HBP 2022

19
20
Annexure - 1
Differential price , by type of city)
Specialt
Package Procedure National
y Code AB PMJAY Implant Stratification Stratification
SL NO. Specialty Code code HBP Procedure Name Reference Tier3 (Z) Tier2(Y) Tier1(X) implant cost
HBP Package Name mapped. Criteria (Y/N) remarks
HBP 2022 2022 Price (NRP)
2022
Criteria 1: % Total Body

Surface Area Burns
(TBSA):less than 20% in
Burns
1 BM BM001 Thermal burns BM001A adults and less than 7000 7000 8200 8800 NA No NA
Management
10% in children younger
than 12 years. Dressing
without anesthesia

Surface Area Burns
(TBSA): Upto 25%;
Includes % TBSA skin
grafted, flap cover,
Burns follow-up dressings etc.
2 BM BM001 Thermal burns BM001B 40000 50000 56800 60000 NA ` No NA
Management as deemed necessary;
Surgical procedures are
required for deep burns
that are not amenable to
heal with dressings
alone.

Surface Area Burns
(TBSA): 25-40 %;
3 BM BM001 Thermal burns BM001C 50000 62500 71000 75000 NA No NA
heal with dressings
alone.

Surface Area Burns
(TBSA):40- 60 %;
4 BM BM001 Thermal burns BM001D 80000 100000 113600 120000 NA No NA
heal with dressings
alone.
Surface Area Burns
(TBSA):60-80 %;
5 BM BM001 Thermal burns BM001E 80000 100000 113600 120000 NA NA
heal with dressings
alone.

Surface Area Burns
(TBSA): less than 20%
Burns
6 BM BM002 Scald burns BM002A in adults and less than 7000 7000 8200 8800 NA No NA
Management
10% in children younger
than 12 years. Dressing
without anesthesia

Surface Area Burns
(TBSA): Upto 25%;
7 BM BM002 Scald burns BM002B 40000 50000 56800 60000 NA No NA
heal with dressings
alone.

Surface Area Burns
(TBSA): 25-40 %;
8 BM BM002 Scald burns BM002C 50000 62500 71000 75000 NA No NA
heal with dressings
alone.
Surface Area Burns
(TBSA):40- 60 %;
9 BM BM002 Scald burns BM002D 80000 100000 113600 120000 NA No NA
heal with dressings
alone.

Surface Area Burns
(TBSA):60-80 %;
10 BM BM002 Scald burns BM002E 80000 100000 113600 120000 NA NA
heal with dressings
alone.
% Total Body Surface

Area Burns (TBSA) -
any %
Burns
11 BM BM003 Flame burns BM003A (not requiring 7000 7000 8200 8800 NA No NA
Management
admission).
Needs at least 5-6
dressing
Area Burns (TBSA):
Upto 40 %; Includes %
TBSA skin grafted, flap
cover, follow-up
Burns dressings etc. as
12 BM BM003 Flame burns BM003B 40000 50000 56800 60000 NA No NA
Management deemed necessary;
heal with dressings
alone.
Area Burns (TBSA): 40
% - 60 %; Includes %
cover, follow-up
Burns dressings etc. as
13 BM BM003 Flame burns BM003C 50000 62500 71000 75000 NA No NA
Management deemed necessary;
heal with dressings
alone.
Area Burns (TBSA): >
60 %; Includes % TBSA
skin grafted, flap cover,
follow-up dressings etc.
Burns
14 BM BM003 Flame burns BM003D as deemed necessary; 80000 100000 113600 120000 NA No NA
Management
heal with dressings
alone.
Electrical contact burns:

Low voltage - without
part of limb / limb loss;
Burns Electrical contact follow-up dressings etc.
15 BM BM004 BM004A 30000 37500 42600 45000 NA No NA
Management burns as deemed necessary;
heal with dressings
alone.

Low voltage - with part
of limb / limb loss;
follow-up dressings
Burns Electrical contact
16 BM BM004 BM004B Amputation etc. as 40000 50000 56800 60000 NA No NA
Management burns
deemed necessary;
heal with dressings
alone.

High voltage - with part
of limb / limb loss;
grafted, flap
cover,fasciotomy +/-
/amputation/Central IV
Line/debridement/early
17 BM BM004 BM004C skin grafting pedicle or 60000 75000 85200 90000 NA No NA
Management burns
free flap coverage,follow-
up dressings etc. as
deemed necessary;
heal with dressings
alone.
High voltage - without
part of limb / limb loss;
fasciotomy +/-
/debridement/early skin
grafting/flap cover:
18 BM BM004 BM004D pedicle or free flap 50000 62500 71000 75000 NA No NA
Management burns
coverage,follow-up
dressings etc. as
deemed necessary;
heal with dressings
alone.
Chemical burns:
Without significant facial
scarring and/or loss of
function; Includes %
cover, follow-up
dressings etc. as
deemed necessary;
Burns
19 BM BM005 Chemical burns BM005A Surgical procedures are 40000 50000 56800 60000 NA No NA
Management
heal with dressings
alone.(Similar to therma
burns
require more grafting,
debridement,(skin
grafing/canthopexy)
Chemical burns: With

significant facial scarring
and/or loss of function;
grafted, flap
cover,debridement,skin
Burns grafting,follow-up
20 BM BM005 Chemical burns BM005B 60000 75000 85200 90000 NA No NA
Management dressings etc. as
deemed necessary;
heal with dressings
alone.
Post Burn Contracture
surgeries for Functional
Improvement (Package
including splints,
pressure garments,
silicone - gel sheet and
physiotherapy):
Post Burn Excluding Neck
Burns Contracture surgeries contracture; Contracture
21 BM BM006 BM006A 50000 62500 71000 75000 NA No NA
Management for Functional release with - Split
Improvement thickness Skin Graft
(STSG) / Full Thickness
Skin Graft (FTSG) / Flap
cover is done for each
joint with post -
operative regular
dressings for STSG /
FTSG / Flap cover.
Post Burn Contracture
surgeries for Functional
Improvement (Package
including splints,
pressure
garments,contracture
release & split skin graft
with or without flap
Post Burn
reconstruction,silicone -
Burns Contracture surgeries
22 BM BM006 BM006B gel sheet and 50000 62500 71000 75000 NA No NA
Management for Functional
physiotherapy): Neck
Improvement
contracture; Contracture
release with - Split
thickness Skin Graft
(STSG) /
Full Thickness Skin
Graft (FTSG) / Flap
cover is done for each
joint with post-operative
Emergency
Laceration - Suturing Laceration - Suturing /
23 Room ER ER001 ER001A 2000 2000 2300 2300 NA No NA
/ Dressing Dressing
Packages
Emergency
Cardiopulmonary Emergency with stable
24 Room ER ER002 ER002A 2000 2000 2300 2300 NA No NA
emergency cardiopulmonary status
Packages
Emergency with
Emergency unstable
Cardiopulmonary
25 Room ER ER002 ER002B cardiopulmonary status 10000 11000 12300 12300 NA No NA
emergency
Packages with
resuccitation
Emergency Animal bites
Animal bites (Excluding
26 Room ER ER003 (Excluding Snake ER003A 1700 1700 2000 2000 NA No NA
Snake Bite)
Packages Bite)
Laboratory Tests for (Reimburseme (Reimburseme (Reimburseme (Reimburseme
COVID-19 Infection nt level for this nt level for this nt level for this nt level for this
Infectious (PCR) package will be package will be package will be package will be
Diseases, (Reimbursement level Screening Test for as per the as per the as per the as per the
27 ID ID001 ID001A NA Yes NA
General for this package will COVID-19 Infection ICMR/State ICMR/State ICMR/State ICMR/State
Medicine be as per the ICMR guidelines, guidelines, guidelines, guidelines,
guidelines, issued issued from issued from issued from issued from
from time to time) time to time) time to time) time to time) time to time)
Laboratory Tests for (Reimburseme (Reimburseme (Reimburseme (Reimburseme

COVID-19 Infection nt level for this nt level for this nt level for this nt level for this
Infectious (PCR) package will be package will be package will be package will be
Diseases, (Reimbursement level Test for Confirmation of as per the as per the as per the as per the
28 ID ID001 ID001B NA No NA
General for this package will COVID-19 Infection ICMR/State ICMR/State ICMR/State ICMR/State
Medicine be as per the ICMR guidelines, guidelines, guidelines, guidelines,
guidelines, issued issued from issued from issued from issued from
from time to time) time to time) time to time) time to time) time to time)
Routine Ward - Routine Ward - Routine Ward - Routine Ward - Routine Ward -
2100 2100 2300 2300 2100 HDU -
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Infectious
ICU (without ICU (without ICU (without ICU (without ICU (without
Diseases, Treatment of COVID- Treatment of COVID-19
29 ID ID003 ID003A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
General 19 Infection Infection
8500 8500 8800 8800 8500
Medicine
ICU (with ICU (with ICU (with ICU (with ICU (with
Ventilator) - Ventilator) - Ventilator) - Ventilator) - Ventilator) -
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Infectious
Treatment of ICU (without ICU (without ICU (without ICU (without ICU (without
Diseases, Treatment of systemic
30 ID ID005 systemic fungal ID005A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
General fungal infections
infections 8500 8500 8800 8800 8500
Medicine
9000 9000 10350 10350 9000
Carotico-cavernous
Fistula (CCF)
Carotico-cavernous embolization with coils.
Interventional
31 IN IN001 Fistula (CCF) IN001A [includes 5 coils, guide 150000 187500 213000 225000 120000 120000 No NA
Radiology
embolization catheter, micro-catheter,
micro-guidewire,
general items]
Carotid-cavernous
Fistula (CCF)
embolization with
Carotico-cavernous
Interventional balloon (includes one
32 IN IN001 Fistula (CCF) IN001B 75000 93800 106500 112500 11000 11000 No NA
Radiology balloon, guide catheter,
embolization
micro-catheter, micro-
guidewire, general
items)
Intracranial balloon Intracranial balloon

Interventional
33 IN IN002 angioplasty with IN002A angioplasty with 160000 200000 227200 240000 NA No NA
Radiology
stenting stenting
Intracranial Intracranial thrombolysis
Interventional
34 IN IN003 thrombolysis / clot IN003A / clot 160000 200000 227200 240000 NA No NA
Radiology
retrieval retrieval
Interventional
35 IN IN004 Balloon test occlusion IN004A Balloon test occlusion 70000 87500 99400 105000 NA No NA
Radiology
Interventional Parent vessel Parent vessel occlusion -
36 IN IN005 IN005A 30000 37500 42600 45000 NA No NA
Radiology occlusion - Basic Basic
Primary percutaneous Primary percutaneous
Interventional
37 IN IN006 transhepatic biliary IN006A transhepatic biliary 40520 50700 57600 60800 Metallic stent 37000 NA
Radiology
stenting (SEMS) stenting (SEMS)
Percutaneous Percutaneous
Interventional transhepatic biliary transhepatic biliary
38 IN IN006 IN006B 28360 35500 40300 42600 NA NA
Radiology stenting (SEMS) after stenting (SEMS) after
prior PTBD prior PTBD
Interventional Percutaneous Percutaneous Balloon - Rs.
39 IN IN007 IN007A 12160 15200 17300 18300 9800 NA
Radiology cholangioplasty cholangioplasty 9800
Hepatic venous
Hepatic venous wedge
Interventional wedge pressure
40 IN IN008 IN008A pressure measurement 13920 17400 19800 20900 NA NA
Radiology measurement
(HVPG)
(HVPG)
Interventional Tunnelled long-term Tunnelled long-term
41 IN IN009 IN009A 11640 14600 16600 17500 Permcath 18000 NA
Radiology venous catheter venous catheter
Tunelled longterm
Tunelled longterm
indwelling catheter for
Interventional indwelling catheter for
42 IN IN010 refractory IN010A 13360 16700 19000 20100 Pleurex kit 32000 NA
Radiology refractory ascites/pleural
ascites/pleural
effusion
effusion
Peripherally inserted
Peripherally inserted
43
Interventional radiology IN IN011 central catheter IN011A 7120 8900 10200 10700 PICC line 8000 NA
central catheter (PICC)
(PICC)
Chemoport/implantab Chemoport/implantable
44
Interventional radiology IN IN012 IN012A 11640 14600 16600 17500 Chemoport 18000 NA
le lines lines
45
Interventional radiology IN IN013 IN013A 17640 22100 25100 26500 NA NA
nephrostomy nephrostomy
Primary percutaneous Primary percutaneous
46
Interventional radiology IN IN014 antegrade uretric IN014A antegrade uretric 19340 24200 27500 29100 Silicon Stent 6700 NA
stenting stenting
Percutaneous
Percutaneous
antegrade uretric
47
Interventional radiology IN IN015 IN015A antegrade uretric 13220 16600 18800 19900 Silicon Stent 6700 NA
stenting after prior
stenting after prior PCN
PCN
Lymphatic occlusion Lymphatic occlusion of Lipidol+Microcat 18000+19000+
48
Interventional radiology IN IN016 IN016A 17020 21300 24200 25600 NA
of chylous leak chylous leak heter+Coil 7900
PVA embolization 5000x2=

49
Interventional radiology IN IN017 PVA embolization IN017A 12640 15800 18000 19000 2 PVA particle NA
(without microcatheter) 11000
PVA
Interventional PVA embolization (with 5500x4=
50 IN IN017 PVA embolization IN017B 30400 38000 43200 45600 particle+Microca NA
Radiology microcatheter) 22000+19000
thetr
Glue embolization
51
Interventional radiology IN IN018 Glue embolization IN018A 20160 25200 28700 30300 Lipidol+Coils(2) 18000+13800 NA
(without microcatheter)
Glue embolization (with Lipidol+Microcat 18000+19000+
52
Interventional radiology IN IN018 Glue embolization IN018B 32360 40500 46000 48600 NA
microcatheter) heter+Coil 7900
Gelfoam embolization
53
Interventional radiology IN IN019 Gelfoam embolization IN019A 11640 14600 16600 17500 NA NA
Gelfoam embolization
54
Interventional radiology IN IN019 Gelfoam embolization IN019B 23480 29400 33400 35300 Microcatheter 19000 NA
(with microcatheter)
Coil embolization
55
Interventional radiology IN IN020 Coil embolization IN020A 15980 20000 22700 24000 Coils(3 ) 21700 NA
Interventional Coil embolization (with Microcatheter+C
56 IN IN020 Coil embolization IN020B 30340 38000 43100 45600 19000+21700 NA
Radiology microcatheter) oil (3)
57
Interventional radiology IN IN021 Alcohol embolisation IN021A Alcohol embolisation 23480 29400 33400 35300 Microcatheter 19000 NA
Vascular plug Vascular plug assisted Vacsular

58
Interventional radiology IN IN022 IN022A 39280 49100 55800 59000 44000+13800 NA
assisted embolization embolization Plug+Coils
Interventional
59 IN IN023 Angioplasty (arterial) IN023A Angioplasty (arterial) 28720 35900 40800 43100 Balloon 9800 NA
Radiology
Angioplasty (arterial)
Interventional
60 IN IN023 Angioplasty (arterial) IN023B using microguidewire 44560 55700 63300 66900 Balloon 9800 NA
Radiology
and guiding catheter
Interventional Angioplasty and bare Balloon
61 IN IN023 Angioplasty (arterial) IN023C 38520 48200 54700 57800 9800+37000 NA
Radiology metal stenting (arterial) +metallic stent
Angioplasty and bare
Interventional Balloon
62 IN IN023 Angioplasty (arterial) IN023D metal stenting (arterial) 60880 76100 86500 91400 9800+37000 NA
Radiology +metallic stent
CTO lesion
Angioplasty and covered
Interventional Balloon +
63 IN IN023 Angioplasty (arterial) IN023E stent placement 50120 62700 71200 75200 9800+95000 NA
Radiology Covered stent
(arterial)
multiside hole
Catheter directed Catheter directed
Interventional thrombolysis 11800+30000+
64 IN IN024 thrombolysis IN024A thrombolysis 35280 44100 50100 53000 NA
Radiology catheter), r TPA , 9800
(arterial/venous) (arterial/venous)
balloon
multiside hole
Thrombectomy
Thrombectomy followed thrombolysis
followed by 11800+30000+
65
Interventional radiology IN IN025 IN025A by thrombolysis 43680 54600 62100 65600 catheter), r TPA , NA
thrombolysis 95000
(arterial/venous) Thrombectomy
(arterial/venous)
Catheter
66
Interventional radiology IN IN026 Angioplasty (venous) IN026A Angioplasty (venous) 20080 25100 28600 30200 Ballon 9800 NA
Interventional Angioplasty and stenting Balloon+Metallic
67 IN IN026 Angioplasty (venous) IN026B 50180 62800 71300 75300 9800+37000 NA
Radiology hepatic vein stent
Ballon+High
Angioplasty and bare
Interventional Angioplasty and bare Pressure large 9800+18800+3
68 IN IN026 metal stenting IN026C 35440 44300 50400 53200 NA
Radiology metal stenting (venous) Balloon+metallic 7000
(venous)
stent
Angioplasty (IVC/central
Interventional High Pressure
69 IN IN026 Angioplasty (venous) IN026D vein) with high pressure 46600 58300 66200 69900 18800 NA
Radiology large Ballon
balloon
High Pressure
Angioplasty and covered
Interventional large
70 IN IN026 Angioplasty (venous) IN026E stent placement 45080 56400 64100 67700 18800+95000 NA
Radiology Ballon+Covered
(venous)
stent
Angioplasty-Below Angioplasty Below knee below knee
71
knee angioplasty angioplasty Balloon
Angioplasty
Angioplasty (complex): Drug Coated
(complex): cutting
72
Interventional radiology IN IN028 IN028A cutting balloon/drug 53160 66500 75500 79800 balloon/Cutting 42000+ NA
balloon/drug coated
coated balloon Ballon
balloon
Angioplasty with Angioplasty with
medicated SFA stent medicated SFA stent
73
/Specialised stent /Specialised stent
(arterial) CTO lesion (arterial) CTO lesion
Angioplasty (central
Angioplasty (central
vein/ CIV ) with high
vein/ CIV ) with high
74
Interventional radiology IN IN030 pressure balloon IN030A 166200 207800 236100 249300 NA NA
pressure balloon and
Aand specilaised
specilaised venous stent
venous stent
Fenestration of Fenestration of
75
Interventional radiology IN IN031 IN031A 29800 37300 42400 44700 Balloon 9800 NA
dissecting aneurysm dissecting aneurysm
TEVAR for aortic TEVAR for aortic

76
Interventional radiology IN IN032 IN032A 66975 83800 95200 100500 Graft 350000 NA
aneurysm/ dissection aneurysm/ dissection
Post EVAR endoleak Post EVAR endoleak

77
management management
78
Interventional radiology IN IN034 IVC filter placement IN034A IVC filter placement 15520 19400 22100 23300 IVC filter 50000 NA
IVC filter placement IVC filter placement with multiside hole
Interventional with Catheter directed Catheter directed thrombolysis 11800+30000+
79 IN IN034 IN034B 28920 36200 41100 43400 NA
Radiology thrombolysis thrombolysis catheter), r TPA , 50000
(arterial/venous) (arterial/venous) IVC filter
Interventional
80 IN IN034 IVC filter retrieval IN034C IVC filter retrieval 11520 14400 16400 17300 Retrieval kit 30000 NA
Radiology
Retrieval of Retrieval of
81
Interventional radiology IN IN035 intravascular foreign IN035A intravascular foreign 13520 16900 19200 20300 Snare 40000 NA
body body
Interventional Joint/bursa
82 IN IN036 IN036A Joint/bursa intervention 5520 6900 7900 8300 NA NA
Radiology intervention
Sacroiliac joint Sacroiliac joint
83
denervation denervation
Facet joint intra- Facet joint intra-articular
84
Interventional radiology IN IN038 articular intervention- IN038A intervention- 5520 6900 7900 8300 NA NA
CS/Thoracic/LS CS/Thoracic/LS
Median branch
85
Interventional radiology IN IN039 rhizotomy- IN039A Median branch rhizotomy- CS/Thoracic/LS
15120 18900 21500 22700 NA NA
CS/Thoracic/LS
Radiofrequency Radiofrequency ablation-

ablation-Trigeminal Trigeminal
nerve/genicular nerve nerve/genicular nerve
86
/celiac plexus /stellate /celiac plexus /stellate
Ganglion/sympathetic Ganglion/sympathetic
nerve (any branch) nerve (any branch)
PRP -suprascapular PRP -suprascapular

87
Interventional radiology IN IN041 /tennis elbow/other IN041A /tennis elbow/other 5520 6900 7900 8300 NA NA
tendon tendon
Discotomy/nucleotom Discotomy/nucleotomy
88
Interventional radiology IN IN042 IN042A 13520 16900 19200 20300 Nucleotome set 40000 NA
y using laser or using laser or
nucleuotome nucleuotome
Neural foraminal
89
Interventional radiology IN IN043 IN043A Neural foraminal block 5520 6900 7900 8300 NA NA
block
Radiofrequency
Radiofrequency Ablation
Ablation (RFA) of
(RFA) of bone tumor
90
Interventional radiology IN IN044 bone tumor IN044A 25440 31800 36200 38200 RF probe 75000 NA
/metastases/osteoid
/metastases/osteoid
osteoma
osteoma
Microwave ablation of Microwave ablation of
Microwave
91
Interventional radiology IN IN045 bone tumor /osteoid IN045A bone tumor /osteoid 31840 39800 45300 47800 95000 NA
probe
osteoma osteoma
Stroke-Stent
92
Interventional radiology IN IN046 IN046A Stroke-Stent Retreiver 232800 291000 330600 349200 NA NA
Retreiver
Interventional Stroke-Aspiration Stroke-Aspiration
93 IN IN046 IN046B 248200 310300 352500 372300 NA NA
Radiology Catheter Catheter
Intervention for Acute Intervention for Acute
94
Interventional radiology IN IN047 stroke (Aspiration & IN047A stroke (Aspiration & 393200 393200 500000 500000 NA NA
stent retrieval) stent retrieval)
Endovascular therapy
95
Interventional radiology IN IN048 for intracranial IN048A Aneurysm-3 Coil 109807.5 137300 156000 164800 NA NA
aneurysm
Interventional
96 IN IN048 for intracranial IN048B Aneurysm-5 Coil 216300 270400 307200 324500 NA NA
Radiology
aneurysm
Interventional
97 IN IN048 for intracranial IN048C Aneurysm-7 Coil 257300 321700 365400 386000 NA NA
Radiology
aneurysm
Interventional
98 IN IN048 for intracranial IN048D 3 Coil + Balloon 122662.5 153400 174200 184000 NA NA
Radiology
aneurysm
Interventional
99 IN IN048 for intracranial IN048E 5 Coil + Balloon 276300 345400 392400 414500 NA NA
Radiology
aneurysm
Interventional
100 IN IN048 for intracranial IN048F 3 Coil + Balloon+Stent 177112.5 221400 251500 265700 NA NA
Radiology
aneurysm
Interventional
101 IN IN048 for intracranial IN048G 5 Coil + Balloon+Stent 432300 432300 500000 500000 NA NA
Radiology
aneurysm
Interventional
102 IN IN048 for intracranial IN048H 7 Coil + Balloon+Stent 474300 474300 500000 500000 NA NA
Radiology
aneurysm
Arteriovenous fistula
103
Interventional radiology IN IN049 (AVF)/Arteriovenous IN049A Pial AVF (Single hole) 96300 120400 136800 144500 NA NA
Malformation (AVM)
104
Interventional radiology IN IN049 (AVF)/Arteriovenous IN049B AVF 104300 130400 148200 156500 NA NA
Malformation (AVM)
105
Interventional radiology IN IN049 (AVF)/Arteriovenous IN049C AVM (nidus upto 3 cm) 125300 156700 178000 188000 NA NA
Malformation (AVM)
Carotid angioplasty &

106
Interventional radiology IN IN050 IN050A Carotid stenting 100000 125000 142000 150000 NA NA
stenting
Carotid angioplasty & Carotid stenting-
107
Interventional radiology IN IN050 IN050B 141300 176700 200700 212000 NA NA
stenting membrane layered
Intracranial stenting Intracranial stenting for
for Intracranial Intracranial
108
atheroscelorosis atheroscelorosis
disease (ICAD) disease (ICAD)
109
Interventional radiology IN IN052 Dural sinus stenting IN052A Dural sinus stenting 106300 132900 151000 159500 NA NA
Carotid stenting with Carotid stenting with

110
protection device protection device
Vasospasm Vasospasm
management-post management-post
111
coiling/clipping (Cost coiling/clipping (Cost
per session) per session)
Retinoblastoma Retinoblastoma under
112
package GA
113
cholecystostomy cholecystostomy
PAIR / percutaneous PAIR / percutaneous
114
Interventional radiology IN IN057 sclerotherapy for IN057A sclerotherapy for 7320 9200 10400 11000 NA NA
Hydatid cyst Hydatid cyst
Oesophageal /gastric Oesophageal /gastric /

/ duodenal / colonic duodenal / colonic Balloon+Metallic
115
stenting/balloon stenting/balloon stent
dilatation dilatation
Transjugular Liver Transjugular Liver
116
Interventional radiology IN IN059 IN059A 14040 17600 20000 21100 LABS set 30000 NA
biopsy biopsy
Percutaneous Percutaneous Gastrostomy
117
Interventional radiology IN IN060 IN060A 6320 7900 9000 9500 4000 NA
gastrostomy gastrostomy set
Transarterial
Transarterial lipoiodol+Microc
118
Interventional radiology IN IN061 IN061A chemoembolization - 47960 60000 68200 72000 18000+19000 NA
chemoembolization ather
conventional (cTACE)
Transarterial
Interventional Transarterial chemoembolization - DEB+Microcathe
119 IN IN061 IN061B 41160 51500 58500 61800 50000+19000 NA
Radiology chemoembolization Drug eluting beads r
(DEB-TACE)
Transjugular
intrahepatic Transjugular
portosystemic shunt intrahepatic RUPS
creation portosystemic shunt set,covered 31000+95000+
120
Interventional radiology IN IN062 (TIPSS)/Direct IN062A creation (TIPSS)/Direct 75760 94700 107600 113700 stent, uncovered 37000+9800+9 NA
transjugular transjugular Intrahepatic stent,Balloon 800
Intrahepatic Portosystemic catheter
Portosystemic shunt(DIPSS)
shunt(DIPSS)
Balloon-occluded
Balloon-occluded
retrograde lipoiodol+Ballon 18000+9800+7
121
Interventional radiology IN IN063 IN063A retrograde transvenous 40760 51000 57900 61200 NA
transvenous +coils 2 900+7900
obliteration (BRTO)
obliteration (BRTO)
Plug-assisted
Plug-assisted retrograde Vacsular
retrograde
122
Interventional radiology IN IN064 IN064A transvenous obliteration 46020 57600 65400 69100 Plug+coil+lipoido NA
transvenous
(PARTO) l
obliteration (PARTO)
44000+7900+18000
Lipoidol+coils(Va
Pre-operative portal Pre-operative portal vein scular plug 18000+7900+7
123
Interventional radiology IN IN065 IN065A 26680 33400 37900 40100 NA
vein embolization embolization separate 900
additional cost
USG guided USG guided
percutaneous percutaneous
124
ganglion/plexus block ganglion/plexus block
(Neuronolysis) (Neuronolysis)
CT guided CT guided
125
ganglion/plexus block ganglion/plexus block
(Neuronolysis) (Neuronolysis)
Vertebroplasty
Vertebroplasty/Ceme Vertebroplasty/Cemento
126
Interventional radiology IN IN068 IN068A 22040 27600 31300 33100 kit including 22000 NA
ntoplasty plasty
cement
Kyphoplasty
127
Interventional radiology IN IN069 Kyphoplasty IN069A Kyphoplasty 31740 39700 45100 47700 52000+18500 NA
kit+Cement
Vaccum assisted Vaccum assisted breast
128
Interventional radiology IN IN070 IN070A 8520 10700 12100 12800 VABB gun 15000 NA
breast biopsy biopsy
USG guided USG guided
Microwave
129
Interventional radiology IN IN071 Microwave Ablation IN071A Microwave Ablation 29440 36800 41900 44200 95000 NA
antenna
(MWA)- benign (MWA)- benign breast
breast /thyroid tumor /thyroid tumor
Diagnostic Diagnostic angiography
130
angiography (DSA) (DSA)
Varicose vein:
Varicose vein:
endovenous
131
Interventional radiology IN IN073 IN073A endovenous treatment 12320 15400 17500 18500 NA NA
treatment (for one
(for one limb)
limb)
Percutaneous
Percutaneous Injection
Injection
sclerotherapy for low
132
Interventional radiology IN IN074 sclerotherapy for low IN074A 9120 11400 13000 13700 NA NA
flow vascular
flow vascular
malformation
malformation
Varicocele Coils(4 ),
133
Interventional radiology IN IN075 IN075A Varicocele embolization 18160 22700 25800 27300 31600+19000 NA
embolization microcatheter
Balloon+Drug
Fistuloplasty / Fistuloplasty /
Coated
134
Interventional radiology IN IN076 Thrombectomy of IN076A Thrombectomy of 32440 40600 46100 48700 9800+42000 NA
ballon/Cutting
dialysis fistula dialysis fistula
Ballon
135
Interventional radiology IN IN077 EVOH Package IN077A AVM (1 vial) 107300 134200 152400 161000 NA NA
Interventional
136 IN IN077 EVOH Package IN077B AVM (3 vial) 176300 134200 152400 161000 NA NA
Radiology
Interventional
137 IN IN077 EVOH Package IN077C AVM (5 vial) 251300 134200 152400 161000 NA NA
Radiology
138
Interventional radiology IN IN078 Tumor Embolization IN078A Tumor Embolization 72037.5 90100 102300 108100 NA NA
Right / Left Heart Right Heart
139 Cardiology MC MC001 MC001A 10000 12500 14200 15000 NA No NA
Catheterization Catheterization
Right / Left Heart Left Heart
140 Cardiology MC MC001 MC001B 10000 12500 14200 15000 NA No NA
Catheterization Catheterization
Cardiology,
Catheter directed For Deep vein
141 Interventional MC MC002 MC002A 30800 38500 43800 46200 NA No NA
Thrombolysis thrombosis (DVT)
Radiology
Cardiology,
Catheter directed For Mesenteric
142 Interventional MC MC002 MC002B 30800 38500 43800 46200 NA No NA
Thrombolysis Thrombosis
Radiology
Cardiology,
Catheter directed
143 Interventional MC MC002 MC002C For Peripheral vessels 30800 38500 43800 46200 NA No NA
Thrombolysis
Radiology
Cardiac
Balloon - Adult -
14000 Adult ballon -
144 Cardiology MC MC003 Balloon Dilatation MC003A Coarctation of Aorta 38600 48300 54900 57900 Cardiac 14000 pediatric No NA
Balloon - 33000
Pediatric -
33000
Cardiac
Balloon - Adult -
Pulmonary Artery
145 Cardiology MC MC003 Balloon Dilatation MC003B 38600 48300 54900 57900 Cardiac 14000 pediatric No NA
Stenosis
Balloon - 33000
Pediatric -
33000
Cardiac
Balloon - Adult -
Balloon Pulmonary / Balloon Pulmonary
146 Cardiology MC MC004 MC004A 23400 29300 33300 35100 Cardiac 14000 pediatric No NA
Aortic Valvotomy Valvotomy
Balloon - 33000
Pediatric -
33000
Cardiac
Balloon - Adult -
Balloon Pulmonary / Balloon Aortic
147 Cardiology MC MC004 MC004B 23400 29300 33300 35100 Cardiac 14000 pediatric No NA
Aortic Valvotomy Valvotomy
Balloon - 33000
Pediatric -
33000
Balloon &
Balloon Mitral Balloon Mitral
148 Cardiology MC MC005 MC005A 35700 44700 50700 53600 Accessories - 55000 No NA
Valvotomy Valvotomy
55000
Balloon &
Balloon Atrial Balloon Atrial
149 Cardiology MC MC006 MC006A 24400 30500 34700 36600 Accessories - 55000 No NA
Septostomy Septostomy
55000
ASD Device -
150 Cardiology MC MC007 ASD Device Closure MC007A ASD Device Closure 36900 46200 52400 55400 62000 No NA
62000
VSD Device -
151 Cardiology MC MC008 VSD Device Closure MC008A VSD Device Closure 37900 47400 53900 56900 72000 No NA
72000
PDA Device -
152 Cardiology MC MC009 PDA Device Closure MC009A PDA Device Closure 32600 40800 46300 48900 30000 No NA
30000
Coronary
Stent for PDA
stenting - Bare Baremetal -
Metal - 9373 9373
153 Cardiology MC MC010 PDA stenting MC010A PDA stenting 40260 50400 57200 60400 No NA
Coronary Stent Drug Eluting-
for PDA 34128
stenting - Drug
Eluting - 34128
Coronary
Stent for PDA
stenting - Bare Baremetal -
PTCA, inclusive of PTCA, inclusive of Metal - 9373 9373
154 Cardiology MC MC011 MC011A 40600 50800 57700 60900 No NA
diagnostic angiogram diagnostic angiogram Coronary Stent Drug Eluting-
for PDA 34128
stenting - Drug
Eluting - 34128
Steerable
decapolar
Electrophysiological Electrophysiological catheter,
155 Cardiology MC MC012 MC012A 27700 34700 39400 41600 46000 No NA
Study Study Quadripolar
Catheter -
46000
Steerable
decapolar
catheter,
Electrophysiological
Quadripolar
Electrophysiological Study
156 Cardiology MC MC012 MC012B 27700 34700 39400 41600 Catheter, 76000 No NA
Study with Radio Frequency
Radio
Ablation
Frequency
Catheter -
76000
157 Cardiology MC MC013 Transluminal Septal MC013A Transluminal Septal 34000 42500 48300 51000 NA No NA
Myocardial Ablation Myocardial Ablation
Temporary
Cardiology, Temporary Pacemaker
158 MC MC014 Pacemaker MC014A 19200 24000 27300 28800 NA No NA
CTVS implantation
implantation
Single Chamber Single
Permanent Pacemaker
Cardiology, Permanent Chamber
159 MC MC015 MC015A Implantation - 24500 30700 34800 36800 45000 No NA
CTVS Pacemaker Pacemaker -
Single Chamber
Implantation 45000
Double Chamber Double
Permanent Pacemaker
Cardiology, Permanent Chamber
160 MC MC016 MC016A Implantation - 33000 41300 46900 49500 75000 No NA
CTVS Pacemaker Pacemaker -
Double Chamber
Implantation 75000
Peripheral
Peripheral
161 Cardiology MC MC017 MC017A Peripheral Angioplasty 34500 43200 49000 51800 Stent - Bare 21000 No NA
Angioplasty
Metal - 21000
Bronchial artery Bronchial artery
162 Cardiology MC MC018 Embolisation MC018A Embolisation 32800 41000 46600 49200 NA No NA
(for Haemoptysis) (for Haemoptysis)
Cardiology,
163 General MC MC019 Pericardiocentesis MC019A Pericardiocentesis 12100 15200 17200 18200 NA No NA
Surgery
Systemic Systemic Thrombolysis
164 Cardiology MC MC020 MC020A 17900 22400 25500 26900 NA No NA
Thrombolysis (for MI) (for MI)
Arteriovenous
165 Cardiology MC MC021 Embolization MC021A Malformation (AVM) in 40600 50800 57700 60900 NA No NA
the Limbs
First Follow-up- 2-4
weeks after discharge -
166 Cardiology MC MC022 follow up -Cardiology MC022A Inc. in package Inc. in package Inc. in package Inc. in package NA NA
AT NETWORK
HOSPITAL
Second Follow-up- After
167 Cardiology MC MC022 follow up -Cardiology MC022B 4000 4400 5000 5000 NA NA
3 months
Third Follow-up- After 3
168 Cardiology MC MC022 follow up -Cardiology MC022C 2000 2200 2500 2500 NA NA
months
fourth Follow-up- After 3
169 Cardiology MC MC022 follow up -Cardiology MC022D 2000 2200 2500 2500 NA NA
months
FifthFollow-up - After 3
170 Cardiology MC MC022 follow up -Cardiology MC022E 2000 2200 2500 2500 NA NA
months
2100 2100 2300 2300 2100 HDU -
General HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Medicine, ICU (without ICU (without ICU (without ICU (without ICU (without
171 Pediatric MG MG001 Acute febrile illness MG001A Acute febrile illness Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical 8500 8500 8800 8800 8500
Management ICU (with ICU (with ICU (with ICU (with ICU (with
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
172 Pediatric MG MG002 Severe sepsis MG002A Severe sepsis Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
173 Pediatric MG MG002 Severe sepsis MG002B Septic shock Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
174 Pediatric MG MG003 Malaria MG003A Malaria Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
175 Pediatric MG MG003 Malaria MG003B Complicated malaria Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
176 Pediatric MG MG004 Dengue fever MG004A Dengue fever Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
Dengue hemorrhagic
177 Pediatric MG MG004 Dengue fever MG004B Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
fever
Medical 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
Dengue shock
178 Pediatric MG MG004 Dengue fever MG004C Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
syndrome
Medical 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
179 Pediatric MG MG005 Chikungunya fever MG005A Chikungunya fever Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
180 Pediatric MG MG006 Enteric fever MG006A Enteric fever Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
HIV with
181 Pediatric MG MG007 MG007A HIV with complications Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
complications
Medical 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
182 Pediatric MG MG008 Leptospirosis MG008A Leptospirosis Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
General 2100 2100 2300 2300 2100 HDU -
Medicine, HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Pediatric Acute gastroenteritis ICU (without ICU (without ICU (without ICU (without ICU (without
Acute gastroenteritis
183 Medical MG MG009 MG009A with moderate Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
with dehydration
Management, dehydration 8500 8500 8800 8800 8500
Gastroenterolo ICU (with ICU (with ICU (with ICU (with ICU (with
gy Ventilator) - Ventilator) - Ventilator) - Ventilator) - Ventilator) -
9000 9000 10350 10350 9000
General 2100 2100 2300 2300 2100 HDU -
Pediatric ICU (without ICU (without ICU (without ICU (without ICU (without
Acute gastroenteritis Acute gastroenteritis
184 Medical MG MG009 MG009B Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
with dehydration with severe dehydration
Management, 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
General
Medicine, Chronic PD catheter Chronic PD catheter
185 MG MG010 MG0100A 4025 4100 4700 4700 NA NA
Nephrology- Insertion Insertion
Interventional
2100 2100 2300 2300 2100
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 HDU - 3300
General
Medicine, Acute severe Acute severe ulcerative
186 MG MG0101 MG0101A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
Gastroenterolo ulcerative colitis colitis
8500 8500 8800 8800 8500
gy
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100
General
Medicine,
187 MG MG0102 Mesenteric Ischemia MG0102A Mesenteric Ischemia Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
Gastroenterolo
8500 8500 8800 8800 8500
gy
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100
General
Medicine,
188 MG MG0103 Intestinal obstruction MG0103A Intestinal obstruction Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
Gastroenterolo
8500 8500 8800 8800 8500
gy
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100
General
Medicine, Acute necrotizing Acute necrotizing
Gastroenterolo severe pancreatitis severe pancreatitis
8500 8500 8800 8800 8500
gy
9000 9000 10350 10350 9000
General
Pulmonary Pulmonary
190 medicine /high MG MG0105 MG0105A 25000 25000 28800 28800 NA NA
Thromboembolism Thromboembolism
end drugs
Diffuse alveolar
Diffuse alveolar
General Hemorrhage
Hemorrhage Associated
191 medicine /high MG MG0106 Associated with MG0106A 136000 136000 156400 156400 NA NA
with SLE/Vasculitis/GP
end drugs SLE/Vasculitis/GP
Syndrome
Syndrome
General
Severe/Refractory Severe/Refractory
192 medicine /high MG MG0107 MG0107A 75000 75000 86300 86300 NA NA
Vasculitis Vasculitis
end drugs
Acute liver Acute liver
General
193 MG MG0108 failure/Fulminant MG0108A failure/Fulminant 50000 50000 57500 57500 NA NA
medicine
Hepatitis Hepatitis
2100 2100 2300 2300 2100
General Pulmonary Pulmonary
medicine thromboembolism thromboembolism
8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
General 2100 2100 2300 2300 2100 HDU -
195 Medical MG MG010 Diarrohea MG010A Chronic diarrohea Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Management, 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
General 2100 2100 2300 2300 2100 HDU -
196 Medical MG MG010 Diarrohea MG010B Persistent diarrohea Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Management, 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100
General
197 MG MG0110 Acute liver failure MG0110A Acute liver failure Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
medicine
8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100
General
198 MG MG0111 Pleural Effusion MG0111A Pleural Effusion Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
medicine
8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100
General
199 MG MG0112 Hyberbilirubinemia MG0112A Hyberbilirubinemia Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
medicine
8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100
General
200 MG MG0113 Polytrauma MG0113A Polytrauma Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
medicine
8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100
General Trauma-
201 MG MG0113 MG0113B Trauma- FacioMaxillary Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
medicine FacioMaxillary
8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100
General
202 MG MG0113 Trauma Hand injury MG0113C Trauma Hand injury Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
medicine
8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100
General Trauma Rib fracture Trauma Rib fracture
203 MG MG0113 MG0113D Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
medicine conservative conservative
8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100
General Trauma Blunt injury Trauma Blunt injury
204 MG MG0113 MG0113E Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
medicine conservative conservative
8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100
General Trauma Contusion Trauma Contusion chest
205 MG MG0113 MG0113F Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
medicine chest injury injury
8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100
General Oesophageal Varices Oesophageal Varices
medicine Banding Banding
8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
General
Medicine, Inflammatory
Inflammatory Myopathy/
207 neurology, MG MG0115 Myopathy/ MG0115A 2100/day 2100/day 2300/day 2300/day NA NA
Myaesthenic Crisis
pediatric Myaesthenic Crisis
medicine
General
Medicine,
Guillain Barre Guillain Barre syndrome
208 neurology, MG MG0116 MG0116A 2100/day 2100/day 2300/day 2300/day NA NA
syndrome (Plasmapheresis)
pediatric
medicine
General
Medicine,
Myasthenic crisis Myasthenic crisis
209 neurology, MG MG0116 MG0116B 2100/day 2100/day 2300/day 2300/day NA NA
(Plasmapheresis) (Plasmapheresis)
pediatric
medicine
General
Medicine,
Moyamoya Moyamoya
210 neurology, MG MG0117 MG0117A 2100/day 2100/day 2300/day 2300/day NA NA
revascularization revascularization
pediatric
medicine
General
Medicine, Evaluation of drug Evaluation of drug
211 neurology, MG MG0118 resistant epilepsy- MG0118A resistant epilepsy-Phase- 2100/day 2100/day 2300/day 2300/day NA NA
pediatric Phase-1 1
medicine
General
Medicine,
Drug resistant
212 neurology, MG MG0119 MG0119A Drug resistant epilepsy 2100/day 2100/day 2300/day 2300/day NA NA
epilepsy
pediatric
medicine
General 2100 2100 2300 2300 2100 HDU -
213 Medical MG MG011 Dysentery MG011A Dysentery Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Management, 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
Comprehensive medical
General
rehabilitation for spinal
Medicine,
Medical/ neuro injury/ traumatic brain
214 neurology, MG MG0120 MG0120A 25000 25000 28800 28800 NA NA
rehablitation injury, CVA, Cerebral
pediatric
palsy with or without
medicine
orthosis
Comprehensive medical
rehabilitation for of
General complication secondary
Medicine, to specified
Medical/ neuro
215 neurology, MG MG0120 MG0120B disanility/multiple 35000 35000 40300 40300 NA NA
rehablitation
pediatric disability including
medicine procedures,
chemodenevaration with
or with out orthosis
General
Single event multiple
Medicine,
Medical/ neuro level surgery for
216 neurology, MG MG0120 MG0120C 15000 15000 17300 17300 NA NA
rehablitation spasticity management
pediatric
in cerebral palsy
medicine
General
Medicine,
Medical/ neuro Medical rehabilitation of
217 neurology, MG MG0120 MG0120D 7000 7000 8100 8100 NA NA
rehablitation muscular dystrophy
pediatric
medicine
General
Medicine,
Medical/ neuro Medical Rehabilitation
218 neurology, MG MG0120 MG0120E 7000 7000 8100 8100 NA NA
rehablitation intellectual dissability
pediatric
medicine
General
Medicine, Medical Rehabilitation
Medical/ neuro
219 neurology, MG MG0120 MG0120F special learning 7000 7000 8100 8100 NA NA
rehablitation
pediatric disability
medicine
General
Medicine,
Medical/ neuro Medical Rehabilitation
220 neurology, MG MG0120 MG0120G 7000 7000 8100 8100 NA NA
rehablitation multiple disability
pediatric
medicine
General 2100 2100 2300 2300 2100 HDU -
221 Medical MG MG012 Acute viral hepatitis MG012A Acute viral hepatitis Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Management, 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
General 2100 2100 2300 2300 2100 HDU -
222 Medical MG MG013 Chronic Hepatitis MG013A Chronic Hepatitis Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Management, 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
General 2100 2100 2300 2300 2100 HDU -
223 Medical MG MG014 Liver abscess MG014A Liver abscess Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Management, 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
General 2100 2100 2300 2300 2100 HDU -
Visceral
224 Medical MG MG015 MG015A Visceral leishmaniasis Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
leishmaniasis
Management, 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
General
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Medicine,
Pediatric
225 MG MG016 Pneumonia MG016A Pneumonia Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical
8500 8500 8800 8800 8500
Management,
Pulmonology
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
General
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Medicine,
Pediatric
226 MG MG017 Severe pneumonia MG017A Severe pneumonia Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical
8500 8500 8800 8800 8500
Management,
Pulmonology
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
General
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Medicine,
Pediatric
227 MG MG018 Empyema MG018A Empyema Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical
8500 8500 8800 8800 8500
Management,
Pulmonology
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
General
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Medicine,
Pediatric
228 MG MG019 Lung abscess MG019A Lung abscess Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical
8500 8500 8800 8800 8500
Management,
Pulmonology
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
General
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Medicine,
Pediatric Pericardial
229 MG MG020 MG020A Pericardial tuberculosis Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical tuberculosis
8500 8500 8800 8800 8500
Management,
Pulmonology
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
General
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Medicine,
Pediatric
230 MG MG020 Pleural tuberculosis MG020B Pleural tuberculosis Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical
8500 8500 8800 8800 8500
Management,
Pulmonology
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
Urinary Tract
231 Pediatric MG MG021 MG021A Urinary Tract Infection Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Infection
Medical 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
232 Pediatric MG MG022 Viral Encephalitis MG022A Viral Encephalitis Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
233 Pediatric MG MG023 Septic Arthritis MG023A Septic Arthritis Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
Skin and soft tissue Skin and soft tissue
234 Pediatric MG MG024 MG024A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
infections infections
Medical 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
General 2100 2100 2300 2300 2100 HDU -
Recurrent vomiting Recurrent vomiting with
235 Medical MG MG025 MG025A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
with dehydration dehydration
Management, 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
Pyrexia of unknown Pyrexia of unknown
origin origin
Medical 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
General
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Medicine,
Pediatric
237 MG MG027 Bronchiectasis MG027A Bronchiectasis Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical
8500 8500 8800 8800 8500
Management,
Pulmonology
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
General
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Medicine,
Pediatric
238 MG MG028 Acute bronchitis MG028A Acute bronchitis Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical
8500 8500 8800 8800 8500
Management,
Pulmonology
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
General ICU (without ICU (without ICU (without ICU (without ICU (without
Acute excaberation of Acute excaberation of
239 Medicine,Pulm MG MG029 MG029A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
COPD COPD
onology 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
General
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Medicine,
Acute excaberation of ICU (without ICU (without ICU (without ICU (without ICU (without
Pediatric Acute excaberation of
240 MG MG030 Interstitial Lung MG030A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical Interstitial Lung Disease
Disease 8500 8500 8800 8800 8500
Management,
Pulmonology
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
General
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Medicine,
Pediatric
241 MG MG031 Endocarditis MG031A Bacterial Endocarditis Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical
8500 8500 8800 8800 8500
Management,
Cardiology
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
General
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Medicine,
Pediatric
242 MG MG031 Endocarditis MG031B Fungal Endocarditis Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical
8500 8500 8800 8800 8500
Management,
Cardiology
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
243 Pediatric MG MG032 Vasculitis MG032A Vasculitis Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
General 2100 2100 2300 2300 2100 HDU -
244 Medical MG MG033 Pancreatitis MG033A Acute pancreatitis Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Management, 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
General 2100 2100 2300 2300 2100 HDU -
245 Medical MG MG033 Pancreatitis MG033B Chronic pancreatitis Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Management, 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
General 2100 2100 2300 2300 2100 HDU -
246 Medical MG MG034 Ascites MG034A Ascites Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Management, 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
Acute transverse Acute transverse
myelitis myelitis
Medical 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
General
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Medicine,
Pediatric
248 MG MG036 Atrial Fibrillation MG036A Atrial Fibrillation Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical
8500 8500 8800 8800 8500
Management,
Cardiology
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
249 Medicine, MG MG037 Cardiac Tamponade MG037A Cardiac Tamponade Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Cardiology 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
General
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Medicine,
Pediatric Congestive heart
250 MG MG038 MG038A Congestive heart failure Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical failure
8500 8500 8800 8800 8500
Management,
Cardiology
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
General
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Medicine,
Pediatric
251 MG MG039 Asthma MG039A Acute asthmatic attack Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical
8500 8500 8800 8800 8500
Management,
Pulmonology
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
General
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Medicine,
Pediatric
252 MG MG039 Asthma MG039B Status asthmaticus Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical
8500 8500 8800 8800 8500
Management,
Pulmonology
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
General
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Medicine,
Pediatric Type 1 respiratory
253 MG MG040 Respiratory failure MG040A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical failure
8500 8500 8800 8800 8500
Management,
Pulmonology
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
General
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Medicine,
Pediatric Type 2 respiratory
254 MG MG040 Respiratory failure MG040B Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical failure
8500 8500 8800 8800 8500
Management,
Pulmonology
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
General
Due to any cause HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Medicine,
(pneumonia, asthma, ICU (without ICU (without ICU (without ICU (without ICU (without
Pediatric
255 MG MG040 Respiratory failure MG040C COPD, ARDS, foreign Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical
body, poisoning, head 8500 8500 8800 8800 8500
Management,
injury etc.) ICU (with ICU (with ICU (with ICU (with ICU (with
Pulmonology
9000 9000 10350 10350 9000
General 2100 2100 2300 2300 2100 HDU -
Upper GI bleeding
256 Medical MG MG041 Upper GI bleeding MG041A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
(conservative)
Management, 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
General 2100 2100 2300 2300 2100 HDU -
Upper GI bleeding
257 Medical MG MG041 Upper GI bleeding MG041B Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
(endoscopic)
Management, 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
General 2100 2100 2300 2300 2100 HDU -
258 Medical MG MG042 Lower GI hemorrhage MG042A Lower GI hemorrhage Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Management, 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
General
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Medicine,
Pediatric
259 MG MG043 Addison’s disease MG043A Addison’s disease Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical
8500 8500 8800 8800 8500
Management,
Endocrinology
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
260 General MG MG044 Renal colic MG044A Renal colic Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Surgery,Nephr 8500 8500 8800 8800 8500
ology ICU (with ICU (with ICU (with ICU (with ICU (with
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
261 General MG MG045 AKI / Renal failure MG045A AKI / Renal failure Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Surgery,Nephr 8500 8500 8800 8800 8500
ology ICU (with ICU (with ICU (with ICU (with ICU (with
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Pediatric
Medical Pediatric seizure
262 MP MG047 MG047A Status epilepticus Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Management, disorders
8500 8500 8800 8800 8500
Neurology
9000 9000 10350 10350 9000
2100 2100 2300 2300 1800 HDU -
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 2700
Acute ischemic
263 Medical MP MP017 MG049C Acute ischemic stroke Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
stroke
Management 8500 8500 8800 8800 3600
9000 9000 10350 10350 4500
2100 HDU - 2100 HDU - 2300 HDU - 2300 HDU - 2100 HDU -
3300 3300 3800 3800 3300
Acute hemorrhagic Acute hemorrhagic
264 Medicine,Neur MG MG049 MG049D Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
stroke stroke
ology 8500 8500 9800 9800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
Immune mediated Immune mediated CNS
CNS disorders disorders
Medical 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
266 Pediatric MG MG051 Hydrocephalus MG051A Hydrocephalus Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
General
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Medicine,
Pediatric
267 MG MG052 Myxedema coma MG052A Myxedema coma Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical
8500 8500 8800 8800 8500
Management,
Endocrinology
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
General
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Medicine,
Pediatric
268 MG MG053 Thyrotoxic crisis MG053A Thyrotoxic crisis Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical
8500 8500 8800 8800 8500
Management,
Endocrinology
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
General
269 MG MG054 Gout MG054A Gout Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medicine
8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
General
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Medicine,
Pediatric
270 MG MG055 Pneumothorax MG055A Pneumothorax Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical
8500 8500 8800 8800 8500
Management,
Pulmonology
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
General
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Medicine,
Pediatric Neuromuscular Neuromuscular
271 MG MG056 MG056A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical Disorders Disorders
8500 8500 8800 8800 8500
Management,
Neurology
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
General
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Medicine,
Pediatric
272 MG MG057 Hypoglycemia MG057A Hypoglycemia Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical
8500 8500 8800 8800 8500
Management,
Endocrinology
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
Diabetic Foot --
273 General MG MG058 Diabetic Foot MG058A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
debridement
Surgery,Endoc 8500 8500 8800 8800 8500
rinology ICU (with ICU (with ICU (with ICU (with ICU (with
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
General
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Medicine,
Pediatric
274 MG MG059 Diabetic ketoacidosis MG059A Diabetic ketoacidosis Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical
8500 8500 8800 8800 8500
Management,
Endocrinology
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
275 Pediatric MG MG060 Electrolyte Imbalance MG060A Hypercalcemia Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
276 Pediatric MG MG060 Electrolyte Imbalance MG060B Hypocalcemia Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
277 Pediatric MG MG060 Electrolyte Imbalance MG060C Hyponatremia Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
278 Pediatric MG MG060 Electrolyte Imbalance MG060D Hypernatremia Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
3300 3300 3800 3800 3300
General
279 MG MG060 Electrolyte Imbalance MG060E Hyperkalaemia Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medicine
8500 8500 9800 9800 8500
9000 9000 10350 10350 9000
3300 3300 3800 3800 3300
General
280 MG MG060 Electrolyte Imbalance MG060F Hypokalaemia Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medicine
8500 8500 9800 9800 8500
9000 9000 10350 10350 9000
2100 2300HDU - 2400 HDU - 2400 HDU - 2100 HDU -
General HDU - 3300 3630 3800 3800 3300
Hyperosmolar Non- Hyperosmolar Non-
Ketotic coma Ketotic coma
Medical 8500 9350 9700 9700 8500
9000 9900 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
Accelerated Accelerated
hypertension hypertension
Medical 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
Hypertensive Hypertensive
emergencies emergencies
Medical 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
284 Pediatric MG MG064 Severe anemia MG064A Severe anemia Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
285 Pediatric MG MG065 Sickle cell Anemia MG065A Sickle cell Anemia Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
286 Pediatric MG MG066 Anaphylaxis MG066A Anaphylaxis Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
287 Pediatric MG MG067 Heat stroke MG067A Heat stroke Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
General Systematic lupus HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Medicine, erythematosus (SLE)/ ICU (without ICU (without ICU (without ICU (without ICU (without
Systematic lupus
288 Pediatric MG MG068 MG068A Diffuse alveolar Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
erythematosus
Medical hemmorhage 8500 8500 8800 8800 8500
Management associated with SLE ICU (with ICU (with ICU (with ICU (with ICU (with
9000 9000 10350 10350 9000
General
Medicine,
Guillain Barre Guillain Barre syndrome Routine Ward -
289 neurology, MG MG069 MG069A 2100/day 2300/day 2625/day 2625/day NA Yes
syndrome (IVIG) 2100
pediatric
medicine
2100 2100 2300 2300 2100 HDU -
290 Pediatric MG MG070 Snake bite MG070A Snake bite Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
Medicine, Acute ICU (without ICU (without ICU (without ICU (without ICU (without
291 Pediatric MG MG071 Poisoning MG071A organophosphorus Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical poisoning 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
292 Pediatric MG MG071 Poisoning MG071B Other poisonings Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medical 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
Pd Catheter Pd Catheter Pd Catheter Pd Catheter

Insertion Rs Insertion Rs Insertion Rs Insertion Rs
General
Haemodialysis / 1500, PD fluid 1500, PD fluid 1700, PD fluid 1700, PD fluid
293 Medicine, MG MG072 MG072B Peritoneal Dialysis NA No NA
Peritoneal Dialysis & disposables & disposables & disposables & disposables
Nephrology
Rs 1000 per Rs 1000 per Rs 1150 per Rs 1150 per
day day day day
General
Medicine,
Haemodialysis /
294 Nephrology, MG MG072 MG072C Acute Haemodialysis 1500 1500 1800 1800 NA No NA
Peritoneal Dialysis
Organ
transplantation
General
Medicine,
Haemodialysis /
295 Nephrology, MG MG072 MG072D Chronic Haemodialysis 1500 1500 1800 1800 NA No NA
Peritoneal Dialysis
Organ
transplantation
General
Medicine,
296 Pediatric MG MG073 Plasmapheresis MG073A Plasmapheresis 2000 2000 2300 2300 NA No NA
Medical
Management
General
Medicine,
297 Pediatric MG MG074 Blood transfusion MG074A Whole Blood transfusion 2000 2000 2300 2300 NA No NA
Medical
Management
General
Blood component
Medicine,
including platelet
298 Pediatric MG MG074 Blood transfusion MG074B 2000 2000 2300 2300 NA No NA
transfusion (RDP, PC,
Medical
SDP)
Management
General
High end radiological High end radiological
Medicine,
diagnostic diagnostic
Pediatric
299 MG MG075 (CT, MRI, Imaging MG075A (CT, MRI, Imaging 5000 5000 5800 5800 NA No NA
Medical
including nuclear including nuclear
Management,
imaging) imaging)
Cardiology
General
High end
Medicine, High end histopathology
histopathology
Pediatric (Biopsies) and
300 MG MG076 (Biopsies) and MG076A 5000 5000 5800 5800 NA No NA
Medical advanced serology
advanced serology
Management, investigations
investigations
Cardiology
Pediatric
Continuous renal Rs 30,000 per Rs 33,000 per Rs 37,500 per Rs45000 per
Medical Continuous renal
replacement day for day for day for day for
Management, replacement therapy in
301 MG MG077 therapy/Continuous MG077A maximum of 5 maximum of 5 maximum of 5 maximum of 5 NA No NA
General AKI (initiation cost for
veno-venous in one in one in one in one
Medicine,Neph disposable)
hemofiltration admission admission admission admission
rology
2100 HDU - 2300HDU - 2400 HDU - 2400 HDU - 2100 HDU -
3300 3630 3800 3800 3300
Alcoholic Liver
302 Medicine,Gastr MG MG078 MG078A Alcoholic Liver Disease Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Disease
oenterology 8500 9350 9700 9700 8500
9000 9900 10350 10350 9000
3300 3630 3800 3800 3300
General Peripheral Arterial Peripheral Arterial
303 MG MG079 MG079A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medicine Thrombosis Thrombosis
8500 9350 9700 9700 8500
9000 9900 10350 10350 9000
3300 3630 3800 3800 3300
General IHD / CAD /
304 MG MG081 MG081A Arrhythmia Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medicine Arrhythmia
8500 9350 9700 9700 8500
9000 9900 10350 10350 9000
3300 3630 3800 3800 3300
General IHD / CAD /
305 MG MG081 MG081B CAD Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Medicine Arrhythmia
8500 9350 9700 9700 8500
9000 9900 10350 10350 9000
Interventional
Bone marrow Bone marrow aspiration
306 General MG MG082 MG082A 1060 1200 1600 1600 NA NA
aspiration of biopsy of biopsy
Medicine
Interventional
307 General MG MG083 Lumbar puncture MG083A Lumbar puncture 100 100 200 200 NA NA
Medicine
Interventional
308 General MG MG084 Joint Aspiration MG084A Joint Aspiration 150 200 300 300 NA NA
Medicine
DVT Pneumatic
Interventional DVT Pneumatic
Compression
309 General MG MG085 MG085A Compression Stockings 750 900 1100 1200 NA NA
Stockings (Add on
Medicine (Add on package in ICU)
package in ICU)
3300 3300 3800 3800 3300
310 Medicine,Neur MG MG086 Acute Ischemic Stoke MG086A Acute Ischemic Stoke Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
ology 8500 8500 9800 9800 8500
9000 9000 10350 10350 9000
Acute ischemic stroke- 3300 3300 3800 3800 3300
General Acute ischemic intravenous ICU (without ICU (without ICU (without ICU (without ICU (without
311 Medicine,Neur MG MG086 stroke- intravenous MG086B thrombolysis - Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
ology thrombolysis Recombinant tissue 8500 8500 9800 9800 8500
plasminogen activator ICU (with ICU (with ICU (with ICU (with ICU (with
9000 9000 10350 10350 9000
3300 3300 3800 3800 3300
Acute ischemic stroke-
General Acute ischemic ICU (without ICU (without ICU (without ICU (without ICU (without
Intravenous
312 Medicine,Neur MG MG086 stroke- Intravenous MG086C Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
thrombolysis-
ology thrombolysis 8500 8500 9800 9800 8500
Tenecteplase
9000 9000 10350 10350 9000
3300 3300 3800 3800 3300
Venous sinus Venous sinus
313 Medicine,Neur MG MG087 MG087A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
thrombosis thrombosis
ology 8500 8500 9800 9800 8500
9000 9000 10350 10350 9000
3300 3300 3800 3800 3300
314 Medicine,Neur MG MG088 Pyogenic Meningitis MG088A Pyogenic Meningitis Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
ology 8500 8500 9800 9800 8500
9000 9000 10350 10350 9000
3300 3300 3800 3800 3300
315 Medicine,Neur MG MG089 Fungal Meningitis MG089A Fungal Meningitis Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
ology 8500 8500 9800 9800 8500
9000 9000 10350 10350 9000
3300 3300 3800 3800 3300
General Autoimmune ICU (without ICU (without ICU (without ICU (without ICU (without
Autoimmune
316 Medicine,Neur MG MG090 MG090A encephalitis - Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
encephalitis
ology Plasmapheresis 8500 8500 9800 9800 8500
9000 9000 10350 10350 9000
3300 3300 3800 3800 3300
General Autoimmune ICU (without ICU (without ICU (without ICU (without ICU (without
Autoimmune
317 Medicine,Neur MG MG090 MG090B encephalitis - Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
encephalitis (IVIG)
ology Immunoglubulin (IVIG) 8500 8500 9800 9800 8500
9000 9000 10350 10350 9000
3300 3300 3800 3800 3300
Acute transverse Acute transverse
myelitis/ Acute myelitis/ Acute
318 Medicine,Neur MG MG090 MG090C Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
demyelinating demyelinating
ology 8500 8500 9800 9800 8500
encephalitis encephalitis
9000 9000 10350 10350 9000
3300 3300 3800 3800 3300
General Acute hemorrhagic Acute hemorrhagic ICU (without ICU (without ICU (without ICU (without ICU (without
319 Medicine,Neur MG MG091 stroke- Hematoma MG091A stroke- Hematoma Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
ology evacuation evacuation 8500 8500 9800 9800 8500
9000 9000 10350 10350 9000
3300 3300 3800 3800 3300
General Acute hemorrhagic Acute hemorrhagic ICU (without ICU (without ICU (without ICU (without ICU (without
320 Medicine,Neur MG MG091 stroke- (Extra MG091B stroke- Extra ventricular Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
ology ventricular drainage) drainage 8500 8500 9800 9800 8500
9000 9000 10350 10350 9000
3300 3300 3800 3800 3300
Myasthenic crisis Myasthenic crisis -
321 Medicine,Neur MG MG092 MG092B Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
(IVIG) Immunoglobulins (IVIG)
ology 8500 8500 9800 9800 8500
9000 9000 10350 10350 9000
3300 3300 3800 3800 3300
Myasthenic crisis Myasthenic crisis -
322 Medicine,Neur MG MG093 MG093A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
(Plasmapheresis) Plasmapheresis
ology 8500 8500 9800 9800 8500
9000 9000 10350 10350 9000
Tuberculous 3300 3300 3800 3800 3300
General meningitis Tuberculous meningitis ICU (without ICU (without ICU (without ICU (without ICU (without
323 Medicine,Neur MG MG094 (Hydrocephalus – VP MG094A (Hydrocephalus – VP Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
ology SHUNT/ SHUNT/ EVD/Omaya) 8500 8500 9800 9800 8500
EVD/Omaya) ICU (with ICU (with ICU (with ICU (with ICU (with
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
324 medicine,Gastr MG MG095 Cholangitis MG095A Cholangitis Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
oenterology 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
325 Pulmonology, MG MG096 Intercostal drainage MG096A Intercostal drainage Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
General 8500 8500 8800 8800 8500
surgery ICU (with ICU (with ICU (with ICU (with ICU (with
9000 9000 10350 10350 9000
Routine Ward -
2100
For foreign For foreign For foreign For foreign HDU - 3300
General body removal- body removal- body removal- body removal- ICU (without
Fibreoptic
326 Medicine, MG MG096 MG096A Bronchoscopy 2438 & Video 2400 & Video 2800 & Video 2800 & Video NA Ventilator) -
bronchoscopy (FOB)
Pulmonology Bronchoscopy Bronchoscopy Bronchoscopy Bronchoscopy 8500
8500 8500 9300 9300 ICU (with
Ventilator) -
9000
General
Endobronchial
Medicine, Endobronchial
327 MG MG097 MG097A Ultrasound guided fine 15614 15700 18000 18000 NA NA
Pulmonology Ultrasound (EBUS)
needle biopsy
interventional
General Whole body- Whole body- Whole body- Whole body- Whole body-
Medicine, 20528, Brain- 20528, Brain- 23600, Brain- 23600, Brain- 20528, Brain-
Pediatric 14663, Gallium 14663, Gallium 16900, Gallium 16900, Gallium 14663, Gallium
328 MG MG098 PET scan MG098A PET scan NA
Medical 68 Peptide- 68 Peptide- 68 Peptide- 68 Peptide- 68 Peptide-
Management, 15000, Cardiac- 15000, Cardiac- 17000, Cardiac- 17000, Cardiac- 15000,
Cardiology 1500 1500 1700 1700 Cardiac- 1500
General
Medicine,
329 Pediatric MG MG099 Platelet pheresis MG099A Platelet pheresis 11000 11000 12700 12700 NA NA
Medical
Management
Intellectual Disability Routine Ward -
Routine Ward - Routine Ward - Routine Ward - Routine Ward -
Mental Mental Retardation (ID) 2100 HDU -
330 MM MM001 MM001A 2100 2100 2300 2300 NA Yes
Disorders (intellectual disability) 3300
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800
Routine Ward -
Mental disorders - Mental disorders - Routine Ward - Routine Ward - Routine Ward - Routine Ward -
Mental 2100 HDU -
331 MM MM002 Organic, including MM002A Organic, including 2100 2100 2300 2300 NA Yes
Disorders 3300
symptomatic symptomatic HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800
Routine Ward -
Schizophrenia, Schizophrenia, Routine Ward - Routine Ward - Routine Ward - Routine Ward -
Mental 2100 HDU -
332 MM MM003 schizotypal and MM003A schizotypal and 2100 2100 2300 2300 NA Yes
Disorders 3300
delusional disorders delusional disorders HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800
Routine Ward -
Neurotic, stress- Neurotic, stress-related Routine Ward - Routine Ward - Routine Ward - Routine Ward -
Mental 2100 HDU -
333 MM MM004 related and MM004A and somatoform 2100 2100 2300 2300 NA Yes
Disorders 3300
somatoform disorders disorders HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800
Routine Ward -
Mental Mood (affective) Mood (affective) 2100 HDU -
334 MM MM005 MM005A 2100 2100 2300 2300 NA Yes
Disorders disorders disorders 3300
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800
Behavioural
Behavioural syndromes
syndromes Routine Ward -
associated with Routine Ward - Routine Ward - Routine Ward - Routine Ward -
Mental associated with 2100 HDU -
335 MM MM006 MM006A physiological 2100 2100 2300 2300 NA Yes
Disorders physiological 3300
disturbances and HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800
disturbances and
physical factors
physical factors
Mental and Mental and Behavioural Routine Ward -

Mental Behavioural disorders disorders due to 2100 HDU -
336 MM MM007 MM007A 2100 2100 2300 2300 NA Yes
Disorders due to psychoactive psychoactive substance 3300
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800
substance use use
Package (Cognitive
Package (Cognitive
Tests, Complete
Tests, Complete
Haemogram, Liver
Haemogram, Liver
Function Test, Renal
Function Test, Renal
Function Test, Serum
Function Test, Serum
Electrolytes, Electro
Electrolytes, Electro
Cardiogram (ECG),
Cardiogram (ECG), CT /
CT / MRI Brain,
Mental MRI Brain,
337 MM MM008 Electroencephalogra MM008A 6000 6600 7500 7500 NA No NA
Disorders Electroencephalogram,
m, Thyroid Function
Thyroid Function Test,
Test, VDRL, HIV
VDRL, HIV Test,
Test, Vitamin B12
Vitamin B12 levels,
levels, Folate levels,
Folate levels, Lipid
Lipid Profile,
Profile, Homocysteine
Homocysteine
levels), serum Lithium
levels), serum
level
Lithium level
Electro Convulsive Electro Convulsive
Mental
338 MM MM009 Therapy (ECT) - per MM009A Therapy (ECT) - per 3000 3300 3800 3800 NA No NA
Disorders
session session
NeuroDevelopmental
Mental Disorders (NDD) Autism Spectrum
339 MM MM010 MM010A 2100 2100 2300 2300 NA No NA
Disorders Other than Intellectual Disorder
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800
Disability
NeuroDevelopmental
Mental Disorders (NDD) Mixed Developmental
340 MM MM010 MM010B 2100 2100 2300 2300 NA 2100
Disorders Other than Intellectual Disorder
Disability
NeuroDevelopmental
Mental Disorders (NDD) Tourette Syndrome /
341 MM MM010 MM010C 2100 2100 2300 2300 NA 2100
Disorders Other than Intellectual Chronic Tic Disorder
Disability
NeuroDevelopmental
Attention Deficit Routine Ward - Routine Ward - Routine Ward - Routine Ward - Routine Ward -
Mental Disorders (NDD)
342 MM MM010 MM010D Hyperactivity Disorder 2100 2100 2300 2300 NA 2100
Disorders Other than Intellectual
(ADHD) HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 HDU - 3300
Disability
NeuroDevelopmental
Mental Disorders (NDD) Specific Developmental
343 MM MM010 MM010E 2100 2100 2300 2300 NA 2100
Disorders Other than Intellectual Disorders
Disability
Behavioral and
Mental motional Disorders of Oppositional Defiant
344 MM MM011 MM011A 2100 2100 2300 2300 NA 2100
Disorders Childhood and Disorder
Adolescence
Behavioral and
Mental motional Disorders of
345 MM MM011 MM011B Conduct Disorder 2100 2100 2300 2300 NA 2100
Disorders Childhood and
Adolescence
Behavioral and
Mental motional Disorders of Mixed Disorder of
346 MM MM011 MM011C 2100 2100 2300 2300 NA 2100
Disorders Childhood and Conduct and Emotions
Adolescence
Behavioral and
Mental motional Disorders of Anxiety and Depressive
347 MM MM011 MM011D 2100 2100 2300 2300 NA 2100
Disorders Childhood and Disorders
Adolescence
Behavioral and Other Internalizing and
Mental motional Disorders of Externalizing Disorders
348 MM MM011 MM011E 2100 2100 2300 2300 NA 2100
Disorders Childhood and of Childhood and
Adolescence Adolescence
Psychological,
Behavioural and
Developmental and
Educational
Interventions (Typically
Includes Child
Counselling /
Psychotherapy, Family
Counselling /
Mental Non-Pharmacological
349 MM MM012 MM012A Psychotherapy / 3000 3300 3800 3900 NA NA
Disorders Interventions
Training Such As Parent
Management Training,
Behavioral / Cognitive-
Behavioral
Interventions,
Developmental
Interventions Such As
Early Intervention,
Speech / Language
Common Medications
Used in Management of
Mental Pharmacological Child & Adult
350 MM MM013 MM013A 2000 2200 2500 2600 NA NA
Disorders Interventions Psycholoigical
DisordersiIncluding Anti-
ADHD Medication
Psychological
Assessments (Includes
IQ Testing, Specific
Learning Disability
Assessments,
Psychological /
Assessments For
Psychosocial
Autism Spectrum
Mental Assessment Package
351 MM MM014 MM014A Disorder, 2500 2800 3200 3300 NA NA
Disorders for All Child And
Developmental
Adolescent
Assessments, Projective
Psychiatric Disorders
Tests and Other Tests
Of Psychopathology),
Other Psychosocial
Assessments (Family,
Schooling)
Basic neonatal care Neonates 1800-2500g
package: Babies that OR Neonates of any
can be managed by weight requiring closer
side of mother in monitoring or short-term
postnatal ward care on mother's
without requiring bedside for conditions
admission in like, but not limited to:
SNCU/NICU: o Birth asphyxia (need
• Any newborn for positive pressure
Neo - natal Routine Ward -
352 MN MN001 needing feeding MN001A ventilation at birth; no 1000/day 1000/day 1150/day 1150/day NA Yes
Care 1000
support HIE)
• Babies requiring o Moderate jaundice
closer monitoring or requiring phototherapy
short-term care for o Large for dates (>97
conditions like: percentile) or Small for
o Birth asphyxia gestational age (less
(need for positive than 3rd centile)
pressure ventilation; o Rule-out sepsis .
no HIE) Neonatal
Special o Investigations
Neonates between
Care Package: 1500-1799g OR
Babies that required Neonates of any weight
admission to SNCU with mild illness like, but
or NICU: not limited to:
Babies admitted for • Mild Respiratory
short term care for Distress/tachypnea
conditions like: • Mild encephalopathy
• Mild Respiratory • Severe jaundice
Neo - natal SNCU / NICU -
353 MN MN002 Distress/tachypnea MN002A requiring intensive 4000/day 4000/day 4600/day 4600/day NA Yes
Care 4000
• Mild encephalopathy phototherapy
• Severe jaundice • Unwell baby requiring
requiring intensive monitoring
phototherapy • Some dehydration
• Haemorrhagic • Hypoglycaemia
disease of newborn The above list is
• Unwell baby illustrative but not
requiring monitoring limited to these
• Some dehydration
Intensive Neonatal conditions.of any
Neonates
Care Package birthweight with
Babies with moderate illness like
birthweight 1500- • Need for mechanical
1799 g ventilation for less than
or 24 hours or non-
Babies of any invasive respiratory
birthweight and at support (CPAP, HFFNC)
least one of the • Sepsis / pneumonia
354 MN MN003 following conditions: MN003A without complications 6000/day 6000/day 6900/day 6900/day NA Yes
Care 6000
• Need for • Hyperbilirubinemia
mechanical requiring exchange
ventilation for less transfusion
than 24 hours or non- • Seizures requring anti-
invasive respiratory convulsants
support (CPAP, • Major congenital
HFFNC) malformations (pre-
• Sepsis / pneumonia surgical stabilization)
without complications • Cholestasis requiring
Advanced Neonatal Neonates between
Care Package: 1200-1499 g OR
Babies with Neonates of any weight
birthweight of 1200- with at least one of the
1499 g following conditions:
• Any condition
or requiring invasive
Babies of any ventilation longer than
birthweight with at 24 hours
355 MN MN004 least one of the MN004A • Moderate to Severe 7500/day 7750/day 8900/day 8900/day NA Yes
Care 7500
following conditions: Hypoxic Ischemic
• Any condition encephalopathy
requiring invasive • Cardiac rhythm
ventilation longer disorders needing
than 24 hours intervention (the cost of
• Hypoxic Ischemic cardiac surgery or
encephalopathy implant will be covered
requiring Therapeutic under cardiac surgery
Hypothermia
Critical Care Neonatal packages)
Neonates <1200 g OR
Package: Neonates of any weight
Babies with with at least one of the
birthweight of <1200 following conditions:
g • Severe Respiratory
or Failure requiring High
Babies of any Frequency Ventilation or
birthweight with at inhaled Nitric Oxide
least one of the (iNO)
356 MN MN005 following conditions: MN005A • Multisystem failure 9000/day 9900/day 11250/Day 11250/Day NA Yes
Care 9000
• Severe Respiratory requiring multiple organ
Failure requiring High support including
Frequency Ventilation mechanical ventilation
or inhaled Nitric and multiple inotropes
Oxide (iNO) • Reuiring parenteral
• Multisystem failure nutrition
requiring multiple Critical congenital heart
organ support disease (excluding
including mechanical surgical costs)
Neonates in Special
Chronic Care
Neonatal Care, Special
Package: If the baby
Neonatal Care-Plus,
requires stay beyond
Intensive Neonatal Care
the upper limit of
or Critical Neonatal Care
usual stay in Package
packages
no MN004A or
Neo - natal (MN002,MN003,MN004, SNCU / NICU -
357 MN MN006 MN005A for MN006A 4000/day 4000/day 5000/day 5000/day NA Yes
Care MN005) who have not 4000
conditions like severe
fully recovered and
BPD requiring
continue to require
respiratory support,
NICU/SNCU care, e.g.
severe NEC requiring
for respiratory support,
prolonged TPN
gavage feeding, thermal
support
support, etc.,
Includes but not limited
to minimum six follow-
up visits at 40 weeks
PMA, and corrected
High Risk Newborn
ages of 3,6,9, 12 and
Neo - natal Post Discharge Care
358 MN MN007 MN007A 18 months for 1000/visit 1000/visit 1150/visit 1150/visit NA No NA
Care Package (Protocol
Assessment and
Driven)
Management of growth
and development.
Neurosonogram at 40
weeks PMA if indicated.
Laser Therapy for Laser Therapy for

Retinopathy of Retinopathy of
Neo - natal
Prematurity Prematurity
359 Care/opthalmo MN MN008 MN008A 1500 1900 2200 2300 NA No NA
(Irrespective of no. of (Irrespective of no. of
logy
eyes affected) - per eyes affected)
session per session
Advanced Surgery for Advanced Surgery for
Neo - natal
360 MN MN009 Retinopathy of MN009A Retinopathy 15000 18800 21300 22500 NA No NA
Care
Prematurity of Prematurity
Ventriculoperitoneal Ventriculoperitoneal
Shunt Surgery (VP) or Shunt Surgery (VP) or
Neo - natal
361 MN MN010 Omaya Reservoir or MN010A Omaya Reservoir or 5000 6300 7100 7500 NA No NA
Care
External Drainage for External Drainage for
Hydrocephalus Hydrocephalus
Neonates > 2.5 kg

nursed with mother :
Includes clinical
monitoring,
Neo - natal Basic neonatal care breastfeeding support,
362 MN MN011 MN011A 750/day 775/day 900/day 900/day NA 775/ day
Care (Level IA) birth vaccination, thyroid
screening, universal
hearing screening and
pre-discharge
counselling
500 per 550 per 625per 625per

screening for screening for screening for screening for
both both both both
eyes(document eyes(document eyes(document eyes(document
Neo - natal
363 MN MN012 ROP screening MN012A ROP screening ation of ation of ation of ation of NA NA
Care
findingsto be findingsto be findingsto be findingsto be
done in a done in a done in a done in a
structured structured structured structured
format) format) format) format)
Neo - natal 1500 per
364 MN MN013 BERA MN013A BERA 1650 per Bera 1900 per bera 1900 per bera NA 1500/ day
Care BERA
Cyclophosphamide +
Epirubcin
Medical Cyclophosphamide -
365 MO MO001 CT for CA Breast MO001A 7312.5 8100 9200 9200 NA No NA
Oncology 600 mg /m2 D1
Epirubicin -90mg/m2 D1
every 21 days
Weekly Paclitaxel for
Medical Adjuvant Therapy
366 MO MO001 CT for CA Breast MO001B 5987.5 6600 7500 7500 NA No NA
Oncology Paclitaxel 80mg/m2
every week
Weekly Paclitaxel in
Medical metastatic setting
367 MO MO001 CT for CA Breast MO001C 5987.5 6600 7500 7500 NA No NA
Oncology Paclitaxel 80mg/m2
every week
Cyclophosphamide +
Methotrexate + 5 - FU
Cyclophosphamide -
Medical 100mg/m2 orally D1-
368 MO MO001 CT for CA Breast MO001D 3528.75 3900 4500 4500 NA No NA
Oncology D14 Methotrexate
40mg/m2 IV D1
D8 5FU 600 mg/m2 D1,
D8 every 28 days
Docetaxel +
Cyclophosphamide
Medical Docetaxel 75mg/m2 D1
369 MO MO001 CT for CA Breast MO001E 9250 10200 11600 12100 NA No NA
Oncology Cyclophosphamide 600
mg/m2 D1 every 21
days
Trastuzumab
Trastuzumab 8 mg/Kg in
Medical Cycle 1 D1
370 MO MO001 CT for CA Breast MO001F 21200 23400 26500 27600 NA No NA
Oncology Trastuzumab 6 mg/kg
D1 from C2 every 21
days
Tamoxifen
Medical
371 MO MO001 CT for CA Breast MO001G Tamoxifem 20 mg orally 1200 1300 1400 1400 NA No NA
Oncology
daily
Letrozole
Medical
372 MO MO001 CT for CA Breast MO001H Letrozole 2.5 mg orally 3900 4300 4900 4900 NA No NA
Oncology
daily
Carboplatin + Paclitaxel
Medical Paclitaxel 175mg/m2 D1
373 MO MO001 CT for CA Breast MO001I 14900 16400 18700 18700 NA No NA
Oncology Carboplatin AUC 5-6 D1
every 21 days
Capecitabine
Capecitabine -
Medical
374 MO MO001 CT for CA Breast MO001J 1000mg/m2 orally twice 7400 8200 9300 9300 NA No NA
Oncology
daily D1-D14 every 21
days
Carboplatin +
Gemcitabine
Gemcitabine -
1000mg/m2 D1 D8
Medical Carboplatin AUC 2 D1
375 MO MO001 CT for CA Breast MO001K 13900 15300 17400 17400 NA No NA
Oncology D8
Gemcitabine -
1000mg/m2 D1 D8
Carboplatin AUC 5-6 D1
only
Cyclophosphamide +
Adriamycin
Medical Cyclophosphamide -
376 MO MO001 CT for CA Breast MO001L 4500 5000 5700 5700 NA No NA
Oncology 600 mg /m2 D1
Adriamycin - 60mg/m2
D1 every 21 days
12000 per 13200 per 15000 per 15000 per

Fulvestrant
dose (36000 in dose (39600 in dose (45000 in dose (45000 in
Medical Fulvestrant 500 mg D1
377 MO MO001 CT for CA Breast MO001M cycle1 ) then cycle1 ) then cycle1 ) then cycle1 ) then NA No NA
Oncology D15 D28 then every 28
12,000 per 13200 per 15000 per 15000 per
days
month month month month
Paclitaxel
Medical
378 MO MO001 CT for CA Breast MO001N Paclitaxel 175 mg/m2 11800 13000 14800 14800 NA No NA
Oncology
D1 every 21 days
Exemestane
Medical Exemestane 25 mg
379 MO MO001 CT for CA Breast MO001O 3900 4300 4900 4900 NA No NA
Oncology orally daily (q 3
monthsly)
Lapatinib
Medical
380 Mo MO001 CT for CA Breast MO001P Lapatinib 500 mg BD 15050 16600 18900 19600 NA NA
Oncology
orally , daily
CT for Metastatic Zoledronic Acid
Medical
381 MO MO002 bone malignancy and MO002A Zoledronic acid 4 mg IV 3500 3900 4400 4400 NA No NA
Oncology
multiple myeloma Monthly
Cisplatin + Irinotecan
Medical Cisplatin 60mg/m2 D1
382 MO MO003 CT for CA Ovary MO003A 13050 14400 16400 17000 NA No NA
Oncology Irinotecan 60 mg/m2 D1
D8 D15 every 28 days
Lipodox + Carboplatin
Medical Lipopdox 30 mg/m2 D1
383 MO MO003 CT for CA Ovary MO003B 17200 19000 21500 22400 NA No NA
every 28 days
Medical Etoposide 50 mg/m2

384 MO MO003 CT for CA Ovary MO003C 3400 3800 4300 4300 NA No NA
Oncology OD D1-D21 every 28
days
Irinotecan
Medical
385 MO MO003 CT for CA Ovary MO003D Irinotecan 60 -90 mg/m2 10950 12100 13700 14300 NA No NA
Oncology
D1 D8 every 21 days
Lipodox
Medical
386 MO MO003 CT for CA Ovary MO003E Lipodox 40 mg/m2 IV 17950 19800 22500 23400 NA No NA
Oncology
every 28 days
Carboplatin +
Gemcitabine
Gemcitabine -
1000mg/m2 D1 D8
Medical Carboplatin AUC 2 D1
387 MO MO003 CT for CA Ovary MO003F 13900 15300 17400 17400 NA No NA
Oncology D8
Gemcitabine -
1000mg/m2 D1 D8
only
388 MO MO003 CT for CA Ovary MO003G 14850 16400 18600 18600 NA No NA
every 21 days
Medical Cyclophosphamide 50
389 MO MO003 CT for CA Ovary MO003H 2800 3100 3500 3700 NA NA
Oncology mg/m2 OD D1-D21
every 28 days
Tamoxifen
Medical
390 MO MO003 CT for CA Ovary MO003I Tamoxifem 20 mg orally 1200 1400 1500 1600 NA NA
Oncology
daily (3 months)
Letrozole
Medical
391 MO MO003 CT for CA Ovary MO003J Letrozole 2.5 mg orally 3900 4300 4900 5100 NA NA
Oncology
daily (3 months)
Single agent
Carboplatin
Medical
392 Mo MO003 CT for CA Ovary MO003K Carboplatin AUC 5-6 D1 7000 7700 8800 9100 NA NA
Oncology
every 21 days (
maximum -6 cycle)
Cisplatin
Medical Cisplatin 40 mg/m2
393 Mo MO003 CT for CA Ovary MO003L 4100 4600 5200 5400 NA NA
Oncology every week (maximum-
6 cycles)
Carboplatin (AUC 7)
Medical CT for Germ Cell
394 MO MO004 MO004A Carboplatin AUC 7 7300 8100 9200 9500 NA No NA
Oncology Tumor
every 21 days
Bleomycin + Etoposide
+ Cisplatin
Bleomycin 30 units D1
Medical CT for Germ Cell D8 D15
395 MO MO004 MO004B 12322.5 13600 15500 16100 NA No NA
Oncology Tumor Cisplatin 20 mg/m2 IV
D1-D5
Etoposide 100mg/m2
D1-D5 every 21 days
Etoposide + Cisplatin
Cisplatin 20 mg/m2 IV
396 MO MO004 MO004C D1-D5 10860 12000 13600 14200 NA No NA
Oncology Tumor
Etoposide 100mg/m2
D1-D5 every 21 days
Gemcitabine +
Oxaliplatin
Medical CT for Germ Cell Gemcitabine
397 MO MO004 MO004D 17500 19300 21900 22800 NA No NA
Oncology Tumor 1000mg/m2 D1 D8
Oxaiplatin 130mg/m2
D1 every 21 days
Gemcitabine +
Paclitaxel
Gemcitabine
398 MO MO004 MO004E 1000mg/m2 D1 D8 D15 17500 19300 21900 22800 NA No NA
Oncology Tumor
Paclitaxel 100 mg/m2
D1 D8 D15 every 28
days
Paclitaxel + Ifosfamide +
Cisplatin
D1
Medical CT for Germ Cell Ifosfamide 1500mg/m2
399 MO MO004 MO004F 24400 26900 30500 31800 NA No NA
Oncology Tumor D2-D5
Mesna 300 mg/m2 0h
4h 8h D2-D5
Cisplatin 25mg/m2 D2-
D5 every 21 days
Vinblastin + Ifosfamide
+ Cisplatin
Vinblastine 0.11 mg/kg
IV D1-D2
Medical CT for Germ Cell Mesna 240mg/m2 0h 4h
400 MO MO004 MO004G 13597.5 15000 17000 17700 NA No NA
Oncology Tumor 8h D1-D5
Ifosfamide 1200mg/m2
D1-D5
Cisplatin 20 mg/m2 D1-
D5 every 21 days
Etoposide +
Methotrexate +
Dactinomycin-
Cyclophosphamide +
Vincristine
Etoposide 100mg/m2 IV
D1 D2
CT for Gestational Dactinomycin 0.5 mg IV
Medical
401 MO MO005 Trophoblastic MO005A push D1 D2 12041.25 13300 15100 15700 NA No NA
Oncology
Neoplasia Methotrexate 300 mg
/m2 D1
Leucovorin 15 mg PO
every 12 hrs for 4 doses
Cyclophosphamide
600mg/m2 D8
Vincrstine 1 mg/m2 D8
every 2 weeks
Etoposide +
Methotrexate +
Dactinomycin +
Cisplatin
Etoposide 100mg/m2 IV
D1 D2 D8
CT for Gestational
Medical Dactinomycin 0.5 mg IV
402 MO MO005 Trophoblastic MO005B 12746.25 14100 16000 16600 NA No NA
Oncology push D1 D2
Neoplasia
Methotrexate 300 mg
/m2 D1
Leucovorin 15 mg PO
every 12 hrs for 4 doses
Cisplatin 75mg/m2 D8
every 2 weeks
Methotrexate
Methotrexate 1/mg/kg
IM every other day x 4
CT for Gestational
Medical days D1 3 D5 D7
403 MO MO005 Trophoblastic MO005C 1218.75 1400 1600 1600 NA No NA
Oncology Alternating every other
Neoplasia
day with
Leucovorin 15 mg PO
repeat every 14 days
Dactinomycin
CT for Gestational
Medical Inj Dactinomycin 0.5
404 MO MO005 Trophoblastic MO005D 6950 7700 8700 9100 NA NA
Oncology mg D1- D5 every 14
Neoplasia
days
Medical CT for Cervical Paclitaxel 175mg/m2 D1
405 MO MO006 MO006A 14900 16400 18700 18700 NA No NA
Oncology Cancer Carboplatin AUC 5-6 D1
every 21 days
Cisplatin
Medical CT for Cervical
406 MO MO006 MO006B Cisplatin 40 mg/m2 2362.5 2600 3000 3100 NA No NA
Oncology Cancer
every week
Medical CT for Endometrial Paclitaxel 175mg/m2 D1
407 MO MO007 MO007A 14900 16400 18700 18700 NA No NA
Oncology Cancer Carboplatin AUC 5 D1
every 21 days
Cisplatin + Doxorubicin
Doxorubicin 60 mg/m2
Medical CT for Endometrial
408 MO MO007 MO007B D1 4410 4900 5600 5600 NA No NA
Oncology Cancer
Cisplatin 50mg/m2
every 3 weeks
Lipodox + Carboplatin
Medical CT for Endometrial Lipopdox 30 mg/m2 D1
409 MO MO007 MO007C 17200 19000 21500 22400 NA NA
every 28 days
Carboplatin +
Gemcitabine
Gemcitabine -
1000mg/m2 D1 D8
Medical CT for Endometrial Carboplatin AUC 2 D1
410 MO MO007 MO007D 13900 15300 17400 18100 NA NA
Oncology Cancer D8
Gemcitabine -
1000mg/m2 D1 D8
only every 3 weeks
Anastrozole
Medical CT for Endometrial
411 MO MO007 MO007E 1 mg orally daily (for 3 3900 4300 4900 5100 NA NA
Oncology Cancer
months)
Cisplatin + 5 FU
Medical 5 FU 1000mg/m2 D1-D4
412 MO MO008 CT for Vulvar Cancer MO008A 8250 9100 10400 10800 NA No NA
Oncology Cisplatin 75mg/m2 D1
every 3 weeks
Cisplatin
Medical
413 MO MO008 CT for Vulvar Cancer MO008B Cisplatin 40 mg/m2 2362.5 2600 3000 3100 NA No NA
Oncology
every week
414 MO MO008 CT for Vulvar Cancer MO008C 14500 16000 18200 18900 NA NA
Oncology Carboplatin AUC 5 D1
every 21 days
Vincristine + Topotecan
+ Cyclophosphamide +
Irinotecan +
Temozolamide
Vincristine 1.5mg/m2(
day 1)
Topotecan 1.5mg/m2
(day 1-5)
Medical CT for Ewing Cyclophosphamide
415 MO MO009 MO009A 23152.5 25500 29000 30100 NA No NA
Oncology Sarcoma 250mg/m2 (days 1-5)
Given every 3 weeks
Irinotecan 10-50
mg/sqM days 1-5 and
days 8-12
Temozolamide
100mg/m2 days 1-5 of
each cycle every 3
weeks
Vincristine + Ifosfamide
+ Etoposide
Vincristine +
Doxorubicin +
Cyclophosphamide
Vincristine +
Cyclophosphamide +
Dactinomycin.
4 cycles VIE, 6 cycles
Medical CT for Ewing
416 MO MO009 MO009B VAC, 4 cycles VCD 9900 10900 12400 12900 NA No NA
Oncology Sarcoma
Vincristine 1.5mg/m2
(day 1, 8 and 15)
Ifosfamide: 1800mg/m2
(days1-5)
Etposide: 100mg/sq.m
(days 1-5)
Given every 3 weeks
(day 1 and 8)
Vincristine + Adriamycin
+ Cyclophosphamide
Ifosfamide + Etoposide
Ifosfamide: 1800mg/m2
(days1-5)
Etposide: 100mg/sq.m
(days 1-5)
Medical CT for Ewing
417 MO MO009 MO009C Given every 2-3 weekly 12708.75 14000 15900 16600 NA No NA
Oncology Sarcoma
(day 1 and 8)
Adriamyicn: 75mg/m2
(day 1)
Cyclophosphamide
1200mg/m2 (day 1)
Given 2-3 weekly
Doxorubicin + Cisplatin
Medical CT for Osteogenic Cisplatin 100mg/m2
418 MO MO010 MO010A 12000 13200 15000 15600 NA No NA
Oncology Sarcoma Doxorubicin 75mg/m2
given every 3 weeks
Methotrexate +
Doxorubicin + Cisplatin
for Relapsed
Osteogenic Sarcoma
Medical CT for Osteogenic
419 MO MO010 MO010B Cisplatin 120mg/sq.m 27000 29700 33800 35100 NA No NA
Oncology Sarcoma
Doxorubicin 75mg/m2
Methotrexate 8-12
gram/m2
Each cycle for 5 weeks
OGS - 12
Ifosfamide 1800 mg/m2
D1-D5
Mesna 600mg/m2 0h 3h
420 MO MO010 MO010C 6h 9h D1-D5 29600 32600 37000 38500 NA No NA
Oncology Sarcoma
Adriamycin 25mg/m2
D1- D3
D3 every 21 days
OGS - 12
Ifosfamide 1800 mg/m2
D1-D5
421 MO MO010 MO010D Mesna 600mg/m2 0h 3h 28600 31500 35800 37200 NA No NA
Oncology Sarcoma
6h 9h D1-D5
D3 every 21 days
Gemcitabine +
Docetaxel
Medical CT for Soft Tissue Gemcitabine 900
422 MO MO011 MO011A 24000 26400 30000 31200 NA No NA
Oncology Sarcoma mg/m2 D1 D8
Docetaxel 100 mg/m2
D8 every 21 days
Ifosfamide + Adriamycin
Doxorubicin 30mg/m2
D1 D2
Ifosfamide 2000 to
Medical CT for Soft Tissue
423 MO MO011 MO011B 3000mg/m2 13700 15100 17200 17900 NA No NA
Oncology Sarcoma
Mesna 400 to 600
mg/m2 0h 4h 8h D1 -
D3
Every 21 days
Medical CT for Soft Tissue Doxorubicin 60-75/m2,

424 MO MO011 MO011C 4000 4400 5000 5200 NA NA
Oncology Sarcoma every 21 days
Dacarbazine + Cisplatin
Dacarbazine 250mg/m2
Medical CT for Metastatic
425 MO MO012 MO012A D1-D5 7100 7900 8900 9300 NA No NA
Oncology Melanoma
Cisplatin 75 mg/m2
Every 21 days
Temozolamide
Medical CT for Metastatic Temozolamide
426 MO MO012 MO012B 5000 5500 6300 6500 NA No NA
Oncology Melanoma 200mg/m2 D1-D5 every
28 days
Imatinib
Medical CT for Metastatic Tab Imatinib 400/800
427 MO MO012 MO012C 5000 5500 6300 6500 NA NA
Oncology Melanoma mg daily
5 FU + Mitomycin C
428 MO MO013 CT for Anal Cancer MO013A 10950 12100 13700 14300 NA No NA
Oncology D29-D32
Mitomycin 10mg/m2 D1
Capecitabine +
Mitomycin C
Medical Capecitabine 825mg/m2
429 MO MO013 CT for Anal Cancer MO013B 16875 18600 21100 22000 NA No NA
Oncology PO twice daily till
completion of RT
Mitomycin 10mg/2 D1
Cisplatin + 5 FU
430 MO MO013 CT for Anal Cancer MO013C 8100 9000 10200 10600 NA No NA
every 4 weeks
431 MO MO013 CT for Anal Cancer MO013D 14900 16400 18700 18700 NA No NA
every 21 days
Cisplatin + Paclitaxel
Medical
432 MO MO013 CT for Anal Cancer MO013E D1 13300 14700 16700 16700 NA No NA
Oncology
every 21 days
5 FU + Leucovorin
Medical CT for Colorectal 5 FU 1200mg/m2 D1 D2
433 MO MO014 MO014A 5512.5 6100 6900 6900 NA No NA
Oncology Cancer Leucovorin 400mg/m2
D1 every 14 days
Capecitabine +
Irinotecan
Medical CT for Colorectal Capecitabine
434 MO MO014 MO014B 12500 13800 15700 16300 NA No NA
Oncology Cancer 1000mg/m2 D1-D14
Irinotecan 200 mg/m2
D1 every 21 days
5 FU + Leucovorin +
Oxaliplatin
5 FU 1200mg/m2 D1 D2
Medical CT for Colorectal
435 MO MO014 MO014C Leucovorin 400mg/m2 13650 15100 17100 17800 NA No NA
Oncology Cancer
D1
Oxaliplatin 85 mg/m2
D1 every 14 days
5FU + Leucovorin +
Irinotecan
5 FU 1200mg/m2 D1 D2
Medical CT for Colorectal Leucovorin 400mg/m2
436 MO MO014 MO014D 9570 10600 12000 12500 NA No NA
Oncology Cancer D1
Irinotecan 180mg/m2 85
mg/m2 D1 every 14
days
Capecitabine +
Oxaliplatin
437 MO MO014 MO014E 12500 13800 15700 16300 NA No NA
D1 every 21 days
Capecitabine along with

Medical CT for Colorectal RT
438 MO MO014 MO014F 7200 8000 9000 9400 NA No NA
Oncology Cancer Capecitabine 825
mg/m2 twice daily
Capecitabine
439 MO MO014 MO014G 7300 8100 9200 9500 NA No NA
every 21 days
5FU + Leucovorin +
Oxaliplatin + Irinotecan
5 FU 1200mg/m2 D1 D2
Leucovorin 400mg/m2
Medical CT for Colorectal
440 MO MO014 MO014H D1 18775 20700 23500 24500 NA No NA
Oncology Cancer
D1
Irinotecan 180mg/m2
every 14 days
Medical CT for Esophageal Paclitaxel 175mg/m2 D1
441 MO MO015 MO015A 14900 16400 18700 18700 NA No NA
Oncology Cancer Carboplatin AUC 5-6 D1
every 21 days
Cisplatin + 5 FU
Medical CT for Esophageal 5 FU 1000mg/m2 D1-D4
442 MO MO015 MO015B 9675 10700 12100 12600 NA No NA
Oncology Cancer Cisplatin 75mg/m2 D1
every 4 weeks
Cisplatin + 5 FU
Medical CT for Esophageal
443 MO MO015 MO015C D29 14100 15600 17700 18400 NA No NA
Oncology Cancer
5FU 1000mg/m2 D1-D4
Paclitaxel + Carboplatin
444 MO MO015 MO015D 27172.5 29900 34000 34000 NA No NA
every week
445 MO MO015 MO015E 27172.5 29900 34000 34000 NA No NA
every week
Cisplatin + Docetaxel
Docetaxel 40mg/m2 D1
Cisplatin 40 mg/m2 D1
Medical CT for Esophageal /
446 MO MO016 MO016A Leucovorin 400mg/m2 13900 15300 17400 18100 NA No NA
Oncology Stomach Cancer
D1
5FU 1000mg/m2 D1 D2
every 14 days
Irinotecan
447 MO MO016 MO016B Irinotecan 60- 90 mg/m2 10925 12100 13700 14300 NA No NA
D1 D8 every 21 days
5 FU
448 MO MO016 MO016C 5 FU 250 mg/m2 D1-D5 9375 10400 11800 12200 NA No NA
over 24 hrs every week
Capecitabine
449 MO MO016 MO016D Capecitabine 825 7200 8000 9000 9000 NA No NA
mg/m2 twice daily
Capecitabine +
Oxaliplatin
Medical CT for Esophageal / Capecitabine
450 MO MO016 MO016E 12500 13800 15700 16300 NA No NA
Oncology Stomach Cancer 1000mg/m2 D1-D14
D1 every 21 days
Docetaxel + Cisplatin +
5 FU
Medical CT for Esophageal / Cisplatin 40 mg/m2 D1
451 MO MO016 MO016F 14500 16000 18200 18900 NA No NA
Oncology Stomach Cancer Leucovorin 400mg/m2
D1
5FU 1000mg/m2 D1 D2
every 14 days
Capecitabine
452 MO MO016 MO016G Cisplatin 40 mg/m2 D1 14500 16000 18200 18900 NA No NA
Capecitabine 825mg/m2
twice daily every 14
days
Docetaxel + Oxaliplatin
+ 5 FU
453 MO MO016 MO016H D1 18500 20400 23200 24100 NA No NA
Leucovorin 400mg/m2
D1
5FU 1200mg/m2 D1 D2
every 14 days
Docetaxel + Oxaliplatin
+ Capecitabine
Medical CT for Esophageal / Oxaliplatin 85 mg/m2
454 MO MO016 MO016I 18500 20400 23200 24100 NA No NA
Oncology Stomach Cancer D1
Capecitabine 825
mg/m2 Twice daily
every 14 days
5FU + Leucovorin +
Irinotecan
5 FU 1200mg/m2 D1 D2
Medical CT for Esophageal / Leucovorin 400mg/m2
455 MO MO016 MO016J 9570 10600 12000 12500 NA No NA
Oncology Stomach Cancer D1
mg/m2 D1 every 14
days
5FU + Leucovorin +
Oxaliplatin
5 FU 1200mg/m2 D1 D2
456 MO MO016 MO016K Leucovorin 400mg/m2 13650 15100 17100 17800 NA No NA
D1
D1 every 14 days
Paclitaxel
457 MO MO016 MO016L Paclitaxel 80mg/m2 5987.5 6600 7500 7500 NA No NA
every week
Doxorubicin (TACE)
Medical CT for Hepatocellular
458 MO MO017 MO017A Doxorubicin 30-75 22500 24800 28200 29300 NA No NA
Oncology Carcinoma
mg/m2 one course
Sorafenib
459 MO MO017 MO017B Sorafenib 400mg PO 8975 9900 11300 11300 NA No NA
Oncology Carcinoma
twice daily
460 MO MO017 MO017C Lenvatinib 12 mg daily 17000 18700 21300 22100 NA NA
Oncology Carcinoma
Gemcitabine +
Nanopaclitaxel
Gemcitabine
Medical CT for Panceratic
461 MO MO018 MO018A 1000mg/m2 D1 D8 D16 28375 31300 35500 36900 NA No NA
Oncology Cancer
Albumin bound
Paclitaxel 125mg/m2 D1
Gemcitabine
Medical CT for Panceratic Gemcitabine 1000mg
462 MO MO018 MO018B 9000 9900 11300 11700 NA No NA
Oncology Cancer /m2 D1 D8 every 21
days
Gemcitabine
463 MO MO018 MO018C Gemcitabine 300mg/m2 4000 4400 5000 5200 NA No NA
Oncology Cancer
weekly
5FU + Leucovorin +
Oxaliplatin + Irinotecan
5 FU 1200mg/m2 D1 D2
Leucovorin 400mg/m2
464 MO MO018 MO018D D1 18875 20800 23600 24600 NA No NA
Oncology Cancer
D1
Irinotecan 180mg/m2
every 14 days
Capecitabine
465 MO MO018 MO018E Capecitabine 825 7200 8000 9000 9000 NA No NA
Oncology Cancer
mg/m2 twice daily
Capecitabine +
Gemcitabine
Gemcitabine
466 MO MO018 MO018F 1000mg/m2 D1 D8 D15 34125 37600 42700 44400 NA No NA
Oncology Cancer
Capecitabine 830mg/m2
twice daily D1-D21
every 28 days
Capecitabine
CT for Gall Bladder
Medical Capecitabine 1000 -
467 MO MO019 Cancer / MO019A 7300 8100 9200 9500 NA No NA
Oncology 1250 mg/m2 twice daily
Cholangiocarcinoma
D1 -D14 every 21 days
Cisplatin + Gemcitabine
CT for Gall Bladder Gemcitabine 1000
Medical
468 MO MO019 Cancer / MO019B mg/m2 D1 D8 12100 13400 15200 15800 NA No NA
Oncology
Cholangiocarcinoma Cisplatin 25 mg/m2 D1
D8 every 21 days
5FU + Leucovorin +
Irinotecan
5 FU 1200mg/m2 D1 D2
CT for Gall Bladder
Medical Leucovorin 400mg/m2
469 MO MO019 Cancer / MO019C 9615 10600 12100 12500 NA No NA
Oncology D1
Cholangiocarcinoma
mg/m2 D1 every 14
days
Gemcitabine
CT for Gall Bladder
Medical Gemcitabine 300 4000(per
470 MO MO019 Cancer / MO019D 4400/week 5000/week 5000/week NA No NA
Oncology mg/m2 D 1every week week)
Cholangiocarcinoma
(till RT ends)
Gemcitabine
CT for Gall Bladder
Medical Gemcitabine 1000mg
471 MO MO019 Cancer / MO019E 8975 9900 11300 11700 NA No NA
Oncology /m2 D1 D8 every 21
Cholangiocarcinoma
days
Oxaliplatin +
Gemcitabine
CT for Gall Bladder
Medical Gemcitabine 1000
472 MO MO019 Cancer / MO019F 17400 19200 21800 22700 NA No NA
Oncology mg/m2 D1
Cholangiocarcinoma
D1 every 14 days
Capecitabine +
Irinotecan
CT for Gall Bladder
Medical Capecitabine
473 MO MO019 Cancer / MO019G 12500 13800 15700 16300 NA No NA
Oncology 1000mg/m2 D1-D14
Cholangiocarcinoma
Irinotecan 200 mg/m2
D1 every 21 days
5FU + Leucovorin +
Oxaliplatin
CT for Gall Bladder 5 FU 1200mg/m2 D1 D2
Medical
474 MO MO019 Cancer / MO019H Leucovorin 400mg/m2 13700 15100 17200 17900 NA No NA
Oncology
Cholangiocarcinoma D1
D1 every 14 days
Imatinib
Medical CT for Gastointestinal
475 MO MO020 MO020A Imatinib 400 mg once 15000 16500 18800 18800 NA No NA
Oncology stromal tumor
daily
Sunitinib
Medical CT for Gastointestinal
476 MO MO020 MO020B Sunitinb 37.5 mg once 10000 11000 12500 12500 NA No NA
Oncology stromal tumor
daily
Temozolamide
Medical Temozolomide 150 -
477 MO MO021 CT for CA Brain MO021A 5000 5500 6300 6500 NA No NA
Oncology 200 mg/m2 D1-D5 every
28 days
Temozolamide
Medical
478 MO MO021 CT for CA Brain MO021B Temozolomide 30000 33000 37500 39000 NA No NA
Oncology
75mg/m2 once daily
Gemcitabine + Cisplatin
Gemcitabine 1000
Medical
479 MO MO022 CT for Mesothelioma MO022A mg/m2 D1 D8 12150 13400 15200 15200 NA No NA
Oncology
every 21 days
Pemetrexed + Cisplatin
Pemetrexed 500mg/m2
Medical
480 MO MO022 CT for Mesothelioma MO022B D1 9420 10400 11800 12300 NA No NA
Oncology
every 21 days
Pemetrexed +
Carboplatin
Medical Pemetrexed 500mg/m2
481 MO MO022 CT for Mesothelioma MO022C 10125 11200 12700 13200 NA No NA
Oncology D1
every 21 days
Cisplatin + Etoposide
Etoposide 100mg/m2
Medical CT for Thymic
482 MO MO023 MO023A D1 - D3 7012.5 7800 8800 8800 NA No NA
Oncology Carcinoma
Cisplatin 75-100 mg/m2
D1 every 21 days
Cisplatin + Adriamycin +
Cyclophosphamide
Medical CT for Thymic Doxorubicin 50 mg/m2
483 MO MO023 MO023B 5900 6500 7400 7700 NA No NA
Oncology Carcinoma D1
Cyclophosphamide 500
mg/m2 D1 every 21
days
Cisplatin + Docetaxel
Medical CT for CA Head & Docetaxel 75 mg/m2 D1
484 MO MO024 MO024A 12400 13700 15500 16200 NA No NA
Oncology Neck Cisplatin 75 mg/m2 D1
every 21 days
Cisplatin
Medical CT for CA Head &
485 MO MO024 MO024B Cisplatin 100mg/m2 9800 10800 12300 12800 NA No NA
Oncology Neck
every 21 days
Carboplatin +
Gemcitabine
Medical CT for CA Head & Gemcitabine 1000
486 MO MO024 MO024C 13900 15300 17400 17400 NA No NA
Oncology Neck mg/m2 D1 D8
every 21 days
5 FU
Medical CT for CA Head & Docetaxel 75 mg/m2 D1
487 MO MO024 MO024D 14500 16000 18200 18900 NA No NA
Oncology Neck Cisplatin 75 mg/m2 D1
5 FU 750 mg/m2 D1- D5
every 21 days
Docetaxel
488 MO MO024 MO024E Docetaxel 20mg/m2 3200 3600 4000 4200 NA No NA
Oncology Neck
every week
Docetaxel
489 MO MO024 MO024F Docetaxel 75 mg/m2 D1 8500 9400 10700 11100 NA No NA
Oncology Neck
every 21 days
Etoposide + Carboplatin
Etoposide 100mg/m2
490 MO MO024 MO024G D1 - D3 7687.5 8500 9700 9700 NA No NA
Oncology Neck
every 21 days
Etoposide 100mg/m2
491 MO MO024 MO024H D1 - D3 9262.5 10200 11600 11600 NA No NA
Oncology Neck
D1 every 21 days
Gemcitabine
Medical CT for CA Head & Gemcitabine 1000
492 MO MO024 MO024I 9000 9900 11300 11300 NA No NA
Oncology Neck mg/m2 D1 D8 every 21
days
Gemcitabine 1000
493 MO MO024 MO024J mg/m2 D1 D8 12150 13400 15200 15200 NA No NA
Oncology Neck
every 21 days
Medical CT for CA Head & Paclitaxel 80mg/m2 D1
494 MO MO024 MO024K 7700 8500 9700 9700 NA No NA
Oncology Neck Carboplatin AUC 2 D1
every week
495 MO MO024 MO024L Paclitaxel 175mg/m2 14500 16000 18200 18200 NA No NA
Oncology Neck
every 21 days
Paclitaxel
496 MO MO024 MO024M Paclitaxel 80mg/m2 5962.5 6600 7500 7500 NA No NA
Oncology Neck
every week
Paclitaxel
497 MO MO024 MO024N Paclitaxel 175mg/m2 11800 13000 14800 15400 NA No NA
Oncology Neck
every 21 days
Carboplatin
498 MO MO024 MO024O Carboplatin AUC 2 2692.5 3000 3400 3600 NA No NA
Oncology Neck
every week
Cisplatin
499 MO MO024 MO024P Cisplatin 40mg/m2 2362.5 2600 3000 3100 NA No NA
Oncology Neck
every week
Sunitinib
Medical CT for Renal Cell
500 MO MO025 MO025A 50 mg once daily 4 10000 11000 12500 12500 NA No NA
Oncology Cancer
weeks on 2 weeks off
Cabozantinib 60 mg od
Medical CT for Renal Cell x 1 month
501 MO MO025 MO025B 13000 14300 16300 16900 NA NA
Oncology Cancer every 4 weeks
Cisplatin + Methotrexate
+ Vinblastin
Methotrexate 30mg/m2
D1 D8
Vinblastine 4 mg/m2 D1
Medical CT for Ureter /
502 MO MO026 MO026A D8 6750 7500 8500 8800 NA No NA
Oncology Bladder / Urethra
D2
Leucovorin 15 mg PO
D2 D9 every 21 days
Carboplatin +
Gemcitabine
Medical CT for Ureter / Gemcitabine 1000
503 MO MO026 MO026B 13900 15300 17400 17400 NA No NA
Oncology Bladder / Urethra mg/m2 D1 D8
every 21 days
Cisplatin + Gemcitabine
Gemcitabine 1000
504 MO MO026 MO026C mg/m2 D1 D8 12150 13400 15200 15200 NA No NA
every 21 days
Cisplatin + 5 FU
Medical CT for Ureter / 5 FU 1000mg/m2 D1-D4
505 MO MO026 MO026D 8175 9000 10300 10700 NA No NA
Oncology Bladder / Urethra Cisplatin 75mg/m2 D1
every 4 weeks
Paclitaxel 175 mg /m2
506 MO MO026 MO026E D1 13300 14700 16700 16700 NA No NA
Cisplatin 75 mg /m2 D1
every 21 days
Docetaxel
507 MO MO026 MO026F Docetaxel 75 mg/m2 D1 8500 9400 10700 11100 NA No NA
every 21 days
Gemcitabine +
Paclitaxel
Medical CT for Ureter / Gemcitabine 2500
508 MO MO026 MO026G 15500 17100 19400 20200 NA No NA
Oncology Bladder / Urethra mg/m2 D1
D1 every 14 days
Gemcitabine
Medical CT for Ureter / Gemcitabine 1000mg
509 MO MO026 MO026H 9000 9900 11300 11700 NA No NA
Oncology Bladder / Urethra /m2 D1 D8 every 21
days
Methotrexate +
Vinblastin + Doxorubicin
+ Cisplatin
Medical CT for Ureter / D1
510 MO MO026 MO026I 7537.5 8300 9500 9800 NA No NA
Oncology Bladder / Urethra Vinblastine 3 mg/m2 D2
D2
Cuisplatin 70 mg/m2 D2
every 14 days
Medical CT for Ureter / Paclitaxel 175mg/m2 D1
511 MO MO026 MO026J 14500 16000 18200 18200 NA No NA
Oncology Bladder / Urethra Carboplatin AUC 5-6 D1
every 21 days
Paclitaxel
512 MO MO026 MO026K Paclitaxel 80 mg/m2 D1 6375 7100 8000 8300 NA No NA
every week
Medical
513 MO MO027 CT for CA Penis MO027A D1 13300 14700 16700 17300 NA No NA
Oncology
every 21 days
5 FU + Cisplatin
514 MO MO027 CT for CA Penis MO027B 8175 9000 10300 10700 NA No NA
every 4 weeks
Capecitabine
Medical Capecitabine 1000-1250
515 MO MO027 CT for CA Penis MO027C 7300 8100 9200 9500 NA No NA
Oncology mg/m2 PO twice daily
D1 -D14 every 21 days
516 MO MO027 CT for CA Penis MO027D 14500 16000 18200 18200 NA No NA
every 21 days
Paclitaxel
Medical
517 MO MO027 CT for CA Penis MO027E Paclitaxel 80 mg/m2 D1 5962.5 6600 7500 7800 NA No NA
Oncology
every week
Paclitaxel
Medical
518 MO MO027 CT for CA Penis MO027F Paclitaxel 175 mg/m2 11800 13000 14800 14800 NA No NA
Oncology
D1 every 21 days
Medical Paclitaxel 80 mg/m2 D1
519 MO MO027 CT for CA Penis MO027G 7700 8500 9700 10100 NA No NA
every week
Docetaxel
Medical
520 MO MO028 CT for CA Prostate MO028A Docetaxel 60 mg/m2 D1 8000 8800 10000 10400 NA No NA
Oncology
every 14 days
Docetaxel
Medical
521 MO MO028 CT for CA Prostate MO028B Docetaxel 75 mg/m2 D1 8500 9400 10700 11100 NA No NA
Oncology
every 21 days
Etoposide 100mg/m2
Medical
522 MO MO028 CT for CA Prostate MO028C D1 - D3 7687.5 8500 9700 9700 NA No NA
Oncology
every 21 days
LHRH Agonist
Medical
523 MO MO028 CT for CA Prostate MO028D Leuprolide 22.5 ug 15300 16900 19200 19200 NA No NA
Oncology
every 3 months
Mitoxantrone +
Prednisolone
Medical Mitoxantrone 12mg/m2
524 MO MO028 CT for CA Prostate MO028E 4200 4700 5300 5500 NA No NA
Oncology every 3 weeks
Prednsiolone 10 mg
daily
525 MO MO028 CT for CA Prostate MO028F 7700 8500 9700 9700 NA No NA
every week
526 MO MO028 CT for CA Prostate MO028G 14500 16000 18200 18200 NA No NA
every 21 days
Docetaxel
Medical
527 MO MO028 CT for CA Prostate MO028H Docetaxel 20mg/m2 D1 3200 3600 4000 4200 NA No NA
Oncology
every week
Abiraterone 1000 mg +
Medical Prednisolone 10mg
528 MO MO028 CT for CA Prostate MO028I 13000 14300 16300 16900 NA NA
Oncology daily
Once every month
Rituximab +
Cyclophosphamide +
Etoposide +
Prednsiolone
Rituximab 375mg/m2
CT for B - Cell NHL -
mg/m2
Medical High Grade
529 MO MO029 MO029A Vincristine 1.4 mg/m2, 26200 28900 32800 32800 NA No NA
Oncology (Except Burkitt's &
on Day1
PCNSL)
Etoposide 65mg/m2
Day 1 to 3
Prednisolone 100 mg
Day 1-5
Total 6 cycles, repeat 21
days
Rituximab +
Cyclophosphamide +
Doxorubicin +
Prednsiolone
Rituximab 375mg/m2
CT for B - Cell NHL - Cyclophosphamide 750
Medical High Grade mg/m2
530 MO MO029 MO029B 27000 29700 33800 33800 NA No NA
Oncology (Except Burkitt's & Doxorubicin 50mg/m2
PCNSL) Vincristine 1.4 mg/m2
on Day1
Prednisolone 100 mg
Day 1-5
Total 6 cycles, repeat 21
days
Rituxmab +
Dexamethasone + High
Dose Cytarabine +
Cisplatin
Rituximab 375mg/m2
Day 1
Cytarabine 2g/m2 BD on
Medical CT for High - Grade
531 MO MO030 MO030A day 2 34900 38400 43700 45400 NA No NA
Oncology NHL - B Cell
Dexamethasone 40 mg
Day 1 - 4
Cisplatin 75mg/m2 or
Carboplatin AUC-5 on
day 1
Cycle to be repeated
every 21days
GDP - R
Rituximab 375mg/m2
Day 1
Gemcitabine
CT for Relapsed B - 1000mg/m2 on day 1
Cell NHL - High and 8
Medical
532 MO MO031 Grade MO031A Dexamethasone 40 mg 35300 38900 44200 45900 NA No NA
Oncology
(Except Burkitt's & Day 1 - 4
PCNSL) Cisplatin 75mg/m2 on
day 1
Cycle to be repeated
every 21days
Total- 6 cycles
ICE - R
Rituximab 375mg/m2
Ifosfamide 1.66g/m2 on
day 1 - 3
CT for Relapsed B -
Mesna 1.66g/m2 day 1 -
Cell NHL - High
Medical 3
533 MO MO031 Grade MO031B 31900 35100 39900 41500 NA No NA
Oncology Carboplatin AUC 5 on
(Except Burkitt's &
day 1
PCNSL)
Etoposide 100mg/m2 on
day 1 - 3
Cycle every 21days for 6
cycles
Etoposide +
Prednsiolone +
Vincristine +
Cyclophosphamide +
Doxorubicin
Rituximab 375mg/m2
Day 1
Etoposide 50mg/m2
CT for PMBCL /
VCR 0.4mg/m2
Medical Burkitt's Lymphoma /
534 MO MO032 MO032A Doxorubicin 10mg/m2 31700 34900 39700 41300 NA No NA
Oncology Seropositive
Day1 - 4
B - Cell NHLR
Cyclophosphamide
750mg/m2 on day 5
Prednisolone 100 mg
day 1-5
Every 21 days
Dose adjustment each
cycle depending on
nadir counts
Codox - M - IVAC /
Medical
535 MO MO033 CT for Burkitt's NHL MO033A GMALL / BFM / Hyper 34500 38000 43200 44900 NA No NA
Oncology
CVAD
Bendamustine +
Rituximab
Bendamustine 90mg/m2
Medical CT for Low Grade B - on day 1, 2
536 MO MO034 MO034A 25000 27500 31300 31300 NA No NA
Oncology Cell NHL Rituximab 375mg/m2 on
day 1
Repeat every 28 days,
Total 6 cycles
Lenalidomide +
Rituximab
Medical CT for Low Grade B - Rituximab 375mg/m2
537 MO MO034 MO034B 22500 24800 28200 28200 NA No NA
Oncology Cell NHL Day 1
Lenlidomide 25 mg D1-
28, for 8 cycles
Rituximab
Medical CT for Low Grade
538 MO MO035 MO035A Rituximab 375mg/m2 16000 17600 20000 20000 NA No NA
Oncology NHL
per week for 6 weeks
Rituximab +
Cyclophosphamide +
Vincristine +
Prednisolone
Rituximab 375 mg/m2
Cyclophosphamide
539 MO MO035 MO035B 750mg/m2 17500 19300 21900 21900 NA No NA
Oncology NHL
Day 1
Prednisolone 100 mg
Day 1 - 5
Repeat every 21days.
Total 6 cycles
Fludarabine +
Cyclophosphamide
CT for Chronic Fludarabine 25mg/m2
Medical
540 MO MO036 Lymphocytic MO036A D1-3 18100 20000 22700 23600 NA No NA
Oncology
Leukemia Cyclophosphamide 250
mg/m2 D1-3 every 28
days for 6 cycles
Rituxmab +
Chlorambucil
Rituximab 375mg/m2
CT for Chronic
Medical Day 1
541 MO MO036 Lymphocytic MO036B 17100 18900 21400 21400 NA No NA
Oncology Chlorambucil 10 mg/m2
Leukemia
D1-7
Repeat every 28 days
for 12 cycles
Rituximab + Fludarabine
+ Cyclophosphamide
Rituximab 375mg/m2 on
day 1
CT for Chronic
Medical Fludarabine 25mg/m2
542 MO MO036 Lymphocytic MO036C 40700 44800 50900 53000 NA No NA
Oncology D1 - 3
Leukemia
mg/m2 D1 - 3
Every 28 days for 6
cycles
Lenalidomide
CT for Chronic
Medical lenalidomide-10-25
543 MO MO036 Lymphocytic MO036D 4800 5300 6000 6000 NA No NA
Oncology mg/day day 1 to 21
Leukemia
every 28 days
CHOEP
Cyclophosphamide
750mg/m2 D1
Vincristine 1.4mg/m2 D1
Adriamycin 50 mg/m2
Medical CT for Peripheral T - D1
544 MO MO037 MO037A 5250 5800 6600 6900 NA No NA
Oncology Cell Lymphoma Etoposide 100mg/m2
D1-3
Prednisolone 100 mg
D1-5
Every 21days. Total 6
cycles
CHOP
Cyclophosphamide
750mg/m2 D1
Vincristine 1.4mg/m2 D1
Medical CT for Peripheral T - Adriamycin 50 mg/m2
545 MO MO037 MO037B 5125 5700 6500 6500 NA No NA
Oncology Cell Lymphoma D1
Prednisolone 100 mg
D1-5
Every 21days. Total 6
cycles
SMILE
Methotrexate 2gm/m2
D1
Ifosfamide 1500mg/m2
D2-4
Medical CT for Peripheral T - Etoposide 100mg/m2
546 MO MO037 MO037C 19672.5 21700 24600 25600 NA No NA
Oncology Cell Lymphoma D2-4
L-asparginase
6000U/m2
D8,10,12,14,16,18,20
Dexamethasone 40mg
D1-4 every 28 days
GELOX
Gemcitabine
1000mg/m2 D1 and D8
Medical CT for NK - T Cell Oxaliplatin 130mg/m2
547 MO MO038 MO038A 19293.75 21300 24200 25100 NA No NA
Oncology Lymphoma D1
L- asparginase 6000
U/m2 D1-7
LVP
L-asparginase
6000U/m2 D1-5
Medical CT for NK - T Cell
548 MO MO038 MO038B Vincristine 1.4mg/m2 D1 7950 8800 10000 10000 NA No NA
Oncology Lymphoma
Prednisolone 100mg D1-
5
COPP
Cyclophosphamide
650mg/m2 D1, 8
D1, 8
Medical CT for Hodgkin's
549 MO MO039 MO039A Procarbazine 100 3825 4300 4800 4800 NA No NA
Oncology Lymphoma
mg/m2 D1-14
Prednisolone 40mg/m2
D1-14
Every 28days. Total 6 -
8 cycles
ABVD
Adriamycin 25mg/m2
Bleomycin 10unit/m2
Medical CT for Hodgkin's Vinblastine 6mg/m2
550 MO MO039 MO039B 10200 11300 12800 12800 NA No NA
Oncology Lymphoma Dacarbazine 375 mg/m2
Day 1,15
Every 28 days for 6
cycles
AEVD
Adriamycin 25mg/m2
Vinblastine 6mg/m2
Dacarbazine 375 mg/m2
Medical CT for Hodgkin's
551 MO MO039 MO039C Day 1,15 10200 11300 12800 12800 NA No NA
Oncology Lymphoma
Etoposide 65mg/m2
Day 1-3, 15-17
Every 28 days for 6
cycles
ICE
Ifosfamide 1.5 mg/m2
D1-3
Medical CT for Relapsed
552 MO MO040 MO040A Carboplatin AUC5 D2 10530 11600 13200 13700 NA No NA
Oncology Hodgkin Lymphoma
Etoposide 100mg/m2
D1-3
Every 3 weeks
MINE
Ifosfamide 4 gm/m2
over 3days (D1-3)
553 MO MO040 MO040B Mitoxantrone 8mg/m2 10530 11600 13200 13700 NA No NA
Etoposide 65mg/m2 D1-
3
Every 3 weeks
PTCL - GDP
Gemcitabine
1000mg/m2 D1 and D8
Dexamethasone 40mg
554 MO MO040 MO040C D1-4 14750 16300 18500 19200 NA No NA
or
Cacrboplatin AUC-5
Every 3 weeks
DHAP
Dexamethasone 40mg
D1-4
Medical CT for Relapsed NHL Cisplatin 100mg/m2 or
555 MO MO041 MO041A 12510 13800 15700 16300 NA No NA
Oncology & HL Carboplatin AUC-5D1
Cytarabine 2 gm/m2 BD
D2
Lenalidomide +
Dexamethasone
Lenalidomide 25 mg
Medical CT for MM /
556 MO MO042 MO042A daily Day1-21 5200 5800 6500 6500 NA No NA
Oncology Amyloidosis / POEMS
Dexamethasone 40mg
Day 1, 8, 15, 22
Every 28days
Pomalidomide +
Dexamethasone
Pomalidomide 4 mg
Medical CT for MM /
557 MO MO042 MO042B daily Day 1-21 7100 7900 8900 8900 NA No NA
Oncology Amyloidosis / POEMS
Dexamethasone 40mg
Day 1, 8, 15, 22
Every 28 days
Cyclophosphamide +
Thalidomide +
Dexamethasone
Cyclophosphamide
Medical CT for MM / 100mg D1-D14
558 MO MO043 MO043A 4075 4500 5100 5100 NA No NA
Oncology Amyloidosis Thalidomide 100-200
mg daily Day 1-28
Dexamethasone 40mg
Day 1, 8, 15, 22
Every 28 days
Melphalan +
Thalidomide +
Prednisolone
Melphalan 9mg/m2 D1-
Medical CT for MM / D4
559 MO MO043 MO043B 4100 4600 5200 5200 NA No NA
Oncology Amyloidosis Thalidomide 100mg D1-
28
Prednisolone 100mg
Day1-4
Every 28days
Bortezomib +
Cyclophosphamide +
Dexamethasone
Cyclophosphamide -
300 mg/m2 day 1, 8, 15,
Medical CT for MM /
560 MO MO043 MO043C 22 14600 16100 18300 18300 NA No NA
Oncology Amyloidosis
Dexamethasone 40mg
Day 1, 8, 15, 22
Bortezomib 1.3 mg/m2
Day1, 8, 15, 22
Every 28 days
Bortezomib +
Dexamethasone
Medical CT for MM /
561 MO MO043 MO043D Day1, 8, 15, 22 13300 14700 16700 16700 NA No NA
Dexamethasone 40mg
Day1, 8, 15, 22
Every 28 day
Bortezomib + Melphalan
+ Prednsiolone
Melphalan 9mg/m2 D1-
D4
Medical CT for MM /
562 MO MO043 MO043E Prednisolone 100mg 12600 13900 15800 15800 NA No NA
Day 1-4
Day 1, 8, 15, 22
Every 28 days
Bortezomib +
Lenalidomide +
Dexamethasone
Lenalidomide 25 mg
Medical CT for MM / daily Day 1 - 21
563 MO MO043 MO043F 17800 19600 22300 22300 NA No NA
Oncology Amyloidosis Dexamethasone 40mg
Day 1, 8, 15, 22
Day 1, 8, 15, 22
Every 28 days
Bortezomib +
Thalidomide +
Dexamethasone
Thalidomide 100 mg
Medical CT for MM / daily Day 1 - 28
564 MO MO043 MO043G 15000 16500 18800 19500 NA No NA
Oncology Amyloidosis Dexamethasone 40 mg
Day 1, 8, 15, 22
Day 1, 8, 15, 22
Every 28 days
Imatinib
Medical CT for Chronic Imatinib 400 mg, 600
565 MO MO044 MO044A 15000 16500 18800 18800 NA No NA
Oncology Myeloid Leukemia mg, 800 mg
(per month X 5 years)
Medical CT for Chronic Dasatinib 100 mg once
566 MO MO044 MO044B 5000 5500 6300 6500 NA NA
Oncology Myeloid Leukemia a day
Hydroxurea
CT for
Medical Hydroxurea daily
567 MO MO045 Myeloproliferative MO045A 2200 2500 2800 2800 NA No NA
Oncology (Dose will be based on
Neoplasm
blood counts)
Cytarabine 2 gm / M2
Medical CT for Acute Myeloid BD for 3 days
568 MO MO046 MO046A 71250 78400 89100 92700 NA No NA
Oncology Leukemia Every 21 days for 3
cycles
Cytarabine 100 mg / M2
7 days
Daunomycin 60 mg / M2
Medical CT for Acute Myeloid
569 MO MO046 MO046B 3 days ( this does not 105600 116200 132000 137300 NA No NA
Oncology Leukemia
include antibiotics,
antifungals, blood and
platelets transfusion)
BFM-90
BFM-95
BFM-2000
CT for Acute HyperCVAD
Medical
570 MO MO047 Lymphoblastic MO047A UKALL 160000 176000 200000 208000 NA No NA
Oncology
Leukemia GMALL ( this does not
include antibiotics,
antifungals, blood and
platelets transfusion)
BFM-90
BFM-95
CT for Acute
Medical BFM-2000
571 MO MO047 Lymphoblastic MO047B 123750 136200 154700 160900 NA No NA
Oncology HyperCVAD
Leukemia
UKALL
GMALL
6 Mercaptopurine 50 mg
CT for Acute
Medical / M2 daily
572 MO MO047 Lymphoblastic MO047C 4000 4400 5000 5200 NA No NA
Oncology Methotrexate 25 mg /
Leukemia
M2 Weekly for 2 years
BFM-90
BFM-95
Medical CT for Lymphoblastic BFM-2000
573 MO MO048 MO048A 160000 176000 200000 208000 NA No NA
Oncology Lymphoma HyperCVAD
UKALL
GMALL
BFM-90
BFM-95
Medical CT for Lymphoblastic BFM-2000
574 MO MO048 MO048B 123750 136200 154700 160900 NA No NA
Oncology Lymphoma HyperCVAD
UKALL
GMALL
6 Mercaptopurine 50
Medical CT for Lymphoblastic mg/M2 daily and
575 MO MO048 MO048C 4000 4400 5000 5200 NA No NA
Oncology Lymphoma Methotrexate 25 mg/M2
Weekly for 2 Years
Arsenic trioxide
CT for Acute ATRA
Medical Promyelocytic Daunomycin or
576 MO MO049 MO049A 72000 79200 90000 93600 NA No NA
Oncology Leukemia Idarubcin
(High Risk) Cytarabine - multiagent -
vary in each protocol
Arsenic trioxide
CT for Acute ATRA
Medical Promyelocytic Daunomycin or
577 MO MO049 MO049B 96750 106500 121000 125800 NA No NA
Oncology Leukemia Idarubcin
(High Risk) Cytarabine - multiagent -
vary on protocol
6 MP 50 mg / day daily
Methotrexate 15 mg
CT for Acute
Weekly
Medical Promyelocytic
578 MO MO049 MO049C ATRA 45 mg / M2 for 14 8000 8800 10000 10400 NA No NA
Oncology Leukemia
days
(High Risk)
Every three months for
18 Months
ATO 0.15 mg / kg day 1-

Day 5, day 8-12, day 15-
CT for Acute 19, day 22-26 every 56
Medical Promyelocytic days for 4 cycles 55000 (per 56 60500 (per 56 68750(per 56 68750(per 56
579 MO MO050 MO050A NA No NA
Oncology Leukemia ATRA 45 mg / M2 day 1- day cycle) day cycle) day cycle) day cycle)
(Low Risk) Day 14 and Day 29-43
every 56 days for 4
cycles
CT for Acute ATO 0.15 mg / kg day 1-

Medical Promyelocytic 45 or 60
580 MO MO050 MO050B 81000 89100 101300 105300 NA No NA
Oncology Leukemia ATRA 45 mg / M2 - day
(Low Risk) 1-45 or 60
Cefoperazone +
Sulbactum
Piperalicillin +
Tazobactum
Cefoperazone
Piperacillin
Medical Amikacin
581 MO MO051 Febrile Neutopenia MO051A 33250 36600 41600 41600 NA No NA
Oncology Gentamicin
Cefipime
Levofloxacin
Amoxycillin and
clavulanate
Teicoplanin
Vancomycin
Meropenem
Imipenem
Colistin
Medical Tigecyclin
582 MO MO051 Febrile Neutopenia MO051B 78750 86700 98500 102400 NA No NA
Oncology Linezolid
Voriconazole
Caspfungin
Amphotericin - B
Chemotherapy Rasburicase
Medical Complications - Febuxostat
583 MO MO052 MO052A 24000 26400 30000 30000 NA No NA
Oncology Tumor Lysis Allopurinol
Syndrome Sevelamer
5 microgram / kg / day
(max 300 microgram per
Granulocyte Colony
Medical day) for 7 days or
584 MO MO053 Stimulating Factor MO053A 4500 5000 5700 5700 NA No NA
Oncology PEG - GCSF 6mg one
Use
single dose per
chemotherapy cycle
Langerhans Cell
Medical CT for Langerhans Histiocytosis
585 MO MO054 MO054A 25275 27900 31600 32900 NA No NA
Oncology Cell Histiocytosis (Histiocytosis Protocol -
Induction)
Langerhans Cell
Medical CT for Langerhans Histiocytosis
586 MO MO054 MO054B 28875 31800 36100 37600 NA No NA
Oncology Cell Histiocytosis (Histiocytosis Protocol -
Maintenance)
Vincristine + Carboplatin
(day 1, 8 and 15 for first
Medical CT for Low Grade 4 cycles and then only
587 MO MO055 MO055A 5850 6500 7400 7700 NA No NA
Oncology Glioma day 1 from cycle 5 to 17)
Carboplatin 550mg/m2
every 3 weeks (all
cycles)
Vinblastin
588 MO MO055 MO055B Vinblastine 6 mg/m2 3337.5 3700 4200 4400 NA No NA
Oncology Glioma
every week
CT for
Medical
589 MO MO056 Medulloblastoma / MO056A PACKER 6337.5 7000 8000 8300 NA No NA
Oncology
Brain PNET
Cisplatin +
Cyclophosphamide +
Vincristine
Cyclophosphamide
1000mg/m2 (2 days
CT for
Medical every cycles)
590 MO MO056 Medulloblastoma / MO056B 8306.25 9200 10400 10800 NA No NA
Oncology Vincristine 1.5mg/m2
CNS PNET
(days 1 and 8)
Cisplatin 100mg/m2 (1
day per cycle)
Cycles given every 3
weekly
Cabroplatin + Etoposide
+ Cyclophosphamide +
Doxorubicin
Medical CT for Carboplatin 600mg/m2
591 MO MO057 MO057A 8587.5 9500 10800 11200 NA No NA
Oncology Neuroblastoma Etoposide 100mg/m2
(days 1-5)
Cyclophosphamide
Doxorubicin
Carboplatin + Cisplatin +
Medical CT for
592 MO MO057 MO057B Cyclophosphamide + 7612.5 8400 9600 9900 NA No NA
Oncology Neuroblastoma
Vincristine + Etoposide
13-cis retinoic acid

160mg/m2 per day for 2
Medical CT for
593 MO MO057 MO057C weeks 2025 2300 2600 2700 NA No NA
Oncology Neuroblastoma
Each cycle given 4
weekly
Vincristine + Carboplatin
+ Etoposide
Carboplatin 600mg/m2
Medical CT for day 1
594 MO MO058 MO058A 7372.5 8200 9300 9600 NA No NA
Oncology Retinoblastoma Etoposide 150mg/m2
days 1-3
Vincristine1.5mg/m2
day 1
Vincristine +
Cyclophosphamide +
Dactinomycin
Medical CT for (day 1, 8 and 15)
595 MO MO059 MO059A 5700 6300 7200 7500 NA No NA
Oncology Rhabdomyosarcoma Cyclophosphamie 1200 -
2200 mg/m2 (day 1)
Dactinomycin 1.5mg /
m2 (day 1)
3 weekly cycle
Vincristine + Ifosfamide
+ Etoposide
(days 1, 8 and 15)
Medical CT for Ifosfamide 1.8gm/m2
596 MO MO059 MO059B 16200 17900 20300 21100 NA No NA
Oncology Rhabdomyosarcoma (days 1-5)
Etoposide 100mg/m2
(days 1-5)
Each cycle every 3
weeks
Vincristine + Topotecan
+ Cyclophosphamide
and
Vincristine + Adriamycin
+ Cyclophosphamide
(day 1)
Topotecan 1.5mg/m2
Medical CT for Relapse (day 1-5)
597 MO MO060 MO060A 12412.5 13700 15600 16200 NA No NA
Oncology Rhabdomyosarcoma Cyclophosphamide
250mg/m2 (days 1-5)
3 - weekly
Adriamyicn 60mg/m2
Cyclophosphamide
600mg/m2 (all Day 1)
Every 3 weeks. Cycles
given in couplets
Vincristine +
Actinomycin D
Vincristine 1.5 mg/m2
Medical weekly for 12 weeks
598 MO MO061 CT for Wilms Tumor MO061A 3750 4200 4700 4900 NA No NA
Oncology and then 3 weekly
Actinomycin D 45
microgram / kg 3 weekly
for 24 weeks
Vincristine +
Actinomycin D +
Doxorubicin
Medical weekly for 12 weeks
599 MO MO061 CT for Wilms Tumor MO061B 4950 5500 6200 6500 NA No NA
Oncology and then 3 weekly
Actinomycin D 45
microgram/kg 3 weekly
Doxorubicin 60mg/m2
for 24 weeks
Cyclophosphamide +
Doxorubicin + Etoposide
+ Vincristine +
Dactinomycin
Medical Dactinomycin 45
600 MO MO061 CT for Wilms Tumor MO061C 15225 16800 19100 19800 NA No NA
Oncology microgram/kg
Adriamyicn 60mg/m2
Cyclophosphamide
Etoposide
Weekly chemotherapy -
varying hybrid regimen
CT for Pediatric Acute Consolidation

Medical
601 MO MO062 Lymphoblastic MO062A (Phase II, CNS Therapy 239650 263700 299600 311600 NA No NA
Oncology
Leukemia Reinduction)
ICICLE
CT for Pediatric Acute
Medical BFM
Oncology KLALL
Leukemia
MCP:841
6 - Mercaptopurine
75mg/m2 daily
Medical weekly
603 MO MO062 Lymphoblastic MO062C 2662.5 3000 3400 3500 NA No NA
Leukemia
monthly
Intrathecal methotrexate
12 mg 3 monthly
CT for Ph+ve
Pediatric Acute Dasatinib + chemo (to
Medical 5000 per
604 MO MO062 Lymphoblastic MO062D be used only with ALL 5500/month 6250 /month 6250 /month NA NA
Oncology menth
Leukemia for adult therapy)
and paediatric
CT for Ph+ve
Pediatric Acute Imatinib + chemo ((to be
Medical 5000 per
605 MO MO062 Lymphoblastic MO062E used only with ALL 5500/month 6250 /month 6250 /month NA NA
Oncology month
Leukemia for adult therapy)
and paediatric
CT for Pediatric Consolidation
Medical
606 MO MO063 Lymphoblastic MO063A (Phase II, CNS Therapy 239650 263700 299600 311600 NA No NA
Oncology
Lymphoma Reinduction)
ICICLE
CT for Pediatric
Medical BFM
Oncology KLALL
Lymphoma
MCP:841
6 - Mercaptopurine
75mg/m2 daily
CT for Pediatric
Medical weekly
608 MO MO063 Lymphoblastic MO063C 2662.5 3000 3400 3500 NA No NA
Lymphoma
monthly
Intrathecal methotrexate
12 mg 3 monthly
Cytrabine 3 gram/m2
Medical CT for Pediatric Acute
609 MO MO064 MO064A twice a day 57600 63400 72000 74900 NA No NA
Oncology Myeloid Leukemia
Days 1, 3 and 5
Cytrabine
200mg/m2/day days 1-
10 and
610 MO MO064 MO064B Daunorubicin 50mg/m2 105240 115800 131600 136900 NA No NA
days 1, 3 and 5
Etposide 100mg/m2
days 1-5
Cytrabine 100-
200mg/m2/day days 1-7
611 MO MO064 MO064C and Daunorubicin 104880 115400 131100 136400 NA No NA
50mg/m2 days 1, 3 and
5
Medical
612 MO MO065 Promyelocytic MO065A Consolidation 58800 64700 73500 76500 NA No NA
Oncology
Leukemia

Medical
613 MO MO065 Promyelocytic MO065B Induction 129400 142400 161800 168300 NA No NA
Oncology
Leukemia

Medical Maintenance (18
614 MO MO065 Promyelocytic MO065C 39300 43300 49200 51100 NA No NA
Oncology months total cost)
Leukemia
Medical CT for Pediatric

615 MO MO066 MO066A COPDAC 9450 10400 11900 12300 NA No NA
Oncology Hodgkins Lymphoma

616 MO MO066 MO066B OPEA 13000 14300 16300 16900 NA No NA
CT for Pediatric
Medical
617 MO MO067 Hodgkins Lymphoma MO067A ICE 14000 15400 17500 18200 NA No NA
Oncology
Relapse
CT for Pediatric
Medical
618 MO MO067 Hodgkins Lymphoma MO067B DECA 14000 15400 17500 18200 NA No NA
Oncology
Relapse
CT for Pediatric
Medical
619 MO MO067 Hodgkins Lymphoma MO067C IGVD 34000 37400 42500 44200 NA No NA
Oncology
Relapse
LMB 89 - 96 -
Medical CT for Pediatric Non
620 MO MO068 MO068A Consolidation (second 42562.5 46900 53300 55400 NA No NA
month)
Medical CT for Pediatric Non LMB 89 - 96 - Induction -

621 MO MO068 MO068B 42412.5 46700 53100 55200 NA No NA
Oncology Hodgkins Lymphoma COPADAM ( first month)
Medical CT for Pediatric Non LMB 89 - 96 -

622 MO MO068 MO068C 65775 72400 82300 85600 NA No NA
Oncology Hodgkins Lymphoma Maintenance
Medical CT for Pediatric Non
623 MO MO068 MO068D MCP - 842 98700 108600 123400 128400 NA No NA
Medical Pediatric - Germ Cell
624 MO MO069 PEDIATRIC-GCT/JEB MO069A 10650 11800 13400 13900 NA No NA
Oncology Tumor / JEB
Medical CT for Pediatric Carboplatin + Cisplatin +
625 MO MO070 MO070A 5587.5 6200 7000 7300 NA No NA
Oncology Hepatoblastoma Doxorubicin
626 MO MO070 MO070B Cisplatin 5600 6200 7000 7300 NA No NA
Oncology Hepatoblastoma
Docetaxel
Medical
627 MO MO071 CT for CA Lung MO071A Docetaxel 75 mg/m2 D1 8500 9400 10700 11100 NA No NA
Oncology
every 21 days
Erlotinib
Medical
628 MO MO071 CT for CA Lung MO071B Erlotinib 150 mg once 4500 5000 5700 5700 NA No NA
Oncology
daily
Gefitnib
Medical
629 MO MO071 CT for CA Lung MO071C Gefitinib 250 mg once 2500 2800 3200 3200 NA No NA
Oncology
daily
630 MO MO071 CT for CA Lung MO071D 14500 16000 18200 18200 NA No NA
every 21 days
Pemetrexed +
Carboplatin
Medical Pemetrexed 500mg/m2
631 MO MO071 CT for CA Lung MO071E 10125 11200 12700 13200 NA No NA
Oncology D1
every 21 days
Topotecan
Medical
632 MO MO071 CT for CA Lung MO071F Topotecan 1.5 mg/m2 24600 27100 30800 32000 NA No NA
Oncology
D1-D5 every 21 days
Docetaxel
Medical
633 MO MO071 CT for CA Lung MO071G Docetaxel 20 mg/m2 D1 3200 3500 4000 4000 NA No NA
Oncology
every week
Etoposide 100mg/m2
Medical
634 MO MO071 CT for CA Lung MO071H D1 - D3 7687.5 8500 9700 9700 NA No NA
Oncology
every 21 days
Etoposide 100mg/m2
Medical
635 MO MO071 CT for CA Lung MO071I D1 - D3 6750 7500 8500 8500 NA No NA
Oncology
D1 every 21 days
Gemcitabine
Medical Gemcitabine 1000mg
636 MO MO071 CT for CA Lung MO071J 8975 9900 11300 11700 NA No NA
Oncology /m2 D1 D8 every 21
days
Gemcitabine +
Carboplatin
Medical Gemcitabine 1000
637 MO MO071 CT for CA Lung MO071K 13900 15300 17400 17400 NA No NA
Oncology mg/m2 D1 D8
every 21 days
Gemcitabine 1000
Medical
638 MO MO071 CT for CA Lung MO071L mg/m2 D1 D8 12150 13400 15200 15200 NA No NA
Oncology
D8 every 21 days
Paclitaxel
Medical
639 MO MO071 CT for CA Lung MO071M Paclitaxel 80mg/m2 5987.5 6600 7500 7500 NA No NA
Oncology
every week
Paclitaxel
Medical
640 MO MO071 CT for CA Lung MO071N Paclitaxel 175mg/m2 11800 13000 14800 15400 NA No NA
Oncology
every 21 days
641 MO MO071 CT for CA Lung MO071O 7700 8500 9700 9700 NA No NA
every week
Paclitaxel + Cisplatin
Medical
642 MO MO071 CT for CA Lung MO071P D1 13300 14700 16700 16700 NA No NA
Oncology
every 21 days
Pemetrexed + Cisplatin
Pemetrexed 500mg/m2
Medical
643 MO MO071 CT for CA Lung MO071Q D1 9420 10400 11800 12300 NA No NA
Oncology
every 21 days
Pemetrexed
Medical
644 MO MO071 CT for CA Lung MO071R Pemetrexed 500mg/m2 7612.5 8400 9600 9900 NA No NA
Oncology
D1 every 21 days
Vinorelbine +
Carboplatin
Medical Vinorelbine 25mg/m2
645 MO MO071 CT for CA Lung MO071S 17000 18700 21300 22100 NA No NA
Oncology D1 D8
CarboplatinAUC 5-6 D1
every 21 days
Vinorelbine + Cisplatin
Vinorelbine 25mg/m2
Medical
646 MO MO071 CT for CA Lung MO071T D1 D8 17000 18700 21300 22100 NA No NA
Oncology
every 21 days
Medical Carboplatin Carboplatin

647 MO MO072 CT for CA Cervix MO072A 2692.5 3000 3400 3600 NA No NA
Oncology AUC 2 every week
De-Angelis/MTR
(methotrexate,
Medical CT for primary CNS dexamethasone,
648 MO MO073 MO073A 36000 39600 45000 46800 NA NA
Oncology lymphoma procarbazine,
vincristine, intrathecal
MTX, CYTARABINE)
6000 per cycle. 6600 per cycle. 7500per cycle. 7500per cycle.
Medical SA Carboplatin AUC 7 Max 4 cycles Max 4 cycles Max 4 cycles Max 4 cycles
649 MO M0074 GCT Testis MO074A NA NA
Oncology once every 3 weeks once every 3 once every 3 once every 3 once every 3
week week week week
Denosumab
Denosumab 120 mg s/c 18000 per 19800 per 22500 per 22500 per
Medical
650 MO MO075 CT for GCT of bone MO075A D1, 8, 15 then every 28 dose. Max 6 dose. Max 6 dose. Max 6 dose. Max 6 NA NA
Oncology
days dose dose dose dose
Temozolamide
GEP NET
Medical 150mg/m2 D9-14 +
651 MO MO076 Neuroendocrine MO076A 8000 8800 10000 10400 NA NA
Oncology Capecitabine 1gm/me
carcinoma
D1-14 every 28 days
GEP NET high grade Carboplatin AUC 5 +
Medical
652 MO MO076 Neuroendocrine MO076B Etoposide 100mg/m2 13400 14800 16800 17500 NA NA
Oncology
carcinoma D1-D3 every 21 days
2100 2100 2300 2300 2100 HDU -
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Pediatric seizure
653 Medical MP MP001 MP001A Febrile seizures Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
disorders
Management 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
Pediatric HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Medical ICU (without ICU (without ICU (without ICU (without ICU (without
Pediatric seizure Acute non-febrile
654 Management, MP MP001 MP001D Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
disorders seizures
General 8500 8500 8800 8800 8500
Medicine ICU (with ICU (with ICU (with ICU (with ICU (with
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Epileptic Epileptic
655 Medical MP MP002 MP002A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
encephalopathy encephalopathy
Management 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
ACUTE Acute Febrile
656 Management, MP MP003 MP003A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
ENCEPHALOPATHY encephalopathy
General 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
ACUTE Acute Disseminated
657 Management, MP MP003 MP003B Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
ENCEPHALOPATHY Encephalomyelitis
General 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2300HDU - 2400 HDU - 2400 HDU - 2100 HDU -
Pediatric HDU - 3300 3630 3800 3800 3300
Medical hypertensive/metabolic/f ICU (without ICU (without ICU (without ICU (without ICU (without
ACUTE
658 Management, MP MP004 MP004A ebrile/hepatic Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
ENCEPHALOPATHY
General encephalopathy 8500 9350 9700 9700 8500
9000 9900 10350 10350 9000
2100 2300HDU - 2400 HDU - 2400 HDU - 2100 HDU -
Pediatric HDU - 3300 3630 3800 3800 3300
ACUTE INFECTIOUS
MENINGITIS AND Acute meningo
MENINGOENCEPHA encephalitis pyogenic
General 8500 9350 9700 9700 8500
LITIS.
9000 9900 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
ACUTE INFECTIOUS
MENINGITIS AND Aseptic meningitis
MENINGOENCEPHA tubercular,
General 8500 8500 8800 8800 8500
LITIS.
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
ACUTE INFECTIOUS
MENINGITIS AND Febrile encephalopathy
661 Medical MP MP005 MP005C Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
MENINGOENCEPHA fungal
Management 8500 8500 8800 8800 8500
LITIS.
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
ACUTE INFECTIOUS
MENINGITIS AND Hypertensive
662 Management, MP MP005 MP005D Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
MENINGOENCEPHA encehalopathy viral,
General 8500 8500 8800 8800 8500
LITIS.
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
ACUTE INFECTIOUS
Pediatric Metabolic ICU (without ICU (without ICU (without ICU (without ICU (without
MENINGITIS AND
663 Medical MP MP005 MP005E encephalopathy Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
MENINGOENCEPHA
Management parasitic, 8500 8500 8800 8800 8500
LITIS.
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
ACUTE INFECTIOUS Brain
MENINGITIS AND abscess/Intracranial
664 Management, MP MP005 MP005G Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
MENINGOENCEPHA abscess/ Aseptic
General 8500 8500 8800 8800 8500
LITIS. meningitis
9000 9000 10350 10350 9000
2100 2300HDU - 2400 HDU - 2400 HDU - 2100 HDU -
HDU - 3300 3630 3800 3800 3300
665 Medical MP MP006 Meningitis MP006A Chronic meningitis Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Management 8500 9350 9700 9700 8500
9000 9900 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
Partially treated
666 Management, MP MP006 Meningitis MP006B Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
pyogenic meningitis
General 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
667 Management, MP MP006 Meningitis MP006C Neuro tuberculosis Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
General 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
Complicated bacterial
668 Management, MP MP006 Meningitis MP006D Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
meningitis
General 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
669 Management, MP MP006 Meningitis MP006E Acute meningitis Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
General 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
Routine Ward -
2100 2100 2300 2300
2100 HDU -
Pediatric HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800
Raised ICP due to neuro 3300
Medical Medical Management ICU (without ICU (without ICU (without ICU (without
surgical procedures/due ICU (without
670 Management, MP MP008 for Raised intracranial MP008A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes
to trauma/malignancies/ Ventilator) -
General pressure 8500 8500 8800 8800
meningo-encephalitis 8500 ICU (with
Medicine ICU (with ICU (with ICU (with ICU (with
Ventilator) -
Ventilator) - Ventilator) - Ventilator) - Ventilator) -
9000
9000 9000 10350 10350
2100 2100 2300 2300 2100 HDU -
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Pediatric INTRACRANIAL ICU (without ICU (without ICU (without ICU (without ICU (without
671 Medical MP MP009 SPACE OCCUPYING MP009A Intracranial hemorrhage Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Management LESIONS 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2300HDU - 2400 HDU - 2400 HDU - 2100 HDU -
HDU - 3300 3630 3800 3800 3300
Pediatric INTRACRANIAL Intracranial space ICU (without ICU (without ICU (without ICU (without ICU (without
672 Medical MP MP010 SPACE OCCUPYING MP010A occupying lesion Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Management LESIONS tuberculoma, 8500 9350 9700 9700 8500
9000 9900 10350 10350 9000
2100 2300HDU - 2400 HDU - 2400 HDU - 2100 HDU -
Pediatric HDU - 3300 3630 3800 3800 3300
Medical INTRACRANIAL ICU (without ICU (without ICU (without ICU (without ICU (without
neurocysticercosis,
673 Management, MP MP011 SPACE OCCUPYING MP011A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
brain tumours
General LESIONS 8500 9350 9700 9700 8500
9000 9900 10350 10350 9000
2100 2300HDU - 2400 HDU - 2400 HDU - 2100 HDU -
Pediatric HDU - 3300 3630 3800 3800 3300
Juvenile myasthenia-
requiring admission for
674 Management, MP MP015 Juvenile myasthenia MP015A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
work-up or in-patient
General 8500 9350 9700 9700 8500
care
9000 9900 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
675 Medical MP MP016 Acute ataxia MP016A Acute ataxia Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Management 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
Acute childhood Acute asthma/Status
asthma asthmaticus
General 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Acute urticaria / Acute
Anaphylaxis urticaria/anaphylaxis
Management 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
Acute urticaria / Steven Johnson
Anaphylaxis syndrome
General 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
679 Management, MP MP021 Acute abdomen MP021A Acute abdomen pain Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
General 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Celiac disease-
680 Medical MP MP022 Celiac disease MP022A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Work Up and/or in-
Management 8500 8500 8800 8800 8500
patient management
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
Pediatric Unexplained HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Medical hepatosplenomegaly- ICU (without ICU (without ICU (without ICU (without ICU (without
Unexplained
681 Management, MP MP023 MP023A requiring admission for Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
hepatosplenomegaly
General Work Up and/or in- 8500 8500 8800 8800 8500
Medicine patient management ICU (with ICU (with ICU (with ICU (with ICU (with
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
Medical Neonatal/infantile ICU (without ICU (without ICU (without ICU (without ICU (without
Neonatal/ Infantile
682 Management, MP MP024 MP024A cholestasis / Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
cholestasis
General Choledochal cysts 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Acute Acute
glomerulonephritis glomerulonephritis
Management 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
NEPHROTIC Nephrotic syndrome
SYNDROME with peritonitis
General 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2300HDU - 2400 HDU - 2400 HDU - 2100
Pediatric HDU - 3300 3630 3800 3800 HDU - 3300
NEPHROTIC Steroid dependent or
685 Management, MP MP026 MP026B Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
SYNDROME resistent
General 8500 9350 9700 9700 8500
9000 9900 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
Haemolytic uremic Haemolytic uremic
syndrome syndrome
General 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
Global developmental
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Global developmental delay/Intellectual
delay / Intellectual disability-requiring
disability of unknown admission for Work Up
Management 8500 8500 8800 8800 8500
etiology and/or in-patient
management
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Rickets - requiring
Pediatric Rickets - requiring ICU (without ICU (without ICU (without ICU (without ICU (without
admission for Work Up
688 Medical MP MP030 admission for Work MP030A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
and/or in-patient
Management Up 8500 8500 8800 8800 8500
management
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Acute severe Acute severe
malnutrition malnutrition
Management 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Developmental and
Developmental and behavioral disorders for
behavioral disorders Work Up and/or in-
Management 8500 8500 8800 8800 8500
patient management
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Short stature- requiring
691 Medical MP MP033 Short stature MP033A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
admission for Work Up
Management 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Children with
Children with dysmorphic features-
dysmorphic features requiring admission for
Management 8500 8500 8800 8800 8500
work-up
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Pediatric Floppy infant syndrome ICU (without ICU (without ICU (without ICU (without ICU (without
Floppy infant
693 Medical MP MP035 MP035A requiring admission for Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
syndrome
Management work-up 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Inborn errors of
Inborn errors of metabolism-requiring
metabolism admission for work-up
Management 8500 8500 8800 8800 8500
and/or inpatient care
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Wilson’s disease-
695 Medical MP MP037 Wilson’s disease MP037A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
work-up and/or inpatient
Management 8500 8500 8800 8800 8500
care
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
696 Medical MP MP038 Juvenile Arthritis MP038A Juvenile Arthritis Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Management 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
Acute rheumatic fever
697 Management, MP MP039 Rheumatic fever MP039A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
General 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2300HDU - 2400 HDU - 2400 HDU - 2100
Rheumatic valvular
698 Management, MP MP039 Rheumatic fever MP039B Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
heart disease
General 8500 9350 9700 9700 8500
9000 9900 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
Cyanotic spells without
699 Management, MP MP040 Cyanotic spells MP040A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
CHD
General 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Cyanotic spells with
700 Medical MP MP040 Cyanotic spells MP040B Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
CHD
Management 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
SEVERE ANEMIA IN
701 Medical MP MP041 MP041A Iron deficiency anemia Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
CHILDREN
Management 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2300HDU - 2400 HDU - 2400 HDU - 2100
HDU - 3300 3630 3800 3800 HDU - 3300
SEVERE ANEMIA IN
702 Medical MP MP041 MP041B Thalessmia Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
CHILDREN
Management 8500 9350 9700 9700 8500
9000 9900 10350 10350 9000
2100 2300HDU - 2400 HDU - 2400 HDU - 2100
HDU - 3300 3630 3800 3800 HDU - 3300
SEVERE ANEMIA IN
703 Medical MP MP041 MP041D Other anemias Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
CHILDREN
Management 8500 9350 9700 9700 8500
9000 9900 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Pediatric Idiopathic Idiopathic ICU (without ICU (without ICU (without ICU (without ICU (without
704 Medical MP MP042 Thrombocytopenic MP042A Thrombocytopenic Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Management Purpura Purpura 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
705 Management, MP MP043 Kawasaki Disease MP043A Kawasaki Disease Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
General 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Steve Johnson Steve Johnson
syndrome syndrome
Management 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
Pediatric Ketogenic diet ICU (without ICU (without ICU (without ICU (without ICU (without
Ketogenic diet initiation
707 Medical MP MP046 initiation in refractory MP046A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
in refractory epilepsy
Management epilepsy 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
Medical Acute ICU (without ICU (without ICU (without ICU (without ICU (without
708 Management, MP MP047 Croup syndrome MP047A laryngotracheobronchitis Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
General /Acute epiglottitis 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2100 2300 2300 2100 HDU -
HDU - 3300 HDU - 3300 HDU - 3800 HDU - 3800 3300
709 Medical MP MP048 Hemostatic Disorders MP048A Hemophilia Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
Management 8500 8500 8800 8800 8500
9000 9000 10350 10350 9000
2100 2300HDU - 2400 HDU - 2400 HDU - 2100
HDU - 3300 3630 3800 3800 HDU - 3300
710 Medical MP MP048 Hemostatic Disorders MP048B Platelet disorders Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
Management 8500 9350 9700 9700 8500
9000 9900 10350 10350 9000
2100 2300HDU - 2400 HDU - 2400 HDU - 2100
NEPHROTIC Uncomplicated steroid
711 Management, MP MP050 MP050A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
SYNDROME sensitive
General 8500 9350 9700 9700 8500
9000 9900 10350 10350 9000
2100 2300HDU - 2400 HDU - 2400 HDU - 2100
HDU - 3300 3630 3800 3800 HDU - 3300
Pediatric Staphylococcal ICU (without ICU (without ICU (without ICU (without ICU (without
Staphylococcal scalded
712 Medical MP MP051 scalded skin MP051A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
skin syndrome
Management syndrome 8500 9350 9700 9700 8500
9000 9900 10350 10350 9000
Linear Accelerator,
External Beam
Radiotherapy 3D CRT
Radiation
713 MR MR004 (6 Fractions) MR001A Radical 21000 23100 26300 27300 NA No NA
Oncology
(Inclusive of
Simulation &
Planning Cost)
2D External Beam
Radiotherapy
(Telecobalt / Strock
Radiation LA)
714 MR MR001 MR001B Adjuvant 11000 12100 13800 14300 NA No NA
Oncology (6 Fractions)
(Inclusive of
Simulation &
Planning Cost)
2D External Beam
Radiotherapy
Radiation LA)
715 MR MR001 MR001C Neoadjuvant 11000 12100 13800 14300 NA No NA
(Inclusive of
Simulation &
Planning Cost)
2D External Beam
Radiotherapy
(Telecobalt / Strock Additional fractions - 18
Radiation LA) Max upto (Every
716 MR MR001 MR001D 9000 9900 11300 11700 500 (18) 9000 No NA
Oncology (6 Fractions) additional fraction at
(Inclusive of Rs.500 per Fraction)
Simulation &
Planning Cost)
2D External Beam
Radiotherapy -
Palliative (Telecobalt
Radiation / Strock LA)
717 MR MR002 MR002A Palliative 10000 11000 12500 13000 NA No NA
Oncology (Upto 10 Fractions)
(Inclusive of
Simulation &
Planning Cost)
2D External Beam
Radiotherapy
Radiation LA)
718 MR MR003 MR003A Radical 20000 22000 25000 26000 NA No NA
(Inclusive of
Simulation &
Planning Cost)
2D External Beam
Radiotherapy
Radiation LA)
(Inclusive of
Simulation &
Planning Cost)
2D External Beam
Radiotherapy
Radiation LA)
(Inclusive of
Simulation &
Planning Cost)
2D External Beam
Radiotherapy
(Telecobalt / Strock Additional fractions - 10
Radiation LA) Max upto (additional
721 MR MR003 MR003D 5000 5500 6300 6500 500 (10) 5000 No NA
Oncology (25 Fractions) fraction at Rs.500 per
(Inclusive of Fraction upto a max)
Simulation &
Planning Cost)
2D External Beam
Radiotherapy
Radiation LA)
(Inclusive of
Simulation &
Planning Cost)
Linear Accelerator,
External Beam
Radiotherapy 3D CRT
Radiation
723 MR MR004 (6 Fractions) MR004B Adjuvant 21000 23100 26300 27300 NA No NA
Oncology
(Inclusive of
Simulation &
Planning Cost)
Linear Accelerator,
External Beam
Radiotherapy 3D CRT
Radiation
724 MR MR004 (6 Fractions) MR004C Neoadjuvant 21000 23100 26300 27300 NA No NA
Oncology
(Inclusive of
Simulation &
Planning Cost)
Linear Accelerator,
External Beam
Additional fractions - 18
Radiotherapy 3D CRT
Radiation Max upto (Every
725 MR MR004 (6 Fractions) MR004D 18000 19800 22500 23400 1000 (18) 18000 No NA
Oncology additional fraction at
(Inclusive of
Rs.1000 per Fraction)
Simulation &
Planning Cost)
Linear Accelerator,
External Beam
Radiotherapy 3D CRT
Radiation
726 MR MR005 (25 Fractions) MR005A Radical 40000 44000 50000 52000 NA No NA
Oncology
(Inclusive of
Simulation &
Planning Cost)
Linear Accelerator,
External Beam
Radiotherapy 3D CRT
Radiation
727 MR MR005 (25 Fractions) MR005B Adjuvant 40000 44000 50000 52000 NA No NA
Oncology
(Inclusive of
Simulation &
Planning Cost)
Linear Accelerator,
External Beam
Radiotherapy 3D CRT
Radiation
728 MR MR005 (25 Fractions) MR005C Neoadjuvant 40000 44000 50000 52000 NA No NA
Oncology
(Inclusive of
Simulation &
Planning Cost)
Linear Accelerator,
External Beam
Radiotherapy 3D CRT
729 MR MR005 (25 Fractions) MR005D 10000 11000 12500 13000 1000 (10) 10000 No NA
(Inclusive of
Simulation &
Planning Cost)
Linear Accelerator,
External Beam
Radiotherapy IMRT
(Intensity Modulated
Radiation
730 MR MR006 Radiotherapy) MR006A Radical 70000 77000 87500 91000 NA No NA
Oncology
(20 Fractions)
(Inclusive of
Simulation &
Planning Cost)
Linear Accelerator,
External Beam
Radiotherapy IMRT
Radiation
731 MR MR006 Radiotherapy) MR006B Adjuvant 70000 77000 87500 91000 NA No NA
Oncology
(20 Fractions)
(Inclusive of
Simulation &
Planning Cost)
Linear Accelerator,
External Beam
Radiotherapy IMRT
Radiation
732 MR MR006 Radiotherapy) MR006C Neoadjuvant 70000 77000 87500 91000 NA No NA
Oncology
(20 Fractions)
(Inclusive of
Simulation &
Planning Cost)
Linear Accelerator,
External Beam
Radiotherapy IMRT
Radiation (Every additional
733 MR MR006 Radiotherapy) MR006D 30000 33000 37500 39000 2000 (15) 30000 No NA
Oncology fraction at Rs.2000 per
(20 Fractions)
Fraction)
(Inclusive of
Simulation &
Planning Cost)
Linear Accelerator,
External Beam
Radiotherapy IMRT
Radiation
734 MR MR007 Radiotherapy) MR007A Radical 42000 46200 52500 54600 NA No NA
Oncology
(6 Fractions)
(Inclusive of
Simulation &
Planning Cost)
Linear Accelerator,
External Beam
Radiotherapy IMRT
Radiation
735 MR MR007 Radiotherapy) MR007B Adjuvant 42000 46200 52500 54600 NA No NA
Oncology
(6 Fractions)
(Inclusive of
Simulation &
Planning Cost)
Linear Accelerator,
External Beam
Radiotherapy IMRT
Radiation
736 MR MR007 Radiotherapy) MR007C Neoadjuvant 42000 46200 52500 54600 NA No NA
Oncology
(6 Fractions)
(Inclusive of
Simulation &
Planning Cost)
Linear Accelerator,
External Beam
Radiotherapy IMRT
737 MR MR007 Radiotherapy) MR007D 36000 39600 45000 46800 2000 (18) 36000 No NA
(6 Fractions)
(Inclusive of
Simulation &
Planning Cost)
Linear Accelerator
External Beam
Radiotherapy IGRT
(Image Guided
Radiation radiotherapy) with 3D
Oncology CRT or IMRT
(20 Fractions)
(Inclusive of
Simulation &
Planning Cost)
Linear Accelerator
External Beam
Radiotherapy IGRT
(Image Guided
(20 Fractions)
(Inclusive of
Simulation &
Planning Cost)
Linear Accelerator
External Beam
Radiotherapy IGRT
(Image Guided
(20 Fractions)
(Inclusive of
Simulation &
Planning Cost)
Linear Accelerator
External Beam
Radiotherapy IGRT
(Image Guided
Max upto
741 MR MR008 MR008D (Every additional 37500 41300 46900 48800 2500 (15) 37500 No NA
fraction at Rs.2500 per
(20 Fractions)
Fraction)
(Inclusive of
Simulation &
Planning Cost)
Linear Accelerator
External Beam
Radiotherapy IGRT
(Image Guided
(6 Fractions)
(Inclusive of
Simulation &
Planning Cost)
Linear Accelerator
External Beam
Radiotherapy IGRT
(Image Guided
(6 Fractions)
(Inclusive of
Simulation &
Planning Cost)
Linear Accelerator
External Beam
Radiotherapy IGRT
(Image Guided
(6 Fractions)
(Inclusive of
Simulation &
Planning Cost)
Linear Accelerator
External Beam
Radiotherapy IGRT
(Image Guided Additional fractions - 18
Radiation radiotherapy) with 3D Max upto
745 MR MR009 MR009D 45000 49500 56300 58500 2500 (18) 45000 No NA
Oncology CRT or IMRT Every additional fraction
(6 Fractions) at Rs.2500 per Fraction
(Inclusive of
Simulation &
Planning Cost)
SRT / SBRT with
IGRT
(Stereotacatic
SRT / SBRT with IGRT
Radiation radiotherapy)
746 MR MR010 MR010A (Stereotacatic 82000 90200 102500 106600 NA No NA
radiotherapy)
(Inclusive of
Simulation &
Planning Cost)
SRT / SBRT with
IGRT
(Stereotacatic Additional fractions - 4
Radiation radiotherapy) Every additional fraction
747 MR MR010 MR010B 44000 48400 55000 57200 11000 (4) 44000 No NA
Oncology (4 Fractions) at Rs.11000 per
(Inclusive of Fraction
Simulation &
Planning Cost)
SRS with IGRT
(Stereotacatic
SRS with IGRT
Radiation radiotherapy)
748 MR MR011 MR011A (Stereotacatic 70000 77000 87500 91000 NA No NA
Oncology (Inclusive of
radiotherapy)
Simulation &
Planning Cost)
Respiratory Gating
along with Linear
Accelerator planning Respiratory Gating
Radiation
749 MR MR012 (5 Fractions) MR012A along with Linear 65000 71500 81300 84500 NA No NA
Oncology
(Inclusive of Accelerator planning
Simulation &
Planning Cost)
Respiratory Gating
along with Linear
Accelerator planning
Radiation Max upto
750 MR MR012 (5 Fractions) MR012B 35000 38500 43800 45500 3500 (10) 35000 No NA
Oncology Every additional fraction
(Inclusive of
at Rs.3500 per Fraction
Simulation &
Planning Cost)
Brachytherapy High
Dose Radiation
Radiation
751 MR MR013 (2D/X-ray) MR013A Intracavitory 3500 3900 4400 4600 NA No NA
Oncology
(Maximum of 4
session)
Brachytherapy High
Dose Radiation
Radiation
752 MR MR013 (2D/X-ray) MR013B Intraluminal 3500 3900 4400 4600 NA No NA
Oncology
(Maximum of 4
session)
Brachytherapy High
Dose Radiation
Radiation
753 MR MR013 (2D/X-ray) MR013C Endobiliary 3500 3900 4400 4600 NA No NA
Oncology
(Maximum of 4
session)
Brachytherapy High
Dose Radiation
Radiation
754 MR MR013 (2D/X-ray) MR013D Endobronchial 3500 3900 4400 4600 NA No NA
Oncology
(Maximum of 4
session)
Brachytherapy High
Dose Radiation
Radiation
755 MR MR013 (2D/X-ray) MR013E CVS 3500 3900 4400 4600 NA No NA
Oncology
(Maximum of 4
session)
Brachytherapy High
Dose Radiation (5
doses) Interstitial / Intracavitary
Radiation
756 MR MR014 (Inclusive of MR014A complex planning like 42000 46200 52500 54600 NA No NA
Oncology
Simulation, Planning CT or MR
Cost, OT & other
charges )
Brachytherapy High
Dose Radiation (5
doses) Surface Mould /
Radiation
757 MR MR014 (Inclusive of MR014B Intracavitary complex 42000 46200 52500 54600 NA No NA
Oncology
Simulation, Planning planning like CT or MR
Cost, OT & other
charges )
Brachytherapy High
Dose Radiation (5
doses)
Radiation
758 MR MR014 (Inclusive of MR014C Additional fractions - 11 18750 20700 23500 24400 1250 (15) 18750 No NA
Oncology
Simulation, Planning
Cost, OT & other
charges )
large Dose scan/ Pre
Radiation iodine treatment 3
759 MR MR015 MR015A Ablation - calculation of 10290 11400 12900 13400 NA NA
Oncology mCi
treatment
Radiation iodine treatment 30 Ablation residual
760 MR MR015 MR015B 15290 16900 19200 19900 NA NA
Oncology mCi disease any risk
Ablation of residual neck
Radiation Iodine treatment 50
761 MR MR016 MR016A disease 16290 18000 20400 21200 NA NA
Oncology mCi
low/intermediate
Radiation Iodine treatment 100 Ablation for metastatic
762 MR MR017 MR017A 20290 22400 25400 26400 NA NA
Oncology mCi disease, High risk
763 MR MR018 MR018A 27290 30100 34200 35500 NA NA
764 MR MR019 MR019A 31290 34500 39200 40700 NA NA
765 MR MR020 MR020A 36290 40000 45400 47200 NA NA
Pre Procedure workup-

Donor/ Recipient,
Immunosuppressives,
Organ and
Transplant and
766 Tissue OT OT001 Renal Transplant OT001A 225000 281300 319500 337500 NA No NA
Induction for recipients
Transplant
with unrelated/deceased
donor/or at high risk for
rejection
Bannff
typeII/III/
Organ and
Antibody
767 Tissue OT OT001 Renal Transplant OT001C Banff type 1Aor 1B 40000 50000 56800 60000 NA Yes
mediated
Transplant
rejection
:150000
Organ and
Post-Transplant
768 Tissue OT OT001 Renal Transplant OT001D 40000 50000 56800 60000 NA No NA
Medication – Month 1-3
Transplant
Organ and
Post-Transplant
769 Tissue OT OT001 Renal Transplant OT001E 30000 37500 42600 45000 NA No NA
Medication – Month 3-6
Transplant
Organ and Post-Transplant
770 Tissue OT OT001 Renal Transplant OT001F Medication – Month 6- 30000 37500 42600 45000 NA No NA
Transplant 12
Pre Transplant
Organ and Bone Marrow
Evaluation and Stem
771 Tissue OT OT002 Transplant OT002A 100000 125000 142000 150000 NA NA
Cell Collection and
Transplant (Autologous)
Cryopreservation
Transplant
772 Tissue OT OT002 Transplant OT002B 250000 312500 355000 375000 NA NA
(includes conditioning)
Post Transplant Care for
3 months
773 Tissue OT OT002 Transplant OT002C 50000 62500 71000 75000 NA NA
(includes supportive
care and investigations)
Palliative Care
Approach to
managing
Urology/Medic Haematuria in
al/Surigal advanced cancer Hematuria Palliative
774 PM PM001 PM001A 40000 44000 50000 52000 NA NA
Oncology/Radi patients- Interventions
otherapy Endoscopic/Surgical/
Radiological,
Radiotherpay
interventions
Surgical
Management of Haemostatic Surgery in
Oncology/Radi
bleeding malignant advance cancer
775 ation Oncology PM PM002 PM002A 40000 44000 50000 52000 NA NA
head and neck / patient/Haemostatic
/ Genral
inguinal lesions Radiotherapy
Surgery
Management of
Surgical
bleeding in malignant Trans arterial
776 Oncology/Radi PM PM003 PM003A 60000 66000 75000 78000 NA NA
head and neck / Embolization
ation Oncology
inguinal malignancies
Surgical
Oncology/ Oro- Palliative Care
facio-maxillary Management of Osteoradionecrosis -
777 PM PM004 PM004A 40000 44000 50000 52000 NA NA
surgeons / Osteoradionecrosis - Surgical intervention
Radiation Surgical intervention
Oncology
Palliative Care
approach to
Surgical
managing Pressure
Oncology / Pressure sore-
778 PM PM005 sore in advanced PM005A 40000 44000 50000 52000 NA NA
PMR / General Interventions
chronic diseases who
Surgery
are bed ridden-
Surgical
Palliative surgical
interventions like-
Colostomy,
Tracheostomy,
Surgical /
Feeding
Medical / Palliative surgical
779 PM PM006 Jejunostomy/Gastrost PM006A 40000 44000 50000 52000 NA NA
Radiation interventions
omy, Bowel bypas,
Oncology
Fistulas, Urinary
diversions etc.in
advanced cancer
patients
Malignant Spinal
Cord compression
Radiation with Diagnostics,
Malignant Spinal cord
780 Oncology/Neur PM PM007 palliative PM007A 15000 16500 18800 19500 NA NA
compression
osurgery radiotherapy, Brace in
advanced cancer
patients
Palliative
Radiation nerurosurgical
Palliative neurological
781 Oncology/Neur PM PM008 interventions for PM008A 60000 66000 75000 78000 NA NA
interventions
osurgery secondary vertebral
and brain metastasis
Palliative Care 3300 3630 3800 3800 3300
palliativemedic Management of ICU (without ICU (without ICU (without ICU (without ICU (without
Osteoradionecrosis -
782 ine / PM PM009 Osteoradionecrosis - PM009A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
Conservative
orthopedics Conservative 8500 9350 9700 9700 8500
management ICU (with ICU (with ICU (with ICU (with ICU (with
9000 9900 10350 10350 9000
Communications in
Adavnced chronic
diseases/ terminal
3300 3630 3800 3800 3300
stage of illness, for
Palliativemedci Communications ICU (without ICU (without ICU (without ICU (without ICU (without
patient and family
783 ne /general PM PM010 PM010A terminal stage/ end of Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
members with
medicine life care Conservative 8500 9350 9700 9700 8500
discussions on Goals
of care and facilitated
shared decision
9000 9900 10350 10350 9000
making
Palliative care
management of
3300 3630 3800 3800 3300
Breathlessness in
Palliativemedci ICU (without ICU (without ICU (without ICU (without ICU (without
advanced cancers Palliative Management
784 ne /general PM PM011 PM011A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
and chronic of Breathlessnes
medicine 8500 9350 9700 9700 8500
respiratory diseases -
Conservative
management
9000 9900 10350 10350 9000
Palliative Care 3300 3630 3800 3800 3300
Palliativemedci Management of Pain ICU (without ICU (without ICU (without ICU (without ICU (without
Cancer Pain
785 ne /general PM PM012 for treating Pain PM012A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
Management
medicine crisis, analgesic 8500 9350 9700 9700 8500
titration ICU (with ICU (with ICU (with ICU (with ICU (with
9000 9900 10350 10350 9000
Palliative Care 3300 3630 3800 3800 3300
Palliativemedci approach to ICU (without ICU (without ICU (without ICU (without ICU (without
Pressure sore-in
786 ne /general PM PM013 managing Pressure PM013A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
palliative care
medicine sore -Conservative 8500 9350 9700 9700 8500
9000 9900 10350 10350 9000
3300 3630 3800 3800 3300
Palliative Care Hiccups in Palliative
Package for Hiccups care
medicine 8500 9350 9700 9700 8500
9000 9900 10350 10350 9000
Conservative
management of post
procedural or
3300 3630 3800 3800 3300
teratment related
complications in Complications in
palliative medicine palliative care patients
medicine 8500 9350 9700 9700 8500
including electrolyte
disorders (including
hypercalcemia and
9000 9900 10350 10350 9000
ketoacidosis).
Malignant Ascites
Pallative drainage with long
Ascitis tapping with long
789 medicine/medi PM PM016 term catheter PM016A 40000 44000 50000 52000 NA NA
term indwelling catheter
cal oncology insertion in advanced
cancer patients
Palliative Care
Approach to
3300 3630 3800 3800 3300
managing
Pallative ICU (without ICU (without ICU (without ICU (without ICU (without
Haematuria in Hematuria in advance
790 medicine/medi PM PM017 PM017A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
advanced cancer cancer patient
cal oncology 8500 9350 9700 9700 8500
patients -
Conservative
management
9000 9900 10350 10350 9000
Central lines in
cancer patients for
Pallative drug therapy -Silicon
Long term indwelling
791 medicine/medi PM PM018 catheters in PM018A 10000 11000 12500 13000 NA NA
venous catheter
cal oncology advanced cancer
patients- Long term
central lines
Symptom
3300 3630 3800 3800 3300
Management of Intractable Cough in
Pallative ICU (without ICU (without ICU (without ICU (without ICU (without
Cough in advanced cancer patients -
792 medicine/medi PM PM019 PM019A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
cancer patients - Conservative
cal oncology 8500 9350 9700 9700 8500
Conservative management
management
9000 9900 10350 10350 9000
Palliative Care 3300 3630 3800 3800 3300
Pallative Management of ICU (without ICU (without ICU (without ICU (without ICU (without
Palliative care in
793 medicine/medi PM PM020 Trismus, mucositis in PM020A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
Trismus mucositis
cal oncology advanced cancer 8500 9350 9700 9700 8500
patient ICU (with ICU (with ICU (with ICU (with ICU (with
9000 9900 10350 10350 9000
Management of 3300 3630 3800 3800 3300
Conservative
Pallative terminal /fatal ICU (without ICU (without ICU (without ICU (without ICU (without
management of fatal
794 medicine/medi PM PM021 bleeding malignant PM021A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
bleeding in cancer
cal oncology head and neck / 8500 9350 9700 9700 8500
patients
inguinal lesions ICU (with ICU (with ICU (with ICU (with ICU (with
9000 9900 10350 10350 9000
Palliative Care 3300 3630 3800 3800 3300
Pallative Management of ICU (without ICU (without ICU (without ICU (without ICU (without
Fatigue in Palliative
795 medicine/medi PM PM022 Symptom Cluster – PM022A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
care
cal oncology Fatigue in advanced 8500 9350 9700 9700 8500
cancer patients ICU (with ICU (with ICU (with ICU (with ICU (with
9000 9900 10350 10350 9000
Malignant Pleural
Effusion for Pleural
Medical/Suriga
tap with Pig tail
l/Radiation
catheter/chest tube Pleural effusion &
796 Oncology and PM PM023 PM023A 7500 8300 9400 9800 NA NA
insertion with Pleurodesis
Pulmonary
Pleurodesis in
Medicine
advanced cancer
patients
Malignant Ascites Management of 3300 3630 3800 3800 3300
Medical/Suriga
drainage with malignant ICU (without ICU (without ICU (without ICU (without ICU (without
l/Radiation
797 PM PM024 catheter insertion in PM024A Ascitis,Tapping & Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
Oncology &
advanced cancer conservative 8500 9350 9700 9700 8500
Radiology
patients management ICU (with ICU (with ICU (with ICU (with ICU (with
9000 9900 10350 10350 9000
Symptom
Medical/Suriga Management of
l/ Radiation Cough in advanced
Malignant Cough-
798 Oncology and PM PM025 cancer patients- PM025A 40000 44000 50000 52000 NA NA
Invasive intervantions
Pulmonary endoscopic/Surgical/
Medicine Radiological/Radiothe
rpay interventions
Palliative care
management of
Breathlessness in
Medical/Suriga
advanced cancers
l/ Radiation Palliative
and chronic
799 Oncology and PM PM026 PM026A Breathlessness 40000 44000 50000 52000 NA NA
respiraroty diseases-
Pulmonary Intervntions
endoscopic/Surgical/
Medicine
Radiological,
Radiotherpay
interventions
Symptom
3300 3630 3800 3800 3300
Management of
Medical/Suriga Palliative Delirium in ICU (without ICU (without ICU (without ICU (without ICU (without
Delirium in advanced
800 l/ Radiation PM PM027 PM027A advance chronic Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
chronic diseases -
Oncology disease 8500 9350 9700 9700 8500
Conservative
management
9000 9900 10350 10350 9000
Palliative Care
approach for
3300 3630 3800 3800 3300
Medical/Suriga malignant wound -
Palliative Wound ICU (without ICU (without ICU (without ICU (without ICU (without
l Conservative
801 PM PM028 PM028A Conservative Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
Oncology/Radi management using
management 8500 9350 9700 9700 8500
otherapy drugs and dressings
including special
dressings.
9000 9900 10350 10350 9000
Palliative Care
Management of
Medical/Suriga Constipation in
l / Radiation advanced cancer Constipation - Palliative
802 PM PM029 PM029A 30000 33000 37500 39000 NA NA
oncology & patients - Invasive interventions
Radiology endoscopic/Surgical/
Radiological
interventions
Palliative care
management of
Nausea &Vomiting in
Medical/Suriga
advanced cancer
l / Radiation Pallitive Nausea and
803 PM PM030 patients- PM030A 30000 33000 37500 39000 NA NA
Oncology & vomiting interventions
Endoscopic/Surgical/
Radiology
Radiological,
Radiotherapy
interventions.
Palliative Care
Management of
Lymphadema in
3300 3630 3800 3800 3300
cancer patients
Medical/Suriga Conservative ICU (without ICU (without ICU (without ICU (without ICU (without
including
804 l / Radiation PM PM031 PM031A management of Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
(Information,
oncology Lymphedema 8500 9350 9700 9700 8500
Education,
Communication
(IEC), and pneumatic
9000 9900 10350 10350 9000
compression therapy
Palliative Radiological
Medical/Suriga Palliative Radiological Interventions. Like-
805 l & Radiation PM PM032 and endoscopical PM032A PTBD/ERCP/PCN//Peric 20000 22000 25000 26000 NA NA
Oncology Interventions ardiostomy, DJ Stenting,
etc
Medical,
Surgical
Vertebroplasty/Kypho Vertebroplasty/Kyphopla
806 Radiation PM PM033 PM033A 40000 44000 50000 52000 NA NA
plasty sty
Oncology /
Orthopaedics
Palliative Care 2100 HDU - 2300HDU - 2400 HDU - 2400 HDU - 2100 HDU -
Management of 3300 3630 3800 3800 3300
Constipation in ICU (without ICU (without ICU (without ICU (without ICU (without
Medical Palliative care in
807 PM PM034 advanced cancer PM034A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
Oncology Constipation
patients - 8500 9350 9700 9700 8500
Conservative ICU (with ICU (with ICU (with ICU (with ICU (with
menagament Ventilator) - Ventilator) - Ventilator) - Ventilator) - Ventilator) -
9000 9900 10350 10350 9000
Palliative Care
3300 3630 3800 3800 3300
management of Palliative care in Bowel
Medical Malignant bowel Obstruction
808 PM PM035 PM035A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
Oncology obstruction - Conservative
8500 9350 9700 9700 8500
Conservative management
management
9000 9900 10350 10350 9000
Medical / Palliative Care

Surgical management of
oncology/ Malignant bowel Palliative Bowel
809 gastroenterolo PM PM036 obstruction- PM036A Obstruction 40000 44000 50000 52000 NA NA
gy / / Radiation endoscopic/Surgical/ interventions
Oncology & Radiological
Radiology interventions
Palliative
management of
3300 3300 3800 3800 3300
thrombosis and
Medical / Thrombosis and ICU (without ICU (without ICU (without ICU (without ICU (without
embolism like DVT,
810 Radiation PM PM036 PM036A Embolism in chronic Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
Pulmonary embolism
Oncology disease 8500 8500 9700 9700 8500
in advanced chronic
diseases, TED
stockings
9000 9000 10350 10350 9000
Palliative care
3300 3630 3800 3800 3300
management of
Medical & ICU (without ICU (without ICU (without ICU (without ICU (without
Nausea & Vomiting in Pallitive care in Nausea
811 Radiation PM PM037 PM037A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
cancer patients- and vomiting.
Oncology 8500 9350 9700 9700 8500
Conservative
management
9000 9900 10350 10350 9000
Management of 3300 3630 3800 3800 3300
General
Diarrhea in cancer ICU (without ICU (without ICU (without ICU (without ICU (without
medicine/Medi Palliative care in
812 PM PM038 patients - PM038A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
cal & Radiation Diarrhoea
Conservative 8500 9350 9700 9700 8500
Oncology
9000 9900 10350 10350 9000
Cardiac,
Palliative and 3300 3630 3800 3800 3300
Neuro,
supportive care for ICU (without ICU (without ICU (without ICU (without ICU (without
Pulmonary, Palliative care end stage
813 PM PM039 non-malignant PM039A Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Ventilator) -
Nephrology & disease
disease at advanced 8500 9350 9700 9700 8500
Geriatric
or end stage ICU (with ICU (with ICU (with ICU (with ICU (with
Medicine
9000 9900 10350 10350 9000
Spinal/Epidural/Regio
Anaesthesiolo
nal Nerve block,
gy/Pain Cancer pain
814 PM PM040 Radiofrequency PM040A 7500 8300 9400 9800 NA NA
specialists/Rad interventions
ablation (RFA) for
iology
analgesia
Celiac Plexus
Block/Hypogastric
Anaesthesiolo
plexus block/ganglion
gy/Pain Cancer pain plexus
815 PM PM041 impar block and PM041A 10000 11000 12500 13000 NA NA
specialists/Rad interventions
Neurolysis in
iology
advanced cancer
patients
Orthopedics, Fracture -
Fracture - Conservative
Emergency Conservative
816 SB SB001 SB001A Management - 2300 2300 2600 2900 NA No NA
Room Management -
Without plaster
Packages Without plaster
Application of Skeletal Tractions with Pin Cost - 300
817 Orthopedics SB SB002 SB002A 3468.75 3500 4100 4400 300/pin No NA
Traction pin per pin
Application of
818 Orthopedics SB SB002 SB002B Skin Traction 825 900 1000 1100 NA No NA
Traction
Application of P.O.P.
819 Orthopedics SB SB003 SB003A Upper Limbs 3000 3000 3600 3800 NA No NA
casts
820 Orthopedics SB SB003 SB003B Lower Limbs 3000 3000 3600 3800 NA No NA
casts
821 Orthopedics SB SB004 SB004A Spikas 3500 3500 4100 4400 NA No NA
Spikas & Jackets
822 Orthopedics SB SB004 SB004B Jackets 3500 3500 4100 4400 NA No NA
Spikas & Jackets
tubular external
fixator with 6
shanz pins and Tubular
single rod exteranl fixator
assembly - with 6 shaz
8000 pins and single
double rod rodassembly-
assembly - 10000
External fixation of
823 Orthopedics SB SB005 SB005A Long bone 14000 14000 16400 17500 10000 Duble Rod No NA
Fracture
ilizarov fixator assembly for
assembly for tibia -12000
tibia -12000 ilizarov fixator
ilizarov fixator for femur -7000
assembly for Jess fixator -
femur -7000 7000
JESS fixator -
7000
External fixation of External
824 Orthopedics SB SB005 SB005B Small bone 9500 9500 11200 11900 7000 No NA
Fracture Fixator - 7000
External fixation of External
825 Orthopedics SB SB005 SB005C Pelvis 19200 19200 22500 24000 7000 No NA
Fracture Fixator - 7000
External fixation of Both bones - forearms + External
826 Orthopedics SB SB005 SB005D 14000 14000 16400 17500 7000 No NA
Fracture JESS Ligamentotaxis Fixator - 7000
K - Wire - 250
Percutaneous - Percutaneous - Fixation 250 per wire LA - 3000
827 Orthopedics SB SB006 SB006A 3000 3000 3600 3800 per wire Yes
Fixation of Fracture of Fracture 1000 per screw GA - 8000
Screw - 1000
per screw
Elastic nailing for
828 Orthopedics SB SB007 SB007A Femur + shaft tibia 11000 11000 12900 13800 (Elastic Nail) - 5000 No NA
fracture fixation
5000
Elastic nailing for
829 Orthopedics SB SB007 SB007B Humerus 19100 19100 22400 23900 (Elastic Nail) - 5000 No NA
fracture fixation
5000
Elastic nailing for
830 Orthopedics SB SB007 SB007C Forearm 17300 17300 20300 21700 (Elastic Nail) - 5000 No NA
fracture fixation
5000
Plates, screws Per

and K wire - plate/screw/
1500 per plate, kwire -1500,
Internal Fixation of
831 Orthopedics SB SB008 SB008A ORIF Small Bones 11300 11300 13300 14200 one 6 hole one 6 hole No NA
Small Bones
small DCP with small DCP with
screws -3500 screws- 3500
per plate per plate
Locking Plate
for
Metaphyseal longbone -
Fracture - Long
Fracture - Long Bones - fracture - Long 7000 /plate,
832 Orthopedics SB SB009 Bones - Metaphyseal - SB009A 16400 16400 19200 20500 No NA
Metaphyseal - ORIF Bone - 7000 CC screw -
ORIF
per plate, CC 1000 per screw
Screw -1000
per screw
Plate for ORIF -

Diaphyseal
Fixation of
fracture - Long per plate -6000
833 Orthopedics SB SB010 Diaphyseal Fracture - SB010A ORIF Long Bones 20800 20800 24400 26000 No NA
Bone - 6000 Nail -7000
Long Bone
per plate, Nail -
7000 per nail
IM Nail for
Fixation of Closed Reduction & CR&F -
834 Orthopedics SB SB010 Diaphyseal Fracture - SB010B Internal Fixation of long 20800 20800 24400 26000 Diaphyseal 7000 No NA
Long Bone bones Fixation fracture - Long
Bone - 7000
Plate for
Surgery for Comminuted
Plating olecrenon
835 Orthopedics SB SB011 Comminuted Fracture SB011A 11800 11800 13900 14800 Fracture - 8000 No NA
fracture, ulna
- Olecranon of Ulna Olecranon of
Ulna - 8000
(Plate / Screw)
Plate /screw-
- 8000 per
8000per piece,
836 Orthopedics SB SB012 Fracture Head radius SB012A Fixation 10000 10000 11700 12500 piece, Herbert No NA
Herbert screw-
screw - 2500
2500
per screw
837 Orthopedics SB SB012 Fracture Head radius SB012B Excision 9200 9200 10800 11500 NA No NA
Nail - 2000 per

Fracture - Single Fracture - Single Bone - Per nail-2000,
nail, Plate -
Bone - Forearm - Forearm - ORIF - Plate -5000
838 Orthopedics SB SB013 SB013A 8900 8900 10500 11200 5000 per plate, No NA
ORIF - Plating / Plating / small DCP with
one small DCP
Nailing Nailing/DCP/LCP screw -2500
with screw-
2500 per piece
Fracture - Both Bones -

Fracture - Both Bones two Plates with 2 plateswith
Forearm - ORIF -
839 Orthopedics SB SB014 - Forearm - ORIF - SB014A 16100 16100 18900 20200 screw -5000 , screw-5000 No NA
Plating / Nailing
Plating / Nailing Nails - 2000 nail 2000
/DCP/LCP
per nail
Implant for
Fracture Condyle
Fracture Condyle -
840 Orthopedics SB SB015 SB015A Lateral Condyle 8500 8500 10000 10700 - 1500 No NA
Humerus - ORIF
Humerus - ORIF -
1500
Implant for
Fracture Condyle
Fracture Condyle - ORIF with screw/wire of
841 Orthopedics SB SB015 SB015B 8500 8500 10000 10700 - 1500 No NA
Humerus - ORIF Medial Condyle
Humerus - ORIF -
1500
ORIF Fracture
Fracture intercondylar
intercondylar Humerus + (TBW + 2
842 Orthopedics SB SB016 Humerus + olecranon SB016A 15100 15100 17700 18900 11000 No NA
olecranon osteotomy + Plates) - 11000
osteotomy
TBW
Displaced Clavicle Open Reduction Internal
843 Orthopedics SB SB017 SB017A 17000 17000 19900 21300 (Plate) - 3000 3000 No NA
Fracture Fixation
Fracture - ORIF THROUGH Single - Recon Plate
844 Orthopedics SB SB018 SB018A 28000 28000 32800 35000 10000 No NA
Acetabulum Approach PLATING (2) - 10000
ORIF THROUGH
Fracture - - Recon Plate
845 Orthopedics SB SB018 SB018B combined Approach 33500 33500 39200 41900 15000 No NA
Acetabulum (3) - 15000
PLATING
Cannulated
Screws for
Closed
Closed Reduction and
Fracture - Neck Reduction and
846 Orthopedics SB SB019 SB019A Percutaneous Screw 15500 15500 18200 19400 5000 No NA
Femur Percutaneous
Fixation
Screw Fixation
(neck femur) -
5000
Dynamic Hip
ORIF Intertrochanteric Screw for
Fracture - Neck
847 Orthopedics SB SB019 SB019B Fracture with Dynamic 18400 18400 21600 23000 Intertrochanteri 5000 No NA
Femur
Hip Screw c Fracture -
5000
ORIF Intertrochanteric Proximal
Fracture - Neck
848 Orthopedics SB SB019 SB019C Fracture with Proximal 16100 16100 18900 20200 Femoral Nail - 8000 No NA
Femur
Femoral Nail 8000
Implant for
Ankle Fracture
ORIF
ORIF of medial Tension Band Per Tension
malleolus or bimalleolar Wire - 1500 band -1500,
849 Orthopedics SB SB020 Ankle Fractures SB020A 15600 15600 18300 19500 No NA
fracture or Trimalleolar per tension plate 5000
fracture band ,Plate - screw -1000
5000 per plate,
Screw - 1000
per screw
Implant for
Cervical spine
fixation
including
odontoid
(Screw) - 5000
Implant for
Cervical spine
Screw -5000
fixation
Cervical spine fixation Cervical spine fixation Odontoid
850 Orthopedics SB SB021 SB021A 21300 26700 30300 32000 including No NA
including odontoid including odontoid screw-20000
odontoid
Cage-10000
(Odontoid
Screw) - 20000
Implant for
Cervical spine
fixation
including
odontoid
(Cage) - 10000
(Plate including
screw) (6) -
5000
Dorsal and lumber spine plate including
Dorsal and lumber or
851 Orthopedics SB SB022 SB022A fixation THROUGH 40000 50000 56800 60000 screw-5000 No NA
spine fixation Implant for
Anterior approach cage -10000
Dorsal and
lumber spine
fixation (Cage) -
10000
(Plate including
screw) - 5000
per plate
or plate including
Implant for screw-5000
Dorsal and lumber spine
Dorsal and lumber Dorsal and cage -10000
852 Orthopedics SB SB022 SB022B fixation THROUGH 30000 37500 42600 45000 No NA
spine fixation lumber spine pedicle screws
Posterior approach
fixation (Cage) - and rods -
10000 or 25000
IMPLANT
(PEDICLE
SCREWS +
RODS)-25000
Bone grafting for Non Bone grafting for

853 Orthopedics SB SB023 SB023A 18600 18600 21800 23300 NA No NA
union Fracture Non union
Arthorotomy of any
854 Orthopedics SB SB024 SB024A Arthorotomy of any joint 14000 14000 16400 17500 NA No NA
joint
855 Orthopedics SB SB025 Arthrolysis of joint SB025A Elbow 15000 15000 17600 18800 NA No NA
856 Orthopedics SB SB025 Arthrolysis of joint SB025B Knee 15000 15000 17600 18800 NA No NA
857 Orthopedics SB SB025 Arthrolysis of joint SB025C Ankle 15000 15000 17600 18800 NA No NA
Ankle / Triple with
858 Orthopedics SB SB026 Arthrodesis SB026A 17100 17100 20100 21400 NA No NA
implant
(Screw / Plate)
859 Orthopedics SB SB026 Arthrodesis SB026B Shoulder 17100 17100 20100 21400 5000 No NA
- 5000
860 Orthopedics SB SB026 Arthrodesis SB026C Wrist, Wrist with plating 17100 17100 20100 21400 (Plate) - 5000 5000 No NA
Comprehensiv
-Compression
Knee, Knee with e assembly-
861 Orthopedics SB SB026 Arthrodesis SB026D 17100 17100 20100 21400 Assembly - No NA
plating/Nailing 5000 ilizarov-
5000/ Ilizarov -
10000
10000
Orthopedics,
862 Surgical SB SB026 Arthrodesis SB026E Hand 27000 27000 31600 33800 NA No NA
Oncology
Orthopedics,
863 Surgical SB SB026 Arthrodesis SB026F Foot 27000 27000 31600 33800 NA No NA
Oncology
Ankle / Triple without
864 Orthopedics SB SB026 Arthrodesis SB026G 17400 17400 20400 21800 NA No NA
implant
865 Orthopedics SB SB027 Disarticulation SB027A Hind quarter 25000 31300 35500 37500 NA No NA
866 Orthopedics SB SB027 Disarticulation SB027B Fore quarter 25000 25000 29300 31300 NA No NA
Closed reduction of
867 Orthopedics SB SB028 SB028A Hip 11400 11400 13400 14300 NA No NA
joint dislocation
Closed reduction of
868 Orthopedics SB SB028 SB028B Shoulder 5500 5500 6500 6900 NA No NA
joint dislocation
Closed reduction of
869 Orthopedics SB SB028 SB028C Elbow 13200 13200 15500 16500 NA No NA
joint dislocation
Closed reduction of
870 Orthopedics SB SB028 SB028D Knee 11400 11400 13400 14300 NA No NA
joint dislocation
Open Reduction of
Small Joint without
Open Reduction of
871 Orthopedics SB SB029 SB029A fixation/Open Reduction 8500 8500 10000 10700 (K - Wire) - 300 300/per wire No NA
Small Joint
of Small Joint with for each K wire
fixation
872 Orthopedics SB SB030 Tension Band Wiring SB030A Tension Band Wiring 13000 13000 15300 16300 (Wire) - 2000 2000 No NA
Implant for
Unipolar
873 Orthopedics SB SB031 Hemiarthroplasty SB031A Unipolar 17400 17400 20400 21800 4000 No NA
Hemiarthroplas
ty - 4000
Non - Modular -
Non -
Cemented - Non cemented -
Bipolar (Non - Modular)
8500 8500
874 Orthopedics SB SB031 Hemiarthroplasty SB031B cemented /non 17400 17400 20400 21800 No NA
or Cemented
cemented
Non - Modular - 12000
Cemented -
12000
Modular -
Cemented - Cemeneted-
Bipolar (Modular)
20000, 20000
875 Orthopedics SB SB031 Hemiarthroplasty SB031C cemented/non 17400 17400 20400 21800 No NA
Modular - Uncemented -
cemented
Uncemented - 25000
25000
(Plate/ screw /
AC Joint
Fibre wire /
876 Orthopedics SB SB032 reconstruction / SB032A Rockwood Type - I 20500 20500 24000 25700 10000 No NA
reconstruction
Stabilization
by tendon etc) -
10000
(Plate/ screw /
AC Joint
Fibre wire /
877 Orthopedics SB SB032 reconstruction / SB032B Rockwood Type - II 20500 20500 24000 25700 10000 No NA
reconstruction
Stabilization
by tendon etc) -
10000
(Plate/ screw /
Fibre wire /
AC Joint reconstruction
tendon/implant
878 Orthopedics SB SB032 reconstruction / SB032C Rockwood Type - III 20500 20500 24000 25700 by tendon etc) - No NA
10000
Stabilization 10000, Indian
readymade
Implant -
10000
(Plate/ screw /
Fibre wire /
tendon/implant
879 Orthopedics SB SB032 reconstruction / SB032D Rockwood Type - IV 20500 20500 24000 25700 by tendon etc) - No NA
10000
readymade
implant -
10000
(Plate/ screw /
Fibre wire /
tendon/implant
880 Orthopedics SB SB032 reconstruction / SB032E Rockwood Type - V 20500 20500 24000 25700 by tendon etc) - No NA
10000
readymade
implant -
10000
I
(Plate/ screw /
AC Joint
Fibre wire / tendon/implant
881 Orthopedics SB SB032 reconstruction / SB032F Rockwood Type - VI 20500 20500 24000 25700 No NA
reconstruction 10000
Stabilization
by tendon etc) -
10000
Excision Arthoplasty Excision Arthoplasty of
of Femur head Femur head
Open Reduction of
883 Orthopedics SB SB034 SB034A Open Reduction of CDH 20000 20000 23400 25000 NA No NA
CDH
884 Orthopedics SB SB035 Patellectomy SB035A Patellectomy 11000 11000 12900 13800 NA No NA
arthroscopic
meniscal repair
with fibre wire
Arthroscopic fibre wire -3000
Arthroscopic Meniscus for inside out
885 Orthopedics SB SB036 Meniscus Repair / SB036A 12000 12000 14100 15000 crutch 1000 No NA
Repair / Meniscectomy technique -
Meniscectomy brace-1000
3000, Crutch -
1000, Brace -
1000
Implant for
Elbow
886 Orthopedics SB SB037 Elbow replacement SB037A Elbow replacement 27262.5 27300 31900 34100 31000 No NA
Replacement -
31000
Implant for
Total Hip
Total Hip
887 Orthopedics SB SB038 SB038A Cemented 49218.75 61600 69900 73900 Replacement - 40250 No NA
Replacement
Cemented -
40,250
Implant for
Total Hip
Total Hip
888 Orthopedics SB SB038 SB038B Cementless 37000 46300 52600 55500 Replacement - 65000 No NA
Replacement
Cementless -
65000
Implant for
Total Hip Total Hip
889 Orthopedics SB SB038 SB038C Hybrid 50906.25 63700 72300 76400 51750 No NA
Replacement Replacement -
Hybrid - 51,750
Implant for
Revision Total
Total Hip Revision - Total Hip
890 Orthopedics SB SB038 SB038D 62812.5 78600 89200 94300 Hip 140000 No NA
Replacement Replacement
Replacement -
140000
Implant for
Total Knee Primary - Total Knee Total Knee
891 Orthopedics SB SB039 SB039A 29062.5 36400 41300 43600 55000 No NA
Replacement Replacement Replacement -
55000
Implant for
Revision Total
Total Knee Revision - Total Knee
892 Orthopedics SB SB039 SB039B 35625 44600 50600 53500 Knee 100000 No NA
Replacement Replacement
Replacement -
100000
Modular
Custom
Prosthesis for
Bone Tumour
Bone Tumour Bone Tumour Excision
Excision - Joint
Excision (malignant) (malignant) including
malignant replacement-
including GCT + Joint GCT + Joint
893 Orthopedics SB SB040 SB040A 65000 81300 92300 97500 including GCT 150000 mega No NA
replacement replacement
+ Joint prothesis-
(depending upon type (depending upon type of
replacement - 100000
of joint and implant) joint and implant)
150000, Mega
prosthesis (1) -
100000
Orthopedics, Bone Tumour (Plate) - 10000, Plate -10000

Bone Tumour Excision +
894 Surgical SB SB041 Excision + SB041A 30000 37500 42600 45000 Mega Megaprothesis No NA
reconstruction
Oncology reconstruction prosthesis (1) - 100000
100000
Bone Tumour
Bone Tumour (benign)
(benign) curettage /
895 Orthopedics SB SB042 SB042A curettage / Excision and 22100 27700 31400 33200 NA No NA
Excision
bone grafting
and bone grafting
Single Stage
896 Orthopedics SB SB043 SB043A Above Elbow 15400 15400 18100 19300 NA No NA
Amputation
Single Stage
897 Orthopedics SB SB043 SB043B Below Elbow 16200 16200 19000 20300 NA No NA
Amputation
Single Stage
898 Orthopedics SB SB043 SB043C Above Knee 18100 18100 21200 22700 NA No NA
Amputation
Single Stage
899 Orthopedics SB SB043 SB043D Below Knee 18600 18600 21800 23300 NA No NA
Amputation
Single Stage
900 Orthopedics SB SB043 SB043E Foot 18600 18600 21800 23300 NA No NA
Amputation
Single Stage
901 Orthopedics SB SB043 SB043F Hand 18600 18600 21800 23300 NA No NA
Amputation
Single Stage
902 Orthopedics SB SB043 SB043G Wrist 18600 18600 21800 23300 NA No NA
Amputation
Two Stage
903 Orthopedics SB SB044 SB044A Above Elbow 23200 23200 27200 29000 NA No NA
Amputation
Two Stage
904 Orthopedics SB SB044 SB044B Below Elbow 23200 23200 27200 29000 NA No NA
Amputation
Two Stage
905 Orthopedics SB SB044 SB044C Above Knee 23200 23200 27200 29000 NA No NA
Amputation
Two Stage
906 Orthopedics SB SB044 SB044D Below Knee 23200 23200 27200 29000 NA No NA
Amputation
Two Stage
907 Orthopedics SB SB044 SB044E Foot 23200 23200 27200 29000 NA No NA
Amputation
Two Stage
908 Orthopedics SB SB044 SB044F Hand 23200 23200 27200 29000 NA No NA
Amputation
Two Stage
909 Orthopedics SB SB044 SB044G Wrist 23200 23200 27200 29000 NA No NA
Amputation
Amputation - Fingers
910 Orthopedics SB SB045 SB045A Finger(s) 13500 13500 15800 16900 NA No NA
/ Toes
Amputation - Fingers
911 Orthopedics SB SB045 SB045B Toe(s) 13500 13500 15800 16900 NA No NA
/ Toes
Tendon Grafting /
912 Orthopedics SB SB046 SB046A Tendon Grafting 15600 15600 18300 19500 NA No NA
Repair
Tendon Grafting /
913 Orthopedics SB SB046 SB046B Tendon Repair 15600 15600 18300 19500 NA No NA
Repair
Tendon Release / Tendon Release /
Tenotomy Tenotomy
915 Orthopedics SB SB048 Tenolysis SB048A Tenolysis 5000 5000 5900 6300 NA No NA
Implant &
brace for
Reconstruction
Bioscrew/endo
of ACL / PCL
Reconstruction of button/Sture
(Bio screw /
Cruciate Ligament disc+ethibond-
916 Orthopedics SB SB049 SB049A Anterior 25700 32200 36500 38600 Endobutton / No NA
with implant and 17000,brace
Suture disc +
brace and crutches-
Ethibond) -
2000per piece
17000, brace
and crutches -
2000 per piece
L
(Bio screw / Bioscrew/endo
Endobutton / button/Sture
Suture disc + disc+ethibond-
Reconstruction of
Ethibond) - 17000,brace
Cruciate Ligament
917 Orthopedics SB SB049 SB049B Posterior 25700 32200 36500 38600 17000, brace and crutches- No NA
with implant and
and crutches - 2000per piece
brace
2000 per Radiofrequenc
piece,radiofreq y ablationwand-
uency ablation 18000
wand - 18,000
918 Orthopedics SB SB050 Fasciotomy SB050A Fasciotomy 10500 10500 12300 13200 NA No NA
Duputryen’s
Duputryen’s Contracture
919 Orthopedics SB SB051 Contracture release + SB051A 11000 13800 15700 16500 NA No NA
release + rehabilitation
rehabilitation
Debridement &
Closure of injuries - Anti-biotic + dressing -
contused lacerated minimum of 5 sessions
wounds
Debridement &
Closure of injuries - Anti-biotic + dressing -
921 Orthopedics SB SB052 SB052B 4875 4900 5800 6100 NA No NA
contused lacerated minimum of 2 sessions
wounds
Sequestectomy / Sequestectomy /
Curettage Curettage
Implant for
Spine
deformity
correction
For 8 to 10 For 8 to 10 For 8 to 10 For 8 to 10 (Plate including
Spine deformity Spine deformity screws - 45000 screws - 45000 screws - 51650 screws - 56250 screw) - 5000 screw-5000
923 Orthopedics SB SB054 SB054A No NA
correction correction More than 10 More than 10 More than 10 More than 10 per screw Cage -10000
screws - 55000 screws - 55000 screws - 64350 screws - 68750 Implant for
Spine
deformity
correction
(Cage) - 10000
Long Bone
Long bone
(Plate/Screw) -
(plate /screw)-
7000 per
7000 per piece
piece, broad
, Broad DCP
924 Orthopedics SB SB055 Osteotomy SB055A Long Bone 18000 18000 21100 22500 DCP with No NA
with screw-
screws - 5000
5000 Per piece
per piece, LC
LC DCP- 6000
DCP - 6000
per piece
per piece
K Wire - 300
925 Orthopedics SB SB055 Osteotomy SB055B Small Bone 10000 10000 11700 12500 300/ piece No NA
per piece
K Wire - 300 Kwire -
Pelvic Osteotomy and Pelvic Osteotomy and per piece, 300/piece
926 Orthopedics SB SB056 SB056A 20000 20000 23400 25000 No NA
fixation fixation Recon plate - reconplate -
4000 per piece 4000/piece
Plate for High
Tibial
High Tibial plate -7000
927 Orthopedics SB SB057 SB057A High Tibial Osteotomy 16000 16000 18800 20000 Osteotomy - No NA
Osteotomy Fixator-15000
7000, Fixator -
15000
Implant for
928 Orthopedics SB SB058 Ilizarov Fixation SB058A Ilizarov Fixation 15000 15000 17600 18800 Ilizarov fixation - 12000 No NA
12000
Implant for
Limb
Limb Lengthening / Limb Lengthening /
Lengthening /
929 Orthopedics SB SB059 Bone Transport by SB059A Bone Transport by 23700 23700 27800 29700 12000 No NA
Bone Transport
Ilizarov Ilizarov
by Ilizarov -
12000
Implant for
Growth
Growth Modulation Growth Modulation and
930 Orthopedics SB SB060 SB060A 5625 5700 6600 7100 Modulation & 5000 No NA
and fixation fixation
Fixation (Plate)
(6) - 5000
Corrective Surgery for
931 Orthopedics SB SB061 SB061A Vertical Talus 15000 15000 17600 18800 NA No NA
foot deformities
Corrective Surgery for
932 Orthopedics SB SB061 SB061B Other foot deformities 15000 15000 17600 18800 NA No NA
foot deformities
Correction of club Correction of club foot
foot per cast per cast
Corrective Surgery in Corrective Surgery in
JESS Fixator -
934 Orthopedics SB SB063 Club Foot / JESS SB063A Club Foot / JESS 12000 12000 14100 15000 7000 No NA
7000
Fixator Fixator
Excision of
935 Orthopedics SB SB064 Osteochondroma / SB064A Osteochondroma 10000 10000 11700 12500 NA No NA
Exostosis
Excision of
936 Orthopedics SB SB064 Osteochondroma / SB064B Exostosis 10000 10000 11700 12500 NA No NA
Exostosis
Orthopedics,
937 General SB SB065 Excision of Bursa SB065A Excision of Bursa 3000 3000 3600 3800 NA No NA
Surgery
Nerve Transposition /
938 Orthopedics SB SB066 SB066A Nerve Transposition 13000 13000 15300 16300 NA No NA
Release / Neurolysis
939 Orthopedics SB SB066 SB066B Nerve Release 13000 13000 15300 16300 NA No NA
940 Orthopedics SB SB066 SB066C Nerve Neurolysis 13000 13000 15300 16300 NA No NA
941 Orthopedics SB SB067 Nerve Repair Surgery SB067A Nerve Repair Surgery 13800 13800 16200 17300 NA No NA
Orthopedics,
942 SB SB068 Nerve root block SB068A Nerve root block 3000 3000 3600 3800 NA No NA
Neurosurgery
Exploration and Ulnar Exploration and Ulnar
nerve Repair nerve Repair
Implant Removal
944 Orthopedics SB SB070 SB070A K - Wire 5000 5000 5900 6300 NA No NA
under LA
Implant Removal
945 Orthopedics SB SB070 SB070B Screw 5000 5000 5900 6300 NA No NA
under LA
Implant Removal
946 Orthopedics SB SB071 SB071A Nail 15000 15000 17600 18800 NA No NA
under RA / GA
Implant Removal
947 Orthopedics SB SB071 SB071B Plate 15000 15000 17600 18800 NA No NA
under RA / GA
948 Orthopedics SB SB072 Core Decompression SB072A Core Decompression 14062.5 14100 16500 17600 NA No NA
radiofrequency
Arthroscopy / open - Arthroscopy / open -
949 Orthopedics SB SB074 SB074A 10000 10000 11700 12500 ablation wand - 18000 No NA
synovectomy synovectomy
18,000
Application of crutchfiled tong cervical
950 Orthopedics SB SB002 SB075A 5000 5000 5900 6300 NA NA
Traction spine traction
Application of
951 Orthopedics SB SB002 SB076A POP slab 2000 2000 2400 2500 NA NA
Traction
952 Orthopedics SB SB003 SB076B POP slab 2200 2200 2600 2800 NA NA
casts
Replacement with Head Implant Cost -
953 Orthopedics SB SB012 Fracture Head radius SB077A 10000 10000 11700 12500 10000 NA
Radius Prosthesis 10000
Implant for
Fracture -
Fracture Condyle - ORIF with screw of Humerus -
954 Orthopedics SB SB015 SB078A 8500 8500 10000 10700 12000 NA
Humerus - ORIF proximal humerus ORIF - plate -
12000 per
plate
Implant for
Total Hip Revision of failed hemi Total Hip
955 Orthopedics SB SB038 SB079A 52500 52500 61500 65700 40250 NA
Replacement Arthroplasty in to THR Replacement -
40,250
Implant for
Spine
deformity
For 8 to 10
Combined spinal correction
For 8 to 10 For 8 to 10 For 8 to 10 For 8 to 10 screws -
segment - front and (Plates)(16) -
Spine deformity screws - 45000 screws - 45000 screws - 51650 screws - 56250 screw- 4000 45000
956 Orthopedics SB SB054 SB080A back (anterior/posterior/ 4000 per screw
correction More than 10 More than 10 More than 10 More than 10 Cage 10000 More than 10
combined anterior and Implant for
screws - 55000 screws - 55000 screws - 64350 screws - 68750 screws -
posterior) Spine
55000
deformity
correction
(Cage) - 10000
Surgical
957 SC SC001 Glossectomy SC001A Hemiglossectomy 70588.4 88300 100300 105900 NA No NA
Oncology
Surgical
958 SC SC001 Glossectomy SC001B Total Glossectomy 82847.79 103600 117700 124300 NA No NA
Oncology
Surgical
959 SC SC002 Palatectomy SC002A Soft palate 45043.2 56400 64000 67600 NA No NA
Oncology, ENT
Surgical
960 SC SC002 Palatectomy SC002B Hard palate 51441.3 64400 73100 77200 NA No NA
Oncology, ENT
Surgical
961 SC SC003 Maxillectomy SC003A Partial 60759.6 76000 86300 91200 NA No NA
Oncology
Surgical
962 SC SC003 Maxillectomy SC003B Radical 67103.7 67200 83900 83900 NA No NA
Oncology
Surgical
963 SC SC003 Maxillectomy SC003C Total 67103.7 83900 95300 100700 NA No NA
Oncology
Surgical Composite resection Composite resection
964 SC SC004 SC004A 43675.65 54600 62100 65600 NA No NA
Oncology (Oral Cavity) (Oral Cavity)
Surgical Oesophageal / Oesophageal
965 SC SC005 SC005A Oesophageal stenting 66122.4 82700 93900 99200 No NA
Oncology Tracheal stenting stent
Surgical Oesophageal /
966 SC SC005 SC005B Tracheal stenting 66122.4 82700 93900 99200 Tracheal stent No NA
Oncology Tracheal stenting
Transthoracic
Surgical
967 SC SC006 esophagectomy: 2F / SC006A Open 103097.97 128900 146400 154700 NA No NA
Oncology
3F
Transthoracic
Surgical
968 SC SC006 esophagectomy: 2F / SC006B MIS 103097.97 128900 146400 154700 NA No NA
Oncology
3F
Surgical Gastric pull-up / Gastric pull-up / Jejunal
969 SC SC007 SC007A 81571.05 102000 115900 122400 NA No NA
Oncology Jejunal Graft Graft
Surgical Radical Small Bowel
970 SC SC008 SC008A Open 77648.7 97100 110300 116500 NA No NA
Oncology Resection
Surgical Radical Small Bowel
971 SC SC008 SC008B Lap. 103531.6 129500 147100 155300 NA No NA
Oncology Resection
Surgical Intersphincteric
Oncology resection
Surgical Intersphincteric
Oncology resection
Surgery for
Surgical Abdominal wall tumour
974 SC SC010 Abdominal wall SC010A 46103.2 57700 65500 69200 NA No NA
Oncology resection
tumour
Surgery for Abdominal wall tumour
Surgical
975 SC SC010 Abdominal wall SC010B resection with 67943.7 85000 96500 102000 NA No NA
Oncology
tumour reconstruction
Exploratory
Surgical laparotomy f / b Exploratory laparotomy f
976 SC SC011 SC011A 60803.2 76100 86400 91300 NA No NA
Oncology diversion stoma / / b diversion stoma
bypass
Exploratory
Surgical laparotomy f / b Exploratory laparotomy f
977 SC SC011 SC011B 60803.2 76100 86400 91300 NA No NA
Oncology diversion stoma / / b diversion bypass
bypass
Surgical Abdominoperineal
Oncology resection
Surgical Abdominoperineal
Oncology resection
Surgical
980 SC SC013 Omentectomy SC013A Omentectomy 28471.2 35600 40500 42800 NA No NA
Oncology
Surgical Procedures Requiring Procedures Requiring
981 SC SC014 SC014A 49043.2 61400 69700 73600 NA No NA
Oncology Bypass Techniques Bypass Techniques
Surgical Segmentectomy - Segmentectomy -

982 SC SC015 SC015A 55369.35 69300 78700 83100 NA No NA
Oncology hepatobiliary system hepatobiliary system
Surgical Radical / Revision
983 SC SC016 SC016A Radical 69443.7 86900 98700 104200 NA No NA
Oncology Cholecystectomy
Surgical Radical / Revision
984 SC SC016 SC016B Revision 69443.7 86900 98700 104200 NA No NA
Oncology Cholecystectomy
Surgical Enucleation of Enucleation of
985 SC SC017 SC017A 47761.05 59800 67900 71700 NA No NA
Oncology pancreatic neoplasm pancreatic neoplasm
Surgical
Oncology, Hepatoblastoma Hepatoblastoma
986 SC SC018 SC018A 68212.35 85300 96900 102400 NA No NA
Pediatric Excision Excision
Surgery
Surgical Hemipelvectomy - Hemipelvectomy -
987 SC SC019 SC019A 74071.05 92600 105200 111200 NA No NA
Oncology Internal Internal
Surgical
988 SC SC020 Pelvic Exenteration SC020A Anterior - Open 103609.29 129600 147200 155500 NA No NA
Oncology
Surgical
989 SC SC020 Pelvic Exenteration SC020B Anterior - Lap. 103609.29 129600 147200 155500 NA No NA
Oncology
Surgical
990 SC SC020 Pelvic Exenteration SC020C Total - Open 103609.29 129600 147200 155500 NA No NA
Oncology
Surgical
991 SC SC020 Pelvic Exenteration SC020D Total - Lap. 103609.29 129600 147200 155500 NA No NA
Oncology
Surgical
Oncology, Wilms tumors:
992 SC SC021 SC021A Wilms tumors: surgery 45550.65 57000 64700 68400 NA No NA
Pediatric surgery
Surgery
Surgical Ureteric end to end Ureteric end to end
993 SC SC022 SC022A 35159.85 44000 50000 52800 NA No NA
Oncology anastomosis anastomosis
Surgical
Distal ureterectomy Distal ureterectomy with
994 Oncology, SC SC023 SC023A 35534.85 44500 50500 53400 NA No NA
with reimplantation reimplantation
Urology
Surgical
With continent diversion
995 Oncology, SC SC024 Radical cystectomy SC024A 100024.47 125100 142100 150100 NA No NA
- Open
Urology
Surgical
With Ileal Conduit -
996 Oncology, SC SC024 Radical cystectomy SC024B 129699.6 162200 184200 194600 NA No NA
Open
Urology
Surgical
997 Oncology, SC SC024 Radical cystectomy SC024C With Ileal Conduit - Lap. 129699.6 162200 184200 194600 NA No NA
Urology
Surgical
998 Oncology, SC SC024 Radical cystectomy SC024D With neobladder - Open 148522.8 185700 211000 222800 NA No NA
Urology
Surgical
999 Oncology, SC SC024 Radical cystectomy SC024E With neobladder - Lap 148522.8 185700 211000 222800 NA No NA
Urology
Surgical With
1000 Oncology, SC SC024 Radical cystectomy SC024F ureterosigmoidostomy - 115699.6 144700 164300 173600 NA No NA
Urology Open
Surgical With
1001 Oncology, SC SC024 Radical cystectomy SC024G ureterosigmoidostomy - 77617.29 97100 110300 116500 NA No NA
Urology Lap
Surgical
With ureterostomy -
1002 Oncology, SC SC024 Radical cystectomy SC024H 77392.29 96800 109900 116100 NA No NA
Open
Urology
Surgical
1003 Oncology, SC SC024 Radical cystectomy SC024I With ureterostomy -Lap. 77392.29 96800 109900 116100 NA No NA
Urology
Surgical
1004 SC SC025 Channel TURP SC025A Channel TURP 30629.85 38300 43500 46000 NA No NA
Oncology
Surgical
1005 Oncology, SC SC026 Radical Urethrectomy SC026A Radical Urethrectomy 38868.15 48600 55200 58400 NA No NA
Urology
Penile preserving Penile preserving
Surgical
surgery surgery
1006 Oncology, SC SC027 SC027A 28868.7 36100 41000 43400 NA No NA
(WLE, Glansectomy, (WLE, Glansectomy,
Urology
Laser) Laser)
Excision of Excision of
Surgical
1007 SC SC028 undescended SC028A undescended testicular 28493.7 35700 40500 42800 NA No NA
Oncology
testicular mass mass
Surgical Germ Cell Tumour Germ Cell Tumour
1008 SC SC029 SC029A 35534.85 44500 50500 53400 NA No NA
Oncology Excision Excision
1009 OBG & Gynec SO SC030 Salpingoophorectomy SC030A Open 20000 25000 28400 30000 NA No NA
1010 OBG & Gynec SO SC030 Salpingoophorectomy SC030B Lap. 20000 25000 28400 30000 NA No NA
Surgical
1011 SC SC031 Leiomyoma excision SC031A Open 78569.7 98300 111600 117900 NA No NA
Oncology
Surgical
1012 SC SC031 Leiomyoma excision SC031B MIS 78569.7 98300 111600 117900 NA No NA
Oncology
Surgical Class I radical
Oncology, hysterectomy + bilateral
1013 SC SC032 Radical Hysterectomy SC032A 42858.15 53600 60900 64300 NA No NA
Obstetrics & salpingoophorectomy +
Gynecology BPLND - Lap.
Surgical Class I radical

Oncology, hysterectomy + bilateral
1014 SC SC032 Radical Hysterectomy SC032B 42858.15 53600 60900 64300 NA No NA
Obstetrics & salpingoophorectomy +
Gynecology BPLND - Open
Class I radical
Surgical
Hysterectomy +/-
Oncology,
1015 SC SC032 Radical Hysterectomy SC032C bilateral 30721.2 38500 43700 46100 NA No NA
Obstetrics &
salpingoophorectomy -
Gynecology
Lap.
Class I radical
Surgical
Hysterectomy +/-
Oncology,
1016 SC SC032 Radical Hysterectomy SC032D bilateral 30721.2 38500 43700 46100 NA No NA
Obstetrics &
salpingoophorectomy -
Gynecology
Open
Surgical
Oncology, Class II radical
1017 SC SC032 Radical Hysterectomy SC032E 42858.15 53600 60900 64300 NA No NA
Obstetrics & hysterctomy + BPLND
Gynecology
Surgical
Oncology, Class III radical
1018 SC SC032 Radical Hysterectomy SC032F 42858.15 53600 60900 64300 NA No NA
Obstetrics & hysterctomy + BPLND
Gynecology
Hysterectomy + bilateral
Surgical
salpingoophorectomy +
Oncology,
1019 SC SC032 Radical Hysterectomy SC032G omentectomy + 70424.85 88100 100100 105700 NA No NA
Obstetrics &
peritonectomy and
Gynecology
organ resections
Surgical
1020 SC SC033 Radical vaginectomy SC033A Radical vaginectomy 38470.65 48100 54700 57800 NA No NA
Oncology
Surgical
Vulvectomy + Vulvectomy +
Oncology,
1021 SC SC034 reconstruction SC034A reconstruction 57944.85 72500 82300 87000 NA No NA
Obstetrics &
procedures procedures
Gynecology
Surgical Radical
1022 SC SC035 SC035A Radical Trachelectomy 47733.15 59700 67800 71600 NA No NA
Oncology Trachelectomy
Surgical Sacral Tumour Anterior + Posterior
1023 SC SC036 SC036A 114353.97 143000 162400 171600 NA No NA
Oncology Excision approach
Surgical Sacral Tumour
1024 SC SC036 SC036B Posterior approach 97916.97 122400 139100 146900 NA No NA
Oncology Excision
Resection of
Surgical Resection of
1025 SC SC037 nasopharyngeal SC037A 56053.05 70100 79600 84100 NA No NA
Oncology nasopharyngeal tumour
tumour
Surgical
1026 SC SC038 Total Pharyngectomy SC038A Total Pharyngectomy 53887.35 67400 76600 80900 NA No NA
Oncology
Surgical Parapharyngeal Parapharyngeal Tumour
1027 SC SC039 SC039A 38170.65 47800 54300 57300 NA No NA
Oncology Tumour Excision Excision
Voice
Surgical Partial laryngectomy
1028 SC SC040 Laryngectomy SC040A 75591.6 94500 107400 113400 prosthesis - 30000 No NA
Oncology (voice preserving)
30000
Surgical
1029 SC SC040 Laryngectomy SC040B Total Laryngectomy 75218.7 94100 106900 112900 NA No NA
Oncology
Surgical
1030 SC SC041 Tracheal resection SC041A Tracheal resection 52678.05 65900 74900 79100 NA No NA
Oncology
Surgical Tracheal / Carinal Tracheal / Carinal
1031 SC SC042 SC042A 77438.55 96800 110000 116200 NA No NA
Oncology resection resection
Tracheal Stenosis
Tracheal Stenosis (End
Surgical (End to end
1032 SC SC043 SC043A to end Anastamosis) 39970.65 50000 56800 60000 NA No NA
Oncology Anastamosis)
(Throat)
(Throat)
Surgical Central airway tumour Central airway tumour
1033 SC SC044 SC044A 28043.7 35100 39900 42100 NA No NA
Oncology debulking debulking
Surgical Diagnostic
1034 SC SC045 SC045A Diagnostic thoracoscopy 20708.7 25900 29500 31100 NA No NA
Oncology thoracoscopy
Surgical Sleeve resection of Sleeve resection of lung
1035 SC SC046 SC046A 91786.05 114800 130400 137700 NA No NA
Oncology lung cancer cancer
Surgical
1036 SC SC047 Mediastinoscopy SC047A Diagnostic 43163.2 54000 61300 64800 NA No NA
Oncology
Surgical
1037 SC SC047 Mediastinoscopy SC047B Staging 43163.2 54000 61300 64800 NA No NA
Oncology
Surgical Removal of Chest Chest Wall Tumour
1038 SC SC048 SC048A 87762.8 109800 124700 131700 NA No NA
Oncology Wall Tumour Excision
Removal of chest wall
Surgical Removal of Chest
1039 SC SC048 SC048B tumour with 99325.29 124200 141100 149000 NA No NA
Oncology Wall Tumour
reconstruction
Surgical Pleurectomy Pleurectomy
1040 SC SC049 SC049A 51328.65 64200 72900 77000 NA No NA
Oncology Decortication Decortication
Surgical Chamberlain
1041 SC SC050 SC050A Chamberlain procedure 24511.2 30700 34900 36800 NA No NA
Oncology procedure
Surgical Extrapleural Extrapleural
1042 SC SC051 SC051A 86536.05 108200 122900 129900 NA No NA
Oncology pneumonectomy pneumonectomy
Surgical
1043 SC SC052 Pneumonectomy SC052A Pneumonectomy 76057.35 95100 108100 114100 NA No NA
Oncology
Surgical
1044 SC SC053 Lung metastectomy SC053A Open 59043.2 73900 83900 88600 NA No NA
Oncology
Surgical
1045 SC SC053 Lung metastectomy SC053B VATS 59043.2 73900 83900 88600 NA No NA
Oncology
Surgical
1046 SC SC054 Thoracostomy SC054A Thoracostomy 23611.2 29600 33600 35500 NA No NA
Oncology
Surgical Mediastinal
Oncology lymphadenectomy
Surgical Mediastinal
1048 SC SC055 SC055B Video - assisted 78664.5 98400 111800 118000 NA No NA
Oncology lymphadenectomy
Mediastinal mass Mediastinal mass
Surgical
1049 SC SC056 excision with lung SC056A excision with lung 81308.55 101700 115500 122000 NA No NA
Oncology
resection resection
Surgical Segmental resection
1050 SC SC057 SC057A Open 69564 87000 98800 104400 NA No NA
Oncology of lung
Surgical Segmental resection
1051 SC SC057 SC057B Thoracoscopic 69564 87000 98800 104400 NA No NA
Oncology of lung
Surgical
1052 SC SC058 Wedge resection lung SC058A Open 79923.2 100000 113500 119900 NA No NA
Oncology
Surgical
1053 SC SC058 Wedge resection lung SC058B Thoracoscopic 79923.2 100000 113500 119900 NA No NA
Oncology
Breast conserving
Surgical Breast conserving surgery
1054 SC SC059 SC059A 49139.6 61500 69800 73800 NA No NA
Oncology surgery (lumpectomy + axillary
surgery)
Surgical Breast conserving Breast conserving
1055 SC SC059 SC059B 45231.3 56600 64300 67900 NA No NA
Oncology surgery surgery with Oncoplasty
Surgical Axillary Sampling / Axillary Sampling /

1056 SC SC060 SC060A 20663.7 25900 29400 31000 NA No NA
Oncology Sentinel Node Biopsy Sentinel Node Biopsy
Surgical
1057 SC SC061 Axillary dissection SC061A Axillary dissection 25702.35 32200 36500 38600 NA No NA
Oncology
Scalp tumour
Surgical Scalp tumour excision
1058 SC SC062 excision with skull SC062A 35534.85 44500 50500 53400 NA No NA
Oncology with skull bone excision
bone excision
Surgical Neuroblastoma
1059 SC SC063 SC063A Neuroblastoma Excision 84488.55 105700 120000 126800 NA No NA
Oncology Excision
Excision of Pinna for
Growths / Injuries -
Surgical
1060 SC SC064 Total Amputation & SC064A Growth - Squamous 44992 56300 63900 67500 NA No NA
Oncology, ENT
Excision of External
Auditory Meatus

Surgical
1061 SC SC064 Total Amputation & SC064B Growth - Basal 44992 56300 63900 67500 NA No NA
Oncology, ENT
Auditory Meatus

Surgical
1062 SC SC064 Total Amputation & SC064C Injury 44992 56300 63900 67500 NA No NA
Oncology, ENT
Auditory Meatus
Surgical Neck dissection - Neck dissection -
1063 SC SC065 SC065A 26579.85 33300 37800 39900 NA No NA
Oncology comprehensive comprehensive
Benign Soft Tissue
Surgical Benign Soft Tissue
1064 SC SC066 SC066A Tumour - Excision 15419.52 19300 21900 23200 NA No NA
Oncology Tumour - Excision
(Small)
Malignant Soft Tissue
Surgical Malignant Soft Tissue Tumour (Small)-
1065 SC SC067 SC067A 40744.35 51000 57900 61200 NA No NA
Oncology Tumour -Excision Excision (New
procedure)
Surgical
Oncology,
1066 Plastic & SC SC068 Regional flap SC068A Myocutaneous flap 52236.3 65300 74200 78400 NA No NA
Reconstructive
Surgery
Surgical
Oncology,
1067 Plastic & SC SC068 Regional flap SC068B Fasciocutaneous flap 52236.3 65300 74200 78400 NA No NA
Reconstructive
Surgery
Surgical
1068 SC SC069 Rotationplasty SC069A Rotationplasty 64036.05 80100 91000 96100 NA No NA
Oncology
Surgical Bone tumors / soft Bone tumors / soft
1069 Oncology, SC SC070 tissue sarcomas: SC070A tissue sarcomas: 42220.65 52800 60000 63400 NA No NA
Orthopedics surgery surgery
Surgical Endoprosthesis
1070 SC SC071 SC071A Complete 77648.7 97100 110300 116500 NA No NA
Oncology Revision
Surgical Endoprosthesis
1071 SC SC071 SC071B Partial 54043.2 67600 76800 81100 NA No NA
Oncology Revision
Vertebral Tumour Vertebral Tumour
Surgical
1072 SC SC072 Excision and SC072A Excision and 79921.05 100000 113500 119900 NA No NA
Oncology
Reconstruction Reconstruction
Surgical
Implant for
Oncology, Microvascular Microvascular
Microvascular
1073 Plastic & SC SC073 reconstruction (free SC073A reconstruction (free 58036.05 72600 82500 87100 15000 No NA
reconstruction -
Reconstructive flaps) flaps)
15000
Surgery
Surgical
Oncology,
CTVS, Plastic Vascular
1074 SC SC074 SC074A Vascular reconstruction 76216.05 95300 108300 114400 NA No NA
& reconstruction
Reconstructive
Surgery
Surgical Curopsy /
1075 SC SC075 SC075A Curopsy / Sclerotherapy 22283.7 27900 31700 33500 NA No NA
Oncology Sclerotherapy
Chemo Port -
Adult - 15000 Adult 15000
Surgical
1076 SC SC076 Chemo Port Insertion SC076A Chemo Port Insertion 19186.2 24000 27300 28800 Chemo Port - Pediatric - No NA
Oncology
Pediatric - 25000
25000
Posterior
Surgical Posterior Exenteration
1077 SC SC077 Exenteration SC077A 80866.05 101100 114900 121300 NA No NA
Oncology (Gynaec)
(Gynaec)
Bilateral pelvic lymph Bilateral pelvic lymph
Surgical
1078 SC SC078 Node Dissection SC078A Node Dissection 44824.35 56100 63700 67300 NA No NA
Oncology
(BPLND)18 (BPLND)
Surgical Plastic surgery flap Head & Neck Flap
1079 SC SC079 SC079A 19163.7 24000 27300 28800 NA No NA
Oncology division Cutting any type
Surgical Cytoreductive surgery Cytoreductive surgery
1080 SC SC081 SC081A 72588.4 90800 103100 108900 NA No NA
Oncology for ovarian cancer for ovarian cancer
Surgical Wide Excision- Oral Wide Excision- Oral
1081 SC SC082 SC082A 39163.2 49000 55700 58800 NA NA
Oncology Cavity Malignancy Cavity Malignancy
1082 Ophthalmology SE SE001 Ptosis Surgery SE001A Ptosis Surgery 8000 8000 9400 10000 NA No NA
1083 Ophthalmology SE SE002 Entropion correction SE002A Entropion correction 6600 6600 7800 8300 NA No NA
1084 Ophthalmology SE SE003 Ectropion correction SE003A Ectropion correction 6500 6500 7700 8200 NA No NA
1085 Ophthalmology SE SE004 Lid Tear Repair SE004A Lid Tear Repair 7700 7700 9100 9700 NA No NA
1086 Ophthalmology SE SE005 Lid Abscess Drainage SE005A Lid Abscess Drainage 5700 5700 6700 7200 NA No NA
Lid Tumor excision + Lid Tumor excision + Lid

1087 Ophthalmology SE SE006 SE006A 14000 14000 16400 17500 NA No NA
Lid Reconstruction Reconstruction
1088 Ophthalmology SE SE007 Chalazion Removal SE007A Chalazion Removal 2000 2000 2400 2500 NA No NA
1089 Ophthalmology SE SE008 Squint correction SE008A Minor - upto 2 muscles 4050 4100 4800 5100 NA No NA
Major - 3 or more
muscles (complex
1090 Ophthalmology SE SE008 Squint correction SE008B surgery involving four 12000 12000 14100 15000 NA No NA
muscles or oblique
muscles)
Conjunctival tumour Conjunctival tumour
Tissue graft-
excision including excision including
1091 Ophthalmology SE SE009 SE009A 7000 7000 8200 8800 amniotic No NA
Amniotic Membrane Amniotic Membrane
membrane
Graft Graft
Canaliculo Silicon Tube /
Dacryocystorhinosto
1092 Ophthalmology SE SE010 SE010A Dacryocystorhinostomy 10000 12500 14200 15000 Silicon stent - 2000 No NA
my
with Silicon Tube / Stent 2000
Canaliculo
Dacryocystorhinosto Dacryocystorhinostomy
1093 Ophthalmology SE SE010 SE010B 8000 10000 11400 12000 NA No NA
my without Silicon Tube /
Stent
Silicon Tube /
Dacryocystorhinosto Dacryocystorhinostomy
1094 Ophthalmology SE SE010 SE010C 10000 12500 14200 15000 Silicon stent - 2000 No NA
my with Silicon Tube / Stent
2000
Dacryocystorhinostomy
Dacryocystorhinosto
1095 Ophthalmology SE SE010 SE010D without Silicon Tube / 8000 10000 11400 12000 NA No NA
my
Stent
Corneal Ulcer Corneal Ulcer
Management Management
1097 Ophthalmology SE SE012 Corneal Grafting SE012A Corneal Grafting 10900 13700 15500 16400 NA No NA
1098 Ophthalmology SE SE012 Corneal Grafting SE012C Lamellar Keratoplasty 13750 17200 19600 20700 NA No NA
Corneal Collagen Corneal Collagen
Crosslinking Crosslinking
Pterygium +
Pterygium +
1100 Ophthalmology SE SE014 Conjunctival SE014A 9300 11700 13300 14000 NA No NA
Conjunctival Autograft
Autograft
Corneo / Scleral / Corneo / Scleral /
1101 Ophthalmology SE SE015 Corneo scleral tear SE015A Corneo scleral tear 6000 7500 8600 9000 NA No NA
repair repair
Corneal / Scleral Corneal / Scleral Patch
Patch Graft Graft
Scleral buckling
1103 Ophthalmology SE SE017 SE017A Scleral buckling surgery 19700 24700 28000 29600 NA No NA
surgery
Scleral Buckle
1104 Ophthalmology SE SE018 SE018A Scleral Buckle Removal 5500 6900 7900 8300 NA No NA
Removal
Tissue graft -
Limbal Dermoid Limbal Dermoid
1105 Ophthalmology SE SE019 SE019A 2000 2500 2900 3000 Cornea / 3000 No NA
Removal Removal
Sclera - 3000
Foldable
Phaco emulsification
Hydrophobic
1106 Ophthalmology SE SE020 Cataract surgery SE020A with foldable 4500 4500 5300 5700 3000 No NA
intraocular lens
hydrophobic acrylic IOL
3000
SICS with non-foldable Non foldable
1107 Ophthalmology SE SE020 Cataract surgery SE020B 4000 4000 4700 5000 1000 No NA
IOL IOL - 1000
Foldable
Surgery for Pediatric Hydrophobic
1108 Ophthalmology SE SE021 SE021A Paediatric lensectomy 9200 11500 13100 13800 3000 No NA
Cataract intraocular lens
3000
Pediatric lens aspiration Foldable

Surgery for Pediatric with posterior Hydrophobic
1109 Ophthalmology SE SE021 SE021B 9200 11500 13100 13800 3000 No NA
Cataract capsulotomy & anterior intraocular lens
vitrectomy 3000
Foldable
Paediatric
Surgery for Pediatric Hydrophobic
1110 Ophthalmology SE SE021 SE021C Membranectomy & 8000 10000 11400 12000 3000 No NA
Cataract intraocular lens
anterior vitrectomy
3000
1111 Ophthalmology SE SE022 Capsulotomy (YAG) SE022A Capsulotomy (YAG) 1500 1900 2200 2300 NA No NA
Glue for Scleral

SFIOL (inclusive of SFIOL (inclusive of
1112 Ophthalmology SE SE023 SE023A 15000 18800 21300 22500 fixated IOL - 3000 No NA
Vitrectomy) Vitrectomy)
3000
Secondary IOL / IOL Secondary IOL / IOL

1113 Ophthalmology SE SE024 SE024A 6200 6200 7300 7800 IOL - 3000 3000 No NA
Exchange / Explant Exchange / Explant
IRIS Prolapse –
1114 Ophthalmology SE SE025 SE025A IRIS Prolapse – Repair 4500 4500 5300 5700 NA No NA
Repair
1115 Ophthalmology SE SE026 Iridectomy SE026A Iridectomy 2000 2000 2400 2500 NA No NA
Cyclocryotherapy /
1116 Ophthalmology SE SE027 Glaucoma Surgery SE027A 3700 4700 5300 5600 NA No NA
Cyclophotocoagulation
Glaucoma Surgery
(Trabeculectomy only)
with or without
Mitomycin C, including
postoperative
medications for 12
1117 Ophthalmology SE SE027 Glaucoma Surgery SE027B weeks 11300 14200 16100 17000 NA No NA
(and wherever surgical
or laser procedures
required for bleb
augmentation and
anterior chamber
maintenance)
Valved / Non
Valved
Glaucoma Shunt
1118 Ophthalmology SE SE027 Glaucoma Surgery SE027C 13000 16300 18500 19500 Glaucoma tube 7000 No NA
Surgery
-
shunt - 7000
Pediatric Glaucoma
1119 Ophthalmology SE SE027 Glaucoma Surgery SE027D 15000 18800 21300 22500 NA No NA
Surgery
EUA for Confirmation
EUA for Confirmation of
1120 Ophthalmology SE SE028 of Pediatric SE028A 3000 3000 3600 3800 NA No NA
Pediatric Glaucoma
Glaucoma
Retinal Laser For retinal tear repair
Photocoagulation Per Eye Per Sitting
Pan Retinal
Photocoagulation (PRP)
- Retinal Laser including
Retinal Laser 3 sittings / package of
1122 Ophthalmology SE SE029 SE029B 8500 8500 10000 10700 NA No NA
Photocoagulation retino laser
photocoagulation
(3 sittings per eye for
both eyes)
1123 Ophthalmology SE SE030 ROP Laser - Per Eye SE030A ROP Laser - Per Eye 5000 5000 5900 6300 NA No NA
1124 Ophthalmology SE SE031 Retinal Cryopexy SE031A Retinal Cryopexy 3800 3800 4500 4800 NA No NA
Implant for
"Vitreoretinal
Vitreoretinal Surgery Vitreoretinal Surgery
Surgery" (IOL
1125 Ophthalmology SE SE032 (with Silicon Oil SE032A (with Silicon Oil 25300 25300 29700 31700 6000 No NA
& Per flouro
Insertion) Insertion)
carbon liquid) -
6000
SOR (Silicon Oil SOR (Silicon Oil
Removal) Removal)
Endophthalmitis
Endophthalmitis
1127 Ophthalmology SE SE034 (excluding SE034A 5000 5000 5900 6300 NA No NA
(excluding Vitrectomy)
Vitrectomy)
Enucleation Without
1128 Ophthalmology SE SE035 Enucleation SE035A 9500 11900 13500 14300 NA No NA
implant
Implant for
"Enucleation"
(Conformers
Enucleation With
1129 Ophthalmology SE SE035 Enucleation SE035B 10600 13300 15100 15900 + Plastic / 1000 No NA
implant
silicon ball type
implant) -
1000
Implant for
"Evisceration"
(Conformers
1130 Ophthalmology SE SE036 Evisceration SE036A Evisceration 13300 13300 15600 16700 + Plastic / 1000 No NA
silicon ball type
implant) -
1000
Ophthalmology
1131 , Surgical SE SE037 Exenteration SE037A Exenteration 23700 23700 27800 29700 NA No NA
Oncology
Socket
Socket Reconstruction
Reconstruction
1132 Ophthalmology SE SE038 SE038A including Amniotic 11200 14000 16000 16800 NA No NA
including Amniotic
Membrane Graft
Membrane Graft
1133 Ophthalmology SE SE039 Orbitotomy SE039A Orbitotomy 14000 17500 19900 21000 NA No NA
Ophthalmology
, ENT, General
GA / EUA separate GA / EUA separate add
1134 Surgery, SE SE040 SE040A 3000 3000 3600 3800 NA No NA
add on package on package
Radiation
Oncology
Orbital fracture repair
1135 Ophthalmology SE SE041 Orbital fracture repair SE041A 10500 10500 12300 13200 NA No NA
under GA
Ophthalmology
,Pediatric
Medical
1136 SE MP007 Optic neuritis SE042A Optic neuritis 2100 2100 2500 2700 NA NA
Management,
General
Medicine
Ophthalmology
Vision Refraction-IOP &
1137 / General SE SE043 Glaucoma Screening SE043A 750 800 900 1000 NA NA
Fundus
Medicine
Ophthalmology Vision Refraction-IOP &
1138 / General SE SE043 Glaucoma Screening SE043B Fundus OCT & Visual 1500 1500 1800 1900 NA NA
Medicine Fields
Ophthalmology
Diabetic Retinopathy Vision refraction,fundus
1139 / General SE SE044 SE044A 1000 1000 1200 1300 NA NA
Screening photo and OCT
Medicine
General
Surgery,
1140 SG SG001 Oesophagectomy SG001A Oesophagectomy 100000 125000 142000 150000 NA No NA
Surgical
Oncology
General Operations for
Operations for
Surgery, Replacement of
1141 SG SG002 SG002A Replacement of 48937.5 61200 69500 73500 NA No NA
Pediatric Oesophagus by
Oesophagus by Colon
Surgery Colon
Bleeding Ulcer - Partial
General
1142 SG SG003 Gastrectomy SG003A Gastrectomy without 50000 62500 71000 75000 NA No NA
Surgery
Vagotomy
Bleeding Ulcer - Partial
General
1143 SG SG003 Gastrectomy SG003B Gastrectomy with 50000 62500 71000 75000 NA No NA
Surgery
Vagotomy
General
Surgery, Partial Gastrectomy for
1144 SG SG003 Gastrectomy SG003C 34800 43500 49500 52200 NA No NA
Surgical Carcinoma
Oncology
General
Surgery, Subtotal Gastrectomy
1145 SG SG003 Gastrectomy SG003D 34800 43500 49500 52200 NA No NA
Surgical for Carcinoma
Oncology
General
Surgery, Total Gastrectomy -
1146 SG SG003 Gastrectomy SG003E 65000 81300 92300 97500 NA No NA
Surgical Lap.
Oncology
General
Surgery, Total Gastrectomy -
1147 SG SG003 Gastrectomy SG003F 65000 81300 92300 97500 NA No NA
Surgical Open
Oncology
General
Surgery, Operative
1148 SG SG004 SG004A Operative Gastrostomy 20000 25000 28400 30000 NA No NA
Pediatric Gastrostomy
Surgery
General
1149 SG SG005 Vagotomy SG005A G J Vagotomy 25687.5 32200 36500 38600 NA No NA
Surgery
General Vagotomy +
1150 SG SG005 Vagotomy SG005B 25687.5 32200 36500 38600 NA No NA
Surgery Pyloroplasty
General Operation for Operation for Bleeding
1151 SG SG006 SG006A 27187.5 27200 31900 34000 NA No NA
Surgery Bleeding Peptic Ulcer Peptic Ulcer
Operation for Gastric
General
1152 SG SG007 / Duodenal SG007A Gastric Perforation 22537.5 22600 26400 28200 NA No NA
Surgery
Perforation
Operation for Gastric
General
1153 SG SG007 / Duodenal SG007B Duodenal Perforation 22537.5 22600 26400 28200 NA No NA
Surgery
Perforation
General
Surgery,
1154 SG SG008 Pyloroplasty SG008A Pyloroplasty 16500 20700 23500 24800 NA No NA
Pediatric
Surgery
General
Surgery,
1155 SG SG009 Pyloromyotomy SG009A Pyloromyotomy 30000 37500 42600 45000 NA No NA
Pediatric
Surgery
General
Surgery, Open
1156 SG SG0106 Subtotal Colectomy SG0106A 34875 34900 40900 43600 NA NA
Surgical
Oncology
General
Surgery, Lap
1157 SG SG0106 Subtotal Colectomy SG0106B 34875 34900 40900 43600 NA NA
Surgical
Oncology
General
Surgery, Operation for Operation for Hydrocele
1158 SG SG056 SG0107A 15000 15000 17600 18800 NA NA
Pediatric Hydrocele (U/L) (B/L)
Surgery
General
Surgery, Sympathectomy-
1159 SG SG073 Sympathectomy SG0108A 35000 35000 41000 43800 NA NA
Pediatric Bilateral (B/L)
Surgery
General
1160 SG SG0109 ERCP SG0109A ERCP 15000 15000 17600 18800 NA NA
Surgery
General
Surgery,
1161 SG SG010 Gastrojejunostomy SG010A Gastrojejunostomy 30000 30000 35100 37500 NA No NA
Surgical
Oncology
General Brachial sinus
1162 SG SG0110 SG0110A Brachial sinus excision 20000 20000 23400 25000 NA NA
Surgery excision
General Epididymal Excision Epididymal Excision
1163 SG SG0111 SG0111A 2000 2000 2400 2500 NA NA
Surgery under GA under GA
General Mesentric cyst
1164 SG SG0112 SG0112A Mesentric cyst excision 20000 20000 23400 25000 NA NA
Surgery excision
General
1165 SG SG0113 Mole Excision SG0113A Mole Excision 2000 2000 2400 2500 NA NA
Surgery
General Neurofibroma Neurofibroma Excision
1166 SG SG0114 SG0114A 2000 2000 2400 2500 NA NA
Surgery Excision under LA under LA
General
1167 SG SG0115 Ingrowing Toe Nail SG0115A Ingrowing Toe Nail 2000 2000 2400 2500 NA NA
Surgery
General Splenorenal Splenorenal
1168 SG SG0116 SG0116A 70000 70000 81900 87500 NA NA
Surgery Anastomosis Anastomosis
Replacement Surgery Replacement Surgery
General
1169 SG SG0117 For Corrosive Injury SG0117A For Corrosive Injury 50000 50000 58500 62500 NA NA
Surgery
Stomach Stomach
Choledochoduodenos Choledochoduodenosto
General
1170 SG SG0118 tomy Or Choledocho SG0118A my Or Choledocho 35000 35000 41000 43800 NA NA
Surgery
Jejunostomy Jejunostomy
Hepatico
General Hepatico Jejunostomy
1171 SG SG0119 Jejunostomy for SG0119A 45000 45000 52700 56300 NA NA
Surgery for biliary stricture
biliary stricture
General
Surgery, Surgical Management CystoJejunostomy -
1172 SG SG011 SG011A 22500 22500 26400 28200 NA No NA
Pediatric of PseudoCyst Open
Surgery
General
Surgery, Surgical Management
1173 SG SG011 SG011B CystoJejunostomy - Lap 22500 22500 26400 28200 NA No NA
Pediatric of PseudoCyst
Surgery
General
Surgery, Surgical Management Cystogastrostomy -
1174 SG SG011 SG011C 26250 26300 30800 32900 NA No NA
Pediatric of PseudoCyst Open
Surgery
General
Surgery, Surgical Management
1175 SG SG011 SG011D Cystogastrostomy - Lap 26250 26300 30800 32900 NA No NA
Pediatric of PseudoCyst
Surgery
I Stage- Sub Total I Stage- Sub Total
General
1176 SG SG0120 Colectomy + SG0120A Colectomy + Ileostomy 80000 80000 93600 100000 NA NA
Surgery
Ileostomy + J - Pouch + J - Pouch
General Pancreatic Pancreatic
1177 SG SG0121 SG0121A 60000 60000 70200 75000 NA NA
Surgery Necrosectomy Necrosectomy
Distal
General Distal Pancreatectomy +
1178 SG SG0122 Pancreatectomy + SG0122A 60000 60000 70200 75000 NA NA
Surgery Splenectomy
Splenectomy
General Heller Myotomy Heller Myotomy
1179 SG SG0123 SG0123A 30000 30000 35100 37500 NA NA
Surgery (Lap./Open) (Lap./Open)
I Stage-Sub Total
General I Stage-Sub Total
1180 SG SG0124 Colectomy + SG0124A 40000 40000 46800 50000 NA NA
Surgery Colectomy + Ileostomy
Ileostomy
General
Surgery,
Surgical
1181 SG SG012 Feeding Jejunostomy SG012A Feeding Jejunostomy 15000 15000 17600 18800 NA No NA
Oncology,
Pediatric
Surgery
General
Surgery,
1182 SG SG013 Ileostomy SG013A Ileostomy 16500 16500 19400 20700 NA No NA
Pediatric
Surgery
General
Congenital Atresia & Congenital Atresia &
Surgery,
1183 SG SG014 Stenosis of Small SG014A Stenosis of Small 30000 37500 42600 45000 NA No NA
Pediatric
Intestine Intestine
Surgery
General
Operation for
Surgery, Operation for
1184 SG SG015 Duplication of SG015A 20250 25400 28800 30400 NA No NA
Pediatric Duplication of Intestine
Intestine
Surgery
General Excision Duodenal
1185 SG SG016 Diverticulectomy SG016A 25000 25000 29300 31300 NA No NA
Surgery Diverticulum
General
Surgery, Excision Meckel's
1186 SG SG016 Diverticulectomy SG016B 16875 16900 19800 21100 NA No NA
Pediatric Diverticulum
Surgery
General
Surgery,
1187 SG SG017 Appendicectomy SG017A Open 20000 20000 23400 25000 NA No NA
Pediatric
Surgery
General
Surgery,
1188 SG SG017 Appendicectomy SG017B Lap 20000 20000 23400 25000 NA No NA
Pediatric
Surgery
General
Surgery, Appendicular Appendicular
1189 SG SG018 SG018A 20000 20000 23400 25000 NA No NA
Pediatric Perforation Perforation
Surgery
General
Operative drainage of
Surgery, Operative drainage of
1190 SG SG019 Appendicular SG019A 15000 15000 17600 18800 NA No NA
Pediatric Appendicular Abscess
Abscess
Surgery
General
Surgery, Open
1191 SG SG020 Total Colectomy SG020A 38625 48300 54900 58000 NA No NA
Surgical
Oncology
General
Surgery, Lap
1192 SG SG020 Total Colectomy SG020B 38625 48300 54900 58000 NA No NA
Surgical
Oncology
General
Surgery,
1193 SG SG021 Hemi colectomy SG021A Right-Open 28125 35200 40000 42200 NA No NA
Surgical
Oncology
General
Surgery,
1194 SG SG021 Hemi colectomy SG021B Right- Lap 28125 35200 40000 42200 NA No NA
Surgical
Oncology
General
Surgery,
1195 SG SG021 Hemi colectomy SG021C Left-Open 28125 35200 40000 42200 NA No NA
Surgical
Oncology
General
Surgery,
1196 SG SG021 Hemi colectomy SG021D Left- Lap 28125 35200 40000 42200 NA No NA
Surgical
Oncology
General Operative
Operative Management
Surgery, Management of
1197 SG SG022 SG022A of Volvulus of Large 26250 32900 37300 39400 NA No NA
Pediatric Volvulus of Large
Bowel
Surgery Bowel
General
Surgery,
Surgical
1198 SG SG023 Colostomy SG023A Colostomy 20000 20000 23400 25000 NA No NA
Oncology,
Pediatric
Surgery
General
Surgery,
Surgical
1199 SG SG024 Closure of stoma SG024A Closure of stoma 16687.5 16700 19600 20900 NA No NA
Oncology,
Pediatric
Surgery
General
1200 SG SG025 Sigmoid Resection SG025A Sigmoid Resection 23062.5 23100 27000 28900 NA No NA
Surgery
General Perineal Procedure Perineal Procedure for
1201 SG SG026 SG026A 18750 18800 22000 23500 NA No NA
Surgery for Rectal Prolapse Rectal Prolapse
General Abdominal Procedure Open
1202 SG SG027 SG027A 20250 20300 23700 25400 NA No NA
Surgery for Rectal Prolapse
General Abdominal Procedure Lap

1203 SG SG027 SG027B 20250 20300 23700 25400 NA No NA
Surgery for Rectal Prolapse
General
Surgery,
1204 SG SG028 Rectal Polyp Excision SG028A Rectal Polyp Excision 10000 10000 11700 12500 NA No NA
Surgical
Oncology
General
Surgery, Anterior Resection of
1205 SG SG029 SG029A Open 50000 50000 58500 62500 NA No NA
Surgical rectum
Oncology
General
Surgery, Anterior Resection of Lap
1206 SG SG029 SG029B 50000 50000 58500 62500 NA No NA
Surgical rectum
Oncology
General
Surgery, Resection
Pediatric Anastomosis
Surgery
General
Surgery, Resection Lap
1208 SG SG030 SG030B 26625 26700 29300 33300 NA No NA
Pediatric Anastomosis
Surgery
General Procedure for Fissure Procedure for Fissure in
1209 SG SG031 SG031A 10000 10000 11700 12500 NA No NA
Surgery in Ano Ano
General
1210 SG SG032 Haemorroidectomy SG032A without Stapler 12000 12000 14100 15000 NA No NA
Surgery
Haemorroid
General
1211 SG SG032 Haemorroidectomy SG032B with Stapler 12000 12000 14100 15000 Stapler one- 15000 No NA
Surgery
15000
General Management of Management of LA - 5625
1212 SG SG033 SG033A 5625 5700 6600 7100 NA Yes
Surgery Pilonidal Sinus Pilonidal Sinus GA - 14125
General Exicision of Sinus Exicision of Sinus and
1213 SG SG034 SG034A 5000 5000 5900 6300 NA No NA
Surgery and Curettage Curettage
General
Surgery, Exploratory
1214 SG SG035 SG035A Exploratory Laparotomy 11775 11800 13800 14800 NA No NA
Pediatric Laparotomy
Surgery
General
Surgery,
Pediatric Closure of Burst Closure of Burst
1215 SG SG036 SG036A 15000 15000 17600 18800 NA No NA
Surgery, Abdomen Abdomen
Obstetrics &
Gynecology
General
Surgery,
Surgical
1216 SG SG037 Hepatic Resection SG037A Open 37500 37500 43900 46900 NA No NA
Oncology,
Pediatric
Surgery
General
Surgery,
Surgical
1217 SG SG037 Hepatic Resection SG037B Lap 37500 37500 43900 46900 NA No NA
Oncology,
Pediatric
Surgery
General Operation Operation forAbdominal

Surgery, forAbdominal Hydatid Hydatid Cyst (Single
1218 SG SG038 SG038A 20925 21000 23100 26200 NA No NA
Pediatric Cyst (Single Organ) - Organ) - Change in
Surgery Change in Name Name
General
Surgery, Without Exploration of
1219 SG SG039 Cholecystectomy SG039A 31050 31100 36400 38900 NA No NA
Pediatric CBD - Open
Surgery
General
Surgery, With Exploration of CBD
1220 SG SG039 Cholecystectomy SG039B 31050 31100 36400 38900 NA No NA
Pediatric - Open
Surgery
General
Surgery, Without Exploration of
1221 SG SG039 Cholecystectomy SG039C 31050 31100 36400 38900 NA No NA
Pediatric CBD - Lap
Surgery
General
Surgery, With Exploration of CBD
1222 SG SG039 Cholecystectomy SG039D 31050 31100 36400 38900 NA No NA
Pediatric - Lap
Surgery
General
Surgery, Operative
Pediatric Cholecystostomy
Surgery
General
Surgery, Operative
1224 SG SG040 SG040B Lap 11250 11300 13200 14100 NA No NA
Pediatric Cholecystostomy
Surgery
General
Surgery, Operation of Operation of
1225 SG SG041 SG041A 31687.5 31700 37100 39700 NA No NA
Pediatric Choledochal Cyst Choledochal Cyst
Surgery
General
Surgery,
1226 SG SG042 Splenectomy SG042A Open 28125 35200 40000 42200 NA No NA
Pediatric
Surgery
General
Surgery,
1227 SG SG042 Splenectomy SG042B Lap 28125 35200 40000 42200 NA No NA
Pediatric
Surgery
General
Surgery, Bypass - Inoperable Bypass - Inoperable
1228 SG SG043 SG043A 50000 62500 71000 75000 NA No NA
Surgical Pancreas Pancreas
Oncology
General
Distal
Surgery, Distal
Pancreatectomy/Pancre
Surgical Pancreatectomy with
1229 SG SG044 SG044A atico Jejunostomy 35625 44600 50600 53500 NA No NA
Oncology, Pancreatico
with/without
Pediatric Jejunostomy
spleenlectomy
Surgery
General
Surgery, PancreaticoDuodene PancreaticoDuodenecto
1230 SG SG045 SG045A 100000 125000 142000 150000 NA No NA
Surgical ctomy (Whipple's) my (Whipple's)
Oncology
General Porto Caval Porto Caval
1231 SG SG046 SG046A 39937.5 50000 56800 60000 NA No NA
General Mesenteric Caval Mesenteric Caval
1232 SG SG047 SG047A 38812.5 48600 55200 58300 NA No NA
General
Surgery, Mesenteric Cyst – Mesenteric Cyst –
1233 SG SG048 SG048A 20625 20700 24200 25800 NA No NA
Pediatric Excision Excision
Surgery
General
Surgery,
Surgical Retroperitoneal Retroperitoneal Tumor –
1234 SG SG049 SG049A 31350 39200 44600 47100 NA No NA
Oncology, Tumor – Excision Excision
Pediatric
Surgery
Mesh - 6 X 3 -
General
1235 SG SG050 Groin Hernia Repair SG050A Inguinal - Open 20000 20000 23400 25000 Polypropylene - 15000 No NA
Surgery
15000
Mesh - 6 X 3 -
General
1236 SG SG050 Groin Hernia Repair SG050B Inguinal - Lap. 20000 20000 23400 25000 Polypropylene - 800 No NA
Surgery
800
Mesh - 15 X 15
General
1237 SG SG050 Groin Hernia Repair SG050C Femoral - Open 20000 20000 23400 25000 - Polypropylene 15000 No NA
Surgery
- 15000
Mesh - 6 X 3 -
General
1238 SG SG050 Groin Hernia Repair SG050D Femoral - Lap 20287.5 20300 23800 25400 Polypropylene - 2000 No NA
Surgery
2000
General Tackers -
tackers-15000,
Surgery, 15000
1239 SG SG050 Groin Hernia Repair SG050E Obturator - Lap. 22875 22900 26800 28600 Mesh 15X15- No NA
Pediatric Mesh - 15 X 15
5000
Surgery - 5000
General
Surgery, Mesh - 15 X 15
1240 SG SG051 Hernia - Ventral SG051A Epigastric 20000 20000 23400 25000 2000 No NA
Pediatric - 2000
Surgery
General
1241 SG SG051 Hernia - Ventral SG051B Umbilical 25000 25000 29300 31300 2000 No NA
Pediatric - 2000
Surgery
General
1242 SG SG051 Hernia - Ventral SG051C Paraumbilical 25000 25000 29300 31300 2000 No NA
Pediatric - 2000
Surgery
General
1243 SG SG051 Hernia - Ventral SG051D Spigelian 25000 25000 29300 31300 2000 No NA
Pediatric - 2000
Surgery
Mesh - 30 X 30
General
- 10000
Surgery, Repair of Incisional Repair of Incisional 30X30-10000
1244 SG SG052 SG052A 20250 20300 23700 25400 or No NA
Pediatric Hernia Hernia Lap/Open 15X15-2000
Mesh - 15 X 15
Surgery
- 2000
General
Surgery, Hiatus Hernia Repair Hiatus Hernia Repair -
1245 SG SG053 SG053A 26287.5 26300 30800 32900 NA No NA
Pediatric / Fundoplication Open
Surgery
General
Surgery, Hiatus Hernia Repair Hiatus Hernia Repair -
1246 SG SG053 SG053B 26287.5 26300 30800 32900 NA No NA
Pediatric / Fundoplication Lap
Surgery
General
Fundoplication -
Surgery, Hiatus Hernia Repair
1247 SG SG053 SG053C Open(+/- Hiatus Hernia 26287.5 26300 30800 32900 NA No NA
Pediatric / Fundoplication
repair)
Surgery
Excision of cyst /
General
1248 SG SG054 Sebaceous Cysts SG054A Single Cyst 2625 2700 3100 3300 NA No NA
Surgery
over scrotum
Excision of cyst /
General
1249 SG SG054 Sebaceous Cysts SG054B Multiple Cysts 5000 5000 5900 6300 NA No NA
Surgery
over scrotum
General Excision Filarial Excision Filarial
1250 SG SG055 SG055A 8000 8000 9400 10000 NA No NA
Surgery Scrotum Scrotum
General
Surgery, Operation for Operation for Hydrocele
1251 SG SG056 SG056A 10000 10000 11700 12500 NA No NA
Pediatric Hydrocele (U/L) (U/L)
Surgery
General
Surgery, Epididymal Cyst / Epididymal Cyst
1252 SG SG057 SG057A 5235 5300 6200 6600 NA No NA
Pediatric Nodule Excision excision
Surgery
General
Surgery, Epididymal Cyst / Epididymal Nodule
1253 SG SG057 SG057B 5235 5300 6200 6600 NA No NA
Pediatric Nodule Excision excision
Surgery
General
1254 Surgery, SG SG058 Vasovasostomy SG058A Vasovasostomy 12000 12000 14100 15000 NA No NA
Urology
General
Surgery,
Surgical
1255 SG SG059 Orchidectomy SG059A Orchidectomy 12000 12000 14100 15000 NA No NA
Oncology,
Pediatric
Surgery
General
Surgery, Inguinal Node Inguinal Node
1256 SG SG060 SG060A 19732.5 19800 23100 24700 NA No NA
Pediatric (dissection) - U/L (dissection) - U/L
Surgery
General
Surgery, Estlander Operation
1257 SG SG061 SG061A Estlander Operation (lip) 14737.5 18500 21000 22200 NA No NA
Surgical (lip)
Oncology
General
1258 SG SG062 SG062A Wedge Excision 20025 25100 28500 30100 NA No NA
Surgical Carcinoma Lip
Oncology
General
Surgery, Operation for Wedge Excision and
1259 SG SG062 SG062B 30000 37500 42600 45000 NA No NA
Surgical Carcinoma Lip Vermilionectomy
Oncology
General
1260 SG SG062 SG062C Cheek advancement 30000 37500 42600 45000 NA No NA
Surgical Carcinoma Lip
Oncology
General
Complete Excision of
Surgery, Complete Excision of
Growth from Tongue
Surgical Growth from Tongue
1261 SG SG063 SG063A only 16650 20900 23700 25000 NA No NA
Oncology, only (inclusive of
(inclusive of
Pediatric Histopathology)
Histopathology)
Surgery
General
Excision of Growth Excision of Growth from
Surgery,
1262 SG SG064 from Tongue with SG064A Tongue with neck node 31312.5 39200 44500 47000 NA No NA
Surgical
neck node dissection dissection
Oncology
General Microlaryngoscopic Microlaryngoscopic
1263 SG SG065 SG065A 18500 18500 21700 23200 NA No NA
Surgery Surgery Surgery
General
Surgery, Submandibular Mass Submandibular Mass
1264 SG SG066 SG066A 20000 25000 28400 30000 NA No NA
Surgical Excision Excision
Oncology
General
Surgery, Radical Neck
1265 SG SG067 SG067A Radical Neck Dissection 26925 33700 38300 40400 NA No NA
Surgical Dissection
Oncology, ENT
General Surgical removal of Surgical removal of

1266 SG SG068 SG068A 20000 20000 23400 25000 NA No NA
Surgery, ENT Branchial Cyst/Sinus Branchial Cyst/Sinus
General
Surgery,
Carotid Body tumour - Carotid Body tumour -
1267 Surgical SG SG069 SG069A 30000 37500 42600 45000 NA No NA
Excision Excision
Oncology,
CTVS
General
Surgery,
Surgical
1268 SG SG070 Thyroidectomy SG070A Hemi thyroidectomy 26220 26300 30700 32800 NA No NA
Oncology,
Pediatric
Surgery, ENT
General
Surgery,
Surgical
1269 SG SG070 Thyroidectomy SG070B Total thyroidectomy 26250 26300 30800 32900 NA No NA
Oncology,
Pediatric
Surgery, ENT
General
Surgery,
Surgical Total Thyroidectomy
1270 SG SG070 Thyroidectomy SG070C 34875 43600 49600 52400 NA No NA
Oncology, with Block Dissection
Pediatric
Surgery, ENT
General
Surgery,
Excision of
Surgical Excision of Parathyroid
1271 SG SG071 Parathyroid Adenoma SG071A 25000 25000 29300 31300 NA No NA
Oncology, Adenoma/Carcinoma
/ Carcinoma
Pediatric
Surgery
General
Surgery,
1272 SG SG072 Thymectomy SG072A Thymectomy 48000 60000 68200 72000 NA No NA
Pediatric
Surgery
General
Surgery, Sympathectomy-
1273 SG SG073 Sympathectomy SG073A 16500 20700 23500 24800 NA No NA
Pediatric Unilateral (U/L)
Surgery
General
Surgery, Breast Lump Excision Breast Lump Excision LA - 10000
1274 SG SG074 SG074A 10000 10000 11700 12500 NA Yes
Surgical (Benign) (Benign) GA - 14000
Oncology
General
Surgery,
1275 SG SG075 Mastectomy SG075A Simple Mastectomy 25000 25000 29300 31300 NA No NA
Surgical
Oncology
General
Surgery, Radical / Modified
1276 SG SG075 Mastectomy SG075B 26250 32900 37300 39400 NA No NA
Surgical Radical Mastectomy
Oncology
General Excision Mammary Excision Mammary
1277 SG SG076 SG076A 12000 12000 14100 15000 NA No NA
Surgery Fistula Fistula
General
Surgery, Intercostal drainage Intercostal drainage
1278 SG SG077 SG077A 5550 5600 6500 7000 NA No NA
Pediatric Only Only
Surgery, CTVS
General
Surgery, Rib Resection & Rib Resection &
1279 SG SG078 SG078A 20000 20000 23400 25000 NA No NA
Pediatric Drainage Drainage
Surgery
General
Surgery,
1280 SG SG079 Thoracoplasty SG079A Thoracoplasty 24375 24400 28600 30500 NA No NA
Pediatric
Surgery
General
Surgery, Decortication Decortication
1281 SG SG080 SG080A 33000 33000 38700 41300 NA No NA
Pediatric (Pleurectomy) (Pleurectomy)
Surgery
General
Surgery,
Linear Cutter 3
Pediatric
1282 SG SG081 Lobectomy SG081A Thoracoscopic 32812.5 32900 38400 41100 cartidges- 15000 No NA
Surgery,
15000
Surgical
Oncology
General
Surgery,
Pediatric
1283 SG SG081 Lobectomy SG081B Open 32812.5 32900 38400 41100 NA No NA
Surgery,
Surgical
Oncology
General
Linear Cutter 3
Surgery, Thoracoscopic Thoracoscopic
1284 SG SG082 SG082A 31875 39900 45300 47900 cartidges- 15000 No NA
Pediatric Segmental Resection Segmental Resection
15000
Surgery
General
Surgery, Lung Hydatid Cyst Lung Hydatid Cyst
1285 SG SG083 SG083A 26250 26300 30800 32900 NA No NA
Pediatric removal removal
Surgery
General
Surgery, Incision & Drainage of Incision & Drainage of LA - 5000
1286 SG SG084 SG084A 5000 5000 5900 6300 NA Yes
Pediatric Abscess Abscess GA - 10000
Surgery
Lipoma / Cyst / other
General LA - 5000
1287 SG SG085 cutaneous swellings SG085A Lipoma Excision 5000 5000 5900 6300 NA Yes
Surgery GA - 10000
Excision
General LA - 5000
1288 SG SG085 cutaneous swellings SG085B Cyst Excision 5000 5000 5900 6300 NA Yes
Surgery GA - 10000
Excision
General Other cutaneous LA - 5000
1289 SG SG085 cutaneous swellings SG085C 5000 5000 5900 6300 NA Yes
Surgery swellings Excision GA - 10000
Excision
General LA - 5000
1290 SG SG086 Debridement of Ulcer SG086A Debridement of Ulcer 5000 5000 5900 6300 NA Yes
Surgery GA - 10000
General
Surgery, Flap Reconstructive Flap Reconstructive
1291 SG SG087 SG087A 28837.5 36100 41000 43300 NA No NA
Surgical Surgery Surgery
Oncology
General
Surgery,
Free Grafts - Wolfe Free Grafts - Wolfe
1292 Plastic & SG SG088 SG088A 25000 31300 35500 37500 NA No NA
Grafts Grafts
Reconstructive
Surgery
General Tissue Tissue Reconstruction
1293 SG SG089 SG089A 28125 35200 40000 42200 NA No NA
Surgery Reconstruction Flap Flap
General
Surgery,
Plastic &
Split thickness skin
1294 Reconstructive SG SG090 SG090A Small (< 4% TBSA) 15000 18800 21300 22500 NA No NA
grafts
Surgery,
Pediatric
Surgery
General
Surgery,
Plastic &
1295 Reconstructive SG SG090 SG090B Medium (4 - 8% TBSA) 14437.5 18100 20600 21700 NA No NA
grafts
Surgery,
Pediatric
Surgery
General
Surgery,
Plastic &
1296 Reconstructive SG SG090 SG090C Large (> 8% TBSA) 16312.5 20400 23200 24500 NA No NA
grafts
Surgery,
Pediatric
Surgery
General
Surgery,
Surgical
Skin Flaps - Rotation Skin Flaps - Rotation
1297 Oncology, SG SG091 SG091A 23025 28800 32700 34600 NA No NA
Flaps Flaps
Plastic &
Reconstructive
Surgery
General
1298 Surgery, SG SG092 Tendon Transfer SG092A Tendon Transfer 20000 25000 28400 30000 NA No NA
Orthopedics
Lymphatics Excision
Lymphatics Excision of
General of Subcutaneous
1299 SG SG093 SG093A Subcutaneous Tissues 15000 15000 17600 18800 NA No NA
Surgery Tissues In
In Lymphoedema
Lymphoedema
General AV Fistula without AV Fistula without
1300 SG SG094 SG094A 18400 18400 21600 23000 NA No NA
Surgery prosthesis prosthesis
Management of
General Management of
1301 SG SG095 SG095A Varicose Veins- 16500 16500 19400 20700 NA No NA
Surgery Varicose Veins
Operative management
General Management of
1302 SG SG095 SG095B Minor sclerotherapy 5000 5000 5900 6300 NA NA
Surgery Varicose Veins
General
Surgery,
Pediatric
1303 SG SG096 Biopsy SG096A Lymph Node 5000 5000 5900 6300 NA No NA
Surgery,
Obstetrics &
Gynecology
General
Surgery,
Pediatric
1304 SG SG096 Biopsy SG096B Endometrial Aspiration 2625 2700 3100 3300 NA No NA
Surgery,
Obstetrics &
Gynecology
General
Surgery,
Pediatric Cervix Cancer screening
1305 SG SG096 Biopsy SG096C 2475 2500 2900 3100 NA No NA
Surgery, (PAP + Colposcopy)
Obstetrics &
Gynecology
General
Surgery,
Pediatric
1306 SG SG096 Biopsy SG096E Vulval 2437.5 2500 2900 3100 NA No NA
Surgery,
Obstetrics &
Gynecology
General Stoma Management
1307 SG SG097 Stoma Management SG097A 5437.5 5500 6400 6800 NA No NA
Surgery follow up of Ileostomy
General Stoma Management
1308 SG SG097 Stoma Management SG097B 5437.5 5500 6400 6800 NA No NA
Surgery follow up of Colostomy
General
Surgery, Foreign Body LA - 7000
1309 SG SG098 SG098A Foreign Body Removal 7000 7000 8200 8800 NA Yes
Pediatric Removal GA - 10000
Surgery, ENT
General Necrotising fasciitis / Necrotising fasciitis /
1310 SG SG099 SG099A 11250 14100 16000 16900 NA No NA
Surgery Fournier Gangrene Fournier Gangrene
Surgical management Surgical management of

of Lower GI bleed Lower GI bleed
(inclusive of (inclusive of
sigmoidoscopy / sigmoidoscopy /
General
1311 SG SG100 colonoscopy) - SG100A colonoscopy) - 20000 25000 28400 30000 NA No NA
Surgery
Colonoscopic Colonoscopic
management only management only
excluding local excluding local perineal
perineal conditions conditions
General
1312 SG SG101 Caecopexy SG101A Caecopexy 20000 25000 28400 30000 NA No NA
Surgery
General Repair of Renal Repair of Renal Artery
1313 SG SG102 SG102A 60750 76000 86300 91200 NA No NA
Surgery Artery Stenosis Stenosis
General ERCP + Stenting/Stone
1314 SG SG103 ERCP SG103A 20000 25000 28400 30000 NA No NA
Surgery removal
Circumcision - Phimosis
General
1315 SG SG104 Circumcision SG104A / Paraphimosis or any 10000 10000 11700 12500 NA No NA
Surgery
other clinical condition
Percutaneous
Interventional Percutaneous
transhepatic external
1316 Radiology/Gen SG SG105 SG105A transhepatic external 20160 25200 28700 30300 NA No NA
biliary drainage
eral surgery biliary drainage (PTBD)
(PTBD)
Pinna surgery for 10000 10000
1317 ENT SL SL001 SL001A Pinna surgery for tumor 14200 15000 NA No NA
tumour / trauma
Pinna surgery for Pinna surgery for 10000 10000
1318 ENT SL SL001 SL001B 11700 12500 NA No NA
tumour / trauma trauma
Tympanoplasty (can be
stratified (GA/LA) and
1319 ENT SL SL002 Tympanoplasty SL002A 15337.5 15400 18000 19200 NA Yes NA
price adjusted
accordingly )
Stapedectomy /
1320 ENT SL SL003 SL003A Stapedectomy 17250 17300 20200 21600 NA Yes NA
tympanotomy
Stapedectomy / 15,000 15,000
1321 ENT SL SL003 SL003B Tympanotomy 17600 18800 NA Yes NA
tympanotomy
ENT, Surgical
1322 SL SL004 Mastoidectomy SL004A Simple 28000 28000 32800 35000 NA No NA
Oncology
ENT, Surgical
1323 SL SL004 Mastoidectomy SL004B Radical 28000 28000 32800 35000 NA No NA
Oncology
ENT, Surgical Myringotomy with or LA - 7600

1324 SL SL005 SL005A Unilateral 7600 7600 8900 9500 NA Yes
Oncology without Grommet GA - 12600
ENT, Surgical Myringotomy with or LA - 7600

1325 SL SL005 SL005B Bilateral 7600 7600 8900 9500 NA Yes
Oncology without Grommet GA - 12600
20000 20000
1326 ENT SL SL006 Endoscopic DCR SL006A Endoscopic DCR 23400 25000 NA No NA
Epistaxis treatment - Epistaxis treatment - 2500(inc. of 2500(inc. of 2900(inc. of 3100(inc. of
1327 ENT SL SL007 SL007A NA Yes NA
packing packing pack cost) pack cost) pack cost) pack cost)
Functional septo Functional septo
1328 ENT SL SL008 SL008A 22650 22700 26600 28400 NA No NA
rhinoplasty rhinoplasty
LA - 13875
1329 ENT SL SL009 Septoplasty SL009A Septoplasty 13875 13900 16300 17400 NA Yes
GA - 19875
Fracture - setting Fracture - setting nasal LA - 8625
1330 ENT SL SL010 SL010A 8625 8700 10100 10800 NA Yes
nasal bone bone GA - 12625
Inferior turbinate
reduction under
GA(HOW IS IT
Inferior turbinate
1331 ENT SL SL011 SL011A DIFFERENT FROM 6000 6000 7100 7500 NA No NA
reduction under GA
TURBINATE
REDUCTION AT THE
END?)
Open sinus
surgery(Open Sinus
1332 ENT SL SL012 Open sinus surgery SL012A 16125 16200 18900 20200 NA No NA
Surgery (Single/Multiple
Sinuses)
Functional Endoscopic
Functional
Sinus (FESS)stratified
1333 ENT SL SL013 Endoscopic Sinus SL013A 14625 14700 17200 18300 NA No NA
as U/L or B/L and cost
(FESS)
adjusted
Ant. Ethmoidal /
Ant. Ethmoidal artery
1334 ENT SL SL014 sphenopalatine artery SL014A 16125 16200 18900 20200 NA No NA
ligation - Open
ligation
Ant. Ethmoidal /
Ant. Ethmoidal artery
1335 ENT SL SL014 sphenopalatine artery SL014B 16125 16200 18900 20200 NA No NA
ligation - Endoscopic
ligation
Ant. Ethmoidal /
Sphenopalatine artery
1336 ENT SL SL014 sphenopalatine artery SL014C 16125 16200 18900 20200 NA No NA
ligation - Open
ligation
Ant. Ethmoidal /
Sphenopalatine artery
1337 ENT SL SL014 sphenopalatine artery SL014D 16125 16200 18900 20200 NA No NA
ligation - Endoscopic
ligation
1338 ENT SL SL015 Adenoidectomy SL015A Adenoidectomy 9375 9400 11000 11800 NA No NA
Tonsillectomy - U/L
1339 ENT SL SL016 Tonsillectomy SL016A tonsillectomy 12187.5 12200 14300 15300 NA No NA
(unilateral/bilateral)
Tonsillectomy - B/L
1340 ENT SL SL016 Tonsillectomy SL016B 12187.5 12200 14300 15300 NA No NA
adenotonsillectomy
Peritonsillar abscess
ENT,Pediatric drainage / intraoral Peritonsillar abscess
1341 SL SL017 SL017A 5800 5800 6800 7300 NA No NA
Surgery calculus drainage
removal
Peritonsillar abscess
ENT,Pediatric drainage / intraoral Intraoral calculus
1342 SL SL017 SL017B 5800 5800 6800 7300 NA No NA
Surgery calculus removal
removal
Thyroglossal /
Thyroglossal cyst
1343 ENT SL SL018 Branchial cyst / sinus SL018A 16931.25 17000 19900 21200 NA No NA
excision
/ fistula excision
Thyroglossal /
Thyroglossal sinus
1344 ENT SL SL018 Branchial cyst / sinus SL018B 16931.25 17000 19900 21200 NA No NA
excision
/ fistula excision
Thyroglossal /
Thyroglossal fistula
1345 ENT SL SL018 Branchial cyst / sinus SL018C 16931.25 17000 19900 21200 NA No NA
excision
/ fistula excision
Thyroglossal /
1346 ENT SL SL018 Branchial cyst / sinus SL018D Branchial sinus excision 16987.5 17000 19900 21300 NA No NA
/ fistula excision
Thyroglossal /
Branchial fistula
1347 ENT SL SL018 Branchial cyst / sinus SL018E 16987.5 17000 19900 21300 NA No NA
excision
/ fistula excision
Uvulopalatopharyngo Uvulopalatopharyngopla
1348 ENT SL SL019 SL019A 20100 20100 23600 25200 NA No NA
plasty (UPPP) sty (UPPP)
Implant for
Excision of tumour of Excision of
oral cavity / paranasal Excision of tumour of tumour of oral
ENT,Surgical sinus / oral cavity / paranasal cavity /
1349 SL SL020 SL020A 10000 12500 14200 15000 20000 No NA
Oncology laryngopharynx with sinus / laryngopharynx paranasal
or without without reconstruction sinus /
reconstruction laryngopharynx
- 20000
Excision of tumour of
oral cavity / paranasal
oral cavity / paranasal
ENT,Surgical sinus /
1350 SL SL020 SL020B sinus / laryngopharynx 36500 45700 51900 54800 NA No NA
Oncology laryngopharynx with
with pedicled flap
or without
reconstruction
reconstruction
Implant for
Excision of tumour of Excision of
oral cavity / paranasal tumour of oral
oral cavity /
ENT,Surgical sinus / cavity /
1351 SL SL020 SL020C paranasal sinus / 25000 31300 35500 37500 20000 No NA
Oncology laryngopharynx with paranasal
laryngopharynx with free
or without sinus /
flap reconstruction
reconstruction laryngopharynx
- 20000
ENT, Surgical
Oncology,
1352 SL SL021 Parotidectomy SL021A Total Parotidectomy 28200 28200 33000 35300 NA No NA
General
Surgery
ENT, Surgical
Oncology, Superficial
1353 SL SL021 Parotidectomy SL021B 23800 23800 27900 29800 NA No NA
General Parotidectomy
Surgery
Removal of Removal of
LA - 29000
1354 ENT SL SL022 Submandibular SL022A Submandibular Salivary 29000 29000 34000 36300 NA Yes
GA - 34000
Salivary gland gland
Removal of
LA - 29000
1355 ENT SL SL022 Submandibular SL022B Removal of Ranula 29000 29000 34000 36300 NA Yes
GA - 34000
Salivary gland
Rigid laryngoscopy /
bronchoscopy / Rigid laryngoscopy -
ENT,Pediatric LA - 7000
1356 SL SL023 oesophagoscopy - SL023A Diagnostic + / - 7000 7000 8200 8800 NA Yes
Surgery GA - 12000
Diagnostic + / - biopsy
biopsy
bronchoscopy / Rigid bronchoscopy -
1357 SL SL023 oesophagoscopy - SL023B Diagnostic + / 7000 7000 8200 8800 NA Yes
Surgery GA - 12000
Diagnostic + / - - biopsy
biopsy
bronchoscopy / Rigid oesophagoscopy -
1358 SL SL023 oesophagoscopy - SL023C Diagnostic 7000 7000 8200 8800 NA Yes
Surgery GA - 12000
Diagnostic + / - + / - biopsy
biopsy
Microlaryngeal
Microlaryngeal surgery
1359 ENT SL SL024 surgery with or SL024A 17000 17000 19900 21300 NA No NA
with or without laser
without laser
Implant for
Open laryngeal
Open laryngeal Open laryngeal framework
ENT,Surgical
1360 SL SL025 framework surgery / SL025A framework surgery / 5000 5000 5900 6300 surgery / 15000 No NA
Oncology
Thyroplasty Thyroplasty Thyroplasty
(Keel / Stent) -
15000
ENT,General
Tracheostomy / LA - 28000
1361 Surgery,Peadi SL SL026 SL026A Tracheostomy 28000 28000 32800 35000 NA Yes
Tracheotomy GA - 38000
atric Surgery
ENT,General
Tracheostomy / LA - 28000
1362 Surgery,Peadi SL SL026 SL026B Tracheotomy 28000 28000 32800 35000 NA Yes
Tracheotomy GA - 38000
atric Surgery
ENT,General
Selective Benign neck
Surgery,
1363 SL SL027 Neck dissection SL027A tumour 18800 23500 26700 28200 NA No NA
Surgical
excision
Oncology
ENT,General
Comprehensive Benign
Surgery,
1364 SL SL027 Neck dissection SL027B neck tumour 18800 23500 26700 28200 NA No NA
Surgical
excision
Oncology
ENT,General
Selective Pharyngeal
Surgery,
1365 SL SL027 Neck dissection SL027C diverticulum 18800 23500 26700 28200 NA No NA
Surgical
excision
Oncology
ENT,General
Comprehensive
Surgery,
1366 SL SL027 Neck dissection SL027D Pharyngeal 18800 23500 26700 28200 NA No NA
Surgical
diverticulum excision
Oncology
Deep neck abscess
ENT,General
drainage/ Post Deep neck abscess
1367 Surgery,Peadi SL SL028 SL028A 16800 16800 19700 21000 NA No NA
trauma neck drainage
atric Surgery
exploration
Deep neck abscess
ENT,General
drainage/ Post Post trauma neck
1368 Surgery,Peadi SL SL028 SL028B 16800 21000 23900 25200 NA No NA
trauma neck exploration
atric Surgery
exploration
ENT,Surgical
Anterior skull base Endoscopic CSF Fibrin Glue -
1369 Oncology,Neur SL SL029 SL029A 26000 32500 37000 39000 9000 No NA
surgery Rhinorrhea Repair 9000
osurgery
ENT,Surgical
Anterior skull base Optic nerve Fibrin Glue -
1370 Oncology,Neur SL SL029 SL029B 25500 31900 36300 38300 9000 No NA
surgery decompression 9000
osurgery
ENT,Surgical
Anterior skull base Fibrin Glue -
1371 Oncology,Neur SL SL029 SL029C Orbital decompression 25500 31900 36300 38300 9000 No NA
surgery 9000
osurgery
ENT,Surgical
1372 Oncology,Neur SL SL029 SL029D Craniofacial resection 25500 31900 36300 38300 9000 No NA
surgery 9000
osurgery
ENT,Surgical
1373 Oncology,Neur SL SL029 SL029E Maxillary swing 25500 31900 36300 38300 9000 No NA
surgery 9000
osurgery
ENT,Surgical Advanced anterior Endoscopic Fibrin Glue -
1374 SL SL030 SL030A 39800 49800 56600 59700 9000 No NA
Oncology skull base surgery Hypophysectomy 9000
ENT,Surgical Advanced anterior Fibrin Glue -
1375 SL SL030 SL030B Clival tumour excision 39800 49800 56600 59700 9000 No NA
Oncology skull base surgery 9000
ENT,Surgical Lateral skull base Fibrin Glue -
1376 SL SL031 SL031A Subtotal petrosectomy 24700 30900 35100 37100 9000 No NA
Oncology procedures 9000
Post-traumatic facial
1377 SL SL031 SL031B nerve 24700 30900 35100 37100 9000 No NA
decompression
1378 SL SL031 SL031C CSF Otorrhoea repair 24700 30900 35100 37100 9000 No NA
ENT,Surgical Advanced lateral skull Fibrin Glue -
1379 SL SL032 SL032A Fisch approach 39900 49900 56700 59900 9000 No NA
Oncology base surgery 9000
ENT,Surgical Advanced lateral skull Translabyrinthine Fibrin Glue -
1380 SL SL032 SL032B 39900 49900 56700 59900 9000 No NA
Oncology base surgery approach 9000
ENT,Surgical Advanced lateral skull Fibrin Glue -
1381 SL SL032 SL032C Transcochlear approach 39900 49900 56700 59900 9000 No NA
Oncology base surgery 9000
ENT,Surgical Advanced lateral skull Temporal Bone Fibrin Glue -
1382 SL SL032 SL032D 39900 49900 56700 59900 9000 No NA
Oncology base surgery resection 9000
Closed reduction / Close Close Close Close
intermaxillary fixation Closed reduction for reduction reduction reduction reduction
1383 ENT SL SL033 SL033A NA No NA
for fracture of maxilla fracture of maxilla 5000/Fracture 5000/Fracture 5850/Fracture 6250/Fracture
/ mandible / zygoma 12000 12000 14040 15000
1384 ENT SL SL033 SL033B NA No NA
for fracture of maxilla fracture of mandible 5000/Fracture 5000/Fracture 5850/Fracture 6250/Fracture
/ mandible / zygoma 12000 12000 14040 15000

1385 ENT SL SL033 SL033C NA No NA
for fracture of maxilla fracture of zygoma 5000/Fracture 5000/Fracture 5850/Fracture 6250/Fracture
/ mandible / zygoma 12000 12000 14040 15000

Closed reduction and
intermaxillary fixation reduction reduction reduction reduction
1386 ENT SL SL033 SL033D Intermaxillary fixation for NA No NA
for fracture of maxilla 5000/Fracture 5000/Fracture 5850/Fracture 6250/Fracture
fracture of mandible
/ mandible / zygoma 12000 12000 14040 15000
Implant for
Open reduction
ENT,Oral &
and internal
Maxillofacial Open reduction and
Open reduction and fixation of Single - 14000
Surgery,Plastic internal fixation of
1387 SL SL034 SL034A internal fixation of 14000 14000 16400 17500 maxilla / 4000 Yes Multiple -
& maxilla / mandible /
maxilla mandible / 21000
Reconstructive zygoma
zygoma
Surgery
(Plates /
Screws) - 4000
Implant for
Open reduction
ENT,Oral &
and internal
1388 SL SL034 SL034B internal fixation of 14000 14000 16400 17500 maxilla / 4000 Yes Multiple -
mandible mandible / 21000
zygoma
Surgery
(Plates /
Screws) - 4000
Implant for
Open reduction
ENT,Oral &
and internal
1389 SL SL034 SL034C internal fixation of 14000 14000 16400 17500 maxilla / 4000 Yes Multiple -
zygoma mandible / 21000
zygoma
Surgery
(Plates /
Screws) - 4000
Clinic based
1390 ENT SL SL035 therapeutic SL035A Turbinate reduction 1200 1200 1500 1500 NA No NA
interventions of ENT
Clinic based
1391 ENT SL SL035 therapeutic SL035B Biopsy 1200 1200 1500 1500 NA No NA
Clinic based
1392 ENT SL SL035 therapeutic SL035C Intratympanic injections 1200 1200 1500 1500 NA No NA
Clinic based
1393 ENT SL SL035 therapeutic SL035D Wide bore aspiration 1200 1200 1500 1500 NA No NA
Cochlear Implant
Surgery*
Cochlear Implant
Surgery(53000) *pre -
Surgery*
op
Surgery(53000) *pre -op
evaluation(including
evaluation(including
vaccine for
vaccine for meningitis)-
meningitis)- 10000/-
10000/- *Initial mapping
*Initial mapping and
1394 ENT SL SL036 SL036A and swithch on - 5000/- 130000 162500 184600 195000 NA NA
swithch on - 5000/-
Rehabilitation Therapy
Rehabilitation
(part- 1 for first 6
Therapy (part- 1 for
months) -21700
first 6 months) -21700
Rehabilitation Therapy
Rehabilitation
(part- 2 for second 6
Therapy (part- 2 for
months)-40300
second 6 months)-
40300
Oral & Extraction of

Extraction of impacted
1395 Maxillofacial SM SM001 impacted tooth under SM001A 750 800 900 1000 NA No NA
tooth under LA
Surgery LA
Oral &
Sequestrectomy Osteomyelitis -Acute
1396 Maxillofacial SM SM002 SM002A 2000 2000 2400 2500 NA No NA
Debridement
Surgery
Oral &
Sequestrectomy
1397 Maxillofacial SM SM002 SM002B Osteomyelitis-Chronic 3000 3800 4300 4500 NA NA
Debridement
Surgery
1.TM joint ankylosis of
Oral & both jaws - under GA
TM joint ankylosis of
1398 Maxillofacial SM SM003 SM003A (Unilateral) 15,000 15000 17600 18800 NA No NA
both jaws - under GA
Surgery
2.TM joint ankylosis of

Oral & both jaws - under GA
TM joint ankylosis of
1399 Maxillofacial SM SM003 SM003B (Bilateral)- 25000 31300 35500 37500 NA NA
both jaws - under GA
Surgery (Covering
Reconstruction)
Oral & Closed reduction (1 jaw)
Fixation of fracture of
1400 Maxillofacial SM SM004 SM004A using wires - under 5000 5000 5900 6300 NA No NA
jaw
Surgery LA/GA
Open reduction (1 jaw)

Oral & and fixing of plates /
Fixation of fracture of
1401 Maxillofacial SM SM004 SM004B wire – under LA/GA 12000 12000 14100 15000 8000 8000 No NA
jaw
Surgery Cost of implant
Titanium:- TBF at pre-
auth
Enucleation / excision
Oral & Surgery for Cyst &
of cyst / tumour of jaws
1402 Maxillofacial SM SM005 tumour of Maxilla / SM005A 2625 2700 3100 3300 NA No NA
under LA +cost of
Surgery Mandible
implant
Oral & Surgery for Cyst &

1403 Maxillofacial SM SM005 tumour of Maxilla / SM005B Enucleation / excision 5437.5 5500 6400 6800 NA No NA
Surgery Mandible of cyst / tumour of jaws
under GA
Maxilla / Mandible
Mandible Tumour
Oral & neoplastic Tumour
Resection and
1404 Maxillofacial SM SM006 SM006A Resection and 13500 13500 15800 16900 NA No NA
reconstruction /
Surgery reconstruction (Cancer
Cancer surgery
surgery)
1.Release of fibrous
Release of fibrous
Oral & bands & grafting - in
bands & grafting - in
1405 Maxillofacial SM SM007 SM007A (OSMF) treatment under 3300 3300 3900 4200 NA No NA
(OSMF) treatment
Surgery LA: 5000
under GA
Release of fibrous 2. Release of fibrous

Oral &
bands & grafting - in release bands &
1406 Maxillofacial SM SM007 SM007B 15000 18800 21300 22500 NA NA
(OSMF) treatment coronoidectomy with
Surgery
under GA grafting - in (OSMF)
treatment under GA
Oral & Apicoectomy (A)
Apicoectomy (A)
1407 Maxillofacial SM SM008 SM008A (1-3 teeth) LA/GA 1500 1500 1800 1900 NA No NA
Tooth
Surgery 3-6:4000
Oral &
Correction of oro- Correction of oro-antral
1408 Maxillofacial SM SM009 SM009A 7000 7000 8200 8800 NA Yes NA
antral communication Fistula
Surgery
Oral &
Submandibular Intraoral submandibular
1409 Maxillofacial SM SM010 SM010A 7000 7000 8200 8800 NA Yes NA
sialolithotomy sialolithotomy LA/ GA
Surgery
Oral &
Submandibular Submandibular
1410 Maxillofacial SM SM010 SM010C 9000 9000 10600 11300 NA No NA
sialolithotomy sialolithotomy
Surgery
Oral & Dentoalveolar trauma -
Dentoalveolar trauma
1411 Maxillofacial SM SM011 SM011A wiring (dental /trauma 3000 3000 3600 3800 NA No NA
- wiring
Surgery wiring- one jaw)
Oral &
Extraoral parotid
1412 Maxillofacial SM SM012 Parotid sialolithotomy SM012A 12000 12000 14100 15000 NA No NA
sialolithotomy under GA
Surgery
Oral &
Intraoral parotid
1413 Maxillofacial SM SM012 Parotid sialolithotomy SM012B 7000 7000 8200 8800 NA Yes NA
sialolithotomy
Surgery
Re-
implantation of
Avulsed tooth
with wiring (4-6
Re-implantation of
Oral & Re-implantation of teeth):12000 4-6 teeth-
Avulsed tooth with
1414 Maxillofacial SM SM013 Avulsed tooth with SM013A 1650 1700 2000 2100 12000 No NA
wiring (1-3 teeth)
Surgery wiring Re- 7-9 -18000
3-6 :6000
implantation of
Avulsed tooth
with wiring (7-9
teeth):18000
Osteoradionecrosis of
Oral & Osteoradionecrosis
jaws management by
1415 Maxillofacial SM SM014 management by SM014A 5000 5000 5900 6300 NA Yes NA
excision under LA
Surgery excision
2.Osteoradionecrosis of
Jaws management by
Oral & Osteoradionecrosis
excision and / or
1416 Maxillofacial SM SM014 management by SM014B 12000 15000 17100 18000 NA NA
reconstruction under GA
Surgery excision
+ Implant : 12000
+Implant
Depressed Skull Surgery for Depressed
1417 Neurosurgery SN SN001 SN001A 40000 50000 56800 60000 NA No NA
Fracture Skull fracture
Cranioplasty with
1418 Neurosurgery SN SN002 CranioPlasty SN002A 27500 34400 39100 41300 NA No NA
autologus bone graft
Implant for
"CranioPlasty
Cranioplasty with with
1419 Neurosurgery SN SN002 CranioPlasty SN002B 27500 34400 39100 41300 20000 No NA
exogenous Graft Exogenous
graft" - (Rs.
20000)
Twist Drill
1420 Neurosurgery SN SN003 SN003A Twist Drill Craniostomy 15000 18800 21300 22500 NA No NA
Craniostomy
Cranial vault
1421 Neurosurgery SN SN004 Craniostenosis SN004A remodeling/ surgery for 37750 47200 53700 56700 25000 25000 No NA
"Craniosynostosis"
Anterior cranial fossa
1422 Neurosurgery SN SN005 Meningocele SN005A encephalocele/meningo 49875 62400 70900 74900 NA No NA
cele repair
Surgery for spina bifida
1423 Neurosurgery SN SN005 Meningocele SN005B 37500 46900 53300 56300 NA No NA
cystica/occulta
Posterior cranial fossa
1424 Neurosurgery SN SN005 Meningocele SN005C encephalocele/meningo 51562.5 64500 73300 77400 NA No NA
cele repair
Surgery for
Surgery for tumour supratentorial Extra-
1425 Neurosurgery SN SN006 SN006A 51562.5 64500 73300 77400 NA No NA
meninges axial Tumours
(Meningioma etc)
Surgery for infratentorial
Surgery for tumour
1426 Neurosurgery SN SN006 SN006B ExtraaxialTumour(menin 51562.5 64500 73300 77400 NA No NA
meninges
gioma etc)
Duroplasty with
Endogenous graft- (May
1427 Neurosurgery SN SN007 Duroplasty SN007A 12500 15700 17800 18800 NA No NA
be perfomed as a add-
on procedure)
Duroplasty with
Exogenous graft- (May
1428 Neurosurgery SN SN007 Duroplasty SN007B be perfomed as an add- 12500 15700 17800 18800 20000 No NA
Rs. 20000
on procedure) Cost of
graft will be extra
Burr hole surgery for

evacuation of
1429 Neurosurgery SN SN008 Burr hole surgery SN008A hematoma/ biopsy/ pus 11000 13800 15700 16500 20000 20000 No NA
drainage/Placement of
ICP monitoring device
Burr hole surgery with

1430 Neurosurgery SN SN008 Burr hole surgery SN008B chronic Sub Dural 25000 31300 35500 37500 NA No NA
Haematoma
Evacuation of Post-
Surgery for
trauamtic
1431 Neurosurgery SN SN009 Haematoma - SN009A 56250 70400 79900 84400 NA No NA
Intraparenchymal
Intracranial
Hematoma
Surgery for Spontaneous
1432 Neurosurgery SN SN009 Haematoma - SN009B Intraparenchymal 51562.5 64500 73300 77400 NA No NA
Intracranial hematoma evacuation
Evacuation of Post-
Surgery for trauamtic
1433 Neurosurgery SN SN009 Haematoma - SN009C Intraparenchymal 51562.5 64500 73300 77400 NA No NA
Intracranial Hematoma in Pediatric
Age group
Excision of Brain Excision of Brain
Abscess abscess
Craniotomy/Burr hole Single - 25000
1435 Neurosurgery SN SN011 Abscess Tapping SN011A and Tapping of Brain 25000 31300 35500 37500 NA Yes Multiple -
Abscess 35000
1436 Neurosurgery SN SN012 Epilepsy Surgery SN012A Epilepsy Surgery 68750 86000 97700 103200 NA No NA
Brain Biopsy-
1437 Neurosurgery SN SN013 Brain Biopsy SN013A Open/Stereotactic 16875 21100 24000 25400 NA No NA
guided
Excision of Orbital Excision of Orbital
Tumour Tumour
Excision of Brain
1439 Neurosurgery SN SN015 SN015A Parasagital Tumours 51562.5 64500 73300 77400 NA No NA
Tumor Supratentorial
Excision of Brain
1440 Neurosurgery SN SN015 SN015B Skull Base Tumours 51562.5 64500 73300 77400 NA No NA
Surgerey for
Excision of Brain
1441 Neurosurgery SN SN015 SN015C infratentorial intra-axial 51562.5 64500 73300 77400 NA No NA
tumours
Excision of Brain
1442 Neurosurgery SN SN015 SN015D C P Angle 51562.5 64500 73300 77400 NA No NA
Excision of Brain Supratentorial & other
1443 Neurosurgery SN SN015 SN015E 56250 70400 79900 84400 NA No NA
Tumor Supratentorial Tumours
Stereotactic Stereotactic Lesioning

Lesioning for movement disoders
Endoscpic/Microscopic
Trans Sphenoidal
1445 Neurosurgery SN SN017 SN017A Trans Sphenoidal 51562.5 64500 73300 77400 NA No NA
Surgery
Surgery
1446 Neurosurgery SN SN018 Trans oral Surgery SN018A Trans oral Surgery 54375 68000 77300 81600 NA No NA
Implant for
"Transoral
Transoral surgery Trans oral anterior surgery
(Anterior) and CV decompression and (Anterior) and
1447 Neurosurgery SN SN019 SN019A 74375 93000 105700 111600 30000 No NA
Junction (Posterior Posterior stabilisation ov CV Junction
Sterilisation) C V junction (Posterior
Sterlization)" -
(rs. 30000)
External Ventricular
External Ventricular
1448 Neurosurgery SN SN020 Drainage (EVD) SN020A 33750 42200 48000 50700 NA No NA
Drainage (EVD)
including antibiotics
1449 Neurosurgery SN SN021 Ventricular Puncture SN021A Ventricular Tap 15000 18800 21300 22500 NA No NA
Ventriculo-Peritoneal
Shunt
1450 Neurosurgery SN SN022 Shunt Surgery SN022A (Low/Medium/High 33750 42200 48000 50700 NA No NA
Pressure or Flow
regulated valve)
Ventriculo - pleural
Shunt
1451 Neurosurgery SN SN022 Shunt Surgery SN022B (Low/Medium/High 33750 42200 48000 50700 NA No NA
Pressure or Flow
regulated valve)
Ventriculo - atrial Shunt

(Low/Medium/High
1452 Neurosurgery SN SN022 Shunt Surgery SN022C 33750 42200 48000 50700 NA No NA
Pressure or Flow
regulated valve)
Theco - peritoneal
Shunt
1453 Neurosurgery SN SN022 Shunt Surgery SN022D (Low/Medium/High 33750 42200 48000 50700 NA No NA
Pressure or Flow
regulated valve)
Clip for
Aneurysm Clipping Aneurysm Clipping
1454 Neurosurgery SN SN023 SN023A 68750 86000 97700 103200 Aneurysm (3) - 15000 No NA
including angiogram including DSA or CTA
15000
Superficial Temporal Superficial Temporal

Artery (STA): middle Artery (STA): middle
1455 Neurosurgery SN SN024 cerebral artery (MCA) SN024A cerebral artery (MCA) or 67500 84400 95900 101300 NA No NA
or (other EC - IC) (other EC - IC) Bypass
Bypass procedure procedure
Arterio venous Craniotmy and excision

1456 Neurosurgery SN SN025 malformation (AVM) SN025A of arteriovenous 68750 86000 97700 103200 NA No NA
excision malformation
Laminectomy/Laminoto
Arterio venous my and excision of
1457 Neurosurgery SN SN025 malformation (AVM) SN025B Intraspinal 68750 86000 97700 103200 NA No NA
excision arteriovenous
malformation
Arterio venous Excision of scalp
1458 Neurosurgery SN SN025 malformation (AVM) SN025C arteriovenous 34375 43000 48900 51600 NA No NA
excision malformation
Foramen magnum
decompression for
Foramen Magnum
1459 Neurosurgery SN SN026 SN026A Chiari malormation with 75000 93800 106500 112500 NA No NA
Decompression
or without duraplasty or
tonsillar resection.
1460 Neurosurgery SN SN027 Skull Traction SN027A Skull Traction 10000 12500 14200 15000 NA No NA
Posterior Cervical Posterior cervical
1461 Neurosurgery SN SN028 Discetomy without SN028A laminoforaminotomy 33750 42200 48000 50700 NA No NA
implant and discectomy
Implant for
"Posterior
Posterior Cervical Cervical
Posterior cervical fusion
Fusion with implant Fusion with
1462 Neurosurgery SN SN029 SN029A using lateral mass or 52500 65700 74600 78800 30000 No NA
(Lateral mass implant
pedicle screws and rods
fixation) (Lateral mass
fixation)"-
30000
Anterior cervical
Cervical Disc Multiple
1463 Neurosurgery SN SN030 SN030A discectomy without 50000 62500 71000 75000 NA No NA
level without Fusion
fusion
Single - 28750
Excision of Cervical Excision of Cervical
1464 Neurosurgery SN SN031 SN031A 28750 36000 40900 43200 NA Yes Multiple -
Ribs Ribs
33750
Implant for
Cervical/Thoracic/
Thoracic / Lumbar "Thoracic
Neurosurgery, Lumbar corpectomy with
1465 SN SN032 Corpectomy with SN032A 75000 93800 106500 112500 Corpectomy 30000 No NA
Orthopedics fusion for
fusion with
Tumor/Infection/Trauma
fusion" -30000
Microscopic/Endoscopic
1466 Neurosurgery SN SN033 Lumbar Discectomy SN033A Lumbar Discectomy 33750 42200 48000 50700 NA No NA
(One level)
Laminectomy without
Neurosurgery,
1467 SN SN034 Laminectomy SN034A fusion for lumbar or 50000 62500 71000 75000 NA No NA
Orthopedics
cervical canal stenosis
Laminectomy with
fusion and fixation for Implant for
lumbar/cervical/thoracic Laminectomy
Neurosurgery,
1468 SN SN034 Laminectomy SN034B canal stenosis or for 54375 68000 77300 81600 with Fusion 10000 No NA
Orthopedics
tumor / and fixation -
trauma/Bleed(Cost of 10000
implants to be extra)
1469 Neurosurgery SN SN035 Neurectomy SN035A Peripheral Neurectomy 20000 25000 28400 30000 NA No NA
Neurosurgery,
ENT, Oral & Trigeminal Nerve
1470 SN SN035 Neurectomy SN035B 24812.5 31100 35300 37300 NA No NA
Maxillofacial Neurectomy
Surgery
Anterior Cervical
Discectomy with fusion
1471 Neurosurgery SN SN036 Micro discectomy SN036A 50000 62500 71000 75000 30000 30000 No NA
(Cost of implants to be
extra)
Spine - Extradural Intraspinal Extradural
Haematoma hematoma evacuation
Spine - Extradural Excision of extradural
Tumour spinal tumor
Implant for
Excision of extradural Spine -
Spine - Extradural spinal tumor with fusion Extradural
1474 Neurosurgery SN SN041 SN041B 43125 54000 61300 64700 30000 No NA
Tumour and fixation (Cost of Tumour
implants to be extra) with fixation -
30000
Spine - Intradural Excision of Intradural
Tumour extramedullary tumor
Implant for
Excision of Intradural
Spine -
extramedullary tumor
Spine - Intradural Intradural
1476 Neurosurgery SN SN042 SN042B with fusion and ficxation 54375 68000 77300 81600 30000 No NA
Tumour Tumour
(Cost of implants to be
with fixation -
extra)
30000
Excision of
Spine - Intramedullar
1477 Neurosurgery SN SN043 SN043A Intramedullary tumor of 51562.5 64500 73300 77400 NA No NA
Tumour
spine
Excision of Implant for
Intramedullary tumor Spine -
Spine - Intramedullar
1478 Neurosurgery SN SN043 SN043B with fusion and ficxation 51562.5 64500 73300 77400 Intramedullar 30000 No NA
Tumour
(Cost of implants to be Tumour with
extra) fixation - 30000
R. F. Lesioning for R. F. Lesioning for

Trigeminal Neuralgia Trigeminal Neuralgia
Brachial Plexus –
1480 Neurosurgery SN SN045 SN045A Brachial Plexus repair 36625 45800 52100 55000 NA No NA
Repair
Neurosurgery, Carpal Tunnel
1481 SN SN046 SN046A Carpal tunnel release 15000 18800 21300 22500 NA No NA
Orthopedics Release
Nerve Peripheral nerve
1482 Neurosurgery SN SN047 SN047A 17062.5 21400 24300 25600 NA No NA
Decompression repair/Neurolysis
Cranial nerve re-
Cranial Nerve
1483 Neurosurgery SN SN048 SN048A anastomosis/Repair 25000 31300 35500 37500 NA No NA
Anastomosis
(Facial/)
Peripheral Nerve Peripheral nerve tumor
1484 Neurosurgery SN SN049 SN049B 33750 42200 48000 50700 NA No NA
Surgery excision and repair
Nerve Biopsy Nerve Biopsy excluding
excluding Hensens Hansen's
Muscle Biopsy with
1486 Neurosurgery SN SN051 SN051A Muscle Biopsy 7500 9400 10700 11300 NA No NA
report
Gamma Knife
Gamma Knife
radiosurgery (GKRS)
Radiosurgery for
1487 Neurosurgery SN SN054 / SRS for tumours / SN054A 75000 93800 106500 112500 NA No NA
tumors/AVMs/
Arteriovenous
Trigeminal Neuralgia
malformation (AVM)
Endoscopic Third Endoscopic Third
Ventriculostomy ventriculostomy
Radiofrequency
1489 Neurosurgery SN SN059 R. F. Lesioning SN059A 8125 10200 11600 12200 NA No NA
lesioning for sacroilitis
Radiofrequency
1490 Neurosurgery SN SN059 R. F. Lesioning SN059B lesioning for chronic 8125 10200 11600 12200 NA No NA
back pain
1491 Neurosurgery SN SN060 Discectomy - Dorsal SN060A Discectomy - Dorsal 33750 42200 48000 50700 NA No NA
Diagnostic Cerebral / Diagnostic Cerebral /
Spinal Angiography Spinal Angiography
1492 Neurosurgery SN SN061 (DSA - Digital SN061A (DSA - Digital 16625 20800 23700 25000 NA No NA
Substraction Substraction
Angiography) Angiography)
Reexploration for Reexploration for
1493 Neurosurgery SN SN062 Cranial / Spinal SN062A Cranial / Spinal 25000 31300 35500 37500 NA No NA
surgeries surgeries
3300 3630 3800 3800 3300
Conservative Conservatively ICU (without ICU (without ICU (without ICU (without ICU (without
1494 Neurosurgery SN SN063 management of high SN063A managed spinal injury Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
cervical injury with ventilator 8500 9350 9700 9700 8500
9000 9900 10350 10350 9000
3300 3630 3800 3800 3300
Conservative ICU (without ICU (without ICU (without ICU (without ICU (without
1495 Polytrauma ST SN063 management of high SN063B Moderate head injury Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
cervical injury 8500 9350 9700 9700 8500
9000 9900 10350 10350 9000
3300 3630 3800 3800 3300
Conservative Conservatively ICU (without ICU (without ICU (without ICU (without ICU (without
1496 Neurosurgery SN SN063 management of high SN063C managed Severe Head Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
cervical injury injury 8500 9350 9700 9700 8500
9000 9900 10350 10350 9000
3300 3630 3800 3800 3300
Conservative ICU (without ICU (without ICU (without ICU (without ICU (without
1497 Polytrauma ST SN063 management of high SN063D Simple head injury Ventilator) - Ventilator) - Ventilator) - Ventilator) - NA Yes Ventilator) -
cervical injury 8500 9350 9700 9700 8500
9000 9900 10350 10350 9000
AVM
AVM
1498 Neurosurgery SN SN064 SN064A EMBOLISATION/THRO 175000 218800 248500 262500 NA NA
EMBOLISATION
MBECTOMY
Ventricular tapping with
Omayya
1499 Neurosurgery SN SN065 Ventricular tap SN065A 20000 25000 28400 30000 NA NA
reservoir/external
ventricular drain
Craniectomy/ DECRA
Decompressive for head injury/acute
1500 Neurosurgery SN SN066 SN066A 75000 93800 106500 112500 NA NA
Caniectomy stroke/cerebral venous
thrombosis
Obstetrics & Laparotomy and
Laparotomy and
Gynecology, proceed for Ovarian
proceed for Ovarian
Surgical Cancers. Omentomy
1501 sc SO002 SO002A Cancers. Omentomy 38000 38000 44500 47500 NA No NA
Oncology, with Bilateral
with Bilateral
Pediatric Salpingo-
Salpingo-oophorectomy
Surgery oophorectomy
Laparoscopic tubal Laparoscopic tubal
Obstetrics &
surgeries surgeries
Gynecology,
1502 sc SO003 (for any indication SO003A (for any indication 13900 13900 16300 17400 NA No NA
Surgical
including ectopic including ectopic
Oncology
pregnancy) pregnancy)
Obstetrics & Procedure on Procedure on Fallopian
Gynecology, Fallopian Tube for Tube for
1503 sc SO004 SO004A 11600 11600 13600 14500 NA No NA
Surgical establishing Tubal establishing Tubal
Oncology Patency Patency
Abdominal
1504 OBG & Gynec SO SO006 SO006A Abdominal Myomectomy 25000 25000 29300 31300 NA No NA
Myomectomy
Hysteroscopic Hysteroscopic
1505 OBG & Gynec SO SO007 SO007A 12000 12000 14100 15000 NA No NA
Myomectomy Myomectomy
polypectomy polypectomy
Abdominal
1507 OBG & Gynec SO SO010 Hysterectomy SO010A 20000 20000 23400 25000 NA No NA
Hysterectomy
Abdominal
1508 OBG & Gynec SO SO010 Hysterectomy SO010B Hysterectomy + 20000 20000 23400 25000 NA No NA
Salpingo-oophorectomy
Non descent vaginal
1509 OBG & Gynec SO SO010 Hysterectomy SO010C 20000 20000 23400 25000 NA No NA
hysterectomy
Vaginal hysterectomy
with anterior and
1510 OBG & Gynec SO SO010 Hysterectomy SO010D 20000 20000 23400 25000 NA No NA
posterior
colpoperineorrhaphy
Laparoscopic
1511 OBG & Gynec SO SO010 Hysterectomy SO010E 20000 20000 23400 25000 NA No NA
hysterectomy (TLH)
Laparoscopically
1512 OBG & Gynec SO SO010 Hysterectomy SO010F assisted vaginal 20000 20000 23400 25000 NA No NA
hysterectomy (LAVH)
Caesarean Caesarean
hysterectomy hysterectomy
1514 OBG & Gynec SO SO012 Manchester Repair SO012A Manchester Repair 20000 20000 23400 25000 NA No NA
Sling Surgeries for Surgeries for Prolapse -

1515 OBG & Gynec SO SO013 SO013A 25000 31300 35500 37500 Sling - 5000 5000 No NA
Prolapse Sling Surgeries
1516 OBG & Gynec SO SO014 Hysterotomy SO014A Hysterotomy 6375 6400 7500 8000 NA No NA
Lap. Surgery for Lap. Surgery for
Endometriosis Endometriosis
(Other than (Other than
Hysterectomy) Hysterectomy)
Diagnostic
1518 OBG & Gynec SO SO016 SO016A With biopsy 8000 8000 9400 10000 NA No NA
hysteroscopy
Diagnostic
1519 OBG & Gynec SO SO016 SO016B Without biopsy 8000 8000 9400 10000 NA No NA
hysteroscopy
Hysteroscopic IUCD Hysteroscopic IUCD
removal removal
D&C D&C
(Dilatation&curretage) (Dilatation&curretage)
Dilation and Dilation and Evacuation
Evacuation (D&E) (D&E)
1523 OBG & Gynec SO SO020 Pyometra drainage SO020A Pyometra drainage 5000 5000 5900 6300 NA No NA
Intrauterine
1524 OBG & Gynec SO SO021 SO021A Intrauterine transfusions 10000 10000 11700 12500 NA No NA
transfusions
adhesiolysis adhesiolysis
Laparoscopic Laparoscopic
adhesiolysis adhesiolysis
8000 (tape 8000 (tape 9360 (tape 10000 (tape
Trans - vaginal tape / cost cost cost cost Tension free
1527 OBG & Gynec SO SO024 SO024A Trans-vaginal tape 35000 No NA
Trans-obturator tape additional=30- additional=30- additional=30- additional=30- Vaginal Tape
35000) 35000) 35000) 35000)
8000 (tape 8000 (tape 9360 (tape 10000 (tape
Trans - vaginal tape / cost cost cost cost Trans
1528 OBG & Gynec SO SO024 SO024B Trans-obturator tape 35000 No NA
Trans-obturator tape additional=30- additional=30- additional=30- additional=30- Obturator Tape
35000) 35000) 35000) 35000)
Sacrocolpopexy Mesh - 15 X 15
1529 OBG & Gynec SO SO025 SO025A Open 20000 20000 23400 25000 5000 No NA
(Abdominal) - 5000
Sacrocolpopexy Mesh - 15 X 15
1530 OBG & Gynec SO SO025 SO025B Lap. 20000 20000 23400 25000 5000 No NA
(Abdominal) - 5000
LLETZ (including
LLETZ (including PAP
1531 OBG & Gynec SO SO026 PAP smear and SO026A 7000 7000 8200 8800 NA No NA
smear and colposcopy)
colposcopy)
Vaginal Sacrospinus Vaginal Sacrospinus
fixation with repair fixation with repair
Excision of Vaginal
Excision of Vaginal
1533 OBG & Gynec SO SO028 Septum (vaginal SO028A 24656.25 24700 28900 30900 NA No NA
Septum (vaginal route)
route)
Hymenectomy for Hymenectomy for
imperforate hymen imperforate hymen
Anterior & Posterior Anterior & Posterior
Colpoperineorrhapy Colpoperineorrhapy
Vaginoplasty Vaginoplasty (McIndoe
(McIndoe procedure) procedure)
Vaginal repair for

Vaginal repair for vesico-
1537 OBG & Gynec SO SO032 vesico-vaginal fistula SO032A 40000 40000 46800 50000 NA No NA
vaginal fistula (Open)
(Repair for VVF)
Rectovaginal fistula Rectovaginal fistula
repair repair
Vulval Hematoma Vulval Hematoma
drainage drainage
1540 OBG & Gynec SO SO035 Vulvectomy simple SO035A Vulvectomy simple 20000 20000 23400 25000 NA No NA
Radical Vulvectomy
Radical Vulvectomy with
with Inguinal and
1541 OBG & Gynec SO SO036 SO036A Inguinal and Pelvic 50000 50000 58500 62500 NA No NA
Pelvic lymph node
lymph node disection
disection
Abdomino Perineal Abdomino Perineal
1542 OBG & Gynec SO SO037 repair for Mullerian SO037A repair for Mullerian 34687.5 34700 40600 43400 NA No NA
Anomaly Anomaly
1543 OBG & Gynec SO SO038 Colpotomy SO038A Colpotomy 4818.75 4900 5700 6100 NA No NA
Diagnostic
1544 OBG & Gynec SO SO039 SO039A Diagnostic laparoscopy 12000 12000 14100 15000 NA No NA
laparoscopy
Laparotomy for
1545 OBG & Gynec SO SO040 ectopic/ benign SO040A Open 20000 20000 23400 25000 NA No NA
disorders
Laparotomy for
1546 OBG & Gynec SO SO040 ectopic/ benign SO040B PID 20000 20000 23400 25000 NA No NA
disorders
1547 OBG & Gynec SO SO041 Cystectomy SO041A Lap 20000 20000 23400 25000 NA No NA
Cystocele - Anterior Cystocele - Anterior
repair repair
1549 OBG & Gynec SO SO043 Burch SO043A Abdominal 25000 25000 29300 31300 NA No NA
1550 OBG & Gynec SO SO043 Burch SO043B Laparoscopic 25000 25000 29300 31300 NA No NA
Electro Cauterisation Electro Cauterisation /

/ Cryo Surgery Cryo Surgery
EUA for (minor girls / EUA for (minor girls /

unmarried sexually unmarried sexually
inactive / victims of inactive / victims of
sexual abuse) sexual abuse)
Hospitalisation for
Hospitalisation for
1553 OBG & Gynec SO SO046 Antenatal SO046A 2100 2100 2400 2700 NA Yes NA
Antenatal Complications
Complications
1554 OBG & Gynec SO SO047 Amniocentesis SO047A Amniocentesis 5000 5000 5900 6300 NA No NA
Chorionic villus Chorionic villus
sampling sampling
1556 OBG & Gynec SO SO049 Cordocentesis SO049A Cordocentesis 10000 10000 11700 12500 NA No NA
1557 OBG & Gynec SO SO050 McDonald's stitch SO050A McDonald's stitch 8000 8000 9400 10000 NA No NA
1558 OBG & Gynec SO SO051 Shirodkar's stitch SO051A Shirodkar's stitch 4500 4500 5300 5700 NA No NA
Medical management Medical management of

1559 OBG & Gynec SO SO052 SO052A 2100 2100 2400 2700 NA Yes NA
of ectopic pregnancy ectopic pregnancy
Medical Termination
1560 OBG & Gynec SO SO053 SO053A MTP upto 8 weeks 5000 5000 5900 6300 NA No NA
of Pregnancy
Medical Termination
1561 OBG & Gynec SO SO053 SO053B MTP 8 to 12 weeks 7000 7000 8200 8800 NA No NA
of Pregnancy
Medical Termination
1562 OBG & Gynec SO SO053 SO053C MTP > 12 weeks 7000 7000 8200 8800 NA No NA
of Pregnancy
Mothers with eclampsia

1563 OBG & Gynec SO SO054 High risk delivery SO054B / imminent eclampsia / 15000 15000 17600 18800 NA No NA
severe pre-eclampsia
Major Fetal
malformation requiring
1564 OBG & Gynec SO SO054 High risk delivery SO054C 15000 15000 17600 18800 NA No NA
intervention immediately
after birth
Mothers with severe
1565 OBG & Gynec SO SO054 High risk delivery SO054D 10000 10000 11700 12500 NA No NA
anaemia (<7 g/dL)
Other maternal and fetal

conditions as per
guidelines-eg previous
caesarean section,
1566 OBG & Gynec SO SO054 High risk delivery SO054E 10000 10000 11700 12500 NA No NA
diabetes, severe growth
retardation, etc that
qualify for high risk
delivery.
Manual removal of Manual removal of

placenta placenta
Secondary suturing of Secondary suturing of
episiotomy episiotomy
1569 OBG & Gynec SO SO057 Caesarean Delivery SO057A Caesarean Delivery 12000 12000 14100 15000 NA No NA
Vulvo vaginal /
Vulvo vaginal/ bartholin
bartholin cyst/
1570 OBG & Gynec SO SO059 SO059A cyst/ abscess 7000 7000 8200 8800 NA No NA
abscess enucleation /
enucleation
drainage
Vulvo vaginal /
bartholin cyst/ Vulvo vaginal/ bartholin
1571 OBG & Gynec SO SO059 SO059B 7000 7000 8200 8800 NA No NA
abscess enucleation / cyst/ abscess drainage
drainage
Hysterrectomy +
Staging laparotomy
salpingo opherectomy +
1572 OBG & Gynec SO SO060 for ovarian cancer SO060A 50000 50000 58500 62500 NA NA
omentectomy + BPLND-
(simple)
Open
1573 OBG & Gynec SO SO061 Vaginal Myomectomy SO061A Vaginal Myomectomy 15000 15000 17600 18800 NA NA
1574 OBG & Gynec SO SO062 Cystectomy SO062A Open 20000 20000 23400 25000 NA NA
Laparoscopy for
1575 OBG & Gynec SO SO063 Ectopic/ other benign SO063A lap 20000 20000 23400 25000 NA NA
disorders
1576 OBG & Gynec SO SO064 Sterilisation SO064A Sterilisation- Open 7000 7000 8200 8800 NA NA
1577 OBG & Gynec SO SO064 Sterilisation SO064B Sterilisation- Lap 10000 10000 11700 12500 NA NA
Reversal of
Sterilisation/ Reversal of Sterilisation/
1578 OBG & Gynec SO SO065 SO065A 25000 25000 29300 31300 NA NA
Tuboplasty (lap/ Tuboplasty (lap/ open)
open)
Diagnostic Hystero - Diagnostic Hystero -
Laparoscopy with/ Laparoscopy with/
without without
Chromopertubation Chromopertubation
Laparotomy for Broad
35000 (include 35000 (include 40100(include 43750(include
Laparotomy for Broad Ligament Hematoma
1580 OBG & Gynec SO SO067 SO067A internal iliac internal iliac internal iliac internal iliac NA NA
Ligament Hematoma (with internal iliac
ligation) ligation) ligation) ligation)
ligation)
Complete Perineal
1581 OBG & Gynec SO SO068 SO068A Complete Perineal Tear 25000 25000 29300 31300 NA NA
Tear
Molar follow up for Molar follow up for
chemotherapy chemotherapy
1583 OBG & Gynec SO SO070 Resuturing of wounds SO070A Resuturing of wounds 5000 5000 5900 6300 NA NA
Post coital / Injury Post coital / Injury
Repair Repair
1585 OBG & Gynec SO SO072 Cone biopsy SO072A Cone biopsy 7000 7000 8200 8800 NA NA
Biopsy- Cervical,
Biopsy- Cervical,
Endometrial EA/
1586 OBG & Gynec SO SO073 SO073A Endometrial EA/ ECC; 5000 5000 5900 6300 NA NA
ECC; Vulvar;
Vulvar; Polypectomy
Polypectomy
Normal vaginal
1587 OBG & Gynec SO SO074 SO074A Normal vaginal delivery 8000 8000 8800 10000 NA NA
delivery
Operative vaginal Operative vaginal
1588 OBG & Gynec SO SO075 delivery (Vacuum/ SO075A delivery (Vacuum/ 10000 10000 11700 12500 NA NA
forceps) forceps)
Surgical management Surgical management of
1589 OBG & Gynec SO SO076 of PPH after vaginal SO076A PPH after vaginal 15000 15000 17600 18800 NA NA
delivery delivery
Plastic &
Pressure Sore – Pressure Sore –
1590 Reconstructive SP SP001 SP001A 33750 42200 48000 50700 NA No NA
Surgery Surgery
Surgery
Plastic & Diabetic Foot –
Diabetic Foot –
1591 Reconstructive SP SP002 SP002A Conservative 21000 26300 29900 31500 NA No NA
Surgery
Surgery management
Plastic &
Revascularization of Revascularization of
limb / digit limb / digit (single didgit)
Surgery
Plastic & Revascularization of

Revascularization of
1593 Reconstructive SP SP003 SP03B limb / digit(morethan 90000 112500 127800 135000 90000 NA
limb / digit B. >1digit/limb :
Surgery one digit)
cost -90,000/-
A. ear pinna
with recons.
Cartilage(inc.al
Ear Pinna Ear Pinna l stages): cost-
Reconstruction with Reconstruction with 75,000/
Plastic & Cartilage-
costal cartilage / costal cartilage / B. With Implant
1594 Reconstructive SP SP004 SP004A 39375 49300 56000 59100 75000 Implant No NA
Prosthesis Prosthesis (inc cost of
Surgery :80000
(including the cost of (including the cost of Implat):
prosthesis / implants) prosthesis / implants) 80,000/
(implant cost
approx:
15,000/-)
Ear Pinna Ear Pinna

Reconstruction with Reconstruction with
Plastic &
costal cartilage / costal cartilage /
1595 Reconstructive SP SP004 SP004B 80000 100000 113600 120000 NA NA
Prosthesis Prosthesis
Surgery
(including the cost of (including the cost of
prosthesis / implants) prosthesis / implants)
Plastic &
Scalp avulsion Scalp avulsion
reconstruction reconstruction
Surgery
Tissue
Tissue Expander for
Expander /
disfigurement
Implant for
Plastic & following burns / Tissue Expander for
disfigurement
1597 Reconstructive SP SP006 trauma / congenital SP006A disfigurement following 50000 62500 71000 75000 No NA
following burns
Surgery deformity burns
/ trauma
(including cost of
/ congenital
expander / implant)
deformity
Tissue
Tissue Expander for
Expander /
disfigurement
Implant for
disfigurement
1598 Reconstructive SP SP006 trauma / congenital SP006B disfigurement following 50000 62500 71000 75000 No NA
following burns
Surgery deformity trauma
/ trauma
(including cost of
/ congenital
expander / implant)
deformity
Tissue
Tissue Expander for
Expander /
disfigurement
Implant for
disfigurement
1599 Reconstructive SP SP006 trauma / congenital SP006C disfigurement following 50000 62500 71000 75000 No NA
following burns
Surgery deformity congenital deformity
/ trauma
(including cost of
/ congenital
expander / implant)
deformity
Plastic &
1600 Reconstructive SP SP007 Hemangioma SP007A Sclerotherapy under GA 25000 31300 35500 37500 NA No NA
Surgery
Plastic &
1601 Reconstructive SP SP007 Hemangioma SP007B Debulking 40000 50000 56800 60000 NA No NA
Surgery
Plastic &
1602 Reconstructive SP SP007 Hemangioma SP007C Excision 40312.5 50400 57300 60500 NA No NA
Surgery
Plastic &
1603 Reconstructive SP SP008 NPWT SP008A NPWT 3750 4700 5400 5700 NA No NA
Surgery
Orthopaedics,
Oral and
Maxillofacial
Surgery,Otorhi
nolaryngology,
Paediatric
Resuturing of Any
surgery,Plastic Resuturing of Any
1604 SC SP009 SP009A Wound gap 3800 3800 4300 4500 NA NA
& Wound gap Surgeries
Surgeries
reconstructive
Surgery,Surgic
al
Oncology,Urol
ogy,Polytraum
a
Plastic &
Diabetic Foot –
1605 Reconstructive SP SP009 SP009A Diabetic Foot – Surgery 45000 56300 63900 67500 NA NA
Surgery
Surgery
Pediatric
Surgery, Oral
& Maxillofacial
Cleft Lip and Palate Cleft Lip and Palate
1606 Surgery, SS SS001 SS001A 17025 21300 24200 25600 NA No NA
Surgery (per stage) Surgery (per stage)
Plastic &
Reconstructive
Surgery
Pediatric
1607 SS SS002 Ankyloglossia SS002A Ankyloglossia Minor 7125 9000 10200 10700 NA No NA
Surgery
Pediatric
1608 SS SS002 Ankyloglossia SS002B Ankyloglossia Major 15000 18800 21300 22500 NA No NA
Surgery
Pediatric
1609 SS SS003 Anti GERD Surgery SS003A Anti GERD Surgery 21375 26800 30400 32100 NA No NA
Surgery
Gastrostomy + Gastrostomy +
Pediatric
1610 SS SS004 Esophagoscopy + SS004A Esophagoscopy + 22125 27700 31500 33200 NA No NA
Surgery
Threading Threading
Pediatric
1611 SS SS005 Ladds Procedure SS005A Ladds Procedure 39000 48800 55400 58500 NA No NA
Surgery
Pediatric Duplication Cyst Duplication Cyst
1612 SS SS006 SS006A 24600 30800 35000 36900 NA No NA
Surgery Excision Excision
Pediatric Non – Operative
1613 SS SS007 Intussusception SS007A 23000 28800 32700 34500 NA No NA
Surgery Reduction in infants
Pediatric
1614 SS SS007 Intussusception SS007B Operative in infants 27000 33800 38400 40500 NA No NA
Surgery
Surgery for
Pediatric
1615 SS SS008 Hirschsprung’s SS008A Myectomy 25575 32000 36400 38400 NA No NA
Surgery
Disease
Surgery for
Pediatric
1616 SS SS008 Hirschsprung’s SS008B Pull Through 24750 31000 35200 37200 NA No NA
Surgery
Disease
Surgery for
Pediatric
1617 SS SS008 Hirschsprung’s SS008C Rectal Biopsy - Punch 12750 16000 18200 19200 NA No NA
Surgery
Disease
Surgery for
Pediatric
1618 SS SS008 Hirschsprung’s SS008D Rectal Biopsy – Open 13125 16500 18700 19700 NA No NA
Surgery
Disease
Surgery for
Pediatric
1619 SS SS008 Hirschsprung’s SS008E Sphinecterotomy 16500 20700 23500 24800 NA No NA
Surgery
Disease
Rectal Polypectomy - Rectal Polypectomy -
Pediatric
1620 SS SS009 Sigmoiescopic Under SS009A Sigmoiescopic Under 11625 14600 16600 17500 NA No NA
Surgery
GA GA
Pediatric Ano Rectal
1621 SS SS010 SS010A Abd - Perineal PSARP 25500 31900 36300 38300 NA No NA
Surgery Malformation
1622 SS SS010 SS010B Anoplasty 22875 28600 32500 34400 NA No NA
1623 SS SS010 SS010C Cutback 20000 25000 28400 30000 NA No NA
1624 SS SS010 SS010D PSARP 25125 31500 35700 37700 NA No NA
1625 SS SS010 SS010E Redo - Pullthrough 24000 30000 34100 36000 NA No NA
1626 SS SS010 SS010F Transposition 21375 26800 30400 32100 NA No NA
Pediatric
1627 SS SS011 Fecal Fistula Closure SS011A Fecal Fistula Closure 28275 35400 40200 42500 NA No NA
Surgery
Pediatric
1628 SS SS012 GI Tumor Excision SS012A GI Tumor Excision 33300 41700 47300 50000 NA No NA
Surgery
Pediatric Congenital Congenital
1629 SS SS013 SS013A 40312.5 50400 57300 60500 NA No NA
Surgery Diaphragmatic Hernia Diaphragmatic Hernia
Pediatric Exomphalos /
1630 SS SS014 SS014A Exomphalos 30750 38500 43700 46200 NA No NA
Surgery Gastroschisis
Pediatric Exomphalos /
1631 SS SS014 SS014B Gastroschisis 30750 38500 43700 46200 NA No NA
Surgery Gastroschisis
Pediatric
1632 SS SS015 Hernia & Hydrocele SS015A Hernia & Hydrocele 20000 25000 28400 30000 NA No NA
Surgery
Retro - Peritoneal
Pediatric Retro - Peritoneal
1633 SS SS016 Lymphangioma SS016A 26250 32900 37300 39400 NA No NA
Surgery Lymphangioma Excision
Excision
Surgery for Surgery for
Pediatric
1634 SS SS017 Sacrococcygeal SS017A Sacrococcygeal 24375 30500 34700 36600 NA No NA
Surgery
Teratoma Teratoma
Surgery for
Pediatric Surgery for Congenital
1635 SS SS018 Congenital Lobar SS018A 32325 40500 46000 48500 NA No NA
Surgery Lobar Emphysema
Emphysema
Pediatric Bilateral - Palpable +
1636 SS SS019 Undescended Testis SS019A 15750 19700 22400 23700 NA No NA
Surgery Nonpalpable
Pediatric
1637 SS SS019 Undescended Testis SS019B Bilateral Palpable 15750 19700 22400 23700 NA No NA
Surgery
Pediatric
1638 SS SS019 Undescended Testis SS019C Bilateral Non - Palpable 19000 23800 27000 28500 NA No NA
Surgery
Pediatric
1639 SS SS019 Undescended Testis SS019D Unilateral - Palpable 15750 19700 22400 23700 NA No NA
Surgery
Pediatric Reexploration / Second
1640 SS SS019 Undescended Testis SS019E 18000 22500 25600 27000 NA No NA
Surgery Stage
Pediatric Excision of accessory Excision of accessory
1641 SS SS020 SS020A 19000 23800 27000 28500 NA NA
Surgery auricle auricle
Pediatric MACROSTOMIA
1642 SS SS021 SS021A Repair of macrostomia 39000 48800 55400 58500 NA NA
Surgery REPAIR
Pediatric PARATHYROIDECT
1643 SS SS022 SS022A Parathyroidectomy 39000 48800 55400 58500 NA NA
Surgery OMY
Pediatric STENSON'S DUCT Dilatation of Stenson's
1644 SS SS023 SS023A 11000 13800 15700 16500 NA NA
Surgery DILATATION duct
Pediatric SUPERNUMMERY Excision of
1645 SS SS024 SS024A 14000 17500 19900 21000 NA NA
Surgery DIGIT EXISION supernumerary digit
Pediatric
1646 SS SS025 SYNDACTYLY SS025A Syndactyly repair 35000 43800 49700 52500 NA NA
Surgery
Pediatric TONGUE Repair of tongue
1647 SS SS026 SS026A 14000 17500 19900 21000 NA NA
Surgery LACERATION laceration
Pediatric
1648 SS SS027 TORTICOLLIS SS027A Sternomastoid division 15000 18800 21300 22500 NA NA
Surgery
Non-operative
Pediatric LIVER TRAUMA NON-
1649 SS SS028 SS028A management of liver 40000 50000 56800 60000 NA NA
Surgery OP
trauma
Pediatric PORTAL
1650 SS SS029 SS029A NON-SHUNTS 45000 56300 63900 67500 NA NA
Surgery HYPERTENSION
Pediatric
1651 SS SS030 CONJOINED TWINS SS030A Separation of twins 95000 118800 134900 142500 NA NA
Surgery
Pediatric ESOPHAGEAL
1652 SS SS031 SS031A PRIMARY REPAIR 65000 81300 92300 97500 NA NA
Surgery ATRESIA/TEF
Pediatric
1653 SS SS032 MALROTATION SS032A Ladd's procedure 39000 48800 55400 58500 NA NA
Surgery
POSTERIOR
Pediatric
1654 SS SS033 URETHERAL SS033A VESICOSTOMY 41000 51300 58300 61500 NA NA
Surgery
VALVES
Pediatric
1655 SS SS034 SPLENORRHAPHY SS034A Splenorapphy 31000 38800 44100 46500 NA NA
Surgery
Pediatric ESOPHAGEAL
1656 SS SS035 SS035A Esophageal dilatation 30000 37500 42600 45000 NA NA
Surgery DILATATION
Pediatric OPEN KIDNEY
1657 SS SS036 SS036A Kiidney biopsy 33000 41300 46900 49500 NA NA
Surgery BIOPSY
APPENDICO-
Pediatric Appendicovesicostomy
1658 SS SS037 VESICOSTOMY/Mitra SS037A 43000 53800 61100 64500 NA NA
Surgery or Monti procedure
ffanof
Pediatric
1659 SS SS038 VESICOSTOMY SS038A Vesicostomy 28000 35000 39800 42000 NA NA
Surgery
Pediatric SUPRAGLOTTOPLA
1660 SS SS039 SS039A Supra-glotoplasty 27000 33800 38400 40500 NA NA
Surgery STY
SINGLE STAGE
Pediatric
1661 SS SS040 AIRWAY SS040A Airway reconstruction 55000 68800 78100 82500 NA NA
Surgery
RECONSTRUCTION
Pediatric STAGED AIRWAY Staged airway

1662 SS SS041 SS041A 50000 62500 71000 75000 NA NA
Surgery RECONSTRUCTION reconstruction
Pediatric SLIDE
1663 SS SS042 SS042A Slide tracheoplasty 60000 75000 85200 90000 NA NA
Surgery TRACHEOPLASTY
Polytrauma,
Orthopedics, Conservative
Routine Ward -
1664 Neurosurgery, ST ST001 Management of Head ST001A Severe 1000 1000 1300 1300 NA Yes
1000
General Injury
Surgery
Polytrauma,
Orthopedics, Conservative
Routine Ward -
1665 Neurosurgery, ST ST001 Management of Head ST001B Depressed Fracture 5000 5000 5900 6300 NA Yes
5000
General Injury
Surgery
Implant for
Polytrauma, Open reduction
Orthopedics, Head injury with and internal
Head injury with repair
Neurosurgery, repair of Facio- fixation of
of Facio-Maxillary Injury
1666 General ST ST002 Maxillary Injury & ST002A 31000 38800 44100 46500 maxilla / 4000 No NA
& fixations (including
Surgery, Oral fixations (including mandible /
implants)
& Maxillofacial implants) zygoma
Surgery (Plates /
Screws) - 4000
Polytrauma, Craniotomy and

Subdural hematoma
Orthopedics, evacuation of
along with fixation of
1667 Neurosurgery, ST ST003 Haematoma with ST003A 60000 75000 85200 90000 NA No NA
fracture of single long
General fixation of fracture of
bone
Surgery long bone
Extradural hematoma
1668 Neurosurgery, ST ST003 Haematoma with ST003B 60000 75000 85200 90000 NA No NA
fracture of single long
bone
Surgery long bone
Subdural hematoma
1669 Neurosurgery, ST ST003 Haematoma with ST003C 75000 93800 106500 112500 NA No NA
fracture of 2 or more
long bone.
Surgery long bone
Extradural hematoma
1670 Neurosurgery, ST ST003 Haematoma with ST003D 75000 93800 106500 112500 NA No NA
fracture of 2 or more
long bone.
Surgery long bone
Polytrauma, Implant for

Orthopedics, Management of Management of Chest "One fracture
1671 Neurosurgery, ST ST004 Chest injury with ST004A injury with fixation of 30000 30000 35100 37500 of long bone 5000 No NA
General fracture of Long bone Single Long bone (with implants)"
Surgery - 5000
Polytrauma,
Orthopedics, Management of Management of Chest
1672 Neurosurgery, ST ST004 Chest injury with ST004B injury with fixation of 2 45000 45000 52700 56300 NA No NA
General fracture of Long bone or more Long bones
Surgery
Polytrauma,
Surgical intervention for
Orthopedics, Management of
Visceral injury and
1673 Neurosurgery, ST ST005 Visceral injury and ST005A 30000 37500 42600 45000 NA No NA
fixation of fracture of
General fracture long bone
single long bone
Surgery
Polytrauma,
Surgical intervention for
Visceral injury and
1674 Neurosurgery, ST ST005 Visceral injury and ST005B 45000 56300 63900 67500 NA No NA
fixation of fracture of 2
General fracture long bone
or more long bones
Surgery
Polytrauma,
Orthopedics, Internal fixation of
Internal fixation of
1675 Neurosurgery, ST ST006 Pelviacetabular ST006A 40000 40000 46800 50000 NA No NA
Pelviacetabular fracture
General fracture
Surgery
Implant for
Internal
Fixation of Plates, screws
Polytrauma, Bones by and K wire -
Internal fixation with Internal fixation with
Orthopedics, Plates, screws 1500 per plate,
Flap cover Surgery Flap cover Surgery for
1676 Neurosurgery, ST ST007 ST007A 40000 40000 46800 50000 and K wire - one 6 hole No NA
for wound in wound in compound
General 1500 per plate, small DCP with
compound fracture fracture
Surgery one 6 hole screws -3500
small DCP with per plate
screws -3500
per plate
Polytrauma, Emergency tendons

Orthopedics, repair ± Peripheral Emergency tendons
1677 Neurosurgery, ST ST008 Nerve repair/ ST008A repair ± Peripheral 30000 37500 42600 45000 NA No NA
General reconstructive Nerve repair
Surgery surgery
A. 15000/-
A. 18750/- A. 21300/- A. 22500/-
(Under GA),
(Under GA), (Under GA), (Under GA),
10,000/-
Polytrauma, Nerve and/or tendon 12500/- (Under 14200/- (Under 1500/- (Under
(Under
Orthopedics, Management of injury. A. Wound Local/regional Local/regional Local/regional
Local/regional Tendon rod -
1678 Neurosurgery, ST ST009 Nerve Plexus / ST009A exploration and closure. anesthesia). B - anesthesia). B - anesthesia). B - 7000 No NA
anesthesia). B - 7000/- per rod
General Tendon injuries B. Nerve repair. C. 6250/- per 7100/- per 7500/- per
5000/- per
Surgery Tendon repair nerve. C - nerve. C - nerve. C -
nerve. C -
3750/- per 4260/- per 4500/- per
3000/- per
tendon repair tendon repair tendon repair
tendon repair
A. 15000/-
(Under GA), A. 18750/- A. 21300/- A. 22500/-
10,000/- (Under GA), (Under GA), (Under GA),
Polytrauma, Nerve and/or tendon (Under 12500/- (Under 14200/- (Under 1500/- (Under
Orthopedics, Management of injury. A. Wound Local/regional Local/regional Local/regional Local/regional
1679 Neurosurgery, ST ST009 Nerve Plexus / ST009B exploration and closure. anesthesia). B - anesthesia). B - anesthesia). B - anesthesia). B - NA No NA
General Tendon injuries B. Nerve graft. C. 10000/- per 6250/- per 7100/- per 7500/- per
Surgery Tendon graft/transfer nerve graft. C - nerve. C - nerve. C - nerve. C -
6000/- per 3750/- per 4260/- per 4500/- per
tendon tendon repair tendon repair tendon repair
graft/transfer
Polytrauma,
1680 Neurosurgery, ST ST009 Nerve Plexus / ST009C Tendon injury repair 50000 50000 58500 62500 NA No NA
General Tendon injuries
Surgery
Polytrauma,
1681 Neurosurgery, ST ST009 Nerve Plexus / ST009D Tendon graft repair 50000 50000 58500 62500 NA No NA
Surgery
Polytrauma,
1682 Neurosurgery, ST ST009 Nerve Plexus / ST009E Tendon Transfer 20000 20000 23400 25000 NA No NA
Surgery
A. 15000/-
(Under GA),
10,000/-
(Under A. 18750/- A. 21300/- A. 22500/-
Local/regional (Under GA), (Under GA), (Under GA),
Nerve and/or tendon
Polytrauma, anesthesia). B - 12500/- (Under 14200/- (Under 1500/- (Under
injury. A. Wound
Orthopedics, Plexus injury along 5000/- per Local/regional Local/regional Local/regional
exploration and closure.
1683 Neurosurgery, ST ST010 with Vascular injury ST010A nerve. C - anesthesia). B - anesthesia). B - anesthesia). B - NA No NA
B. Nerve repair. C.
General repair / graft 3000/- per 6250/- per 7100/- per 7500/- per
Tendon repair D.
Surgery tendon repair nerve. C - nerve. C - nerve. C -
Vascular repair/graft
D. 5000/- per 3750/- per 4260/- per 4500/- per
vascular repair tendon repair tendon repair tendon repair
and 5000/-
extra for any
vein graft
Polytrauma,
Orthopedics, Plexus injury along
Plexus injury along with
1684 Neurosurgery, ST ST010 with Vascular injury ST010B 60000 75000 85200 90000 NA No NA
Vascular injury graft
General repair / graft
Surgery
Urology &
U/L - 29800
1685 Pediatric SU SU001 Adrenalectomy SU001A Open 29812.5 29900 42400 44800 NA Yes
B/L - 34800
Surgery
Urology &
U/L - 29000
1686 Pediatric SU SU001 Adrenalectomy SU001B Lap. 29062.5 29100 41300 43600 NA Yes
B/L - 34000
Surgery
Urology,
Pediatric
For Benign pathology -
1687 Surgery, SU SU003 Nephrectomy SU003A 32812.5 41100 46600 49300 NA No NA
Open
Surgical
Oncology
Urology,
Pediatric
For Benign pathology -
1688 Surgery, SU SU003 Nephrectomy SU003B 36562.5 45800 52000 54900 NA No NA
Lap.
Surgical
Oncology
Urology,
Pediatric
Radical (Renal tumor) -
1689 Surgery, SU SU003 Nephrectomy SU003C 32812.5 41100 46600 49300 NA No NA
Open
Surgical
Oncology
Urology,
Pediatric
Radical (Renal tumor) -
1690 Surgery, SU SU003 Nephrectomy SU003D 36562.5 45800 52000 54900 NA No NA
Lap.
Surgical
Oncology
Urology,
Pediatric
Nephrectomy - Partial
1691 Surgery, SU SU004 SU004A Open 43575 54500 61900 65400 NA No NA
or Hemi
Surgical
Oncology
Urology,
Pediatric
Nephrectomy - Partial
1692 Surgery, SU SU004 SU004B Lap. 46200 57800 65700 69300 NA No NA
or Hemi
Surgical
Oncology
1693 Urology SU SU005 Nephrolithotomy SU005A Open 30375 38000 43200 45600 NA No NA
1694 Urology SU SU005 Nephrolithotomy SU005B Anatrophic 30375 38000 43200 45600 NA No NA
PCNL (Percutaneous PCNL (Percutaneous U/L - 45000
1695 Urology SU SU007 SU007A 45000 45000 52700 56300 NA Yes
Nephrolithotomy) Nephrolithotomy) B/L - 50000
Urology,
Pediatric Nephrostomy - Nephrostomy -
1696 Surgery, SU SU008 Percutaneous SU008A Percutaneous 15000 18800 21300 22500 NA No NA
Interventional ultrasound guided ultrasound guided
Neuroradiology
1697 Urology SU SU0100 Torsion of testis SU0100A Torsion of testis 15000 18800 21300 22500 NA NA
Follow up for Follow up for urological
1698 Urology SU SU0101 SU0101A 1500 1900 2200 2300 NA NA
urological procedures procedures
Urology,
Pediatric
Nephro ureterectomy
1699 Surgery, SU SU010 SU010A Open 32812.5 41100 46600 49300 NA No NA
(Benign)
Surgical
Oncology
Urology,
Pediatric
Nephro ureterectomy
1700 Surgery, SU SU010 SU010B Lap. 36562.5 45800 52000 54900 NA No NA
(Benign)
Surgical
Oncology
Urology,
Pediatric
Nephro ureterectomy
1701 Surgery, SU SU011 SU011A Open 32812.5 41100 46600 49300 NA No NA
with cuff of bladder
Surgical
Oncology
Urology,
Pediatric
Nephro ureterectomy
1702 Surgery, SU SU011 SU011B Lap. 36562.5 45800 52000 54900 NA No NA
with cuff of bladder
Surgical
Oncology
Perinephric Abscess
1703 Urology SU SU013 SU013A Open 20000 25000 28400 30000 NA No NA
drainage
Perinephric Abscess
1704 Urology SU SU013 SU013B Percutaneous 15000 18800 21300 22500 NA No NA
drainage
Ureteroscopy + Stone
U/L - 29925
1705 Urology SU SU014 removal with SU014A Lower Ureter 29925 37500 42500 44900 NA Yes
B/L - 45000
lithotripsy
Ureteroscopy + Stone
U/L - 29925
1706 Urology SU SU014 removal with SU014B Upper Ureter 29925 37500 42500 44900 NA Yes
B/L - 45000
lithotripsy
Extracoporeal shock -
Extracoporeal shock -
wave Lithotripsy (ESWL)
1707 Urology SU SU016 wave Lithotripsy SU016A 20000 20000 23400 25000 DJ Stent - 200 200 No NA
stone, with or without
(ESWL)
stent (one side)
Urology,
1708 Pediatric SU SU018 Ureterolithotomy SU018A Open 22875 28600 32500 34400 NA No NA
Surgery
Urology,
1709 Pediatric SU SU018 Ureterolithotomy SU018B Lap. 22500 28200 32000 33800 NA No NA
Surgery
Urology, Pyeloplasty /
1710 Pediatric SU SU021 Pyeloureterostomy / SU021A Pyeloplasty - Open 30937.5 38700 44000 46500 NA No NA
Surgery Pyelopyelostomy
Pyeloplasty -
1711 Pediatric SU SU021 Pyeloureterostomy / SU021B 34687.5 43400 49300 52100 NA No NA
Laparoscopic
Pyeloureterostomy -
1712 Pediatric SU SU021 Pyeloureterostomy / SU021C 30937.5 38700 44000 46500 NA No NA
Open
Pyeloureterostomy -
1713 Pediatric SU SU021 Pyeloureterostomy / SU021D 34687.5 43400 49300 52100 NA No NA
Laparoscopic
1714 Pediatric SU SU021 Pyeloureterostomy / SU021E Pyelopyelostomy - Open 30937.5 38700 44000 46500 NA No NA
Pyelopyelostomy -
1715 Pediatric SU SU021 Pyeloureterostomy / SU021F 34687.5 43400 49300 52100 NA No NA
Laparoscopic
Urology,
Ureterocalycostomy -
1716 Pediatric SU SU023 Ureterocalycostomy SU023A 31875 39900 45300 47900 NA No NA
Open
Surgery
Urology,
Ureterocalycostomy -
1717 Pediatric SU SU023 Ureterocalycostomy SU023B 35625 44600 50600 53500 NA No NA
Laparoscopic
Surgery
Urology,
1718 Pediatric SU SU024 Pyelolithotomy SU024A Open 29925 37500 42500 44900 NA No NA
Surgery
Urology,
1719 Pediatric SU SU024 Pyelolithotomy SU024B Lap. 29925 37500 42500 44900 NA No NA
Surgery
Internal Ureterotomy Internal Ureterotomy

including cystoscopy including cystoscopy as
1720 Urology SU SU025 SU025A 10125 12700 14400 15200 NA No NA
as an independent an independent
procedure procedure
Ureterolysis for
retroperitoneal
1721 Urology SU SU026 fibrosis SU026A Open 29925 37500 42500 44900 NA No NA
(with or without
omental wrapping)
Ureterolysis for
retroperitoneal
1722 Urology SU SU026 fibrosis SU026B Lap. 29250 36600 41600 43900 NA No NA
(with or without
omental wrapping)
Urology,
Ureterostomy
1723 Pediatric SU SU027 Ureterostomy SU027A 20250 25400 28800 30400 NA No NA
(Cutaneous)
Surgery
Urology,
1724 Pediatric SU SU028 Uretero-ureterostomy SU028A Open 30000 37500 42600 45000 NA No NA
Surgery
Urology,
1725 Pediatric SU SU028 Uretero-ureterostomy SU028B Lap. 33750 42200 48000 50700 NA No NA
Surgery
Urology ,
Uretero-vaginal / Uretero - vaginal fistula
1726 Obstetrics & SU SU029 SU029A 26250 32900 37300 39400 NA No NA
Uterine fistula repair repair - Open
Gynecology
Urology ,
Uretero-vaginal / Uretero - Uterine fistula
1727 Obstetrics & SU SU029 SU029B 26250 32900 37300 39400 NA No NA
Uterine fistula repair repair - Open
Gynecology
Urology ,
Uretero-vaginal / Uretero - vaginal fistula
1728 Obstetrics & SU SU029 SU029C 26250 32900 37300 39400 NA No NA
Uterine fistula repair repair - Laparoscopic
Gynecology
Urology ,
Uretero-vaginal / Uretero - Uterine fistula
1729 Obstetrics & SU SU029 SU029D 26250 32900 37300 39400 NA No NA
Uterine fistula repair repair - Laparoscopic
Gynecology
Urology,
Ureteric U/L - 25500
1730 Pediatric SU SU030 SU030A Open 25500 31900 36300 38300 NA Yes
reimplantation B/L - 38500
Surgery
Urology,
Ureteric U/L - 25500
1731 Pediatric SU SU030 SU030B Lap. 25500 31900 36300 38300 NA Yes
reimplantation B/L - 38500
Surgery
Boari flap for ureteric
1732 Urology SU SU031 SU031A Open 31875 39900 45300 47900 NA No NA
stricture
Boari flap for ureteric
1733 Urology SU SU031 SU031B Lap. 33750 42200 48000 50700 NA No NA
stricture
Ileal replacement for Ileal replacement for
ureteric stricture ureteric stricture
DJ stenting including DJ stenting including

Urology,
cystoscopy, ureteric cystoscopy, ureteric
1735 Pediatric SU SU033 SU033A 10080 12600 14400 15200 DJ Stent - 200 200 No NA
catheterization, catheterization,
Surgery
retrograde pyelogram retrograde pyelogram
1736 Urology SU SU034 DJ Stent Removal SU034A DJ Stent Removal 5250 6600 7500 7900 NA No NA
Ureterocele incision
Ureterocele incision
including cystoscopy,
1737 Urology SU SU035 ureteric SU035A 20000 25000 28400 30000 NA No NA
ureteric catheterization,
catheterization,
retrograde pyelogram
Ureteric sampling
Ureteric sampling
1738 Urology SU SU036 ureteric SU036A 15000 18800 21300 22500 NA No NA
ureteric catheterization,
catheterization,
10000 (1-5 11000 (1-5 14200 (1-5 13000 (1-5

Acute management Acute management of
Urology, days)plus high days)plus high days)plus high days)plus high
of upper urinary tract upper urinary tract Routine Ward -
1739 Pediatric SU SU037 SU037A end end end end NA Yes
trauma – trauma – 2100
Surgery investigation investigation investigation investigation
conservative conservative
package package package package
Retrograde with laser /
1740 Urology SU SU038 Endopyelotomy SU038A 30000 37500 42600 45000 NA No NA
bugbee
Antegrade with laser /
1741 Urology SU SU038 Endopyelotomy SU038B 30000 37500 42600 45000 NA No NA
bugbee
Urology, Cystolithotomy -
Open - including
1742 Pediatric SU SU040 Open, including SU040A 19912.5 24900 28300 29900 NA No NA
cystoscopy
Surgery cystoscopy
Cystolithotripsy /
Urology, Cystolithotripsy
Urethral Stone
1743 Pediatric SU SU041 SU041A endoscopic, including 19912.5 24900 28300 29900 NA No NA
endoscopic, including
Surgery cystoscopy
cystoscopy
Cystolithotripsy /
Urology, Urethral Stone removal
Urethral Stone
1744 Pediatric SU SU041 SU041B endoscopic, including 19912.5 24900 28300 29900 NA No NA
endoscopic, including
Surgery cystoscopy
cystoscopy
Urology,
Surgical
1745 Oncology, SU SU043 Partial Cystectomy SU043A Open 26175 32800 37200 39300 NA No NA
Pediatric
Surgery
Urology,
Surgical
1746 Oncology, SU SU043 Partial Cystectomy SU043B Lap. 25500 31900 36300 38300 NA No NA
Pediatric
Surgery
Urology,
Augmentation
1747 Pediatric SU SU045 SU045A Open 31875 39900 45300 47900 NA No NA
cystoplasty
Surgery
Urology,
Augmentation
1748 Pediatric SU SU045 SU045B Lap. 35625 44600 50600 53500 NA No NA
cystoplasty
Surgery
Deflux for VUR(only
1749 Urology SU SU046 Deflux for VUR SU046A 4200 5300 6000 6300 NA No NA
procedure charge)
Open bladder Open bladder
Urology,
diverticulectomy with diverticulectomy with /
1750 Pediatric SU SU048 SU048A 26250 32900 37300 39400 NA No NA
/ without ureteric re- without ureteric re-
Surgery
implantation implantation
Urology, Bladder injury repair Bladder injury repair

1751 Pediatric SU SU049 (with or without SU049A (with or without urethral 25500 31900 36300 38300 NA No NA
Surgery urethral injury) injury)
Bladder injury repair Bladder injury repair

Urology,
with colostomy with colostomy
1752 Pediatric SU SU050 SU050A 29062.5 36400 41300 43600 NA No NA
(with or without (with or without urethral
Surgery
urethral injury) injury)
Extrophy Bladder Extrophy Bladder repair

Urology, repair including including osteotomy if
1753 Pediatric SU SU051 osteotomy if needed SU051A needed + epispadias 90000 112500 127800 135000 NA No NA
Surgery + epispadias repair + repair + ureteric
ureteric reimplant reimplant
Neurogenic bladder -
Package for
Neurogenic bladder -
evaluation /
Package for evaluation /
Urology, investigation
investigation (catheter +
1754 Pediatric SU SU052 (catheter + ultrasound SU052A 16342.5 20500 23300 24600 NA No NA
ultrasound + culture +
Surgery + culture + RGU/
RGU/ MCU) for 1 month
MCU) for 1 month
(medicines - antibiotics)
(medicines -
antibiotics)
Bladder Neck incision Bladder Neck incision -

- Endoscopic Endoscopic
TURBT TURBT
Urology,
(Transurethral (Transurethral
1756 Surgical SU SU055 SU055A 29062.5 36400 41300 43600 NA No NA
Resection of the Resection of the
Oncology
Bladder Tumor) Bladder Tumor)
Urology,
1757 Surgical SU SU056 TURBT - Restage SU056A TURBT - Restage 19800 24800 28200 29700 NA No NA
Oncology
Post TURBT - Check
Post TURBT - Check
Cystoscopy (Per
1758 Urology SU SU057 SU057A Cystoscopy (Per sitting) 10000 12500 14200 15000 NA No NA
sitting) with cold-cup
with cold-cup biopsy
biopsy
Urachal Cyst excision -
1759 Urology SU SU058 Urachal Cyst excision SU058A 21937.5 27500 31200 33000 NA No NA
Open
Urachal Cyst excision -
1760 Urology SU SU058 Urachal Cyst excision SU058B 23812.5 29800 33900 35800 NA No NA
Laparoscopic
Induction cycles (PC)
Urology,
Intravesical BCG / Rate per dose -Rs 5000
1761 Medical SU SU060 SU060A 2500 3200 3600 3800 NA No NA
Mitomycin max no- 06 (including
Oncology
drug)
Urology,
Suprapubic Drainage - Suprapubic Drainage -
1762 Pediatric SU SU061 SU061A 5062.5 6400 7200 7600 NA No NA
Closed / Trocar Closed / Trocar
Surgery
Urology, BIS standard
Stress incontinence Stress incontinence
1763 Surgical SU SU062 SU062A 23550 29500 33500 35400 sling for 5000 No NA
surgery surgery - Open
Oncology women - 5000
Emergency
Urology, Emergency
management of Routine Ward -
1764 Pediatric SU SU064 SU064A management of Acute 2100 one day 2300/day 2625/day 2625/day NA Yes
Acute retention of 2100
Surgery retention of Urine
Urine
Urology,
Meatotomy /
1765 Pediatric SU SU065 SU065A Meatotomy 4125 5200 5900 6200 NA No NA
Meatoplasty
Surgery
Urology,
Meatotomy /
1766 Pediatric SU SU065 SU065B Meatoplasty 4687.5 5900 6700 7100 NA No NA
Meatoplasty
Surgery
Urology,
Urethroplasty - End to
1767 Pediatric SU SU066 Urethroplasty SU066A 29925 37500 42500 44900 NA No NA
end
Surgery
Urology, Urethroplasty -
1768 Pediatric SU SU066 Urethroplasty SU066B Substitution - single 29925 37500 42500 44900 NA No NA
Surgery stage
Urology,
Urethroplasty -
1769 Pediatric SU SU066 Urethroplasty SU066C 60000 75000 85200 90000 NA No NA
Substitution - two stage
Surgery
Urology,
Urethroplasty -
1770 Pediatric SU SU066 Urethroplasty SU066D 34500 43200 49000 51800 NA No NA
Transpubic
Surgery
Urology,
Non endocopic as an
1771 Pediatric SU SU068 Urethral Dilatation SU068A 2500 3200 3600 3800 NA No NA
independent procedure
Surgery
Urology,
Endocopic as an
1772 Pediatric SU SU068 Urethral Dilatation SU068B 5625 7100 8000 8500 NA No NA
independent procedure
Surgery
Urology, Perineal
Perineal Urethrostomy
1773 Pediatric SU SU069 Urethrostomy without SU069A 20250 25400 28800 30400 NA No NA
without closure
Surgery closure
Post. Urethral Valve
Urology,
Post. Urethral Valve fulguration(to be
fulguration checked from pead
Surgery
surgery)
Urology,
Pediatric
Surgery,
1775 SU SU071 Hypospadias repair SU071A Single stage 40000 50000 56800 60000 NA No NA
Plastic &
Reconstructive
Surgery
Urology,
Pediatric
Surgery, Two or more stage (First
1776 SU SU071 Hypospadias repair SU071B 16312.5 20400 23200 24500 NA No NA
Plastic & Stage)
Reconstructive
Surgery
Urology,
Pediatric
Two or more stage
Surgery,
1777 SU SU071 Hypospadias repair SU071D (Final Stage)/Fistula 20000 25000 28400 30000 NA No NA
Plastic &
repair
Reconstructive
Surgery
Urology, Emergency
Emergency
Pediatric management of Routine Ward -
1778 SU SU073 management of SU073A 2100 2700 3000 3200 NA Yes
Surgery, Hematuria(per day) 2100
Hematuria
Emergency LOS-1-5 days
Excision of Urethral Excision of Urethral
Caruncle Caruncle
Urology,
Obstetrics &
Urethrovaginal fistula Urethrovaginal fistula
1780 Gynecology, SU SU075 SU075A 40000 50000 56800 60000 NA No NA
repair repair
Pediatric
Surgery
Urology,
Urethrorectal fistula Urethrorectal fistula
repair repair
Surgery
Open simple
Open simple
1782 Urology SU SU077 prostatetctomy for SU077A 29812.5 37300 42400 44800 NA No NA
prostatetctomy for BPH
BPH
Radical Open (to be checked
prostatectomy with surg onco)
Radical Lap.(to be checked with
1784 Urology SU SU078 SU078B 56250 70400 79900 84400 NA No NA
prostatectomy surg. Onco)
TURP-Transurethral
1785 Urology SU SU080 Resection of the SU080A Monopolar 30937.5 38700 44000 46500 NA No NA
Prostate, BPH
TURP-Transurethral
1786 Urology SU SU080 Resection of the SU080B Bipolar 30937.5 38700 44000 46500 NA No NA
Prostate, BPH
Transrectal
Transrectal Ultrasound
Ultrasound guided
1787 Urology SU SU081 SU081A guided prostate biopsy 10125 12700 14400 15200 NA No NA
prostate biopsy
(minimum 12 core)
(minimum 12 core)
Urology,
1788 Surgical SU SU082 Penectomy SU082A Partial Penectomy 20000 25000 28400 30000 NA No NA
Oncology
Urology,
Total Penectomy +
1789 Surgical SU SU082 Penectomy SU082B 30000 37500 42600 45000 NA No NA
Perineal Urethrostomy
Oncology
1790 Urology SU SU083 Surgery for Priapism SU083A Aspiration 15000 18800 21300 22500 NA No NA
1791 Urology SU SU083 Surgery for Priapism SU083B Shunt 16500 20700 23500 24800 NA No NA
Penile
Prosthesis -
Penile prosthesis Penile prosthesis
1792 Urology SU SU085 SU085A 35000 43800 49700 52500 Malleable - No NA
insertion insertion
Indian
Implant
Urology,
Surgical
1793 Oncology, SU SU086 Orchiectomy SU086A High inguinal 20000 25000 28400 30000 NA No NA
Pediatric
Surgery
Urology, Bilateral
Bilateral Orchidectomy
1794 Surgical SU SU087 Orchidectomy for SU087A 11250 14100 16000 16900 NA No NA
for hormone ablation
Oncology hormone ablation
Orchiopexy with
Urology,
laparoscopyto be cross U/L - 30000
1795 Pediatric SU SU088 Orchiopexy SU088A 30000 37500 42600 45000 NA Yes
checked with pead B/L - 35000
Surgery
surgery
Urology,
Orchiopexy without
1796 Pediatric SU SU088 Orchiopexy SU088B 16500 20700 23500 24800 NA No NA
laparoscopy - U/L
Surgery
Urology,
Orchiopexy without
1797 Pediatric SU SU088 Orchiopexy SU088C 16500 20700 23500 24800 NA No NA
laparoscopy - B/L
Surgery
Surgical Correction of U/L - 10125
1798 Urology SU SU089 SU089A Non Microsurgical 10125 12700 14400 15200 NA Yes
Varicocele B/L - 15125
Surgical Correction of U/L - 20000
1799 Urology SU SU089 SU089B Microsurgical 20000 25000 28400 30000 NA Yes
Varicocele B/L - 25000
Urology,
Surgical Radical
1800 Oncology, SU SU090 Retroperitoneal lymph SU090A Open 39802.5 49800 56600 59800 NA No NA
Obstetrics & node dissection
Gynecology
Urology,
Surgical Radical
1801 Oncology, SU SU090 Retroperitoneal lymph SU090B Lap. 40537.5 50700 57600 60900 NA No NA
Obstetrics & node dissection
Gynecology
Urology,
Ilio-Inguinal Ilio-Inguinal U/L - 21900
1802 Surgical SU SU091 SU091A 21937.5 27500 31200 33000 NA Yes
lymphadenectomy lymphadenectomy B/L - 26900
Oncology
Emergency
management of Emergency
Ureteric stone - management of Ureteric
Urology, Package for stone - Package for
1803 Pediatric SU SU094 evaluation / SU094A evaluation / 2100 2700 3000 3200 NA No NA
Surgery investigation investigation (ultrasound
(ultrasound + culture) + culture) for 3 weeks
for 3 weeks (medicines).
(medicines).
Retrograde Intrarenal Retrograde Intrarenal
1804 Urology SU SU095 Surgery with Laser SU095A Surgery with Laser 30375 38000 43200 45600 NA No NA
Lithotripsy Lithotripsy
1805 Urology SU SU096 Repair for VVF SU096B Laparoscopic/open 37500 37500 53300 56300 NA No NA
Permanent tunnelled
Permanent tunnelled
catheter placement
catheter placement as
1806 Urology SU SU097 as substitute for AV SU097A 30000 30000 35100 37500 NA No NA
substitute for AV fistula
fistula in long term
in long term dialysis
dialysis
Pelvic
Surgical
lymphadenectomy,
1807 Oncology,Urol SU SU098 SU098A Open 30000 37500 42600 45000 NA No NA
after prior cancer
ogy
surgery
Pelvic
lymphadenectomy,
1808 Urology SU SU098 SU098B Laparoscopic 30375 38000 43200 45600 NA No NA
after prior cancer
surgery
Botulinum toxin
Botulinum toxin injection
1809 Urology SU SU099 injection for SU099A 10000 12500 14200 15000 NA NA
for Neuropathic bladder
Neuropathic bladder
Surgical Correction of
Category - I Unifocalization of PTFE Graft -
1810 CTVS SV SV001 SV001A 110000 137500 156200 165000 30000 No NA
Congenital Heart MAPCA Thin - 30000
Disease
Isolated Secundum
Category - I
1811 CTVS SV SV001 SV001B Atrial Septal Defect 110000 137500 156200 165000 NA No NA
Congenital Heart
(ASD) Repair
Disease
Category - I
1812 CTVS SV SV001 SV001C Glenn procedure 110000 137500 156200 165000 NA No NA
Congenital Heart
Disease
Category - I Pulmonary Artery
1813 CTVS SV SV001 SV001D 110000 137500 156200 165000 NA No NA
Congenital Heart Banding
Disease
Category - I Systemic - Pulmonary PTFE graft -
1814 CTVS SV SV001 SV001E 110000 137500 156200 165000 30000 No NA
Congenital Heart Artery shunt Thin - 30000
Disease
Category - I
1815 CTVS SV SV001 SV001F Vascular Ring division 110000 137500 156200 165000 NA No NA
Congenital Heart
Disease
Dacron Graft -
Category - I
1816 CTVS SV SV001 SV001G Coarctation repair 110000 137500 156200 165000 Straight - 30,000 No NA
Congenital Heart
30000
Disease
PTFE Patch -
Thin - 30000
PTFE graft
small (upto 8
mm)- 30000
patch-30000
ASD closure + Partial Graft small-
Category - II PTFE Graft
1817 CTVS SV SV002 SV002A Anomalous Venous 132000 165000 187500 198000 30000 graft big- No NA
Congenital Heart Large (<8mm) -
Drainage Repair 50000 Dacron
Disease 50000
Graft -30000
Dacron Graft
Straight -
30000
PTFE Patch -
Thin - 30000
Mechanical
Valve - Patch -3000
Bileaflet - Bileaflet valve-
40000 40000
Mechanical Tilting disc-
Surgical Correction of Valve - Tilting 28000,
Category - II ASD Closure + Mitral Disc - 28000 Pericardial
1818 CTVS SV SV002 SV002B 132000 165000 187500 198000 No NA
Congenital Heart procedure Pericardial patch-18000
Disease Patch - 18000 Tissue value-
Tissue Valve - 80000
80000 Valve -ring-
Valve Ring - Mitral/tricuspid-
Mitral - 35000 35000
Valve Ring -
Tricuspid -
35000
PTFE Patch -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Category - II ASD Closure + Disc - 28000 Pericardial
1819 CTVS SV SV002 SV002C 132000 165000 187500 198000 No NA
Congenital Heart Tricuspid procedure Pericardial patch-18000
80000 Valve -ring-
Mitral - 35000 35000
Valve Ring -
Tricuspid -
35000
PTFE Patch -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
1820 CTVS SV SV002 SV002D 132000 165000 187500 198000 No NA
Congenital Heart Pulmonary procedure Pericardial patch-18000
80000 Valve -ring-
Mitral - 35000 35000
Valve Ring -
Tricuspid -
35000
PTFE Patch -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
1821 CTVS SV SV002 SV002E 132000 165000 187500 198000 No NA
Congenital Heart Infundibular procedure Pericardial patch-18000
80000 Valve -ring-
Mitral - 35000 35000
Valve Ring -
Tricuspid -
35000
PTFE Patch -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Category - II Disc - 28000 Pericardial
1822 CTVS SV SV002 SV002F VSD closure 132000 165000 187500 198000 No NA
Congenital Heart Pericardial patch-18000
80000 Valve -ring-
Mitral - 35000 35000
Valve Ring -
Tricuspid -
35000
PTFE Patch -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
1823 CTVS SV SV002 SV002G Infundibular PS repair 132000 165000 187500 198000 No NA
80000 Valve -ring-
Mitral - 35000 35000
Valve Ring -
Tricuspid -
35000
PTFE Patch -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
1824 CTVS SV SV002 SV002H Valvular PS / PR repair 132000 165000 187500 198000 No NA
80000 Valve -ring-
Mitral - 35000 35000
Valve Ring -
Tricuspid -
35000
PTFE Patch -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
1825 CTVS SV SV002 SV002I Partial AV canal repair 132000 165000 187500 198000 No NA
80000 Valve -ring-
Mitral - 35000 35000
Valve Ring -
Tricuspid -
35000
PTFE Patch -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Category - II Intermediate AV canal Disc - 28000 Pericardial
1826 CTVS SV SV002 SV002J 132000 165000 187500 198000 No NA
Congenital Heart repair Pericardial patch-18000
80000 Valve -ring-
Mitral - 35000 35000
Valve Ring -
Tricuspid -
35000
PTFE Patch -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Category - II Atrial septectomy + Disc - 28000 Pericardial
1827 CTVS SV SV002 SV002K 132000 165000 187500 198000 No NA
Congenital Heart Glenn Pericardial patch-18000
80000 Valve -ring-
Mitral - 35000 35000
Valve Ring -
Tricuspid -
35000
PTFE Patch -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Category - II Atrial septectomy + PA Disc - 28000 Pericardial
1828 CTVS SV SV002 SV002L 132000 165000 187500 198000 No NA
Congenital Heart Band Pericardial patch-18000
80000 Valve -ring-
Mitral - 35000 35000
Valve Ring -
Tricuspid -
35000
PTFE Patch -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Sinus of Valsalva
1829 CTVS SV SV002 SV002M aneurysm repair with 132000 165000 187500 198000 No NA
aortic valve procedure
80000 Valve -ring-
Mitral - 35000 35000
Valve Ring -
Tricuspid -
35000
PTFE Patch -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Sinus of Valsalva
1830 CTVS SV SV002 SV002N aneurysm repair without 132000 165000 187500 198000 No NA
aortic valve procedure
80000 Valve -ring-
Mitral - 35000 35000
Valve Ring -
Tricuspid -
35000
PTFE Patch -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Category - II Sub-aortic membrane Disc - 28000 Pericardial
1831 CTVS SV SV002 SV002O 132000 165000 187500 198000 No NA
Congenital Heart resection Pericardial patch-18000
80000 Valve -ring-
Mitral - 35000 35000
Valve Ring -
Tricuspid -
35000
PTFE Patch -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Valve - Tilting 28000,
Disc - 28000 Pericardial
Category - III
1832 CTVS SV SV003 SV003A Ebstien anomoly repair 165000 206300 234300 247500 Pericardial patch-18000 No NA
Congenital Heart
Patch - 18000 RV-PA conduit-
Disease
RV - PA 120000
Conduit - Valve -ring-
120000 Mitral/tricuspid-
Tissue Valve - 35000 tissue
80000 valve-80000
Valve Ring -
Mitral - 35000
Valve Patch
PTFE Ring - -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Category - III
1833 CTVS SV SV003 SV003B Double switch operation 165000 206300 234300 247500 Pericardial patch-18000 No NA
Congenital Heart
Disease
RV - PA 120000
80000 valve-80000
Valve Ring -
Mitral - 35000
Valve Patch
PTFE Ring - -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Category - III
1834 CTVS SV SV003 SV003C Rastelli Procedure 165000 206300 234300 247500 Pericardial patch-18000 No NA
Congenital Heart
Disease
RV - PA 120000
80000 valve-80000
Valve Ring -
Mitral - 35000
Valve Ring -
PTFE Patch -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Category - III
1835 CTVS SV SV003 SV003D Fontan procedure 165000 206300 234300 247500 Pericardial patch-18000 No NA
Congenital Heart
Disease
RV - PA 120000
80000 valve-80000
Valve Ring -
Mitral - 35000
Valve Patch
PTFE Ring - -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Category - III
1836 CTVS SV SV003 SV003E AP window repair 165000 206300 234300 247500 Pericardial patch-18000 No NA
Congenital Heart
Disease
RV - PA 120000
80000 valve-80000
Valve Ring -
Mitral - 35000
Valve Patch
PTFE Ring - -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Category - III Arch interruption Repair
1837 CTVS SV SV003 SV003F 165000 206300 234300 247500 Pericardial patch-18000 No NA
Congenital Heart without VSD closure
Disease
RV - PA 120000
80000 valve-80000
Valve Ring -
Mitral - 35000
Valve Ring -
PTFE Patch -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Category - III Arch interruption Repair
1838 CTVS SV SV003 SV003G 165000 206300 234300 247500 Pericardial patch-18000 No NA
Congenital Heart with VSD closure
Disease
RV - PA 120000
80000 valve-80000
Valve Ring -
Mitral - 35000
Valve Patch
PTFE Ring - -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Category - III
1839 CTVS SV SV003 SV003H DORV Repair 165000 206300 234300 247500 Pericardial patch-18000 No NA
Congenital Heart
Disease
RV - PA 120000
80000 valve-80000
Valve Ring -
Mitral - 35000
Valve Patch
PTFE Ring - -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Category - III
1840 CTVS SV SV003 SV003I Supravalvular AS repair 165000 206300 234300 247500 Pericardial patch-18000 No NA
Congenital Heart
Disease
RV - PA 120000
80000 valve-80000
Valve Ring -
Mitral - 35000
Valve Ring -
PTFE Patch -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Category - III
1841 CTVS SV SV003 SV003J Konno procedure 165000 206300 234300 247500 Pericardial patch-18000 No NA
Congenital Heart
Disease
RV - PA 120000
80000 valve-80000
Valve Ring -
Mitral - 35000
Valve Patch
PTFE Ring - -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Category - III
1842 CTVS SV SV003 SV003K Norwood procedure 165000 206300 234300 247500 Pericardial patch-18000 No NA
Congenital Heart
Disease
RV - PA 120000
80000 valve-80000
Valve Ring -
Mitral - 35000
Valve Patch
PTFE Ring - -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Category - III VSD closure + RV - PA
1843 CTVS SV SV003 SV003L 165000 206300 234300 247500 Pericardial patch-18000 No NA
Congenital Heart conduit
Disease
RV - PA 120000
80000 valve-80000
Valve Ring -
Mitral - 35000
Valve Ring -
PTFE Patch -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Category - III
1844 CTVS SV SV003 SV003M VSD + Aortic procedure 165000 206300 234300 247500 Pericardial patch-18000 No NA
Congenital Heart
Disease
RV - PA 120000
80000 valve-80000
Valve Ring -
Mitral - 35000
Valve Patch
PTFE Ring - -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Category - III
1845 CTVS SV SV003 SV003N VSD + Mitral procedure 165000 206300 234300 247500 Pericardial patch-18000 No NA
Congenital Heart
Disease
RV - PA 120000
80000 valve-80000
Valve Ring -
Mitral - 35000
Valve Patch
PTFE Ring - -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Category - III VSD + Tricuspid
1846 CTVS SV SV003 SV003O 165000 206300 234300 247500 Pericardial patch-18000 No NA
Congenital Heart procedure
Disease
RV - PA 120000
80000 valve-80000
Valve Ring -
Mitral - 35000
Valve Ring -
PTFE Patch -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Category - III VSD + Pulmonary artery
1847 CTVS SV SV003 SV003P 165000 206300 234300 247500 Pericardial patch-18000 No NA
Disease
RV - PA 120000
80000 valve-80000
Valve Ring -
Mitral - 35000
Valve Patch
PTFE Ring - -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Category - III VSD + Infundibular
1848 CTVS SV SV003 SV003Q 165000 206300 234300 247500 Pericardial patch-18000 No NA
Disease
RV - PA 120000
80000 valve-80000
Valve Ring -
Mitral - 35000
Valve Patch
PTFE Ring - -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Category - III VSD + Coarctation
1849 CTVS SV SV003 SV003R 165000 206300 234300 247500 Pericardial patch-18000 No NA
Congenital Heart repair
Disease
RV - PA 120000
80000 valve-80000
Valve Ring -
Mitral - 35000
Valve Ring -
PTFE Patch -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Category - III
1850 CTVS SV SV003 SV003S TAPVC Repair 165000 206300 234300 247500 Pericardial patch-18000 No NA
Congenital Heart
Disease
RV - PA 120000
80000 valve-80000
Valve Ring -
Mitral - 35000
Valve Patch
PTFE Ring - -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Category - III Truncus arteriosus
1851 CTVS SV SV003 SV003T 165000 206300 234300 247500 Pericardial patch-18000 No NA
Disease
RV - PA 120000
80000 valve-80000
Valve Ring -
Mitral - 35000
Valve Patch
PTFE Ring - -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Category - III Tetralogy of Fallot
1852 CTVS SV SV003 SV003U 165000 206300 234300 247500 Pericardial patch-18000 No NA
Congenital Heart Repair
Disease
RV - PA 120000
80000 valve-80000
Valve Ring -
Mitral - 35000
Valve Ring -
PTFE Patch -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Category - III Complete AV canal
1853 CTVS SV SV003 SV003V 165000 206300 234300 247500 Pericardial patch-18000 No NA
Disease
RV - PA 120000
80000 valve-80000
Valve Ring -
Mitral - 35000
Valve Patch
PTFE Ring - -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Category - III
1854 CTVS SV SV003 SV003W Arterial switch operation 165000 206300 234300 247500 Pericardial patch-18000 No NA
Congenital Heart
Disease
RV - PA 120000
80000 valve-80000
Valve Ring -
Mitral - 35000
Valve Patch
PTFE Ring - -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Category - III
1855 CTVS SV SV003 SV003X Senning Operation 165000 206300 234300 247500 Pericardial patch-18000 No NA
Congenital Heart
Disease
RV - PA 120000
80000 valve-80000
Valve Ring -
Mitral - 35000
Valve Ring -
PTFE Patch -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Category - III
1856 CTVS SV SV003 SV003Y Mustard Operation 165000 206300 234300 247500 Pericardial patch-18000 No NA
Congenital Heart
Disease
RV - PA 120000
80000 valve-80000
Valve Ring -
Mitral - 35000
Valve Ring -
Category - III
1857 CTVS SV SV003 SV003Z ALCAPA repair 220000 275000 312400 330000 NA No NA
Congenital Heart
Disease
Coronary artery
bypass grafting Coronary artery bypass
(CABG), grafting (CABG), with or
1858 CTVS SV SV004 SV004A 129910 162400 184500 194900 NA No NA
including intra without intraoperative
operative balloon IABP)
pump (if required)
Mechanical
Valve -
Bileaflet valve-
Bileaflet -
40000
40000
Single Valve Aortic valve Tilting disc-
1859 CTVS SV SV005 SV005A 130900 163700 185900 196400 Mechanical No NA
Procedure replacement 28000,
Valve - Tilting
tissue valve-
Disc - 28000
80000
Tissue Valve -
80000
Mechanical
Valve -
Bileaflet valve-
Bileaflet -
40000
40000
Tilting disc-
Mechanical
Single Valve Mitral valve replacement 28000,
1860 CTVS SV SV005 SV005B 130900 163700 185900 196400 Valve - Tilting No NA
Procedure / Mitral valve repair tissue valve-
Disc - 28000
80000 Value
Tissue Valve -
ring mitral -
80000
35000
Valve Ring -
Mitral - 35000
Mechanical
Valve -
40000 40000
Tricuspid valve
Single Valve Valve - Tilting 28000,
1861 CTVS SV SV005 SV005C replacement / Tricuspid 130900 163700 185900 196400 No NA
Procedure Disc - 28000 tissue valve-
valve repair
Tissue Valve - 80000 Value
80000 ring Tricuspid -
Valve Ring - 35000
Tricuspid -
35000
Aortic Valve -
Repair -
Mechanical 156200 Aortic
Valve - Valve -
Bileaflet - Relacement -
Bileaflet valve-
40000 156200 Mitral
40000
Mechanical Valve - Repair -
Tilting disc-
Valve - Tilting 156200
28000,
Double Valve Double valve Disc - 28000 Mitral Valve -
1862 CTVS SV SV006 SV006A 156200 195300 221900 234300 tissue valve- Yes
Procedure replacement / repair Tissue Valve - Replacement -
80000 Value
80000 156200
ring
Valve Ring - Tricuspid
Mitral/Tricuspid
Mitral - 35000 Valve - Repair -
-35000
Valve Ring - 156200
Tricuspid - Tricuspid
35000 Valve -
Replacement -
156200
Aortic Valve -
Repair -
Mechanical 187000 Aortic
Valve - Valve -
Bileaflet - Relacement -
Bileaflet valve-
40000 187000 Mitral
40000
Mechanical Valve - Repair -
Tilting disc-
Valve - Tilting 187000
28000,
Triple valve Triple valve replacement Disc - 28000 Mitral Valve -
1863 CTVS SV SV007 SV007A 187000 233800 265600 280500 tissue valve- Yes
procedure / repair Tissue Valve - Replacement -
80000 Value
80000 187000
ring
Valve Ring - Tricuspid
Mitral/Tricuspid
Mitral - 35000 Valve - Repair -
-35000
Valve Ring - 187000
Tricuspid - Tricuspid
35000 Valve -
Replacement -
187000
Closed Mitral
1864 CTVS SV SV008 Valvotomy including SV008A Closed mitral valvotomy 62700 78400 89100 94100 NA NA No NA
thoracotomy
RV - PA
1865 CTVS SV SV009 Ross Procedure SV009A Ross Procedure 165000 206300 234300 247500 Conduit - 1,20,000 No NA
120000
Mechanical
Valve -
Bileaflet -
Bileaflet valve-
40000
40000
Mechanical
Surgery for Tilting disc-
Surgery for Hypertrophic Valve - Tilting
Hypertrophic 28000,
Obstructive Disc - 28000
1866 CTVS SV SV010 Obstructive SV010A 122100 152700 173400 183200 tissue valve- No NA
Cardiomyopathy Tissue Valve -
Cardiomyopathy 80000 Value
(HOCM) 80000
(HOCM) ring
Valve Ring -
Mitral/Tricuspid
Mitral - 35000
-35000
Valve Ring -
Tricuspid -
35000
Pericardial window Pericardial window (via
(via thoracotomy) thoracotomy)
1868 CTVS SV SV012 Pericardiectomy SV012A Pericardiectomy 73700 92200 104700 110600 NA No NA
Patent Ductus
Patent Ductus
Arteriosus (PDA)
1869 CTVS SV SV013 SV013A Arteriosus (PDA) 62700 78400 89100 94100 NA No NA
Closure via
Closure via thoracotomy
thoracotomy
Composite Composite
Aortic Valved Aortic Valved
conduit - conduit -
Mechanical - Mechanical -
100000 100000
Dacron Graft - Dacron Graft -
Straight - Straight -
30000 30000
Aortic Root
1870 CTVS SV SV014 SV014A Bental Procedure 165000 206300 234300 247500 Mechanical Mechanical No NA
Replacement Surgery
Valve - Valve -
Bileaflet - Bileaflet -
40000 40000
Mechanical Mechanical
Valve - Tilting Valve - Tilting
Disc - 28000 Disc - 28000
Tissue Valve - Tissue Valve -
80000 80000
Composite Composite
conduit - conduit -
100000 100000
30000 30000
Aortic Root
1871 CTVS SV SV014 SV014B Aortic Dissection 165000 206300 234300 247500 Mechanical Mechanical No NA
Replacement Surgery
Valve - Valve -
40000 40000
Disc - 28000 Disc - 28000
80000 80000
Composite Composite
conduit - conduit -
100000 100000
30000 30000
Aortic Root Aortic Aneurysm ( Root
1872 CTVS SV SV014 SV014C 165000 206300 234300 247500 Mechanical Mechanical No NA
Replacement Surgery Ascending )
Valve - Valve -
40000 40000
Disc - 28000 Disc - 28000
80000 80000
Composite Composite
conduit - conduit -
100000 100000
30000 30000
Aortic Root Valve sparing root
1873 CTVS SV SV014 SV014D 165000 206300 234300 247500 Mechanical Mechanical No NA
Replacement Surgery replacement
Valve - Valve -
40000 40000
Disc - 28000 Disc - 28000
80000 80000
PTFE Patch - PTFE Patch -
Thin - 30000 Thin - 30000
Valve - Valve -
40000 40000
Disc - 28000 Disc - 28000
Aortic Root AVR + Root
1874 CTVS SV SV014 SV014E 165000 206300 234300 247500 Pericardial Pericardial No NA
Replacement Surgery enlargement
Patch - 18000 Patch - 18000
RV - PA RV - PA
Conduit - Conduit -
120000 120000
80000 80000
Valve Ring - Valve Ring -
Mitral - 35000 Mitral - 35000
Arch Graft - Arch Graft -
85000 85000
Aortic Arch
Coselli Graft - Coselli Graft -
Replacement / Aortic Arch
85000 85000
1875 CTVS SV SV015 Thoracoabdominal SV015A Replacement using 165000 206300 234300 247500 No NA
Complex grafts Complex grafts
aneurysm Repair cardiopulmonary bypass
other than Arch other than Arch
using bypass
Graft & Coseli Graft & Coseli
Graft - 85000 Graft - 85000
Arch Graft -
85000
Aortic Arch
Thoracoabdominal Coselli Graft -
Replacement /
aneurysm Repair using 85000
1876 CTVS SV SV015 Thoracoabdominal SV015B 165000 206300 234300 247500 85,000 No NA
partial cardiopulmonary Complex grafts
aneurysm Repair
bypass other than Arch
using bypass
Graft & Coseli
Graft - 85000
Aortic Aneurysm Repair Dacron Graft -

Aortic Aneurysm
1877 CTVS SV SV016 SV016A using Cardiopulmonary 132000 165000 187500 198000 Straight - 30,000 No NA
Repair
bypass (CPB) 30000
Dacron Graft -
Aortic Aneurysm Aortic Aneurysm Repair
1878 CTVS SV SV016 SV016B 132000 165000 187500 198000 Straight - 30,000 No NA
Repair using Left Heart Bypass
30000
Aortic Aneurysm Repair
Dacron Graft -
Aortic Aneurysm without using
1879 CTVS SV SV016 SV016C 72050 90100 102400 108100 Straight - 30,000 No NA
Repair Cardiopulmonary
30000
bypass (CPB)
Aortic Aneurysm Repair Dacron Graft -
Aortic Aneurysm
1880 CTVS SV SV016 SV016D without using Left Heart 72050 90100 102400 108100 Straight - 30,000 No NA
Repair
Bypass 30000
Bifurcated - Bifurcated -
Aorto Iliac / Aorto
35000 35000
1881 CTVS SV SV017 femoral bypass (Uni SV017A Aorto Iliac bypass - U/L 70950 88700 100800 106500 No NA
PTFE Graft - PTFE Graft -
and Bi)
50000 50000
Aorto Iliac / Aorto
Aorto femoral bypass - 35000 35000
1882 CTVS SV SV017 femoral bypass (Uni SV017B 70950 88700 100800 106500 No NA
U/L PTFE Graft - PTFE Graft -
and Bi)
50000 50000
Aorto Iliac / Aorto
35000 35000
1883 CTVS SV SV017 femoral bypass (Uni SV017C Aorto Iliac bypass - B/L 70950 88700 100800 106500 No NA
PTFE Graft - PTFE Graft -
and Bi)
50000 50000
Aorto Iliac / Aorto
Aorto femoral bypass - 35000 35000
1884 CTVS SV SV017 femoral bypass (Uni SV017D 70950 88700 100800 106500 No NA
B/L PTFE Graft - PTFE Graft -
and Bi)
50000 50000
Pulmonary
Embolectomy / Pulmonary
Thromboendarterecto Embolectomy
my
Pulmonary
Pulmanary
Embolectomy /
1886 CTVS SV SV018 SV018B Thromboendarterectom 155100 193900 220300 232700 NA No NA
Thromboendarterecto
y
my
PTFE graft PTFE graft

small (upto 8 small (upto 8
mm ) - 30000 mm ) - 30000
Peripheral Arterial Femoro - Femoral
1887 CTVS SV SV019 SV019A 55000 68800 78100 82500 No NA
Surgeries Bypass PTFE Graft PTFE Graft
Large (<8mm) - Large (<8mm) -
50000 50000

mm ) - 30000 mm ) - 30000
Peripheral Arterial Carotid -
1888 CTVS SV SV019 SV019B 55000 68800 78100 82500 No NA
Surgeries endearterectomy PTFE Graft PTFE Graft
50000 50000

mm ) - 30000 mm ) - 30000
Peripheral Arterial Carotid Body Tumor
1889 CTVS SV SV019 SV019C 55000 68800 78100 82500 No NA
Surgeries Excision PTFE Graft PTFE Graft
50000 50000

mm ) - 30000 mm ) - 30000
Peripheral Arterial Thoracic Outlet
1890 CTVS SV SV019 SV019D 55000 68800 78100 82500 No NA
Surgeries syndrome Repair PTFE Graft PTFE Graft
50000 50000

mm ) - 30000 mm ) - 30000
Peripheral Arterial
1891 CTVS SV SV019 SV019E Carotid aneurysm repair 55000 68800 78100 82500 No NA
Surgeries PTFE Graft PTFE Graft
50000 50000
mm ) - 30000 mm ) - 30000
Peripheral Arterial Subclavian aneurysm
1892 CTVS SV SV019 SV019F 55000 68800 78100 82500 No NA
Surgeries repair PTFE Graft PTFE Graft
50000 50000

mm ) - 30000 mm ) - 30000
Peripheral Arterial
1893 CTVS SV SV019 SV019G Axillary aneurysm repair 55000 68800 78100 82500 No NA
50000 50000

mm ) - 30000 mm ) - 30000
Peripheral Arterial Brachial artery
1894 CTVS SV SV019 SV019H 55000 68800 78100 82500 No NA
Surgeries aneurysm repair PTFE Graft PTFE Graft
50000 50000

mm ) - 30000 mm ) - 30000
Peripheral Arterial Femoral artery
1895 CTVS SV SV019 SV019I 55000 68800 78100 82500 No NA
50000 50000

mm ) - 30000 mm ) - 30000
Peripheral Arterial Popliteal artery
1896 CTVS SV SV019 SV019J 55000 68800 78100 82500 No NA
50000 50000

mm ) - 30000 mm ) - 30000
Peripheral Arterial Femoral - popliteal
1897 CTVS SV SV019 SV019K 55000 68800 78100 82500 No NA
Surgeries Bypass PTFE Graft PTFE Graft
50000 50000
mm ) - 30000 mm ) - 30000
Peripheral Arterial
1898 CTVS SV SV019 SV019L Axillo - Brachial Bypass 55000 68800 78100 82500 No NA
50000 50000

mm ) - 30000 mm ) - 30000
Peripheral Arterial
1899 CTVS SV SV019 SV019M Carotio - carotid Bypass 55000 68800 78100 82500 No NA
50000 50000

mm ) - 30000 mm ) - 30000
Peripheral Arterial Carotido - subclavian
1900 CTVS SV SV019 SV019N 55000 68800 78100 82500 No NA
Surgeries artery bypass PTFE Graft PTFE Graft
50000 50000

mm ) - 30000 mm ) - 30000
Peripheral Arterial Carotido - axillary
1901 CTVS SV SV019 SV019O 55000 68800 78100 82500 No NA
Surgeries bypass PTFE Graft PTFE Graft
50000 50000

mm ) - 30000 mm ) - 30000
Peripheral Arterial Axillo - femoral bypass -
1902 CTVS SV SV019 SV019P 55000 68800 78100 82500 No NA
Surgeries U/L PTFE Graft PTFE Graft
50000 50000

mm ) - 30000 mm ) - 30000
Peripheral Arterial Axillo - femoral bypass -
1903 CTVS SV SV019 SV019Q 55000 68800 78100 82500 No NA
Surgeries B/L PTFE Graft PTFE Graft
50000 50000
mm ) - 30000 mm ) - 30000
Peripheral Arterial
1904 CTVS SV SV019 SV019R Aorto - carotid bypass 55000 68800 78100 82500 No NA
50000 50000

mm ) - 30000 mm ) - 30000
Peripheral Arterial Aorto - subclavian
1905 CTVS SV SV019 SV019S 55000 68800 78100 82500 No NA
Surgeries bypass PTFE Graft PTFE Graft
50000 50000

mm ) - 30000 mm ) - 30000
Peripheral Arterial
1906 CTVS SV SV019 SV019T Patch Graft Angioplasty 55000 68800 78100 82500 No NA
50000 50000

mm ) - 30000 mm ) - 30000
Peripheral Arterial Small Arterial
1907 CTVS SV SV019 SV019U 55000 68800 78100 82500 No NA
Surgeries Aneurysms – Repair PTFE Graft PTFE Graft
50000 50000

mm ) - 30000 mm ) - 30000
Medium size arterial
Peripheral Arterial
1908 CTVS SV SV019 SV019V aneurysms with 55000 68800 78100 82500 No NA
synthetic graft
50000 50000

mm ) - 30000 mm ) - 30000
Peripheral Arterial Surgery for Arterial
1909 CTVS SV SV019 SV019W 55000 68800 78100 82500 No NA
Surgeries Aneursysm –Vertebral PTFE Graft PTFE Graft
50000 50000
mm ) - 30000 mm ) - 30000
Peripheral Arterial Surgery for Arterial
1910 CTVS SV SV019 SV019X 55000 68800 78100 82500 No NA
Surgeries Aneurysm Renal Artery PTFE Graft PTFE Graft
50000 50000

mm ) - 30000 mm ) - 30000
Peripheral Arterial Operations for Acquired
1911 CTVS SV SV019 SV019Y 55000 68800 78100 82500 No NA
Surgeries Arteriovenous Fistual PTFE Graft PTFE Graft
50000 50000
Peripheral Arterial Congenital Arterio

1912 CTVS SV SV019 SV019Z 55000 68800 78100 82500 NA No NA
Surgeries Venous Fistula
Thromboembolectom Peripheral
y Thromboembolectomy
Peripheral arterial
Peripheral arterial injury
1914 CTVS SV SV021 injury repair (without SV021A 33000 41300 46900 49500 NA No NA
repair (without bypass)
bypass)
Thoracotomy,
Thoracotomy, Thoraco
1915 CTVS SV SV022 Thoraco Abdominal SV022A 33000 41300 46900 49500 NA No NA
Abdominal Approach
Approach
Lung surgery
1916 CTVS SV SV023 including SV023A Lung cyst exision 49500 61900 70300 74300 NA No NA
Thoracotomy
Lung surgery
1917 CTVS SV SV023 including SV023B Decortication 49500 61900 70300 74300 NA No NA
Thoracotomy
Lung surgery
1918 CTVS SV SV023 including SV023C Hydatid cyst 49500 61900 70300 74300 NA No NA
Thoracotomy
Lung surgery Other simple lung
1919 CTVS SV SV023 including SV023D procedure excluding 49500 61900 70300 74300 NA No NA
Thoracotomy lung resection
Lung surgery Bronchial Repair
1920 CTVS SV SV023 including SV023E Surgery for Injuries due 49500 61900 70300 74300 NA No NA
Thoracotomy to FB
Non infective -
77000
1921 CTVS SV SV024 Pulmonary Resection SV024A Pulmonary Resection 77000 96300 109400 115500 NA Yes
Infective -
90000
Foreign Body Foreign Body Removal
Removal with scope with scope
1923 CTVS SV SV026 Bronchopleural SV026A 71500 89400 101600 107300 NA No NA
Bronchopleural Fistula
Fistula
Space - Occupying Space - Occupying
1924 CTVS SV SV027 Lesion (SOL) SV027A Lesion (SOL) 72050 90100 102400 108100 NA No NA
mediastinum mediastinum
Isolated Intercostal Isolated Intercostal
Drainage and Drainage and
Management of ICD, Management of ICD,
Intercostal Block, Intercostal Block,
Antibiotics & Antibiotics &
Physiotherapy Physiotherapy
Mesh - 6 X 3 -
1926 CTVS SV SV029 Diaphragmatic Repair SV029A Diaphragmatic Repair 33000 41300 46900 49500 Polypropylene - 2000 No NA
2000
Surgery for Cardiac Surgery for Cardiac
Tumour Tumour
PTFE Patch -
Thin - 30000
Mechanical
Valve - Patch -3000
40000 40000
Immediate Tetralogy of Fallot Disc - 28000 Pericardial
1928 CTVS SV SV031 reoperation (within 5 SV031A Repair (immediate re 82500 103200 117200 123800 Pericardial patch-18000 No NA
days) operation) Patch - 18000 RV-PA conduit-
RV - PA 120000
80000 valve-80000
Valve Ring -
Mitral - 35000
Valve Ring -
Mechanical
Valve -
Bileaflet -
Bileaflet -
40000
Immediate 40000
Aortic valve Tilting Disc -
1929 CTVS SV SV031 reoperation (within 5 SV031B 156860 196100 222800 235300 Mechanical No NA
replacement /repair 28000
days) Valve - Tilting
Tissue Valve -
Disc - 28000
80000
Tissue Valve -
80000
Valve - Valve -
40000 40000
Immediate Mechanical Mechanical
Mitral valve replacement
1930 CTVS SV SV031 reoperation (within 5 SV031C 156860 196100 222800 235300 Valve - Tilting Valve - Tilting No NA
/repair
days) Disc - 28000 Disc - 28000
80000 80000
Valve - Valve -
40000 40000
Immediate
Tricuspid valve Valve - Tilting Valve - Tilting
1931 CTVS SV SV031 reoperation (within 5 SV031D 156860 196100 222800 235300 No NA
replacement /repair Disc - 28000 Disc - 28000
days)
80000 80000
Tricuspid - Tricuspid -
35000 35000
Aortic Valve -
Repair - 78100
Aortic Valve -
Valve - Valve -
Relacement -
78100 Mitral
40000 40000
Valve - Repair -
78100
Immediate Mitral Valve -
Double valve Disc - 28000 Disc - 28000
1932 CTVS SV SV031 reoperation (within 5 SV031E 78100 97700 111000 117200 Yes Replacement -
replacement /repair Tissue Valve - Tissue Valve -
days) 78100
80000 80000
Tricuspid
Valve - Repair -
78100
Tricuspid
Valve -
35000 35000
Replacement -
78100
Aortic Valve -
Repair - 93500
Aortic Valve -
Valve - Valve -
Relacement -
93500Mitral
40000 40000
Valve - Repair -
93500
Immediate Mitral Valve -
Triple valve replacement Disc - 28000 Disc - 28000
1933 CTVS SV SV031 reoperation (within 5 SV031F 93500 116900 132800 140300 Yes Replacement -
/repair Tissue Valve - Tissue Valve -
days) 93500
80000 80000
Tricuspid
Valve - Repair -
93500
Tricuspid
Valve -
35000 35000
Replacement -
93500
Low Cardiac Output Low Cardiac Output

syndrome requiring syndrome requiring IABP Catheter-
1934 CTVS SV SV032 SV032A 55000 68800 78100 82500 50,000 No NA
IABP insertion post - IABP insertion post - 50000
operatively operatively
1935 CTVS SV SV033 Re-do sternotomy SV033A Re-do sternotomy 22000 27500 31300 33000 NA No NA
Excessive bleeding
Excessive bleeding
1936 CTVS SV SV034 requiring re- SV034A 11000 13800 15700 16500 NA No NA
requiring re-exploration
exploration
1937 CTVS SV SV035 Mediastinotomy SV035A Mediastinotomy 31625 39600 45000 47500 NA No NA
50,000 + 62500 +
1938 CTVS SV SV036 Pectus excavation SV036A Pectus excavation 71000+implant 75000+implant NA NA
Implant Implant
Left ventricular Left ventricular
1939 CTVS SV SV037 SV037A 129910 162400 184500 194900 NA NA
aneurysm repair aneurysm repair
CABG + Left
CABG + Left ventricular
1940 CTVS SV SV038 ventricular aneurysm SV038A 179910 224900 255500 269900 NA NA
aneurysm repair
repair
1941 CTVS SV SV039 Tracheal repair SV039A Tracheal repair 50000 62500 71000 75000 NA NA
50,000 + Cost 62500 + Cost 71000 + Cost 75000+Cost of
1942 CTVS SV SV040 Aortic stenting SV040A Aortic stenting Stent -350000 3,50,000 NA
of Stent of Stent of Stent Stent
First Follow-up- 2-4
weeks after discharge -
1943 CTVS SV SV041 follow up -CTVS SV041A Inc. in package Inc. in package Inc. in package Inc. in package NA NA
AT NETWORK
HOSPITAL
Second Follow-up- After
1944 CTVS SV SV041 follow up -CTVS SV041B 4000 4400 5000 5000 NA NA
3 months
Third Follow-up- After 3
1945 CTVS SV SV041 follow up -CTVS SV041C 2000 2200 2500 2500 NA NA
months
fourth Follow-up- After 3
1946 CTVS SV SV041 follow up -CTVS SV041D 2000 2200 2500 2500 NA NA
months
FifthFollow-up - After 3
1947 CTVS SV SV041 follow up -CTVS SV041E 2000 2200 2500 2500 NA NA
months
Unspecified
Unspecified Surgical Unspecified Surgical
1948 Surgical US US001 US001A Upto one lakh na na na NA No NA
Package Package
Package
Unspecified
Unspecified Surgical Unspecified Surgical one to five
1949 Surgical US US001 US001B na na na NA NA
Package Package lakhs
Package
Note : The benefits within this Scheme under the basic risk cover are to be provided on a cashless basis to the AB PM-
JAY Beneficiaries up to the limit of their annual coverage and includes: • Consulation/Teleconsulation
•Hospitalization expense • Day care treatment (as applicable) • Follow-up care • Pre and post hospitalization
expense • New born child / children.
Annexure - 2
High End Drugs
Sl No. Name Price Recommended Dose
Recombinant tissue plasminogen 42000 0.9 mg/kg (not to exceed 90 mg total

1 activator treatment dose) infused over 60 minutes.
0.2 mg/kg given as a bolus dose over 1-
24900 2min volume of TNK to be administered
2 Tenecteplase at a dilution of 2mg/ml
3 Heparin 15000 Based on wieght and age of patient
4 Antibiotic 10000 Based on wieght and age of patient
5 Antifungal 75000 Based on wieght and age of patient
0.117-1.66 mg/kg/day orally divided every
6 Methylprednisolone 25000 6-8 hours
7 IV immunoglobins 250000
5000 units-Rs700 5000 units-Rs700
8 Erythropoeitin 10000 units-Rs1000 10000 units-Rs1000
9 Liposomal amphotericin Minimum 125000 for 2.5 Gm dosage. @ 2500 per 50mg
3000 per GM @ 2 GM/Per Kg body
10 IVIG atleast 1.5 to 2 lakh total
weight. Almost 20 GM in adult dose.
11 IvIg for Kawasaki Disease 2000 per gm 0.4 gm/Kg body wt/day
12 IvIg for GB Syndrome 2000 per gm 2gm /Kg body weight
13 IvIg for ITP 2000 per gm 1gm /Kg body weight
14 Rituximab Rs 7500 per 500mg/50ml box 500mg to 1 gm
15 Human Albumin 20% Rs 6000 per 100ml infusion 250-500ml
16 Albumin 5% Rs 3000 per 100ml infusion 250-500ml
etanercept
17 Rs 10000 for 50gm and Rs5000 for 25mg 0.8mg/kg body wt
adalimumab Rs 15000 for 40mg Injection, 40 mg / 0.8
18 24mg/m2
ml
19 abatacept Rs 23000 for 250 mg 10 mg/kg
20 Imipenem 7000 1gm147.57. 3 gm per day dose
21 Meropenem 7000 1gm 159.93. 3 gm Per day dose
Piperacillin-Tazobactem
22 3000 4.5gm 66.52. 4.5gm TDS per day dose
23 Colistin 7000 1 MU 73.92. Dose 9 MU
24 Vancomycin 2100 500mg 45.15. 2gm per day dose.
25 Amphotericin deoxycholate 1000 50mg 121.06.
High end procedures
SL No. Procedure Package amount in Rs. Implant price Implant Details

USG guided percutaneous
1 26640 75000 RF probe for tumor ablation
Radiofrequency Ablation (RFA)
USG guided percutaneous Microwave
2 30640 95000 Microwave Antenna
Ablation (MWA)
CT guided percutaneous Radiofrequency
3 29040 75000 RF probe for tiomr ablation
Ablation (RFA)
CT guided percutaneous Microwave
4 33040 95000 Microwave Antenna
Ablation (MWA)
USG guided percutaneous catheter
5 5820 1500 Pig tail drainage Catheter
drainage
CT guided percutaneous catheter
6 5820 1500 Pig tail drainage Catheter
drainage
Cerebral angiogram under local
7 5800
anesthesia
Cerebral angiogram under general
8 18900
anesthesia
Spinal Angiogram under general
9 18900
anesthesia
10 Plasmapheresis 70000
High End Diagnostics
SL No. Diagnostics Procedure Rate Instrument/Implant price Details

1 Lymphangiography 10920
2 Diagnostic venography (DVA) 5520
3 IVUS(Intravascular Ultrasound) 16560
4 Diskography 5520
5 USG guided percutaneous biopsy 2520 3000 Biopsy Gun
6 USG guided percutaneous FNAC 720
USG guided percutaneous needle
7 720 3000 Biopsy Gun
aspiration
8 CT guided percutaneous biopsy 3720
9 CT guided percutaneous FNAC 3120
CT guided percutaneous needle
10 3120
aspiration
11 Genetic workup 20000
12 Metabolic work up 30000
13 Vedio EEG Monitoring Test (VEEG) 3600
Type of City X( Tier -1)
Sl. No Name of the city

1 Delhi
2 Hyderabad
3 Ahmadabad
4 Bangalore
5 Mumbai
6 Pune
7 Chennai
8 Kolkata
Type of City Y ( Tier 2)

1 Agra
2 Ajmer
3 Aligarh
4 Amravati
5 Amritsar
6 Asansol
7 Aurangabad
8 Bareilly
9 Belgaum
10 Bhavnagar
11 Bhiwandi
12 Bhopal
13 Bhubaneswar
14 Bikaner
15 Bilaspur
16 Bokaro Steel City
17 Chandigarh
18 Coimbatore
19 Cuttack
20 Dehradun
21 Dhanbad
22 Bhilai
23 Durgapur
24 Erode
25 Faridabad
26 Firozabad
27 Ghaziabad
28 Gorakhpur
29 Gulbarga
30 Guntur
31 Gwalior
32 Gurugram
33 Guwahati
34 Hamirpur
35 Hubli–Dharwad
36 Indore
37 Jabalpur
38 Jaipur
39 Jalandhar
40 Jalgaon
41 Jammu
42 Jamnagar
43 Jamshedpur
44 Jhansi
45 Jodhpur
46 Kannur
47 Kanpur
48 Karnal
49 Kochi
50 Kolhapur
51 Kollam
52 Kozhikode
53 Kurnool
54 Ludhiana
55 Lucknow
56 Madurai
57 Malappuram
58 Mathura
59 Mangalore
60 Meerut
61 Moradabad
62 Mysore
63 Nagpur
64 Nanded
65 Nashik
66 Nellore
67 Noida
68 Patna
69 Puducherry
70 Purulia
71 Prayagraj
72 Raipur
73 Rajkot
74 Ranchi
75 Rourkela
76 Ratlam
77 Salem
78 Sangli
79 Shimla
80 Siliguri
81 Solapur
82 Srinagar
83 Surat
84 Thanjavur
85 Thiruvananthapuram
86 Thrissur
87 Tiruchirappalli
88 Tirunelveli
89 Tiruvannamalai
90 Ujjain
91 Vadodara
92 Varanasi
93 Vasai-Virar City
94 Vijayawada
95 Visakhapatnam
96 Vellore
97 and Warangal

HBP 2022

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Copyright:

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HBP 2022

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19

Criteria 1: % Total Body

Criteria 2: % Total Body

Criteria 3: % Total Body

Criteria 4: % Total Body

Criteria 1: % Total Body

Criteria 2: % Total Body

Criteria 3: % Total Body

Criteria 5: % Total Body

% Total Body Surface

Electrical contact burns:

Electrical contact burns:

Electrical contact burns:

Chemical burns: With

Laboratory Tests for (Reimburseme (Reimburseme (Reimburseme (Reimburseme

Intracranial balloon Intracranial balloon

PVA embolization 5000x2=

Vascular plug Vascular plug assisted Vacsular

TEVAR for aortic TEVAR for aortic

Post EVAR endoleak Post EVAR endoleak

Radiofrequency Radiofrequency ablation-

PRP -suprascapular PRP -suprascapular

Carotid angioplasty &

Carotid stenting with Carotid stenting with

Oesophageal /gastric Oesophageal /gastric /

Pd Catheter Pd Catheter Pd Catheter Pd Catheter

Mental and Mental and Behavioural Routine Ward -

Laser Therapy for Laser Therapy for

Neonates > 2.5 kg

500 per 550 per 625per 625per

12000 per 13200 per 15000 per 15000 per

Medical Etoposide 50 mg/m2

Medical CT for Soft Tissue Doxorubicin 60-75/m2,

Capecitabine along with

ATO 0.15 mg / kg day 1-

CT for Acute ATO 0.15 mg / kg day 1-

13-cis retinoic acid

CT for Pediatric Acute Consolidation

CT for Pediatric Acute

CT for Pediatric Acute

Medical CT for Pediatric

Medical CT for Pediatric

Medical CT for Pediatric Non LMB 89 - 96 - Induction -

Medical CT for Pediatric Non LMB 89 - 96 -

Medical Carboplatin Carboplatin

Pre Procedure workup-

Medical / Palliative Care

Plates, screws Per

Plate for ORIF -

Nail - 2000 per

Fracture - Both Bones -

Bone grafting for Non Bone grafting for

Orthopedics, Bone Tumour (Plate) - 10000, Plate -10000

Surgical Segmentectomy - Segmentectomy -

Surgical Class I radical

Surgical Axillary Sampling / Axillary Sampling /

Excision of Pinna for

Excision of Pinna for

Lid Tumor excision + Lid Tumor excision + Lid

Pediatric lens aspiration Foldable

Glue for Scleral

Secondary IOL / IOL Secondary IOL / IOL

General Abdominal Procedure Lap