DROP PREPARATION URINE CULTURE CULTURE (Blood,Sputum,Pus,HUS,Body Fluid,Stool,Biopsy,Semen) CULTURE (TA,ET,BAL,All Tips) CRYPTOCOCCAL ANTIGEN LFA PNEUMO CYSTIS CARINI PHEUMONIA General 200 210 200 860 130 160 130 800 860 1000 1200 500 Private 200 210 200 860 130 160 130 800 860 1000 1200 500 III. SE01 SE02 SE03 SE04 SE06 SE13 SE14 SE15 SE16 SE17 SE18 SE39 SE40 SE41 SE42 SE43 SE44 SE45 SE46 SE47 SEROLOGY WIDAL CRP- hs ASO RA FACTOR RPR HIV SPOT HIV ELISA HBs Ag SPOT HBs Ag ELISA HCV SPOT HCV ELISA DENGUE IgG SPOT/ ELISA DENGUE NS 1 ANTIGEN ENTEROCHECK (S. typhi IgM) HEV-IgM LEPTOSPIRA-IgM CHIKUNGUNIA-IgM NAT DENGUE IgM SPOT/ELISA ANTI CCP ELISA (CYCLIC CITRULLINATED General 210 550 430 320 120 370 430 320 430 370 1100 900 1800 370 1340 1070 750 1390 900 1200 Private 210 550 430 320 120 370 430 320 430 370 1100 900 1800 370 1340 1070 750 1390 900 1200 8 SE48 ANTI HAV –IgM IV. BB01 BB02 BB03 BB04 BB05 BB06 BB07 BB08 BB09 BB15 BB17 BB18 BB19 BB20 BB21 BB23 BB24 BB25 V. BC01 BC02 BC03 BC05 BC06 BC07 BC09 BC10 BC11 BC12 BC13 BC14 BC16 BC17 BC18 BC19 BC20 BC21 BC22 BC23 BC24 BC25 BC26 BC27 BC30 BC31 BC33 BC34 BC35 BC36 BC37 BC38 BC40 BC41 900 900 BLOOD BANK ABO Rh (BLOOD GROUP) SUB GROUPS Rho PHENOTYPE DIRECT COOMBS INDIRECT COOMBS RHO ANTI BODY TITER AUTOANTIBODY SCREENING COLD AGGLUTININS CROSS MATCH VENESECTION – THALASSEMIA DONOR SCREENING FOR APHERESIS VENESECTION – TRIPLE BAG CROSS MATCH – FOR THALASEEMIA PATIENTS ONLY ANTIBODY SCREEN- FOR B.T COLD HEMOLYSIN PROCESSING CHARGES FOR WHOLE BLOOD/PACKED CEL PROCESSING CHARGES FOR FFP PROCESSING CHARGES FOR PLATELETS General 200 160 370 320 370 750 160 370 370 500 540 540 250 370 370 2200 2000 2000 Private 200 160 370 320 370 750 160 370 370 500 540 540 250 370 370 2200 2000 2000 BIOCHEMISTRY FBS PPBS RBS GTT FOR GDM GLYCOSYLATED Hb (Hb,A1c) ACETONE BUN (BLOOD UREA NITROGEN) CREATININE URIC ACID SODIUM POTASSIUM CHLORIDE URINE PROTEIN 24 HRS URINE CREATININE (24 HRS) CREATININE CLEARANCE UREA CLEARANCE TEST CALCIUM PHOSPHOROUS MAGNESIUM LFT BILIRUBIN SGPT SGOT ALKALINE PHOSPHATASE TOTAL PROTEIN ALBUMIN AMYLASE LIPASE LDH CPK CK MB LIPID PROFILE CHOLESTEROL TRIGLYCERIDES General 90 90 90 350 400 50 110 110 120 150 150 150 180 180 400 320 150 150 430 640 250 150 150 150 140 120 370 560 320 280 340 800 120 260 Private 90 90 90 350 400 50 110 110 120 150 150 150 180 180 400 320 150 150 430 640 250 150 150 150 140 120 370 560 320 280 340 800 120 260 9 BC42 BC43 BC44 BC46 BC47 BC48 BC50 BC51 BC52 BC53 BC54 BC55 BC56 BC58 BC61 BC62 BC65 BC66 BC67 HDL LDL Iron & TIBC URINE AMYLASE URINE CALCIUM- 24 HRS URINE CHLORIDE- 24 HRS URINE CREATININE RANDOM QUANTITATIVE URINE POTASSIUM- RANDOM URINE MAGNISIUM- 24 HRS URINE PHOSPHOROUS- 24 HRS URINE PROTEIN RANDOM QUANTITATIVE URINE SODIUM- RANDOM URINE HEMOSIDERINE URINE URIC ACID – 24HRS ADA RENAL PROFILE (BUN,CR,UA,NA,K,Ca,Phos.) URINE SODIUM – 24 HRS URINE POTASSIUM – 24 HRS GTT 200 200 400 400 180 180 110 180 450 180 180 180 210 200 500 800 180 180 350 200 200 400 400 180 180 110 180 450 180 180 180 210 200 500 800 180 180 350 VI. CP01 CP02 CP03 CP04 CP05 CP06 CP07 CP08 CP09 CP10 CP11 CP12 CP13 CP14 CP15 CP16 CP17 CP18 CP19 CP20 CP21 CP22 CP23 CP24 CP25 CP26 CP27 CP28 CLINICAL PATHOLOGY STOOL ROUTINE STOOL OCCULT BLOOD STOOL REDUCING SUBSTANCE URINE ROUTINE URINE BILLIRUBIN URINE UROBILINOGEN URINE ACETONE (KETONE) URINE SPECIFIC GRAVITY URINE pH URINE GLUCOSE URINE PROTEIN URINE NITRATE URINE BENCE JONES PROTEIN URINE PREGNANCY TEST BODY FLUIDS EXAM.(CSF,AF,PF,PC) SEMEN ANALYSIS PCT (POST COITAL TEST) APT TEST ASPIRATE FOR POLYMORPHS STOOL pH STOOL FATGLOBULES URINE OCCULT BLOOD BODY FLUID AMYLASE BODY FLUID LDH BODY FLUID BILIRUBIN URINE LEUCOCYTE ESTERASE URINE REDUCING SUBSTANCES URINE FOR HEMOGLOBINURIA General 100 110 110 110 50 50 50 50 50 50 50 50 160 130 650 270 110 70 110 50 50 50 430 290 250 50 100 100 Private 100 110 110 110 50 50 50 50 50 50 50 50 160 130 650 270 110 70 110 50 50 50 430 290 250 50 100 100 VII. IA01 IA02 IA03 IA04 IA05 IA06 IMMUNO ASSAYS T3 FREE T3 T4 FREE T4 TSH LH General 320 320 320 320 320 480 Private 320 320 320 320 320 480 10 IA07 IA08 IA09 IA10 IA11 IA12 IA13 IA14 IA20 IA22 IA23 IA24 IA25 IA26 IA27 IA28 IA29 IA34 IA56 IA58 IA61 IA62 IA63 IA67 IA72 IA73 IA74 IA75 IA76 FSH PROLACTIN ESTRADIOL (E2) PROGESTRONE B-HCG TESTOSTERONE CORTISOL INSULIN PSA AFP CEA CA – 125 SERUM FERRITIN VIT B12 SERUM FOLATE IgE TFT INTACT PTH ANTI TPO Ab URINE CORTISOL ANA FT CA-19.9 VIT D – 25 – HYDROXY PROCALCITONIN (PCT) CELIAC DESEASE PROFILE VASCULITIS PROFILE ANA PROFILE AUTOIMMUNE GASTRITIS PROFILE ANTI CARDIOLIPIN/ BEETA 2 GPI COMPLEX VIII. HP01 HP25 HP03 HP26 HP29 HP04 HP05 HP06 HP16 HP08 HP17 HP09 HP18 HP20 HP21 HP27 HP28 HP32 HP30 HP31 HP35 HISTOPATHOLOGY & CYTOLOGY HISTOPATHOLOGY – SMALL (UPTO 2 CONTAINERS) ADDITIONAL CONTAINER (SMALL BIOPSY) HISTOPATHOLOGY – LARGE ADDITIONAL CONTAINER (LARGE BIOPSY) ONCOLOGY SPECIMEN FNAC PAP SMEAR INTRA OPERATIVE PATHOLOGY (IOP) (UPTO TWO) ADDITIONAL CONTAINER (IOP) BODY FLUIDS FOR MALIGNANT CELLS (UPTO TWO SITES) ADDITIONAL SITE IMMUNO HISTOCHEMISTRY (FIRST) ADDITIONAL IMMUNO HISTOCHEMISTRY –(each Test) DUPLICATE SLIDE CHARGES (per slide) BLOCK CHARGES (per block) IMMUNOFLUOROSCENCE FOR KIDNY BIOPSY H P V- DNA HIGH RISK TEST HPV GENOTYPES 16 & 18 F N A C SLIDE REVIEW- up to 3 slides BIOPSY SLIDE REVIEW - up to 3 slides ADDITIONAL SLIDE REVIEW CHARGES (PER SLIDE) 11 480 480 500 500 550 500 500 700 650 700 640 1000 640 960 960 650 1450 1200 1100 600 1250 1100 1500 2140 1280 1610 2680 1280 1070 480 480 500 500 550 500 500 700 650 700 640 1000 640 960 960 650 1450 1200 1100 600 1250 1100 1500 2140 1280 1610 2680 1280 1070 General 700 150 1200 250 1800 900 600 1200 350 600 200 1400 1000 50 50 2000 1800 3740 450 550 100 Private 700 150 1200 250 1800 900 600 1200 350 600 200 1400 1000 50 50 2000 1800 3740 450 550 100 RADIOLOGY SERVICE CHARGES I. PORT XR01 XR04 XR05 XR07 XR08 XR09 XR10 XR11 XR12 XR13 XR14 XR15 XR18 XR19 XR21 XR22 XR23 XR27 XR28 XR29 XR30 XR31 XR33 XR35 XR36 XR38 XR42 XR43 XR44 XR45 XR48 XR49 XR50 XR51 XR52 XR55 XR56 XR57 XR58 XR61 XR62 XR64 XR65 XR66 XR67 XR68 XR69 XR70 XR71 X-RAY PORTABLE X-RAY CHARGES FLUROSCOPY CHEST ABDOMEN A P ABDOMEN FOR LAT. VIEW ABDOMEN ERECT & SPINE CHEST P A CHEST OBLIQUE OR LATERAL CHEST P A & LATERAL MASTOIDS LATERAL VIEWS- 2 EXPOSURES EXTREMITIES,BONES&JOINTS- 1 EXPOSURE EXTREMITIES,BONES&JOINTS- 2 EXPOSURES PELVIS PARA-NASAL SINUSES K.U.B.(ABDOM. & PELVIS) 2 EXPOSURES SKULL A P & LATERAL SKULL AP OR LATERAL SPINE A P & LATERAL (2 EXPOSURES) SPINE A P / LAT. – 1 EXPOSURE SPINE A P, LATERAL & OBLIQUE BARIUM SWALLOW/GASTROGRAFFIN SINOGRAPHY/SIALOGRAPHY/FISTULOGRAM MICTURATING CYSTOURETHROGRAPHY HYSTERO-SALPINGOGRAPHY RETROGRADE UROGRAPHY BARIUM ENEMA BARIUM MEAL UPPER I V UROGRAPHY CEREBRAL/FEMORAL ANGIOGRAPHY APICOGRAM (CHEST) CHEST DECUBITUS VIEW CHILD K.U.B. SPLENO-PORTOGRAPHY T-TUBE CHOLANGIOGRAPHY INTRA-OPERATIVE CHOLANGIOGRAPHY PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY BILIARY DRAINAGE UNDER GUIDANCE BARIUM MEAL FOLLOW THROUGH PERCT. TRANSHEPATIC BILIARY DRAINAGE MAMMOGRAPHY SMALL BOWEL ENEMA TM JOINTS –TWO EXPOSURES EXTREMITIES, BONES, JOINTS- 3 EXPOSURES SOFT TISSUE NECK LATERAL ERCP PERCUTANEOUS NEPHROSTOMY NASOJEJUNAL TUBE INSERTION FLUROSCOPY NASAL BONE LAT. VIEW DEXA- SINGLE SITE DEXA- HIP & SPINE DEXA- THREE SITES (HIP,SPINE & FOREARM) 12 General 190 190 250 250 510 250 250 510 470 250 470 250 250 470 510 250 470 250 890 1550 1280 2520 1230 2520 2930 2930 2930 2930 250 250 250 3360 2020 2020 1690 3360 3220 3630 1280 2930 350 630 280 1130 1280 400 280 1660 2170 3300 Private 230 230 320 320 600 320 320 630 550 320 550 320 320 550 600 320 550 320 1150 2100 1740 2770 1530 2770 3470 3470 3470 3470 320 320 320 3930 2540 2540 2100 3930 3570 4160 1800 3460 550 660 320 1280 1400 560 320 1740 2310 3500 XR72 XR73 XR74 XR75 XR76 XR77 XR78 XR79 XR80 DEXA- WHOLE BODY DEXA- 3 SITES FOR THALLASSEMIA DISTAL COLOGRAM BEDSIDE CHEST X RAY (ONE EXPOSURE) BEDSIDE CHEST X RAY (TWO EXPOSURE) BEDSIDE ABDOMEN X RAY (ONE EXPOSURE) BEDSIDE ABDOMEN X RAY (TWO EXPOSRE) BEDSIDE EXTREMITIES X RAY (ONE EXPOSURE) BEDSIDE EXTREMITIES X RAY (TWO EXPOSURE) 3300 1400 2020 440 690 440 690 440 690 3500 1400 2540 650 830 650 830 650 830 II. CT SCAN CT01 CT HEAD BASIC BRAIN SCAN CT02 CT PNS,ORBIT,PITUTARY FOSSA,TEMPORAL BONE, CT03 CT CHEST CT04 CT UPPER ABDOMEN CT05 CT LOWER ABDOMEN CT06 CT SPINE (FOR 3 LEVELS) CT07 CT LIMBS & JOINTS CT08 CT NECK CT09 SPINE ADDITIONAL 1 LEVEL CT11 CT SCANOGRAM CT12 CT GUIDED BIOPSY, FNAC, ASPIRATION CT13 EMERGENCY SCAN CHARGE FOR CT CT14 CT FOR P.N.S LIMITED CUTS CT21 CT WHOLE ABDOMEN CT22 CT HEAD INTRACRANIAL ANGIOGRAPHY CT23 CT HEAD PERFUSION STUDIES CT24 LARYNX CT25 THORAX HRCT CT26 THORACIC AORTA ANGIOGRAPHY CT27 CORONARY ANGIOGRAPHY + CA SCORING CT28 CT BRONCHOSCOPY CT29 UPPER ABDOMEN SINGLE,DUAL,TRIPHASIC LIVER SCAN CT30 SPLENO-PORTAL,MESENTRIC, VENOUS CT31 UPPER ABDOMEN HEPATIC VOLUME CT32 UPPER ABDOMEN HEPATIC PERFUSION CT33 UPPER ABDOMINAL AORTA ANGIOGRAPHY CT34 UPPER ABDOMEN RENAL ANGIOGRAPHY CT35 LOWER ABDOMEN + COLONOSCOPY CT36 CT PERIPHERAL ANGIOGRAPHY CT37 CT DENTA SCAN (ORTHOPANTOMOGRAM) CT38 CT BONE MINERAL ANALYSIS CT39 3-D RECONSTRUCTIONS CT40 CT ANAESTHESIA CHARGES CT48 CT ANGIOGRAPHY OF NECK CT49 CT ANGIOGRAPHY OF NECK & BRAIN Note: Contrast & Injector Charges to be charged extra General 1700 2200 2900 2900 2900 2200 2200 2200 740 530 3200 530 1500 5400 7400 7400 2200 2900 7400 7400 4400 7400 7400 3700 2900 7400 7400 4400 7400 1600 2200 740 1100 7400 9500 Private 2050 2900 4200 4200 4200 2900 2900 2900 1000 750 4000 750 2100 6700 9800 9800 3000 4200 9800 9800 6400 9800 9800 5600 4200 9800 9800 6400 9800 2200 2900 1400 1100 9800 12700 III. US01 US02 US03 US04 General 780 610 1070 870 Private 1100 1040 2040 1440 ULTRA SOUND OBSTETRICS FIRST SCAN OBSTETRICS FOLLOW UP (2ND VISIT) OBSTETRICS DOPLER STUDY BIOPHYSICAL PROFILE 13 US05 US06 US07 US08 US09 US10 US11 US13 US15 US16 US17 US18 US19 US20 US21 US22 US23 US24 US25 US26 US27 US28 US29 US32 US33 US34 US35 US36 US41 US42 US43 US44 US45 US47 US48 US49 US50 US51 US52 US53 US54 OBSTETRICS DOPLER AND BIOPHYSICAL PROFILE PELVIC SCAN TRANSVAGINAL SCAN FOLLICULAR STUDY Ist SITTING FOLLICULAR STUDY SUBSEQUENT SITTING LEVEL II SCAN FOR FOETAL ANOMALIES FOETAL ECHO NEONATAL SKULL NEONATAL HIP ABDOMINAL SCANS (Paediatric) UPPER ABDOMEN – GENERAL SCAN LOWER ABDOMEN GENERAL SCAN WHOLE ABDOMEN GENERAL SCAN KUB GENERAL SCAN TRANSRECTAL GENERAL SCAN SMALL PARTS (BREAST,EYE,TESTIS,THYROID, JOINT) VEINS DOPPLER STUDY-SINGLE LIMB ARTERIAL DOPPLER STUDY- SINGLE LIMB RENAL DOPPLER / PORTAL VEIN STUDY WITH ABDOMINAL SCAN FNAC USG INTERVENTIONS DIAGNOSTIC PLEURAL/ ASCETIC TAP LUNG/ LIVER ABSCESS / PELVIC ABSCESS DRAINAGE DRAINAGE WITH INDWELLING CATHETERS (Pig Tail) /MALECOT TRANSRECTAL BIOPSIES BIOPSY NEEDLE CHARGES USG CHEST ECV RENAL INTERVENTION (PC NEPHROSTOMY) EMERGENCY ULTRASOUND (Ultrasound charges extra) PORTABLE CHARGES (Ultrasound charges Extra) VENOUS DOPPLER STUDY BOTH LIMBS CAROTID DOPPLER STUDY ARTERIAL DOPPLER STUDY BOTH LIMBS SINGLE LOOK USG USG FOR PVR USG GUIDED RENAL BIOPSY USG GUIDED INT. JUGULAR VEIN CANNULATION FOETAL DOPPLER –ADDITIONAL CHARGES PER FOETUS FOETAL ECHO- ADDITIONAL CHARGES PER FOETUS LEVEL II – ADDITIONAL CHARGES PER FOETUS ARTERIES VASCULAR STUDY IV. MRI01 MRI02 MRI04 MRI05 MRI06 MRI07 MRI08 MRI09 MRI10 MRI11 MRI12 MRI MRI BRAIN MRI SPINE MRI THORAX MRI PELVIS MRI JOINTS MRI EXTREMITIES MRCP MR UROGRAPHY MRI CSF FLOW STUDY MRI ANGIOGRAPHY ONE PART MRI BRAIN+ANGIOGRAPHY(CIRCLE OF WILLIS) 14 1660 780 990 870 210 2010 1120 670 670 670 740 740 1070 670 1010 1060 1610 1610 2540 2310 1160 2890 2890 2400 1130 210 320 2400 290 210 2490 2290 2490 260 260 2890 2890 580 580 870 2280 2490 1100 1500 1330 350 2660 2120 1160 1160 1160 1100 1100 1480 1160 1690 2040 3050 3360 3300 2500 1500 3000 3000 3820 1970 250 600 3820 350 250 4680 3360 4680 350 350 3000 3000 700 700 1000 3360 General 5300 5800 6300 6300 6300 6300 6300 6300 6300 6300 9700 Private 6000 6600 7300 7300 7300 7300 7300 7300 7300 7300 10800 MRI13 MRI BRAIN+ANGIOGRAPHY (NECK+CIRCLE OF WILLIS) MRI14 MRI ANGIOGRAPHY(NECK+CIRCLE OF WILLIS) MRI15 MRI MARROW SCREENING MRI16 MRI SPINE ONE PART + SCREENING WHOLE SPINE MRI17 MRI PELVIMETRY/PLACENTA LOCALISATION MRI18 MRI ARTHOGRAPHY+1 FILM CONVENTIONAL MRI19 MRI LUMBER SPINE & SI JOINTS MRI20 MRI LTD STUDY OF IAM MRI23 MRI ANAESTHESIA CHARGES MRI24 MRI BRAIN-PITUITARY FOSSA MRI25 MRI ORBIT MRI26 MRI PNS MRI27 MRI T.M. JOINTS (SPECIFY SIDE) MRI28 MRI ANGIOGRAPHY-CIRCLE OF WILLIS MRI29 MRI BRAIN-VENOGRAPHY MRI30 MRI ANGIOGRAPHY-NECK MRI31 MRI ANGIOGRAPHY-RENAL ANGIOGRAPHY MRI32 MRI NASOPHARYNX MRI33 MRI NECK MRI34 MRI FISTULOGRAPHY MRI35 MRI BOTH HIPS-DYNAMIC STUDY MRI36 MRI EXTREMITY/JOINT- DOUBLE MRI37 MRI EMERGENCY CHARGES MRI38 MRI BRAIN SCREENING MRI39 MR VENOGRAPHY MRI40 MRI LOWER ABDOMEN/PELVIS MRI41 JOINT SCREENING (ONE JOINT) MRI42 CARTILAGE MAPPING MRI43 BRAIN SPECTOSCOPY MRI44 MRI OF BRACHIAL PLEXUS MRI45 MR MAMMOGRAPHY MRI46 PERFUSION IMAGING IN STROKE MRI47 MR ARTHROGRAPHY MRI48 3-D MRI OF SPINE MRI49 WHOLE BODY SCREENING FOR METASTASIS MRI50 MRI UPPER ABDOMEN MRI51 MRI FULL ABDOMEN MRI52 MRI BRAIN AFTER BRAIN SCREENING- SAME DAY SITTING MRI53 BRAIN VENOGRAPHY AFTER MRI BRAIN-SAME DAY SITTING MRI54 MRI BRAIN WITH ORBIT Note: Contrast & Injector Charges to be charged extra V. INR01 INR02 INR03 INR04 INR05 INR06 INR07 INR08 INR09 INR10 INR11 INTERVENTIONAL RADIOLOGY PERIPHERAL ANGIOGRAPHY (DIAGNOSTIC) (ONE LIMB) PERIPHERAL TRAUMA INTERVENTIONAL PERIPHERAL ARTERIAL ANGIOPLASTY WITHOUT STENT RT/LT PERIPHERAL ARTERIAL ANGIOPLASTY WITH STENT RT/LT ILAIC ANGIOPLASTY/STENTING PERIPHERAL ARTERIAL THROMBOLYSIS RT/LT PERIPHERAL HEMANGIOMA SCLEROTHERAPY (DIRECT) PERIPHERAL HEMANGIOMA SCLERO/EMBOLISATION (TRANSAR.) UTERINE ART EMBOL FOR FIBROIDS-PRE MYOMECTOMY UTERINE ARTERY EMBOLIZATION FOR FIBROIDS UTERINE ART/PELVIC ANGIO- POST PART HRAGE-OTHERS 15 11300 9700 3300 7800 3200 8000 7400 2400 1100 6300 6300 6300 6300 6300 6300 6300 6300 6300 6300 6300 6300 12300 500 2100 5300 5300 1400 5300 5300 5300 5300 5300 5300 2300 4600 5300 7800 3500 3200 7900 12400 10800 4600 9500 5000 9200 8500 3800 1100 7300 7300 7300 7300 7300 7300 7300 7300 7300 7300 7300 7300 14600 750 3140 6600 6600 1650 6600 6600 6600 6600 6600 6600 2750 5500 6600 9900 3500 3500 8000 General 15500 29800 29800 29800 33400 36700 2100 29800 22700 22700 19000 Private 20700 39800 39800 39800 44600 47700 2800 39800 30300 30300 25400 INR12 INR13 INR14 INR15 INR16 INR17 INR18 INR19 INR20 INR21 INR22 INR23 INR24 INR25 INR26 INR27 INR28 INR29 INR30 INR31 INR32 INR33 INR34 INR35 INR36 INR37 INR38 INR39 INR40 INR41 INR42 INR43 INR44 INR45 INR46 INR47 INR48 INR49 INR50 INR51 INR52 INR53 INR54 INR55 INR56 INR57 INR58 INR59 INR60 INR61 INR62 INR63 INR64 UTERINE ARTERY/PELVIC EMBOLIZATION FOR POST PARTUM PELVIC CONGESTION SYNDROME (OVARIAN VEIN) EMBOLISAT. FALLOPIAN TUBE CATHETERIZATION ( FOR BLOCKED TUBE PRE/POST PROCEDURE USG EVALUATION FOR FIBROIDS/ ADENOMYOSIS/UTERUS/BODY PUDENDAL ARTERY EVALUATION VERICOSEAL EVALUATION VERICOSEAL INTERVENTIONAL RENAL ARTERY ANGIOGRAPHY RENAL ARTERY ANGIOPLASTY RENAL ARTERY STENTING RENAL ARTERY EMBOLIZATION (ONE SIDE) PERCUTANOUS NEPHROSTOMY & DRAINAGE (RT/LT) URETRIC STENT (DOUBLE PIGTAIL/J) RT/LT INTERVENT FOLLOW UP FOR NEPHROSTOMY DRAINAGE CATHETER GUIDED PERIPHERAL INSERTION OF CENTRAL CATH-PICC DIALYSIS CATH INSERT IJ,SUBCLAV,FEMORAL-NON TUNNEL DIALYSIS CATH INSERT (IJ,FEMORAL)TUNNELLED/ EXCHANGE CHEST PORT INSERTION FOR CHEMOTHERAPY CENTRAL VENOGRAM/ARM VENOGRAM (DIAGNOSTIC) CENTRAL VENOGRAM/ARM VENOGRAM INTERVENTIONAL MEDIASTINAL SYNDROMES INTERVENTIONAL VENOUS SAMPLING (ADRENAL & RENAL VEIN) I V C MEMBRANOTOMY AND ANGIOPLASTY/STENTING PORTAL VEIN EMBOLISATION AORTOGRAM/SPECIFIC SINGLE AORTOGRAM AORTIC ANGIOPLASTY/STENTING AORTIC STENT GRAFT ENDOLEAK EMBOLIZATION ABDOMINAL AORTIC ANEURYSM GRAFT BRONCHIAL ARTERY EVALUATION BRONCHIAL ARTERY EMBOLIZATION INTRA VASCULAR CATHETER/ FOREIGN BODY REMOVAL PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAM POST PTBD CHECK CHOLANGIOGRAM PRE/INTRA/POST PROCD PTBD- POST OPERATIVE/BILIARY LEAK PTBD EXTERNAL DRAINAGE(SINGLE) PTBD-EXTERNO-INTERNALISATION PTBD--INTERNALISATION PCN/PTBD WITH STENTING TRANSJUGLAR LIVER BIOPSY TIPS (TRANS-JUGULAR PORTO-SYSTIMIC SHUNT) INTERVEN ARTERIO-PORTOGRAM GI BLEED AND ISCHEMIA (TRIPLE VESSEL) EVALUATION GI BLEED EMBOLISATION GI ISCHEMIA INTERVENTION (ANGIOPLATY/STENTING) PARTIAL SPLENIC EMBOLIZATION EMPERICAL ANY ARTERY EMBOLISATION USG GUIDED ANEURYSM EMBOLISATION CHEMOEMBOLIZATION OF HEPATIC TUMOUR/METS TRANS ARTERIAL CHEMOTHERAPY INFUSION RADIOFREQUENCY ABLATION OF HEPATIC TUMOURS/ METS NASO JEJUNAL INTUBATION CEREBRAL ANGIOGRAM CAROTID ANGIOGRAM 16 23900 33400 15800 31800 44600 22300 1000 17500 22700 29800 17800 29300 29300 13100 13100 16700 2400 6100 2900 6100 11300 6100 16700 19100 12000 29800 29800 12000 41700 41700 47700 13100 33000 6100 8500 3600 16700 12000 16700 9600 27500 10000 45200 21600 18200 30300 25100 41700 41700 10700 41700 33400 33400 4800 19100 12000 1300 24000 30300 39800 24000 38900 38900 17600 17600 22300 3300 7200 4000 8000 15200 7200 22300 25400 16000 39800 39800 16000 55700 55700 63600 17600 38500 7200 11200 4800 22300 16000 22300 12800 36600 14400 58900 28600 24200 36300 33400 55700 55700 14400 55700 44600 44600 6400 25400 16000 INR65 VESSELS EVAL CEREBRAL+CAROTID+ SUBCLAVIAN+ VERTEBRAL INR66 SPINAL ANGIOGRAM INR67 EVALUATION FOR NASAL BLEEDING / NASAL MASS INR68 EMBOLIZATION FOR NASAL BLEEDING / SINUS MASS INR69 EMBOL OF EXTERNAL CAROTID ARTERY/SINGLE VESSEL INR70 EMBOLIZATION OF TUMOURS FED BY BOTH ICA & ECA INR71 EMBOLIZATION OF TUMOURS FED BY VA OR/AND BA INR72 GLUE EMBOLIZATION OF TUMOURS INR73 EMBOLIZATION OF SPINAL TUMOURS INR74 EMBOLIZATION FOR VERTEBRAL BODY HEMANGIOMA/METS INR75 VERTEBROPLASTY (VERTERAL BODY/PELVIC BONE INR76 VENOUS SINUS SAMPLING (PETROSAL SINUS) INR77 CCF OCCLUSION INR79 PROXIMAL OCCLUSION OF INTERNAL CAROTID ARTERY INR80 CEREBRAL AVM EMBOLIZATION (BESIDES VB TERRITORY) INR81 AVM EMBOLIZATION IN THE VERTEBROBASILAR TERRITORY INR82 SPINAL AVM EMBOLIZATION/AVF EMBOLIZATION INR83 COILING OF INTRACRANIAL ANEURYSM INR84 COILING OF MULTIPLE ANEURYSMS INR85 GDC COILING OF INTRACRANIAL ANEURYSMS WITH SPASM INR86 COILING OF INTRACRANIAL ANEURYSM ATTEMPTED INR87 POST SAH INTRACRANIAL ANGIOPLASTY FOR SPASM INR88 INTRACRANIAL DRUG THERAPY FOR POST SAH VASOSPASAM INR89 INTRA ARTERIAL THROMBOLYSIS INR90 MANAGEMENT OF DURAL SINUS THROMBOSIS INR91 ANGIOGPLASTY FOR CAROTID/VERTEBRAL ARTERY STENOSIS INR92 STENTING FOR CAROTID/VERTEBRAL ARTERY STENOSIS INR93 INTRACRANIAL ANGIOPLASTY INR94 INTRACRANIAL STENTING Note: Contrast & Injector Charges to be charged extra. 22700 23900 14300 22700 34700 67500 63300 63300 44100 33400 44100 44100 71500 65600 66700 66700 75000 59600 66700 71500 35800 66700 41700 56400 66700 66700 51200 66700 66700 30300 31800 19100 30300 46200 89000 84300 84300 58900 44600 58900 58900 95400 87500 89000 89000 100200 79400 89000 95400 47700 89000 55700 72300 89000 89000 68400 89000 89000 PHYSIOTHERAPY SERVICES I. PHY01 PHY02 PHY03 PHY04 PHY05 PHY06 PHY07 PHY08 PHY09 PHY10 PHY11 PHY12 PHY13 PHY14 PHY15 PHY16 PHYSIOTHERAPY SERVICES EXERCISE/HOME PROGRAM MUSCLE ASSESSMENT FUNCTIONAL MOBILIZATION MANUAL THERAPY GAIT TRAINING ANC (3 SITTINGS) POSTNATAL (3 SITTINGS) EXERCISE/DAY FOR PMR PATIENT ICU CARE(PHYSIO) EXERCISE FOR CTS CLOSED HEART (7 DAYS) EXERCISE FOR CTS OPEN HEART (7 DAYS) PULMONARY PHYSIOTHERAPY SHORT WAVE DIATHERMY ULTRASOUND INFRA RED RAYS/ULTRAVIOLET HYDRO COLLATOR THERAPY 17 General 180 190 200 240 200 350 350 300 250 3000 3500 240 180 180 180 180 Private 270 280 280 360 300 510 510 450 350 4000 4500 360 270 270 270 270 PHY17 PHY18 PHY19 PHY20 PHY21 PHY22 PHY23 PHY24 PHY25 PHY26 PHY27 PHY28 PHY29 PHY30 PHY31 PHY32 PHY33 PHY34 PHY35 PHY36 PHY37 PHY38 PHY39 PHY40 PHY41 PHY42 PHY43 PHY44 PHY45 PHY46 PHY47 PHY48 PHY49 PHY50 PHY51 PHY52 PHY53 PHY54 PARAFFIN WAX BATH INTERFERENTIAL THERAPY MUSCLE STIMULATION LUMBER TRACTION CERVICAL TRACTION TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION McKENZIE EXERCISE PROGRAMME MULLIGAN’S MOBILIZATION CPM CRYO THERAPY TRACTION/S W D TRACTION U S T TRACTION/I F T S W D/U S T WAX BATH/EXERCISE HOT PACKS/EXERCISE C P M/EXERCISE FUNCTIONAL MOBILIZATION AND CHEST CARE PULMONARY PT (NIGHT) US & PWB SWD & IFT US & IFT ICT & HP CPM & HP PWB & CPM PT CONSULTATION & ADVISES PRE-OPERATIVE ASSESSMENT ANY TWO MODULE TREATMENT PACKAGE (5 Days) MANUAL MOBILIZATION + ELECTROTHERAPY (5 Days) SPECIAL PHYSIOTHERAPY CARE (HOLIDAYS) NEURO MUSCULAR DYSFUNCTION MANAGEMENT RENAL TRANSPLANT- RECEIPENT (10 DAYS) RENAL TRANSPLANT – DONOR (5 DAYS) ASSESSMENT AND PRESCRIPTION & DOCUMENTATION HOT PACKS/MOBILISATION HOT PACKS/IFT PHYSICAL ASSESSMENT/ EVALUATION FUNCTIONAL ASSESSMENT/ EVALUATION 180 180 180 180 180 180 220 220 180 180 240 240 240 240 240 240 240 240 240 240 240 240 240 240 240 220 220 1100 1100 300 260 3500 2000 220 240 240 340 340 270 270 270 270 270 270 320 320 270 270 370 370 370 370 370 370 370 370 370 370 370 370 370 370 370 320 320 1750 1750 370 390 5500 4000 320 370 370 400 400 II. OCC01 OCC02 OCC03 OCC04 OCC05 OCC06 OCC07 OCCUPATIONAL THERAPY ASSESSMENT ASSESSMENT & THERAPY 1 HOUR ASSESSMENT & THERAPY 3 HOURS ASSESSMENT & THERAPY MORE THAN 3 HRS ASSESSMENT & THERAPY FOR SMALL PARTS THERAPY FOR ICU PATIENTS REHAB. MED. PATIENT’S THERAPY/DAY General 160 190 270 320 160 210 270 Private 270 350 540 640 270 210 480 III. ALC001 ALC002 ALC003 ALC004 ARTIFICIAL LIMB CENTRE SYM S SIZE I SYM S SIZE II SYM S SIZE III PTB PROTHESIS SIZE I General 5400 6400 7200 8600 Private 5900 7000 7800 9400 18 ALC005 ALC006 ALC007 ALC008 ALC009 ALC010 ALC011 ALC012 ALC013 ALC014 ALC015 ALC016 ALC017 ALC018 ALC019 ALC020 ALC021 ALC022 ALC023 ALC024 ALC025 ALC026 ALC027 ALC028 ALC029 ALC030 ALC031 ALC032 ALC033 ALC034 ALC035 ALC036 ALC037 ALC038 ALC039 ALC040 ALC041 ALC042 ALC043 ALC044 ALC045 ALC046 ALC047 ALC048 ALC049 ALC050 ALC051 ALC052 ALC053 ALC054 ALC055 ALC056 ALC057 PTB PROTHESIS SIZE II PTB PROTHESIS SIZE III ABOVE KNEE PROTHESIS SIZE I ABOVE KNEE PROTHESIS SIZE II ABOVE KNEE PROTHESIS SIZE III COSMETIC HAND SIZE I COSMETIC HAND SIZE II COSMETIC HAND SIZE III BELOW ELBOW & MECH. HAND SIZE I BELOW ELBOW & MECH. HAND SIZE II BELOW ELBOW & MECH. HAND SIZE III AE PROTHESIS MECH. HAND SIZE I AE PROTHESIS MECH. HAND SIZE II AE PROTHESIS MECH. HAND SIZE III EXTENSION PROTHESIS SIZE I EXTENSION PROTHESIS SIZE II EXTENSION PROTHESIS SIZE III CHOPART PROTHESIS SIZE I CHOPART PROTHESIS SIZE II CHOPART PROTHESIS SIZE III FINGER SPLINT SIZE I FINGER SPLINT SIZE II FINGER SPLINT SIZE III LONG OPPONENS SIZE I LONG OPPONENS SIZE II LONG OPPONENS SIZE III SHORT OPPONENS SIZE I SHORT OPPONENS SIZE II SHORT OPPONENS SIZE III STATIC COCK UP SPLINT SIZE I STATIC COCK UP SPLINT SIZE II STATIC COCK UP SPLINT SIZE III DYNAMIC COCK UP SPLINT SIZE I DYNAMIC COCK UP SPLINT SIZE II DYNAMIC COCK UP SPLINT SIZE III TURN BUCKLE COCK UP SPLINT SIZE I TURN BUCKLE COCK UP SPLINT SIZE II TURN BUCKLE COCK UP SPLINT SIZE III E ARM BRACE SIZE I (For Arm Brace) E ARM BRACE SIZE II (For Arm Brace) E ARM BRACE SIZE III (For Arm Brace) ELBOW BRACE WITH ELBIT SIZE I ELBOW BRACE WITH ELBIT SIZE II ELBOW BRACE WITH ELBIT SIZE III SHOULDER CAPSULE BRACE SIZE I SHOULDER CAPSULE BRACE SIZE II SHOULDER CAPSULE BRACE SIZE III SHOULDER ABDUCTION SPLINT SIZE I SHOULDER ABDUCTION SPLINT SIZE II SHOULDER ABDUCTION SPLINT SIZE III TLSO (TAYLOR S BRACE) SIZE I TLSO (TAYLOR S BRACE) SIZE II TLSO (TAYLOR S BRACE) SIZE III 10200 16100 10200 12300 23500 2700 3200 4300 5700 7700 12300 9100 10200 13900 8000 10200 16100 5400 5900 7000 370 430 540 700 750 910 700 750 910 860 1000 1200 900 1000 1200 1400 1600 1800 1700 1900 2500 2500 2900 3800 2500 2900 3800 2500 2900 3800 1500 1900 2400 19 11200 20300 12300 13400 26800 3400 3700 5400 6400 8600 13900 9600 11200 15000 9100 11800 17100 5900 6700 7700 500 600 600 700 900 1100 750 860 1100 1000 1200 1400 1000 1200 1400 1400 1700 1900 1900 2000 2700 2700 3300 4500 2900 3200 4200 2900 3300 4000 1900 2500 2800 ALC058 ALC059 ALC060 ALC061 ALC062 ALC063 ALC064 ALC065 ALC066 ALC067 ALC068 ALC069 ALC070 ALC071 ALC072 ALC073 ALC074 ALC075 ALC076 ALC077 ALC078 ALC079 ALC080 ALC081 ALC082 ALC083 ALC084 ALC085 ALC086 ALC087 ALC088 ALC089 ALC090 ALC091 ALC092 ALC093 ALC094 ALC095 ALC096 ALC097 ALC098 ALC099 ALC100 ALC101 ALC102 ALC103 ALC104 ALC105 ALC106 ALC107 ALC108 ALC110 ALC111 TLSO (MOULDED SPL. JACKET) SIZE I TLSO (MOULDED SPL. JACKET) SIZE II TLSO (MOULDED SPL. JACKET) SIZE III LS FRAME SIZE I LS FRAME SIZE II LS FRAME SIZE III LS BELT SIZE II LS BELT SIZE III KT BRACE SIZE II KT BRACE SIZE III ASH BRACE SIZE I ASH BRACE SIZE II ASH BRACE SIZE III SOMI BRACE SIZE II SOMI BRACE SIZE III TWO POST MOULDED COLLER SIZE I TWO POST MOULDED COLLER SIZE II TWO POST MOULDED COLLER SIZE III FOUR POST COLLER SIZE I FOUR POST COLLER SIZE II FOUR POST COLLER SIZE III SOFT COLLER SIZE I SOFT COLLER SIZE II SOFT COLLER SIZE III LS MOULDED SIZE I LS MOULDED SIZE II LS MOULDED SIZE III AFO SIZE I AFO SIZE II AFO SIZE III KAFOAK PVC SPLINT SIZE I KAFO WITHOUT JOINT SIZE I KAFO U/L JOINT SIZE I KAFO U/L JOINT SIZE II KAFO U/L JOINT SIZE III HKAFO U/L JOINT SIZE I HKAFO U/L JOINT SIZE II HKAFO U/L JOINT SIZE III HKAFO B/L JOINT SIZE I HKAFO B/L JOINT SIZE II HKAFO B/L JOINT SIZE III KNEE BRACE WITH JOINT SIZE I KNEE BRACE WITH JOINT SIZE II KNEE BRACE WITH JOINT SIZE III KNEE BRACE WITHOUT JOINT SIZE I KNEE BRACE WITHOUT JOINT SIZE II KNEE BRACE WITHOUT JOINT SIZE III AFO WITH HINGE SIZE I AFO WITH HINGE SIZE II AFO WITH HINGE SIZE III CDH SIZE I KAFO WITH PLASTIC THIGH SIZE I KAFO WITH PLASTIC THIGH SIZE II 3400 4000 5300 1500 1900 2400 750 1000 2400 2900 1200 1900 2200 2600 3000 2000 2300 3200 1900 2300 3200 600 700 800 2700 3200 4200 1100 1300 1900 2000 2100 4300 4700 5600 4700 5600 6400 9100 10300 14400 3000 4000 4500 2000 2700 3300 1400 1900 2200 2500 5100 5400 20 4000 4700 5900 1800 2500 2900 900 1200 2800 3300 1600 2100 2700 2900 3400 2400 2900 3700 2300 3200 3600 640 750 860 3200 3700 4600 1400 1700 2000 2400 2600 4700 5100 5700 5100 5700 6700 9500 10600 15500 3700 4800 5200 2600 3000 3700 1700 2000 2500 2600 5500 5700 ALC112 ALC113 ALC114 ALC115 ALC116 ALC117 ALC118 ALC119 ALC120 ALC121 ALC122 ALC123 ALC124 ALC125 ALC126 ALC127 ALC128 ALC129 ALC130 ALC131 ALC132 ALC133 ALC134 ALC135 ALC136 ALC137 ALC138 ALC146 ALC148 ALC149 ALC150 ALC151 ALC152 ALC153 ALC154 ALC155 ALC156 ALC157 KAFO WITH PLASTIC THIGH SIZE III GAITERS B/L SIZE I GAITERS B/L SIZE II GAITERS B/L SIZE III MERMAID SPLINT B/L SIZE I MERMAID SPLINT B/L SIZE II FRO SIZE I FRO SIZE II FRO SIZE III PTB BRACE SIZE I PTB BRACE SIZE II PTB BRACE SIZE III AK CAST BRACE U/L SIZE I AK CAST BRACE U/L SIZE II AK CAST BRACE U/L SIZE III ARCH SUPPORT SIZE I ARCH SUPPORT SIZE II ARCH SUPPORT SIZE III HEEL PAD SIZE I HEEL PAD SIZE II HEEL PAD SIZE III CRUTCH ELBOW ADJUSTABLE (AL) SIZE I CRUTCH ELBOW ADJUSTABLE (AL) SIZE II CRUTCH AXILLA ADJUSTABLE (AL) EXTRA SMALL CRUTCH AXILLA ADJUSTABLE (AL) SMALL CRUTCH AXILLA ADJUSTABLE (AL) MEDIUM CRUTCH AXILLA ADJUSTABLE (AL) LARGE REPAIR CHARGE THUMB SPICA FOREARM BRACE SIZE I FOREARM BRACE SIZE II FOREARM BRACE LONG SIZE I FOREARM BRACE LONG SIZE II ELBOW BRACE HUMERUS BRACE GAIT TRAINING PER/HR ASSESSMENT/ EVALUATION FOOT ORTHOTICS 6200 1300 1900 2400 2000 2400 2800 3200 4100 2900 3500 4200 4800 5500 5900 370 480 590 430 480 590 640 710 540 590 640 710 370 1800 2000 3000 2800 4300 4300 4300 160 210 1070 6700 1600 2100 2800 2500 2900 3000 3700 4600 3300 4100 4600 5700 5900 6300 430 590 700 540 590 640 640 710 540 590 640 710 370 2000 2200 3400 3200 4600 4600 4600 210 320 1500 CARDIOLOGY SERVICE CHARGES I. CPR01 CPR02 CPR03 CPR04 CPR05 CPR07 CPR08 CARDIOLOGY PROCEDURE TEMPORARY PACEMAKER IMPLANTATION PERMANENT PACEMAKER IMPLANTATION SINGLE CHAMBER PERMANENT PACEMAKER IMPLANTATION DUEL CHAMBER PERMANENT PACEMAKER IMPLANTATION TRIPLE CHAMBER PERI-CARDIAL TAPPING NON IONIC DYE PER VIAL CARDIAC CATHERERISATION 21 General. 5000 13200 16500 27500 5000 2750 7700 Private 7200 22000 27500 52800 7500 2750 12100 CPR09 CPR11 CPR18 CPR20 CPR21 CPR22 II. INVASIVE PRESSURE MONITORING PERICARDIACTOMY FUNCTION FLOW RESERVE ANAESTHESIA CHARGES FOR CATH LAB PROCEDURE CATH LAB CHARGES FOR INTERVENTIONAL RADIOLOGY (per hour) PERCUTANEOUS DEVICE CLOSURE ECG E.C.G. III. ACT AMBBP ECHO EVR HOLT STEC TEE TMT BSP CARDIOLOGY INVESTIGATION ACT TEST AMBULATORY B.P. MONITORING ECHO DOPPLER EVENT RECORDING (PER DAY) HOLTER CHARGES (PER DAY) STRESS ECHO TRANS ESOPHAGEAL ECHO STRESS TEST(TMT TREAD MILL TEST) BED SIDE ECHO DOPPLER ECG 3000 66000 10000 1100 4000 30000 General. 6050 99000 12000 1100 4000 40000 Private 190 290 General. 440 1500 1800 440 2200 2500 2400 1320 2750 Private 600 2500 2750 990 3100 3100 3300 2530 3500 PACKAGE CHARGES FOR CARDIOLOGY PROCEDURES Code Service Name I. CATH-LAB PROCEDURES: ABMV ANGIOPLASTY/BALOON MITRAL VALVOTOMY General. Semi Pvt. Private No. of days 33000 44000 55000 02 ACAG CORONARY/RENAL ANGIOGRAPHY 9900 12100 14300 01 ACAWS CORONARY/RENAL ANGIOPLASTY 90000 100000 120000 03 ACPA CORONORY PERIPHERAL ANGIOGRAPHY 9900 12100 14300 01 ADSA CERIBRAL ANGIOGRAPHY 9900 12100 14300 01 AEPS ELECTRO PHYSIOLOGY STUDY 9900 12100 14300 01 APA PERIPHERAL ANGIOPLASTY 85000 95000 110000 02 ARFA RADIO FREQUENCY ABLATION 33000 44000 55000 01 ARHS RIGHT HEART STUDY 7700 9900 12100 01 A3DM 3D MAPPING 50000 60000 70000 01 Extra Cost: 1. Stent a) Drug Eluting Stent b) Mounted Stent 2. Pharmacy 3. Non- Ionic Dye 4. Extended Stay Note: a. Any Cardiology procedure done in emergency shall be charged as per higher category, ie minimum Semi- Private Category will be charged. b. When two or more procedures are performed 50% of the minor procedure will be charged extra. 22 PACKAGE CHARGES FOR C T S S Pvt. General Non AC S Pvt. AC Pvt. Non AC PVT AC (S) Deluxe/ Special No. of days ASD 148000 205000 205000 230000 250000 260000 08 AOHS AVR/MVR/CABG/VSD 175000 230000 230000 260000 280000 300000 08 AOHSE AVR/MVR/CABG EMERGENCY 193200 260000 260000 290000 296000 307000 08 Code Service Name II. CARDIO-THORACIC SURGERIES AVSD Note: a. Package is for 8 days. b. Valve will be charged extra. c. Extended stay will be charged extra for all services. d. IABP charges and permanent pace maker implant shall be charged extra. e. Patient to pay an advance at the time of admission equivalent to the approximate amount of bill. ENDOCRINOLOGY SERVICE CHARGES I. END01 END02 END03 END04 END05 END06 ENDOCRINOLOGY SCREENING DOPPLER (DIABETIC) BIOTHESIOMETER TOTAL DIABETIC FOOT STUDY PODIA SCAN CARDIAC AND AUTONOMIC NERVOUS SYSTEM ASSMNT. (CANS) PEDINOVA General 590 300 770 320 430 320 Private 890 450 1160 480 650 480 4800 1700 4800 1700 General. 2000 4500 4500 4800 3250 3700 3700 3250 6000 5000 2500 Private 3000 7000 7000 7200 4900 5600 5600 4900 8500 7000 4000 ENDOCRINOLOGY PACKAGE CHARGES CHK62 CHK63 DIABETIC HEALTH CHECKUP DIABETIC FOOT ASSESSMENT GASTROENTROLOGY SERVICE CHARGES I. GENT10 GENT11 GENT12 GENT13 GENT14 GENT15 GENT16 GENT17 GENT18 GENT19 GENT20 GASTROENTEROLOGY EMERGENCY ENDOSCOPY CHARGES ESOPHAGEAL DILATION GASTRIC STRICTURE DILATION ESOPHAGEAL VARICEAL GLUE INJECTION TUMOR ABLATION BY ALCOHOL INJECTION PLACEMENT OF FEEDING TUBES WITH ENDOSCOPY FOREIGN BODY REMOVAL INJECTION BLEEDING ULCER SPHINCTEROTOMY STONE EXTRACTION STENTING 23 GENT21 GENT22 GENT23 GENT24 GENT25 GENT26 GENT27 GENT28 GENT29 GENT30 GENT31 GENT32 GENT33 GENT34 GENT35 GENT36 GENT37 GENT39 GENT40 GENT42 GENT43 GENT50 GENT51 NASOBILARY DRAINAGE ESOPHAGEAL PROSTHESIS INSERTION GASTRIC POLYPECTOMY GASTRIC VARICES GLUE INJECTION COLONOSCOPIC POLYPECTOMY DECOMPRESSION OF COLONIC CELLS ENDOSCOPIC MUCOSAL RESECTION TUMOR ABLATION BY ELECTROCAUTERY/LA VARICEAL LIGATION BY ENDOSCOPY COLONIC STRICTURE DILATION ENDOSCOPIC FISTULA CLOSURE PRECUTANEAS ENDOSCOPIC GASTROSTOMY DRAINAGE OF PSEUDOCYST ACHALASIA DIALATION COLONOSCOPY LEFT SIDE COLONOSCOPY EVL SET EVL SET(VIEW MAX) BILARY DIALATATION INTRA OPERATIVE ENDOSCOPIC METALIC STENT INSERTION IN CBD ENDOLOOP APPLICATION ANAESTHESIA CHARGES GASTRO II. GENT01 GENT03 GENT04 GENT06 GENT07 GENT08 GENT09 GENT41 GENT44 GENT45 GENT46 GENT47 GENT48 GENT49 GASTROENTEROLOGY INVESTIGATION UPPER G.I. ENDOSCOPY st ESOPHAGEAL SCLERO THERAPY: a. VARICES - 1 SITTING ESOPHAGEAL SCLERO THERAPY: b. VARICES - SUBS. SITTING SIGMOIDOSCOPY (FLEXIBLE) ESOPHAGOSCOPY BIOPSY CHARGES FOR GASTRO PROCEDURE ERCP (EXCLUDING STENT) VARICEAL INJECTION ENDOSCOPIC BRUSH CYTOLOGY CBD STENT REMOVAL SIDE VIEWING DUODENOSCOPY MECHANICAL LITHOTRIPSY ERCP ACCESSORIES CHARGES BALLOON DILATATION OF PAPILLA 4500 7500 5400 5400 5500 3250 6400 5900 5000 6000 4300 9000 10000 8400 5000 3000 5500 2400 12000 10000 6500 6000 1100 6000 12000 8100 8100 8500 4900 9600 8900 7000 8000 6500 15000 16000 12600 8000 5000 8300 3600 18000 15000 9500 8000 1100 General 2700 4300 4300 3000 2000 1200 7300 3500 1200 5250 3700 15000 2100 4500 Private 4100 6500 6500 4500 2500 1800 11000 4500 1600 7900 5600 20000 2100 6500 General 900 300 1500 300 300 300 300 500 550 Private 1700 600 2100 600 600 600 600 900 1100 DERMATOLOGY SERVICE CHARGES I. SKN01 SKN03 SKN04 SKN05 SKN06 SKN07 SKN08 SKN11 SKN13 SKIN PROCEDURE SKIN BIOPSY EXCISION – WARTS EXCISION - SAB CYST CAUTERIZATION & SCRAPING – WARTS CAUTERIZATION SCRAPING MOLLUS CUM CONTRA- SINGLE CAUTERIZATION & SCRAPING VENERAL WARTS CAUTERIZATION & SCRAPING CORNS INTRALESIONAL INJECTIONS- SINGLE LESION CAUTERIZATION SCRAPING MOLLUS CUM CONTRA- DOUBLE 24 SKN14 SKN16 SKN17 SKN18 SKN19 SKN20 SKN21 SKN22 SKN23 SKN24 SKN25 SKN26 SKN27 SKN28 SKN30 CHEMICAL PEELING- MULTIPLE PEEL CRYO SURGERY- SINGLE LESION CRYO SURGERY- DOUBLE LESION CRYO SURGERY- MULTIPLE LESION MILIA EXTRACTION ELECTRIC CAUTERIZATION (WARTS,SKIN)- SINGLE LESION ELECTRIC CAUTERIZATION (WARTS,SKIN)- DOUBLE LESION ELECTRIC CAUTERIZATION (WARTS,SKIN)- MULTI LESIONS DERMAROLLER FOR ACNE SCAR TCA APPLICATION- SINGLE LESION TCA APPLICATION- DOUBLE LESIONS TCA APPLICATION- MULTIPLE LESIONS COSMO PEEL FOR HYPER PIGMENTATION NEORONOX INJECTION (PER UNIT) ACNE SCAR TREATMENT PER SITTING 1100 500 800 1100 1100 550 900 1900 4300 200 300 550 1500 550 1000 2100 900 1600 2000 2000 1100 1700 3900 8600 300 500 1100 3000 1100 1900 RESPIRATORY MEDICINE SERVICE CHARGES I. RESPIRATORY LAB RES01 RES02 RES05 RES06 RES07 RES08 RES09 RES10 RES12 RES13 RES14 RES15 RES16 RES17 BRONCHOSCOPY PULMONARY FUNCTION TESTING (Pre & Post Nebulisation) PLEURODESIS PLEURAL TAP SMOKING CESSATION CLINIC BRONCHOSCOPY WITH BIOPSY SLEEP STUDY FIBROPTIC BRONCHOSCOPY BRONCHOSCOPIC GLUE INJECTION 0.50ML BRONCHOSCOPIC GLUE INJECTION 1 ML ALLERGY TEST ( Complete Package) SIX MINUTES WALK TEST BRONCHOSCOPY BIOPSY WITH TBNA NEEDLE ALLERGY TEST (Fungal Antigens) General. Private 7500 1000 3500 1500 500 9500 8000 3500 9100 9600 2000 200 9600 750 10000 1300 4800 2800 800 13000 12000 5000 12800 13400 2500 350 12800 1200 General 500 300 500 1500 1000 1000 1000 1350 Private 800 500 800 3000 1600 2000 1500 2000 PSYCHIATRY SERVICE CHARGES I. PSY01 PSY02 PSY03 PSY04 PSY05 PSY06 PSY07 PSY08 PSYCHOLOGY SERVICES COUNSELING PSYCHOTERAPY PLAY THERAPY RELAXATION TRAINING ASSESSMENT OF CHILDHOOD DISORDERS ASSESSMENT OF DEVELOPMENT AND SOCIAL QUOTIENT IQ TEST THEMATIC APPERCEPTION TEST RORSCHACH TEST 25 PSY09 PSY10 PSY11 PSY12 PSY13 PSY14 PSY15 PSY16 PSY17 BEHAVIOUR THERAPY OR PSYCHOTHERAPY (10 SESSION) NEUROPSYCHOLOGICAL BATTERY PERSONALITY TEST COMPLETE PSYCHODIAGNOSTIC TEST MEMORY TEST RELAXATION TRAINING ( 5 SESSION) MARITAL THERAPY (5 SESSION) MARITAL INTERVENTION (PER SITTING) FAMILY INTERVENTION (5 SESSION) 3000 3000 1500 2800 1300 2200 2500 500 2500 4500 4000 2500 4500 2000 3500 3500 800 3500 ONCOLOGY SERVICE CHARGES I. ONCO001 ONCO002 ONCO003 ONCO004 ONCO005 ONCO006 ONCO007 ONCOLOGY SERVICES MONITORING CHARGES - LESS THAN ONE HOUR - 1 HOUR TO 4 HOURS - 4 HOUR TO 12 HOURS - MORE THAN 12 HOURS CHEMO PORT FLUSHING INTRATHECAL METHOTREXATE CHEMOTHERAPY General 210 540 750 1600 210 1600 1000 Private 320 810 1130 2400 320 2400 1900 NEUROPHYSIOLOGY SERVICE CHARGES I. NEPHY01 NEPHY02 NEPHY03 NEPHY04 NEPHY05 NEPHY06 NEPHY07 NEPHY08 NEPHY12 NEPHY13 NEPHY15 NEPHY16 NEPHY17 NEPHY18 NEPHY19 NEPHY20 NEPHY21 NEPHY22 NEPHY23 NEPHY24 NEPHY25 NEUROPHYSIOLOGY SERVICES E.E.G NERVE CONDUCTION STUDY (NCV) NERVE CONDUCTION STUDY AND EMG VISUAL EVOKED RESPONSE BRAINSTEM AUDITORY EVOKED RESPONSE SOMATOSENSORY EVOKED RESPONSE DECREMENTAL RESPONSE E.M.G SHORT TERM VIDEO EEG LONG TERM VIDEO EEG FACIAL N.C. STUDY PORTABLE CHARGES IN ICU REPITITIVE NERVE STIMULATION TEST(RNST) SLEEP DEPRIVE EEG BLINK REFLEX SLEEP STUDY SINGLE FIBRE EMG NCS CTS PROTOCOL LONG TERM BEDSIDE EEG SHORT TERM BEDSIDE EEG NCS BRACHIAL 26 General 1050 1600 3200 1600 1600 1600 1600 1900 1800 7000 1600 500 1600 1600 1400 5700 2100 1400 3900 2350 1600 Private 1600 2400 4800 2400 2400 2400 2400 2900 2700 10500 2400 800 2400 2400 2100 8600 3200 2100 5900 3500 2400 NEPHY26 NEPHY27 NEPHY28 NEPHY29 NEPHY30 NEPHY31 NEPHY32 NEPHY33 NEPHY34 NEPHY35 NEPHY36 NEPHY37 NEPHY38 NEPHY39 NEPHY41 NEPHY42 NCS RADIAL NCS ULNAR EVOKED POTENTIAL P300 EXERCISE PROTOCOL SYMPATATIC SKIN RESPONSE (SSR) SURFACE EMG TREMOR ANALYSIS MINI SPHENOIDAL EEG NCS TOS PROTOCOL DIAPHRAMATRIC CONDUCTION BOTOX INJ. UNDER EMG CONTROL MUSCLE BIOPSY CTS INJ. STEROID BOTOX INJ. (WITHOUT EMG) – Procedure only THROMBOLYSIS (50) THROMBOLYSIS (70) 1600 1600 1250 1600 850 1600 1600 1600 1400 1400 500 1400 350 760 48000 67000 2400 2400 1900 2400 1300 2400 2400 2400 2100 2100 800 2100 530 1100 48000 67000 General 2100 2100 2200 2700 2500 3000 1000 700 10000 Private 3200 3200 3000 3200 3000 4000 1000 700 10000 NEPHROLOGY SERVICES CHARGES I. DIA01 DIA02 DIA03 DIA04 DIA05 DIA06 DIA07 DIA16 DIA23 NEPHROLOGY CHARGES PERITONEAL DIALYSIS HAEMODIALYSIS FEMORAL CATHETERISATION SUB CLAVIAN CATHETERISATION VASCULAR ACCESS KIDNEY BIOPSY ADD CHG FOR BEDSIDE HEMODIALYSIS EMERGENCY DIALYSIS CHARGES PLASMOPHERESIS Note: I. Haemodialysis includes all consumables and professional charges but it does not include dialyser charges. II. Charges for procedures to be done in O T. 1. A V Shunt Category – II 2. A V Fistula Category – II 3. CAPD placement Category – IB PACKAGE CHARGES FOR NEPHROLOGY Code Service Name S Pvt. General Non AC S Pvt. AC Pvt. Non AC PVT AC (S) No. of days RENAL TRANSPLANTATION ARTD RENAL TRANSPLANTATION DONOR ARTR RENAL TRANSPLANTATION RECIPIENT 75000 100000 100000 100000 100000 12 250000 400000 400000 400000 400000 12 Note: a. The package is for 12 days and starts one day before the operation. Any extra stay and services beyond the package will be charged. b. Package includes the charges for surgery and stay in the hospital for the donor. c. Donor opting for the special accommodation than allowed in the package shall be charged for the difference in accommodation. d. Pharmacy to be charged extra. 27 PEADIATRIC SERVICE CHARGES I. PAED01 PAED02 PAED03 PAED04 PAED05 PAED07 PAED08 PAED09 PAED14 PAED15 PAED18 PAED21 PAED22 PAED23 PAED24 PAED25 PAED26 PEADIATRICS SERVICE CHARGES PEADIATRIC CARE FOR NEW BORN NURSERY CARE PER DAY (WITHOUT MONITOR) PREMATURE BABY CARE PER DAY INCUBATOR/WAMER PER DAY NURSERY INTENSIVE CARE PER DAY (WITH MONITOR) RESUSCITATION RESUSCITATION WITH INTUBATION (BY SPECIALIST) EXCHANGE TRANSFUSION INFUSION PUMPS & SYRINGE PUMPS NON INVASIVE/ BP MONITOR ROP SCREENING CHARGES NURSERY CARE PER DAY (WITH MONITOR) C PAP PER DAY (EQUIPMENT CHARGES) CUP FEEDING CHARGES PER DAY TUBE FEEDING CHARGES PER DAY PHOTOTHERAPY SINGLE PHASE PHOTOTHERAPY DOUBLE PHASE General 850 550 620 750 1700 900 1050 1610 240 240 500 1120 110 110 160 210 320 Private 1300 1300 900 1100 2550 1350 1900 2600 480 480 750 1880 200 200 240 560 630 General 430 140 140 140 140 360 820 320 320 420 420 420 420 420 420 500 1800 2900 1800 2800 2900 30000 Private 430 210 210 210 210 540 1230 480 480 630 630 630 630 630 630 750 2700 4350 2700 4200 2900 30000 OPTHALMOLOGY SERVICE CHARGES I. BUT1 OPTHA02 OPTHA03 OPTHA04 OPTHA08 OPTHA09 OPTHA10 OPTHA11 OPTHA12 OPTHA13 OPTHA14 OPTHA15 OPTHA16 OPTHA17 OPTHA18 OPTHA19 OPTHA20 OPTHA21 OPTHA22 OPTHA23 OPTHA24 OPTHA26 OPTHALMOLOGY SERVICE CHARGES BOTOX INJECTION PER UNIT REFRACTION FUNDUS EXAMINATION (DIRECT OPTHALMOSCOPY) FUNDUS EXAMINATION (INDIRECT OPTHALMOSCOPY) GLAUCOMA INVESTIGATION – GONIOSCOPY ORTHOPTIC EXERCISES FIELD CHARTING WITH FIELD MACHINE- BOTH EYES INCISION OF ABSCESS CORNEAL F.B REMOVAL CHALOZION EXCISION WART EXCISION APPLICATION OF THE LIMBAL RING CONJUNCTIVAL RESUTURING ELECTROLYTIC EPLATION A SCAN BIOMETRY ROP SCREENING CHARGES FLUROSCENE ANGIOGRAPHY(LASER THERAPY) ARGON LASER PHOTOCOAGULATION YAG LASER CAPSULOTOMY YAG LASER IRODOTOMY CORNEA PROCESSING CHARGES PER CORNEA LASIK LASER TREATMENT –BOTH EYES 28 OPTHA27 OPTHA28 OPTHA30 OPTHA31 OPTHA38 OPTHA44 OPTHA45 OPTHA47 OPTHA48 OPTHA49 OPTHA51 OPTHA52 OPTHA53 COSTOMUVE LASIK LASER –BOTH EYES FIELD CHARTING WITH FIELD MACHINE ONE EYE LASIK LASER TREATMENT ONE EYE COSTOMUVE LASIK LASER ONE EYE LASIK WORK UP VISION THERAPY SOFTWARE VISION THERAPY ACCESSORIES OCT RETINA AND MACULAR OCT GLAUCOMA OCTANTERIOR SEGMENT EXAMINATION CORNEA GRAFT I- LASIK STANDARD I- LASIK COSTOMIZED 35000 470 17500 21000 1000 8000 1100 2100 1600 1100 5900 75000 80000 35000 710 17500 21000 1000 8000 1100 3200 2400 1700 5900 75000 80000 PACKAGE CHARGES FOR OPHTHALMOLOGY Code Service Name General S Pvt. Private Deluxe/ Special No. of days CATARACT WITH IOL IMPLANTATION ACTIO CATARACT SURGERY 11300 12600 14300 16200 01 MICS MICS CATARACT SURGERY 16200 17300 20500 24900 01 Note: IOL Charges will be charged extra ENT AUDIOLOGY SERVICE CHARGES I. ENT01 ENT02 ENT03 ENT04 ENT05 ENT06 ENT07 ENT08 ENT09 ENT10 ENT11 ENT12 ENT13 ENT14 ENT15 ENT & AUDIOLOGY PURE TONE AUDIOGRAM SISI, TONE DECAY & DIFFERENCE LIMEA MULTIPLE HEARING ASSESSMENT TEST/AD HEARING AID SELECTION SPEECH DISCRIMINATION SCORE SPEECH ASSESSMENT SPEECH THERAPY PER SESSION 30-40 Min. DELAYED SPEECH: AUDIOMETRY & SPEECH & BEHAVIOUR COLD CARORIC TEST FOR VESTIBULAR FUNCTION SPECIAL TEST TYMPANOMETRY TYMPANOMETRY & STAPE DIAL REFLEX SPECIAL TEST ARLT, DE, CAY TYMPANOMETRY STAPE DIAL REFLEX, ARL HEARING TEST FOR NEW BORN BABIES(OA) General 400 270 650 270 170 230 275 540 390 310 350 430 300 750 190 Private 600 450 1000 450 260 350 400 820 590 470 510 650 450 1140 290 II. ENT16 ENT17 ENT18 ENT19 ENT20 ENT22 ENT23 ENT OPD PROCEDURES MYRINGO PLASTY MYRINGOTOMY MYRINGOTOMY WITH GROMMET EXAMINATION UNDER MICROSCOPE BIOPSY (ENT) DIAGNOSTIC NASAL ENDOSCOPY ENDOSCOPY SUCTION CLEANING General 3200 1400 1800 700 1800 900 900 Private 4800 2100 2700 1100 2700 1300 1200 29 ENT24 ENT25 ENT26 ENT28 ENT29 ENT30 ENT31 ENT32 ENT33 ENT34 ENT35 ENT36 ENT38 ENT39 ENT40 ENT41 BRONCHOSCOPY LARYNGOSCOPY (FLEXIBLE) BRONCHOSCOPY WITH BIOPSY SYRINGING OF EAR UNILATERAL TRACHEOSTOMY TUBE CHANGE LOBULOPLASTY UNILATERAL FOREIGN BODY EAR FOREIGN BODY NOSE 90 DEGREE LARINGOSCOPY SUTURING WOUNDS NASAL PACKING TRACHEOSTOMY WEANING EAR PACKING NASAL SUCTIONING COBLATOR WAND A COBLATOR WAND B 5400 2100 5900 740 740 2100 1400 1400 750 750 700 800 200 200 22000 24000 8100 3200 8900 1100 1100 3200 2100 2100 1100 1100 1100 1200 300 300 22000 24000 PACKAGE CHARGES FOR ENT SURGERY Code Service Name General Cubicle S Pvt. Non AC S Pvt. AC Pvt. Non AC PVT AC (S) Deluxe No. of days ENT SURGERIES AMTDTM MASTOIDECTOMY 20000 23000 28000 38000 48000 58000 68000 04 ATMPT TYMPANOPLASTY 14000 17000 21000 28000 38000 48000 55000 02 AADNTM ADENOTONSILLECTOMY 19000 21000 24000 28000 33000 37000 44000 03 ASPLT SEPTOPLASTY 14000 16000 19000 23000 28000 32000 38500 03 ADLS D/L SCOPY 13000 14500 16500 20500 24500 29500 34500 02 ANME NECK MASS EXCISIONLARGE 25000 29500 35000 44500 54500 62500 76500 07 ANBFS NASEL BONE FRACTURE SIMPLE 15000 16500 20000 25000 32000 38000 46000 04 ANBFC NASEL BONE FRACTURE COMPOUND 20000 25000 32000 41000 50000 60000 69000 04 AADTM ADENOIDECTOMY 12000 13000 15000 17000 20000 23000 27500 02 ADWC D N E WITH CAUTERISATION 14500 17500 21500 28500 38500 48500 58500 05 AMLS MICRO LARYNGEAL SURGERY 16000 19000 24000 31000 39000 46000 54000 03 OSA OSA SURGERY 30000 36500 45000 49000 61000 72000 80000 07 AEF EXTENDED FESS 32000 38300 47200 54500 62100 72700 81000 05 AFESS FESS MINOR 19000 25000 32000 44000 55000 67000 77000 03 AFESSM FESS MAJOR 24000 30000 38000 50000 61000 73000 83000 03 ACAL CALDWELL- LUC 13500 15900 19800 21600 26700 30500 35000 03 LME LARGE MASS EXCISION 25000 29500 35000 44500 54500 62500 76500 07 30 ASPA 28500 34800 42500 46500 58000 69000 78000 05 ASMGE SUP- PAROTIDECTOMY SUBMANDIBULAR GLAND EXCISION 20000 24200 30400 33000 41000 47200 55000 04 AOSPH OESOPHAGOSCOPY 11500 13500 17500 23500 29500 34500 40000 02 ANMAE NASEL MASS EXCISION ANTERIOR & POSTERIOR NASAL PACKING IN OT PRE AURICULAR SINUS EXCISION 12500 14500 18100 19500 23500 26700 30000 02 8000 9600 11300 12500 15900 18300 21500 02 14000 16500 20800 22300 27100 31000 34500 02 16500 21000 23000 27000 30000 35000 02 24750 31200 33450 40650 46500 51750 02 AMGBG TONSILLECTOMY 14000 PRE AURICULAR SINUS EXCISION- BILATERAL 21000 MYRINGOTOMY+ GROMMET BILATERAL UNDER GA 14000 14750 16250 18500 20750 23750 29750 01 AEM EXCISION MASS 10000 11800 14900 15600 18700 21600 23500 02 AFB FESS BIOPSY EXCISION SMALL MASS UNDER GA 9000 10300 12200 13100 15700 17800 19500 01 6000 6800 8200 8800 10800 12000 14500 01 SMALL BIOPSY UNDER GA SUTURING FACIAL/ NECK WOUND SMALL SUTURING FACIAL/ NECK WOUND LARGE REPAIR OF LASERATED TONGUE COBLATION SURGERYMINOR COBLATION SURGERYMAJOR MYRINGOTOMY+ GROMMET UNILATERAL GA 6000 6800 8200 8800 10800 12000 14500 01 10000 11000 12400 13100 15200 16800 19000 01 14000 15800 18500 19600 22700 25600 27500 01 8000 9600 11200 12300 15200 18000 20000 01 10000 11800 14900 15600 18700 21600 23500 01 15000 18800 24500 26600 29700 33600 34500 01 10000 10500 11500 13000 14500 16500 20500 01 AAPNP APASE ATON APASEB AESMUG ASBUG ASFNWL ASFNW ARLT ACSM ACSMJ AMGU ENT DAY CARE SURGERY ATRAC TRACHEOSTOMY 8000 10000 11500 13000 15000 17000 19000 - ATC TRACHEOSTOMY CLOSURE 7000 9000 11500 13000 15000 17000 19000 - AMGULA MYRINGOTOMY+GROMMET UNILATERAL LA 5000 6000 7500 10000 14000 20000 23000 ATTR TOUNG TIE RELEASE 4000 5000 6500 8500 11000 15000 17000 - AFBEN FOREIGN BODY EAR/NOSE MYRINGOTOMY+GROMMET BILATERAL UNDER LA 4000 5000 6500 8500 11000 15000 17000 - 7500 9000 11250 15000 21000 30000 34500 - 30000 30000 30000 30000 30000 30000 30000 - 27500 27500 27500 27500 27500 - AMGBL ACAP ACAITR COBLATION ASSISTED PHARYNGOPLASTY COBLATION ASSISTED INFERIOR TURBINATE REDUCTION SURGERY 27500 27500 31 - CATBS ASLEND COBLATION ASSISTED TONGUE BASE SURGERY SLEEP ENDOSCOPY PROCEDURE 30000 30000 30000 30000 30000 30000 30000 - 5000 5000 7000 7000 7000 7000 7000 - Note: a. Pharmacy to be charged extra. b. Any Service provided beyond the package days shall be charged extra. c. The package starts one day before the operation/procedure. d. Package rates are applicable for the category as mentioned. Difference of accommodation will charged extra for patients taking the Semi-Private (Deluxe) Room or A.C Single Room- Special. e.10% of the package amount shall be charged extra in case of Emergency surgery. DENTAL SERVICE CHARGES I. DENT04 DENT06 DENT07 DENT07A DENT08 DENT08A DENT10 DENT11 DENT12 DENT13 DENT14 DENT15 DENT16 DENT17 DENT18 DENT19 DENT21 DENT22 DENT23 DENT24 DENT25 DENT26 DENT27 DENT30 DENT30A DENT30B DENT30C DENT31 DENT32 DENT33 DENT34 DENT35 DENT36 DENT39 DENT41 DENT43 DENT44 DENTAL COMPOSITE FILLING-LIGHT CURE GLASS IONOMER RCT ANTERIORS(ENDODONTICS) st RCT ANTERIOR 1 SITTING RCT POSTERIORS(ENDODONTICS) st RCT POSTERIOR 1 SITTING APICAL CURETTAGE (ENDODONTICS) ORATEKE AND LUCITONE-COMPLETE DENTURES ACRYLIC & PREMA DENTURES-COMPLETE DENTURES RELINING COMPLETE DENTURES (PROSTHETICS) DENTURE REPAIR (PROSTHETICS) SINGLE TOOTH PARTIAL DENTURES(ACRYLIC) EACH ADDITIONAL TOOTH-PARTIAL DENTURE CAST PARTIAL DENTURE JACKET CROWN (ACRYLIC PER UNIT) CROWN (CHROME COBALT PER UNIT) WITHOUT FACING CROWN (CHROME COBALT PER UNIT) PORCELAIN FACING DOWEL CROWN (ACRYLIC PER UNIT) POST AND CORE OBTURATOR FOR CLEFT PALATE COST OF APPLIANCES(ORTHODONTICS) COST OF EACH VISIT FOR ADJUSTMENT(ORTHODONTICS) EACH BREAKAGE/LOSS (ORTHODONTICS) COST OF FIXED APPLIANCE METAL BRACES st COST OF METAL BRACES PART PAYMENT- 1 INSTALLMENT nd COST OF METAL BRACES PART PAYMENT- 2 INSTALLMENT rd COST OF METAL BRACES PART PAYMENT- 3 INSTALLMENT COST OF EACH VISIT FOR ADJUSTMENT (FIXED ORTH.) EACH BREAKAGE/LOSS OF BAND(FIXED ORTHODONTICS) EXTRA ORAL APPLIANCE HEAD GEAR SCALING AND POLISHING OR TEETH (I) SCALING AND POLISHING OF TEETH (II) SCALING AND POLISHING OF TEETH (III GINGIVECTOMY – PER QUADRANT FRENECTOMY SPACE MAINTAINER FUNCTIONAL (PER UNIT) SPACE MAINTAINER NON FUNCTIONAL 32 General 900 500 2200 1100 2700 1700 2700 13500 10200 1400 1100 1900 400 11800 2100 2400 3700 2400 5400 5400 4800 500 300 23500 16100 5400 5400 1200 1100 2100 900 1200 1600 4300 1600 400 600 Private 1200 700 3000 1400 4000 2400 3600 20000 13400 1800 1700 2600 600 15000 2500 3500 4800 3000 8000 8000 6400 700 400 26800 16100 8000 8000 2100 1300 2700 1100 1600 2100 5400 2100 600 900 DENT45 DENT46 DENT47A DENT47B DENT47C DENT49 DENT50 DENT52 DENT53A DENT53B DENT54 DENT57 DENT58 DENT59 DENT60 DENT61 DENT62 DENT63 DENT64 DENT65 DENT67 DENT67A DENT69 DENT69A DENT70 DENT71 DENT72 DENT73 DENT74 DENT75 DENT76 DENT77 DENT78 DENT81 DENT82 DENT84 DENT85 DENT86 DENT87 DENT88 DENT89 DENT90 DENT91 DENT92 DENT93 DENT94 DENT96 DENT97 DENT98A DENT98B DENT99 DENT100 DENT101 DENT102 DENT103 DENT104 EXTRACTION PER TOOTH EXTRACTION ALL TEETH IN A JAW rd 3 MOLAR DISIMPACTION- CATEGORY A rd 3 MOLAR DISIMPACTION- CATEGORY B rd 3 MOLAR DISIMPACTION- CATEGORY C TOOTH REPLANTATION ALVEOLECTOMY (PER QUADRANT) ABCESS INCISION (PER TOOTH) GROWTH REMOVAL LESS THAN 1cmx1cm IN SIZE GROWTH REMOVAL MORE THAN 1cmx1cm IN SIZE BIOPSY FLAP OPERATION (PER QUADRANT) FIXATION OF FRACTURED JAW – I.M.F IMPRESSIONS FOR STUDY MODELS COST OF APPLIANCE (FIXED, ORTHODONTICS SINGLE) COST OF EACH VISIT FOR ADJUSTMENT SINGLE COST OF APPLIANCE (FIXED, ORTHODONTICS SEGM.) DENTAL X-RAY ORATEKE AND LUCITONE DENTURE ONE JAW ACRYLIC & PREMA DENTURES ONE JAW RCT (PREMOLARS) st RCT PREMOLAR – 1 SITTING BLEACHING OF SINGLE TEETH BLEACHING PER ARCH BLEACHING OF TEETH (LOWER QUADRANT) FLEXIBLE PARTIAL DENTURE FOR SINGLE TOOTH ALL CERAMIC CROWN FLEXIBLE FULL DENTURE I &D OF FACIAL ABCESS SEALANT FOR CARIES PREVENTION RCT OF PRIMARY TEETH TEMPORARY FILLING TWIN BLOCK APPLIANCE FLOURIDE APPLICATION (PEDODONTICS) PER ARCH ESTHETIC COMPOSITE REPEAT ENDODONTICS COMPOSITE SPLINTING FOR LUXATED TEETH PER ARCH OCCLUSAL X- RAY rd 3 MOLAR EXTRACTION (SIMPLE) ROTARY ENDO- ANTERIOR ROTARY ENDO- POSTERIOR AUTOGENOUS GRAFT FOR AUGMENTATION MTA APPLICATION SINGLE TOOTH REMOVABLE PARTIAL DENTURE (LUCITONE) ARTHROCENTESIS INTRA ARTICULAR INJECTION ORTHOGNATHIC SURGERY PLANNING DEPIGMENTATION OF GINGIVA PACKAGE FOR IMPLANT (ALFABIO) - WITHOUT CROWN PACKAGE FOR IMPLANT (BIOHORIZON) - WITHOUT CROWN PEDO CROWN MICRO IMPLANT (FOR ORTHODONTIC PURPOSE) CERAMIC FIXED APPL. BONE GRAFT SUTURE-SILK SUTURE- NYLON 33 400 1900 2700 3700 5400 1600 1600 500 1600 3200 1600 4800 10700 400 11800 600 4400 200 4400 4800 2500 1500 1900 4300 8600 8200 8600 23500 5900 450 1100 200 6400 1600 1600 3700 2700 500 800 3200 3700 8600 1100 3700 3200 1100 3200 2100 25000 28000 1100 3200 26800 4300 300 500 600 2900 3600 5000 8000 2100 2100 600 2100 4800 2100 6400 16100 400 13100 1100 6200 300 6400 5900 3000 1600 2600 6400 9600 11800 10200 29400 8200 700 1600 300 8000 2700 2700 4800 3700 700 1100 3700 4300 10700 1300 4800 4300 1600 4300 3200 27000 30000 1600 4000 33000 5400 350 600 DENT105 DENT106 DENT107 DENT108 DENT109 DENT110 DENT111 DENT112 DENT113 DENT114 DENT115 DENT116 DENT117 DENT117A DENT117B DENT117C DENT118 DENT118A DENT118B DENT118C DENT119 DENT119A DENT119B DENT119C DENT120 DENT120A DENT120B DENT120C DENT121 DENT121A DENT121B DENT121C DENT122 DENT123 DENT124 DENT125 DENT126 DENT127 DENT128 DENT129 DENT130 DENT131 SUTURE- VICRYL NANCE PALATAL ARCH COMPLICATED EXTRACTION (Surgical) MIRACLE MIX RESTORATION GLASS IONOMER FILLING TYPE- 2 KETAC MOLAR RESTORATION (HIGH STRENGTH GIC) RCT SUBSEQUENT SITTING EXTRACTION OF TEETH PER QUADRANT INCISIONAL BIOPSY SUBGINGIVAL CURETTAGE & ROOT PLANNING (PER QUADRANT) OPEN REDUCTION OF FRACTURED JAW UNDER L.A (Plate Fixation) SCALING & POLISHING PER QUADRANT COST OF FIXED APPLIANCE CERAMIC BRACES st COST OF CERAMIC BRACES PART PAYMENT -1 INSTALLMENT nd COST OF CERAMIC BRACES PART PAYMENT- 2 INSTALLMENT rd COST OF CERAMIC BRACES PART PAYMENT- 3 INSTALLMENT COST OF LINGUAL BRACES st COST OF LINGUAL BRACES PART PAYMENT- 1 INSTALLMENT nd COST OF LINGUAL BRACES PART PAYMENT- 2 INSTALLMENT rd COST OF LINGUAL BRACES PART PAYMENT- 3 INSTALLMENT SINGLE ARCH NON -EXTRACTION SINGLE ARCH NON -EXTRACTION- 1st INSTALLMENT (Impressions) SINGLE ARCH NON- EXTRACTION- 2nd INSTALLMENT (Virtual set up) SINGLE ARCH NON- EXTRACTION- 3rd INSTALLMENT (Final Aligners) BOTH ARCHES NON -EXTRACTION BOTH ARCHES NON -EXTRACTION-1st INSTALLMENT (Impressions) BOTH ARCHES NON -EXTRACTION-2nd INSTALLMENT (Virtual set up) BOTH ARCHES NON -EXTRACTION- 3rd INSTALLMENT (Final Aligners) ANY ARCH EXTRACTION CASE ANY ARCH EXTRACTION CASE- 1st INSTALLMENT (Impressions) ANY ARCH EXTRACTION CASE- 2nd INSTALLMENT (Virtual set up) ANY ARCH EXTRACTION CASE- 3rd INSTALLMENT (Final Aligners) COST OF FIXED RETAINER PER ARCH NIGHT GUARD CYST ENUCLEATION UP TO 2 cm CYST ENUCLEATION MORE THAN 2 cm CANINE EXPOSURE FOR ORTHODONTIC TREATMENT TMJ OCCLUSAL SPLINT DRESSING SMALL DRESSING LARGE IODOFORM DRESSING METAPEX RCT DRESSING 500 2100 2100 400 300 800 500 2100 1600 2100 16100 500 32100 21400 6400 6400 80300 42800 21400 21400 96300 48200 24600 23500 107000 53500 26800 26800 160500 80300 40700 39600 3200 4300 5400 8600 2100 3200 200 300 500 300 600 3000 3000 600 400 1200 700 3200 2100 3200 20000 800 38000 27000 6400 6400 85600 48200 21400 21400 107000 53500 26800 26800 128400 64200 32100 32100 187300 96300 48200 42800 4800 6400 8000 12800 3200 3700 300 450 750 450 MATERNITY SERVICE CHARGES I. MAT01 MAT03 MAT04 MAT05 MAT06 MAT07 MAT11 MATERNITY CHARGES COLPOSCOPY END. BIOPSY END. ASPIRATION CERVICAL CAUTERISATION (ELECTRICAL) Cx PUNCH BIOPSY VAGINAL VULVAL/PUNCH BIOPSY CARDIO TOCOGRAPH (CTG) 34 General. 800 1000 300 470 330 330 340 Private 1200 1500 500 700 500 500 650 MAT13 MAT15 MAT18 MAT19 MAT20 MAT23 MAT26 MAT38 MAT39 MAT40 MAT42 MAT43 MAT44 CHK50 CRYO CAUTERY Cx VASECTOMY HEGARS TEST AFI AFI + NST UNBOOKED DELIVERY CASES (EXTRA CHARGES) ECLAMPSIA PATIENTS CHARGES DISPOSABLE DELIVERY KIT ECV NST IUD INSERTION PROCEDURE CHARGES FOR MINOR SURGERIES (I A) PROCEDURE CHARGES FOR MINOR SURGERIES (I B) D&C AND CERVICAL BIOPSY/ FRACTIONAL D&C (OPD PACK.) 800 2400 800 320 1100 2300 900 1300 1000 670 500 4100 4900 4300 1200 2400 1200 500 1700 3500 900 1300 1500 1070 800 6200 7400 7500 II. DELIVERY CHARGES Code Service Name MAT30 MAT31 MAT32 MAT33 Deluxe/ Spl. Special L/R General Cubicle S. Pvt. Private NORMAL DELIVERY FORCEPS DELIVERY BREECH DELIVERY 4500 5600 6100 8000 10000 10900 8900 11100 12100 11100 13900 15100 13400 16700 18200 14000 17500 20000 TWINS DELIVERY 6600 11800 13100 16400 19700 21500 III.ADDITIONAL CHARGES FOR EPIDURAL ANALGESIA (PAINLESS DELIVERY) Code ANA19 ANA20 Service Name EPIDURAL ANALGESIA FOR PAINLESS DELIVERY EPIDURAL ANALGESIA FOR FAILED PAINLESS DELIVERY Deluxe/ Spl. Private Special L/R General Cubicle S. Pvt. 3400 3500 3700 4100 4400 4600 1200 1300 1500 1800 2100 2400 IV. LABOUR ROOM CHARGES Code Service Name General MAT61 LABOUR ROOM CHARGES V. MONITORING CHARGES IN 1 ST Deluxe/ Spl. Cubicle S. Pvt. 3000 3400 General Cubicle S. Pvt. Private Deluxe/ Spl. 1800 Private 4100 Special L/R 4800 6000 STAGE WARD (PER DAY) Special L/R Code Service Name MAT57 FOR LESS THAN 6 HOURS 1100 1300 1600 1800 2100 2400 MAT58 FOR MORE THAN 6 HOURS 1600 2100 2900 3200 4000 4500 st st Note: For LSCS patients, only the 1 stage charges will be applied for the total stay in 1 stage Ward and Labour Room. REPRODUCTIVE AND FOETAL MEDICINE SERVICE CHARGES I. IVF01 IVF03 IVF04 IVF05 REPRODUCTIVE AND FOETAL MEDICINE UNIT (RFMU) CYST ASPIRATION – TAS CVS(CHORIONIC VILLUS SAMPLING) AMNIOCENTESIS CORDOCENTESIS 35 General 1300 3100 1300 3100 Private 2100 4900 2100 5700 IVF06 IVF07 IVF09 IVF10 IVF11 IVF15 IVF17 IVF18 IVF19 IVF20 IVF21 IVF22 IVF23 IVF24 IVF25 IVF26 IVF27 IVF28 IVF29 IVF30 IVF32 IVF33 IVF34 IVF36 IVF35 IVF37 IVF38 IVF40 IVF44 IVF45 IVF46 IVF47 IVF55 IVF59 IVF60 IVF61 IVF62 IVF64 IVF65 IVF66 IVF67 IVF68 IVF74 IVF75 IVF76 IVF77 IVF78 IVF79 IVF80 IVF81 IVF82 IVF83 ADH FOETOSCOPY FOLLICULAR STUDY I SITTING MALE INFERTILITY SCAN SEMEN ANALYSIS IUI (INTRA UTERINE INSEMINATION) FOETAL SCAN ROUTINE BIOPHYSICAL PROFILE FOETAL DOPPLER FOETAL ECHO OBSTETRIC DOPLER & BIOPHYSICAL PROFILE LEVEL II SCAN FOR FOETAL ANOMALIES Cx SCORE FOETAL BIOPSY FOETAL DOPPLER & FOETAL ECHO FOETAL SCAN ROUTINE & FOETAL ECHO FOETAL SCAN ROUTINE & FOETAL DOPPLER FOETAL SCAN ROUTINE & BIOPHYSICAL SCORE CYST ASPITATION – TVS SPERM FUNCTION FOETAL INTERVENTIONAL FOETAL SCAN ROUTINE + DOPPLER + ECHO SONO HYSTEROSALPINGOGRAM SPERM WASH st ART 1 INSTALLMENT AT THE TIME OF REGISTRATION nd ART 2 INSTALLMENT AT THE TIME OF OOCYTE RETRIEVAL SPERM FREEZING-INITIAL CHARGE OOCYTE/EMBRYO FREEZING – INITIAL CHARGE PESA/TESA/MESA ETC AFI AFI + NST ECV NST IUD INSERTION st OBSTETRIC ULTRASOUND 1 VISIT OBSTETRIC ULTRASOUND FOLLOW UP GYNAE ULTRASOUND (PELVIC SCAN) HSG (HYSTEROSALINOGRAM) TRANSVAGINAL SCAN FOETAL THERAPY QUICK LOOK ULTRASOUND END. BIOPSY TESTICULAR BIOPSY CRYO PRESERVATION OF EMBRYO/SPERM- 4 ½ YEARS CRYO PRESERVATION OF EMBRYO/SPERM- TWO YEARS COLPOSCOPY CX BIOPSY END ASPIRATION CX POLYPECTOMY/PUNCH BIOPSY VAGINAL/VULVAL PUNCH BIOPSY CRYOCAUTERY CX IUD INSERTION/REMOVAL st FROZEN EMBRYO TRANSFER (FET) 1 INSTALMENT nd FROZEN EMBRYO TRANSFER (FET) 2 INSTALMENT DIAGNOSTIC HYSTEROSCOPY (OPD PACKAGE) 36 3100 1650 1400 700 3900 780 870 870 1100 1120 2010 220 3100 1600 1600 1600 1600 3100 600 3600 1900 1100 1700 5000 70000 4300 16500 2800 320 1100 1000 670 500 780 610 780 1100 990 3600 260 1000 2800 21400 10700 800 300 330 330 800 500 2000 21500 7000 5700 2600 2100 1100 6100 1100 1440 1440 2120 2490 2660 570 5700 2600 2800 2800 2800 4600 900 5700 3200 1700 2700 5000 84000 4900 19800 4300 500 1700 1500 1070 600 1100 1040 1100 1700 1500 5700 350 1300 4500 26800 12800 1200 500 500 500 1200 800 2000 27000 12000 PACKAGE CHARGES FOR OBSTETRICS & GYNAECOLOGY Code S. Pvt. General Cubicle Non AC Service Name S. Pvt. AC Pvt. PVT Non AC AC (S) No. of Deluxe days LAPAROSCOPIC SURGERIES IN OBS & GYNAE DEPARTMENT: LAPAROSCOPIC OVARIAN CYSTECTOMY 29000 36000 52000 56000 65000 67000 85000 03 ALAVH LAPAROSCOPICALLY ASST. VAGINAL HYSTERECTOMY 39000 47000 65000 69000 77000 80000 99000 05 ADLH DIAGNOSTIC LAPAROSCOPY WITH HYSTEROSCOPY 25000 29000 40000 42000 46000 48000 54000 02 ATLH TOTAL LAPAROSCOPIC HYSTERECTOMY 41000 50000 70000 74000 82000 86000 105000 05 ALMEP LAPAROSCOPIC MANAGEMENT OF ECTOPIC PREGNANCY 27000 34000 49000 52000 61000 63000 79000 03 ALM LAPAROSCOPIC MYOMECYOMY 39000 47000 65000 69000 77000 80000 99000 05 ALOCY LAPAROSCOPIC OVARIAN CYSTECTOMY WITH HYSTEROSCOPY 39000 57000 61000 71000 73000 91000 03 ALOC 32000 Note: a. Pharmacy to be charged extra. b. Any Lab test done will be charged extra. c. Any service provided beyond the package days will be extra. d. Package rates are applicable for the category as mentioned. Difference of accommodation will charged extra for patients taking the Semi-Private (Deluxe) Room or A.C Single Room- Special. e.10% of the package amount shall be charged extra in case of Emergency surgery. MINOR OT PROCEDURE CHARGES I. MOT001 MOT002 MOT003 MOT004 MOT005 MOT006 MOT007 MOT008 MOT009 MOT010 MOT012 MOT013 MOT014 MOT015 MOT017 MOT018 MOT019 MOT020 MOT021 MOT022 MINOR OT PROCEDURES I&D SUTURING INTERCOSTAL DRAINAGE CHEST TUBE INSERTION NASAL PACKING REMOVAL OF FOREIGN BODY-NASAL/EAR BIOPSY URETHRAL DILATATION CYSTOSCOPY DJ STENT REMOVAL SUPRA-PUBIC CYSTOSTOMY CLOSED REDUCTION IN DISLOCATION ELB. CLOSED REDUCTION + POP LEG CLOSED REDUCTION + POP H K WIRE FIXATION NAIL REMOVAL EAR LOBE REPAIR EXCISION OF CYST POP CHARGES SUTURE REMOVAL 37 General 640 470 1230 1230 780 430 470 430 1030 1710 1710 1710 1030 1710 440 1710 1030 500 310 430 Private 960 710 1850 1850 1170 650 710 650 1550 2570 2570 2570 1550 2570 660 2570 1550 750 470 650 MOT023 MOT024 MOT025 MOT026 MOT027 MOT028 MOT029 MOT030 MOT031 MOT032 MOT033 MOT035 MOT037 MOT038 MOT039 MOT040 MOT041 MOT042 MOT043 MOT044 MOT045 MOT046 BLADDER IRRIGATION B C G INSTALLATION DORSAL SLIT KNEE ASPIRATION MINOR AMPUTATION CARDIAC MONITORING OXYGEN THERAPY (per hour) ARTERIAL BLOOD GAS MORTURY SHEETS AIRWAY SPC RANDOM BLOOD SUGAR BLOOD KETONE CASUALTY MINOR PROCEDURE A CASUALTY MINOR PROCEDURE B REMOVAL OF FOREIGN BODY- HAND/ FOOT N/G TUBE INSERTION N G TUBE REMOVAL CATHETER REMOVAL DAY CARE FOR ADMISSION OF MEDICATION REQUIRED UP TO 3 HRS OF STAY rd TROPONIN I (QUANTATIVE TRIAGE 3 GEN.) TRACHEOSTOMY TUBE REINSERTION 400 400 1710 790 390 570 120 500 210 120 1410 120 300 150 530 560 120 40 40 600 600 2570 1190 590 570 180 750 320 180 2120 180 450 230 800 840 180 60 60 540 1020 480 810 1530 720 PAIN CLINIC CHARGES I. ANA08 ANA16 ANA17 ANA18 ANA23 ANA24 ANA25 ANA26 ANA27 ANA28 ANA29 ANA30 ANA31 ANA32 ANA33 ANA34 ANA35 ANA36 ANA37 ANA38 PAC PAIN CLINIC NERVE BLOCKS FOR CHRONIC PAIN COELIAC PLEXUS BLOCK SCAR/LOCAL INFILTRATION FLUROSCOPY RADIO FREQUENCY ABLATION UP TO 3 FACET JOINTS OR SINGLE NERVE ROOT SYMPATHECTOMY/ COELIAC PLEXUS EPIDURAL FACET JOINT/ MEDIAL BRANCH BLOCKS CAUDAL EPIDURAL TRANSORAMINAL NERVE ROOT BLOCK GENICULAR NERVE BLOCK SACROILIACS JOINT/PYRIFORMIS INTERCOSTAL NERVE BLOCK GANGLION IMPAR BLOCK COCCYDYNIA NEUROLYTIC PROCEDURES OR VARIOUS CANCER CERVICAL EPIDURAL INTRATHECAL BACLOFEN/BACLOFEN MUSCULAR INJECTIONS INTRATHECAL PUMP REFIL/INFUSION PUMP MORPHINE/FENTANYL/OPIOID TRIAL FLUOROSCOPIC EXAMINATIONS TRIGGER POINT INJECTIONS PRE ANAESTHESIA CHECKUP Extra Charges: a) Pharmacy b) Disposables 38 General 2100 2900 1400 700 Private 2700 3200 1800 800 16100 4300 4300 2900 4300 2900 1800 1800 2900 1800 4300 2900 1100 700 400 700 350 21400 6400 6400 4300 6400 4300 2700 2700 4300 2700 6400 4300 1600 1100 550 1100 650 OXYGEN CHARGES I. OXY01 OXY02 OXY03 OXY04 OXY05 OXY06 OXY07 OXY08 OXYGEN OXYGEN CHARGES PER HOUR ADULT OXYGEN CHARGES PER HOUR PAED. OXYGEN CHARGES PER DAY PAED. OXYGEN CHARGES PER DAY ADULT OXYGEN CHARGES PER HR. IN ICU ADULT OXYGEN CHARGES PER DAY ICU OXYGEN CHARGES PER HR IN ICU PAED OXYGEN CHARGES PER DAY IN ICU PAED General 130 110 820 1070 140 1350 130 1200 Private 150 150 1640 1700 140 1350 130 1200 NOTE: 1) These rates apply for supply of Oxygen whether piped or cylinder. 2) In the Operation Theater and ICU charges at the above rates will apply for the entire period for which oxygen is supplied OPERATION CHARGES I. OPER1 OPER1A OPER1B OPER2 OPER3A OPER3B OPER4A OPER4B OPER5 OPER6 OPER A OPER B OPER C OPERATION CHARGES OPERATION CATEGORY 1 OPERATION CATEGORY 1A OPERATION CATEGORY 1B OPERATION CATEGORY 2 OPERATION CATEGORY 3A OPERATION CATEGORY 3B OPERATION CATEGORY 4A OPERATION CATEGORY 4B OPERATION CATEGORY 5 OPERATION CATEGORY 6 CTS OPERATION CATEGORY A CTS OPERATION CATEGORY B CTS OPERATION CATEGORY C General 700 850 1200 3200 4500 5400 7000 10100 11200 12400 9000 16850 28100 Cubicle 1100 1300 1800 5700 8100 9600 12500 18200 20100 22200 9000 16850 28100 S. Pvt. 1200 1400 2000 6300 9000 10700 13900 20200 22300 24700 14600 22500 33700 II. OT1 OT1A OT1B OT2 OT3A OT3B OT4A OT4B OT5 OT6 OTC001 THEATRE/LABOUR ROOM CHARGES OT CATEGORY 1 OT CATEGORY 1A OT CATEGORY 1B OT CATEGORY 2 OT CATEGORY 3A OT CATEGORY 3B OT CATEGORY 4A OT CATEGORY 4B OT CATEGORY 5 OT CATEGORY 6 THEATRE ADDITIONAL CHARGES General 240 300 680 1060 1500 1620 2100 3030 3400 4070 410 Cubicle 550 650 900 2850 4050 4800 6250 9100 10050 11100 550 S. Pvt. 700 820 1200 3900 4700 5450 7650 10100 11150 12950 710 III. ANA1 ANA1A ANAESTHESIA CHARGES ANAESTHESIA CATEGORY 1 ANAESTHESIA CATEGORY 1A General 110 130 Cubicle 330 390 S. Pvt. 360 420 39 Special/ Deluxe 1800 2100 3000 9500 13500 16100 20900 30300 33500 37100 23650 31500 42700 Special/ Private Deluxe 950 1250 1000 1450 1500 1800 4600 5450 5650 6750 6900 8200 9350 11450 13650 18150 14350 19250 16650 21350 970 1230 Special/ Private Deluxe 450 540 540 630 Private 1500 1800 2500 7900 11300 13400 17400 25300 27900 30900 23650 31500 42700 ANA1B ANA2 ANA3A ANA3B ANA4A ANA4B ANA5 ANA6 ANA07 ANAESTHESIA CATEGORY 1B ANAESTHESIA CATEGORY 2 ANAESTHESIA CATEGORY 3A ANAESTHESIA CATEGORY 3B ANAESTHESIA CATEGORY 4A ANAESTHESIA CATEGORY 4B ANAESTHESIA CATEGORY 5 ANAESTHESIA CATEGORY 6 IV SEDATION 180 480 680 810 1050 1520 1680 1860 700 540 1710 2430 2880 3540 5160 5700 6300 750 600 1890 2700 3210 4170 6060 6690 7410 1050 750 2370 3390 4020 5220 7590 8370 9270 1300 900 2850 4050 4830 6270 9090 10050 11130 1500 Note: 1. For Emergency Surgery the next higher category rate will be charged from Category 3A to Category 5. For Category 6, an additional 20% will be charged. 2. Charges for Multiple Operation: When 2 or more operations are performed in one sitting by the same surgeon, the following shall be the basis of the charges: 1. Operation Fee: Full fee for the main operation plus 50% of the fee for Other operation. 2. OT Room Charges / Anaesthesia Charges: Full charges in respect of the main operation up to 1 hour and thereafter extra charges for every 30 minutes or part thereof. 3. Laparoscope Procedure Charges: a. Up to one hour Each subsequent half hour Rs.5400/Rs.1600/- b. If the procedure is converted to open then Rs.1600/- to be charged extra. 4. Package Charge for Anaesthesia (Gases and Drugs): Up to half an hour Rs.910/- Half an hour to one and half hour Rs.1450/- Each subsequent hour Rs.600/- Code AGD001 General Private Anaesthesia for Minor Procedures 810 810 Spinal 600 1300 Epidural/Brachial Block 750 1550 1020 2100 550 910 1400 2620 350 650 Combined Spinal/Epidural CSE Any other block Labour Analgesia PAC PAC Charges PACKAGE CHARGES FOR GENERAL SURGERY Code Service Name S Pvt. S Pvt. General Cubicle Non AC AC Pvt. Non AC PVT AC (S) Deluxe No. of days GENERALSURGERY/UROLOGY/PAEDIATRIC SURGERY: ALC LAPAROSCOPIC CHOLECYSTECTOMY 23500 30900 40600 46900 52200 57500 63000 04 APCNB P C N L BILATERAL 37800 47300 71400 73500 87200 89300 105000 04 40 APCNL P.C.N.L. TRANSURETHRA RESECTION OF PROSTATE (T.U.R.P) 29400 36800 52500 54600 65100 67200 78800 03 23600 29400 41000 44100 50400 57800 65100 03 AURSD URS + DJ STENTING 23100 30700 41600 47400 52500 63500 71600 03 AURSB URS + DJ STENTING BILATERAL 29900 39900 50900 57800 63000 73000 76100 03 APSB HERNIOTOMY BILATERAL 11600 17100 22650 25550 27500 30500 31750 01 APSBO ORCHIOPEXY BILATERAL 14000 19300 24500 28200 29600 33300 34600 01 AHU HERNIOTOMY-UNILATERAL 7800 12900 17950 20650 22100 26100 27350 01 AOU ORCHIDOPEXY-UNILATERAL 9500 14800 20300 23100 24600 28800 30100 01 ACIR CIRCUMCISION RE-LOOK SURGERY FOR KIDNEY STONE 6700 11000 15350 17150 18300 22000 23250 01 9000 12100 15400 17600 18700 22000 25300 -- ATURP ARKS Note: a. Pharmacy and Lab Investigations to be charged extra. b. Any Service provided beyond the package days shall be charged extra. c. Package rates are applicable for the category as mentioned. Difference of accommodation will be charged extra for the patients taking the Semi-Private (Deluxe) Room or A.C Single Room-Special. d.10% of the package amount shall be charged extra in case of Emergency surgery. e. Laparoscope charges for laparoscopic Cholecystectomy i. If duration exceeds 1½ hrs, Rs.1600/- will be charged extra for every additional ½ hour. ii. In case of any Laparoscopic Cholecystectomy is converted to open then Rs.1600/- will be charged extra. MISCELLANEOUS CHARGES I. CERTIFICATE FEE: 1. Fitness Certificate 130 2. Other Certificates 130 3. Birth Time Certificate - up to 5 Yrs 150 - 5 - 10 Yrs 170 - above 10 Yrs 200 4. Correction of letters 70 5. Duplicate Bills or Receipts (per Bill) - 5% of the Bill Amount (Minimum of Rs.10/- and Maximum of Rs.50/-) II. Room Booking charges - III. Mortuary charges: Rs.550/- Any inpatient has expired in Hospital - Rs.350/- per day. Dead Bodies brought from outside - Rs.2000/- per day. 41 42
