Packages Swasthyasathi 3-1-2017

Assurance
Mode Packages
Total Package
Amount to be
Package Swasthya Sathi Procedure / Rate in Grade A Device and Claimed by
Sl No. Group MLOS Remarks
Category Code Package Code Package Hospitals implant cost Hospital
including
implant
Permanent As Advised by
CE/FDA/DCGI
1 1 Cardiology SS00100023 pacing Double 30,000 1,00,000 1,30,000 Attending
approved
chamber (DDDR) Doctor
Permanent
As Advised by
pacing Double CE/FDA/DCGI
2 1 Cardiology SS00100024 30,000 1,65,000 1,95,000 Attending
chamber (DDDR) approved
Doctor
MRI Compatible
As Advised by
Single chamber CE/FDA/DCGI
ICD implantation approved
Doctor
Single chamber As Advised by

CE/FDA/DCGI
4 1 Cardiology SS00100026 ICD implantation 30,000 3,00,000 3,30,000 Attending
approved
MRI Compatible Doctor
As Advised by
Double chamber CE/FDA/DCGI
ICD implantation approved
Doctor
Double chamber As Advised by

CE/FDA/DCGI
6 1 Cardiology SS00100028 ICD implantation 40,000 4,00,000 4,40,000 Attending
approved
5
As Advised by
CRT-P CE/FDA/DCGI
Implantation approved
Doctor
CRT-P As Advised by
CE/FDA/DCGI
8 1 Cardiology SS00100030 Implantation 60,000 3,50,000 4,10,000 Attending
approved
As Advised by
CRT-D CE/FDA/DCGI
Implantation approved
Doctor
CRT-D As Advised by
CE/FDA/DCGI
10 1 Cardiology SS00100032 Implantation 65,000 6,00,000 6,65,000 Attending
approved
As Advised by
PDA - Device CE/FDA/DCGI
11 1 Cardiology SS00100035 45,000 75,000 1,20,000 Attending
closure approved
Doctor
As Advised by
ASD - Device CE/FDA/DCGI
closure approved
Doctor
As Advised by
VSD - Device CE/FDA/DCGI
closure approved
Doctor
As Advised by
RSOV - Device CE/FDA/DCGI
closure approved
Doctor
Prosthetic valve As Advised by

CE/FDA/DCGI
15 1 Cardiology SS00100039 leaks - Device 55,000 75,000 1,30,000 Attending
approved
closure Doctor
As Advised by
Vascular device CE/FDA/DCGI
closure approved
Doctor
6
Atrial As Advised by
CE/FDA/DCGI
17 1 Cardiology SS00100041 appendage 55,000 1,50,000 2,05,000 Attending
approved
closure Doctor
2a.LA Myxoma
2b. SingleValve
As Advised by
CTVS or Surgery open Rate as per
18 2 SS00200002 Attending
Cardiothoracic Heart+Cost of Preauthorisation
Doctor
valve Package+
High cost
medicine
3.a Valve
As Advised by Includes
CTVS or prosthetic 47,0
19 2 SS00200003 130,000 1,77,000 Attending standard
Cardiothoracic valve(Normal 00
Doctor investigations
metallic)
3.b Valve for
CTVS or small aortic 60,0
Cardiothoracic root/special 00
prosthetic
3.c Tissue Valves

CTVS or Normal(OH+tiss 60,0
Cardiothoracic ue Valve+SP 00
med)
3.d Tissue
Valves Higher As Advised by Includes
CTVS or 90,0
22 2 SS00200006 generation 180,000 2,70,000 Attending standard
Cardiothoracic 00
(OH+Valve+SP Doctor investigations
med)
7
3.e Double
Valve As Advised by Rate as per
CTVS or
23 2 SS00200007 Prosthetic 180,000 Attending Preauthorisation
Cardiothoracic
(commonly Doctor for Prosthetic
used)
CTVS or 3.f Single valve + 40,0
Cardiothoracic ring 00
As Advised by Rate as per

CTVS or 3.g Double Valve
25 2 SS00200009 200,000 Attending Preauthorisation
Cardiothoracic + ring
Doctor for ring
3.h Root
CTVS or Replacement(inc
26 2 SS00200010 200,000 Attending standard
Cardiothoracic luding valve
conduit)
CTVS or 4.b CABG on
Cardiothoracic pump
CTVS or 4.c CABG- off
Cardiothoracic pump + 1ABP
CTVS or
29 2 SS00200014 4.d CABG + ring 180,000 Attending standard
Cardiothoracic
8
Sending Arterial
Swicth after As Advised by Includes
CTVS or
30 2 SS00200025 (A.S.O.) 120,000 Attending standard
Cardiothoracic

Arch As Advised by Includes

CTVS or
31 2 SS00200037 aneurysm(graft 150,000 Attending standard
Cardiothoracic
& on pump) Doctor investigations
Some highly
selective cases
Non package-
CTVS or Unifocalisation
Cardiothoracic for pulmonary
abesia (includin
g pre operative
procedures)
Gastroenterolog As Advised by Includes

Colon pull up for
33 7 y Medical and SS00700019 160,000 Attending standard
corrosive
surgical Doctor investigations
stricture
Surgery for ca
esophagus

D2 gastrectomy
9
RYHJ for biliary
stricture

Extended
cholecystectomy
Hepatectomy
Right/Left
Whipple's
Frey's
Distal
pancreatectomy
Low anterior
resection-open

43 7 y Medical and SS00700029 Ileal pouch 180,000 Attending standard
10
Subtotal
colectomy

Splenorenal
shunt

Total
gastrectomy

Hemicolectomy
Right/Left

Abdominoperine
al resection
Includes
As Advised by standard
Aplastic anaemia
49 8 Haematology SS00800008 700,000 Attending investigations.
Treatment 2
Doctor ATG with
Cyclosporin
Includes
standard
As Advised by
investigations.
50 8 Haematology SS00800011 AML - Tretment 150,000 Attending
1,50,000 per
Doctor
cycle - Total of 4
cycles
11
Includes
standard
As Advised by
investigations.
51 8 Haematology SS00800013 ALL - Treatment 100,000 Attending
1,00,000 per
Doctor
cycle - Total of4
cycles
Includes
standard
As Advised by
investigations.
52 8 Haematology SS00800017 APML 100,000 Attending
1,00,000 per
Doctor
cycle - Total of4
cycles
Includes
53 8 Haematology SS00800018 CLL 70,000 Attending investigations.
Doctor 70000 per cycle -
Total of 6 cycles
Includes
As Advised by
standard
54 8 Haematology SS00800019 CML - Imatinib 7,000 Attending
investigations.
Doctor
7,000 per month
Includes
55 8 Haematology SS00800020 CML - Desatinib 20,000 Attending investigations.
Doctor 20,000 per
month
12
Includes
56 8 Haematology SS00800021 CML - Nilotinib 20,000 Attending investigations.
Doctor 20,000 per
month
Includes
57 8 Haematology SS00800023 MF - Ruxolitinib 22,000 Attending investigations.
Doctor 22,000 per
month
Includes
MDS -
Treatment
Doctor 65,000 per cycle
for life long
Includes
AML - Elderly
Treatment
Doctor 65,000 per cycle
for life long
Includes
AML-
Chemotherapy
Doctor 2,00,000 per
cycle for 4 cycles
Includes
ITP - IVIG
Treatment
Doctor 2,50,000 for 1
cycle
13
Includes
ITP - Rituximab
Treatment
Doctor 45,000 per week
for 4 cycles
Includes
standard
ITP- As Advised by
investigations.
63 8 Haematology SS00800034 Eltrombopag Tre 45,000 Attending
45,000 per
atment Doctor
month for 3
cycles
Includes
ITP - Anti D
Treatment
Doctor 1,00,000 for 1
cycle
Includes
Hemophilia B - As Advised by standard
65 8 Haematology SS00800038 On Demand 180,000 Attending investigations.
Treatment Doctor 1,80,000 per
bleed
Includes
Hemophilia A - As Advised by standard
66 8 Haematology SS00800039 On Demand 140,000 Attending investigations.
Treatment Doctor 1,40,000 per
bleed
Includes
Hemophilia A - As Advised by standard
67 8 Haematology SS00800040 Treatment for 1,000,000 Attending investigations.
1year Doctor 10,00,000 per
year
14
Includes
Hemophilia B - As Advised by standard
68 8 Haematology SS00800041 Treatment 1,200,000 Attending investigations.
for 1year Doctor 12,00,000 per
year
Includes
Hemophilia - As Advised by standard
69 8 Haematology SS00800042 Inhibitor 400,000 Attending investigations. 4
Treatment Doctor ,00,000 per
bleed
Includes
AIHA - As Advised by standard
70 8 Haematology SS00800046 Treatment - 45,000 Attending investigations.
Rituximab Doctor 45,000 per cycle
for 4 cycle
Includes
Anaemia-ACD-
Darbopoietin
Doctor 45,000 per
month
Includes
Anaemia -ACD-
EPO
Doctor 35,000 per
month
Includes
Aplastic anaemia
BMT
Doctor 8,00,000 one
time
15
Includes
Thalassaemia
BMT
Doctor 8,00,000 one
time
Includes
75 8 Haematology SS00800054 Leukemia-BMT 600,000 Attending investigations.
Doctor 6,00,000 one
time
Includes
Auto SCT-
Myeloma
Doctor 4,00,000 one
time
Includes
Auto SCT-
Lymphoma
Doctor 4,00,000 one
time
Includes
Auto SCT-
Leukemia
Doctor 4,50,000 one
time
Rate as per
Spine - Depends upon As Advised by
Preauthorisation
79 11 Neuro-Surgery SS01100009 Decompression 20000+Implants( the types of Attending
for implants to
& Fusion implantation) Doctor
be added
16
Rate as per
Preauthorisation
As Advised by
20000 (Medium pressure Programmable for
80 11 Neuro-Surgery SS01100012 Shunt Attending
enabra shunt) shunt extra cat. Programmable
Doctor
shunt to be
added
Rate as per
As Advised by
Microdiscectom Preauthorisation
81 11 Neuro-Surgery SS01100018 20000+cost of implant, Attending
y - Cervical for implants to
Doctor
be added
Rate as per
As Advised by
Laminectomy Preauthorisation
82 11 Neuro-Surgery SS01100023 20000+cost of implant Attending
with Fusion for implants to
Doctor
be added
As Advised by Pre-
Programmable Depends on type
83 11 Neuro-Surgery SS01100051 Attending Authorization
shunts of shunt,
Doctor Required
Immunoglobulin
84 12 Neuro-Medicine SS01200004 200,000 Attending standard
Therapy - IV
Arthroscopic
reconstruction /
85 13 Orthopaedics SS01300074 55,000 Attending standard
repair - knee / -
shoulder
Arthroscopic sur
gery hip /
ankle / elbow /
wrist
17
Open reduction
& internal
fixation -
acetabulum
Open reduction As Advised by Includes

88 13 Orthopaedics SS01300077 & internal 65,000 Attending standard
fixation - pelvis Doctor investigations
Costotransverse
ctomy
Antero-lateral As Advised by Includes

90 13 Orthopaedics SS01300079 decompression 75,000 Attending standard
of spine & fusion Doctor investigations
Spinal stabilizati As Advised by Includes

91 13 Orthopaedics SS01300080 on by posterior 70,000 Attending standard
instrumentation Doctor investigations
Spinal stabilizati
on by
instrumentation
& fusion
Discectomy
(spine)
Cervical rib
excision
18
Anterior cervic As Advised by Includes
95 13 Orthopaedics SS01300084 al fusion & 65,000 Attending standard
stabilisation Doctor investigations
Posterior As Advised by Includes

96 13 Orthopaedics SS01300085 cervical 50,000 Attending standard
97 13 Orthopaedics SS01300086 Scoliosis surgery 75,000 Attending standard
Vertebroplasty /
Kyphoplasty
PAEDIATRIC Multi System
NEONATE CARE Organ Failure
IMAGE GUIDED
Radiotherapy As Advised by Includes
RADIO
100 16 and chemo SS01600008 100,000 Attending standard
therapy Doctor investigations
THERAPY (IGRT)
Radiotherapy IGRT WITH 4D As Advised by Includes

101 16 and chemo SS01600011 CT BASED 120,000 Attending standard
therapy PLANNING Doctor investigations
19
Swasthaya Sathi Packages for Grade A hospitals
Implants cost whereever mentioned to be added to arrive at the total package cost. If package cost is not menntioned the cost will be reimbursed as per the approval through Pre-
authorisation. Cost of orthopaedic impalnts to be added as required for the treatment as per the list attached. No additional investigation cost will be allowed. In case implant is not
provided or any diagnostic test not done by the hospital and patient was asked to do it from outside the amount of such test as per approved diagnostic test rate to be refunded else
payment will not be reimbursed
Total Package Amount
Package
Swasthya Sathi Rate in Grade A Device and implant to be Claimed by
Sl No. Category Group Procedure / Package MLOS Remarks
Package Code Hospitals cost Hospital including
Code
implant
Acute Coronary
Syndrome - Hospital stay 6 days /
Includes standard
1 1 Cardiology SS00100001 Uncomplicated - 25,000 As Advised by Attending
investigations
Medical treatment Doctor
(Hospital stay < 6 days)
Acute Coronary
Syndrome - Complicated
by Shock/Complete AV 7-14 days/As Advised by Includes standard
2 1 Cardiology SS00100002 35,000
Blocks or Hospital stay 7- Attending Doctor investigations
14 days - Medical
treatment
Acute Coronary
Syndrome - Drug eluting stents
As Advised by Attending
3 1 Cardiology SS00100003 Uncomplicated 60,000 30,000 stent 90000 (CE/FDA/DCGI
Doctor
Treated by Coronary approved)
Angioplasty
20
Acute Coronary
Syndrome - Complicated
by Shock or Complex
Drug eluting stents
Arrhythmias or Hospital 7-14 days/As Advised by
4 1 Cardiology SS00100004 75,000 30,000 stent 105000 (CE/FDA/DCGI
stay 7-14 days Treated Attending Doctor
approved)
by Coronary
Angioplasty/temporary
pacing/IABP
Heart failure Medical As Advised by Attending Includes standard

5 1 Cardiology SS00100005 20,000
treatment Doctor investigations
Infective endocarditis As Advised by Attending Includes standard

6 1 Cardiology SS00100006 35,000
Medical treatment Doctor investigations
Deep vein thrombosis As Advised by Attending Includes standard

7 1 Cardiology SS00100007 20,000
Pulmonary embolism As Advised by Attending Includes standard

8 1 Cardiology SS00100008 35,000
Drug eluting stents

Pulmonary embolism As Advised by Attending
9 1 Cardiology SS00100009 55,000 IVC Filter: 25,000 80000 (CE/FDA/DCGI
Intervention treatment Doctor
approved)
Simple arrhythmias As Advised by Attending Includes standard

10 1 Cardiology SS00100010 20,000
21
Complex arrhythmias As Advised by Attending Includes standard
11 1 Cardiology SS00100011 65,000
Ablation procedures Doctor investigations
Pericardial effusion As Advised by Attending Includes standard

12 1 Cardiology SS00100012 20,000
Medical management Doctor investigations
As Advised by Attending Includes fluid analysis

13 1 Cardiology SS00100013 Pericardiocentesis 15,000
Doctor and culture-sensitivity
Coronary angioplasty Drug eluting stents

14 1 Cardiology SS00100014 Stable Ischemic Heart 40,000 30,000 stent 70000 (CE/FDA/DCGI
Doctor
Disease approved)
As Advised by Attending Includes standard

15 1 Cardiology SS00100015 Coronary angiography 10,000
16 1 Cardiology SS00100016 Renal angiography 8,000
17 1 Cardiology SS00100017 Peripheral angiography 10,000 Including DSA
Doctor
4-vessel Cerebral As Advised by Attending
18 1 Cardiology SS00100018 12,000 Including DSA
angiography Doctor
19 1 Cardiology SS00100019 Temporary pacing 9,000 2,500 11,500
Permanent pacing Single As Advised by Attending

20 1 Cardiology SS00100020 25,000 40,000 65,000 CE/FDA/DCGI approved
chamber (VVI/AAI) Doctor
Permanent pacing Single

21 1 Cardiology SS00100021 chamber (VVIR/AAIR) 25,000 50,000 75,000 CE/FDA/DCGI approved
Doctor
MRI Compatible
22
Permanent pacing As Advised by Attending
22 1 Cardiology SS00100022 30,000 95,000 1,25,000 CE/FDA/DCGI approved
Double chamber (DDD) Doctor
Mitral balloon As Advised by Attending Includes standard

23 1 Cardiology SS00100033 40,000
valvuloplasty Doctor investigations
Pulmonary balloon As Advised by Attending Includes standard

24 1 Cardiology SS00100034 30,000
valvuloplasty Doctor investigations
25 1 Cardiology SS00100035 PDA - Device closure 45,000 75,000 1,20,000 CE/FDA/DCGI approved
Doctor
26 1 Cardiology SS00100036 ASD - Device closure 55,000 75,000 1,30,000 CE/FDA/DCGI approved
Doctor
27 1 Cardiology SS00100037 VSD - Device closure 55,000 75,000 1,30,000 CE/FDA/DCGI approved
Doctor
28 1 Cardiology SS00100038 RSOV - Device closure 55,000 75,000 1,30,000 CE/FDA/DCGI approved
Doctor
Prosthetic valve leaks - As Advised by Attending

29 1 Cardiology SS00100039 55,000 75,000 1,30,000 CE/FDA/DCGI approved
Device closure Doctor
30 1 Cardiology SS00100040 Vascular device closure 45,000 75,000 1,20,000 CE/FDA/DCGI approved
Doctor
Coarctation of aorta - 65,000 stent and As Advised by Attending

31 1 Cardiology SS00100042 55,000 120000 CE/FDA/DCGI approved
intervention treatment balloons Doctor
Transcutaneous MAPCA As Advised by Attending

32 1 Cardiology SS00100043 45,000 3,000 per coil 48000 CE/FDA/DCGI approved
closure Doctor
Coil closure of bleeding As Advised by Attending
33 1 Cardiology SS00100044 35,000 3,000 per coil 38000 CE/FDA/DCGI approved
vessels Doctor
Embolisation of vessels 3,000 per coil or any As Advised by Attending
for closure glue/chemical Doctor
23
Carotid artery 35,000 for stent and As Advised by Attending
angioplasty 35,000 for filter Doctor
36 1 Cardiology SS00100047 Renal artery angioplasty 35,000 35,000 stent. 70000 CE/FDA/DCGI approved
Doctor
35,000 for DES, With Baloon-105000

37 1 Cardiology SS00100048 Peripheral angioplasty 40,000 20,000 BMS &/or CE/FDA/DCGI approved
Doctor
10,000 balloon. Without Baloon-95000
35,000 for DES, As Advised by Attending

38 1 Cardiology SS00100049 Below-knee intervention 45,000 100000 CE/FDA/DCGI approved
20,000 DEB. Doctor
35,000 stent and As Advised by Attending
39 1 Cardiology SS00100050 Cavoplasty with stents 35,000 80000 CE/FDA/DCGI approved
10,000 balloon. Doctor
40 1 Cardiology SS00100051 Cardiac catheterisation 8,000
41 1 Cardiology SS00100052 Atrial septostomy 25,000
42 1 Cardiology SS00100053 Endomyocardial biopsy 25,000
43 1 Cardiology SS00100075 FFR 25,000
44 1 Cardiology SS00100076 IV/US 25,000
45 1 Cardiology SS00100077 OCT 35,000
46 1 Cardiology SS00100078 DSA 10,000
47 1 Cardiology SS00100079 ECHO/HOLTER 1,200
48 1 Cardiology SS00100080 TEE 1,800
49 1 Cardiology SS00100081 Stress Echo 1,800
24
50 1 Cardiology SS00100082 CT coronary angio 8,000
CTVS or
51 2 Cardiothoraci SS00200001 A.S.D. , V.S.D. 50,000
c
CTVS or
52 2 Cardiothoraci SS00200011 CABG- off pump 80,000
c
CTVS or Package for
53 2 Cardiothoraci SS00200015 TOF (including 4 90,000
c albumin)
CTVS or
54 2 Cardiothoraci SS00200016 TAPVC 60,000
c
CTVS or
55 2 Cardiothoraci SS00200017 BDG 60,000
c
CTVS or
B.T. shunt (including As Advised by Attending Includes standard
56 2 Cardiothoraci SS00200018 80,000
10cm. PTFE graft Doctor investigations
c
CTVS or
57 2 Cardiothoraci SS00200019 TC, PC including graft 80,000
c
CTVS or
58 2 Cardiothoraci SS00200020 Coarctation 50,000
c
CTVS or
59 2 Cardiothoraci SS00200021 Pericardiectomy 50,000
c
CTVS or
60 2 Cardiothoraci SS00200022 PA banding 50,000
c
CTVS or
61 2 Cardiothoraci SS00200023 CMV 50,000
c
CTVS or
62 2 Cardiothoraci SS00200024 P.D.A. 50,000
c
CTVS or Exploratory
63 2 Cardiothoraci SS00200026 thoracatomy (including 30,000
c foreign body removal)
25
CTVS or
64 2 Cardiothoraci SS00200027 Decortication 40,000
c
CTVS or
65 2 Cardiothoraci SS00200028 Lobectomy 40,000
c
CTVS or
66 2 Cardiothoraci SS00200029 Pneumonectomy 40,000
c
CTVS or
67 2 Cardiothoraci SS00200030 Bronchotomy 40,000
c
CTVS or
Intercostal drain- As Advised by Attending Includes standard
package Doctor investigations
c
CTVS or
Mediastrial mass As Advised by Attending Includes standard
removal Doctor investigations
c
CTVS or
Thymectomy (excludin As Advised by Attending Includes standard
g plasmapheresis) Doctor investigations
c
CTVS or
Thymectomy (including As Advised by Attending Includes standard
plasmapheresis) Doctor investigations
c
CTVS or a. Abdominal aorta

72 2 Cardiothoraci SS00200035 aneurysm (infrarenal) 80,000
c (including graft)
CTVS or
b. Aortotemoral As Advised by Attending Includes standard
bypass grafting Doctor investigations
c
CTVS or
74 2 Cardiothoraci SS00200038 a) Embolictomy 20,000
c
CTVS or
75 2 Cardiothoraci SS00200039 b) A.V.F. Creation 20,000
c
CTVS or
c) A.V.F. As Advised by Attending Includes standard
(pseudoameurysm) Doctor investigations
c
26
a) Non invasive-Blood,
CTVS or
chest xray , ECG ,
77 2 Cardiothoraci SS00200042 10,000 Daycare
Echo
c

CTVS or
b) Non invasiveangio
78 2 Cardiothoraci SS00200043 10,000 Daycare
C.T.
c
CTVS or
79 2 Cardiothoraci SS00200044 c) MRI 10,000 Daycare
c
CTVS or
Includes standard
80 2 Cardiothoraci SS00200045 d)Invasive Cardiaccath 10,000 Daycare
investigations
c
CTVS or
e) Varicose vein- As Advised by Attending Includes standard
ligation+stripping Doctor investigations
c
Includes standard
82 3 Dental SS00300001 Fistulectomy 5,600 Daycare
investigations
Fixation of fracture of Includes standard
83 3 Dental SS00300002 8,000 Daycare
jaw investigations
Includes standard
84 3 Dental SS00300003 Sequestrectomy 11,000 Daycare
investigations
Includes standard
85 3 Dental SS00300004 Apisectomy including LA 1,500 Daycare
investigations
Complicated Ext. per Includes standard

Tooth including LA investigations
Includes standard
87 3 Dental SS00300006 Cyst under LA (Large) 2,000 Daycare
investigations
Includes standard
88 3 Dental SS00300007 Cyst under LA (Small) 1,500 Daycare
investigations
Extraction of tooth Includes standard
89 3 Dental SS00300008 400 Daycare
including LA investigations
Flap operation per Includes standard
Tooth investigations
27
Fracture wiring including Includes standard
LA investigations
Includes standard
92 3 Dental SS00300011 Gingivectomy per Tooth 1,000 Daycare
investigations
Impacted Molar Includes standard
including LA investigations
Drainage of parotid Includes standard
94 3 Dental SS00300013 8,000 2 Days
abscess investigations
Includes standard
95 3 Dental SS00300014 Excision of mandible 15,000 2 Days
investigations
Includes standard
96 3 Dental SS00300015 Repair of parotid duct 20,000 2 Days
investigations
Includes standard
97 3 Dental SS00300016 Abscess incision 600 Daycare
investigations
Includes standard
98 3 Dental SS00300017 Alveolectomy per tooth 1,000 Daycare
investigations
Apical Curettage per Includes standard
tooth investigations
Includes standard
100 3 Dental SS00300019 condylectomy 5,000 2 Days
investigations
Includes standard
101 3 Dental SS00300020 Fistula closure 400 Daycare
investigations
Includes standard
102 3 Dental SS00300021 ginivectomy full mouth 3,000 3 Days
investigations
Fracture Jaws closed Includes standard
reduction investigations
Includes standard
104 3 Dental SS00300023 Frenectomy 300 Daycare
investigations
1 Day/As advise by Includes standard
105 3 Dental SS00300024 growth removal 1,000
surgeon investigations
Includes standard
106 3 Dental SS00300025 Osteotomy 2,000 2 Days
investigations
28
Includes standard
107 3 Dental SS00300026 Pericoronotomy 600 Daycare
investigations
Includes standard
108 3 Dental SS00300027 pulpotomy 800 Daycare
investigations
109 3 Dental SS00300028 Removal of Impaction 2,000
Segmental resection of Includes standard
110 3 Dental SS00300029 6,000 3 Days
jaw investigations
treatment of
Includes standard
111 3 Dental SS00300030 malocclusion through 15,000 Daycare
investigations
wiring
treatment Nursing
Includes standard
112 3 Dental SS00300031 bottle caries (Full 5,000 Daycare
investigations
mouth)
Includes standard
113 3 Dental SS00300032 Complete denture 4,000 Daycare
investigations
Removable partial Includes standard
denture investigations
Restoration of teeth per Includes standard
tooth investigations
treatment of gums
Includes standard
116 3 Dental SS00300035 through scaling (three 1,200 Daycare
investigations
sittings )
Root canal treatment Includes standard

per tooth investigations
Includes standard
118 3 Dental SS00300037 Metal crown per cap 1,200 Daycare
investigations
Includes standard
119 3 Dental SS00300038 Ceramic crown per cap 1,500 Daycare
investigations
Reduction And
2 Days/As advise by Includes standard
120 3 Dental SS00300039 3,000
29
Immobilisation Of 2 Days/As advise by Includes standard
120 3 Dental SS00300039 3,000
Fracture- surgeon investigations
Maxilla Under LA
Reduction And
Immobilisation Of
121 3 Dental SS00300040 Fracture- 4,000
Mandible Under LA\
Splints/ Circum
Mandibular Wiring 1 Day/As advise by Includes standard
122 3 Dental SS00300041 4,000
Under surgeon investigations
GA
Internal Wire Fixation/
Plate
123 3 Dental SS00300042 Fixation Of Maxilla 7,000
Under
LA
Plate
124 3 Dental SS00300043 Fixation Of Maxilla 8,000
Under
GA
Plate
125 3 Dental SS00300044 Fixation Of Mandible 8,000
Under
LA/GA
Cyst Tumour Of
Maxilla/
126 3 Dental SS00300045 Mandible By 5,000
Enucleation/
Excision (Package)
30
Tm Joint Ankylosis-
127 3 Dental SS00300046 Under 15,000
GA (Package)
Hemi-Mandibulectomy
128 3 Dental SS00300047 15,000
With Graft (Package)
Hemi-Mandibulectomy
129 3 Dental SS00300048 12,000
Without Graft (Package)
Segmentalmandibulecto
my 3 Days/As advise by Includes standard
130 3 Dental SS00300049 10,000
With Graft surgeon investigations
(Package)
Segmentalmandibulecto
my 3 Days/As advise by Includes standard
131 3 Dental SS00300050 8,000
Without surgeon investigations
Graft (Package)
Maxillectomy- Partial
132 3 Dental SS00300051 With 8,000
Graft (Package)
Maxillectomy- Partial
133 3 Dental SS00300052 7,000
Without Graft (Package)

134 3 Dental SS00300053 Maxillo-Facial Prosthesis 8,000
Alvelolectomy,
135 3 Dental SS00300054 Frenectomy Per 2,000
Quadrant
Amalgam Filling/Tooth Includes standard

investigations
31
Includes standard
investigations
(Compound)
Amalgam Filling/Tooth Includes standard

investigations
(Regular)
Includes standard
138 3 Dental SS00300057 Arch Bar Removal 500 Daycare
investigations
Includes standard
139 3 Dental SS00300058 Bite Plate/ Retainers 1,500 Daycare
investigations
Includes standard
140 3 Dental SS00300059 Cast Rpd (Per Tooth) 1,000 Daycare
investigations
Includes standard
141 3 Dental SS00300060 De Sensitising Per Sitting 600 Daycare
investigations
Dento Alveolar Fracture

Includes standard
Reduction And investigations
Splinting/L.A.
Denture Repair Includes standard
(Category1) investigations
Dialation Of Whartons Includes standard

investigations
Duct Under L.A.
Direct/ Indirect Pulp Includes standard

investigations
Capping
Fibre Post Based Post
Includes standard
146 3 Dental SS00300065 And 2,000 Daycare
investigations
Core
Floride Application (Per Includes standard

investigations
Sitting)
Extraction Of Misp
Tooth Includes standard
investigations
32
Includes standard
By Operation (Open investigations
Meth)
Gtr (Guided Tissue Includes standard
Regeneration) investigations
Includes standard
150 3 Dental SS00300069 Glass Ionomer Filling 600 Daycare
investigations
Intra Articular Inj. Of Includes standard

investigations
Steroids In Tmj
Post Core/ Tooth (Cast

Includes standard
Post) Lab Metal Chgs. investigations
Extra
Preformed Carbonate Includes standard

investigations
Jacket Crown
Includes standard
154 3 Dental SS00300073 Preformed Steel Crown 1,500 Daycare
investigations
Reduction Of Dislocation 1 Day/As advise by Includes standard

155 3 Dental SS00300074 2,000
Of Tmj (Under LA.)
Reimplantation (Per 1 Day/As advise by Includes standard

156 3 Dental SS00300075 3,600
Tooth)
Repair Of Facial Soft 1 Day/As advise by Includes standard

157 3 Dental SS00300076 1,150
Tissue Laceration
Repair Of Facial Soft

158 3 Dental SS00300077 700
Tissue Laceration surgeon investigations
(Minor)
33
Includes standard
159 3 Dental SS00300078 Scaling Per Sitting 600 Daycare
investigations
Sialolithotomy For Small Includes standard

investigations
Stones
Surgical Removal Of
Benin Includes standard
Neoplasm Of Oral investigations
(Package)
Surgical Removal Of Soft

Includes standard
investigations
Tissue Lesion (Package)
Disto-Impacted Teeth
163 3 Dental SS00300082 (Two) 22,000
Under Ga
Aural polypectomy As Advised by Attending Includes standard

164 4 Ear SS00400001 11,900
+Tympanoplasty Doctor investigations
Tympanoplasty+ As Advised by Attending Includes standard

165 4 Ear SS00400002 11,500
Ossiculoplasty Doctor investigations
Aural polypectomy +
166 4 Ear SS00400003 Mastoidectomy with 12,500
tympanoplasty
Removal of foreign body As Advised by Attending Includes standard

167 4 Ear SS00400004 1,200
from ear Doctor investigations

168 4 Ear SS00400005 Tympanotomy 5,000
34
Total amputation of As Advised by Attending Includes standard
169 4 Ear SS00400006 5,100
Pinna(Growth/injuries) Doctor investigations
Total Amputation &

Excision of Pinna and As Advised by Attending Includes standard
170 4 Ear SS00400007 8,500
External Auditory Doctor investigations
Meatus

171 4 Ear SS00400008 Skull base surgery 29,000
Pharyngectomy and As Advised by Attending Includes standard

172 4 Ear SS00400009 12,000
reconstruction Doctor investigations
Excision of Pinna for

Growth As Advised by Attending Includes standard
173 4 Ear SS00400010 2,000
(Squamous/Basal/ Doctor investigations
Injuries) Skin Only
Excision of Pinna for
Growth
174 4 Ear SS00400011 (Squamous/Basal/ 3,000
Injuries) Skin and
Cartilage
175 4 Ear SS00400012 Ear lobe repair - single 1,000
Vidian neurectomy - As Advised by Attending Includes standard

176 4 Ear SS00400013 7,000
Microscopic Doctor investigations

177 4 Ear SS00400014 Tympanoplasty 11,000
178 4 Ear SS00400015 Stapedectomy 8,000
35
Partial amputation - As Advised by Attending Includes standard
179 4 Ear SS00400016 4,050
Pinna Doctor investigations

180 4 Ear SS00400017 Ossiculoplasty 9,000
Myrinogotomy with As Advised by Attending Includes standard

181 4 Ear SS00400018 6,500
Grommet - Both ear Doctor investigations
Myringotomy with As Advised by Attending Includes standard

182 4 Ear SS00400019 5,000
Grommet - One ear Doctor investigations
Myringotomy - As Advised by Attending Includes standard

183 4 Ear SS00400020 2,500
Unilateral Doctor investigations
184 4 Ear SS00400021 Myringotomy - Bilateral 4,500
185 4 Ear SS00400022 Myringoplasty 7,000
Mastoidectomy with As Advised by Attending Includes standard

186 4 Ear SS00400023 14,000
tympanoplasty Doctor investigations

187 4 Ear SS00400024 Mastoidectomy 13,000
188 4 Ear SS00400025 Labyrinthectomy 9,000
189 4 Ear SS00400026 Fenestration 7,000
Endolymphatic sac As Advised by Attending Includes standard
190 4 Ear SS00400027 11,500
decompression Doctor investigations
191 4 Ear SS00400028 Aural polypectomy 5,000
36
Ant. Ethmoidal artery
192 4 Nose SS00400029 ligation+Functional 14,500
Endoscopic Sinus (FESS)
Antrostomy Bilateral+ As Advised by Attending Includes standard

193 4 Nose SS00400030 9,000
Septoplasty Doctor investigations
Functional Endoscopic
194 4 Nose SS00400031 Sinus (FESS) + Nasal 10,250
polypectomy - Unilateral

195 4 Nose SS00400032 ligation+Nasal 13,750
polypectomy - Bilateral

196 4 Nose SS00400033 ligation+ Intra nasal 14,500
ethmoidectomy
Adeno tonsillectomy + As Advised by Attending Includes standard

197 4 Nose SS00400034 11,000
Aural polypectomy Doctor investigations
Removal of FB from As Advised by Attending Includes standard

198 4 Nose SS00400035 1,500
nose Doctor investigations
199 4 Nose SS00400036 Septo-rhinoplasty 15,000
Rhinosporidiosis As Advised by Attending Includes standard
200 4 Nose SS00400037 14,500
excision Doctor investigations
37
Intranasal Submucosal As Advised by Attending Includes standard
201 4 Nose SS00400038 1,800
Diathermy Doctor investigations
Endoscopic As Advised by Attending Includes standard

202 4 Nose SS00400039 20,000
Hypophysectomy Doctor investigations
203 4 Nose SS00400040 Endoscopic DCR 10,000
204 4 Nose SS00400041 cranio-facial resection 11,800
205 4 Nose SS00400042 Angiofibroma Excision 14,500
206 4 Nose SS00400043 Youngs operation 5,600
Trans Antral As Advised by Attending Includes standard
207 4 Nose SS00400044 10,800
Ethmoidectomy Doctor investigations
208 4 Nose SS00400045 Submucos resection 9,000
209 4 Nose SS00400046 Sinus Antroscopy 4,600
210 4 Nose SS00400047 Septoplasty 8,500
211 4 Nose SS00400048 Rhinoplasty 14,500
Radical fronto ethmo As Advised by Attending Includes standard

212 4 Nose SS00400049 15,500
sphenodectomy Doctor investigations
Turbinectomy Partial - As Advised by Attending Includes standard

213 4 Nose SS00400050 6,000
Turbinectomy Partial - As Advised by Attending Includes standard
214 4 Nose SS00400051 8,000
Bilateral Doctor investigations
Nasal polypectomy - As Advised by Attending Includes standard

215 4 Nose SS00400052 5,400
38
Nasal polypectomy - As Advised by Attending Includes standard
216 4 Nose SS00400053 7,700
Bilateral Doctor investigations

217 4 Nose SS00400054 Rhinotomy - Lateral 13,000
Intra Nasal As Advised by Attending Includes standard
218 4 Nose SS00400055 12,600
Ethmoidectomy Doctor investigations
Functional Endoscopic As Advised by Attending Includes standard

219 4 Nose SS00400056 9,200
Sinus (FESS) Doctor investigations
Fracture - setting nasal As Advised by Attending Includes standard

220 4 Nose SS00400057 6,000
bone Doctor investigations
221 4 Nose SS00400058 Fracture - setting maxilla 8,750
Fracture reduction nose As Advised by Attending Includes standard

222 4 Nose SS00400059 6,700
with septal correction Doctor investigations
Ethmoidectomy - As Advised by Attending Includes standard

223 4 Nose SS00400060 12,000
External Doctor investigations
224 4 Nose SS00400061 Septoplasty + FESS 10,500
225 4 Nose SS00400062 Cryosurgery 7,200
226 4 Nose SS00400063 Caldwell - luc- Unilateral 7,000
227 4 Nose SS00400064 Antrostomy Unilateral 4,500
228 4 Nose SS00400065 Antrostomy Bilateral 6,500
Ant. Ethmoidal artery As Advised by Attending Includes standard
229 4 Nose SS00400066 12,360
ligation Doctor investigations
39
Adenoidectomy+
230 4 Throat SS00400067 Tonsillectomy + 12,000
Myrinogotomy
Adeno
231 4 Throat SS00400068 tonsillectomy+Nasal 11,000
polypectomy - Bilatera
Adeno
232 4 Throat SS00400069 tonsillectomy+choanal 13,000
atersia
Adenoidectomy+Aural As Advised by Attending Includes standard

233 4 Throat SS00400070 13,500
polypectomy Doctor investigations
Adeno
234 4 Throat SS00400071 tonsillectomy+Aural 13,500
polypectomy
235 4 Throat SS00400072 Cheek Advancement 9,000
236 4 Throat SS00400073 Total Glossectomy 14,000
Removal of
237 4 Throat SS00400074 Submandibular Salivary 12,000
gland
238 4 Throat SS00400075 Ranula excision 5,000
239 4 Throat SS00400076 Partial Glossectomy 4,000
Parotidectomy - As Advised by Attending Includes standard
240 4 Throat SS00400077 12,000
Superficial Doctor investigations
241 4 Throat SS00400078 Parotidectomy - Total 15,000
242 4 Throat SS00400079 Palatopharyngoplasty 14,000
40
243 4 Throat SS00400080 Hemimandibulectomy 11,000
Excision of the Mandible- As Advised by Attending Includes standard

244 4 Throat SS00400081 5,000
Segmental Doctor investigations
Excision of Cystic As Advised by Attending Includes standard

245 4 Throat SS00400082 5,000
Hygroma- Minor Doctor investigations
246 4 Throat SS00400083 7,000
Hygroma- Major Doctor investigations

247 4 Throat SS00400084 9,000
Hygroma- Extensive Doctor investigations
Excision of Branchial As Advised by Attending Includes standard

248 4 Throat SS00400085 7,000
Sinus Doctor investigations
Excision of Branchial As Advised by Attending Includes standard
249 4 Throat SS00400086 7,000
Cyst Doctor investigations
Commando Operation As Advised by Attending Includes standard

250 4 Throat SS00400087 20,000
( glossectomy)
251 4 Throat SS00400088 Cleft palate repair 8,000
252 4 Throat SS00400089 Uvulophanyngoplasty 11,000
Tonsillectomy - As Advised by Attending Includes standard
253 4 Throat SS00400090 11,000
254 4 Throat SS00400091 Tonsillectomy - Bilateral 12,000
Tonsillectomy + As Advised by Attending Includes standard
255 4 Throat SS00400092 12,500
Styloidectomy Doctor investigations
Styloidectomy - One As Advised by Attending Includes standard
256 4 Throat SS00400093 10,000
side Doctor investigations
Styloidectomy - Both As Advised by Attending Includes standard
257 4 Throat SS00400094 7,500
side Doctor investigations
41
Retro pharyngeal As Advised by Attending Includes standard
258 4 Throat SS00400095 5,000
abscess - Drainage Doctor investigations
259 4 Throat SS00400096 Release of Tongue tie 3,500
260 4 Throat SS00400097 Pharyngoplasty 11,000
Excision of Pharyngeal As Advised by Attending Includes standard

261 4 Throat SS00400098 9,500
Diverticulum Doctor investigations
peritonsillor abscess As Advised by Attending Includes standard

262 4 Throat SS00400099 1,600
under LA Doctor investigations
Parapharyngeal Abscess - As Advised by Attending Includes standard

263 4 Throat SS00400100 15,000
Drainage Doctor investigations
Parapharyngeal tumours- As Advised by Attending Includes standard

264 4 Throat SS00400101 15,000
Exploration Doctor investigations

265 4 Throat SS00400102 Oro Antral fistula repair 10,000
266 4 Throat SS00400103 Maxilla - Excision 15,000
267 4 Throat SS00400104 Laryngophayryngectomy 22,000
268 4 Throat SS00400105 Laryngofissure 5,000
269 4 Throat SS00400106 Laryngectomy 20,000
Pharyngeal As Advised by Attending Includes standard

270 4 Throat SS00400107 12,000
diverticulum's Excision Doctor investigations
Tonsillectomy + As Advised by Attending Includes standard

271 4 Throat SS00400108 12,000
Myrinogotomy Doctor investigations
42
272 4 Throat SS00400109 Choanal atresia 10,000
273 4 Throat SS00400110 Arytenoidectomy 15,000
274 4 Throat SS00400111 Adenoidectomy 8,000
275 4 Throat SS00400112 Adenotonsillectomy 12,500
276 4 Throat SS00400113 Tracheostomy 5,000
Facial Nv. As Advised by Attending Includes standard
277 4 Ear SS00400114 15,000
Decompression Doctor investigations
Peritonsillar abscess As Advised by Attending Includes standard

278 4 Throat SS00400115 1,600
drainage under LA Doctor investigations
Tinnitus Retraining As Advised by Attending Includes standard

279 4 Ear SS00400116 250
therapy Doctor investigations

280 4 Nose SS00400117 Septal perforation repair 12,500
281 4 Nose SS00400118 Antrum puncture 1,100
Endoscopic Optic Nv. As Advised by Attending Includes standard

282 4 Nose SS00400119 29,000
Decompression Doctor investigations

283 4 Nose SS00400120 Orbital Decompression 29,000
284 4 Nose SS00400121 Endoscopic JNA excision 25,000
Submandibular duct As Advised by Attending Includes standard
285 4 Throat SS00400122 2,500
Lithotomy Doctor investigations
286 4 Nose SS00400123 Nasal synechiolysis 4,200
43
Nasal mass As Advised by Attending Includes standard
287 4 Nose SS00400124 11,200
excision(simple) Doctor investigations
Nasal mass As Advised by Attending Includes standard

288 4 Nose SS00400125 13,500
excision(endoscopic)) Doctor investigations

289 4 Nose SS00400126 Anterior nasal packing 300
290 4 Nose SS00400127 Posterior nasal packing 1,000
Preauricular sinus As Advised by Attending Includes standard

291 4 Ear SS00400128 6,000
operation(unilateral) Doctor investigations

292 4 SS00400129 Punch/Wedge biopsy 600
Polyp removal(septal As Advised by Attending Includes standard

293 4 Nose SS00400130 1,400
polyp) from nose Doctor investigations
Diagnostic nasal As Advised by Attending Includes standard

294 4 Nose SS00400131 3,000
endoscopy under GA Doctor investigations

295 4 Throat SS00400132 D/L biopsy under GA 5,000
Oesophagoscopy/Foreig As Advised by Attending Includes standard

296 4 Throat SS00400133 6,000
n body removal Doctor investigations
Bronchoscopy with As Advised by Attending Includes standard

297 4 Throat SS00400134 7,000
Foreign body removal Doctor investigations
Diabetes mellitus with

Endocrinolog 20 days / As Advised by
298 5 SS00500001 foot infection 4,000
y Attending Doctor
Amount is per Day
44
Uncontrolled diabetes
299 5 SS00500002 1,000
y Attending Doctor
Amount is per Day
Diabetic Kidney Disease
300 5 SS00500003 3,000
y Attending Doctor
Amount is per Day
Diabetic ketoacidosis
301 5 SS00500004 3,000
y Attending Doctor
Amount is per Day
Hypoglycaemia
302 5 SS00500005 1,000
y Attending Doctor
Amount is per Day
Cushings syndrome
303 5 SS00500006 3,000
y Attending Doctor
Amount is per Day
Acromegaly
304 5 SS00500007 3,000
y Attending Doctor
Amount is per Day
Undiagnosed pituitary
305 5 SS00500008 macroadenoma 3,000
y Attending Doctor
Amount is per Day
Diabetes insipidus
306 5 SS00500009 3,000
y Attending Doctor
Amount is per Day
Thyrotoxicosis
307 5 SS00500010 3,000
y Attending Doctor
Amount is per Day
Thyroid Cancer
308 5 SS00500011 3,000
y Attending Doctor
Amount is per Day
Parathyroid adenoma
309 5 SS00500012 3,000
y Attending Doctor
Amount is per Day
45
Insulinoma
310 5 SS00500013 3,000
y Attending Doctor
Amount is per Day
Phaeochromocytoma
311 5 SS00500014 5,000
y Attending Doctor
Amount is per Day
Adrenal incidentaloma
312 5 SS00500015 3,000
y Attending Doctor
Amount is per Day
Genital ambiguity
313 5 SS00500016 2,000
y Attending Doctor
Amount is per Day
Hypogonadism
314 5 SS00500017 2,000
y Attending Doctor
Amount is per Day
Short stature
315 5 SS00500018 3,000
y Attending Doctor
Amount is per Day
Injury of Superficial Soft

General 1 Day/As advise by Includes standard
316 6 SS00600001 Tissues - Secondary 1,800
Surgery surgeon investigations
suture of wounds

317 6 SS00600002 Tissues - Delayed 2,400
primary suture

318 6 SS00600003 Tissues - Debridement 1,920
of wounds
46
319 6 SS00600004 Aspiration of Empyema 2,640
General Aspiration of cold 1 Day/As advise by Includes standard

320 6 SS00600005 2,400
Surgery Abscess of Lymphnode surgeon investigations
General Removal of foreign body 1 Day/As advise by Includes standard

321 6 SS00600006 1,800
Surgery ( from skin/muscle) surgeon investigations
General Fissurectomy 1 Day/As advise by Includes standard

322 6 SS00600007 14,400
Surgery +Fistulectomy surgeon investigations
Cholecystectomy &
General As Advised by Attending Includes standard
323 6 SS00600008 exploration + 28,800
Surgery Doctor investigations
Adhenolysis
Cholecystectomy &
324 6 SS00600009 exploration + Repair of 24,000
Common Bile Duct
General Rectal Dilation + Rectal As Advised by Attending Includes standard

325 6 SS00600010 9,000
Surgery Polyp Doctor investigations
Fissurectomy and
326 6 SS00600011 Haemorrhoidectomy+ 15,000
Rectal Dilation
Appendicular
327 6 SS00600012 Perforation +Ovarian 15,000
Cystectomy
General Appendicectomy + As Advised by Attending Includes standard

328 6 SS00600013 15,000
Surgery Ovarian Cystectomy Doctor investigations
General Hernioplasty + As Advised by Attending Includes standard

329 6 SS00600014 18,000
Surgery Orchidectomy Doctor investigations
47
General Skin Grafting + As Advised by Attending Includes standard
330 6 SS00600015 19,800
Surgery Fasciotomy Doctor investigations
Fissurectomy and
General Haemorrhoidectomy+ As Advised by Attending Includes standard
331 6 SS00600016 14,400
Surgery Hysterectomy - Doctor investigations
Abdominal*
Cholecystectomy &
General exploration As Advised by Attending Includes standard
332 6 SS00600017 28,800
Surgery +Hysterectomy - Doctor investigations
abdominal*
Cholecystectmy +
333 6 SS00600018 Hysterectomy - 27,600
abdominal*
Hydrocele - Excision -
334 6 SS00600019 unilateral + Cyst over 9,000
Scrotum - Excision
335 6 SS00600020 Bilateral + Cyst over 10,800
Scrotum - Excision
336 6 SS00600021 Unilateral + 18,000
Hernioplasty
General Hydrocele - Excision - As Advised by Attending Includes standard

337 6 SS00600022 19,800
Surgery Bilateral + Hernioplasty Doctor investigations
48
Hernia - Repair &
338 6 SS00600023 release of obstruction+ 20,400
Hernioplasty
Hernia - Repair &

General release of As Advised by Attending Includes standard
339 6 SS00600024 21,600
Surgery obstruction+Hydrocele - Doctor investigations
Excision - Unilateral

340 6 SS00600025 cleft lip and palate 24,000
341 6 SS00600026 cleft lip 16,200
General Haemorroidectomy + As Advised by Attending Includes standard
342 6 SS00600027 15,000
Surgery Fistulectomy Doctor investigations
General Adhenolysis + As Advised by Attending Includes standard
343 6 SS00600028 15,000
Surgery Appendicectomy Doctor investigations
General Chemical Cautery Wart 1 Day/As advise by Includes standard

344 6 SS00600029 600
Surgery excision ( per sitting) surgeon investigations

345 6 SS00600030 Excision of Warts 840
General Excision of Veneral 1 Day/As advise by Includes standard
346 6 SS00600031 840
Surgery Warts surgeon investigations
General Tendon Transfer- As Advised by Attending Includes standard
347 6 SS00600032 30,000
Surgery Leprosy Doctor investigations
General Tissue Reconstruction As Advised by Attending Includes standard

348 6 SS00600033 30,000
Surgery Flap Leprosy Doctor investigations
General Debridement of Ulcer- As Advised by Attending Includes standard

349 6 SS00600034 14,400
Surgery Leprosy Doctor investigations
49
General Subtotal Thyroidectomy As Advised by Attending Includes standard
350 6 SS00600035 18,000
Surgery (Toxic Goitre) Doctor investigations

351 6 SS00600036 Vasectomy 2,400
352 6 SS00600037 Varicose veins - injection 840
General Trendelenburg As Advised by Attending Includes standard
353 6 SS00600038 15,600
Surgery Operation Doctor investigations
General Total Thyroidectomy As Advised by Attending Includes standard

354 6 SS00600039 23,400
Surgery and Block Dissection Doctor investigations

355 6 SS00600040 Total Laryngectomy 24,000
General Temporal Bone As Advised by Attending Includes standard
356 6 SS00600041 16,200
Surgery resection Doctor investigations
General Sympathetectomy - As Advised by Attending Includes standard
357 6 SS00600042 16,200
Surgery Lumbar Doctor investigations
General Sympathetectomy - As Advised by Attending Includes standard
358 6 SS00600043 18,600
Surgery Cervical Doctor investigations
359 6 SS00600046 Superficial Veriscosity 5,400
General Splenorenal As Advised by Attending Includes standard
360 6 SS00600047 33,600
Surgery Anastomosis Doctor investigations
General Splenectomy - For As Advised by Attending Includes standard
361 6 SS00600048 26,400
Surgery Trauma Doctor investigations
General Splenectomy - For As Advised by Attending Includes standard
362 6 SS00600049 24,000
Surgery Hypersplenism Doctor investigations
363 6 SS00600050 Soft Tissue Sarcoma 19,200
General Skin Flaps - Rotation As Advised by Attending Includes standard
364 6 SS00600051 10,800
Surgery Flaps Doctor investigations
50
General Rib Resection & As Advised by Attending Includes standard
365 6 SS00600052 13,200
Surgery Drainage Doctor investigations
General Removal Tumours of As Advised by Attending Includes standard
366 6 SS00600053 19,200
Surgery Chest Wall Doctor investigations
Removal of Foreign
367 6 SS00600054 Body from Trachea or 5,400
Oesophagus

368 6 SS00600055 Phimosis Under LA 3,600
General
369 6 SS00600056 Peritoneal dialysis 2,160 Daycare
Surgery
370 6 SS00600057 Pericardiostomy 36,000
General Partial/Subtotal As Advised by Attending Includes standard

371 6 SS00600058 25,200
Surgery Gastrectomy for Ulcer Doctor investigations
Partial/Subtotal
372 6 SS00600059 Gastrectomy for 28,800
Carcinoma
373 6 SS00600060 Partial Thyroidectomy 18,600
374 6 SS00600061 Partial Pericardectomy 21,000
General Parapharyngeal Tumour As Advised by Attending Includes standard
375 6 SS00600062 18,000
Surgery Excision Doctor investigations
General Operations for Stenosis As Advised by Attending Includes standard

376 6 SS00600063 36,000
Surgery of Renal Arteries Doctor investigations
Operations for
377 6 SS00600064 Replacement of 36,000
Oesophagus by Colon
51
General Operations for Acquired As Advised by Attending Includes standard
378 6 SS00600065 30,000
Surgery Arteriovenous Fistula Doctor investigations
General Operation of As Advised by Attending Includes standard

379 6 SS00600066 24,000
Surgery Choledochal Cyst Doctor investigations
General Operation for As Advised by Attending Includes standard

380 6 SS00600067 24,000
Surgery Gastrojejunal Ulcer Doctor investigations
General operation for caricinoma As Advised by Attending Includes standard

381 6 SS00600068 16,200
Surgery lip- cheek advancement Doctor investigations

382 6 SS00600069 Intercostal drainage 4,200
General hernia -hiatus- As Advised by Attending Includes standard
383 6 SS00600071 26,400
Surgery Tranthorasic Doctor investigations
General Gastojejunostomy and As Advised by Attending Includes standard
384 6 SS00600072 22,200
Surgery vagotomy Doctor investigations
General Lap. Assisted small As Advised by Attending Includes standard

385 6 SS00600073 26,400
Surgery bowel resection Doctor investigations
General Excision and removal of 1 Day/As advise by Includes standard

386 6 SS00600075 2,400
Surgery superficial cysts surgeon investigations
General Abdomino Perineal As Advised by Attending Includes standard

387 6 SS00600076 31,800
Surgery Resection Doctor investigations
General Adventious Burse - As Advised by Attending Includes standard

388 6 SS00600077 10,200
General Anterior Resection for As Advised by Attending Includes standard
389 6 SS00600078 27,000
Surgery CA Doctor investigations
52
390 6 SS00600079 Appendicectomy 15,000
General Appendicular Abscess - As Advised by Attending Includes standard

391 6 SS00600080 12,000
Arteriovenous (AV)
392 6 SS00600081 Malformation of Soft 24,000
Tissue Tumour - Excision

393 6 SS00600082 Bakers Cyst - Excision 9,000
General Bilateral Inguinal block As Advised by Attending Includes standard
394 6 SS00600083 22,200
Surgery dissection Doctor investigations
Bleeding Ulcer -
395 6 SS00600084 Gastrectomy & 26,400
vagotomy
General Bleeding Ulcer - Partial As Advised by Attending Includes standard

396 6 SS00600085 26,400
Surgery gastrectomy Doctor investigations
General Block dissection Cervical As Advised by Attending Includes standard

397 6 SS00600086 26,400
Surgery Nodes(Bilateral) Doctor investigations

398 6 SS00600087 Branchial Fistula 18,000
General Breast Lump - Left - As Advised by Attending Includes standard
399 6 SS00600088 9,600
General Breast Lump - Right - As Advised by Attending Includes standard
400 6 SS00600089 9,600
401 6 SS00600090 Bronchial Cyst 18,000
402 6 SS00600091 Bursa - Excision 9,000
53
General Bypass - Inoprablaca of As Advised by Attending Includes standard
403 6 SS00600092 24,000
Surgery Pancreas Doctor investigations

404 6 SS00600093 Caecopexy 16,800
405 6 SS00600094 Carbuncle back 6,600
406 6 SS00600095 Cavernostomy 18,000
General Cervial Lymphnodes - As Advised by Attending Includes standard

407 6 SS00600096 7,800

408 6 SS00600097 Colocystoplasty 33,600
409 6 SS00600098 Colostomy 18,000
General Cyst over Scrotum - As Advised by Attending Includes standard
410 6 SS00600099 7,200
411 6 SS00600100 Cystic Mass - Excision 4,200
General Dermoid Cyst - Large - As Advised by Attending Includes standard
412 6 SS00600101 4,800
General Dermoid Cyst - Small - As Advised by Attending Includes standard
413 6 SS00600102 3,600
Distal Pancrcatectomy
414 6 SS00600103 with Pancreatico 33,600
Jejunostomy

415 6 SS00600104 Diverticulectomy 24,000
Dorsal Slit and
416 6 SS00600105 Reduction of 3,000
Paraphimosis
54
General Drainage of Ischio Rectal As Advised by Attending Includes standard
417 6 SS00600106 7,200
Surgery Abscess under GA Doctor investigations
General Incision and Drainage of 1 Day/As advise by Includes standard

418 6 SS00600107 2,400
Surgery large Abscess surgeon investigations
General Drainage of Peripherally As Advised by Attending Includes standard

419 6 SS00600108 9,600
Surgery Gastric Abscess Doctor investigations
General Drainage of Psoas As Advised by Attending Includes standard

420 6 SS00600109 10,800
Surgery Abscess Doctor investigations
Drainage of
421 6 SS00600110 Subdiaphramatic 12,000
Abscess
422 6 SS00600111 Duodenal Diverticulum 24,000
423 6 SS00600112 Duodenal Jejunostomy 24,000
424 6 SS00600113 Duodenectomy 33,600
Dupcrytren's
425 6 SS00600114 (duputryen's 18,000
contracture ?]
426 6 SS00600115 Duplication of Intestine 24,000
General Hydrocelectomy + As Advised by Attending Includes standard
427 6 SS00600116 9,600
Surgery Orchidectomy Doctor investigations
428 6 SS00600117 Epidedectomy 9,600
General Epididymal Swelling - As Advised by Attending Includes standard
429 6 SS00600118 9,000
430 6 SS00600119 Epidymal Cyst 6,000
55
General Evacuation of Scrotal As Advised by Attending Includes standard
431 6 SS00600120 7,200
Surgery Hematoma Doctor investigations
General Excision Benign Tumor - As Advised by Attending Includes standard

432 6 SS00600121 23,400
Surgery Small intestine Doctor investigations

433 6 SS00600122 Excision Bronchial Sinus 18,000
General Excision and drainage of As Advised by Attending Includes standard

434 6 SS00600123 19,200
Surgery liver Abscess Doctor investigations

435 6 SS00600124 Excision Filarial Scrotum 14,400
General Excision Mammary As Advised by Attending Includes standard
436 6 SS00600125 9,000
Surgery Fistula Doctor investigations
General Excision Meckel's As Advised by Attending Includes standard
437 6 SS00600126 24,000
Surgery Diverticulum Doctor investigations
438 6 SS00600127 Excision Pilonidal Sinus 12,000
General Excision Small Intestinal As Advised by Attending Includes standard
439 6 SS00600128 28,800
Surgery Fistulla Doctor investigations
General Excision of Large Growth As Advised by Attending Includes standard

440 6 SS00600129 15,600
Surgery from Tongue Doctor investigations
General Excision of Small Growth As Advised by Attending Includes standard

441 6 SS00600130 7,200
Surgery from Tongue Doctor investigations
General Excision of Swelling in As Advised by Attending Includes standard

442 6 SS00600131 10,800
Surgery Right Cervial Region Doctor investigations
General Excision of Large As Advised by Attending Includes standard

443 6 SS00600132 10,200
Surgery Swelling in Hand Doctor investigations
General Excision of Small As Advised by Attending Includes standard
444 6 SS00600133 5,400
Surgery Swelling in Hand Doctor investigations
56
General Excision of As Advised by Attending Includes standard
445 6 SS00600134 7,200
Surgery Neurofibroma Doctor investigations
General Exicision of Siniuds and As Advised by Attending Includes standard

446 6 SS00600135 10,800
Surgery Curetage Doctor investigations

447 6 SS00600136 Facial Decompression 19,200
Fibro Lipoma of Right

448 6 SS00600137 Sided Spermatic with 7,200
Lord Excision

449 6 SS00600138 Fibroadenoma - Bilateral 14,400
General Fibrodenoma - As Advised by Attending Includes standard
450 6 SS00600139 8,400
Surgery Unilateral Doctor investigations
451 6 SS00600140 Fibroma - Excision 6,000
452 6 SS00600141 Fissurectomy 14,400
General Fissurectomy with As Advised by Attending Includes standard
453 6 SS00600142 14,400
Surgery Sphincterotomy Doctor investigations
454 6 SS00600143 Anal Fistula Repair 14,400
General Foreign Body Removal in As Advised by Attending Includes standard

455 6 SS00600144 4,800
Surgery Deep Region Doctor investigations

456 6 SS00600145 Fulguration 6,000
457 6 SS00600146 Fundoplication 24,000
458 6 SS00600147 G J Vagotomy 18,000
57
459 6 SS00600148 Vagotomy 18,000
General Ganglion - large - As Advised by Attending Includes standard
460 6 SS00600149 6,000
General Ganglion (Dorsum of As Advised by Attending Includes standard

461 6 SS00600150 7,800
Surgery Both Wrist) - Excision Doctor investigations
General Ganglion - Small - As Advised by Attending Includes standard

462 6 SS00600151 4,200
463 6 SS00600152 Gastro jejunal ulcer 19,800
General Gastro jejuno Colic As Advised by Attending Includes standard
464 6 SS00600153 26,400
Surgery Fistula Doctor investigations
465 6 SS00600154 Gastrojejunostomy 18,000
466 6 SS00600155 Gastrotomy 1,800
467 6 SS00600156 Graham's Operation 18,000
468 6 SS00600157 Granuloma - Excision 4,800
469 6 SS00600158 Growth - Excision 3,600
470 6 SS00600159 Haemangioma - Excision 12,000
General Haemorrage of Small As Advised by Attending Includes standard
471 6 SS00600160 24,000
Surgery Intestine Doctor investigations
472 6 SS00600161 Hemithyroplasty 16,200
General Hepatic Resection As Advised by Attending Includes standard
473 6 SS00600162 34,200
Surgery (lobectomy) Doctor investigations
474 6 SS00600163 Hernia - Epigastric 12,000
58
475 6 SS00600164 Hernia - Incisional 19,800
General Hernia - Repair & As Advised by Attending Includes standard

476 6 SS00600165 19,800
Surgery release of obstruction Doctor investigations

477 6 SS00600166 Hernia - Umbilical 14,400
General Hernia - Ventral - As Advised by Attending Includes standard

478 6 SS00600167 19,800
Surgery Lipectomy/Incisional Doctor investigations

479 6 SS00600168 Hernia - Femoral 19,200
480 6 SS00600169 Hernioplasty 16,200
Herniorraphy and
481 6 SS00600170 Hydrocelectomy Sac 18,000
Excision
General Hernia - Hiatus - As Advised by Attending Includes standard
482 6 SS00600171 24,000
Surgery abdominal Doctor investigations
483 6 SS00600172 Hydatid Cyst of Liver 19,200
484 6 SS00600173 Nodular Cyst 6,000
General Hydrocelectomy+Hernio As Advised by Attending Includes standard

485 6 SS00600174 18,000
Surgery plasty - Excision Doctor investigations

486 6 SS00600175 6,600
Surgery Unilateral Doctor investigations

487 6 SS00600176 9,600
Surgery Bilateral Doctor investigations
488 6 SS00600177 Ilieo Sigmoidostomy 24,000
59
General Infected Bunion Foot - As Advised by Attending Includes standard
489 6 SS00600178 6,600
General Inguinal Node (bulk As Advised by Attending Includes standard

490 6 SS00600179 14,400
Surgery dissection) axial Doctor investigations

491 6 SS00600180 Instestinal perforation 18,000
492 6 SS00600181 Intestinal Obstruction 18,000
493 6 SS00600182 Intussusception 18,000
494 6 SS00600183 Jejunostomy 14,400
General Closure of As Advised by Attending Includes standard

495 6 SS00600184 16,800
Surgery Intestinal Perforation Doctor investigations

496 6 SS00600185 Gastric Perforation 15,600
General Intestinal Perforation As Advised by Attending Includes standard

497 6 SS00600186 16,800
Surgery (Resection Anastomosis) Doctor investigations
General Appendicular As Advised by Attending Includes standard

498 6 SS00600187 15,000
Surgery Perforation Doctor investigations
General Burst Abdomen As Advised by Attending Includes standard
499 6 SS00600188 16,200
Surgery Obstruction Doctor investigations
General Closure of Hollow Viscus As Advised by Attending Includes standard
500 6 SS00600189 15,600
Surgery Perforation Doctor investigations
Laryngectomy &
501 6 SS00600190 Pharyngeal Diverticulum 14,400
(Throat)
60
502 6 SS00600191 Anorectoplasty 19,800
Laryngectomy with
503 6 SS00600192 Block Dissection 24,000
(Throat)

504 6 SS00600193 Laryngo Fissure (Throat) 18,000
General Laryngopharyngectomy As Advised by Attending Includes standard
505 6 SS00600194 24,000
Surgery (Throat) Doctor investigations
506 6 SS00600195 Ileostomy 18,000
507 6 SS00600196 Lipoma 6,000
508 6 SS00600197 Loop Colostomy Sigmoid 15,000
General Lords Procedure As Advised by Attending Includes standard
509 6 SS00600198 12,000
Surgery (haemorrhoids) Doctor investigations
510 6 SS00600199 Lumpectomy - Excision 10,800
511 6 SS00600200 Mastectomy 14,400
General Mesenteric Cyst - As Advised by Attending Includes standard
512 6 SS00600201 21,000
General Mesenteric Caval As Advised by Attending Includes standard
513 6 SS00600202 30,000
Surgery Anastomosis Doctor investigations
General Microlaryngoscopic As Advised by Attending Includes standard
514 6 SS00600203 18,000
Surgery Surgery Doctor investigations
General Oeshophagoscopy for As Advised by Attending Includes standard

515 6 SS00600204 9,000
Surgery foreign body removal Doctor investigations

516 6 SS00600205 Oesophagectomy 30,000
61
General Oesophagus Portal As Advised by Attending Includes standard
517 6 SS00600206 36,000
Surgery Hypertension Doctor investigations
General Pelvic Abscess - Open As Advised by Attending Includes standard

518 6 SS00600207 11,400
519 6 SS00600208 Orchidectomy 9,600
General Orchidectomy + As Advised by Attending Includes standard
520 6 SS00600209 19,800
Surgery Herniorraphy Doctor investigations
521 6 SS00600210 Orchidopexy 11,400
General Orchidopexy with As Advised by Attending Includes standard
522 6 SS00600211 15,000
Surgery Circumsion Doctor investigations
General Orchidopexy With As Advised by Attending Includes standard
523 6 SS00600212 16,200
Surgery Eversion of Sac Doctor investigations
General Orchidopexy with As Advised by Attending Includes standard
524 6 SS00600213 18,600
Surgery Herniotomy Doctor investigations
General Pancreatrico As Advised by Attending Includes standard
525 6 SS00600214 36,000
Surgery Deodeneotomy Doctor investigations
General Papilloma Rectum - As Advised by Attending Includes standard
526 6 SS00600215 6,000
General Phytomatous Growth in As Advised by Attending Includes standard

527 6 SS00600216 5,400
Surgery the Scalp - Excision Doctor investigations

528 6 SS00600217 Porto Caval Anastomosis 36,000
529 6 SS00600218 Pyeloroplasty 16,800
530 6 SS00600219 Radical Mastectomy 21,000
General Radical Neck Dissection - As Advised by Attending Includes standard

531 6 SS00600220 30,000
62
532 6 SS00600221 Hernia - Spigelian 18,000
533 6 SS00600222 Rectal Dilation 6,000
General Prolapse of Rectal Mass - As Advised by Attending Includes standard
534 6 SS00600223 15,000
535 6 SS00600224 Rectopexy 16,200
General Repair of Common Bile As Advised by Attending Includes standard
536 6 SS00600225 21,000
Surgery Duct Doctor investigations
General Foreign Body Removal in Includes standard

537 6 SS00600226 1,200 Day care
Surgery Superficial investigations
General Resection Anastomosis As Advised by Attending Includes standard

538 6 SS00600227 24,000
Surgery (Large Intestine) Doctor investigations
General Retroperitoneal Tumor - As Advised by Attending Includes standard

539 6 SS00600228 24,000
540 6 SS00600229 Haemorroidectomy 14,400
541 6 SS00600230 Salivary Gland - Excision 13,200
General Sebaceous Cyst - As Advised by Attending Includes standard
542 6 SS00600231 2,400
General Segmental Resection of As Advised by Attending Includes standard

543 6 SS00600232 13,200
Surgery Breast Doctor investigations
General Scrotal Swelling As Advised by Attending Includes standard

544 6 SS00600233 7,800
Surgery (Multiple) - Excision Doctor investigations

545 6 SS00600234 Sigmoid Diverticulum 22,800
63
General Simple closure - Peptic As Advised by Attending Includes standard
546 6 SS00600235 15,600
Surgery perforation Doctor investigations
547 6 SS00600236 Sinus - Excision 8,400
General Soft Tissue Tumor - As Advised by Attending Includes standard
548 6 SS00600237 6,000
General Spindle Cell Tumor - As Advised by Attending Includes standard
549 6 SS00600238 9,600
General Submandibular Lymphs - As Advised by Attending Includes standard
550 6 SS00600239 6,000
Submandibular Mass
551 6 SS00600240 Excision + 26,400
Reconstruction
552 6 SS00600241 Superficial Parodectomy 15,600
553 6 SS00600242 Terminal Colostomy 18,000
554 6 SS00600243 Coloectomy - Total 28,800
General Pharyngectomy & As Advised by Attending Includes standard

555 6 SS00600244 24,000
Surgery Reconstruction - Total Doctor investigations
Tracheal Stenosis (End

556 6 SS00600245 to end Anastamosis) 24,000
(Throat)

557 6 SS00600246 Tracheoplasty (Throat) 19,200
558 6 SS00600247 Tranverse Colostomy 17,400
General Umbilical Sinus - As Advised by Attending Includes standard
559 6 SS00600248 8,400
64
General Resection Anastomosis As Advised by Attending Includes standard
560 6 SS00600249 24,000
Surgery (Small Intestine) Doctor investigations
General Varicose Veins - Excision As Advised by Attending Includes standard

561 6 SS00600250 11,400
Surgery and Ligation Doctor investigations

562 6 SS00600251 Volvlous of Large Bowel 24,000
563 6 SS00600252 Warren's Shunt 24,000
564 6 SS00600253 Abbe Operation 12,000
General Aneurysm not Requiring As Advised by Attending Includes standard

565 6 SS00600254 132,000
Surgery Bypass Techniques Doctor investigations
General Aneurysm Resection & As Advised by Attending Includes standard

566 6 SS00600255 132,000
Surgery Grafting Doctor investigations

567 6 SS00600256 Aorta-Femoral Bypass 132,000
568 6 SS00600257 Arterial Embolectomy 66,000
General Aspiration of As Advised by Attending Includes standard
569 6 SS00600258 3,000
Surgery Empymema Doctor investigations
General Benign Tumour of As Advised by Attending Includes standard

570 6 SS00600259 21,000
Surgery intestine Excisions Doctor investigations

571 6 SS00600260 Carotid artery aneurism 72,000
572 6 SS00600261 Carotid Body Excision 60,000
65
General Cholecystectomy & As Advised by Attending Includes standard
573 6 SS00600262 19,800
Surgery Exploration of CBD Doctor investigations

574 6 SS00600263 Cholecystostomy 15,600
575 6 SS00600264 Diagnostic Laproscopy 7,800
576 6 SS00600265 Dressing under GA 4,200
577 6 SS00600266 Estlander Operation 10,200
General Examination under As Advised by Attending Includes standard
578 6 SS00600267 3,000
Surgery Anesthesia Doctor investigations
General Excision and Skin Graft As Advised by Attending Includes standard

579 6 SS00600268 16,200
Surgery of Venous Ulcer Doctor investigations
General Includes standard

580 6 SS00600269 Excision of Corns 600 Daycare
Surgery investigations
581 6 SS00600270 Excision of Moles 840 Daycare
General Excision of Includes standard

582 6 SS00600271 840 Daycare
Surgery Molluscumcontagiosum investigations
General Excision of Parathyroid As Advised by Attending Includes standard

583 6 SS00600272 21,600
Surgery Adenoma/Carcinoma Doctor investigations
General Vagotomy & As Advised by Attending Includes standard

584 6 SS00600273 21,600
Surgery Pyloroplasty Doctor investigations
General Excision of Superficial Includes standard

585 6 SS00600274 3,600 Daycare
Surgery Liipoma investigations
66
General Excision of Superficial Includes standard
586 6 SS00600275 840 Daycare
Surgery Neurofibroma investigations
General Femoropopliteal by pass As Advised by Attending Includes standard

587 6 SS00600276 132,000
Surgery procedure Doctor investigations
General Flap Reconstructive As Advised by Attending Includes standard

588 6 SS00600277 30,000
Surgery Surgery Doctor investigations
General Free Grafts - Large Area As Advised by Attending Includes standard

589 6 SS00600278 15,000
Surgery 10% Doctor investigations
General Free Grafts - Theirech- As Advised by Attending Includes standard

590 6 SS00600279 9,000
Surgery Small Area 5% Doctor investigations
General Free Grafts - Very Large As Advised by Attending Includes standard

591 6 SS00600280 18,600
Surgery Area 20% Doctor investigations
General Free Grafts - Wolfe As Advised by Attending Includes standard
592 6 SS00600281 12,000
Surgery Grafts Doctor investigations
593 6 SS00600282 Haemorrhoid - injection 840 Daycare
594 6 SS00600283 Hemithyroidectomy 16,200
595 6 SS00600284 Isthmectomy 12,000
General Laaproscopic Hernia As Advised by Attending Includes standard
596 6 SS00600285 22,800
Surgery Repair Doctor investigations
General Lap. Assisted left As Advised by Attending Includes standard
597 6 SS00600286 28,800
Surgery Hemicolectomy Doctor investigations
General Lap. Assisted Right As Advised by Attending Includes standard

598 6 SS00600287 28,800
Surgery Hemicolectomy Doctor investigations
General Excision of Sebaceous Includes standard

599 6 SS00600288 2,400 Daycare
Surgery Cysts investigations
67
General Lap. Assisted Total As Advised by Attending Includes standard
600 6 SS00600289 32,400
Surgery Colectomy Doctor investigations
General Lap. Cholecystectomy & As Advised by Attending Includes standard

601 6 SS00600290 20,400
Surgery CBD exploration Doctor investigations
General Lap. For intestinal As Advised by Attending Includes standard

602 6 SS00600291 18,600
Surgery obstruction Doctor investigations
603 6 SS00600292 Lap. Hepatic resection 30,000
General Lap. Hydatid of liver As Advised by Attending Includes standard
604 6 SS00600293 24,000
Surgery surgery Doctor investigations
605 6 SS00600294 Laproscopic Adhesiolysis 19,200
General Laproscopic As Advised by Attending Includes standard
606 6 SS00600295 24,000
Surgery Adrenalectomy Doctor investigations
607 6 SS00600296 14,400
Surgery Appenjdicectomy Doctor investigations
608 6 SS00600297 19,200
Surgery Cholecystectomy Doctor investigations
609 6 SS00600298 24,000
Surgery cystogastrostomy Doctor investigations
General Laproscopic donor As Advised by Attending Includes standard
610 6 SS00600299 26,400
Surgery Nephroctomy Doctor investigations
611 6 SS00600300 17,400
Surgery Gastrostomy Doctor investigations
General Laproscopic Hiatus As Advised by Attending Includes standard
612 6 SS00600301 28,800
Surgery Hernia Repair Doctor investigations
613 6 SS00600302 24,000
Surgery Pyelolithotomy Doctor investigations
614 6 SS00600303 Laproscopic Rectopexy 21,600
615 6 SS00600304 21,600
Surgery Spleenectomy Doctor investigations
68
General Laproscopic umbilical As Advised by Attending Includes standard
616 6 SS00600305 19,200
Surgery hernia repair Doctor investigations

617 6 SS00600306 21,600
Surgery ureterolithotomy Doctor investigations
General Laproscopic ventral As Advised by Attending Includes standard

618 6 SS00600307 21,600
Surgery hernia repair Doctor investigations
General Laprotomy-peritonitis As Advised by Attending Includes standard

619 6 SS00600308 15,600
Surgery lavage and drainage Doctor investigations
General Ligation of Ankle As Advised by Attending Includes standard

620 6 SS00600309 15,000
Surgery Perforators Doctor investigations
Lymphatics Excision of
621 6 SS00600310 Subcutaneous Tissues In 17,400
Lymphoedema
General Repair of Main Arteries As Advised by Attending Includes standard

622 6 SS00600311 42,000
Surgery of the Limbs Doctor investigations
General Oesophagectomy for As Advised by Attending Includes standard

623 6 SS00600312 36,000
Surgery Carcinoma Easophagus Doctor investigations
General Operation for Bleeding As Advised by Attending Includes standard

624 6 SS00600313 21,600
Surgery Peptic Ulcer Doctor investigations
Operation for
625 6 SS00600314 Carcinoma Lip - 12,000
Vermilionectomy
69
Operation for
General Carcinoma Lip - Wedge As Advised by Attending Includes standard
626 6 SS00600315 12,000
Surgery Excision and Doctor investigations
Vermilonectomy
Operation for
627 6 SS00600316 Carcinoma Lip - Wedge- 12,000
Excision
Appendicectomy -
628 6 SS00600317 Appendicular Abscess - 14,400
Drainage

629 6 SS00600318 Caecostomy 13,200
General Coccygeal Teratoma As Advised by Attending Includes standard
630 6 SS00600319 20,400
Colostomy - Loop
631 6 SS00600320 Colostomy Transverse 17,400
Sigmoid
Congenital Atresia &

632 6 SS00600321 Stenosis of Small 24,000
Intestine
General Cystojejunostomy/or As Advised by Attending Includes standard

633 6 SS00600322 24,000
Surgery Cystogastrostomy Doctor investigations
Direct Operation on
634 6 SS00600323 Oesophagus for Portal 42,000
Hypertension
General Drainage of perinephric As Advised by Attending Includes standard

635 6 SS00600324 14,400
Surgery abscess Doctor investigations
70
General drainage of perivertibral As Advised by Attending Includes standard
636 6 SS00600325 14,400
Surgery abscess Doctor investigations
Gastroentero
637 7 logy Medical SS00700001 Acute Pancreatitis (Mild)
and surgical
Gastroentero
Acute Pancreatitis As Advised by Attending Includes standard
638 7 logy Medical SS00700002
(Severe) Doctor investigations
and surgical
Gastroentero
639 7 logy Medical SS00700003 Obscure GI Bleed 25,000
and surgical
Gastroentero
Cirrhosis with Hepatic As Advised by Attending Includes standard
640 7 logy Medical SS00700004 30,000
Encephalopathy Doctor investigations
and surgical
Gastroentero
Cirrhosis with Hepato As Advised by Attending Includes standard
641 7 logy Medical SS00700005 40,000
Renal Syndrome Doctor investigations
and surgical
Gastroentero
642 7 logy Medical SS00700006 Oesophageal Fistula 24,000
and surgical
Gastroentero
Corrosive Oesophageal As Advised by Attending Includes standard
643 7 logy Medical SS00700007 12,500
Injury Doctor investigations
and surgical
Gastroentero
Acute Pancreatitis with As Advised by Attending Includes standard
644 7 logy Medical SS00700008 28,000
Pseudocyst (Infected) Doctor investigations
and surgical
Gastroentero
Chronic Pancreatitis As Advised by Attending Includes standard
645 7 logy Medical SS00700009
with Severe Pain Doctor investigations
and surgical
Gastroentero
Biliary Strictures - Post As Advised by Attending Includes standard
646 7 logy Medical SS00700010 35,000
OP Stent Doctor investigations
and surgical
71
Gastroentero
Biliary Strictures - Post As Advised by Attending Includes standard
647 7 logy Medical SS00700011 60,000
OP Leaks Doctor investigations
and surgical
Gastroentero
Biliary Strictures - As Advised by Attending Includes standard
648 7 logy Medical SS00700012 18,000
Sclerosing Cholangitis Doctor investigations
and surgical
Gastroentero
Oesophageal As Advised by Attending Includes standard
649 7 logy Medical SS00700013 15,000
Perforation Doctor investigations
and surgical
Gastroentero
650 7 logy Medical SS00700014 Achalasia Cardia 5,600
and surgical
Gastroentero
Oesophageal Varices, As Advised by Attending Includes standard
651 7 logy Medical SS00700015 5,000
Variceal Banding Doctor investigations
and surgical
Gastroentero
Oesophageal Varices, As Advised by Attending Includes standard
652 7 logy Medical SS00700016 7,000
Sclerotherapy Doctor investigations
and surgical
Gastroentero
GAVE (Gastric Antral As Advised by Attending Includes standard
653 7 logy Medical SS00700017 16,000
Vascular Ectasia) Doctor investigations
and surgical
Gastroentero
654 7 logy Medical SS00700018 Gastric Varices 5,000
and surgical
655 8 SS00800001 30,000
Haematology Lymphoma-Diagnosis Doctor investigations
Includes standard
As Advised by Attending investigations. 60,000
656 8 SS00800002 60,000
Non Hodgkin Lymphoma Doctor per cycle - Total of 6
Haematology Treatment cycles
72
Includes standard
As Advised by Attending investigations. 20,000
657 8 SS00800003 20,000
Doctor per cycle - Total of 6
Haematology Hodgkin Lymphoma cycles
658 8 SS00800004 30,000
Haematology Myeloma Diagnosis Doctor investigations
659 8 SS00800005 30,000
Haematology Myeloma Treatment Doctor investigations
Aplastic anaemia As Advised by Attending Includes standard
660 8 SS00800006 20,000
Haematology Diagnosis Doctor investigations
Aplastic anaemia As Advised by Attending Includes standard
661 8 SS00800007 10,000
Haematology Treatment 1 Doctor investigations
Includes standard
662 8 SS00800009 Aplastic anaemia 10,000 investigations. Anabolic
Doctor
Haematology Treatment 3 Steriod
663 8 SS00800010 30,000
Haematology AML- Diagnosis Doctor investigations
664 8 SS00800012 30,000
Haematology ALL - Diagnosis Doctor investigations
Acute Leukemia - As Advised by Attending Includes standard
665 8 SS00800014 30,000
Chronic Leukemia - As Advised by Attending Includes standard
666 8 SS00800015 25,000
Leukemia MPN - As Advised by Attending Includes standard
667 8 SS00800016 25,000
Includes standard
668 8 SS00800019 7,000 investigations. 7,000 per
Doctor
Haematology CML - Imatinib month
Includes standard
669 8 SS00800020 20,000 investigations. 20,000
Doctor
Haematology CML - Desatinib per month
73
Includes standard
Doctor
Haematology CML - Nilotinib per month
Includes standard
Doctor
Haematology MF -Other Therapy month
Includes standard
Doctor
Haematology MF - Ruxolitinib per month
673 8 SS00800024 30,000
Haematology MDS - Diagnosis Doctor investigations
Includes standard
Doctor
per cycle for life long
Haematology MDS - Treatment
Includes standard
Doctor
per cycle for life long
Haematology AML - Elderly Treatment
676 8 SS00800027 30,000
Haematology AML-Diagnosis Doctor investigations
677 8 SS00800029 5,000
Haematology Thalassaemia - Diagosis Doctor investigations
Includes standard
678 8 SS00800030 Thalassaemia - 6,500 investigations. 6,500 per
Doctor
Haematology Treatment month
679 8 SS00800031 5,000
Haematology ITP - Diagnosis Doctor investigations
Includes standard
ITP - Rituximab Doctor
per week for 4 cycles
Haematology Treatment
74
Includes standard
ITP- Doctor
per month for 3 cycles
Haematology Eltrombopag Treatment
Includes standard
Doctor
Haematology ITP - Other Treatment month
683 8 SS00800037 5,000
Haematology Hemophilia - Diagnosis Doctor investigations
684 8 SS00800043 10,000
Haematology Anaemia- Diagnosis Doctor investigations
Includes standard
685 8 SS00800044 Anaemia- Treatment- 12,000 investigations. 12,000
Doctor
Haematology EPO per month
Includes standard
686 8 SS00800045 500 investigations. 500 per
Doctor
Haematology IDA - Treatment month
Includes standard
AIHA - Treatment - Doctor
per cycle for 4 cycle
Haematology Rituximab
Includes standard
Doctor
Haematology PNH - Treatment month
Includes standard
Doctor
Haematology Anaemia-CKD- EPO per month
Includes standard
690 8 SS00800049 Anaemia-CKD- 15,000 investigations. 15,000
Doctor
Haematology Darbopoietin per month
Includes standard
691 8 SS00800050 Anaemia-ACD- 45,000 investigations. 45,000
Doctor
Haematology Darbopoietin per month
75
Includes standard
Doctor
Haematology Anaemia -ACD-EPO per month
Comprhensive mother
Obstertics package (three antenal
693 9 and SS00900001 checkup , diagnositics , 15,000
Gynaecology treatment and Delivery -
normal or caessorian)
Obstertics Suction evacuation

694 9 and SS00900002 vesicular mole, missed 5,000
Gynaecology abortion D/E
Obstertics Rupture Uterus, closure

695 9 and SS00900003 & repair with tubal 15,000
Gynaecology ligation
Obstertics
Repair of post-coital As Advised by Attending Includes standard
696 9 and SS00900004 5,000
tear, perineal injury Doctor investigations
Gynaecology
Obstertics Perforation of Uterus

697 9 and SS00900005 after D/E Laparotomy & 15,000
Gynaecology Closure
Obstertics
Laparotomy-peritonitis As Advised by Attending Includes standard
698 9 and SS00900006 12,000
lavage and drainage Doctor investigations
Gynaecology
Obstertics
Laparotomy-failed As Advised by Attending Includes standard
699 9 and SS00900007 12,000
laparoscopy to explore Doctor investigations
Gynaecology
76
Obstertics
Internal podalic version As Advised by Attending Includes standard
700 9 and SS00900008 10,000
and extraction Doctor investigations
Gynaecology
Obstertics
Gaping pareneal wound As Advised by Attending Includes standard
701 9 and SS00900009 3,000
secondary suturing Doctor investigations
Gynaecology
Obstertics
Exploration of PPH-tear As Advised by Attending Includes standard
702 9 and SS00900010 5,000
repair Doctor investigations
Gynaecology
Exploration of perineal
Obstertics
haematoma & As Advised by Attending Includes standard
703 9 and SS00900011 7,500
Resuturing of Doctor investigations
Gynaecology
episiotomy
Exploration of
Obstertics
abdominal haematoma As Advised by Attending Includes standard
704 9 and SS00900012 15,000
(after laparotomy + Doctor investigations
Gynaecology
LUCS)
Obstertics
Excision of urethral 1 Day / As Advised by Includes standard
705 9 and SS00900013 3,500
caruncle Attending Doctor investigations
Gynaecology
Obstertics
Examination under 1 Day / As Advised by Includes standard
706 9 and SS00900014 2,500
anaesthesia Attending Doctor investigations
Gynaecology
Obstertics
Colpotomy-drainage P/V 1 Day / As Advised by Includes standard
707 9 and SS00900015 3,500
needling EUA Attending Doctor investigations
Gynaecology
Obstertics
708 9 and SS00900016 Brust abodomen repair 11,500
Gynaecology
Obstertics
Broad Ligment 1 Day / As Advised by Includes standard
709 9 and SS00900017 7,650
Haemotoma drainage Attending Doctor investigations
Gynaecology
77
Obstertics Electro Cauterisation
1 Day / As Advised by Includes standard
710 9 and SS00900018 Cryo Surgery +Fractional 4,250
Attending Doctor investigations
Gynaecology Curretage
Obstertics
Normal delivery + 2 Days / As Advised by Includes standard
711 9 and SS00900019 4,500
perineal tear repair Attending Doctor investigations
Gynaecology
Obstertics
Adhenolysis+ Ovarian As Advised by Attending Includes standard
712 9 and SS00900020 15,000
Cystectomy Doctor investigations
Gynaecology
Obstertics
Adhenolysis+ As Advised by Attending Includes standard
713 9 and SS00900021 9,500
Salpingostomy Doctor investigations
Gynaecology
Obstertics Ablation of
714 9 and SS00900022 Endometriotic Spot 9,800
Gynaecology +Salpingostomy
Obstertics
Casearean delivery+ As Advised by Attending Includes standard
715 9 and SS00900023 9,500
Salpingoophrectomy Doctor investigations
Gynaecology
Obstertics D&C ( Dilatation &

716 9 and SS00900024 curretage) + 5,000
Gynaecology Polypectomy
717 9 and SS00900025 Endometrium + 8,400
718 9 and SS00900026 Endometriotic Spot + 8,400
78
Obstertics Casearean
719 9 and SS00900027 delivery+Ovarian 15,000
Gynaecology Cystectomy

720 9 and SS00900028 curretage) +Ovarian 7,500
721 9 and SS00900029 Endometrium +Ovarian 8,750
Gynaecology +Ovarian Cystectomy
Obstertics Ovarian Cystectomy

723 9 and SS00900031 +Hysterotomy -Tumors 14,500
Gynaecology removal
Obstertics Casearean
724 9 and SS00900032 delivery+Hernia - 16,000
Gynaecology Incisional
Obstertics Hysterotomy -Tumors
725 9 and SS00900033 removal+ Hernia - 18,650
Gynaecology Incisional
Obstertics Hysterectomy -
726 9 and SS00900034 abdominal+ Hernia - 16,500
Gynaecology Incisional*
Obstertics Hysterectomy -
727 9 and SS00900035 abdominal+Hernia - 15,500
Gynaecology Epigastric*
79
Obstertics
Hysterectomy - Vaginal+ As Advised by Attending Includes standard
728 9 and SS00900036 13,500
Haemorroidectomy* Doctor investigations
Gynaecology
D&C ( Dilatation &

Obstertics
curretage) +Electro 1 Day / As Advised by Includes standard
729 9 and SS00900037 5,000
Cauterisation Cryo Attending Doctor investigations
Gynaecology
Surgery
Ablation of
Obstertics
Endometrium + Electro 1 Day / As Advised by Includes standard
730 9 and SS00900038 6,250
Cauterisation Cryo Attending Doctor investigations
Gynaecology
Surgery

731 9 and SS00900039 curretage) + Cervical 5,000
Gynaecology polypectomy

732 9 and SS00900040 curretage) +Bartholin 5,000
Gynaecology abscess I & D

733 9 and SS00900041 curretage) + Ablation of 7,500
Gynaecology Endometrium
Obstertics Cervical polypectomy +

734 9 and SS00900042 Cystocele - Anterior 12,500
Gynaecology repair
80
Ablation of
Obstertics
Endometriotic Spot As Advised by Attending Includes standard
735 9 and SS00900043 15,000
+Cystocele - Anterior Doctor investigations
Gynaecology
repair
Obstertics Abdomonal open for

736 9 and SS00900044 stress incision+Cystocele 16,000
Gynaecology - Anterior repair
Obstertics Bartholin abscess I & D

737 9 and SS00900045 +Cyst -Vaginal 5,000
Gynaecology Enucleation
Obstertics
Bartholin cyst removal + As Advised by Attending Includes standard
738 9 and SS00900046 5,000
cervical polypectomy Doctor investigations
Gynaecology
Obstertics
Bartholin abscess I & D + As Advised by Attending Includes standard
739 9 and SS00900047 4,500
cervical polypectomy Doctor investigations
Gynaecology
Gynaecology +Adhenolysis
Obstertics
741 9 and SS00900049 Radical vulvectomy 25,000
Gynaecology
Obstertics
Operation for stress As Advised by Attending Includes standard
742 9 and SS00900050 9,200
incontinence Doctor investigations
Gynaecology
Obstertics
Colpollaisis/Colporrhoph As Advised by Attending Includes standard
743 9 and SS00900051 75,000
y Doctor investigations
Gynaecology
Obstertics
744 9 and SS00900052 Colopotomy 4,000
Gynaecology
Obstertics
745 9 and SS00900053 Cone Biopsy Cervix 5,000
Gynaecology
81
Obstertics
746 9 and SS00900054 Cervical biopsy 2,500
Gynaecology
Obstertics Abdominal perineal neo

747 9 and SS00900055 construction 12,000
Gynaecology Cx+Uteria+Vagina
Cystocele - Anterior
Obstertics
Repair + Perineal Tear As Advised by Attending Includes standard
748 9 and SS00900056 13,500
Repair + Doctor investigations
Gynaecology
Salpingoophrectomy
Hysterectomy
(Abdominal and Vaginal)
Obstertics
+ Cystocele - Anterior As Advised by Attending Includes standard
749 9 and SS00900057 20,000
Repair + Perineal Tear Doctor investigations
Gynaecology
Repair +
Salpingoophrectomy*
Hysterectomy
Obstertics (Abdominal and Vaginal)
750 9 and SS00900058 + Cystocele - Anterior 20,000
Gynaecology Repair +
Salpingoophrectomy*
82
Hysterectomy
Obstertics (Abdominal and Vaginal)
751 9 and SS00900059 + Cystocele - Anterior 20,000
Gynaecology Repair + Perineal Tear
Repair*
Obstertics
Perineal Tear Repair + As Advised by Attending Includes standard
752 9 and SS00900060 7,000
Salpingoophrectomy Doctor investigations
Gynaecology
Obstertics Cystocele - Anterior

753 9 and SS00900061 Repair + 10,000
Gynaecology Salpingoophrectomy
Obstertics Cystocele - Anterior

754 9 and SS00900062 Repair + Perineal Tear 7,500
Gynaecology Repair
Obstertics Hysterectomy
755 9 and SS00900063 (Abdominal and Vaginal) 15,000
Gynaecology + Salpingoophrectomy*
Obstertics Hysterectomy
756 9 and SS00900064 (Abdominal and Vaginal) 15,000
Gynaecology + Perineal Tear Repair*
83
Hysterectomy
Obstertics
(Abdominal and Vaginal) As Advised by Attending Includes standard
757 9 and SS00900065 15,000
+ Cystocele - Anterior Doctor investigations
Gynaecology
Repair*
Obstertics Ovarian Cystectomy +

758 9 and SS00900066 Hysterectomy - 13,000
Gynaecology abdominal*
759 9 and SS00900067 Endometrium + D&C ( 7,500
Gynaecology Dilatation & curretage)
Obstertics
760 9 and SS00900068 Puerperal Sepsis 7,500
Gynaecology
Obstertics
Normal Delivery + As Advised by Attending Includes standard
761 9 and SS00900069 7,500
Tubectomy Doctor investigations
Gynaecology
Obstertics
Pre-eclampsia + Normal As Advised by Attending Includes standard
762 9 and SS00900070 7,500
Delivery Doctor investigations
Gynaecology
Obstertics
Pre-eclampsia + As Advised by Attending Includes standard
763 9 and SS00900071 15,000
Caesearen Delivery Doctor investigations
Gynaecology
Obstertics
Casearean delivery + As Advised by Attending Includes standard
764 9 and SS00900072 15,000
Tubectomy Doctor investigations
Gynaecology
Obstertics
Shirodhkar Mc. Donalds 1 Day / As Advised by Includes standard
765 9 and SS00900073 5,000
stich Attending Doctor investigations
Gynaecology
Obstertics
Salphingo- As Advised by Attending Includes standard
766 9 and SS00900074 7,000
oophorectomy Doctor investigations
Gynaecology
Obstertics Rupture Uterus , closer
767 9 and SS00900075 and repoar with tubal 15,000
Gynaecology ligation
84
Obstertics
Repair of post coital 1 Day / As Advised by Includes standard
768 9 and SS00900076 5,000
tear, perineal injury Attending Doctor investigations
Gynaecology
Obstertics Perforamtion of Uterus

769 9 and SS00900077 after D/E laprotomy and 15,000
Gynaecology closure
Obstertics
Nomal delivery with As Advised by Attending Includes standard
770 9 and SS00900078 7,000
episiosty and P repair Doctor investigations
Gynaecology
Obstertics
Manual removel of As Advised by Attending Includes standard
771 9 and SS00900079 3,000
Plecenta Doctor investigations
Gynaecology
Obstertics Manual removel of
772 9 and SS00900080 Plecenta for outside 4,000
Gynaecology delivery etc.
Obstertics
Lower Segment As Advised by Attending Includes standard
773 9 and SS00900081 15,000
Caesarean Section Doctor investigations
Gynaecology
Obstertics
Low midcavity forceps + As Advised by Attending Includes standard
774 9 and SS00900082 7,500
Normal delivery Doctor investigations
Gynaecology
Obstertics
Low Forceps+ Normal As Advised by Attending Includes standard
775 9 and SS00900083 6,000
delivery Doctor investigations
Gynaecology
Obstertics
Laprotomy for ectopic As Advised by Attending Includes standard
776 9 and SS00900084 10,000
repture Doctor investigations
Gynaecology
Obstertics
Laprotomy -failed As Advised by Attending Includes standard
777 9 and SS00900085 10,000
laproscopy to explore Doctor investigations
Gynaecology
Obstertics
Laproscopy As Advised by Attending Includes standard
778 9 and SS00900086 7,500
Salpingoplasty/ ligation Doctor investigations
Gynaecology
Obstertics
779 9 and SS00900087 Insertion of IUD Device 1,000
Gynaecology
85
Obstertics
Hysterectomy- As Advised by Attending Includes standard
780 9 and SS00900088 15,000
Laproscopy* Doctor investigations
Gynaecology
Obstertics
781 9 and SS00900089 Destructive operation 7,500
Gynaecology
Obstertics
D&C ( Dilatation & 1 Day / As Advised by Includes standard
782 9 and SS00900090 4,000
curretage)upto 8 wks Attending Doctor investigations
Gynaecology
Obstertics
D&C ( dilatation & 1 Day / As Advised by Includes standard
783 9 and SS00900091 5,000
Curretage) upto 12 wks Attending Doctor investigations
Gynaecology
Obstertics
D&C ( Dilatation & 1 Day / As Advised by Includes standard
784 9 and SS00900092 6,000
curetage ) > 12 wks Attending Doctor investigations
Gynaecology
Obstertics
Conventional 1 Day / As Advised by Includes standard
785 9 and SS00900093 3,000
Tubectomy Attending Doctor investigations
Gynaecology
Obstertics
Caesarean+ As Advised by Attending Includes standard
786 9 and SS00900094 17,000
Hysterectomy* Doctor investigations
Gynaecology
Obstertics
787 9 and SS00900095 Normal Delivery 5,000
Gynaecology
Obstertics
788 9 and SS00900096 Vulval Tumors - Removal 7,500
Gynaecology
Obstertics
789 9 and SS00900097 Vulvectomy 10,000
Gynaecology
Obstertics
790 9 and SS00900098 Vaginal Tear -Repair 3,500
Gynaecology
Obstertics
791 9 and SS00900099 Tuboplasty 15,000
Gynaecology
Obstertics
Retro Vaginal Fistula - As Advised by Attending Includes standard
792 9 and SS00900100 15,000
Repair Doctor investigations
Gynaecology
Obstertics
Prolapse Uterus - As Advised by Attending Includes standard
793 9 and SS00900101 15,000
Manchester Doctor investigations
Gynaecology
86
Obstertics
794 9 and SS00900102 Prolapse Uterus -L forts 13,000
Gynaecology
Obstertics
795 9 and SS00900103 Perineal Tear Repair 5,000
Gynaecology
Obstertics
Ovarectomy/Oophrecto As Advised by Attending Includes standard
796 9 and SS00900104 8,000
my Doctor investigations
Gynaecology
Obstertics
Myomectomy - As Advised by Attending Includes standard
797 9 and SS00900105 12,000
Abdominal Doctor investigations
Gynaecology
Obstertics
Hysterectomy - As Advised by Attending Includes standard
798 9 and SS00900106 25,000
Wertheims operation* Doctor investigations
Gynaecology
Obstertics
799 9 and SS00900107 Hysterectomy - Vaginal* 15,000
Gynaecology
Obstertics
Hysterectomy - As Advised by Attending Includes standard
800 9 and SS00900108 15,000
abdominal* Doctor investigations
Gynaecology
Obstertics
Hymenectomy & Repair As Advised by Attending Includes standard
801 9 and SS00900109 5,000
of Hymen Doctor investigations
Gynaecology
Obstertics
Haemato Colpo/Excision As Advised by Attending Includes standard
802 9 and SS00900110 7,000
- Vaginal Septum Doctor investigations
Gynaecology
Obstertics
803 9 and SS00900111 Gilliams Operation 7,000
Gynaecology
Obstertics
804 9 and SS00900112 Fractional Curretage 5,000
Gynaecology
Obstertics
Electro Cauterisation As Advised by Attending Includes standard
805 9 and SS00900113 5,000
Cryo Surgery Doctor investigations
Gynaecology
Obstertics
D&C ( Dilatation & As Advised by Attending Includes standard
806 9 and SS00900114 4,000
curretage) Doctor investigations
Gynaecology
Obstertics
Cystocele - Anterior As Advised by Attending Includes standard
807 9 and SS00900115 7,000
repair Doctor investigations
Gynaecology
Obstertics
808 9 and SS00900116 Ovarian Cystectomy 8,000
Gynaecology
87
Obstertics
Cyst -Vaginal 1 Day / As Advised by Includes standard
809 9 and SS00900117 5,000
Enucleation Attending Doctor investigations
Gynaecology
Obstertics
810 9 and SS00900118 Cyst - Labial 5,000
Gynaecology
Obstertics
811 9 and SS00900119 Cervical Polypectomy 3,500
Gynaecology
Obstertics
812 9 and SS00900120 Bartholin cyst removal 5,000
Gynaecology
Obstertics
Abdomonal open for As Advised by Attending Includes standard
813 9 and SS00900121 13,000
stress incision Doctor investigations
Gynaecology
Obstertics
814 9 and SS00900122 Vulvectomy -Simple 15,000
Gynaecology
Obstertics
815 9 and SS00900123 Vulvectomy-Radical 20,000
Gynaecology
Obstertics
816 9 and SS00900124 RVF Repair 18,000
Gynaecology
Obstertics
817 9 and SS00900125 Manchester Operations 15,000
Gynaecology
Obstertics
818 9 and SS00900126 Perineorrhaphy 12,000
Gynaecology
Obstertics
Colporrhaphy with As Advised by Attending Includes standard
819 9 and SS00900127 15,000
mesh. Doctor investigations
Gynaecology
Obstertics
Colporrhaphy without As Advised by Attending Includes standard
820 9 and SS00900128 12,000
mesh. Doctor investigations
Gynaecology
Obstertics
821 9 and SS00900129 Enterocoel repair 10,000
Gynaecology
88
Shirodkars sling
Obstertics
Operation or other sling As Advised by Attending Includes standard
822 9 and SS00900130 15,000
operations for prolapse Doctor investigations
Gynaecology
uterus
Obstertics Laparoscopic sling

823 9 and SS00900131 operations for prolapse 15,000
Gynaecology uterus
Obstertics
824 9 and SS00900132 Diagnostic Curettage 2,500
Gynaecology
Obstertics
825 9 and SS00900133 Fractiol Curettage 3,000
Gynaecology
Obstertics
D & C and Cervical 1 Day / As Advised by Includes standard
826 9 and SS00900134 3,000
Biopsy Attending Doctor investigations
Gynaecology
Obstertics
827 9 and SS00900135 Polypectomy 2,000
Gynaecology
Obstertics
Other-Minor Operation 1 Day / As Advised by Includes standard
828 9 and SS00900136 2,000
Endometrial Attending Doctor investigations
Gynaecology
Obstertics
Excision Vagil 1 Day / As Advised by Includes standard
829 9 and SS00900137 3,000
Cyst/Burtholin Cyst Attending Doctor investigations
Gynaecology
Obstertics
830 9 and SS00900138 Excision Vagil Septum 4,500
Gynaecology
Obstertics
Laparoscopy -Diagnostic 1 Day / As Advised by Includes standard
831 9 and SS00900139 7,000
with chromopertubation Attending Doctor investigations
Gynaecology
89
Obstertics
Laparoscopy 1 Day / As Advised by Includes standard
832 9 and SS00900140 5,000
Sterilisation Attending Doctor investigations
Gynaecology
Obstertics
833 9 and SS00900141 Laparoscopy Operative 10,000
Gynaecology
Obstertics
834 9 and SS00900142 Laparoscopy LAVH 13,000
Gynaecology
Obstertics
Total laparscopic As Advised by Attending Includes standard
835 9 and SS00900143 22,000
hysterectomy Doctor investigations
Gynaecology
Obstertics
836 9 and SS00900144 Drilling of Overy 7,000
Gynaecology
Obstertics Laparascopic treatment

837 9 and SS00900145 of Ectopic pregncy- 10,000
Gynaecology salpingectomy
Obstertics
Laparotomy treatment As Advised by Attending Includes standard
838 9 and SS00900146 13,000
of Ectopic pregncy. Doctor investigations
Gynaecology
Obstertics
839 9 and SS00900147 Conisation of cervix 5,000
Gynaecology
Obstertics
Trachleorraphy of cervix As Advised by Attending Includes standard
840 9 and SS00900148 10,000
for early CA cervix Doctor investigations
Gynaecology
Obstertics
Hysteroscopic 1 Day / As Advised by Includes standard
841 9 and SS00900149 7,500
cannulation Attending Doctor investigations
Gynaecology
Laparotomy
Obstertics
recannulation of As Advised by Attending Includes standard
842 9 and SS00900150 16,000
Fellopian tubes- Doctor investigations
Gynaecology
(Tubuloplasty)
90
Laparoscopic
Obstertics
recannulation of As Advised by Attending Includes standard
843 9 and SS00900151 20,000
Fellopian tubes- Doctor investigations
Gynaecology
(Tubuloplasty)
Obstertics
844 9 and SS00900152 Colposcopy 3,000
Gynaecology
Obstertics LEETZ(Large Loop

845 9 and SS00900153 Excision of 6,000
Gynaecology Transformation Zone)
Obstertics
Loop Electro Surgical As Advised by Attending Includes standard
846 9 and SS00900154 6,000
procedures. Doctor investigations
Gynaecology
Obstertics
847 9 and SS00900155 Chorionic Villi sampling 4,000
Gynaecology
Obstertics
Interventiol 1 Day / As Advised by Includes standard
848 9 and SS00900156 1,500
Ultrasonography Attending Doctor investigations
Gynaecology
Obstertics
849 9 and SS00900157 Amneocentosis 4,000
Gynaecology
Obstertics
Hysteroscopic As Advised by Attending Includes standard
850 9 and SS00900158 10,000
endometrial ablation Doctor investigations
Gynaecology
Obstertics
851 9 and SS00900159 Thermal ballon ablation. 10,000
Gynaecology
Obstertics
Ultrasonographic As Advised by Attending Includes standard
852 9 and SS00900160 6,000
myolysis Doctor investigations
Gynaecology
Obstertics
Laparoscopic As Advised by Attending Includes standard
853 9 and SS00900161 8,000
cystectomy Doctor investigations
Gynaecology
91
Obstertics
854 9 and SS00900162 Intra Uterine Insemition 1,200
Gynaecology
Obstertics
Laparotomy abdomil As Advised by Attending Includes standard
855 9 and SS00900163 20,000
scaro-colpopexy Doctor investigations
Gynaecology
Obstertics
Laparotomy Vault As Advised by Attending Includes standard
856 9 and SS00900164 15,000
suspension Doctor investigations
Gynaecology
Obstertics
Laparscopic abdomil As Advised by Attending Includes standard
857 9 and SS00900165 21,000
scaro-colpopexy Doctor investigations
Gynaecology
Obstertics
Laparoscopic Vault As Advised by Attending Includes standard
858 9 and SS00900166 18,000
suspension Doctor investigations
Gynaecology
Obstertics
Laparotomy radical As Advised by Attending Includes standard
859 9 and SS00900167 22,000
Lymphedenectomy Doctor investigations
Gynaecology
Obstertics
Laparoscopic radical As Advised by Attending Includes standard
860 9 and SS00900168 25,000
Lymphedenectomy Doctor investigations
Gynaecology
Obstertics
Endometrial aspiration As Advised by Attending Includes standard
861 9 and SS00900169 700
cytology Doctor investigations
Gynaecology
Obstertics Transvagil sonography

862 9 and SS00900170 (TVS for Follicular 600
Gynaecology monitioringaspiration)
Obstertics
laparoscopic treatment As Advised by Attending Includes standard
863 9 and SS00900171 10,000
for stress incontinence Doctor investigations
Gynaecology
92
Obstertics
Transvagil tubes for As Advised by Attending Includes standard
864 9 and SS00900172 12,000
Stress incontinence Doctor investigations
Gynaecology
Obstertics
trans-obturator tubes As Advised by Attending Includes standard
865 9 and SS00900173 10,000
for Stress incontinence Doctor investigations
Gynaecology
Obstertics Interventiol
866 9 and SS00900174 radiographic arterial 5,000
Gynaecology embolisation
Obstertics
867 9 and SS00900175 Diagnosticcystoscopy 2,500
Gynaecology
Obstertics
Staging laparotomy As Advised by Attending Includes standard
868 9 and SS00900176 6,000
surgery for CA Overy Doctor investigations
Gynaecology
Obstertics
869 9 and SS00900177 Interl Iliac ligation 15,000
Gynaecology
Obstertics
stepwise As Advised by Attending Includes standard
870 9 and SS00900178 12,000
devascularisation Doctor investigations
Gynaecology
Obstertics
871 9 and SS00900179 Assisted breech delivery 7,500
Gynaecology
Obstertics
872 9 and SS00900180 Cordocentesis 2,700
Gynaecology
Obstertics
Intra-uterine fetal blood As Advised by Attending Includes standard
873 9 and SS00900181
transfusion Doctor investigations
Gynaecology
Obstertics
874 9 and SS00900182 Hysteroscopy TCRE 10,000
Gynaecology
Obstertics
Hysteroscopy Removal As Advised by Attending Includes standard
875 9 and SS00900183 5,000
of IUCD Doctor investigations
Gynaecology
93
Obstertics
Hysteroscopy Removal As Advised by Attending Includes standard
876 9 and SS00900184 10,000
of Septum Doctor investigations
Gynaecology
Obstertics
877 9 and SS00900185 Hysteroscopy Diagnostic 8,000
Gynaecology
Obstertics
Werthimas Hystrectomy As Advised by Attending Includes standard
878 9 and SS00900186 25,000
for Cancer cervix Doctor investigations
Gynaecology
Obstertics
879 9 and SS00900187 Sterilisation Post ertum 4,000
Gynaecology
Obstertics
880 9 and SS00900188 Sterilisation Intravagil 4,000
Gynaecology
Obstertics
881 9 and SS00900189 Abortion- D & C 3,000
Gynaecology
Obstertics
882 9 and SS00900190 Abortion- Evacuation 3,000
Gynaecology
Obstertics
883 9 and SS00900191 MTP- 1st Trimester 3,000
Gynaecology
Obstertics
884 9 and SS00900192 MTP - 2nd Trimester 4,000
Gynaecology
Obstertics
885 9 and SS00900193 Triple test 1,500
Gynaecology
Obstertics
886 9 and SS00900194 Quadriple test 2,500
Gynaecology
Obstertics
1 Day / As Advised by
887 9 and SS00900195 Biophysical score 600
Attending Doctor
Gynaecology
94
Obstertics
Fetal nuechal 1 Day / As Advised by
888 9 and SS00900196 300
translucency Attending Doctor
Gynaecology
Obstertics
889 9 and SS00900197 HPV testing 500
Attending Doctor
Gynaecology
Obstertics
890 9 and SS00900198 BLCG 400
Attending Doctor
Gynaecology
Acute Severe Asthma

Medical As Advised by Attending Includes standard
891 10 SS01000001 with Acute Respiratory
Conditions Doctor investigations
Failure
Medical Copd Respiratory Failure As Advised by Attending Includes standard

892 10 SS01000002
Conditions (Infective Exacerbation) Doctor investigations
Acute Bronchitis and

893 10 SS01000003 Pneumonia with
Respiratory Failure

894 10 SS01000004 ARDS
Medical ARDS with Multi Organ As Advised by Attending Includes standard
895 10 SS01000005
Conditions Failure Doctor investigations
Medical ARDS Plus DIC (Blood & As Advised by Attending Includes standard
896 10 SS01000006
Conditions Blood Products) Doctor investigations
Medical OP Poisioning Requiring As Advised by Attending Includes standard

897 10 SS01000007
Conditions Ventilatory Assistance Doctor investigations
Medical Septic Shock (ICU As Advised by Attending Includes standard

898 10 SS01000008
Conditions Management) Doctor investigations
95
Metabolic Coma
899 10 SS01000009 Requiring Ventilatory
Support
Medical Thrombocytopenia with As Advised by Attending Includes standard

900 10 SS01000010
Conditions Bleeding Diathesis Doctor investigations

901 10 SS01000011 Hemophilia
Medical Other Coagulation As Advised by Attending Includes standard
902 10 SS01000012
Conditions Disorders Doctor investigations
Medical Chelation Therapy for As Advised by Attending Includes standard

903 10 SS01000013
Conditions Thalassemia Major Doctor investigations
Medical Snake Bite Requiring As Advised by Attending Includes standard

904 10 SS01000014
Conditions Ventilator Support Doctor investigations
Medical Scorpion Sting Requiring As Advised by Attending Includes standard

905 10 SS01000015
Conditions Ventilator Support Doctor investigations
Medical Treatment for Sickle Cell As Advised by Attending Includes standard

906 10 SS01000016
Conditions Anemia Doctor investigations
907 10 SS01000017 Tetanus Severe
908 10 SS01000018 Diphtheria Complicated
909 10 SS01000019 Cryptococcal Meningitis
910 10 SS01000020 Cerebral Malaria
96
911 10 SS01000021 Vitamin A deficiency
Medical Viral pneumonia, not As Advised by Attending Includes standard

912 10 SS01000022
Conditions elsewhere classified Doctor investigations

913 10 SS01000023 Viral meningitis
914 10 SS01000024 Viral fever
Medical Viral and other specified As Advised by Attending Includes standard

915 10 SS01000025
Conditions intestinal infections Doctor investigations

916 10 SS01000026 Vasculits
917 10 SS01000027 Urethritis - gonococcal
918 10 SS01000028 Urethritis - chlamydial
Medical Upper GI bleeding ( As Advised by Attending Includes standard

919 10 SS01000029
Conditions endoscopic treatment) Doctor investigations
Medical Upper GI bleeding ( As Advised by Attending Includes standard

920 10 SS01000030
Conditions conservative) Doctor investigations
Medical Unspecified viral As Advised by Attending Includes standard
921 10 SS01000031
Conditions hepatitis Doctor investigations
922 10 SS01000032 Unspecified malaria
Medical Unspecified diabetes As Advised by Attending Includes standard
923 10 SS01000033
Conditions mellitus Doctor investigations
Medical Unspecified chronic As Advised by Attending Includes standard
924 10 SS01000034
Conditions bronchitis Doctor investigations
97
Medical Typhoid and As Advised by Attending Includes standard
925 10 SS01000035
Conditions paratyphoid fevers Doctor investigations

926 10 SS01000036 Typhoid
927 10 SS01000037 Tubercular menigitis
928 10 SS01000038 Transforaminal Block
929 10 SS01000039 Trachoma
930 10 SS01000040 Tonsillitis
Medical Thrombocytopenia ( As Advised by Attending Includes standard

931 10 SS01000041
Conditions plus blood unit costs ) Doctor investigations

932 10 SS01000042 Tetanus
933 10 SS01000043 TB Meningitis
934 10 SS01000044 TB pulmonary
Medical Systenuc Lupus As Advised by Attending Includes standard
935 10 SS01000045
Conditions Erythematosis Doctor investigations
936 10 SS01000046 Syphillis
Medical Subarachnoid As Advised by Attending Includes standard

937 10 SS01000047
Conditions haemorrhage (ICU) Doctor investigations
Stroke, not specified as

938 10 SS01000048 haemorrhage or
infarction
98
939 10 SS01000049 Stroke
940 10 SS01000050 Staus asthamaticus
941 10 SS01000051 status epilepsy
Simple and
942 10 SS01000052 mucopurulent chronic
bronchitis
943 10 SS01000053 Septicemia
944 10 SS01000054 Septic shock
945 10 SS01000055 Scorpion sting
946 10 SS01000056 Schizophrenia
947 10 SS01000057 Scabies
Medical RTA Head Injury Mgt As Advised by Attending Includes standard

948 10 SS01000058
Conditions (conservative) Doctor investigations
Respiratory
Medical tuberculosis, As Advised by Attending Includes standard
949 10 SS01000059
Conditions bacteriologically and Doctor investigations
histologically confirmed
PUO
Management(would
950 10 SS01000060 include fevers -
viral/bacterial/fungal/inf
estation, etc)
99
951 10 SS01000061 Pneumothorax
Medical Pneumonia, organism As Advised by Attending Includes standard

952 10 SS01000062
Conditions unspecified Doctor investigations
Medical Pneumonia in diseases As Advised by Attending Includes standard

953 10 SS01000063
Conditions classified elsewhere Doctor investigations
Pneumonia due to
954 10 SS01000064 Streptococcus
pneumoniae
Pneumonia due to other

955 10 SS01000065 infectious organisms,
not elsewhere classified
Medical Pneumonia due to As Advised by Attending Includes standard

956 10 SS01000066
Conditions Haemophilus influenzae Doctor investigations

957 10 SS01000067 Pneumonia
Medical Plasmodium vivax As Advised by Attending Includes standard
958 10 SS01000068
Conditions malaria Doctor investigations
Medical Plasmodium malariae As Advised by Attending Includes standard
959 10 SS01000069
Medical Plasmodium falciparum As Advised by Attending Includes standard

960 10 SS01000070

961 10 SS01000071 Plague
962 10 SS01000072 Pertussis
100
Medical Peripheral neuritis/ As Advised by Attending Includes standard
963 10 SS01000073
Conditions neuropathy Doctor investigations
Ozone
Therapy(Intradiscal
Medical Paraspinal package As Advised by Attending Includes standard
964 10 SS01000074
Conditions inculde admission one Doctor investigations
day + 4 follow up
procedure)
Medical Ozone Therapy + Nerve As Advised by Attending Includes standard

965 10 SS01000075
Conditions Block Doctor investigations
Other nontraumatic
966 10 SS01000076 intracranial
haemorrhage
Other Coagulation
967 10 SS01000077 disorders ( plus blood
tranfusion units costs)
Other bacterial
968 10 SS01000078 foodborne intoxications,
not elsewhere classified
Medical Other acute viral As Advised by Attending Includes standard

969 10 SS01000079
Conditions hepatitis Doctor investigations
970 10 SS01000080 Organ transplant
971 10 SS01000081 Orchititis
101
Medical Non-insulin-dependent As Advised by Attending Includes standard
972 10 SS01000082
Conditions diabetes mellitus Doctor investigations

973 10 SS01000083 Nephrotic syndrom
Neonatal jaundice from

974 10 SS01000084 other and unspecified
causes
Neonatal jaundice due

975 10 SS01000085 to other excessive
haemolysis

976 10 SS01000086 Myalgia
977 10 SS01000087 Multiple fractures
Medical Mngt of Ischemic As Advised by Attending Includes standard
978 10 SS01000088
Conditions Strokes Doctor investigations
Medical Mngt of Hemorrhagic As Advised by Attending Includes standard

979 10 SS01000089
Conditions Stroke/Strokes Doctor investigations

980 10 SS01000090 Meningitis
Medical Measles - As Advised by Attending Includes standard
981 10 SS01000091
Conditions uncomplicated Doctor investigations
982 10 SS01000092 Measles - complicated
Medical Management of As Advised by Attending Includes standard
983 10 SS01000093
Conditions Pneumothorax Doctor investigations
Medical Malnutrition-related As Advised by Attending Includes standard

984 10 SS01000094
Conditions diabetes mellitus Doctor investigations
102
985 10 SS01000095 Malaria -cerebral
986 10 SS01000096 Malaria - uncomplicated
987 10 SS01000097 Malaria - complicated
988 10 SS01000098 Lung abscess /Empema
989 10 SS01000099 LRTI management
990 10 SS01000100 Localised cellulilits
991 10 SS01000101 Leptospirosis
Medical Leprosy Ulcer Care With As Advised by Attending Includes standard
992 10 SS01000102
Conditions Stay Doctor investigations
Medical Leprosy Reaction & As Advised by Attending Includes standard

993 10 SS01000103
Conditions Neuritis (T1R & T2R) Doctor investigations
Medical Intracerebral As Advised by Attending Includes standard

994 10 SS01000104
Conditions haemorrhage (ICU) Doctor investigations
Medical Intraarticular Steroid As Advised by Attending Includes standard

995 10 SS01000105
Conditions knee package of5 sitting Doctor investigations
Medical Intraarticular Ozone As Advised by Attending Includes standard

996 10 SS01000106
Conditions Knee package of 5sitting Doctor investigations

997 10 SS01000107 Interstial lung diseases
103
Insulin-dependent
998 10 SS01000108 diabetes mellitus-Acute
episode
Medical Hyper Osmolar Non As Advised by Attending Includes standard

999 10 SS01000109
Conditions Ketotic Coma Doctor investigations
1000 10 SS01000110 Herpes Simplex
1001 10 SS01000111 Hepatis B
1002 10 SS01000112 colitis
Medical Hemiplegia / As Advised by Attending Includes standard
1003 10 SS01000113
Conditions quadriplegia Doctor investigations
1004 10 SS01000114 Heat stroke
Gestational [pregnancy-
Medical induced] hypertension As Advised by Attending Includes standard
1005 10 SS01000115
Conditions without significant Doctor investigations
proteinuria
Gestational [pregnancy-
Medical induced] hypertension As Advised by Attending Includes standard
1006 10 SS01000116
Conditions with significant Doctor investigations
proteinuria

1007 10 SS01000117 Food poisoning
1008 10 SS01000118 Filariasis
104
Medical Essential (primary) As Advised by Attending Includes standard
1009 10 SS01000119
Conditions hypertension Doctor investigations
Epiduro-fluroscopy
1010 10 SS01000120 Adhesiolysis (3 days
stay)

1011 10 SS01000121 Enteric fever
1012 10 SS01000122 Endocarditis
Medical Emphysema Acute As Advised by Attending Includes standard
1013 10 SS01000123
Conditions Exacerbation Doctor investigations
Medical Dysfunctional uterine As Advised by Attending Includes standard
1014 10 SS01000124
Conditions bleeding Doctor investigations
1015 10 SS01000125 Dysentery - bacterial
1016 10 SS01000126 Diphtheria
Diarrhoea and
Medical gastroenteritis of As Advised by Attending Includes standard
1017 10 SS01000127
Conditions presumed infectious Doctor investigations
origin
Dengue h'agic fever (

1018 10 SS01000128 plus packed cell
transfusion)
Medical Dengue haemorrhagic As Advised by Attending Includes standard

1019 10 SS01000129
Conditions fever Doctor investigations
Medical Dengue fever [classical As Advised by Attending Includes standard

1020 10 SS01000130
Conditions dengue Doctor investigations
105
1021 10 SS01000131 Dengue fever
Medical COPD+ Respiratory As Advised by Attending Includes standard

1022 10 SS01000132
Conditions Failure Doctor investigations
Medical Control of diabetic As Advised by Attending Includes standard

1023 10 SS01000133
Conditions ketoacidosis Doctor investigations

1024 10 SS01000134 Conjunctivitis (bacterial)
Medical Accidental orgono As Advised by Attending Includes standard

1025 10 SS01000135
Conditions phosphorus poisoining Doctor investigations

1026 10 SS01000136 Acid peptic disease
1027 10 SS01000137 Acute astahamic attack
1028 10 SS01000138 Acute colitis
Acute diarrhea with

1029 10 SS01000139 severe dehydration (
grade 2 and above)
Medical Acute diarrohea with As Advised by Attending Includes standard

1030 10 SS01000140
Conditions moderate dehydration Doctor investigations
Medical Acute Exarcebation of As Advised by Attending Includes standard

1031 10 SS01000141
Conditions COPD Doctor investigations

1032 10 SS01000142 Acute hepatitis A
106
1033 10 SS01000143 Acute hepatitis B
Medical Acute Hytension - As Advised by Attending Includes standard

1035 10 SS01000145
Conditions medical management Doctor investigations
Medical Acute meningitis - As Advised by Attending Includes standard

1036 10 SS01000146
Conditions fungal Doctor investigations
Medical Acute meningitis - As Advised by Attending Includes standard
1037 10 SS01000147
Conditions pyogenic Doctor investigations
1038 10 SS01000148 Acute otitis media
1039 10 SS01000149 Acute Pancreatitis
Medical Acute Pneumonia-/ As Advised by Attending Includes standard

1040 10 SS01000150
Conditions consolidation Bacterial Doctor investigations

1041 10 SS01000151 Acute renal colitis
Medical acute respiratory failure As Advised by Attending Includes standard

1042 10 SS01000152
Conditions ( including ventilator ) Doctor investigations
Medical Acute tubulo-interstitial As Advised by Attending Includes standard

1043 10 SS01000153
Conditions nephritis Doctor investigations

1044 10 SS01000154 Acute urinary infection
Medical Acute virall hepatitis ( As Advised by Attending Includes standard

1045 10 SS01000155
Conditions hepatitis A) Doctor investigations

1046 10 SS01000156 Amoebiasis
107
1047 10 SS01000157 Amoebic abscess - liver
Anemia Severe Hb less

1048 10 SS01000158 than 6 gm/dl ( plus
blood transfusion units )
Medical Aneurysm - resection As Advised by Attending Includes standard

1049 10 SS01000159
Conditions and grafting Doctor investigations

1050 10 SS01000160 Asthma Acute Status
Medical Bacterial pneumonia, As Advised by Attending Includes standard

1051 10 SS01000161
Conditions not elsewhere classified Doctor investigations

1052 10 SS01000162 Bronchiectasis
Medical Caudal Block As Advised by Attending Includes standard

1053 10 SS01000163
Conditions Therapeutic (Cervical) Doctor investigations
Medical Caudal Block As Advised by Attending Includes standard

1054 10 SS01000164
Conditions Therapeutic (Lumbar) Doctor investigations

1055 10 SS01000165 Cerebral infarction
Medical Chicken pox- As Advised by Attending Includes standard
1056 10 SS01000166
Conditions complicated Doctor investigations
1057 10 SS01000167 Chronic otitis media
1058 10 SS01000168 Chronic pancreatitis
108
Medical
Conditions /
General Ward Medical procedures As Advised by Attending Includes standard
1059 Other
:Unspecified rate -1500/day Doctor investigations
Unspecified
Conditions
ICU-designated air
conditioned space, with
Standard ICU bed,
Medical
equipment for the
Conditions /
constant monitoring for Medical procedures Includes standard
1060 Other
vitals, emergency crash rate -3000/day investigations
Unspecified
cart/tray, defibrillator,
Conditions
ventilators, suction
pumps, bedside oxygen
facility.
Medical
Conditions /
1061 Other As per pre-authorization
Unspecified
Conditions
Neuro- Nerve Biopsy excluding As Advised by Attending Includes standard
1062 11 SS01100001 5,000
Surgery Hensens Doctor investigations
Neuro- As Advised by Attending Includes standard

1063 11 SS01100002 Depressed Fracture 20,000
1064 11 SS01100003 Brain Biopsy 15,000
Neuro- Tumours - As Advised by Attending Includes standard
1065 11 SS01100004 50,000
Surgery Supratentorial Doctor investigations
1066 11 SS01100005 Trans Sphenoidal 25,000
109
Neuro- Spine - Intradural As Advised by Attending Includes standard
1067 11 SS01100006 25,000
Surgery Tumour Doctor investigations
Neuro- Spine - Extradural As Advised by Attending Includes standard
1068 11 SS01100007 22,000
Surgery Tumour Doctor investigations
Neuro- Spine - Disc As Advised by Attending Includes standard
1069 11 SS01100008 20,000
Surgery Cervical/Lumber Doctor investigations
1070 11 SS01100010 Spine - Canal Stenosis 20,000
1071 11 SS01100011 Skull Traction 10,000
Neuro- Spina Bifida - Small - As Advised by Attending Includes standard
1072 11 SS01100013 30,000
Neuro- Spina Bifida - Large - As Advised by Attending Includes standard
1073 11 SS01100014 40,000
Neuro- Repair & Transposition As Advised by Attending Includes standard

1074 11 SS01100015 15,000
Surgery Nerve Doctor investigations
Neuro- Posterior Fossa - As Advised by Attending Includes standard

1075 11 SS01100016 35,000
Surgery Decompression Doctor investigations
Neuro- Microdiscectomy - As Advised by Attending Includes standard
1076 11 SS01100017 20,000
Surgery Lumber Doctor investigations
1077 11 SS01100019 Meningococle Ocipital 30,000
1078 11 SS01100020 Meningocele - Lumbar 30,000
1079 11 SS01100021 Meningocele - Anterior 45,000
1080 11 SS01100022 Lumbar Disc 20,000
Neuro- Haematoma - Brain As Advised by Attending Includes standard

1081 11 SS01100024 35,000
Surgery (hypertensive) Doctor investigations
110
Neuro- Haematoma - Brain As Advised by Attending Includes standard
1082 11 SS01100025 35,000
Surgery (head injuries) Doctor investigations
Neuro- Cerebrospinal Fluid As Advised by Attending Includes standard

1083 11 SS01100026 30,000
Surgery (CSF) Rhinorrohea Doctor investigations

1084 11 SS01100027 Craniostenosis 25,000
1085 11 SS01100028 Cervical Ribs - Unilateral 20,000
1086 11 SS01100029 Cervical Ribs Bilateral 25,000
1087 11 SS01100030 Anterior Encephalocele 45,000
Craniotomy and
1088 11 SS01100031 Evacuation of 50,000
Haematoma -Subdural
Craniotomy and
1089 11 SS01100032 Evacuation of 50,000
Haematoma -Extradural
Evacuation /Excision of
1090 11 SS01100033 Brain Abscess by 50,000
craniotomy
Excision of Lobe (Frontal

1091 11 SS01100034 Temporal Cerebellum 55,000
etc.)
Neuro- Excision of Brain As Advised by Attending Includes standard

1092 11 SS01100035 55,000
Surgery Tumours -Supratentotial Doctor investigations
111
Neuro- Excision of Brain As Advised by Attending Includes standard
1093 11 SS01100036 55,000
Surgery Tumours -Infratentorial Doctor investigations
Neuro- Surgery of spil Cord As Advised by Attending Includes standard

1094 11 SS01100037 30,000
Surgery Tumours Doctor investigations
1095 11 SS01100038 Ventricular Tapping 3,000
1096 11 SS01100039 Theco-peritoneal Shunt 20,000
Neuro- Anterior Lateral As Advised by Attending Includes standard

1097 11 SS01100040 50,000
Surgery Decompression of spine Doctor investigations
Combined Trans-oral
1098 11 SS01100041 Surgery & CV Junction 100,000
Fusion
Neuro- Microsurgical excision of As Advised by Attending Includes standard

1099 11 SS01100042 50,000
Surgery Acoustic tomour Doctor investigations
Neuro- Microsurgical excision of As Advised by Attending Includes standard

1100 11 SS01100043 50,000
Surgery meningomas Doctor investigations
Microsurgical
1101 11 SS01100044 decompression for 45,000
Trigemil nerve
Surgery for intracranial

1102 11 SS01100045 Arteriovenous 45,000
malformarions(AVM)
Neuro- 4 vessels cerebral As Advised by Attending Includes standard

1103 11 SS01100046 15,000
Surgery angiography Doctor investigations
Neuro- Foramen magnum As Advised by Attending Includes standard
1104 11 SS01100047 13,000
Surgery decompression Doctor investigations
112
Foramen magnum
Neuro- decompression with As Advised by Attending Includes standard
1105 11 SS01100048 35,000
Surgery syringosubarachnoid Doctor investigations
shunt
Surgery for recurrent

1106 11 SS01100049 disc prolapse/epidural 35,000
fibrosis
Neuro- Surgery for brain stem As Advised by Attending Includes standard

1107 11 SS01100050 45,000
Surgery tumours Doctor investigations
1108 11 SS01100051 Programmable shunts
Decompressive
cranectomy for
Neuro- hemishpherical acute As Advised by Attending Includes standard
1109 11 SS01100052 52,000
Surgery subdural Doctor investigations
haematoma/brain
swelling/large infarct
Neuro- ADEM or Relapse in As Advised by Attending Includes standard

1110 12 SS01200001 30,000
Medicine Multiple Sclerosis Doctor investigations

1111 12 SS01200002 Neuropathies (GBS) 50,000
Medicine Doctor investigations
1112 12 SS01200003 Optic Neuritis 20,000
Chronic Inflammatory
1113 12 SS01200005 Demyelinating Poly 20,000
Neuropathy (CIDP)
113
Neuro- Hemorrhagic As Advised by Attending Includes standard
1114 12 SS01200006 50,000
Medicine Stroke/Strokes Doctor investigations
1115 12 SS01200007 Ischemic Strokes 40,000
1116 12 SS01200008 Myopathies - Acquired 30,000
Neuro- Neuromuscular As Advised by Attending Includes standard

1117 12 SS01200009 30,000
Medicine (Myasthenia Gravis) Doctor investigations
Neuro- Neuroinfections - As Advised by Attending Includes standard

1118 12 SS01200010 40,000
Medicine Pyogenic Meningitis Doctor investigations

1119 12 SS01200011 Tb Meningitis 50,000
Neuroinfections -Viral
Neuro- Meningoencephalitis As Advised by Attending Includes standard
1120 12 SS01200012 40,000
Medicine (Includingherpes Doctor investigations
Encephalitis)
Neuro- Fungal Meningitis (Min As Advised by Attending Includes standard

1121 12 SS01200013 60,000
Medicine 20 Days In ICU) Doctor investigations

1122 12 SS01200014 Management of Coma 50,000
1123 13 Orthopaedics SS01300001 Removal of Plaster 1,200
Doctor
Stitch Removal & 1 Day / As Advised by

1124 13 Orthopaedics SS01300002 1,500
Dressing Attending Doctor
Antiseptic dressing of 1 Day / As Advised by Includes standard

1125 13 Orthopaedics SS01300003 1,500
wound Attending Doctor investigations
114
Collar & Cuff sling or 1 Day / As Advised by Includes standard
1126 13 Orthopaedics SS01300004 2,200
Figure of 8 bandage Attending Doctor investigations
Strapping of toes / 1 Day / As Advised by Includes standard

1127 13 Orthopaedics SS01300005 2,000
fingers Attending Doctor investigations

1128 13 Orthopaedics SS01300006 Arm-chest strapping 3,500

1129 13 Orthopaedics SS01300007 Aspiration of joint 5,000
Intra-articular / Local 1 Day / As Advised by Includes standard

1130 13 Orthopaedics SS01300008 6,000
injection Attending Doctor investigations

1131 13 Orthopaedics SS01300009 Below elbow POP slab 4,000
Above elbow POP slab / 1 Day / As Advised by Includes standard

1132 13 Orthopaedics SS01300010 5,000
U slab Attending Doctor investigations

1133 13 Orthopaedics SS01300011 Below knee POP slab 5,000

1134 13 Orthopaedics SS01300012 Above knee POP slab 5,500

1135 13 Orthopaedics SS01300013 Below elbow POP cast 8,000
Above elbow POP cast / 1 Day / As Advised by Includes standard

1136 13 Orthopaedics SS01300014 11,000
Hanging arm cast Attending Doctor investigations
115
1137 13 Orthopaedics SS01300015 Below knee POP c ast 9,000
Above knee POP cast / 1 Day / As Advised by Includes standard

1138 13 Orthopaedics SS01300016 12,000
Cylinder POP cast Attending Doctor investigations
Functional cast bracing / 1 Day / As Advised by Includes standard

1139 13 Orthopaedics SS01300017 15,000
PTB cast Attending Doctor investigations

1140 13 Orthopaedics SS01300018 POP shoulder spica 20,000

1141 13 Orthopaedics SS01300019 POP hip spica 20,000
Derotation boot plaster 1 Day / As Advised by Includes standard

1142 13 Orthopaedics SS01300020 4,500
/ Broomstick plaster Attending Doctor investigations
CTEV manipulation & 1 Day / As Advised by Includes standard

1143 13 Orthopaedics SS01300021 4000 per sitting
plaster Attending Doctor investigations
CTEV manipulation
1144 13 Orthopaedics SS01300022 under anaesthesia & 6000 per sitting
plaster
MUA of dislocation of As Advised by Attending Includes standard

1145 13 Orthopaedics SS01300023 12,000
major joints Doctor investigations
MUA of dislocation of As Advised by Attending Includes standard

1146 13 Orthopaedics SS01300024 8,000
small joints Doctor investigations
116
MUA of fracture of long As Advised by Attending Includes standard
1147 13 Orthopaedics SS01300025 15,000
bones Doctor investigations
MUA of fracture of small As Advised by Attending Includes standard
1148 13 Orthopaedics SS01300026 8,000
bones Doctor investigations
Surface traction / splint As Advised by Attending Includes standard
1149 13 Orthopaedics SS01300027 6,000
application Doctor investigations
1150 13 Orthopaedics SS01300028 Skeletal traction 8,000
Arthrotomy /
1151 13 Orthopaedics SS01300029 synovectomy of major 18,000
joints
Arthrotomy of small As Advised by Attending Includes standard
1152 13 Orthopaedics SS01300030 8,000
joints Doctor investigations
Incisional drainage of As Advised by Attending Includes standard

1153 13 Orthopaedics SS01300031 18,000
abscess / haematoma Doctor investigations
Debridement of major
1154 13 Orthopaedics SS01300032 wound / Fasciotomy 35,000
/Arthrolysis
Debridement of minor As Advised by Attending Includes standard

1155 13 Orthopaedics SS01300033 20,000
wound Doctor investigations
Amputation /
1156 13 Orthopaedics SS01300034 Disarticulation of fingers 20,000
& toes
Amputation /
Disarticulation of long As Advised by Attending Includes standard
1157 13 Orthopaedics SS01300035 40,000
bones, major joint, foot Doctor investigations
or hand
Forequarter / As Advised by Attending Includes standard

1158 13 Orthopaedics SS01300036 55,000
Hindquarter amputation Doctor investigations
117
Arthrodesis of small As Advised by Attending Includes standard
1159 13 Orthopaedics SS01300037 25,000
joints Doctor investigations
Arthrodesis of major As Advised by Attending Includes standard

1160 13 Orthopaedics SS01300038 45,000
joints including subtalar Doctor investigations
Soft tissue release /

Tenotomy / Tendon As Advised by Attending Includes standard
1161 13 Orthopaedics SS01300039 45,000
grafting / Tendon Doctor investigations
transfer
Sequestrectomy
1162 13 Orthopaedics SS01300040 saucerisation in chronic 45,000
osteomyelitis
External fixation As Advised by Attending Includes standard

1163 13 Orthopaedics SS01300041 38,000
pelvis Doctor investigations
Linear External fixation As Advised by Attending Includes standard

1164 13 Orthopaedics SS01300042 25,000
Small bone Doctor investigations
Linear External fixation As Advised by Attending Includes standard

1165 13 Orthopaedics SS01300043 42,000
long bone Doctor investigations

1166 13 Orthopaedics SS01300044 Ilizarov ring fixator 55,000
JESS Mini Ex-fix As Advised by Attending Includes standard
1167 13 Orthopaedics SS01300045 28,000
application Doctor investigations
Ex-fix application for As Advised by Attending Includes standard
1168 13 Orthopaedics SS01300046 52,000
CTEV Doctor investigations
Soft tissue / Bony As Advised by Attending Includes standard
1169 13 Orthopaedics SS01300047 45,000
surgery for CTEV Doctor investigations
Removal of implant As Advised by Attending Includes standard

1170 13 Orthopaedics SS01300048 42,000
major surgery Doctor investigations
118
Removal of implant As Advised by Attending Includes standard
1171 13 Orthopaedics SS01300049 15,000
minor surgery Doctor investigations
Open reduction of
1172 13 Orthopaedics SS01300050 dislocation of major 45,000
joint
Open reduction of As Advised by Attending Includes standard

1173 13 Orthopaedics SS01300051 25,000
dislocation of small joint Doctor investigations
Closed reduction &

1174 13 Orthopaedics SS01300052 internal fixation of long 52,000
bone (adult)
Closed reduction &

1175 13 Orthopaedics SS01300053 internal fixation of long 38,000
bone(paediatric)
Open reduction &

internal fixation of long As Advised by Attending Includes standard
1176 13 Orthopaedics SS01300054 45,000
bone, clavicle, Doctor investigations
calcaneum
TBW of patella, As Advised by Attending Includes standard

1177 13 Orthopaedics SS01300055 40,000
olecranon Doctor investigations
Patellectomy / Excision
1178 13 Orthopaedics SS01300056 head radius or small 35,000
fragments
Core decompression of As Advised by Attending Includes standard

1179 13 Orthopaedics SS01300057 42,000
head of femur Doctor investigations
119
Closed reduction &
1180 13 Orthopaedics SS01300058 internal fixation of 48,000
fracture of neck femur
Open reduction &

1181 13 Orthopaedics SS01300059 internal fixation of 52,000
fracture of neck femur
O R I F of fracture of
1182 13 Orthopaedics SS01300060 neck femur with muscle 55,000
pedicle bone grafting
Open reduction &

internal fixation of As Advised by Attending Includes standard
1183 13 Orthopaedics SS01300061 52,000
trochanteric fracture Doctor investigations
femur
Corrective osteotomy of As Advised by Attending Includes standard

1184 13 Orthopaedics SS01300062 45,000
long bone Doctor investigations
Corrective osteotomy of As Advised by Attending Includes standard

1185 13 Orthopaedics SS01300063 25,000
small bone Doctor investigations
Partial major joint As Advised by Attending Includes standard

1186 13 Orthopaedics SS01300064 55,000
replacement surgery Doctor investigations
Total major joint As Advised by Attending Includes standard

1187 13 Orthopaedics SS01300065 85,000
replacement surgery Doctor investigations
Radial head
1188 13 Orthopaedics SS01300066 replacement / Finger 40,000
joint arthroplasty
120
Excision arthroplasty of As Advised by Attending Includes standard
1189 13 Orthopaedics SS01300067 40,000
major joint Doctor investigations
Excision arthroplasty of As Advised by Attending Includes standard

1190 13 Orthopaedics SS01300068 22,000
small joint Doctor investigations
Incisional biopsy /
1191 13 Orthopaedics SS01300069 curettage / excision of 35,000
tumour
Resection &
1192 13 Orthopaedics SS01300070 Reconstruction of bone 62,000
tumour
Bone grafting (cortico- As Advised by Attending Includes standard

1193 13 Orthopaedics SS01300071 30,000
cancellous) Doctor investigations

1194 13 Orthopaedics SS01300072 Strut graft ( Fibula / Rib ) 25,000
Diagnostic arthroscopy As Advised by Attending Includes standard

1195 13 Orthopaedics SS01300073 35,000
major joint Doctor investigations
Arthroscopic
1196 13 Orthopaedics SS01300074 reconstruction / repair - 55,000
knee / - shoulder
Arthroscopic surgery
1197 13 Orthopaedics SS01300075 hip / ankle / elbow / 48,000
wrist
Open reduction &
1198 13 Orthopaedics SS01300076 internal fixation - 75,000
acetabulum
121
Open reduction & As Advised by Attending Includes standard
1199 13 Orthopaedics SS01300077 65,000
internal fixation - pelvis Doctor investigations

1200 13 Orthopaedics SS01300078 Costotransversectomy 40,000
Antero-lateral
1201 13 Orthopaedics SS01300079 decompression of spine 75,000
& fusion
Spinal stabilization by
1202 13 Orthopaedics SS01300080 posterior 70,000
instrumentation
Spinal stabilization by
1203 13 Orthopaedics SS01300081 instrumentation & 75,000
fusion

1204 13 Orthopaedics SS01300082 Discectomy (spine) 45,000
1205 13 Orthopaedics SS01300083 Cervical rib excision 52,000
Anterior cervic al fusion As Advised by Attending Includes standard

1206 13 Orthopaedics SS01300084 65,000
& stabilisation Doctor investigations
Posterior cervical As Advised by Attending Includes standard

1207 13 Orthopaedics SS01300085 50,000
1208 13 Orthopaedics SS01300086 Scoliosis surgery 75,000
Vertebroplasty / As Advised by Attending Includes standard
1209 13 Orthopaedics SS01300087 50,000
Kyphoplasty Doctor investigations
Pars plana vitrectomy

Ophthalmolo As Advised by Attending Includes standard
1210 14 SS01400001 with membrane peeling 14,000
gy Doctor investigations
and endolaser
122
Retinal detachment
surgery(internal
approach): Pars plana
1211 14 SS01400002 vitrectomy+ membrane 21,000
peeling + Fluid Gas
exchange + endolaser +
silicone oil /C3F8
Retinal detachment
Ophthalmolo surgery(external As Advised by Attending Includes standard
1212 14 SS01400003 12,000
gy approach) with Band - Doctor investigations
Buckle
Intra ocular foreign

body/ IOL/ Dislocated
lens removal with pars
1213 14 SS01400004 plana vitrectomy+ Fluid 20,000
gas exchange
+endolaser+silicone
oil/C3F8
Ophthalmolo 1 Day / As Advised by Includes standard

1214 14 SS01400005 Silicone oil removal 7,000
gy Attending Doctor investigations

1215 14 SS01400006 Band Buckle removal 4,000
123
Ophthalmolo 3000+cost of 1 Day / As Advised by Includes standard
1216 14 SS01400007 Intra vitreal injection
gy medicines Attending Doctor investigations

1217 14 SS01400008 PRP/Grid/ Barrage laser 1000( per sitting)

1218 14 SS01400009 SICS with rigid IOL 4,000
Phacoemulsification
1219 14 SS01400010 with foldable 6,000
hydrophilic lens
Phacoemulsification
1220 14 SS01400011 with foldable 8,000
hydrophobic lens

1221 14 SS01400012 Yag laser capsulotomy 800

1222 14 SS01400013 Trabeculectomy 6,000

1223 14 SS01400014 Trab-o-Trab 6,000
Trabeculectomy with
1224 14 SS01400015 phacoemulsification 10,000
with foldable lens
Ophthalmolo Trabeculectomy with As Advised by Attending Includes standard

1225 14 SS01400016 7,000
gy SICS with rigid IOL Doctor investigations
124
Cyclocryopexy/Diode
1226 14 SS01400017 laser 1,500
cyclophotocoagulation

1227 14 SS01400018 Yag laser iridectomy 800

1228 14 SS01400019 Dacrocystectomy(DCT) 3,000
Ophthalmolo Dacrocystorhiostomy(D 1 Day / As Advised by Includes standard

1229 14 SS01400020 8,000
gy CR) Attending Doctor investigations

1230 14 SS01400021 Pediatric Probing 1,000

1231 14 SS01400022 Penetrating keratoplasty 8,000

1232 14 SS01400023 DSAEK/DALK 12,000

1233 14 SS01400024 LASIK (one eye) 10,000

1234 14 SS01400025 LASIK( Both eyes) 18,000

1235 14 SS01400026 Pterygium excision 2,000
125
Ophthalmolo Pterygium excision with 1 Day / As Advised by Includes standard
1236 14 SS01400027 4,000
gy graft Attending Doctor investigations
Ophthalmolo Amniotic membrane 1 Day / As Advised by Includes standard

1237 14 SS01400028 5,000
gy graft Attending Doctor investigations

1238 14 SS01400029 Scleral graft 5,000
Ophthalmolo Foreign body removal 1 Day / As Advised by Includes standard

1239 14 SS01400030 2,000
gy from, iris/ Intracorneal Attending Doctor investigations

1240 14 SS01400031 Tarsorraphy 1,000
Ophthalmolo Sclero-corneal rupture As Advised by Attending Includes standard

1241 14 SS01400032 6,000
gy repair Doctor investigations
1242 14 SS01400033 Single rectus muscle 5,000
Ophthalmolo Rectus muscle As Advised by Attending Includes standard
1243 14 SS01400034 8,000
gy (2/3/oblique) Doctor investigations
Ophthalmolo 3500 + cost of As Advised by Attending Includes standard
1244 14 SS01400035 Evisceration
gy implant if given Doctor investigations
Ophthalmolo 3500 + cost of As Advised by Attending Includes standard
1245 14 SS01400036 Enucleation
gy implant if given Doctor investigations
Ophthalmolo Socket reconstruction As Advised by Attending Includes standard

1246 14 SS01400037 8,000
gy with implant Doctor investigations

1247 14 SS01400038 Ectropion correction 3,000
1248 14 SS01400039 Entropion correction 3,000
126
1249 14 SS01400040 Chalazion 1,000
1250 14 SS01400041 Ptosis surgery 7,000
Ophthalmolo Lid tumour excision with As Advised by Attending Includes standard

1251 14 SS01400042 10,000
gy lid reconstruction Doctor investigations
Lid tumour excision with

Ophthalmolo lid reconstruction by As Advised by Attending Includes standard
1252 14 SS01400043 12,000
gy rotational flap / skin Doctor investigations
grafting

1253 14 SS01400044 Orbitotomy 15,000
Ophthalmolo Ocular surface tumour As Advised by Attending Includes standard
1254 14 SS01400045 3,000
gy removal Doctor investigations
1255 14 SS01400046 exenteration 8,000
For paediatric patients 4000 (includ

1256 14 SS01400047 and selective cases of ing cost of gas &
adults medicine)
Acquired Heart Disease

1257 15 SS01500001 with Congestive Cardiac 10,000
Pediatrics Doctor investigations
Failure
General Inborn Error of As Advised by Attending Includes standard

1258 15 SS01500002 30,000
Pediatrics Metabolism Doctor investigations
1259 15 SS01500003 Kerosene Ingestion 5,000
1260 15 SS01500004 Immuno Deficiency 100,000
127
1261 15 SS01500005 Interstital Lung Disease 25,000
General Hemophagocytic As Advised by Attending Includes standard

1262 15 SS01500006 25,000
Pediatrics Lympho Histiocytosis Doctor investigations
Hypoplastic/Aplastic
1263 15 SS01500007 Anemia (Fanconi 5,000
Anemia) without

1264 15 SS01500008 Wilsons Disease 20,000
1265 15 SS01500009 Neonatal Cholestasis 20,000
General End Stage Renal Disease As Advised by Attending Includes standard

1266 15 SS01500010 4,000
Pediatrics (Per-Dialysis) Doctor investigations
General Guillian - Barre As Advised by Attending Includes standard

1267 15 SS01500011 100,000
Pediatrics Syndrome Doctor investigations
Thalassemia Major
1268 15 SS01500012 Requiring Chelation 5,000
Therapy (Per sitting)
Severe
Bronchiolitis/Severe
Paediatric Broncho
1269 15 Intensive SS01500013 Pneumonia/Severe 2,000
Care aspiration Pneumonia
(Non-Ventilated) (per
day)
128
Severe
Bronchiolitis/Severe
Paediatric
Broncho As Advised by Attending Includes standard
1270 15 Intensive SS01500014 4,000
Pneumonia/Severe Doctor investigations
Care
aspiration Pneumonia
(Ventilated) (per day)
Paediatric
Acute Severe Asthma As Advised by Attending Includes standard
1271 15 Intensive SS01500015 5,000
(Ventilated)(per day) Doctor investigations
Care
Severe
Myocarditis/Congenital
Heart Disease with
Paediatric Infection and/or
1272 15 Intensive SS01500016 Cardiogenic 30,000
Care Shock/Cardiogenic
Shock/Infective
Endocarditis(Non-
Ventilated)
Paediatric
Septic Shock/Infective As Advised by Attending Includes standard
1273 15 Intensive SS01500017 40,000
Endocarditis( Ventilated) Doctor investigations
Care
Paediatric
Febrile Seizures (Non As Advised by Attending Includes standard
1274 15 Intensive SS01500018 3,000
ventilated) Doctor investigations
Care
Paediatric
Febrile Seizures ( As Advised by Attending Includes standard
1275 15 Intensive SS01500019 10,000
ventilated) Doctor investigations
Care
Paediatric
Meningitis/Encephalitis As Advised by Attending Includes standard
1276 15 Intensive SS01500020 20,000
(Non-Ventilated) Doctor investigations
Care
129
Paediatric Meningitis/Encephalitis/
1277 15 Intensive SS01500021 Status Epilepticus 35,000
Care (Ventilated)
Paediatric
1278 15 Intensive SS01500022 Intra Cranial Bleed 35,000
Care
Paediatric
Acute Gastro Intestinal As Advised by Attending Includes standard
1279 15 Intensive SS01500023 20,000
Bleed Doctor investigations
Care
Paediatric Acute
1280 15 Intensive SS01500024 Pancreatitis/Acute 12,000
Care Hepatitis
Paediatric
Acute Hepatitis with As Advised by Attending Includes standard
1281 15 Intensive SS01500025 35,000
Hepatic Encephalopathy Doctor investigations
Care
Paediatric Severe Pancratitis
1282 15 Intensive SS01500026 Requiring Surgery as 60,000
Care Add on
Paediatric
1283 15 Intensive SS01500027 Acute Renal Failure 30,000
Care
Paediatric
1284 15 Intensive SS01500028 Diabetic Ketoacidosis 20,000
Care
Paediatric
Dengue Shock As Advised by Attending Includes standard
1285 15 Intensive SS01500029 20,000
Syndrome/DHF Doctor investigations
Care
Paediatric
Snake Bite Requiring As Advised by Attending Includes standard
1286 15 Intensive SS01500030 30,000
Ventilator Assistance Doctor investigations
Care
Scorpion Sting with

Paediatric Myocarditis and
1287 15 Intensive SS01500031 Cardiogenic Shock 20,000
Care Requiring Ventilatory
Assistance
130
Paediatric Poison Ingestion/
1288 15 Intensive SS01500032 Aspiration Requiring 20,000
Care Ventilatory Assistance
Acute Broncho/
Paediatric Lobarpneumonia with
1289 15 Intensive SS01500033 Empyema/ Pleural 30,000
Care Effusion/Pyopneumotho
rax
Paediatric
Acute Stridor/Foreign As Advised by Attending Includes standard
1290 15 Intensive SS01500034 10,000
Body Obstruction Doctor investigations
Care
Paediatric TN0413 : Nehrotic

1291 15 Intensive SS01500035 Syndrome/Acute 15,000
Care Glomerulo Nephritis
Recurrent Urinary Tract

Paediatric Infection with
1292 15 Intensive SS01500036 Complications like 35,000
Care Pyelonephritis and Renal
Failure
Paediatric
Acute Renal Failure As Advised by Attending Includes standard
1293 15 Intensive SS01500037 18,000
with Dialysis Doctor investigations
Care
Paediatric
Acute Renal Failure As Advised by Attending Includes standard
1294 15 Intensive SS01500038 14,000
without Dialysis Doctor investigations
Care
Paediatric
Haemophillia Including As Advised by Attending Includes standard
1295 15 Intensive SS01500039 15,000
Von Willibrands Doctor investigations
Care
131
Paediatric Neuro
1296 15 Intensive SS01500040 Tuberculosis/Neurocysti 12,000
Care cercosis
Paediatric Idipopathic
1297 15 Intensive SS01500041 Thrombocytopenic 50,000
Care Purpura
Paediatric ECMO-Extracorporeal Pre-Authorization As Advised by Attending Includes standard

1298 15 SS01500042
Neonate Care Membrane Oxygenation Required Doctor investigations
Paediatric Adverse Events Pre-Authorization As Advised by Attending Includes standard

1299 15 SS01500043
Neonate Care following Immunisation Required Doctor investigations
Paediatric Multi System Organ As Advised by Attending Includes standard

1300 15 SS01500044 100,000
Neonate Care Failure Doctor investigations
Necrotising
Enterocolitis, Clinical
Paediatric As Advised by Attending Includes standard
1301 15 SS01500045 Sepsis Non-Ventilated 25,000
Neonate Care Doctor investigations
hyper-bilirubinemia
(Non-surgical)
Paediatric Afebrile Seizure As Advised by Attending Includes standard

1302 15 SS01500046 16,000
Neonate Care requiring Ventilation Doctor investigations

1303 15 SS01500047 Acute Leukemia 70,000
1304 15 SS01500048 Lumphoma 70,000
1305 15 SS01500049 Severe Malaria 25,000
Paediatric Malaria As Advised by Attending Includes standard
1306 15 SS01500050 5,000
Neonate Care (Noncomplicated) Doctor investigations
132
Paediatric Interic As Advised by Attending Includes standard
1307 15 SS01500051 8,000
Neonate Care Fever/Pylonephritis Doctor investigations
Rhematoroid
Artharities/HSP/SLE
1308 15 SS01500052 without nephritis /other 10,000
connective tissue
disorder
Paediatric Neonatal Asphyxia As Advised by Attending Includes standard

1309 15 SS01500053 25,000
Neonate Care without ventilation Doctor investigations
Paediatric Neonatal Asphyxia with As Advised by Attending Includes standard

1310 15 SS01500054 40,000
Neonate Care ventilation Doctor investigations
Radiotherapy
Conventional Rt (Linear
1311 16 And Chemo SS01600001 35,000
Accelerator)
Therapy
Radiotherapy
Conventional Rt (Cobalt - 1 Day / As Advised by Includes standard
1312 16 And Chemo SS01600002 15,000
60) Attending Doctor investigations
Therapy
Radiotherapy Palliative Therapy (Less

1313 16 And Chemo SS01600003 5,000
Therapy Than 10 Fractions, Linac)
Radiotherapy Palliative Therapy (Less

Includes standard
1314 16 And Chemo SS01600004 1,000 Day Care
Than 10 Fractions, investigations
Therapy
Cobalt - 60)
Radiotherapy Palliative Therapy (More
1315 16 And Chemo SS01600005 Than 10 20,000
Therapy Fractions, Linac)
133
Palliative Therapy (More
Radiotherapy
Than 10 As Advised by Attending Includes standard
1316 16 And Chemo SS01600006 5,000
Therapy Fractions, Cobalt - 60)
Radiotherapy Intensity Modulated

1317 16 And Chemo SS01600007 Radio 75,000
Therapy Therapy (Imrt)
Radiotherapy
Image Guided Radio As Advised by Attending Includes standard
1318 16 And Chemo SS01600008 100,000
Therapy Therapy (Igrt)
Radiotherapy
3D-Crt (Confirmal Radio As Advised by Attending Includes standard
1319 16 And Chemo SS01600009 55,000
Therapy Therapy)
Radiotherapy 3D-Crt (Confirmal Radio

1320 16 And Chemo SS01600010 70,000
Therapy) With Image Doctor investigations
Therapy
Guidance
Radiotherapy
Igrt With 4D Ct Based As Advised by Attending Includes standard
1321 16 And Chemo SS01600011 120,000
Planning Doctor investigations
Therapy
Radiotherapy
Stereotactic Radio As Advised by Attending Includes standard
1322 16 And Chemo SS01600012 80,000
Surgery (Srs) Doctor investigations
Therapy
Radiotherapy
Stereotactic Radio As Advised by Attending Includes standard
1323 16 And Chemo SS01600013 60,000
Therapy (Srt) Doctor investigations
Therapy
Volumetric Modulated
Radiotherapy
Radiation / Imtensity As Advised by Attending Includes standard
1324 16 And Chemo SS01600014 50,000
Modulated Arc Therapy Doctor investigations
Therapy
Rate
134
Volumetric Modulated
Radiotherapy Radiation / Imtensity
1325 16 And Chemo SS01600015 Modulated Arc Therapy 80,000
Therapy Rate With Image
Guidance
Radiotherapy Electron Beam (Greater

1326 16 And Chemo SS01600016 Than 10 30,000
Therapy Fractions)
Radiotherapy Electron Beam (Less
1327 16 And Chemo SS01600017 Than 10 15,000
Therapy Fractions)
Radiotherapy Intra Cavitary
1328 16 And Chemo SS01600018 Brachytherapy- (Per 5,000
Therapy Insertion)
Radiotherapy Interstitial Brachy
1329 16 And Chemo SS01600019 7,000
Therapy-(Per Insertion) Doctor investigations
Therapy
Infusional
Radiotherapy Chemotherapy
1330 16 And Chemo SS01600020 Administration Charge 1,000
Therapy (Actual Cost Of Medicine
To Be Paid Separately)
ACTUAL COST OF
Radiotherapy Oral Chemotherapy And MEDICINE RELATING
1331 16 And Chemo SS01600021 Hormone Therapy Or TO DIFFERENT
Therapy Targeted Therapy PRODUCTS TO BE
PAID SEPARATELY
135
Radiotherapy
Chemoport Implantation As Advised by Attending Includes standard
1332 16 And Chemo SS01600022 40,000
With Cost Of Chemoport Doctor investigations
Therapy
Skin
1333 17 SS01700001 Excision Of Moles 700 Daycare
Procedures
Skin
1334 17 SS01700002 Excision of Warts 700 Daycare
Procedures
Skin Excision of
1335 17 SS01700003 700 Daycare
Procedures Molluscumcontagiosum
Skin Excision of Veneral

1336 17 SS01700004 700 Daycare
Procedures Warts
Skin
1337 17 SS01700005 Excision of Corns 500 Daycare
Procedures
Skin I/D Injection Keloid of
1338 17 SS01700006 500 Daycare
Procedures Acne
Skin
1339 17 SS01700007 Chemical Cautery (s) 500 Daycare
Procedures
Skin Operations for As Advised by Attending Includes standard
1340 17 SS01700008 22,000
Procedures Neuroblastoma Doctor investigations
Urology Bladder Tumour As Advised by Attending Includes standard
1341 18 SS01800001 15,000
/Nephrology (Fulgration) Doctor investigations
Urology Correction of Extrophy As Advised by Attending Includes standard

1342 18 SS01800002 10,000
/Nephrology of Bladder Doctor investigations
Urology As Advised by Attending Includes standard

1343 18 SS01800003 Cystilithotomy 10,000
/Nephrology Doctor investigations
1344 18 SS01800004 Cysto Gastrostomy 20,000
1345 18 SS01800005 Cysto Jejunostomy 20,000
Urology Dormia Extraction of As Advised by Attending Includes standard
1346 18 SS01800006 15,000
/Nephrology Calculus Doctor investigations
136
Urology Drainage of Perinepheric As Advised by Attending Includes standard
1347 18 SS01800007 10,000
/Nephrology Abscess Doctor investigations

1348 18 SS01800008 Cystolithopexy 10,000
Urology Excision of Urethral As Advised by Attending Includes standard

1349 18 SS01800009 5,000
/Nephrology Carbuncle Doctor investigations
Exploration of
1350 18 SS01800010 Epididymus (Unsuccesful 15,000
Vasco vasectomy)

1351 18 SS01800011 Urachal Cyst 15,000
1352 18 SS01800012 Hydrospadius 20,000
1353 18 SS01800013 Internal Urethrotomy 7,000
1354 18 SS01800014 Litholapexy 7,500
1355 18 SS01800015 Lithotripsy 10,000
1356 18 SS01800016 Meatoplasty 5,000
1357 18 SS01800017 Meatotomy 5,000
1358 18 SS01800018 Neoblastoma 20,000
1359 18 SS01800019 Nephrectomy 20,000
Urology Nephrectomy (Renal As Advised by Attending Includes standard
1360 18 SS01800020 20,000
/Nephrology tumour) Doctor investigations
137
1361 18 SS01800021 Nephro Uretrectomy 20,000
1362 18 SS01800022 Nephrolithotomy 15,000
1363 18 SS01800023 Nephropexy 15,000
1364 18 SS01800024 Nephrostomy 10,000
Nephrourethrotomy ( is
1365 18 SS01800025 it Nephrourethrectomy 15,000
?)
Urology Open Resection of As Advised by Attending Includes standard

1366 18 SS01800026 10,000
/Nephrology Bladder Neck Doctor investigations
Urology Operation for Cyst of As Advised by Attending Includes standard
1367 18 SS01800027 15,000
/Nephrology Kidney Doctor investigations
Urology Operation for Double As Advised by Attending Includes standard
1368 18 SS01800028 15,000
/Nephrology Ureter Doctor investigations
1369 18 SS01800029 Fturp 15,000
Urology Operation for Injury of As Advised by Attending Includes standard
1370 18 SS01800030 15,000
/Nephrology Bladder Doctor investigations
1371 18 SS01800031 Partial Cystectomy 15,000
1372 18 SS01800032 Partial Nephrectomy 15,000
PCNL (Percutaneous
1373 18 SS01800033 nephro lithotomy) - 18,000
Biilateral
138
PCNL (Percutaneous
1374 18 SS01800034 nephro lithotomy) - 18,000
Unilateral

1375 18 SS01800035 Post Urethral Valve 10,000
1376 18 SS01800036 Pyelolithotomy 15,000
Urology Pyeloplasty & Similar As Advised by Attending Includes standard

1377 18 SS01800037 15,000
/Nephrology Procedures Doctor investigations

1378 18 SS01800038 Radical Nephrectomy 15,000
Urology Reduction of As Advised by Attending Includes standard
1379 18 SS01800039 5,000
/Nephrology Paraphimosis Doctor investigations
Urology Reimplanation of As Advised by Attending Includes standard
1380 18 SS01800040 17,000
/Nephrology Urethra Doctor investigations
Urology Reimplantation of As Advised by Attending Includes standard
1381 18 SS01800041 17,000
/Nephrology Bladder Doctor investigations
Urology Reimplantation of As Advised by Attending Includes standard
1382 18 SS01800042 17,000
/Nephrology Ureter Doctor investigations
Urology Repair of Uretero As Advised by Attending Includes standard
1383 18 SS01800043 20,000
/Nephrology Vaginal Fistula Doctor investigations
Ureteric Catheterization -
Urology Cystoscopy+PCNL As Advised by Attending Includes standard
1384 18 SS01800044 12,500
/Nephrology (Percutaneous nephro Doctor investigations
lithotomy) - Unilateral
Urology Retroperitoneal Fibrosis - As Advised by Attending Includes standard

1385 18 SS01800045 26,250
/Nephrology Renal Doctor investigations
Urology Retropubic As Advised by Attending Includes standard
1386 18 SS01800046 20,000
/Nephrology Prostatectomy Doctor investigations
139
Urology Spleno Renal As Advised by Attending Includes standard
1387 18 SS01800047 20,000
/Nephrology Anastomosis Doctor investigations
1388 18 SS01800048 Stricture Urethra 20,000
Urology Suprapubic Cystostomy - As Advised by Attending Includes standard

1389 18 SS01800049 5,000
/Nephrology Open Doctor investigations
Urology Suprapubic Drainage - As Advised by Attending Includes standard

1390 18 SS01800050 5,000
/Nephrology Closed Doctor investigations
1391 18 SS01800051 Cystoscopy+Pyelolithoto 10,500
my
Urology Trans Vesical As Advised by Attending Includes standard

1392 18 SS01800052 20,000
/Nephrology Prostatectomy Doctor investigations
Urology Transurethral As Advised by Attending Includes standard
1393 18 SS01800053 15,000
/Nephrology Fulguration Doctor investigations
TURBT (Transurethral
1394 18 SS01800054 Resection of the Bladder 15,000
Tumor)

1395 18 SS01800055 TURP + Circumcision 15,000
Urology TURP + Closure of As Advised by Attending Includes standard
1396 18 SS01800056 13,000
/Nephrology Urinary Fistula Doctor investigations
1397 18 SS01800057 TURP + Cystolithopexy 18,000
1398 18 SS01800058 TURP + Cystolithotomy 18,000
1399 18 SS01800059 TURP + Fistulectomy 15,000
140
Urology TURP + Cystoscopic As Advised by Attending Includes standard
1400 18 SS01800060 12,000
/Nephrology Removal of Stone Doctor investigations

1401 18 SS01800061 TURP + Nephrectomy 25,000
1402 18 SS01800062 TURP + Orchidectomy 18,000
Urology TURP + Suprapubic As Advised by Attending Includes standard
1403 18 SS01800063 15,000
/Nephrology Cystolithotomy Doctor investigations
1404 18 SS01800064 TURP + TURBT 15,000
1405 18 SS01800065 TURP + URS 14,000
1406 18 SS01800066 TURP + Vesicolithotripsy 15,000
Urology TURP + VIU (visual As Advised by Attending Includes standard

1407 18 SS01800067 12,000
/Nephrology internal urethrotomy) Doctor investigations
Urology TURP + As Advised by Attending Includes standard

1408 18 SS01800068 15,000
/Nephrology Haemorrhoidectomy Doctor investigations

1409 18 SS01800069 TURP + Hydrocele 18,000
1410 18 SS01800070 TURP + Hernioplasty 18,000
Urology TURP with Repair of As Advised by Attending Includes standard
1411 18 SS01800071 18,000
/Nephrology Urethra Doctor investigations
1412 18 SS01800072 TURP + Herniorraphy 18,000
TURP (Trans-Urethral
1413 18 SS01800073 Resection of 15,000
Bladder)Prostate
141
1414 18 SS01800074 TURP + Fissurectomy 18,000
Urology TURP + As Advised by Attending Includes standard
1415 18 SS01800075 20,000
/Nephrology Urethrolithotomy Doctor investigations
Urology TURP + Urethral As Advised by Attending Includes standard
1416 18 SS01800076 15,000
/Nephrology dilatation Doctor investigations
Urology Uretero Colic As Advised by Attending Includes standard
1417 18 SS01800077 20,000
/Nephrology Anastomosis Doctor investigations
1418 18 SS01800078 Ureterolithotomy 15,000
Urology Ureteroscopic Calculi - As Advised by Attending Includes standard
1419 18 SS01800079 20,000
/Nephrology Bilateral Doctor investigations
Urology Ureteroscopic Calculi - As Advised by Attending Includes standard
1420 18 SS01800080 18,000
/Nephrology Unilateral Doctor investigations
Urology Ureteroscopy As Advised by Attending Includes standard
1421 18 SS01800081 20,000
/Nephrology Urethroplasty Doctor investigations
1422 18 SS01800082 Ureteroscopy PCNL 17,000
Ureteroscopic stone
1423 18 SS01800083 Removal And DJ 15,000
Stenting
1424 18 SS01800084 Urethral Dilatation 5,000
1425 18 SS01800085 Urethral Injury 10,000
1426 18 SS01800086 Urethral Reconstuction 15,000
Urology Ureteric Catheterization - As Advised by Attending Includes standard

1427 18 SS01800087 5,000
/Nephrology Cystoscopy Doctor investigations

1428 18 SS01800088 Uretrostomy (Cutanie) 15,000
142
1429 18 SS01800089 URS + Stone Removal 15,000
Urology URS Extraction of Stone As Advised by Attending Includes standard

1430 18 SS01800090 15,000
/Nephrology Ureter - Bilateral Doctor investigations
Urology URS Extraction of Stone As Advised by Attending Includes standard

1431 18 SS01800091 12,000
/Nephrology Ureter - Unilateral Doctor investigations
Urology URS with DJ Stenting As Advised by Attending Includes standard

1432 18 SS01800092 15,000
/Nephrology With ESWL Doctor investigations
Urology URS with As Advised by Attending Includes standard

1433 18 SS01800093 15,000
/Nephrology Endolitholopexy Doctor investigations
1434 18 SS01800094 URS with Lithotripsy 15,000
Urology URS with Lithotripsy As Advised by Attending Includes standard

1435 18 SS01800095 15,000
/Nephrology with DJ Stenting Doctor investigations

1436 18 SS01800096 URS+Cysto+Lithotomy 20,000
1437 18 SS01800097 V V F Repair 20,000
Urology Hypospadias Repair and As Advised by Attending Includes standard

1438 18 SS01800098 20,000
/Nephrology Orchiopexy Doctor investigations
Urology Vesico uretero Reflux - As Advised by Attending Includes standard

1439 18 SS01800099 15,000
/Nephrology Bilateral Doctor investigations
Urology Vesico Uretero Reflux - As Advised by Attending Includes standard
1440 18 SS01800100 10,000
/Nephrology Unilateral Doctor investigations
Urology VIU (Visual Internal As Advised by Attending Includes standard

1441 18 SS01800101 10,000
/Nephrology Urethrotomy ) Doctor investigations
143
1442 18 SS01800102 VIU + Cystolithopexy 15,000
1443 18 SS01800103 VIU + Hydrocelectomy 15,000
1444 18 SS01800104 VIU and Meatoplasty 9,000
1445 18 SS01800105 VIU for Stricture Urethra 10,000
1446 18 SS01800106 VIU with Cystoscopy 10,000
Urology Y V Plasty of Bladder As Advised by Attending Includes standard
1447 18 SS01800107 10,000
/Nephrology Neck Doctor investigations
Bladder Calculi-
1448 18 SS01800108 Removal+Trans vesical 14,500
prostatectomy
Urology Operation for ectopic As Advised by Attending Includes standard

1449 18 SS01800109 15,000
/Nephrology ureter Doctor investigations
Stricture Urethra+TURP
Urology (Trans-Urethral As Advised by Attending Includes standard
1450 18 SS01800110 18,000
/Nephrology Resection of Doctor investigations
Bladder)Prostate

1451 18 SS01800111 TURP + Cystolithotripsy 18,000
Urology TURP with removal of As Advised by Attending Includes standard

1452 18 SS01800112 18,000
/Nephrology the verical calculi Doctor investigations
Urology TURP with As Advised by Attending Includes standard

1453 18 SS01800113 18,000
/Nephrology vesicolithotomy Doctor investigations
Urology Ureteroscopic removal As Advised by Attending Includes standard

1454 18 SS01800114 15,000
/Nephrology of lower ureteric Doctor investigations
144
Urology Ureteroscopic removal As Advised by Attending Includes standard
1455 18 SS01800115 15,000
/Nephrology of ureteric calculi Doctor investigations

1456 18 SS01800116 Varicocele 10,000
1457 18 SS01800117 VIU + TURP 18,000
Ureteroscopic Calculi -
Urology Unilateral+TURP (Trans- As Advised by Attending Includes standard
1458 18 SS01800118 18,000
/Nephrology Urethral Resection of Doctor investigations
Bladder)Prostate
Bladder Calculi-
1459 18 SS01800119 Removal+Stricture 15,000
Urethra
Urology Unilateral+Ureteric As Advised by Attending Includes standard
1460 18 SS01800120 15,000
/Nephrology Catheterization - Doctor investigations
Cystoscopy
1461 18 SS01800121 Cystoscopy+Nephrolitho 10,550
tomy

1462 18 SS01800122 AV Shunt for dialysis 7,500
Urology Includes standard
1463 18 SS01800123 Haemoylaisis per sitting 3,000 Daycare
/Nephrology investigations
1464 18 SS01800124 CAPD Catherisation 15,000
Urology Acute Renal Failure- As Advised by Attending Includes standard
1465 18 SS01800125 10,000
/Nephrology (ARF) Doctor investigations
145
1466 18 SS01800126 Nephrotic Syndrome 25,000
Urology Rapidly Progressive As Advised by Attending Includes standard

1467 18 SS01800127 35,000
/Nephrology Renal Failure (RPRF) Doctor investigations
Urology Chronic Renal Failure 1 As Advised by Attending Includes standard

1468 18 SS01800128 15,000
/Nephrology (CRF ) Doctor investigations
1469 18 SS01800129 ESRD 15,000
1470 18 SS01800130 Kidney Biopsy 25,000
Cholecystectomy and
1471 19 SS01900001 Drainage of Liver 35,000
Procedures Doctor investigations
abscess
Endoscopic Cholecystectomy with As Advised by Attending Includes standard

1472 19 SS01900002 40,000
Procedures Excision of TO Mass Doctor investigations
Endoscopic 1 Day / As Advised by Includes standard

1473 19 SS01900003 Cyst Aspiration 3,000
Procedures Attending Doctor investigations
Endometria to
1474 19 SS01900004 Endometria 10,500
Anastomosis

1475 19 SS01900005 Fimbriolysis 7,500

1476 19 SS01900006 Hemicolectomy 50,000
Hysterectomy with
1477 19 SS01900007 bilateral Salpingo 18,375
Operectomy*
146
Endoscopic Incisional Hernia - As Advised by Attending Includes standard
1478 19 SS01900008 45,000
Procedures Repair Doctor investigations
Endoscopic Inguinal Hernia - As Advised by Attending Includes standard
1479 19 SS01900009 22,000
Procedures Bilateral Doctor investigations
Endoscopic Inguinal hernia - As Advised by Attending Includes standard
1480 19 SS01900010 30,000
Procedures Unilateral Doctor investigations
1481 19 SS01900011 Intestinal resection 50,000
1482 19 SS01900012 Myomectomy 17,000
1483 19 SS01900013 Oophrectomy 12,500
1484 19 SS01900014 Perotionities 13,500
1485 19 SS01900015 Salpingo Ophrectomy 13,500
1486 19 SS01900016 Salpingostomy 13,500
1487 19 SS01900017 Uterine septum 11,250
1488 19 SS01900018 Varicocele - Bilateral 22,500
1489 19 SS01900019 Varicocele - Unilateral 16,500
1490 19 SS01900020 Repair of Ureterocele 15,000
Esophageal
1491 19 SS01900021 Sclerotheraphy for 2,100
varies first sitting
147
Esophageal
1492 19 SS01900022 Sclerotheraphy for 1,650
varies subseqent sitting

1493 19 SS01900023 Upper GI endoscopy 1,500
Endoscopic Upper GI endoscopy 1 Day / As Advised by Includes standard

1494 19 SS01900024 1,800
Procedures with biopsy Attending Doctor investigations

1495 19 SS01900025 ERCP 12,000
Hysteroscopi Ablation of As Advised by Attending Includes standard
1496 19 SS01900026 10,000
c Procedures Endometrium Doctor investigations
Hysteroscopi Hysteroscopic Tubal As Advised by Attending Includes standard
1497 19 SS01900027 12,000
c Procedures Cannulation Doctor investigations
Hysteroscopi As Advised by Attending Includes standard
1498 19 SS01900028 Polypectomy 7,500
c Procedures Doctor investigations
Hysteroscopi Uterine Synechia - As Advised by Attending Includes standard
1499 19 SS01900029 12,000
c Procedures Cutting Doctor investigations
148
Swasthaya Sathi Packages for Grade B Hospitals
Implants cost whereever mentioned to be added to arrive at the total package cost. If package cost is not menntioned the cost will be reimbursed as per the approval through Pre-authorisation. Cost
of orthopaedic impalnts to be added as required for the treatment as per the list attached. No additional investigation cost will be allowed. In case implant is not provided or any diagnostic test not
done by the hospital and patient was asked to do it from outside the amount of such test as per approved diagnostic test rate to be refunded else payment will not be reimbursed
Total Package
Amount to be
Package
Swasthya Sathi Rate in Grade B Device and Claimed by
Sl No. Category Group Procedure / Package MLOS Remarks
Package Code Hospitals implant Hospital
Code
including
implant
Acute Coronary Syndrome - Hospital stay 6 days

Includes standard
1 1 Cardiology SS00100001 Uncomplicated - Medical treatment 20,000 / As Advised by
investigations
(Hospital stay < 6 days) Attending Doctor
Acute Coronary Syndrome -

Complicated by Shock/Complete AV 7-14 days/As Advised Includes standard
2 1 Cardiology SS00100002 30,000
Blocks or Hospital stay 7-14 days - by Attending Doctor investigations
Medical treatment
As Advised by Includes standard
3 1 Cardiology SS00100005 Heart failure Medical treatment 18,000
Infective endocarditis Medical As Advised by Includes standard
4 1 Cardiology SS00100006 31,500
treatment Attending Doctor investigations
Deep vein thrombosis Medical As Advised by Includes standard
5 1 Cardiology SS00100007 18,000
Pulmonary embolism Medical As Advised by Includes standard
6 1 Cardiology SS00100008 31,500
Simple arrhythmias Medical As Advised by Includes standard
7 1 Cardiology SS00100010 18,000
Pericardial effusion Medical As Advised by Includes standard
8 1 Cardiology SS00100012 18,000
management Attending Doctor investigations
Includes fluid analysis

As Advised by
9 1 Cardiology SS00100013 Pericardiocentesis 12,000 and culture-
Attending Doctor
sensitivity

10 1 Cardiology SS00100015 Coronary angiography 9,000
149
11 1 Cardiology SS00100016 Renal angiography 7,200
As Advised by
12 1 Cardiology SS00100017 Peripheral angiography 9,000 Including DSA
Attending Doctor
As Advised by
13 1 Cardiology SS00100018 4-vessel Cerebral angiography 10,800 Including DSA
Attending Doctor
14 1 Cardiology SS00100019 Temporary pacing 8,100 2,500 10,600
15 1 Cardiology SS00100033 Mitral balloon valvuloplasty 35,000
16 1 Cardiology SS00100034 Pulmonary balloon valvuloplasty 25,000
3,000 per As Advised by CE/FDA/DCGI
17 1 Cardiology SS00100043 Transcutaneous MAPCA closure 40,500 43500
coil Attending Doctor approved
3,000 per As Advised by CE/FDA/DCGI
18 1 Cardiology SS00100044 Coil closure of bleeding vessels 31,500 34500
coil Attending Doctor approved
19 1 Cardiology SS00100051 Cardiac catheterisation 7,200
20 1 Cardiology SS00100052 Atrial septostomy 22,500
21 1 Cardiology SS00100053 Endomyocardial biopsy 22,500
22 1 Cardiology SS00100075 FFR
23 1 Cardiology SS00100076 IV/US
24 1 Cardiology SS00100077 OCT
25 1 Cardiology SS00100078 DSA
26 1 Cardiology SS00100079 ECHO/HOLTER
27 1 Cardiology SS00100080 TEE
28 1 Cardiology SS00100081 Stress Echo
150
29 1 Cardiology SS00100082 CT coronary angio
a) Non invasive-Blood, chest xray , ECG
CTVS or
30 2 SS00200042 , Daycare
Cardiothorasic
Echo
CTVS or
31 2 SS00200043 b) Non invasiveangio C.T. Daycare
Cardiothorasic
CTVS or
32 2 SS00200044 c) MRI Daycare
Cardiothorasic
CTVS or Includes standard
33 2 SS00200045 d)Invasive Cardiaccath Daycare
Cardiothorasic investigations
CTVS or As Advised by Includes standard
34 2 SS00200046 e) Varicose vein-ligation+stripping
Cardiothorasic Attending Doctor investigations
Includes standard
35 3 Dental SS00300001 Fistulectomy 5,040 Daycare
investigations
Includes standard
36 3 Dental SS00300002 Fixation of fracture of jaw 7,200 Daycare
investigations
Includes standard
37 3 Dental SS00300003 Sequestrectomy 9,900 Daycare
investigations
Includes standard
38 3 Dental SS00300004 Apisectomy including LA 1,350 Daycare
investigations
Includes standard
39 3 Dental SS00300005 Complicated Ext. per Tooth including LA 900 Daycare
investigations
Includes standard
40 3 Dental SS00300006 Cyst under LA (Large) 1,800 Daycare
investigations
Includes standard
investigations
Includes standard
42 3 Dental SS00300008 Extraction of tooth including LA 360 Daycare
investigations
Includes standard
43 3 Dental SS00300009 Flap operation per Tooth 720 Daycare
investigations
Includes standard
44 3 Dental SS00300010 Fracture wiring including LA 1,350 Daycare
investigations
Includes standard
45 3 Dental SS00300011 Gingivectomy per Tooth 900 Daycare
investigations
151
Includes standard
46 3 Dental SS00300012 Impacted Molar including LA 1,350 Daycare
investigations
Includes standard
47 3 Dental SS00300013 Drainage of parotid abscess 7,200 2 Days
investigations
Includes standard
48 3 Dental SS00300014 Excision of mandible 13,500 2 Days
investigations
Includes standard
49 3 Dental SS00300015 Repair of parotid duct 18,000 2 Days
investigations
Includes standard
investigations
Includes standard
51 3 Dental SS00300017 Alveolectomy per tooth 900 Daycare
investigations
Includes standard
52 3 Dental SS00300018 Apical Curettage per tooth 540 Daycare
investigations
Includes standard
53 3 Dental SS00300019 condylectomy 4,500 2 Days
investigations
Includes standard
54 3 Dental SS00300020 Fistula closure 360 Daycare
investigations
Includes standard
55 3 Dental SS00300021 ginivectomy full mouth 2,700 3 Days
investigations
Includes standard
56 3 Dental SS00300022 Fracture Jaws closed reduction 1,350 Daycare
investigations
Includes standard
investigations
58 3 Dental SS00300024 growth removal 900
Includes standard
59 3 Dental SS00300025 Osteotomy 1,800 2 Days
investigations
Includes standard
60 3 Dental SS00300026 Pericoronotomy 540 Daycare
investigations
Includes standard
investigations
Includes standard
63 3 Dental SS00300029 Segmental resection of jaw 5,400 3 Days
investigations
152
treatment of malocclusion through Includes standard
wiring investigations
treatment Nursing bottle caries (Full Includes standard
mouth) investigations
Includes standard
investigations
Includes standard
67 3 Dental SS00300033 Removable partial denture 360 Daycare
investigations
Includes standard
68 3 Dental SS00300034 Restoration of teeth per tooth 450 Daycare
investigations
treatment of gums through scaling Includes standard
(three sittings ) investigations
Includes standard
70 3 Dental SS00300036 Root canal treatment per tooth 1,440 Daycare
investigations
Includes standard
71 3 Dental SS00300037 Metal crown per cap 1,080 Daycare
investigations
Includes standard
investigations
REDUCTION AND
73 3 Dental SS00300039 IMMOBILISATION OF FRACTURE- 2,700
MAXILLA UNDER LA
REDUCTION AND
74 3 Dental SS00300040 IMMOBILISATION OF FRACTURE- 3,600
MANDIBLE UNDER LA
SPLINTS/ CIRCUM
75 3 Dental SS00300041 MANDIBULAR WIRING UNDER 3,600
GA
INTERNAL WIRE FIXATION/ PLATE
76 3 Dental SS00300042 FIXATION OF MAXILLA UNDER 6,300
LA
77 3 Dental SS00300043 FIXATION OF MAXILLA UNDER 7,200
GA
78 3 Dental SS00300044 FIXATION OF MANDIBLE UNDER 7,200
LA/GA
153
CYST TUMOUR OF MAXILLA/
79 3 Dental SS00300045 MANDIBLE BY ENUCLEATION/ 4,500
EXCISION (PACKAGE)
TM JOINT ANKYLOSIS- UNDER 3 Days/As advise by Includes standard
80 3 Dental SS00300046 13,500
GA (PACKAGE) surgeon investigations
HEMI-MANDIBULECTOMY 3 Days/As advise by Includes standard
81 3 Dental SS00300047 13,500
WITH GRAFT (PACKAGE) surgeon investigations
HEMI-MANDIBULECTOMY 3 Days/As advise by Includes standard
82 3 Dental SS00300048 10,800
WITHOUT GRAFT (PACKAGE) surgeon investigations
SEGMENTALMANDIBULECTOMY
83 3 Dental SS00300049 WITH GRAFT 9,000
(PACKAGE)
SEGMENTALMANDIBULECTOMY
84 3 Dental SS00300050 WITHOUT 7,200
GRAFT (PACKAGE)
MAXILLECTOMY- PARTIAL WITH 3 Days/As advise by Includes standard
85 3 Dental SS00300051 7,200
GRAFT (PACKAGE) surgeon investigations
MAXILLECTOMY- PARTIAL 3 Days/As advise by Includes standard
86 3 Dental SS00300052 6,300
WITHOUT GRAFT (PACKAGE) surgeon investigations
87 3 Dental SS00300053 MAXILLO-FACIAL PROSTHESIS 7,200
ALVELOLECTOMY, 1 Day/As advise by Includes standard
88 3 Dental SS00300054 1,800
FRENECTOMY PER QUADRANT surgeon investigations
AMALGAM FILLING/TOOTH Includes standard
(COMPOUND) investigations
AMALGAM FILLING/TOOTH Includes standard
(REGULAR) investigations
Includes standard
91 3 Dental SS00300057 ARCH BAR REMOVAL 450 Daycare
investigations
Includes standard
92 3 Dental SS00300058 BITE PLATE/ RETAINERS 1,350 Daycare
investigations
Includes standard
93 3 Dental SS00300059 CAST RPD (PER TOOTH) 900 Daycare
investigations
Includes standard
94 3 Dental SS00300060 DE SENSITISING PER SITTING 540 Daycare
investigations
DENTO ALVEOLAR FRACTURE Includes standard
investigations
154
Includes standard
REDUCTION AND SPLINTING/L.A. investigations
DENTURE REPAIR Includes standard
(CATEGORY1) investigations
DIALATION OF WHARTONS Includes standard
DUCT UNDER L.A. investigations
DIRECT/ INDIRECT PULP Includes standard
CAPPING investigations
FIBRE POST BASED POST AND Includes standard
CORE investigations
FLORIDE APPLICATION (PER Includes standard
SITTING) investigations
EXTRACTION OF MISP TOOTH Includes standard
BY OPERATION (OPEN METH) investigations
GTR (GUIDED TISSUE Includes standard
REGENERATION) investigations
Includes standard
103 3 Dental SS00300069 GLASS IONOMER FILLING 540 Daycare
investigations
INTRA ARTICULAR INJ. OF Includes standard
STEROIDS IN TMJ investigations
POST CORE/ TOOTH (CAST
Includes standard
105 3 Dental SS00300071 POST) LAB METAL CHGS. 1,350 Daycare
investigations
EXTRA
PREFORMED CARBONATE Includes standard
JACKET CROWN investigations
Includes standard
107 3 Dental SS00300073 PREFORMED STEEL CROWN 1,350 Daycare
investigations
REDUCTION OF DISLOCATION 1 Day/As advise by Includes standard
108 3 Dental SS00300074 1,800
OF TMJ (UNDER LA.) surgeon investigations
REIMPLANTATION (PER 1 Day/As advise by Includes standard
109 3 Dental SS00300075 3,240
TOOTH) surgeon investigations
REPAIR OF FACIAL SOFT 1 Day/As advise by Includes standard
110 3 Dental SS00300076 1,035
TISSUE LACERATION surgeon investigations
REPAIR OF FACIAL SOFT 1 Day/As advise by Includes standard
111 3 Dental SS00300077 630
TISSUE LACERATION (MINOR) surgeon investigations
Includes standard
112 3 Dental SS00300078 SCALING PER SITTING 540 Daycare
investigations
155
SIALOLITHOTOMY FOR SMALL Includes standard
STONES investigations
SURGICAL REMOVAL OF BENIN
Includes standard
114 3 Dental SS00300080 NEOPLASM OF ORAL 2,700 Daycare
investigations
(PACKAGE)
SURGICAL REMOVAL OF SOFT Includes standard
TISSUE LESION (PACKAGE) investigations
DISTO-IMPACTED TEETH (TWO) 2 Days/As advise by Includes standard
116 3 Dental SS00300082 19,800
UNDER GA surgeon investigations
117 4 Ear SS00400001 Aural polypectomy +Tympanoplasty 10,710
118 4 Ear SS00400002 Tympanoplasty+ Ossiculoplasty 10,500
Aural polypectomy + Mastoidectomy As Advised by Includes standard
119 4 Ear SS00400003 11,250
with tympanoplasty Attending Doctor investigations
120 4 Ear SS00400004 Removal of foreign body from ear 1,100
121 4 Ear SS00400005 Tympanotomy 4,500
Total amputation of As Advised by Includes standard
122 4 Ear SS00400006 4,590
Pinna(Growth/injuries) Attending Doctor investigations
Total Amputation & Excision of Pinna As Advised by Includes standard
123 4 Ear SS00400007 7,650
and External Auditory Meatus Attending Doctor investigations
124 4 Ear SS00400008 Skull base surgery 26,100
125 4 Ear SS00400009 Pharyngectomy and reconstruction 10,800
Excision of Pinna for Growth As Advised by Includes standard
126 4 Ear SS00400010 1,800
(Squamous/Basal/ Injuries) Skin Only Attending Doctor investigations
Excision of Pinna for Growth
127 4 Ear SS00400011 (Squamous/Basal/ Injuries) Skin and 2,700
Cartilage
128 4 Ear SS00400012 Ear lobe repair - single 900
129 4 Ear SS00400013 Vidian neurectomy - Microscopic 6,300
156
130 4 Ear SS00400014 Tympanoplasty 9,900
131 4 Ear SS00400015 Stapedectomy 7,200
132 4 Ear SS00400016 Partial amputation - Pinna 3,645
133 4 Ear SS00400017 Ossiculoplasty 8,000
Myrinogotomy with Grommet - Both As Advised by Includes standard
134 4 Ear SS00400018 5,850
ear Attending Doctor investigations
135 4 Ear SS00400019 Myringotomy with Grommet - One ear 4,500
136 4 Ear SS00400020 Myringotomy - Unilateral 2,250
137 4 Ear SS00400021 Myringotomy - Bilateral 4,050
138 4 Ear SS00400022 Myringoplasty 6,500
139 4 Ear SS00400023 Mastoidectomy with tympanoplasty 12,500
140 4 Ear SS00400024 Mastoidectomy 11,700
141 4 Ear SS00400025 Labyrinthectomy 8,100
142 4 Ear SS00400026 Fenestration 6,300
143 4 Ear SS00400027 Endolymphatic sac decompression 10,350
144 4 Ear SS00400028 Aural polypectomy 4,500
145 4 Nose SS00400029 ligation+Functional Endoscopic Sinus 13,050
(FESS)
146 4 Nose SS00400030 Antrostomy Bilateral+ Septoplasty 8,100
157
Functional Endoscopic Sinus (FESS) + As Advised by Includes standard
147 4 Nose SS00400031 9,225
Nasal polypectomy - Unilateral Attending Doctor investigations
Ant. Ethmoidal artery ligation+Nasal As Advised by Includes standard
148 4 Nose SS00400032 12,375
polypectomy - Bilateral Attending Doctor investigations
Ant. Ethmoidal artery ligation+ Intra As Advised by Includes standard
149 4 Nose SS00400033 13,050
nasal ethmoidectomy Attending Doctor investigations
Adeno tonsillectomy + Aural As Advised by Includes standard
150 4 Nose SS00400034 9,900
polypectomy Attending Doctor investigations
151 4 Nose SS00400035 Removal of FB from nose 1,400
152 4 Nose SS00400036 Septo-rhinoplasty 12,000
153 4 Nose SS00400037 Rhinosporidiosis excision 13,050
154 4 Nose SS00400038 Intranasal Submucosal Diathermy 1,620
155 4 Nose SS00400039 Endoscopic Hypophysectomy 18,000
156 4 Nose SS00400040 Endoscopic DCR 9,000
157 4 Nose SS00400041 cranio-facial resection 10,620
158 4 Nose SS00400042 Angiofibroma Excision 13,050
159 4 Nose SS00400043 Youngs operation 5,040
160 4 Nose SS00400044 Trans Antral Ethmoidectomy 9,720
161 4 Nose SS00400045 Submucos resection 8,100
162 4 Nose SS00400046 Sinus Antroscopy 4,140
163 4 Nose SS00400047 Septoplasty 7,650
164 4 Nose SS00400048 Rhinoplasty 13,050
158
165 4 Nose SS00400049 Radical fronto ethmo sphenodectomy 13,950
166 4 Nose SS00400050 Turbinectomy Partial - Unilateral 5,400
167 4 Nose SS00400051 Turbinectomy Partial - Bilateral 7,200
168 4 Nose SS00400052 Nasal polypectomy - Unilateral 4,860
169 4 Nose SS00400053 Nasal polypectomy - Bilateral 6,930
170 4 Nose SS00400054 Rhinotomy - Lateral 7,700
171 4 Nose SS00400055 Intra Nasal Ethmoidectomy 11,340
172 4 Nose SS00400056 Functional Endoscopic Sinus (FESS) 8,280
173 4 Nose SS00400057 Fracture - setting nasal bone 5,400
174 4 Nose SS00400058 Fracture - setting maxilla 7,875
Fracture reduction nose with septal As Advised by Includes standard
175 4 Nose SS00400059 6,030
correction Attending Doctor investigations
176 4 Nose SS00400060 Ethmoidectomy - External 10,800
177 4 Nose SS00400061 Septoplasty + FESS 9,450
178 4 Nose SS00400062 Cryosurgery 6,480
179 4 Nose SS00400063 Caldwell - luc- Unilateral 6,300
180 4 Nose SS00400064 Antrostomy Unilateral 4,050
181 4 Nose SS00400065 Antrostomy Bilateral 5,850
182 4 Nose SS00400066 Ant. Ethmoidal artery ligation 11,124
159
Adenoidectomy+ Tonsillectomy + As Advised by Includes standard
183 4 Throat SS00400067 10,800
Myrinogotomy Attending Doctor investigations
Adeno tonsillectomy+Nasal As Advised by Includes standard
184 4 Throat SS00400068 9,900
polypectomy - Bilatera Attending Doctor investigations
185 4 Throat SS00400069 Adeno tonsillectomy+choanal atersia 11,700
186 4 Throat SS00400070 Adenoidectomy+Aural polypectomy 12,150
Adeno tonsillectomy+Aural As Advised by Includes standard
187 4 Throat SS00400071 12,150
polypectomy Attending Doctor investigations
188 4 Throat SS00400072 Cheek Advancement 8,100
189 4 Throat SS00400073 Total Glossectomy 12,600
Removal of Submandibular Salivary As Advised by Includes standard
190 4 Throat SS00400074 10,800
gland Attending Doctor investigations
191 4 Throat SS00400075 Ranula excision 4,500
192 4 Throat SS00400076 Partial Glossectomy 3,600
193 4 Throat SS00400077 Parotidectomy - Superficial 10,800
194 4 Throat SS00400078 Parotidectomy - Total 13,500
195 4 Throat SS00400079 Palatopharyngoplasty 12,600
196 4 Throat SS00400080 Hemimandibulectomy 9,900
197 4 Throat SS00400081 Excision of the Mandible-Segmental 4,500
198 4 Throat SS00400082 Excision of Cystic Hygroma- Minor 4,500
199 4 Throat SS00400083 Excision of Cystic Hygroma- Major 6,300
200 4 Throat SS00400084 Excision of Cystic Hygroma- Extensive 8,100
160
201 4 Throat SS00400085 Excision of Branchial Sinus 6,300
202 4 Throat SS00400086 Excision of Branchial Cyst 6,300
Commando Operation As Advised by Includes standard
203 4 Throat SS00400087 18,000
( glossectomy) Attending Doctor investigations
204 4 Throat SS00400088 Cleft palate repair 7,200
205 4 Throat SS00400089 Uvulophanyngoplasty 9,900
206 4 Throat SS00400090 Tonsillectomy - Unilateral 9,900
207 4 Throat SS00400091 Tonsillectomy - Bilateral 10,800
208 4 Throat SS00400092 Tonsillectomy + Styloidectomy 11,250
209 4 Throat SS00400093 Styloidectomy - One side 9,000
210 4 Throat SS00400094 Styloidectomy - Both side 6,750
211 4 Throat SS00400095 Retro pharyngeal abscess - Drainage 4,500
212 4 Throat SS00400096 Release of Tongue tie 3,000
213 4 Throat SS00400097 Pharyngoplasty 9,900
214 4 Throat SS00400098 Excision of Pharyngeal Diverticulum 8,550
215 4 Throat SS00400099 peritonsillor abscess under LA 1,440
216 4 Throat SS00400100 Parapharyngeal Abscess - Drainage 13,500
217 4 Throat SS00400101 Parapharyngeal tumours- Exploration 13,500
218 4 Throat SS00400102 Oro Antral fistula repair 9,000
161
219 4 Throat SS00400103 Maxilla - Excision 13,500
220 4 Throat SS00400104 Laryngophayryngectomy 20,000
221 4 Throat SS00400105 Laryngofissure 4,500
222 4 Throat SS00400106 Laryngectomy 18,000
223 4 Throat SS00400107 Pharyngeal diverticulum's Excision 10,800
224 4 Throat SS00400108 Tonsillectomy + Myrinogotomy 11,000
225 4 Throat SS00400109 Choanal atresia 9,000
226 4 Throat SS00400110 Arytenoidectomy 13,500
227 4 Throat SS00400111 Adenoidectomy 7,200
228 4 Throat SS00400112 Adenotonsillectomy 11,300
229 4 Throat SS00400113 Tracheostomy 4,500
230 4 Ear SS00400114 Facial Nv. Decompression 13,500
231 4 Throat SS00400115 Peritonsillar abscess drainage under LA 1,440
232 4 Ear SS00400116 Tinnitus Retraining therapy 225
233 4 Nose SS00400117 Septal perforation repair 11,250
234 4 Nose SS00400118 Antrum puncture 1,000
235 4 Nose SS00400119 Endoscopic Optic Nv. Decompression 26,100
236 4 Nose SS00400120 Orbital Decompression 26,100
162
237 4 Nose SS00400121 Endoscopic JNA excision 22,500
238 4 Throat SS00400122 Submandibular duct Lithotomy 2,250
239 4 Nose SS00400123 Nasal synechiolysis 3,780
240 4 Nose SS00400124 Nasal mass excision(simple) 10,080
241 4 Nose SS00400125 Nasal mass excision(endoscopic)) 12,150
242 4 Nose SS00400126 Anterior nasal packing 270
243 4 Nose SS00400127 Posterior nasal packing 900
244 4 Ear SS00400128 Preauricular sinus operation(unilateral) 4,400
245 4 SS00400129 Punch/Wedge biopsy 540
246 4 Nose SS00400130 Polyp removal(septal polyp) from nose 1,260
247 4 Nose SS00400131 Diagnostic nasal endoscopy under GA 2,700
248 4 Throat SS00400132 D/L biopsy under GA 4,500
249 4 Throat SS00400133 Oesophagoscopy/Foreign body removal 5,400
Bronchoscopy with Foreign body As Advised by Includes standard
250 4 Throat SS00400134 6,300
removal Attending Doctor investigations
Diabetes mellitus with foot infection
20 days / As Advised
251 5 Endocrinology SS00500001 3,200
by Attending Doctor
Amount per Day
Uncontrolled diabetes
5 days / As Advised
252 5 Endocrinology SS00500002 800
by Attending Doctor
Amount per Day
163
Diabetic Kidney Disease
by Attending Doctor
Amount per Day
Diabetic ketoacidosis
7 days / As Advised
by Attending Doctor
Amount per Day
Hypoglycaemia
5 days / As Advised
255 5 Endocrinology SS00500005 800
by Attending Doctor
Amount per Day
Cushings syndrome
by Attending Doctor
Amount per Day
Acromegaly
by Attending Doctor
Amount per Day
Undiagnosed pituitary macroadenoma
by Attending Doctor
Amount per Day
Diabetes insipidus
by Attending Doctor
Amount per Day
Thyrotoxicosis
7 days / As Advised
by Attending Doctor
Amount per Day
Thyroid Cancer
by Attending Doctor
Amount per Day
Parathyroid adenoma
by Attending Doctor
Amount per Day
Insulinoma
by Attending Doctor
Amount per Day
Phaeochromocytoma
by Attending Doctor
Amount per Day
164
Adrenal incidentaloma
by Attending Doctor
Amount per Day
Genital ambiguity
by Attending Doctor
Amount per Day
Hypogonadism
by Attending Doctor
Amount per Day
Short stature
by Attending Doctor
Amount per Day
Injury of Superficial Soft Tissues - 1 Day/As advise by Includes standard
269 6 General Surgery SS00600001 1,620
Secondary suture of wounds surgeon investigations
Delayed primary suture surgeon investigations
Debridement of wounds surgeon investigations
272 6 General Surgery SS00600004 Aspiration of Empyema 2,376
Aspiration of cold Abscess of 1 Day/As advise by Includes standard
Lymphnode surgeon investigations
Removal of foreign body ( from 1 Day/As advise by Includes standard
skin/muscle) surgeon investigations
275 6 General Surgery SS00600007 Fissurectomy +Fistulectomy 12,960
Cholecystectomy & exploration + As Advised by Includes standard
Adhenolysis Attending Doctor investigations
Cholecystectomy & exploration + Repair As Advised by Includes standard
of Common Bile Duct Attending Doctor investigations
278 6 General Surgery SS00600010 Rectal Dilation + Rectal Polyp 8,100
Fissurectomy and Haemorrhoidectomy+ As Advised by Includes standard
Rectal Dilation Attending Doctor investigations
Appendicular Perforation +Ovarian As Advised by Includes standard
Cystectomy Attending Doctor investigations
165
281 6 General Surgery SS00600013 Appendicectomy + Ovarian Cystectomy 13,500
282 6 General Surgery SS00600014 Hernioplasty + Orchidectomy 16,200
283 6 General Surgery SS00600015 Skin Grafting + Fasciotomy 17,820
Fissurectomy and Haemorrhoidectomy+ As Advised by Includes standard

Hysterectomy - Abdominal* Attending Doctor investigations
Cholecystectomy & exploration As Advised by Includes standard

+Hysterectomy - abdominal* Attending Doctor investigations
Cholecystectmy + Hysterectomy - As Advised by Includes standard
abdominal* Attending Doctor investigations
Hydrocele - Excision - unilateral + Cyst As Advised by Includes standard
over Scrotum - Excision Attending Doctor investigations
Hydrocele - Excision - Bilateral + Cyst As Advised by Includes standard
over Scrotum - Excision Attending Doctor investigations
Hydrocele - Excision - Unilateral + As Advised by Includes standard
Hernioplasty Attending Doctor investigations
Hydrocele - Excision - Bilateral + As Advised by Includes standard
Hernioplasty Attending Doctor investigations
Hernia - Repair & release of As Advised by Includes standard
obstruction+ Hernioplasty Attending Doctor investigations
Hernia - Repair & release of
292 6 General Surgery SS00600024 obstruction+Hydrocele - Excision - 19,440
Unilateral
293 6 General Surgery SS00600025 cleft lip and palate 21,600
294 6 General Surgery SS00600026 cleft lip 14,580
295 6 General Surgery SS00600027 Haemorroidectomy + Fistulectomy 13,500
296 6 General Surgery SS00600028 Adhenolysis + Appendicectomy 13,500
Chemical Cautery Wart excision ( per 1 Day/As advise by Includes standard
297 6 General Surgery SS00600029 540
sitting) surgeon investigations
166
298 6 General Surgery SS00600030 Excision of Warts 756
299 6 General Surgery SS00600031 Excision of Veneral Warts 756
300 6 General Surgery SS00600032 Tendon Transfer-Leprosy 27,000
301 6 General Surgery SS00600033 Tissue Reconstruction Flap Leprosy 27,000
302 6 General Surgery SS00600034 Debridement of Ulcer-Leprosy 12,960
303 6 General Surgery SS00600035 Subtotal Thyroidectomy (Toxic Goitre) 16,200
304 6 General Surgery SS00600036 Vasectomy 2,160
305 6 General Surgery SS00600037 Varicose veins - injection 756
306 6 General Surgery SS00600038 Trendelenburg Operation 14,040
Total Thyroidectomy and Block As Advised by Includes standard
Dissection Attending Doctor investigations
308 6 General Surgery SS00600040 Total Laryngectomy 21,600
309 6 General Surgery SS00600041 Temporal Bone resection 14,580
310 6 General Surgery SS00600042 Sympathetectomy - Lumbar 14,580
311 6 General Surgery SS00600043 Sympathetectomy - Cervical 16,740
312 6 General Surgery SS00600044 Suturing without local anesthesia 324 Daycare
Suturing of wounds with local
313 6 General Surgery SS00600045 540 Daycare
anesthesia
314 6 General Surgery SS00600046 Superficial Veriscosity 4,860
315 6 General Surgery SS00600047 Splenorenal Anastomosis 30,240
167
316 6 General Surgery SS00600048 Splenectomy - For Trauma 23,760
317 6 General Surgery SS00600049 Splenectomy - For Hypersplenism 21,600
318 6 General Surgery SS00600050 Soft Tissue Sarcoma 17,280
319 6 General Surgery SS00600051 Skin Flaps - Rotation Flaps 9,720
320 6 General Surgery SS00600052 Rib Resection & Drainage 11,880
321 6 General Surgery SS00600053 Removal Tumours of Chest Wall 17,280
Removal of Foreign Body from Trachea As Advised by Includes standard
or Oesophagus Attending Doctor investigations
323 6 General Surgery SS00600055 Phimosis Under LA 3,240
324 6 General Surgery SS00600056 Peritoneal dialysis 1,944 Daycare
325 6 General Surgery SS00600057 Pericardiostomy 32,400
326 6 General Surgery SS00600058 Partial/Subtotal Gastrectomy for Ulcer 22,680
Partial/Subtotal Gastrectomy for As Advised by Includes standard
Carcinoma Attending Doctor investigations
328 6 General Surgery SS00600060 Partial Thyroidectomy 16,740
329 6 General Surgery SS00600061 Partial Pericardectomy 18,900
330 6 General Surgery SS00600062 Parapharyngeal Tumour Excision 16,200
Operations for Stenosis of Renal As Advised by Includes standard
Arteries Attending Doctor investigations
Operations for Replacement of As Advised by Includes standard
Oesophagus by Colon Attending Doctor investigations
Operations for Acquired Arteriovenous As Advised by Includes standard
Fistula Attending Doctor investigations
168
334 6 General Surgery SS00600066 Operation of Choledochal Cyst 21,600
335 6 General Surgery SS00600067 Operation for Gastrojejunal Ulcer 21,600
operation for caricinoma lip- cheek As Advised by Includes standard
advancement Attending Doctor investigations
337 6 General Surgery SS00600069 Intercostal drainage 3,780
338 6 General Surgery SS00600070 Incision and Drainage of small abscess 1,296
339 6 General Surgery SS00600071 hernia -hiatus-Tranthorasic 23,760
340 6 General Surgery SS00600072 Gastojejunostomy and vagotomy 19,980
341 6 General Surgery SS00600073 Lap. Assisted small bowel resection 23,760
Excision I/D Injection keloid or Acne ( 1 Day/As advise by Includes standard
per site) surgeon investigations
343 6 General Surgery SS00600075 Excision and removal of superficial cysts 2,160
344 6 General Surgery SS00600076 Abdomino Perineal Resection 28,620
345 6 General Surgery SS00600077 Adventious Burse - Excision 9,180
346 6 General Surgery SS00600078 Anterior Resection for CA 24,300
347 6 General Surgery SS00600079 Appendicectomy 13,500
348 6 General Surgery SS00600080 Appendicular Abscess - Drainage 10,800
Arteriovenous (AV) Malformation of As Advised by Includes standard
Soft Tissue Tumour - Excision Attending Doctor investigations
350 6 General Surgery SS00600082 Bakers Cyst - Excision 8,100
351 6 General Surgery SS00600083 Bilateral Inguinal block dissection 19,980
169
Bleeding Ulcer - Gastrectomy & As Advised by Includes standard
vagotomy Attending Doctor investigations
353 6 General Surgery SS00600085 Bleeding Ulcer - Partial gastrectomy 23,760
Block dissection Cervical As Advised by Includes standard
Nodes(Bilateral) Attending Doctor investigations
355 6 General Surgery SS00600087 Branchial Fistula 16,200
356 6 General Surgery SS00600088 Breast Lump - Left - Excision 8,640
357 6 General Surgery SS00600089 Breast Lump - Right - Excision 8,640
358 6 General Surgery SS00600090 Bronchial Cyst 16,200
359 6 General Surgery SS00600091 Bursa - Excision 8,100
360 6 General Surgery SS00600092 Bypass - Inoprablaca of Pancreas 21,600
361 6 General Surgery SS00600093 Caecopexy 15,120
362 6 General Surgery SS00600094 Carbuncle back 5,940
363 6 General Surgery SS00600095 Cavernostomy 16,200
364 6 General Surgery SS00600096 Cervial Lymphnodes - Excision 7,020
365 6 General Surgery SS00600097 Colocystoplasty 30,240
366 6 General Surgery SS00600098 Colostomy 16,200
367 6 General Surgery SS00600099 Cyst over Scrotum - Excision 6,480
368 6 General Surgery SS00600100 Cystic Mass - Excision 3,780
369 6 General Surgery SS00600101 Dermoid Cyst - Large - Excision 4,320
170
370 6 General Surgery SS00600102 Dermoid Cyst - Small - Excision 3,240
Distal Pancrcatectomy with Pancreatico As Advised by Includes standard
Jejunostomy Attending Doctor investigations
372 6 General Surgery SS00600104 Diverticulectomy 21,600
Dorsal Slit and Reduction of 1 Day/As advise by Includes standard
Paraphimosis surgeon investigations
Drainage of Ischio Rectal Abscess under As Advised by Includes standard
GA Attending Doctor investigations
375 6 General Surgery SS00600107 Incision and Drainage of large Abscess 2,160
376 6 General Surgery SS00600108 Drainage of Peripherally Gastric Abscess 8,640
377 6 General Surgery SS00600109 Drainage of Psoas Abscess 9,720
378 6 General Surgery SS00600110 Drainage of Subdiaphramatic Abscess 10,800
379 6 General Surgery SS00600111 Duodenal Diverticulum 21,600
380 6 General Surgery SS00600112 Duodenal Jejunostomy 21,600
381 6 General Surgery SS00600113 Duodenectomy 30,240
Dupcrytren's (duputryen's contracture As Advised by Includes standard
?] Attending Doctor investigations
383 6 General Surgery SS00600115 Duplication of Intestine 21,600
384 6 General Surgery SS00600116 Hydrocelectomy + Orchidectomy 8,640
385 6 General Surgery SS00600117 Epidedectomy 8,640
386 6 General Surgery SS00600118 Epididymal Swelling -Excision 8,100
387 6 General Surgery SS00600119 Epidymal Cyst 5,400
171
388 6 General Surgery SS00600120 Evacuation of Scrotal Hematoma 6,480
389 6 General Surgery SS00600121 Excision Benign Tumor -Small intestine 21,060
390 6 General Surgery SS00600122 Excision Bronchial Sinus 16,200
391 6 General Surgery SS00600123 Excision and drainage of liver Abscess 17,280
392 6 General Surgery SS00600124 Excision Filarial Scrotum 12,960
393 6 General Surgery SS00600125 Excision Mammary Fistula 8,100
394 6 General Surgery SS00600126 Excision Meckel's Diverticulum 21,600
395 6 General Surgery SS00600127 Excision Pilonidal Sinus 10,800
396 6 General Surgery SS00600128 Excision Small Intestinal Fistulla 25,920
397 6 General Surgery SS00600129 Excision of Large Growth from Tongue 14,040
398 6 General Surgery SS00600130 Excision of Small Growth from Tongue 6,480
Excision of Swelling in Right Cervial As Advised by Includes standard
Region Attending Doctor investigations
400 6 General Surgery SS00600132 Excision of Large Swelling in Hand 9,180
401 6 General Surgery SS00600133 Excision of Small Swelling in Hand 4,860
402 6 General Surgery SS00600134 Excision of Neurofibroma 6,480
403 6 General Surgery SS00600135 Exicision of Siniuds and Curetage 9,720
404 6 General Surgery SS00600136 Facial Decompression 17,280
Fibro Lipoma of Right Sided Spermatic As Advised by Includes standard
with Lord Excision Attending Doctor investigations
172
406 6 General Surgery SS00600138 Fibroadenoma - Bilateral 12,960
407 6 General Surgery SS00600139 Fibrodenoma - Unilateral 7,560
408 6 General Surgery SS00600140 Fibroma - Excision 5,400
409 6 General Surgery SS00600141 Fissurectomy 12,960
410 6 General Surgery SS00600142 Fissurectomy with Sphincterotomy 12,960
411 6 General Surgery SS00600143 Anal Fistula Repair 12,960
412 6 General Surgery SS00600144 Foreign Body Removal in Deep Region 4,320
413 6 General Surgery SS00600145 Fulguration 5,400
414 6 General Surgery SS00600146 Fundoplication 21,600
415 6 General Surgery SS00600147 G J Vagotomy 16,200
416 6 General Surgery SS00600148 Vagotomy 16,200
417 6 General Surgery SS00600149 Ganglion - large - Excision 5,400
Ganglion (Dorsum of Both Wrist) - As Advised by Includes standard
Excision Attending Doctor investigations
419 6 General Surgery SS00600151 Ganglion - Small - Excision 3,780
420 6 General Surgery SS00600152 Gastro jejunal ulcer 17,820
421 6 General Surgery SS00600153 Gastro jejuno Colic Fistula 23,760
422 6 General Surgery SS00600154 Gastrojejunostomy 16,200
423 6 General Surgery SS00600155 Gastrotomy 1,620
173
424 6 General Surgery SS00600156 Graham's Operation 16,200
425 6 General Surgery SS00600157 Granuloma - Excision 4,320
426 6 General Surgery SS00600158 Growth - Excision 3,240
427 6 General Surgery SS00600159 Haemangioma - Excision 10,800
428 6 General Surgery SS00600160 Haemorrage of Small Intestine 21,600
429 6 General Surgery SS00600161 Hemithyroplasty 14,580
430 6 General Surgery SS00600162 Hepatic Resection (lobectomy) 30,780
431 6 General Surgery SS00600163 Hernia - Epigastric 10,800
432 6 General Surgery SS00600164 Hernia - Incisional 17,820
433 6 General Surgery SS00600165 Hernia - Repair & release of obstruction 17,820
434 6 General Surgery SS00600166 Hernia - Umbilical 12,960
435 6 General Surgery SS00600167 Hernia - Ventral - Lipectomy/Incisional 17,820
436 6 General Surgery SS00600168 Hernia - Femoral 17,280
437 6 General Surgery SS00600169 Hernioplasty 14,580
Herniorraphy and Hydrocelectomy Sac As Advised by Includes standard
439 6 General Surgery SS00600171 Hernia - Hiatus - abdominal 21,600
440 6 General Surgery SS00600172 Hydatid Cyst of Liver 17,280
441 6 General Surgery SS00600173 Nodular Cyst 5,400
174
442 6 General Surgery SS00600174 Hydrocelectomy+Hernioplasty - Excision 16,200
443 6 General Surgery SS00600175 Hydrocele - Excision - Unilateral 5,940
444 6 General Surgery SS00600176 Hydrocele - Excision - Bilateral 8,640
445 6 General Surgery SS00600177 Ilieo Sigmoidostomy 21,600
446 6 General Surgery SS00600178 Infected Bunion Foot - Excision 5,940
447 6 General Surgery SS00600179 Inguinal Node (bulk dissection) axial 12,960
448 6 General Surgery SS00600180 Instestinal perforation 16,200
449 6 General Surgery SS00600181 Intestinal Obstruction 16,200
450 6 General Surgery SS00600182 Intussusception 16,200
451 6 General Surgery SS00600183 Jejunostomy 12,960
452 6 General Surgery SS00600184 Closure of Intestinal Perforation 15,120
453 6 General Surgery SS00600185 Gastric Perforation 14,040
Intestinal Perforation (Resection As Advised by Includes standard
Anastomosis) Attending Doctor investigations
455 6 General Surgery SS00600187 Appendicular Perforation 13,500
456 6 General Surgery SS00600188 Burst Abdomen Obstruction 14,580
457 6 General Surgery SS00600189 Closure of Hollow Viscus Perforation 14,040
Laryngectomy & Pharyngeal As Advised by Includes standard
Diverticulum (Throat) Attending Doctor investigations
459 6 General Surgery SS00600191 Anorectoplasty 17,820
175
Laryngectomy with Block Dissection As Advised by Includes standard
(Throat) Attending Doctor investigations
461 6 General Surgery SS00600193 Laryngo Fissure (Throat) 16,200
462 6 General Surgery SS00600194 Laryngopharyngectomy (Throat) 21,600
463 6 General Surgery SS00600195 Ileostomy 16,200
464 6 General Surgery SS00600196 Lipoma 5,400
465 6 General Surgery SS00600197 Loop Colostomy Sigmoid 13,500
466 6 General Surgery SS00600198 Lords Procedure (haemorrhoids) 10,800
467 6 General Surgery SS00600199 Lumpectomy - Excision 9,720
468 6 General Surgery SS00600200 Mastectomy 12,960
469 6 General Surgery SS00600201 Mesenteric Cyst - Excision 18,900
470 6 General Surgery SS00600202 Mesenteric Caval Anastomosis 27,000
471 6 General Surgery SS00600203 Microlaryngoscopic Surgery 16,200
Oeshophagoscopy for foreign body As Advised by Includes standard
removal Attending Doctor investigations
473 6 General Surgery SS00600205 Oesophagectomy 27,000
474 6 General Surgery SS00600206 Oesophagus Portal Hypertension 32,400
475 6 General Surgery SS00600207 Pelvic Abscess - Open Drainage 10,260
476 6 General Surgery SS00600208 Orchidectomy 8,640
477 6 General Surgery SS00600209 Orchidectomy + Herniorraphy 17,820
176
478 6 General Surgery SS00600210 Orchidopexy 10,260
479 6 General Surgery SS00600211 Orchidopexy with Circumsion 13,500
480 6 General Surgery SS00600212 Orchidopexy With Eversion of Sac 14,580
481 6 General Surgery SS00600213 Orchidopexy with Herniotomy 16,740
482 6 General Surgery SS00600214 Pancreatrico Deodeneotomy 32,400
483 6 General Surgery SS00600215 Papilloma Rectum - Excision 5,400
Phytomatous Growth in the Scalp - As Advised by Includes standard
485 6 General Surgery SS00600217 Porto Caval Anastomosis 32,400
486 6 General Surgery SS00600218 Pyeloroplasty 15,120
487 6 General Surgery SS00600219 Radical Mastectomy 18,900
488 6 General Surgery SS00600220 Radical Neck Dissection - Excision 27,000
489 6 General Surgery SS00600221 Hernia - Spigelian 16,200
490 6 General Surgery SS00600222 Rectal Dilation 5,400
491 6 General Surgery SS00600223 Prolapse of Rectal Mass - Excision 13,500
492 6 General Surgery SS00600224 Rectopexy 14,580
493 6 General Surgery SS00600225 Repair of Common Bile Duct 18,900
Includes standard
494 6 General Surgery SS00600226 Foreign Body Removal in Superficial 1,080 Day care
investigations
495 6 General Surgery SS00600227 Resection Anastomosis (Large Intestine) 21,600
177
496 6 General Surgery SS00600228 Retroperitoneal Tumor - Excision 21,600
497 6 General Surgery SS00600229 Haemorroidectomy 12,960
498 6 General Surgery SS00600230 Salivary Gland - Excision 11,880
499 6 General Surgery SS00600231 Sebaceous Cyst - Excision 2,160
500 6 General Surgery SS00600232 Segmental Resection of Breast 11,880
501 6 General Surgery SS00600233 Scrotal Swelling (Multiple) - Excision 7,020
502 6 General Surgery SS00600234 Sigmoid Diverticulum 20,520
503 6 General Surgery SS00600235 Simple closure - Peptic perforation 14,040
504 6 General Surgery SS00600236 Sinus - Excision 7,560
505 6 General Surgery SS00600237 Soft Tissue Tumor - Excision 5,400
506 6 General Surgery SS00600238 Spindle Cell Tumor - Excision 8,640
507 6 General Surgery SS00600239 Submandibular Lymphs - Excision 5,400
Submandibular Mass Excision + As Advised by Includes standard
Reconstruction Attending Doctor investigations
509 6 General Surgery SS00600241 Superficial Parodectomy 14,040
510 6 General Surgery SS00600242 Terminal Colostomy 16,200
511 6 General Surgery SS00600243 Coloectomy - Total 25,920
Pharyngectomy & Reconstruction - As Advised by Includes standard
Total Attending Doctor investigations
Tracheal Stenosis (End to end As Advised by Includes standard
Anastamosis) (Throat) Attending Doctor investigations
178
514 6 General Surgery SS00600246 Tracheoplasty (Throat) 17,280
515 6 General Surgery SS00600247 Tranverse Colostomy 15,660
516 6 General Surgery SS00600248 Umbilical Sinus - Excision 7,560
517 6 General Surgery SS00600249 Resection Anastomosis (Small Intestine) 21,600
518 6 General Surgery SS00600250 Varicose Veins - Excision and Ligation 10,260
519 6 General Surgery SS00600251 Volvlous of Large Bowel 21,600
520 6 General Surgery SS00600252 Warren's Shunt 21,600
521 6 General Surgery SS00600253 Abbe Operation 10,800
Aneurysm not Requiring Bypass As Advised by Includes standard
Techniques Attending Doctor investigations
523 6 General Surgery SS00600255 Aneurysm Resection & Grafting 118,800
524 6 General Surgery SS00600256 Aorta-Femoral Bypass 118,800
525 6 General Surgery SS00600257 Arterial Embolectomy 59,400
526 6 General Surgery SS00600258 Aspiration of Empymema 2,700
527 6 General Surgery SS00600259 Benign Tumour of intestine Excisions 18,900
528 6 General Surgery SS00600260 Carotid artery aneurism 64,800
529 6 General Surgery SS00600261 Carotid Body Excision 54,000
530 6 General Surgery SS00600262 Cholecystectomy & Exploration of CBD 17,820
531 6 General Surgery SS00600263 Cholecystostomy 14,040
179
532 6 General Surgery SS00600264 Diagnostic Laproscopy 7,020
533 6 General Surgery SS00600265 Dressing under GA 3,780
534 6 General Surgery SS00600266 Estlander Operation 9,180
535 6 General Surgery SS00600267 Examination under Anesthesia 2,700
536 6 General Surgery SS00600268 Excision and Skin Graft of Venous Ulcer 14,580
Includes standard
537 6 General Surgery SS00600269 Excision of Corns 540 Daycare
investigations
Includes standard
538 6 General Surgery SS00600270 Excision of Moles 756 Daycare
investigations
Includes standard
539 6 General Surgery SS00600271 Excision of Molluscumcontagiosum 756 Daycare
investigations
Excision of Parathyroid As Advised by Includes standard
Adenoma/Carcinoma Attending Doctor investigations
541 6 General Surgery SS00600273 Vagotomy & Pyloroplasty 19,440
Includes standard
542 6 General Surgery SS00600274 Excision of Superficial Liipoma 3,240 Daycare
investigations
Includes standard
543 6 General Surgery SS00600275 Excision of Superficial Neurofibroma 756 Daycare
investigations
544 6 General Surgery SS00600276 Femoropopliteal by pass procedure 118,800
545 6 General Surgery SS00600277 Flap Reconstructive Surgery 27,000
546 6 General Surgery SS00600278 Free Grafts - Large Area 10% 13,500
547 6 General Surgery SS00600279 Free Grafts - Theirech- Small Area 5% 8,100
548 6 General Surgery SS00600280 Free Grafts - Very Large Area 20% 16,740
549 6 General Surgery SS00600281 Free Grafts - Wolfe Grafts 10,800
180
Includes standard
550 6 General Surgery SS00600282 Haemorrhoid - injection 756 Daycare
investigations
551 6 General Surgery SS00600283 Hemithyroidectomy 14,580
552 6 General Surgery SS00600284 Isthmectomy 10,800
553 6 General Surgery SS00600285 Laaproscopic Hernia Repair 20,520
554 6 General Surgery SS00600286 Lap. Assisted left Hemicolectomy 25,920
555 6 General Surgery SS00600287 Lap. Assisted Right Hemicolectomy 25,920
Includes standard
556 6 General Surgery SS00600288 Excision of Sebaceous Cysts 2,160 Daycare
investigations
557 6 General Surgery SS00600289 Lap. Assisted Total Colectomy 29,160
Lap. Cholecystectomy & CBD As Advised by Includes standard
exploration Attending Doctor investigations
559 6 General Surgery SS00600291 Lap. For intestinal obstruction 16,740
560 6 General Surgery SS00600292 Lap. Hepatic resection 27,000
561 6 General Surgery SS00600293 Lap. Hydatid of liver surgery 21,600
562 6 General Surgery SS00600294 Laproscopic Adhesiolysis 17,280
563 6 General Surgery SS00600295 Laproscopic Adrenalectomy 21,600
564 6 General Surgery SS00600296 Laproscopic Appenjdicectomy 12,960
565 6 General Surgery SS00600297 Laproscopic Cholecystectomy 17,280
566 6 General Surgery SS00600298 Laproscopic cystogastrostomy 21,600
567 6 General Surgery SS00600299 Laproscopic donor Nephroctomy 23,760
181
568 6 General Surgery SS00600300 Laproscopic Gastrostomy 15,660
569 6 General Surgery SS00600301 Laproscopic Hiatus Hernia Repair 25,920
570 6 General Surgery SS00600302 Laproscopic Pyelolithotomy 21,600
571 6 General Surgery SS00600303 Laproscopic Rectopexy 19,440
572 6 General Surgery SS00600304 Laproscopic Spleenectomy 19,440
573 6 General Surgery SS00600305 Laproscopic umbilical hernia repair 17,280
574 6 General Surgery SS00600306 Laproscopic ureterolithotomy 19,440
575 6 General Surgery SS00600307 Laproscopic ventral hernia repair 19,440
Laprotomy-peritonitis lavage and As Advised by Includes standard
drainage Attending Doctor investigations
577 6 General Surgery SS00600309 Ligation of Ankle Perforators 13,500
Lymphatics Excision of Subcutaneous As Advised by Includes standard
Tissues In Lymphoedema Attending Doctor investigations
579 6 General Surgery SS00600311 Repair of Main Arteries of the Limbs 37,800
Oesophagectomy for Carcinoma As Advised by Includes standard
Easophagus Attending Doctor investigations
581 6 General Surgery SS00600313 Operation for Bleeding Peptic Ulcer 19,440
Operation for Carcinoma Lip - As Advised by Includes standard
Vermilionectomy Attending Doctor investigations
Operation for Carcinoma Lip - Wedge As Advised by Includes standard
Excision and Vermilonectomy Attending Doctor investigations
Operation for Carcinoma Lip - Wedge- As Advised by Includes standard
Appendicectomy - Appendicular As Advised by Includes standard
Abscess - Drainage Attending Doctor investigations
182
586 6 General Surgery SS00600318 Caecostomy 11,880
587 6 General Surgery SS00600319 Coccygeal Teratoma Excision 18,360
Colostomy - Loop Colostomy Transverse As Advised by Includes standard
Sigmoid Attending Doctor investigations
Congenital Atresia & Stenosis of Small As Advised by Includes standard
Intestine Attending Doctor investigations
590 6 General Surgery SS00600322 Cystojejunostomy/or Cystogastrostomy 21,600
Direct Operation on Oesophagus for As Advised by Includes standard
Portal Hypertension Attending Doctor investigations
592 6 General Surgery SS00600324 Drainage of perinephric abscess 12,960
593 6 General Surgery SS00600325 drainage of perivertibral abscess 12,960
Gastroenterolog
594 7 y Medical and SS00700001 Acute Pancreatitis (Mild)
Surgical
Gastroenterolog
595 7 y Medical and SS00700002 Acute Pancreatitis (Severe)
Surgical
Gastroenterolog
596 7 y Medical and SS00700003 Obscure GI Bleed 22,500
Surgical
Gastroenterolog
597 7 y Medical and SS00700004 Cirrhosis with Hepatic Encephalopathy 27,000
Surgical
Gastroenterolog
598 7 y Medical and SS00700005 Cirrhosis with Hepato Renal Syndrome 36,000
Surgical
Gastroenterolog
599 7 y Medical and SS00700006 Oesophageal Fistula 21,600
Surgical
183
Gastroenterolog
600 7 y Medical and SS00700007 Corrosive Oesophageal Injury 11,250
Surgical
Gastroenterolog
Acute Pancreatitis with Pseudocyst As Advised by Includes standard
601 7 y Medical and SS00700008 25,200
(Infected) Attending Doctor investigations
Surgical
Gastroenterolog
602 7 y Medical and SS00700009 Chronic Pancreatitis with Severe Pain
Surgical
Gastroenterolog
603 7 y Medical and SS00700010 Biliary Strictures - Post OP Stent 31,500
Surgical
Gastroenterolog
604 7 y Medical and SS00700011 Biliary Strictures - Post OP Leaks 54,000
Surgical
Gastroenterolog
605 7 y Medical and SS00700012 Biliary Strictures - Sclerosing Cholangitis 16,200
Surgical
Gastroenterolog
606 7 y Medical and SS00700013 Oesophageal Perforation 13,500
Surgical
Gastroenterolog
607 7 y Medical and SS00700014 Achalasia Cardia 5,040
Surgical
Gastroenterolog
608 7 y Medical and SS00700015 Oesophageal Varices, Variceal Banding 4,500
Surgical
Gastroenterolog
609 7 y Medical and SS00700016 Oesophageal Varices, Sclerotherapy 6,300
Surgical
Gastroenterolog
610 7 y Medical and SS00700017 GAVE (Gastric Antral Vascular Ectasia) 14,400
Surgical
Gastroenterolog
611 7 y Medical and SS00700018 Gastric Varices 4,500
Surgical
184
Comprhensive mother package (three
Obstertics and antenal checkup , diagnositics , As Advised by Includes standard
612 9 SS00900001 13,500
Gynaecology treatment and Delivery - normal or Attending Doctor investigations
caessorian)
Obstetrics and Suction evacuation vesicular mole, As Advised by Includes standard
613 9 SS00900002 4,000
Gynaecology missed abortion D/E Attending Doctor investigations
Obstetrics and Rupture Uterus, closure & repair with As Advised by Includes standard
614 9 SS00900003 13,500
Gynaecology tubal ligation Attending Doctor investigations
Obstetrics and Repair of post-coital tear, perineal As Advised by Includes standard
615 9 SS00900004 4,500
Gynaecology injury Attending Doctor investigations
Obstetrics and Perforation of Uterus after D/E As Advised by Includes standard
616 9 SS00900005 13,500
Gynaecology Laparotomy & Closure Attending Doctor investigations
Obstetrics and Laparotomy-peritonitis lavage and As Advised by Includes standard
617 9 SS00900006 10,800
Gynaecology drainage Attending Doctor investigations
Obstetrics and Laparotomy-failed laparoscopy to As Advised by Includes standard
618 9 SS00900007 10,800
Gynaecology explore Attending Doctor investigations
Obstetrics and As Advised by Includes standard
619 9 SS00900008 Internal podalic version and extraction 8,000
Gynaecology Attending Doctor investigations
Obstetrics and Gaping pareneal wound secondary As Advised by Includes standard
620 9 SS00900009 2,700
Gynaecology suturing Attending Doctor investigations
621 9 SS00900010 Exploration of PPH-tear repair 4,500
Obstetrics and Exploration of perineal haematoma & As Advised by Includes standard
622 9 SS00900011 6,750
Gynaecology Resuturing of episiotomy Attending Doctor investigations
Obstetrics and Exploration of abdominal haematoma As Advised by Includes standard
623 9 SS00900012 13,500
Gynaecology (after laparotomy + LUCS) Attending Doctor investigations
Obstetrics and 1 Day / As Advised by Includes standard

624 9 SS00900013 Excision of urethral caruncle 3,150

625 9 SS00900014 Examination under anaesthesia 2,250

626 9 SS00900015 Colpotomy-drainage P/V needling EUA 3,150
185
627 9 SS00900016 Brust abodomen repair 10,350
628 9 SS00900017 Broad Ligment Haemotoma drainage 6,800
Obstetrics and Electro Cauterisation Cryo Surgery 1 Day / As Advised by Includes standard
629 9 SS00900018 3,800
Gynaecology +Fractional Curretage Attending Doctor investigations
Obstetrics and 2 Days / As Advised Includes standard

630 9 SS00900019 Normal delivery + perineal tear repair 4,100
Gynaecology by Attending Doctor investigations

631 9 SS00900020 Adhenolysis+ Ovarian Cystectomy 13,500
632 9 SS00900021 Adhenolysis+ Salpingostomy 8,550
Obstetrics and Ablation of Endometriotic Spot As Advised by Includes standard
633 9 SS00900022 8,820
Gynaecology +Salpingostomy Attending Doctor investigations
Obstetrics and Casearean delivery+ As Advised by Includes standard
634 9 SS00900023 8,550
Gynaecology Salpingoophrectomy Attending Doctor investigations
Obstetrics and D&C ( Dilatation & curretage) + As Advised by Includes standard
635 9 SS00900024 3,500
Gynaecology Polypectomy Attending Doctor investigations
Obstetrics and Ablation of Endometrium + As Advised by Includes standard
636 9 SS00900025 7,560
Obstetrics and Ablation of Endometriotic Spot + As Advised by Includes standard
637 9 SS00900026 7,560
638 9 SS00900027 Casearean delivery+Ovarian Cystectomy 12,000
Obstetrics and D&C ( Dilatation & curretage) +Ovarian As Advised by Includes standard
639 9 SS00900028 6,750
Gynaecology Cystectomy Attending Doctor investigations
Obstetrics and Ablation of Endometrium +Ovarian As Advised by Includes standard
640 9 SS00900029 7,875
Gynaecology Cystectomy Attending Doctor investigations
641 9 SS00900030 7,875
Gynaecology +Ovarian Cystectomy Attending Doctor investigations
Obstetrics and Ovarian Cystectomy +Hysterotomy - As Advised by Includes standard
642 9 SS00900031 13,050
Gynaecology Tumors removal Attending Doctor investigations
186
643 9 SS00900032 Casearean delivery+Hernia - Incisional 12,500
Obstetrics and Hysterotomy -Tumors removal+ Hernia - As Advised by Includes standard
644 9 SS00900033 16,785
Gynaecology Incisional Attending Doctor investigations
Obstetrics and Hysterectomy - abdominal+ Hernia - As Advised by Includes standard
645 9 SS00900034 14,850
Gynaecology Incisional* Attending Doctor investigations
Obstetrics and Hysterectomy - abdominal+Hernia - As Advised by Includes standard
646 9 SS00900035 13,950
Gynaecology Epigastric* Attending Doctor investigations
Obstetrics and Hysterectomy - Vaginal+ As Advised by Includes standard
647 9 SS00900036 12,150
Gynaecology Haemorroidectomy* Attending Doctor investigations
Obstetrics and D&C ( Dilatation & curretage) +Electro 1 Day / As Advised by Includes standard
648 9 SS00900037 3,500
Gynaecology Cauterisation Cryo Surgery Attending Doctor investigations
Obstetrics and Ablation of Endometrium + Electro 1 Day / As Advised by Includes standard

649 9 SS00900038 5,625
Gynaecology Cauterisation Cryo Surgery Attending Doctor investigations
Obstetrics and D&C ( Dilatation & curretage) + Cervical 1 Day / As Advised by Includes standard
650 9 SS00900039 3,500
Gynaecology polypectomy Attending Doctor investigations
Obstetrics and D&C ( Dilatation & curretage) 1 Day / As Advised by Includes standard
651 9 SS00900040 3,500
Gynaecology +Bartholin abscess I & D Attending Doctor investigations
Obstetrics and D&C ( Dilatation & curretage) + Ablation 1 Day / As Advised by Includes standard
652 9 SS00900041 6,000
Gynaecology of Endometrium Attending Doctor investigations
Obstetrics and Cervical polypectomy + Cystocele - As Advised by Includes standard

653 9 SS00900042 11,250
Gynaecology Anterior repair Attending Doctor investigations
654 9 SS00900043 12,000
Gynaecology +Cystocele - Anterior repair Attending Doctor investigations
Obstetrics and Abdomonal open for stress As Advised by Includes standard
655 9 SS00900044 14,000
Gynaecology incision+Cystocele - Anterior repair Attending Doctor investigations
Obstetrics and Bartholin abscess I & D +Cyst -Vaginal 1 Day / As Advised by Includes standard
656 9 SS00900045 3,500
Gynaecology Enucleation Attending Doctor investigations
Obstetrics and Bartholin cyst removal + cervical As Advised by Includes standard

657 9 SS00900046 3,500
187
Obstetrics and Bartholin abscess I & D + cervical As Advised by Includes standard
658 9 SS00900047 4,000
659 9 SS00900048 6,000
Gynaecology +Adhenolysis Attending Doctor investigations
660 9 SS00900049 Radical vulvectomy
661 9 SS00900050 Operation for stress incontinence 8,280
662 9 SS00900051 Colpollaisis/Colporrhophy 5,000

663 9 SS00900052 Colopotomy 3,000

664 9 SS00900053 Cone Biopsy Cervix 3,000

665 9 SS00900054 Cervical biopsy 2,000
Obstetrics and Abdominal perineal neo construction As Advised by Includes standard

666 9 SS00900055 10,800
Gynaecology Cx+Uteria+Vagina Attending Doctor investigations
Obstetrics and Cystocele - Anterior Repair + Perineal As Advised by Includes standard
667 9 SS00900056 12,000
Gynaecology Tear Repair + Salpingoophrectomy Attending Doctor investigations
Hysterectomy (Abdominal and Vaginal)

668 9 SS00900057 + Cystocele - Anterior Repair + Perineal 17,000
Tear Repair + Salpingoophrectomy*

669 9 SS00900058 + Cystocele - Anterior Repair + 17,000
Salpingoophrectomy*
670 9 SS00900059 + Cystocele - Anterior Repair + Perineal 17,000
Tear Repair*
Obstetrics and Perineal Tear Repair + As Advised by Includes standard
671 9 SS00900060 5,000
188
Obstetrics and Cystocele - Anterior Repair + As Advised by Includes standard
672 9 SS00900061 8,000
Obstetrics and Cystocele - Anterior Repair + Perineal As Advised by Includes standard
673 9 SS00900062 6,000
Gynaecology Tear Repair Attending Doctor investigations
Obstetrics and Hysterectomy (Abdominal and Vaginal) As Advised by Includes standard
674 9 SS00900063 12,000
Gynaecology + Salpingoophrectomy* Attending Doctor investigations
675 9 SS00900064 12,000
Gynaecology + Perineal Tear Repair* Attending Doctor investigations
676 9 SS00900065 12,000
Gynaecology + Cystocele - Anterior Repair* Attending Doctor investigations
Obstetrics and Ovarian Cystectomy + Hysterectomy - As Advised by Includes standard
677 9 SS00900066 11,700
Gynaecology abdominal* Attending Doctor investigations
Obstetrics and Ablation of Endometrium + D&C ( 1 Day / As Advised by Includes standard

678 9 SS00900067 6,000
Gynaecology Dilatation & curretage) Attending Doctor investigations

679 9 SS00900068 Puerperal Sepsis 6,000
680 9 SS00900069 Normal Delivery + Tubectomy 6,000
681 9 SS00900070 Pre-eclampsia + Normal Delivery 6,000
682 9 SS00900071 Pre-eclampsia + Caesearen Delivery 12,000
683 9 SS00900072 Casearean delivery + Tubectomy 12,000

684 9 SS00900073 Shirodhkar Mc. Donalds stich 3,500

685 9 SS00900074 Salphingo-oophorectomy 6,000
Obstetrics and Rupture Uterus , closer and repoar with As Advised by Includes standard
686 9 SS00900075 12,000
Gynaecology tubal ligation Attending Doctor investigations
Obstetrics and Repair of post coital tear, perineal 1 Day / As Advised by Includes standard
687 9 SS00900076 3,500
Gynaecology injury Attending Doctor investigations
189
Obstetrics and Perforamtion of Uterus after D/E As Advised by Includes standard
688 9 SS00900077 12,000
Gynaecology laprotomy and closure Attending Doctor investigations
Obstetrics and Nomal delivery with episiosty and P As Advised by Includes standard
689 9 SS00900078 6,000
Gynaecology repair Attending Doctor investigations
690 9 SS00900079 Manual removel of Plecenta 2,500
Obstetrics and Manual removel of Plecenta for outside As Advised by Includes standard
691 9 SS00900080 3,000
Gynaecology delivery etc. Attending Doctor investigations
692 9 SS00900081 Lower Segment Caesarean Section 12,000
Obstetrics and Low midcavity forceps + Normal As Advised by Includes standard
693 9 SS00900082 6,000
Gynaecology delivery Attending Doctor investigations
694 9 SS00900083 Low Forceps+ Normal delivery 5,000
695 9 SS00900084 Laprotomy for ectopic repture 8,000
696 9 SS00900085 Laprotomy -failed laproscopy to explore 8,000
697 9 SS00900086 Laproscopy Salpingoplasty/ ligation 6,750
698 9 SS00900087 Insertion of IUD Device 700
699 9 SS00900088 Hysterectomy- Laproscopy* 12,000
700 9 SS00900089 Destructive operation 6,750
Obstetrics and D&C ( Dilatation & curretage)upto 8 1 Day / As Advised by Includes standard
701 9 SS00900090 3,000
Gynaecology wks Attending Doctor investigations
Obstetrics and D&C ( dilatation & Curretage) upto 12 1 Day / As Advised by Includes standard
702 9 SS00900091 3,500
Gynaecology wks Attending Doctor investigations

703 9 SS00900092 D&C ( Dilatation & curetage ) > 12 wks 4,000
190
704 9 SS00900093 Conventional Tubectomy 2,700

705 9 SS00900094 Caesarean+ Hysterectomy* 15,000
706 9 SS00900095 Normal Delivery 3,500
707 9 SS00900096 Vulval Tumors - Removal 5,000
708 9 SS00900097 Vulvectomy 8,000
709 9 SS00900098 Vaginal Tear -Repair 3,000
710 9 SS00900099 Tuboplasty 10,000
711 9 SS00900100 Retro Vaginal Fistula -Repair 12,000
712 9 SS00900101 Prolapse Uterus - Manchester 12,000
713 9 SS00900102 Prolapse Uterus -L forts 10,000
714 9 SS00900103 Perineal Tear Repair 3,500
715 9 SS00900104 Ovarectomy/Oophrectomy 7,000
716 9 SS00900105 Myomectomy - Abdominal 10,800
717 9 SS00900106 Hysterectomy - Wertheims operation*
718 9 SS00900107 Hysterectomy - Vaginal* 12,000
719 9 SS00900108 Hysterectomy - abdominal* 12,000
720 9 SS00900109 Hymenectomy & Repair of Hymen 3,500
191
Obstetrics and Haemato Colpo/Excision - Vaginal As Advised by Includes standard
721 9 SS00900110 5,000
Gynaecology Septum Attending Doctor investigations
722 9 SS00900111 Gilliams Operation 6,000
723 9 SS00900112 Fractional Curretage 3,500
724 9 SS00900113 Electro Cauterisation Cryo Surgery 3,500
725 9 SS00900114 D&C ( Dilatation & curretage) 3,000
726 9 SS00900115 Cystocele - Anterior repair 3,600
727 9 SS00900116 Ovarian Cystectomy 7,200

728 9 SS00900117 Cyst -Vaginal Enucleation 3,500

729 9 SS00900118 Cyst - Labial 3,500

730 9 SS00900119 Cervical Polypectomy 3,000

731 9 SS00900120 Bartholin cyst removal 3,500

732 9 SS00900121 Abdomonal open for stress incision 11,700
733 9 SS00900124 RVF Repair 16,200
734 9 SS00900125 Manchester Operations 12,000
735 9 SS00900126 Perineorrhaphy 10,800
736 9 SS00900127 Colporrhaphy with mesh. 13,500
192
737 9 SS00900128 Colporrhaphy without mesh. 10,800
738 9 SS00900129 Enterocoel repair 9,000
Obstetrics and Shirodkars sling Operation or other As Advised by Includes standard
739 9 SS00900130 12,000
Gynaecology sling operations for prolapse uterus Attending Doctor investigations
Obstetrics and Laparoscopic sling operations for As Advised by Includes standard
740 9 SS00900131 12,000
Gynaecology prolapse uterus Attending Doctor investigations

741 9 SS00900132 Diagnostic Curettage 2,250

742 9 SS00900133 Fractiol Curettage 2,700

743 9 SS00900134 D & C and Cervical Biopsy 2,700

744 9 SS00900135 Polypectomy 1,800

745 9 SS00900136 Other-Minor Operation Endometrial 1,800

746 9 SS00900137 Excision Vagil Cyst/Burtholin Cyst 2,700

747 9 SS00900138 Excision Vagil Septum 4,050
Obstetrics and Laparoscopy -Diagnostic with 1 Day / As Advised by Includes standard

748 9 SS00900139 6,300
Gynaecology chromopertubation Attending Doctor investigations

749 9 SS00900140 Laparoscopy Sterilisation 4,500
193
750 9 SS00900141 Laparoscopy Operative 9,000
751 9 SS00900142 Laparoscopy LAVH 11,700
752 9 SS00900143 Total laparscopic hysterectomy 19,800

753 9 SS00900144 Drilling of Overy 6,300
Obstetrics and Laparascopic treatment of Ectopic As Advised by Includes standard

754 9 SS00900145 9,000
Gynaecology pregncy-salpingectomy Attending Doctor investigations
Obstetrics and Laparotomy treatment of Ectopic As Advised by Includes standard
755 9 SS00900146 11,700
Gynaecology pregncy. Attending Doctor investigations
756 9 SS00900147 Conisation of cervix 4,500
Obstetrics and Trachleorraphy of cervix for early CA As Advised by Includes standard
757 9 SS00900148 8,000
Gynaecology cervix Attending Doctor investigations

758 9 SS00900149 Hysteroscopic cannulation 6,000
Obstetrics and Laparotomy recannulation of Fellopian As Advised by Includes standard

759 9 SS00900150 14,400
Gynaecology tubes-(Tubuloplasty) Attending Doctor investigations
Obstetrics and Laparoscopic recannulation of Fellopian As Advised by Includes standard
760 9 SS00900151 18,000
Gynaecology tubes- (Tubuloplasty) Attending Doctor investigations

761 9 SS00900152 Colposcopy 2,500
Obstetrics and LEETZ(Large Loop Excision of As Advised by Includes standard

762 9 SS00900153 5,400
Gynaecology Transformation Zone) Attending Doctor investigations
763 9 SS00900154 Loop Electro Surgical procedures. 5,400

764 9 SS00900155 Chorionic Villi sampling 3,600
194
765 9 SS00900156 Interventiol Ultrasonography 1,350

766 9 SS00900157 Amneocentosis 3,600
767 9 SS00900158 Hysteroscopic endometrial ablation 9,000
768 9 SS00900159 Thermal ballon ablation. 9,000
769 9 SS00900160 Ultrasonographic myolysis 5,400
770 9 SS00900161 Laparoscopic cystectomy 7,200

771 9 SS00900162 Intra Uterine Insemition 1,080

772 9 SS00900163 Laparotomy abdomil scaro-colpopexy 18,000
773 9 SS00900164 Laparotomy Vault suspension 13,500
774 9 SS00900165 Laparscopic abdomil scaro-colpopexy 18,900
775 9 SS00900166 Laparoscopic Vault suspension 16,200
776 9 SS00900167 Laparotomy radical Lymphedenectomy 19,800
777 9 SS00900168 Laparoscopic radical Lymphedenectomy 22,500
778 9 SS00900169 Endometrial aspiration cytology 630
Obstetrics and Transvagil sonography (TVS for 1 Day / As Advised by Includes standard
779 9 SS00900170 540
Gynaecology Follicular monitioringaspiration) Attending Doctor investigations
Obstetrics and laparoscopic treatment for stress As Advised by Includes standard

780 9 SS00900171 8,000
Gynaecology incontinence Attending Doctor investigations
195
781 9 SS00900172 Transvagil tubes for Stress incontinence 10,800
Obstetrics and trans-obturator tubes for Stress As Advised by Includes standard
782 9 SS00900173 9,000
Gynaecology incontinence Attending Doctor investigations
Obstetrics and Interventiol radiographic arterial As Advised by Includes standard
783 9 SS00900174 4,500
Gynaecology embolisation Attending Doctor investigations

784 9 SS00900175 Diagnosticcystoscopy 2,250
Obstetrics and Staging laparotomy surgery for CA As Advised by Includes standard

785 9 SS00900176 5,400
Gynaecology Overy Attending Doctor investigations

786 9 SS00900177 Interl Iliac ligation 12,000

787 9 SS00900178 stepwise devascularisation 10,000
788 9 SS00900179 Assisted breech delivery 5,000
789 9 SS00900180 Cordocentesis 2,430
790 9 SS00900181 Intra-uterine fetal blood transfusion
791 9 SS00900182 Hysteroscopy TCRE 9,000
792 9 SS00900183 Hysteroscopy Removal of IUCD 4,500
793 9 SS00900184 Hysteroscopy Removal of Septum 9,000
794 9 SS00900185 Hysteroscopy Diagnostic 7,200
Obstetrics and Werthimas Hystrectomy for Cancer As Advised by Includes standard
795 9 SS00900186 22,500
Gynaecology cervix Attending Doctor investigations
796 9 SS00900187 Sterilisation Post ertum 3,600
797 9 SS00900188 Sterilisation Intravagil 3,600
196
798 9 SS00900189 Abortion- D & C 2,500

799 9 SS00900190 Abortion- Evacuation 2,500

800 9 SS00900191 MTP- 1st Trimester 2,500

801 9 SS00900192 MTP - 2nd Trimester 3,600

802 9 SS00900193 Triple test 1,350

803 9 SS00900194 Quadriple test 2,250
Obstetrics and 1 Day / As Advised by

804 9 SS00900195 Biophysical score 540
Gynaecology Attending Doctor

805 9 SS00900196 Fetal nuechal translucency 270

806 9 SS00900197 HPV testing 450

807 9 SS00900198 BLCG 360
Medical Acute Severe Asthma with Acute As Advised by Includes standard

808 10 SS01000001
Conditions Respiratory Failure Attending Doctor investigations
Medical Copd Respiratory Failure (Infective As Advised by Includes standard
809 10 SS01000002
Conditions Exacerbation) Attending Doctor investigations
Medical Acute Bronchitis and Pneumonia with As Advised by Includes standard
810 10 SS01000003
Conditions Respiratory Failure Attending Doctor investigations
197
Medical As Advised by Includes standard
811 10 SS01000004 ARDS
Conditions Attending Doctor investigations
812 10 SS01000005 ARDS with Multi Organ Failure
813 10 SS01000006 ARDS Plus DIC (Blood & Blood Products)
Medical OP Poisioning Requiring Ventilatory As Advised by Includes standard
814 10 SS01000007
Conditions Assistance Attending Doctor investigations
815 10 SS01000008 Septic Shock (ICU Management)
Medical Metabolic Coma Requiring Ventilatory As Advised by Includes standard
816 10 SS01000009
Conditions Support Attending Doctor investigations
Medical Thrombocytopenia with Bleeding As Advised by Includes standard
817 10 SS01000010
Conditions Diathesis Attending Doctor investigations
818 10 SS01000011 Hemophilia
819 10 SS01000012 Other Coagulation Disorders
Medical Chelation Therapy for Thalassemia As Advised by Includes standard
820 10 SS01000013
Conditions Major Attending Doctor investigations
821 10 SS01000014 Snake Bite Requiring Ventilator Support
Medical Scorpion Sting Requiring Ventilator As Advised by Includes standard
822 10 SS01000015
Conditions Support Attending Doctor investigations
823 10 SS01000016 Treatment for Sickle Cell Anemia
824 10 SS01000017 Tetanus Severe
825 10 SS01000018 Diphtheria Complicated
826 10 SS01000019 Cryptococcal Meningitis
827 10 SS01000020 Cerebral Malaria
828 10 SS01000021 Vitamin A deficiency
198
Medical Viral pneumonia, not elsewhere As Advised by Includes standard
829 10 SS01000022
Conditions classified Attending Doctor investigations
830 10 SS01000023 Viral meningitis
831 10 SS01000024 Viral fever
Medical Viral and other specified intestinal As Advised by Includes standard
832 10 SS01000025
Conditions infections Attending Doctor investigations
833 10 SS01000026 Vasculits
834 10 SS01000027 Urethritis - gonococcal
835 10 SS01000028 Urethritis - chlamydial
Medical Upper GI bleeding ( endoscopic As Advised by Includes standard
836 10 SS01000029
Conditions treatment) Attending Doctor investigations
837 10 SS01000030 Upper GI bleeding ( conservative)
838 10 SS01000031 Unspecified viral hepatitis
839 10 SS01000032 Unspecified malaria
840 10 SS01000033 Unspecified diabetes mellitus
841 10 SS01000034 Unspecified chronic bronchitis
842 10 SS01000035 Typhoid and paratyphoid fevers
843 10 SS01000036 Typhoid
844 10 SS01000037 Tubercular menigitis
845 10 SS01000038 Transforaminal Block
846 10 SS01000039 Trachoma
199
847 10 SS01000040 Tonsillitis
Medical Thrombocytopenia ( plus blood unit As Advised by Includes standard
848 10 SS01000041
Conditions costs ) Attending Doctor investigations
849 10 SS01000042 Tetanus
850 10 SS01000043 TB Meningitis
851 10 SS01000044 TB pulmonary
852 10 SS01000045 Systenuc Lupus Erythematosis
853 10 SS01000046 Syphillis
854 10 SS01000047 Subarachnoid haemorrhage (ICU)
Medical Stroke, not specified as haemorrhage or As Advised by Includes standard
855 10 SS01000048
Conditions infarction Attending Doctor investigations
856 10 SS01000049 Stroke
857 10 SS01000050 Staus asthamaticus
858 10 SS01000051 status epilepsy
Medical Simple and mucopurulent chronic As Advised by Includes standard
859 10 SS01000052
Conditions bronchitis Attending Doctor investigations
860 10 SS01000053 Septicemia
861 10 SS01000054 Septic shock
862 10 SS01000055 Scorpion sting
863 10 SS01000056 Schizophrenia
864 10 SS01000057 Scabies
200
865 10 SS01000058 RTA Head Injury Mgt (conservative)
Respiratory tuberculosis,
866 10 SS01000059 bacteriologically and histologically
confirmed
Medical PUO Management(would include fevers As Advised by Includes standard

867 10 SS01000060
Conditions - viral/bacterial/fungal/infestation, etc) Attending Doctor investigations

868 10 SS01000061 Pneumothorax
869 10 SS01000062 Pneumonia, organism unspecified
Medical Pneumonia in diseases classified As Advised by Includes standard
870 10 SS01000063
Conditions elsewhere Attending Doctor investigations
Medical Pneumonia due to Streptococcus As Advised by Includes standard
871 10 SS01000064
Conditions pneumoniae Attending Doctor investigations
Medical Pneumonia due to other infectious As Advised by Includes standard
872 10 SS01000065
Conditions organisms, not elsewhere classified Attending Doctor investigations
Medical Pneumonia due to Haemophilus As Advised by Includes standard
873 10 SS01000066
Conditions influenzae Attending Doctor investigations
874 10 SS01000067 Pneumonia
875 10 SS01000068 Plasmodium vivax malaria
876 10 SS01000069 Plasmodium malariae malaria
877 10 SS01000070 Plasmodium falciparum malaria
878 10 SS01000071 Plague
879 10 SS01000072 Pertussis
880 10 SS01000073 Peripheral neuritis/ neuropathy
201
Ozone Therapy(Intradiscal Paraspinal
881 10 SS01000074 package inculde admission one day + 4
follow up procedure)
882 10 SS01000075 Ozone Therapy + Nerve Block
Medical Other nontraumatic intracranial As Advised by Includes standard
883 10 SS01000076
Conditions haemorrhage Attending Doctor investigations
Medical Other Coagulation disorders ( plus As Advised by Includes standard
884 10 SS01000077
Conditions blood tranfusion units costs) Attending Doctor investigations
Medical Other bacterial foodborne intoxications, As Advised by Includes standard
885 10 SS01000078
Conditions not elsewhere classified Attending Doctor investigations
886 10 SS01000079 Other acute viral hepatitis
887 10 SS01000080 Organ transplant
888 10 SS01000081 Orchititis
Medical Non-insulin-dependent diabetes As Advised by Includes standard
889 10 SS01000082
Conditions mellitus Attending Doctor investigations
890 10 SS01000083 Nephrotic syndrom
Medical Neonatal jaundice from other and As Advised by Includes standard
891 10 SS01000084
Conditions unspecified causes Attending Doctor investigations
Medical Neonatal jaundice due to other As Advised by Includes standard
892 10 SS01000085
Conditions excessive haemolysis Attending Doctor investigations
893 10 SS01000086 Myalgia
894 10 SS01000087 Multiple fractures
895 10 SS01000088 Mngt of Ischemic Strokes
896 10 SS01000089 Mngt of Hemorrhagic Stroke/Strokes
897 10 SS01000090 Meningitis
202
898 10 SS01000091 Measles - uncomplicated
899 10 SS01000092 Measles - complicated
900 10 SS01000093 Management of Pneumothorax
901 10 SS01000094 Malnutrition-related diabetes mellitus
902 10 SS01000095 Malaria -cerebral
903 10 SS01000096 Malaria - uncomplicated
904 10 SS01000097 Malaria - complicated
905 10 SS01000098 Lung abscess /Empema
906 10 SS01000099 LRTI management
907 10 SS01000100 Localised cellulilits
908 10 SS01000101 Leptospirosis
909 10 SS01000102 Leprosy Ulcer Care With Stay
910 10 SS01000103 Leprosy Reaction & Neuritis (T1R & T2R)
911 10 SS01000104 Intracerebral haemorrhage (ICU)
Medical Intraarticular Steroid knee package of5 As Advised by Includes standard
912 10 SS01000105
Conditions sitting Attending Doctor investigations
Medical Intraarticular Ozone Knee package of As Advised by Includes standard
913 10 SS01000106
Conditions 5sitting Attending Doctor investigations
914 10 SS01000107 Interstial lung diseases
Medical Insulin-dependent diabetes mellitus- As Advised by Includes standard
915 10 SS01000108
Conditions Acute episode Attending Doctor investigations
203
916 10 SS01000109 Hyper Osmolar Non Ketotic Coma
917 10 SS01000110 Herpes Simplex
918 10 SS01000111 Hepatis B
919 10 SS01000112 colitis
920 10 SS01000113 Hemiplegia / quadriplegia
921 10 SS01000114 Heat stroke
Gestational [pregnancy-induced]
922 10 SS01000115 hypertension without significant
proteinuria
Gestational [pregnancy-induced]
923 10 SS01000116 hypertension with significant
proteinuria
924 10 SS01000117 Food poisoning
925 10 SS01000118 Filariasis
926 10 SS01000119 Essential (primary) hypertension
Medical Epiduro-fluroscopy Adhesiolysis (3 days As Advised by Includes standard
927 10 SS01000120
Conditions stay) Attending Doctor investigations
928 10 SS01000121 Enteric fever
929 10 SS01000122 Endocarditis
930 10 SS01000123 Emphysema Acute Exacerbation
931 10 SS01000124 Dysfunctional uterine bleeding
932 10 SS01000125 Dysentery - bacterial
204
933 10 SS01000126 Diphtheria
Medical Diarrhoea and gastroenteritis of As Advised by Includes standard
934 10 SS01000127
Conditions presumed infectious origin Attending Doctor investigations
Medical Dengue h'agic fever ( plus packed cell As Advised by Includes standard
935 10 SS01000128
Conditions transfusion) Attending Doctor investigations
936 10 SS01000129 Dengue haemorrhagic fever
937 10 SS01000130 Dengue fever [classical dengue
938 10 SS01000131 Dengue fever
939 10 SS01000132 COPD+ Respiratory Failure
940 10 SS01000133 Control of diabetic ketoacidosis
941 10 SS01000134 Conjunctivitis (bacterial)
Medical Accidental orgono phosphorus As Advised by Includes standard
942 10 SS01000135
Conditions poisoining Attending Doctor investigations
943 10 SS01000136 Acid peptic disease
944 10 SS01000137 Acute astahamic attack
945 10 SS01000138 Acute colitis
Medical Acute diarrhea with severe dehydration As Advised by Includes standard
946 10 SS01000139
Conditions ( grade 2 and above) Attending Doctor investigations
Medical Acute diarrohea with moderate As Advised by Includes standard
947 10 SS01000140
Conditions dehydration Attending Doctor investigations
948 10 SS01000141 Acute Exarcebation of COPD
949 10 SS01000142 Acute hepatitis A
205
952 10 SS01000145 Acute Hytension - medical management
953 10 SS01000146 Acute meningitis - fungal
954 10 SS01000147 Acute meningitis - pyogenic
955 10 SS01000148 Acute otitis media
956 10 SS01000149 Acute Pancreatitis
Medical Acute Pneumonia-/ consolidation As Advised by Includes standard
957 10 SS01000150
Conditions Bacterial Attending Doctor investigations
958 10 SS01000151 Acute renal colitis
Medical acute respiratory failure ( including As Advised by Includes standard
959 10 SS01000152
Conditions ventilator ) Attending Doctor investigations
960 10 SS01000153 Acute tubulo-interstitial nephritis
961 10 SS01000154 Acute urinary infection
962 10 SS01000155 Acute virall hepatitis ( hepatitis A)
963 10 SS01000156 Amoebiasis
964 10 SS01000157 Amoebic abscess - liver
Medical Anemia Severe Hb less than 6 gm/dl ( As Advised by Includes standard
965 10 SS01000158
Conditions plus blood transfusion units ) Attending Doctor investigations
966 10 SS01000159 Aneurysm - resection and grafting
967 10 SS01000160 Asthma Acute Status
Medical Bacterial pneumonia, not elsewhere As Advised by Includes standard
968 10 SS01000161
Conditions classified Attending Doctor investigations
206
969 10 SS01000162 Bronchiectasis
970 10 SS01000163 Caudal Block Therapeutic (Cervical)
971 10 SS01000164 Caudal Block Therapeutic (Lumbar)
972 10 SS01000165 Cerebral infarction
973 10 SS01000166 Chicken pox- complicated
974 10 SS01000167 Chronic otitis media
975 10 SS01000168 Chronic pancreatitis
Medical
Conditions /
Medical procedures As Advised by Includes standard
976 Other General Ward :Unspecified
rate -750/day Attending Doctor investigations
Unspecified
Conditions
ICU-designated air conditioned space,
Medical
with Standard ICU bed, equipment for
Conditions /
the constant monitoring for vitals, Medical procedures Includes standard
977 Other
emergency crash cart/tray, defibrillator, rate -1500/day investigations
Unspecified
ventilators, suction pumps, bedside
Conditions
oxygen facility.
Medical
Conditions /
978 Other As per pre-authorization
Unspecified
Conditions
979 11 Neuro-Surgery SS01100001 Nerve Biopsy excluding Hensens 4,500
980 11 Neuro-Surgery SS01100002 Depressed Fracture 18,000
981 11 Neuro-Surgery SS01100003 Brain Biopsy 13,500
207
982 11 Neuro-Surgery SS01100004 Tumours - Supratentorial 45,000
983 11 Neuro-Surgery SS01100005 Trans Sphenoidal 22,500
984 11 Neuro-Surgery SS01100006 Spine - Intradural Tumour 22,500
985 11 Neuro-Surgery SS01100007 Spine - Extradural Tumour 19,800
986 11 Neuro-Surgery SS01100008 Spine - Disc Cervical/Lumber 18,000
987 11 Neuro-Surgery SS01100010 Spine - Canal Stenosis 18,000
988 11 Neuro-Surgery SS01100011 Skull Traction 9,000
989 11 Neuro-Surgery SS01100013 Spina Bifida - Small - Repair 27,000
990 11 Neuro-Surgery SS01100014 Spina Bifida - Large - Repair 36,000
991 11 Neuro-Surgery SS01100015 Repair & Transposition Nerve 13,500
992 11 Neuro-Surgery SS01100016 Posterior Fossa - Decompression 31,500
993 11 Neuro-Surgery SS01100017 Microdiscectomy - Lumber 18,000
994 11 Neuro-Surgery SS01100019 Meningococle Ocipital 27,000
995 11 Neuro-Surgery SS01100020 Meningocele - Lumbar 27,000
996 11 Neuro-Surgery SS01100021 Meningocele - Anterior 40,500
997 11 Neuro-Surgery SS01100022 Lumbar Disc 18,000
998 11 Neuro-Surgery SS01100024 Haematoma - Brain (hypertensive) 31,500
999 11 Neuro-Surgery SS01100025 Haematoma - Brain (head injuries) 31,500
208
1000 11 Neuro-Surgery SS01100026 Cerebrospinal Fluid (CSF) Rhinorrohea 27,000
1001 11 Neuro-Surgery SS01100027 Craniostenosis 22,500
1002 11 Neuro-Surgery SS01100028 Cervical Ribs - Unilateral 18,000
1003 11 Neuro-Surgery SS01100029 Cervical Ribs Bilateral 22,500
1004 11 Neuro-Surgery SS01100030 Anterior Encephalocele 40,500
Craniotomy and Evacuation of As Advised by Includes standard
1005 11 Neuro-Surgery SS01100031 45,000
Haematoma -Subdural Attending Doctor investigations
Craniotomy and Evacuation of As Advised by Includes standard
1006 11 Neuro-Surgery SS01100032 45,000
Haematoma -Extradural Attending Doctor investigations
Evacuation /Excision of Brain Abscess by As Advised by Includes standard
1007 11 Neuro-Surgery SS01100033 45,000
craniotomy Attending Doctor investigations
Excision of Lobe (Frontal Temporal As Advised by Includes standard
1008 11 Neuro-Surgery SS01100034 49,500
Cerebellum etc.) Attending Doctor investigations
Excision of Brain Tumours - As Advised by Includes standard
1009 11 Neuro-Surgery SS01100035 49,500
Supratentotial Attending Doctor investigations
Excision of Brain Tumours - As Advised by Includes standard
1010 11 Neuro-Surgery SS01100036 49,500
Infratentorial Attending Doctor investigations
1011 11 Neuro-Surgery SS01100037 Surgery of spil Cord Tumours 27,000
1012 11 Neuro-Surgery SS01100038 Ventricular Tapping 2,700
1013 11 Neuro-Surgery SS01100039 Theco-peritoneal Shunt 18,000
Anterior Lateral Decompression of As Advised by Includes standard
1014 11 Neuro-Surgery SS01100040 45,000
spine Attending Doctor investigations
Combined Trans-oral Surgery & CV As Advised by Includes standard
1015 11 Neuro-Surgery SS01100041 90,000
Junction Fusion Attending Doctor investigations
Microsurgical excision of Acoustic As Advised by Includes standard
1016 11 Neuro-Surgery SS01100042 45,000
tomour Attending Doctor investigations
1017 11 Neuro-Surgery SS01100043 Microsurgical excision of meningomas 45,000
209
Microsurgical decompression for As Advised by Includes standard
1018 11 Neuro-Surgery SS01100044 40,500
Trigemil nerve Attending Doctor investigations
Surgery for intracranial Arteriovenous As Advised by Includes standard
1019 11 Neuro-Surgery SS01100045 40,500
malformarions(AVM) Attending Doctor investigations
1020 11 Neuro-Surgery SS01100046 4 vessels cerebral angiography 13,500
1021 11 Neuro-Surgery SS01100047 Foramen magnum decompression 11,700
Foramen magnum decompression with As Advised by Includes standard
1022 11 Neuro-Surgery SS01100048 31,500
syringosubarachnoid shunt Attending Doctor investigations
Surgery for recurrent disc As Advised by Includes standard
1023 11 Neuro-Surgery SS01100049 31,500
prolapse/epidural fibrosis Attending Doctor investigations
1024 11 Neuro-Surgery SS01100050 Surgery for brain stem tumours 40,500
Decompressive cranectomy for

1025 11 Neuro-Surgery SS01100052 hemishpherical acute subdural 46,800
haematoma/brain swelling/large infarct

1026 12 Neuro-Medicine SS01200001 ADEM or Relapse in Multiple Sclerosis 25,500
1027 12 Neuro-Medicine SS01200002 Neuropathies (GBS) 42,500
1028 12 Neuro-Medicine SS01200003 Optic Neuritis 17,000
Chronic Inflammatory Demyelinating As Advised by Includes standard
1029 12 Neuro-Medicine SS01200005 17,000
Poly Neuropathy (CIDP) Attending Doctor investigations
1030 12 Neuro-Medicine SS01200006 Hemorrhagic Stroke/Strokes 42,500
1031 12 Neuro-Medicine SS01200007 Ischemic Strokes 34,000
1032 12 Neuro-Medicine SS01200008 Myopathies - Acquired 25,500
1033 12 Neuro-Medicine SS01200009 Neuromuscular (Myasthenia Gravis) 25,500
1034 12 Neuro-Medicine SS01200010 Neuroinfections -Pyogenic Meningitis 34,000
210
1035 12 Neuro-Medicine SS01200011 Tb Meningitis 42,500
Neuroinfections -Viral
1036 12 Neuro-Medicine SS01200012 Meningoencephalitis (Includingherpes 34,000
Encephalitis)
1037 12 Neuro-Medicine SS01200013 Fungal Meningitis (Min 20 Days In ICU) 51,000
1038 12 Neuro-Medicine SS01200014 Management of Coma 42,500
As Advised by
1039 13 Orthopaedics SS01300001 Removal of Plaster 1,080
Attending Doctor
1040 13 Orthopaedics SS01300002 Stitch Removal & Dressing 1,350
Attending Doctor

1041 13 Orthopaedics SS01300003 Antiseptic dressing of wound 1,350
Collar & Cuff sling or Figure of 8 1 Day / As Advised by Includes standard

1042 13 Orthopaedics SS01300004 1,980
bandage Attending Doctor investigations

1043 13 Orthopaedics SS01300005 Strapping of toes / fingers 1,800



1046 13 Orthopaedics SS01300008 Intra-articular / Local injection 5,400

211
1048 13 Orthopaedics SS01300010 Above elbow POP slab / U slab 4,500



Above elbow POP cast / Hanging arm 1 Day / As Advised by Includes standard
1052 13 Orthopaedics SS01300014 9,900
cast Attending Doctor investigations

Above knee POP cast / Cylinder POP 1 Day / As Advised by Includes standard
1054 13 Orthopaedics SS01300016 10,800
cast Attending Doctor investigations

1055 13 Orthopaedics SS01300017 Functional cast bracing / PTB cast 13,500

1056 13 Orthopaedics SS01300018 POP shoulder spica 18,000

1057 13 Orthopaedics SS01300019 POP hip spica 18,000
Derotation boot plaster / Broomstick 1 Day / As Advised by Includes standard

1058 13 Orthopaedics SS01300020 4,050

1059 13 Orthopaedics SS01300021 CTEV manipulation & plaster 3600 per sitting
212
CTEV manipulation under anaesthesia & 1 Day / As Advised by Includes standard
1060 13 Orthopaedics SS01300022 5400 per sitting

1061 13 Orthopaedics SS01300023 MUA of dislocation of major joints 10,800
1062 13 Orthopaedics SS01300024 MUA of dislocation of small joints 7,200
1063 13 Orthopaedics SS01300025 MUA of fracture of long bones 13,500
1064 13 Orthopaedics SS01300026 MUA of fracture of small bones 7,200
1065 13 Orthopaedics SS01300027 Surface traction / splint application 5,400
1066 13 Orthopaedics SS01300028 Skeletal traction 7,200
Arthrotomy / synovectomy of major As Advised by Includes standard
1067 13 Orthopaedics SS01300029 16,200
joints Attending Doctor investigations
1068 13 Orthopaedics SS01300030 Arthrotomy of small joints 7,200
Incisional drainage of abscess / As Advised by Includes standard
1069 13 Orthopaedics SS01300031 16,200
haematoma Attending Doctor investigations
Debridement of major wound / As Advised by Includes standard
1070 13 Orthopaedics SS01300032 31,500
Fasciotomy /Arthrolysis Attending Doctor investigations
1071 13 Orthopaedics SS01300033 Debridement of minor wound 18,000
Amputation / Disarticulation of fingers As Advised by Includes standard
1072 13 Orthopaedics SS01300034 18,000
& toes Attending Doctor investigations
Amputation / Disarticulation of long As Advised by Includes standard
1073 13 Orthopaedics SS01300035 36,000
bones, major joint, foot or hand Attending Doctor investigations
1074 13 Orthopaedics SS01300036 Forequarter / Hindquarter amputation 49,500
1075 13 Orthopaedics SS01300037 Arthrodesis of small joints 22,500
Arthrodesis of major joints including As Advised by Includes standard
1076 13 Orthopaedics SS01300038 40,500
subtalar Attending Doctor investigations
213
Soft tissue release / Tenotomy / Tendon As Advised by Includes standard
1077 13 Orthopaedics SS01300039 40,500
grafting / Tendon transfer Attending Doctor investigations
Sequestrectomy saucerisation in As Advised by Includes standard
1078 13 Orthopaedics SS01300040 40,500
chronic osteomyelitis Attending Doctor investigations
1079 13 Orthopaedics SS01300041 External fixation pelvis 34,200
1080 13 Orthopaedics SS01300042 Linear External fixation Small bone 22,500
1081 13 Orthopaedics SS01300043 Linear External fixation long bone 37,800
1082 13 Orthopaedics SS01300044 Ilizarov ring fixator 49,500
1083 13 Orthopaedics SS01300045 JESS Mini Ex-fix application 25,200
1084 13 Orthopaedics SS01300046 Ex-fix application for CTEV 46,800
1085 13 Orthopaedics SS01300047 Soft tissue / Bony surgery for CTEV 40,500
1086 13 Orthopaedics SS01300048 Removal of implant major surgery 37,800
1087 13 Orthopaedics SS01300049 Removal of implant minor surgery 13,500
Open reduction of dislocation of major As Advised by Includes standard
1088 13 Orthopaedics SS01300050 40,500
joint Attending Doctor investigations
Open reduction of dislocation of small As Advised by Includes standard
1089 13 Orthopaedics SS01300051 22,500
joint Attending Doctor investigations
Closed reduction & internal fixation of As Advised by Includes standard
1090 13 Orthopaedics SS01300052 46,800
long bone (adult) Attending Doctor investigations
1091 13 Orthopaedics SS01300053 34,200
long bone(paediatric) Attending Doctor investigations
Open reduction & internal fixation of As Advised by Includes standard
1092 13 Orthopaedics SS01300054 40,500
long bone, clavicle, calcaneum Attending Doctor investigations
1093 13 Orthopaedics SS01300055 TBW of patella, olecranon 36,000
Patellectomy / Excision head radius or As Advised by Includes standard
1094 13 Orthopaedics SS01300056 31,500
small fragments Attending Doctor investigations
214
1095 13 Orthopaedics SS01300057 Core decompression of head of femur 37,800
1096 13 Orthopaedics SS01300058 43,200
fracture of neck femur Attending Doctor investigations
1097 13 Orthopaedics SS01300059 46,800
fracture of neck femur Attending Doctor investigations
O R I F of fracture of neck femur with As Advised by Includes standard
1098 13 Orthopaedics SS01300060 49,500
muscle pedicle bone grafting Attending Doctor investigations
1099 13 Orthopaedics SS01300061 46,800
trochanteric fracture femur Attending Doctor investigations
1100 13 Orthopaedics SS01300062 Corrective osteotomy of long bone 40,500
1101 13 Orthopaedics SS01300063 Corrective osteotomy of small bone 22,500
1102 13 Orthopaedics SS01300064 Partial major joint replacement surgery 49,500
1103 13 Orthopaedics SS01300065 Total major joint replacement surgery 76,500
Radial head replacement / Finger joint As Advised by Includes standard
1104 13 Orthopaedics SS01300066 36,000
arthroplasty Attending Doctor investigations
1105 13 Orthopaedics SS01300067 Excision arthroplasty of major joint 36,000
1106 13 Orthopaedics SS01300068 Excision arthroplasty of small joint 19,800
Incisional biopsy / curettage / As Advised by Includes standard
1107 13 Orthopaedics SS01300069 31,500
excision of tumour Attending Doctor investigations
Resection & Reconstruction of bone As Advised by Includes standard
1108 13 Orthopaedics SS01300070 55,800
tumour Attending Doctor investigations
1109 13 Orthopaedics SS01300071 Bone grafting (cortico-cancellous) 27,000
1110 13 Orthopaedics SS01300072 Strut graft ( Fibula / Rib ) 22,500
1111 13 Orthopaedics SS01300073 Diagnostic arthroscopy major joint 31,500
Arthroscopic reconstruction / repair - As Advised by Includes standard
1112 13 Orthopaedics SS01300074 49,500
knee / - shoulder Attending Doctor investigations
215
Arthroscopic surgery hip / ankle / As Advised by Includes standard
1113 13 Orthopaedics SS01300075 43,200
elbow / wrist Attending Doctor investigations
Open reduction & internal fixation - As Advised by Includes standard
1114 13 Orthopaedics SS01300076 67,500
acetabulum Attending Doctor investigations
Open reduction & internal fixation - As Advised by Includes standard
1115 13 Orthopaedics SS01300077 58,500
pelvis Attending Doctor investigations
1116 13 Orthopaedics SS01300078 Costotransversectomy 36,000
Antero-lateral decompression of spine As Advised by Includes standard
1117 13 Orthopaedics SS01300079 67,500
& fusion Attending Doctor investigations
Spinal stabilization by posterior As Advised by Includes standard
1118 13 Orthopaedics SS01300080 63,000
instrumentation Attending Doctor investigations
Spinal stabilization by instrumentation As Advised by Includes standard
1119 13 Orthopaedics SS01300081 67,500
& fusion Attending Doctor investigations
1120 13 Orthopaedics SS01300082 Discectomy (spine) 40,500
1121 13 Orthopaedics SS01300083 Cervical rib excision 46,800
1122 13 Orthopaedics SS01300084 Anterior cervic al fusion & stabilisation 58,500
1123 13 Orthopaedics SS01300085 Posterior cervical stabilisation 45,000
1124 13 Orthopaedics SS01300086 Scoliosis surgery 67,500
1125 13 Orthopaedics SS01300087 Vertebroplasty / Kyphoplasty 45,000
Note:
1.For name and rate of implants
required for treating any orthopaedic
patient, please check ORTHO-
1126 IMPLANTS.
2.The rate of implant selected, is to be
added to the rate of any of the above
package selected for treatment of the
patient.
216
Pars plana vitrectomy with membrane As Advised by Includes standard
1127 14 Ophthalmology SS01400001 12,600
peeling and endolaser Attending Doctor investigations
Retinal detachment surgery(internal
approach): Pars plana vitrectomy+
1128 14 Ophthalmology SS01400002 membrane peeling + Fluid Gas 18,900
exchange + endolaser + silicone oil
/C3F8
Retinal detachment surgery(external As Advised by Includes standard
approach) with Band - Buckle Attending Doctor investigations
Intra ocular foreign body/ IOL/
Dislocated lens removal with pars plana As Advised by Includes standard
vitrectomy+ Fluid gas exchange Attending Doctor investigations
+endolaser+silicone oil/C3F8

1131 14 Ophthalmology SS01400005 Silicone oil removal 6,300

1132 14 Ophthalmology SS01400006 Band Buckle removal 3,600

1133 14 Ophthalmology SS01400007 Intra vitreal injection 2,700

1134 14 Ophthalmology SS01400008 PRP/Grid/ Barrage laser 900( per sitting)

1135 14 Ophthalmology SS01400009 SICS with rigid IOL 3,600
Phacoemulsification with foldable 1 Day / As Advised by Includes standard

hydrophilic lens Attending Doctor investigations
Phacoemulsification with foldable 1 Day / As Advised by Includes standard

hydrophobic lens Attending Doctor investigations
217
1138 14 Ophthalmology SS01400012 Yag laser capsulotomy 720

1139 14 Ophthalmology SS01400013 Trabeculectomy 5,400

1140 14 Ophthalmology SS01400014 Trab-o-Trab 5,400
Trabeculectomy with As Advised by Includes standard

phacoemulsification with foldable lens Attending Doctor investigations

1142 14 Ophthalmology SS01400016 Trabeculectomy with SICS with rigid IOL 6,300
Cyclocryopexy/Diode laser 1 Day / As Advised by Includes standard

cyclophotocoagulation Attending Doctor investigations

1144 14 Ophthalmology SS01400018 Yag laser iridectomy 720

1145 14 Ophthalmology SS01400019 Dacrocystectomy(DCT) 2,700

1146 14 Ophthalmology SS01400020 Dacrocystorhiostomy(DCR) 7,200

1147 14 Ophthalmology SS01400021 Pediatric Probing 900

1148 14 Ophthalmology SS01400022 Penetrating keratoplasty 7,200

1149 14 Ophthalmology SS01400023 DSAEK/DALK 10,800
218
1150 14 Ophthalmology SS01400024 LASIK (one eye) 9,000

1151 14 Ophthalmology SS01400025 LASIK( Both eyes) 16,200

1152 14 Ophthalmology SS01400026 Pterygium excision 1,800

1153 14 Ophthalmology SS01400027 Pterygium excision with graft 3,600

1154 14 Ophthalmology SS01400028 Amniotic membrane graft 4,500

1155 14 Ophthalmology SS01400029 Scleral graft 4,500
Foreign body removal from, iris/ 1 Day / As Advised by Includes standard

Intracorneal Attending Doctor investigations

1157 14 Ophthalmology SS01400031 Tarsorraphy 900

1158 14 Ophthalmology SS01400032 Sclero-corneal rupture repair 5,400
1159 14 Ophthalmology SS01400033 Single rectus muscle 4,500
1160 14 Ophthalmology SS01400034 Rectus muscle (2/3/oblique) 7,200
1161 14 Ophthalmology SS01400037 Socket reconstruction with implant 7,200
1162 14 Ophthalmology SS01400038 Ectropion correction 2,700
1163 14 Ophthalmology SS01400039 Entropion correction 2,700
219
1164 14 Ophthalmology SS01400040 Chalazion 900
1165 14 Ophthalmology SS01400041 Ptosis surgery 6,300
Lid tumour excision with lid As Advised by Includes standard
reconstruction Attending Doctor investigations
Lid tumour excision with lid
1167 14 Ophthalmology SS01400043 reconstruction by rotational flap / skin 10,800
grafting
1168 14 Ophthalmology SS01400044 Orbitotomy 13,500
1169 14 Ophthalmology SS01400045 Ocular surface tumour removal 2,700
1170 14 Ophthalmology SS01400046 exenteration 7,200
General Acquired Heart Disease with Congestive As Advised by Includes standard
1171 15 SS01500001 9,000
Pediatrics Cardiac Failure Attending Doctor investigations
General As Advised by Includes standard
1172 15 SS01500002 Inborn Error of Metabolism 27,000
Pediatrics Attending Doctor investigations
1173 15 SS01500003 Kerosene Ingestion 4,500
1174 15 SS01500005 Interstital Lung Disease 22,500
1175 15 SS01500006 Hemophagocytic Lympho Histiocytosis 22,500
General Hypoplastic/Aplastic Anemia (Fanconi As Advised by Includes standard
1176 15 SS01500007 4,500
Pediatrics Anemia) without Attending Doctor investigations
1177 15 SS01500008 Wilsons Disease 18,000
1178 15 SS01500009 Neonatal Cholestasis 18,000
1179 15 SS01500010 End Stage Renal Disease (Per-Dialysis) 3,600
General Thalassemia Major Requiring Chelation As Advised by Includes standard
1180 15 SS01500012 4,500
Pediatrics Therapy (Per sitting) Attending Doctor investigations
220
Severe Bronchiolitis/Severe Broncho
Paediatric As Advised by Includes standard
1181 15 SS01500013 Pneumonia/Severe aspiration 1,800
Intensive Care Attending Doctor investigations
Pneumonia (Non-Ventilated) (per day)
Severe Bronchiolitis/Severe Broncho

1182 15 SS01500014 Pneumonia/Severe aspiration 3,600
Pneumonia (Ventilated) (per day)
Paediatric Acute Severe Asthma (Ventilated)(per As Advised by Includes standard
1183 15 SS01500015 4,500
Intensive Care day) Attending Doctor investigations
Severe Myocarditis/Congenital Heart
Disease with Infection and/or
1184 15 SS01500016 Cardiogenic Shock/Cardiogenic 27,000
Shock/Infective Endocarditis(Non-
Ventilated)
Paediatric Septic Shock/Infective Endocarditis( As Advised by Includes standard
1185 15 SS01500017 36,000
Intensive Care Ventilated) Attending Doctor investigations
1186 15 SS01500018 Febrile Seizures (Non ventilated) 2,700
1187 15 SS01500019 Febrile Seizures ( ventilated) 9,000
Paediatric Meningitis/Encephalitis (Non- As Advised by Includes standard
1188 15 SS01500020 18,000
Intensive Care Ventilated) Attending Doctor investigations
Paediatric Meningitis/Encephalitis/Status As Advised by Includes standard
1189 15 SS01500021 31,500
Intensive Care Epilepticus (Ventilated) Attending Doctor investigations
1190 15 SS01500022 Intra Cranial Bleed 31,500
1191 15 SS01500023 Acute Gastro Intestinal Bleed 18,000
1192 15 SS01500024 Acute Pancreatitis/Acute Hepatitis 10,800
Paediatric Acute Hepatitis with Hepatic As Advised by Includes standard
1193 15 SS01500025 31,500
Intensive Care Encephalopathy Attending Doctor investigations
Paediatric Severe Pancratitis Requiring Surgery as As Advised by Includes standard
1194 15 SS01500026 54,000
Intensive Care Add on Attending Doctor investigations
1195 15 SS01500027 Acute Renal Failure 27,000
221
1196 15 SS01500028 Diabetic Ketoacidosis 18,000
1197 15 SS01500029 Dengue Shock Syndrome/DHF 18,000
Paediatric Snake Bite Requiring Ventilator As Advised by Includes standard
1198 15 SS01500030 27,000
Intensive Care Assistance Attending Doctor investigations
Scorpion Sting with Myocarditis and
1199 15 SS01500031 Cardiogenic Shock Requiring Ventilatory 18,000
Assistance
Paediatric Poison Ingestion/ Aspiration Requiring As Advised by Includes standard
1200 15 SS01500032 18,000
Intensive Care Ventilatory Assistance Attending Doctor investigations
Acute Broncho/ Lobarpneumonia with
1201 15 SS01500033 Empyema/ Pleural 27,000
Effusion/Pyopneumothorax
1202 15 SS01500034 Acute Stridor/Foreign Body Obstruction 9,000
Paediatric TN0413 : Nehrotic Syndrome/Acute As Advised by Includes standard
1203 15 SS01500035 13,500
Intensive Care Glomerulo Nephritis Attending Doctor investigations
Recurrent Urinary Tract Infection with
1204 15 SS01500036 Complications like Pyelonephritis and 31,500
Renal Failure
1205 15 SS01500037 Acute Renal Failure with Dialysis 16,200
1206 15 SS01500038 Acute Renal Failure without Dialysis 12,600
1207 15 SS01500039 Haemophillia Including Von Willibrands 13,500
1208 15 SS01500040 Neuro Tuberculosis/Neurocysticercosis 10,800
Paediatric ECMO-Extracorporeal Membrane As Advised by As per
1209 15 SS01500042
Neonate Care Oxygenation Attending Doctor Preauthorisation
Paediatric As Advised by As per
1210 15 SS01500043 Adverse Events following Immunisation
Neonate Care Attending Doctor Preauthorisation
Necrotising Enterocolitis, Clinical Sepsis
1211 15 SS01500045 Non-Ventilated hyper-bilirubinemia 22,500
Neonate Care Attending Doctor investigations
(Non-surgical)
222
1212 15 SS01500046 Afebrile Seizure requiring Ventilation 14,400
1213 15 SS01500049 Severe Malaria 22,500
1214 15 SS01500050 Malaria (Noncomplicated) 4,500
1215 15 SS01500051 Interic Fever/Pylonephritis 7,200
Rhematoroid Artharities/HSP/SLE
1216 15 SS01500052 without nephritis /other connective 9,000
tissue disorder
1217 15 SS01500053 Neonatal Asphyxia without ventilation 22,500
1218 15 SS01500054 Neonatal Asphyxia with ventilation 36,000
Radiotherapy
CONVENTIONAL RT (LINEAR
1219 16 And Chemo SS01600001 35,000
ACCELERATOR)
Therapy
Radiotherapy
1220 16 And Chemo SS01600002 CONVENTIONAL RT (COBALT - 60) 15,000
Therapy
Radiotherapy PALLIATIVE THERAPY (LESS 1 Day / As Advised by Includes standard
1221 16 And Chemo SS01600003 4,000
THAN 10 FRACTIONS, LINAC) Attending Doctor investigations
Therapy
Radiotherapy PALLIATIVE THERAPY (LESS Includes standard
1222 16 SS01600004 800 Day Care
And Chemo THAN 10 FRACTIONS, COBALT - 60) investigations
Radiotherapy PALLIATIVE THERAPY (MORE THAN 10 As Advised by Includes standard
1223 16 SS01600005 15,000
And Chemo FRACTIONS, LINAC) Attending Doctor investigations
Radiotherapy PALLIATIVE THERAPY (MORE THAN 10 As Advised by Includes standard
1224 16 SS01600006 3,500
And Chemo FRACTIONS, COBALT - 60) Attending Doctor investigations
Radiotherapy INTENSITY MODULATED RADIO As Advised by Includes standard
1225 16 SS01600007
And Chemo THERAPY (IMRT) Attending Doctor investigations
Radiotherapy IMAGE GUIDED RADIO As Advised by Includes standard
1226 16 SS01600008
And Chemo THERAPY (IGRT) Attending Doctor investigations
Radiotherapy 3D-CRT (CONFIRMAL RADIO As Advised by Includes standard
1227 16 SS01600009
And Chemo THERAPY) Attending Doctor investigations
Radiotherapy 3D-CRT (CONFIRMAL RADIO As Advised by Includes standard
1228 16 SS01600010
And Chemo Attending Doctor investigations
223
Radiotherapy As Advised by Includes standard
1228 16 SS01600010
And Chemo THERAPY) WITH IMAGE GUIDANCE Attending Doctor investigations
Radiotherapy
1229 16 And Chemo SS01600011 IGRT WITH 4D CT BASED PLANNING
Therapy
Radiotherapy STEREOTACTIC RADIO As Advised by Includes standard
1230 16 SS01600012
And Chemo SURGERY (SRS) Attending Doctor investigations
Radiotherapy STEREOTACTIC RADIO As Advised by Includes standard
1231 16 SS01600013
And Chemo THERAPY (SRT) Attending Doctor investigations
Radiotherapy VOLUMETRIC MODULATED RADIATION
1232 16 And Chemo SS01600014 / IMTENSITY MODULATED ARC
Therapy THERAPY RATE
Radiotherapy VOLUMETRIC MODULATED RADIATION
1233 16 And Chemo SS01600015 / IMTENSITY MODULATED ARC
Therapy THERAPY RATE WITH IMAGE GUIDANCE
Radiotherapy ELECTRON BEAM (GREATER THAN 10 As Advised by Includes standard
1234 16 SS01600016 20,000
And Chemo FRACTIONS) Attending Doctor investigations
Radiotherapy ELECTRON BEAM (LESS THAN 10 As Advised by Includes standard
1235 16 SS01600017 10,000
And Chemo FRACTIONS) Attending Doctor investigations
Radiotherapy INTRA CAVITARY As Advised by Includes standard
1236 16 SS01600018 4,000
And Chemo BRACHYTHERAPY- (PER INSERTION) Attending Doctor investigations
Radiotherapy INTERSTITIAL BRACHY As Advised by Includes standard
1237 16 SS01600019 5,000
And Chemo THERAPY-(PER INSERTION) Attending Doctor investigations
INFUSIONAL CHEMOTHERAPY
Radiotherapy
ADMINISTRATION CHARGE (ACTUAL As Advised by Includes standard
1238 16 And Chemo SS01600020 750
COST OF MEDICINE TO BE PAID Attending Doctor investigations
Therapy
SEPARATELY)
Radiotherapy
ORAL CHEMOTHERAPY AND HORMONE As Advised by Includes standard
1239 16 And Chemo SS01600021
THERAPY OR TARGETED THERAPY Attending Doctor investigations
Therapy
Radiotherapy
CHEMOPORT IMPLANTATION WITH As Advised by Includes standard
1240 16 And Chemo SS01600022 30,000
COST OF CHEMOPORT Attending Doctor investigations
Therapy
1241 17 Skin Procedures SS01700001 Excision of Moles 630 Daycare
1242 17 Skin Procedures SS01700002 Excision of Warts 630 Daycare
1243 17 Skin Procedures SS01700003 Excision of Molluscumcontagiosum 630 Daycare
1244 17 Skin Procedures SS01700004 Excision of Veneral Warts 630 Daycare
224
1245 17 Skin Procedures SS01700005 Excision of Corns 450 Daycare
1246 17 Skin Procedures SS01700006 I/D Injection Keloid of Acne 450 Daycare
1247 17 Skin Procedures SS01700007 Chemical Cautery (s) 450 Daycare
1248 17 Skin Procedures SS01700008 Operations for Neuroblastoma 18,000
Urology As Advised by Includes standard
1249 18 SS01800001 Bladder Tumour (Fulgration) 13,500
/Nephrology Attending Doctor investigations
1250 18 SS01800002 Correction of Extrophy of Bladder 9,000
1251 18 SS01800003 Cystilithotomy 9,000
1252 18 SS01800004 Cysto Gastrostomy 18,000
1253 18 SS01800005 Cysto Jejunostomy 18,000
1254 18 SS01800006 Dormia Extraction of Calculus 13,500
1255 18 SS01800007 Drainage of Perinepheric Abscess 9,000
1256 18 SS01800008 Cystolithopexy 9,000
1257 18 SS01800009 Excision of Urethral Carbuncle 4,500
Urology Exploration of Epididymus (Unsuccesful As Advised by Includes standard
1258 18 SS01800010 13,500
/Nephrology Vasco vasectomy) Attending Doctor investigations
1259 18 SS01800011 Urachal Cyst 13,500
1260 18 SS01800012 Hydrospadius 18,000
1261 18 SS01800013 Internal Urethrotomy 6,300
1262 18 SS01800014 Litholapexy 6,750
1263 18 SS01800015 Lithotripsy 9,000
225
1264 18 SS01800016 Meatoplasty 4,500
1265 18 SS01800017 Meatotomy 4,500
1266 18 SS01800018 Neoblastoma 18,000
1267 18 SS01800019 Nephrectomy 18,000
1268 18 SS01800020 Nephrectomy (Renal tumour) 18,000
1269 18 SS01800021 Nephro Uretrectomy 18,000
1270 18 SS01800022 Nephrolithotomy 13,500
1271 18 SS01800023 Nephropexy 13,500
1272 18 SS01800024 Nephrostomy 9,000
Urology Nephrourethrotomy ( is it As Advised by Includes standard
1273 18 SS01800025 13,500
/Nephrology Nephrourethrectomy ?) Attending Doctor investigations
1274 18 SS01800026 Open Resection of Bladder Neck 9,000
1275 18 SS01800027 Operation for Cyst of Kidney 13,500
1276 18 SS01800028 Operation for Double Ureter 13,500
1277 18 SS01800029 Fturp 13,500
1278 18 SS01800030 Operation for Injury of Bladder 13,500
1279 18 SS01800031 Partial Cystectomy 13,500
1280 18 SS01800032 Partial Nephrectomy 13,500
Urology PCNL (Percutaneous nephro lithotomy) - As Advised by Includes standard
1281 18 SS01800033 16,200
/Nephrology Biilateral Attending Doctor investigations
226
Urology PCNL (Percutaneous nephro lithotomy) - As Advised by Includes standard
1282 18 SS01800034 16,200
/Nephrology Unilateral Attending Doctor investigations
1283 18 SS01800035 Post Urethral Valve 9,000
1284 18 SS01800036 Pyelolithotomy 13,500
1285 18 SS01800037 Pyeloplasty & Similar Procedures 13,500
1286 18 SS01800038 Radical Nephrectomy 13,500
1287 18 SS01800039 Reduction of Paraphimosis 4,500
1288 18 SS01800040 Reimplanation of Urethra 15,300
1289 18 SS01800041 Reimplantation of Bladder 15,300
1290 18 SS01800042 Reimplantation of Ureter 15,300
1291 18 SS01800043 Repair of Uretero Vaginal Fistula 18,000
1292 18 SS01800044 Cystoscopy+PCNL (Percutaneous 11,250
nephro lithotomy) - Unilateral
1293 18 SS01800045 Retroperitoneal Fibrosis - Renal 23,625
1294 18 SS01800046 Retropubic Prostatectomy 18,000
1295 18 SS01800047 Spleno Renal Anastomosis 18,000
1296 18 SS01800048 Stricture Urethra 18,000
1297 18 SS01800049 Suprapubic Cystostomy - Open 4,500
1298 18 SS01800050 Suprapubic Drainage - Closed 4,500
227
Urology Ureteric Catheterization - As Advised by Includes standard
1299 18 SS01800051 9,450
/Nephrology Cystoscopy+Pyelolithotomy Attending Doctor investigations
1300 18 SS01800052 Trans Vesical Prostatectomy 18,000
1301 18 SS01800053 Transurethral Fulguration 13,500
Urology TURBT (Transurethral Resection of the As Advised by Includes standard
1302 18 SS01800054 13,500
/Nephrology Bladder Tumor) Attending Doctor investigations
1303 18 SS01800055 TURP + Circumcision 13,500
1304 18 SS01800056 TURP + Closure of Urinary Fistula 11,700
1305 18 SS01800057 TURP + Cystolithopexy 16,200
1306 18 SS01800058 TURP + Cystolithotomy 16,200
1307 18 SS01800059 TURP + Fistulectomy 13,500
1308 18 SS01800060 TURP + Cystoscopic Removal of Stone 10,800
1309 18 SS01800061 TURP + Nephrectomy 22,500
1310 18 SS01800062 TURP + Orchidectomy 16,200
1311 18 SS01800063 TURP + Suprapubic Cystolithotomy 13,500
1312 18 SS01800064 TURP + TURBT 13,500
1313 18 SS01800065 TURP + URS 12,600
1314 18 SS01800066 TURP + Vesicolithotripsy 13,500
Urology TURP + VIU (visual internal As Advised by Includes standard
1315 18 SS01800067 10,800
/Nephrology urethrotomy) Attending Doctor investigations
1316 18 SS01800068 TURP + Haemorrhoidectomy 13,500
228
1317 18 SS01800069 TURP + Hydrocele 16,200
1318 18 SS01800070 TURP + Hernioplasty 16,200
1319 18 SS01800071 TURP with Repair of Urethra 16,200
1320 18 SS01800072 TURP + Herniorraphy 16,200
Urology TURP (Trans-Urethral Resection of As Advised by Includes standard
1321 18 SS01800073 13,500
/Nephrology Bladder)Prostate Attending Doctor investigations
1322 18 SS01800074 TURP + Fissurectomy 16,200
1323 18 SS01800075 TURP + Urethrolithotomy 18,000
1324 18 SS01800076 TURP + Urethral dilatation 13,500
1325 18 SS01800077 Uretero Colic Anastomosis 18,000
1326 18 SS01800078 Ureterolithotomy 13,500
1327 18 SS01800079 Ureteroscopic Calculi - Bilateral 18,000
1328 18 SS01800080 Ureteroscopic Calculi - Unilateral 16,200
1329 18 SS01800081 Ureteroscopy Urethroplasty 18,000
1330 18 SS01800082 Ureteroscopy PCNL 15,300
Urology Ureteroscopic stone Removal And DJ As Advised by Includes standard
1331 18 SS01800083 13,500
/Nephrology Stenting Attending Doctor investigations
1332 18 SS01800084 Urethral Dilatation 4,500
1333 18 SS01800085 Urethral Injury 9,000
1334 18 SS01800086 Urethral Reconstuction 13,500
229
1335 18 SS01800087 Ureteric Catheterization - Cystoscopy 4,500
1336 18 SS01800088 Uretrostomy (Cutanie) 13,500
1337 18 SS01800089 URS + Stone Removal 13,500
Urology URS Extraction of Stone Ureter - As Advised by Includes standard
1338 18 SS01800090 13,500
/Nephrology Bilateral Attending Doctor investigations
Urology URS Extraction of Stone Ureter - As Advised by Includes standard
1339 18 SS01800091 10,800
/Nephrology Unilateral Attending Doctor investigations
1340 18 SS01800092 URS with DJ Stenting With ESWL 13,500
1341 18 SS01800093 URS with Endolitholopexy 13,500
1342 18 SS01800094 URS with Lithotripsy 13,500
1343 18 SS01800095 URS with Lithotripsy with DJ Stenting 13,500
1344 18 SS01800096 URS+Cysto+Lithotomy 18,000
1345 18 SS01800097 V V F Repair 18,000
1346 18 SS01800098 Hypospadias Repair and Orchiopexy 18,000
1347 18 SS01800099 Vesico uretero Reflux - Bilateral 13,500
1348 18 SS01800100 Vesico Uretero Reflux - Unilateral 9,000
1349 18 SS01800101 VIU (Visual Internal Urethrotomy ) 9,000
1350 18 SS01800102 VIU + Cystolithopexy 13,500
1351 18 SS01800103 VIU + Hydrocelectomy 13,500
1352 18 SS01800104 VIU and Meatoplasty 8,100
230
1353 18 SS01800105 VIU for Stricture Urethra 9,000
1354 18 SS01800106 VIU with Cystoscopy 9,000
1355 18 SS01800107 Y V Plasty of Bladder Neck 9,000
Urology Bladder Calculi- Removal+Trans vesical As Advised by Includes standard
1356 18 SS01800108 13,050
/Nephrology prostatectomy Attending Doctor investigations
1357 18 SS01800109 Operation for ectopic ureter 13,500
Urology Stricture Urethra+TURP (Trans-Urethral As Advised by Includes standard

1358 18 SS01800110 16,200
/Nephrology Resection of Bladder)Prostate Attending Doctor investigations

1359 18 SS01800111 TURP + Cystolithotripsy 16,200
1360 18 SS01800112 TURP with removal of the verical calculi 16,200
1361 18 SS01800113 TURP with vesicolithotomy 16,200
1362 18 SS01800114 Ureteroscopic removal of lower ureteric 13,500
Urology Ureteroscopic removal of ureteric As Advised by Includes standard
1363 18 SS01800115 13,500
/Nephrology calculi Attending Doctor investigations
1364 18 SS01800116 Varicocele 9,000
1365 18 SS01800117 VIU + TURP 16,200
Ureteroscopic Calculi - Unilateral+TURP
1366 18 SS01800118 (Trans-Urethral Resection of 16,200
Bladder)Prostate
Urology Bladder Calculi- Removal+Stricture As Advised by Includes standard
1367 18 SS01800119 13,500
/Nephrology Urethra Attending Doctor investigations
1368 18 SS01800120 Unilateral+Ureteric Catheterization - 13,500
Cystoscopy
231
Urology Ureteric Catheterization - As Advised by Includes standard
1369 18 SS01800121 9,495
/Nephrology Cystoscopy+Nephrolithotomy Attending Doctor investigations
1370 18 SS01800122 AV Shunt for dialysis 6,750
Urology Includes standard
1371 18 SS01800123 Haemoylaisis per sitting 2,700 Daycare
/Nephrology investigations
1372 18 SS01800124 CAPD Catherisation 13,500
1373 18 SS01800125 Acute Renal Failure-(ARF) 9,000
1374 18 SS01800126 Nephrotic Syndrome 22,500
1375 18 SS01800127 Rapidly Progressive Renal Failure (RPRF) 31,500
1376 18 SS01800128 Chronic Renal Failure 1 (CRF ) 13,500
1377 18 SS01800129 ESRD 13,500
1378 18 SS01800130 Kidney Biopsy 22,500
Endoscopic Cholecystectomy and Drainage of Liver As Advised by Includes standard
1379 19 SS01900001 28,000
Procedures abscess Attending Doctor investigations
Endoscopic Cholecystectomy with Excision of TO As Advised by Includes standard
1380 19 SS01900002 32,000
Procedures Mass Attending Doctor investigations

1381 19 SS01900003 Cyst Aspiration 2,400
Endoscopic As Advised by Includes standard

1382 19 SS01900004 Endometria to Endometria Anastomosis 8,400

1383 19 SS01900005 Fimbriolysis 6,000

1384 19 SS01900006 Hemicolectomy 40,000
Endoscopic Hysterectomy with bilateral Salpingo As Advised by Includes standard
1385 19 SS01900007 14,700
Procedures Operectomy* Attending Doctor investigations
232
1386 19 SS01900008 Incisional Hernia - Repair 36,000
1387 19 SS01900009 Inguinal Hernia - Bilateral 17,600
1388 19 SS01900010 Inguinal hernia - Unilateral 24,000
1389 19 SS01900011 Intestinal resection 40,000
1390 19 SS01900012 Myomectomy 15,000
1391 19 SS01900013 Oophrectomy 10,000
1392 19 SS01900014 Perotionities 10,800
1393 19 SS01900015 Salpingo Ophrectomy 10,800
1394 19 SS01900016 Salpingostomy 10,800
1395 19 SS01900017 Uterine septum 9,000
1396 19 SS01900018 Varicocele - Bilateral 18,000
1397 19 SS01900019 Varicocele - Unilateral 13,200
1398 19 SS01900020 Repair of Ureterocele 12,000
Endoscopic Esophageal Sclerotheraphy for varies 1 Day / As Advised by Includes standard

1399 19 SS01900021 1,680
Procedures first sitting Attending Doctor investigations
Endoscopic Esophageal Sclerotheraphy for varies 1 Day / As Advised by Includes standard

1400 19 SS01900022 1,320
Procedures subseqent sitting Attending Doctor investigations

1401 19 SS01900023 Upper GI endoscopy 1,200
233
1402 19 SS01900024 Upper GI endoscopy with biopsy 1,400

1403 19 SS01900025 ERCP 9,600
Hysteroscopic As Advised by Includes standard
1404 19 SS01900026 Ablation of Endometrium 8,000
1405 19 SS01900027 Hysteroscopic Tubal Cannulation 9,600
1406 19 SS01900028 Polypectomy 6,000
1407 19 SS01900029 Uterine Synechia - Cutting 9,600
234
Swasthaya Sathi Packages for Grade C hospitals
If package cost is not menntioned the cost will be reimbursed as per the approval through Pre-authorisation. Cost of orthopaedic impalnts to be added as required
for the treatment as per the list attached. No additional investigation cost will be allowed. In case implant is not provided or any diagnostic test not done by the
hospital and patient was asked to do it from outside the amount of such test as per approved diagnostic test rate to be refunded else payment will not be
reimbursed
Package
Swasthya Sathi Package Rate in Grade C
Sl No. Category Group Procedure / Package MLOS
Code Hospitals
Code
Heart failure Medical As Advised by

1 1 Cardiology SS00100005 16,000
treatment Attending Doctor
Infective endocarditis Medical As Advised by
2 1 Cardiology SS00100006 28,000
Deep vein thrombosis Medical As Advised by
3 1 Cardiology SS00100007 16,000
Pulmonary embolism Medical As Advised by
4 1 Cardiology SS00100008 28000
Simple arrhythmias Medical As Advised by
5 1 Cardiology SS00100010 16,000
Pericardial effusion Medical As Advised by
6 1 Cardiology SS00100012 16,000
management Attending Doctor
Complicated Ext. per Tooth
including LA
9 3 Dental SS00300008 Extraction of tooth including LA 324 Daycare
10 3 Dental SS00300009 Flap operation per Tooth 648 Daycare
11 3 Dental SS00300011 Gingivectomy per Tooth 810 Daycare
12 3 Dental SS00300012 Impacted Molar including LA 1,215 Daycare
235
Package
Code Hospitals
Code
14 3 Dental SS00300018 Apical Curettage per tooth 486 Daycare
1 Day/As advise by
16 3 Dental SS00300024 growth removal 810
surgeon
1 Day/As advise by
surgeon
treatment Nursing bottle caries

(Full mouth)
21 3 Dental SS00300033 Removable partial denture 324 Daycare
22 3 Dental SS00300034 Restoration of teeth per tooth 405 Daycare
treatment of gums through

scaling (three sittings )
24 3 Dental SS00300036 Root canal treatment per tooth 1,296 Daycare
25 3 Dental SS00300037 Metal crown per cap 972 Daycare
AMALGAM FILLING/TOOTH
236
Package
Code Hospitals
Code
(COMPOUND)
AMALGAM FILLING/TOOTH
(REGULAR)
DIRECT/ INDIRECT PULP
CAPPING
FLORIDE APPLICATION (PER

SITTING)
31 3 Dental SS00300069 GLASS IONOMER FILLING 486 Daycare
POST CORE/ TOOTH (CAST

POST) LAB METAL CHGS.
EXTRA
33 3 Dental SS00300073 PREFORMED STEEL CROWN 1,215 Daycare
34 3 Dental SS00300078 SCALING PER SITTING 486 Daycare
Injury of Superficial Soft Tissues - 1 Day/As advise by

Secondary suture of wounds surgeon

Delayed primary suture surgeon

Debridement of wounds surgeon
237
Package
Code Hospitals
Code
1 Day/As advise by
42 6 General Surgery SS00600004 Aspiration of Empyema 2,138
surgeon
Aspiration of cold Abscess of 1 Day/As advise by
Lymphnode surgeon
Removal of foreign body ( from 1 Day/As advise by

skin/muscle) surgeon
1 Day/As advise by
45 6 General Surgery SS00600007 Fissurectomy +Fistulectomy 11,664
surgeon
Fissurectomy and
As Advised by
46 6 General Surgery SS00600011 Haemorrhoidectomy+ Rectal 12,150
Attending Doctor
Dilation
Appendicular Perforation As Advised by

+Ovarian Cystectomy Attending Doctor
Appendicectomy + Ovarian As Advised by

Cystectomy Attending Doctor
As Advised by
49 6 General Surgery SS00600014 Hernioplasty + Orchidectomy 14,580
Attending Doctor
Hydrocele - Excision - unilateral As Advised by

+ Cyst over Scrotum - Excision Attending Doctor
Hydrocele - Excision - Bilateral + As Advised by

Cyst over Scrotum - Excision Attending Doctor
Hydrocele - Excision - Unilateral As Advised by

+ Hernioplasty Attending Doctor
238
Package
Code Hospitals
Code
Hydrocele - Excision - Bilateral + As Advised by

Hernioplasty Attending Doctor
Hernia - Repair & release of As Advised by

obstruction+ Hernioplasty Attending Doctor
Hernia - Repair & release of

As Advised by
55 6 General Surgery SS00600024 obstruction+Hydrocele - 17,496
Attending Doctor
Excision - Unilateral
Haemorroidectomy + As Advised by
Fistulectomy Attending Doctor
As Advised by
57 6 General Surgery SS00600028 Adhenolysis + Appendicectomy 12,150
Attending Doctor
Chemical Cautery Wart excision 1 Day/As advise by
( per sitting) surgeon
1 Day/As advise by
59 6 General Surgery SS00600030 Excision of Warts 680
surgeon
1 Day/As advise by
60 6 General Surgery SS00600031 Excision of Veneral Warts 680
surgeon
As Advised by
61 6 General Surgery SS00600034 Debridement of Ulcer-Leprosy 11,664
Attending Doctor
1 Day/As advise by
62 6 General Surgery SS00600036 Vasectomy 1,944
surgeon
1 Day/As advise by
63 6 General Surgery SS00600037 Varicose veins - injection 680
surgeon
Suturing without local
anesthesia
Suturing of wounds with local
anesthesia
239
Package
Code Hospitals
Code
As Advised by
66 6 General Surgery SS00600046 Superficial Veriscosity 4,374
Attending Doctor
As Advised by
67 6 General Surgery SS00600055 Phimosis Under LA 2,916
Attending Doctor
Excision I/D Injection keloid or 1 Day/As advise by

Acne ( per site) surgeon
Excision and removal of 1 Day/As advise by

superficial cysts surgeon
As Advised by
70 6 General Surgery SS00600079 Appendicectomy 12,150
Attending Doctor
Appendicular Abscess - As Advised by
Drainage Attending Doctor
As Advised by
72 6 General Surgery SS00600082 Bakers Cyst - Excision 7,290
Attending Doctor
As Advised by
73 6 General Surgery SS00600088 Breast Lump - Left - Excision 7,776
Attending Doctor
As Advised by
74 6 General Surgery SS00600089 Breast Lump - Right - Excision 7,776
Attending Doctor
As Advised by
75 6 General Surgery SS00600091 Bursa - Excision 7,290
Attending Doctor
As Advised by
76 6 General Surgery SS00600096 Cervial Lymphnodes - Excision 6,318
Attending Doctor
As Advised by
77 6 General Surgery SS00600098 Colostomy 14,580
Attending Doctor
As Advised by
78 6 General Surgery SS00600099 Cyst over Scrotum - Excision 5,832
Attending Doctor
As Advised by
79 6 General Surgery SS00600100 Cystic Mass - Excision 3,402
Attending Doctor
240
Package
Code Hospitals
Code
As Advised by
80 6 General Surgery SS00600101 Dermoid Cyst - Large - Excision 3,888
Attending Doctor
As Advised by
81 6 General Surgery SS00600102 Dermoid Cyst - Small - Excision 2,916
Attending Doctor
Dorsal Slit and Reduction of 1 Day/As advise by

Paraphimosis surgeon
Drainage of Ischio Rectal As Advised by

Abscess under GA Attending Doctor
Incision and Drainage of large 1 Day/As advise by

Abscess surgeon
Hydrocelectomy + As Advised by
Orchidectomy Attending Doctor
As Advised by
86 6 General Surgery SS00600117 Epidedectomy 7,776
Attending Doctor
As Advised by
87 6 General Surgery SS00600118 Epididymal Swelling -Excision 7,290
Attending Doctor
As Advised by
88 6 General Surgery SS00600119 Epidymal Cyst 4,860
Attending Doctor
Evacuation of Scrotal As Advised by
Hematoma Attending Doctor
As Advised by
90 6 General Surgery SS00600125 Excision Mammary Fistula 7,290
Attending Doctor
Excision of Small Growth from As Advised by
Tongue Attending Doctor
Excision of Swelling in Right As Advised by
Cervial Region Attending Doctor
241
Package
Code Hospitals
Code
Excision of Large Swelling in As Advised by

Hand Attending Doctor
Excision of Small Swelling in As Advised by
Hand Attending Doctor
As Advised by
95 6 General Surgery SS00600134 Excision of Neurofibroma 5,832
Attending Doctor
As Advised by
96 6 General Surgery SS00600138 Fibroadenoma - Bilateral 11,664
Attending Doctor
As Advised by
97 6 General Surgery SS00600140 Fibroma - Excision 4,860
Attending Doctor
As Advised by
98 6 General Surgery SS00600141 Fissurectomy 11,664
Attending Doctor
As Advised by
99 6 General Surgery SS00600143 Anal Fistula Repair 11,664
Attending Doctor
As Advised by
100 6 General Surgery SS00600149 Ganglion - large - Excision 4,860
Attending Doctor
Ganglion (Dorsum of Both As Advised by
Wrist) - Excision Attending Doctor
As Advised by
102 6 General Surgery SS00600151 Ganglion - Small - Excision 3,402
Attending Doctor
As Advised by
103 6 General Surgery SS00600155 Gastrotomy 1,458
Attending Doctor
As Advised by
104 6 General Surgery SS00600158 Growth - Excision 2,916
Attending Doctor
As Advised by
105 6 General Surgery SS00600161 Hemithyroplasty 13,122
Attending Doctor
As Advised by
106 6 General Surgery SS00600163 Hernia - Epigastric 9,720
Attending Doctor
242
Package
Code Hospitals
Code
As Advised by
107 6 General Surgery SS00600164 Hernia - Incisional 16,038
Attending Doctor
Hernia - Repair & release of As Advised by
obstruction Attending Doctor
As Advised by
109 6 General Surgery SS00600166 Hernia - Umbilical 11,664
Attending Doctor
Hernia - Ventral - As Advised by
Lipectomy/Incisional Attending Doctor
As Advised by
111 6 General Surgery SS00600168 Hernia - Femoral 15,552
Attending Doctor
As Advised by
112 6 General Surgery SS00600169 Hernioplasty 13,122
Attending Doctor
Herniorraphy and As Advised by

Hydrocelectomy Sac Excision Attending Doctor
As Advised by
114 6 General Surgery SS00600171 Hernia - Hiatus - abdominal 19,440
Attending Doctor
Hydrocelectomy+Hernioplasty - As Advised by
Excision Attending Doctor
As Advised by
116 6 General Surgery SS00600175 Hydrocele - Excision - Unilateral 5,346
Attending Doctor
As Advised by
117 6 General Surgery SS00600176 Hydrocele - Excision - Bilateral 7,776
Attending Doctor
As Advised by
118 6 General Surgery SS00600178 Infected Bunion Foot - Excision 5,346
Attending Doctor
As Advised by
119 6 General Surgery SS00600185 Gastric Perforation 12,636
Attending Doctor
243
Package
Code Hospitals
Code
Intestinal Perforation (Resection As Advised by

Anastomosis) Attending Doctor
As Advised by
121 6 General Surgery SS00600187 Appendicular Perforation 12,150
Attending Doctor
As Advised by
122 6 General Surgery SS00600188 Burst Abdomen Obstruction 13,122
Attending Doctor
Closure of Hollow Viscus As Advised by
Perforation Attending Doctor
As Advised by
124 6 General Surgery SS00600196 Lipoma 4,860
Attending Doctor
As Advised by
125 6 General Surgery SS00600200 Mastectomy 11,664
Attending Doctor
As Advised by
126 6 General Surgery SS00600208 Orchidectomy 7,776
Attending Doctor
As Advised by
127 6 General Surgery SS00600210 Orchidopexy 9,234
Attending Doctor
As Advised by
128 6 General Surgery SS00600229 Haemorroidectomy 11,664
Attending Doctor
As Advised by
129 6 General Surgery SS00600230 Salivary Gland - Excision 10,692
Attending Doctor
130 6 General Surgery SS00600269 Excision of Corns 486 Daycare
131 6 General Surgery SS00600270 Excision of Moles 680 Daycare
Excision of
Molluscumcontagiosum
244
Package
Code Hospitals
Code
Comprhensive mother package

(three antenal checkup , As Advised by
133 9 Obstetrics and Gynaecology SS00900001 12,000
diagnositics , treatment and Attending Doctor
Delivery - normal or caessorian)
Suction evacuation vesicular As Advised by

mole, missed abortion D/E Attending Doctor
Rupture Uterus, closure & As Advised by

repair with tubal ligation Attending Doctor
Repair of post-coital tear, As Advised by

perineal injury Attending Doctor
Internal podalic version and As Advised by
extraction Attending Doctor
Gaping pareneal wound As Advised by
secondary suturing Attending Doctor
As Advised by
139 9 Obstetrics and Gynaecology SS00900010 Exploration of PPH-tear repair 4,000
Attending Doctor
Exploration of perineal
As Advised by
140 9 Obstetrics and Gynaecology SS00900011 haematoma & Resuturing of 6,000
Attending Doctor
episiotomy
141 9 Obstetrics and Gynaecology SS00900013 Excision of urethral caruncle 2,500
Attending Doctor
142 9 Obstetrics and Gynaecology SS00900014 Examination under anaesthesia 2,000
Attending Doctor
Colpotomy-drainage P/V 1 Day / As Advised by
needling EUA Attending Doctor
245
Package
Code Hospitals
Code
Electro Cauterisation Cryo 1 Day / As Advised by

Surgery +Fractional Curretage Attending Doctor
Normal delivery + perineal tear 2 Days / As Advised

repair by Attending Doctor
D&C ( Dilatation & curretage) + As Advised by

Polypectomy Attending Doctor
D&C ( Dilatation & curretage)

147 9 Obstetrics and Gynaecology SS00900037 +Electro Cauterisation Cryo 3,000
Attending Doctor
Surgery
D&C ( Dilatation & curretage) + 1 Day / As Advised by

Cervical polypectomy Attending Doctor
D&C ( Dilatation & curretage) 1 Day / As Advised by

+Bartholin abscess I & D Attending Doctor
D&C ( Dilatation & curretage) + 1 Day / As Advised by

Ablation of Endometrium Attending Doctor
Bartholin abscess I & D +Cyst - 1 Day / As Advised by

Vaginal Enucleation Attending Doctor
Bartholin cyst removal + cervical As Advised by

polypectomy Attending Doctor
Bartholin abscess I & D + As Advised by
cervical polypectomy Attending Doctor
246
Package
Code Hospitals
Code
154 9 Obstetrics and Gynaecology SS00900052 Colopotomy 2,500
Attending Doctor
155 9 Obstetrics and Gynaecology SS00900053 Cone Biopsy Cervix 2,500
Attending Doctor
156 9 Obstetrics and Gynaecology SS00900054 Cervical biopsy 1,800
Attending Doctor
Ablation of Endometrium + D&C 1 Day / As Advised by

( Dilatation & curretage) Attending Doctor
As Advised by
158 9 Obstetrics and Gynaecology SS00900068 Puerperal Sepsis 5,000
Attending Doctor
As Advised by
159 9 Obstetrics and Gynaecology SS00900069 Normal Delivery + Tubectomy 5,000
Attending Doctor
Pre-eclampsia + Normal As Advised by
Delivery Attending Doctor
161 9 Obstetrics and Gynaecology SS00900073 Shirodhkar Mc. Donalds stich 3,000
Attending Doctor
Repair of post coital tear, 1 Day / As Advised by
perineal injury Attending Doctor
Nomal delivery with episiosty As Advised by
and P repair Attending Doctor
As Advised by
164 9 Obstetrics and Gynaecology SS00900079 Manual removel of Plecenta 2,000
Attending Doctor
Manual removel of Plecenta for As Advised by

outside delivery etc. Attending Doctor
Low midcavity forceps + Normal As Advised by

delivery Attending Doctor
247
Package
Code Hospitals
Code
As Advised by
167 9 Obstetrics and Gynaecology SS00900083 Low Forceps+ Normal delivery 4,000
Attending Doctor
As Advised by
168 9 Obstetrics and Gynaecology SS00900087 Insertion of IUD Device 500
Attending Doctor
D&C ( Dilatation & 1 Day / As Advised by
curretage)upto 8 wks Attending Doctor
D&C ( dilatation & Curretage) 1 Day / As Advised by
upto 12 wks Attending Doctor
D&C ( Dilatation & curetage ) > 1 Day / As Advised by
12 wks Attending Doctor
172 9 Obstetrics and Gynaecology SS00900093 Conventional Tubectomy 2,500
Attending Doctor
As Advised by
173 9 Obstetrics and Gynaecology SS00900095 Normal Delivery 3,000
Attending Doctor
As Advised by
174 9 Obstetrics and Gynaecology SS00900096 Vulval Tumors - Removal 4,000
Attending Doctor
As Advised by
175 9 Obstetrics and Gynaecology SS00900098 Vaginal Tear -Repair 2,500
Attending Doctor
As Advised by
176 9 Obstetrics and Gynaecology SS00900103 Perineal Tear Repair 3,000
Attending Doctor
Hymenectomy & Repair of As Advised by
Hymen Attending Doctor
Haemato Colpo/Excision - As Advised by

Vaginal Septum Attending Doctor
As Advised by
179 9 Obstetrics and Gynaecology SS00900112 Fractional Curretage 3,000
Attending Doctor
Electro Cauterisation Cryo As Advised by
Surgery Attending Doctor
248
Package
Code Hospitals
Code
As Advised by
181 9 Obstetrics and Gynaecology SS00900114 D&C ( Dilatation & curretage) 2,500
Attending Doctor
As Advised by
182 9 Obstetrics and Gynaecology SS00900115 Cystocele - Anterior repair 3,000
Attending Doctor
183 9 Obstetrics and Gynaecology SS00900117 Cyst -Vaginal Enucleation 3,000
Attending Doctor
184 9 Obstetrics and Gynaecology SS00900118 Cyst - Labial 3,000
Attending Doctor
185 9 Obstetrics and Gynaecology SS00900119 Cervical Polypectomy 3,000
Attending Doctor
186 9 Obstetrics and Gynaecology SS00900120 Bartholin cyst removal 3,000
Attending Doctor
187 9 Obstetrics and Gynaecology SS00900132 Diagnostic Curettage 2,000
Attending Doctor
188 9 Obstetrics and Gynaecology SS00900133 Fractiol Curettage 2,500
Attending Doctor
189 9 Obstetrics and Gynaecology SS00900134 D & C and Cervical Biopsy 2,500
Attending Doctor
190 9 Obstetrics and Gynaecology SS00900135 Polypectomy 1,500
Attending Doctor
Other-Minor Operation 1 Day / As Advised by
Endometrial Attending Doctor
Excision Vagil Cyst/Burtholin 1 Day / As Advised by
Cyst Attending Doctor
193 9 Obstetrics and Gynaecology SS00900138 Excision Vagil Septum 3,500
Attending Doctor
194 9 Obstetrics and Gynaecology SS00900140 Laparoscopy Sterilisation 4,000
Attending Doctor
249
Package
Code Hospitals
Code
195 9 Obstetrics and Gynaecology SS00900152 Colposcopy 2,000
Attending Doctor
196 9 Obstetrics and Gynaecology SS00900155 Chorionic Villi sampling 3,000
Attending Doctor
As Advised by
197 9 Obstetrics and Gynaecology SS00900157 Amneocentosis 3,000
Attending Doctor
As Advised by
198 9 Obstetrics and Gynaecology SS00900179 Assisted breech delivery 4,500
Attending Doctor
As Advised by
199 9 Obstetrics and Gynaecology SS00900187 Sterilisation Post ertum 3,000
Attending Doctor
As Advised by
200 9 Obstetrics and Gynaecology SS00900188 Sterilisation Intravagil 3,000
Attending Doctor
201 9 Obstetrics and Gynaecology SS00900189 Abortion- D & C 2,500
Attending Doctor
202 9 Obstetrics and Gynaecology SS00900190 Abortion- Evacuation 2,500
Attending Doctor
203 9 Obstetrics and Gynaecology SS00900191 MTP- 1st Trimester 2,500
Attending Doctor
204 9 Obstetrics and Gynaecology SS00900192 MTP - 2nd Trimester 3,000
Attending Doctor
205 9 Obstetrics and Gynaecology SS00900193 Triple test 1,350
Attending Doctor
Viral pneumonia, not elsewhere As Advised by
206 10 Medical Conditions SS01000022
classified Attending Doctor
As Advised by
207 10 Medical Conditions SS01000023 Viral meningitis
Attending Doctor
As Advised by
208 10 Medical Conditions SS01000024 Viral fever
Attending Doctor
250
Package
Code Hospitals
Code
Viral and other specified As Advised by

intestinal infections Attending Doctor
As Advised by
210 10 Medical Conditions SS01000026 Vasculits
Attending Doctor
As Advised by
211 10 Medical Conditions SS01000027 Urethritis - gonococcal
Attending Doctor
As Advised by
212 10 Medical Conditions SS01000028 Urethritis - chlamydial
Attending Doctor
Upper GI bleeding ( endoscopic As Advised by
treatment) Attending Doctor
Upper GI bleeding ( As Advised by
conservative) Attending Doctor
As Advised by
215 10 Medical Conditions SS01000031 Unspecified viral hepatitis
Attending Doctor
As Advised by
216 10 Medical Conditions SS01000032 Unspecified malaria
Attending Doctor
As Advised by
217 10 Medical Conditions SS01000033 Unspecified diabetes mellitus
Attending Doctor
As Advised by
218 10 Medical Conditions SS01000034 Unspecified chronic bronchitis
Attending Doctor
As Advised by
219 10 Medical Conditions SS01000035 Typhoid and paratyphoid fevers
Attending Doctor
As Advised by
220 10 Medical Conditions SS01000036 Typhoid
Attending Doctor
As Advised by
221 10 Medical Conditions SS01000037 Tubercular menigitis
Attending Doctor
As Advised by
222 10 Medical Conditions SS01000038 Transforaminal Block
Attending Doctor
251
Package
Code Hospitals
Code
As Advised by
223 10 Medical Conditions SS01000039 Trachoma
Attending Doctor
As Advised by
224 10 Medical Conditions SS01000040 Tonsillitis
Attending Doctor
As Advised by
225 10 Medical Conditions SS01000042 Tetanus
Attending Doctor
As Advised by
226 10 Medical Conditions SS01000043 TB Meningitis
Attending Doctor
As Advised by
227 10 Medical Conditions SS01000044 TB pulmonary
Attending Doctor
As Advised by
228 10 Medical Conditions SS01000045 Systenuc Lupus Erythematosis
Attending Doctor
As Advised by
229 10 Medical Conditions SS01000046 Syphillis
Attending Doctor
As Advised by
230 10 Medical Conditions SS01000067 Pneumonia
Attending Doctor
As Advised by
231 10 Medical Conditions SS01000068 Plasmodium vivax malaria
Attending Doctor
As Advised by
232 10 Medical Conditions SS01000069 Plasmodium malariae malaria
Attending Doctor
As Advised by
233 10 Medical Conditions SS01000070 Plasmodium falciparum malaria
Attending Doctor
As Advised by
234 10 Medical Conditions SS01000071 Plague
Attending Doctor
As Advised by
235 10 Medical Conditions SS01000072 Pertussis
Attending Doctor
As Advised by
236 10 Medical Conditions SS01000073 Peripheral neuritis/ neuropathy
Attending Doctor
252
Package
Code Hospitals
Code
As Advised by
237 10 Medical Conditions SS01000075 Ozone Therapy + Nerve Block
Attending Doctor
Non-insulin-dependent diabetes As Advised by
mellitus Attending Doctor
As Advised by
239 10 Medical Conditions SS01000083 Nephrotic syndrom
Attending Doctor
Neonatal jaundice from other As Advised by

and unspecified causes Attending Doctor
Neonatal jaundice due to other As Advised by

excessive haemolysis Attending Doctor
As Advised by
242 10 Medical Conditions SS01000086 Myalgia
Attending Doctor
As Advised by
243 10 Medical Conditions SS01000090 Meningitis
Attending Doctor
As Advised by
244 10 Medical Conditions SS01000091 Measles - uncomplicated
Attending Doctor
As Advised by
245 10 Medical Conditions SS01000092 Measles - complicated
Attending Doctor
As Advised by
246 10 Medical Conditions SS01000093 Management of Pneumothorax
Attending Doctor
Malnutrition-related diabetes As Advised by
mellitus Attending Doctor
As Advised by
248 10 Medical Conditions SS01000095 Malaria -cerebral
Attending Doctor
As Advised by
249 10 Medical Conditions SS01000096 Malaria - uncomplicated
Attending Doctor
253
Package
Code Hospitals
Code
As Advised by
250 10 Medical Conditions SS01000102 Leprosy Ulcer Care With Stay
Attending Doctor
Leprosy Reaction & Neuritis As Advised by
(T1R & T2R) Attending Doctor
As Advised by
252 10 Medical Conditions SS01000111 Hepatis B
Attending Doctor
As Advised by
253 10 Medical Conditions SS01000112 colitis
Attending Doctor
As Advised by
254 10 Medical Conditions SS01000114 Heat stroke
Attending Doctor
As Advised by
255 10 Medical Conditions SS01000117 Food poisoning
Attending Doctor
As Advised by
256 10 Medical Conditions SS01000118 Filariasis
Attending Doctor
As Advised by
257 10 Medical Conditions SS01000119 Essential (primary) hypertension
Attending Doctor
Epiduro-fluroscopy Adhesiolysis As Advised by

(3 days stay) Attending Doctor
As Advised by
259 10 Medical Conditions SS01000121 Enteric fever
Attending Doctor
As Advised by
260 10 Medical Conditions SS01000122 Endocarditis
Attending Doctor
As Advised by
261 10 Medical Conditions SS01000123 Emphysema Acute Exacerbation
Attending Doctor
As Advised by
262 10 Medical Conditions SS01000124 Dysfunctional uterine bleeding
Attending Doctor
As Advised by
263 10 Medical Conditions SS01000125 Dysentery - bacterial
Attending Doctor
254
Package
Code Hospitals
Code
As Advised by
264 10 Medical Conditions SS01000126 Diphtheria
Attending Doctor
Diarrhoea and gastroenteritis of As Advised by

presumed infectious origin Attending Doctor
As Advised by
266 10 Medical Conditions SS01000131 Dengue fever
Attending Doctor
As Advised by
267 10 Medical Conditions SS01000134 Conjunctivitis (bacterial)
Attending Doctor
As Advised by
268 10 Medical Conditions SS01000136 Acid peptic disease
Attending Doctor
As Advised by
269 10 Medical Conditions SS01000156 Amoebiasis
Attending Doctor
Rate of Diagnostic
Medical Conditions / Other Medical procedures rate - test essentials to be
General Ward :Unspecified
Unspecified Conditions 750/day added as per the
diagnostic rate chart
ICU-designated air conditioned

space, with Standard ICU bed,
equipment for the constant
Medical Conditions / Other Medical procedures rate -
monitoring for vitals,
Unspecified Conditions 1500/day
emergency crash cart/tray,
defibrillator, ventilators, suction
pumps, bedside oxygen facility.
255
Package
Code Hospitals
Code
As Advised by
270 13 Orthopaedics SS01300001 Removal of Plaster 972
Attending Doctor
271 13 Orthopaedics SS01300002 Stitch Removal & Dressing 972
Attending Doctor
272 13 Orthopaedics SS01300003 Antiseptic dressing of wound 1,215
Attending Doctor
Collar & Cuff sling or 1 Day / As Advised by
273 13 Orthopaedics SS01300004 1,215
Figure of 8 bandage Attending Doctor
274 13 Orthopaedics SS01300005 Strapping of toes / fingers 1,782
Attending Doctor
Attending Doctor
Attending Doctor
277 13 Orthopaedics SS01300008 Intra-articular / Local injection 4,050
Attending Doctor
Attending Doctor
279 13 Orthopaedics SS01300010 Above elbow POP slab / U slab 3,240
Attending Doctor
Attending Doctor
Attending Doctor
Attending Doctor
Above elbow POP cast / 1 Day / As Advised by
283 13 Orthopaedics SS01300014 6,480
Hanging arm cast Attending Doctor
256
Package
Code Hospitals
Code
Attending Doctor
285 14 Ophthalmology SS01400009 SICS with rigid IOL 2,500
Attending Doctor
Phacoemulsification with 1 Day / As Advised by

foldable hydrophilic lens Attending Doctor
Phacoemulsification with 1 Day / As Advised by

foldable hydrophobic lens Attending Doctor
Trabeculectomy with
As Advised by
288 14 Ophthalmology SS01400015 phacoemulsification with 6,000
Attending Doctor
foldable lens
Trabeculectomy with SICS with As Advised by
rigid IOL Attending Doctor
290 17 Skin Procedures SS01700001 Excision of Moles 567 Daycare
291 17 Skin Procedures SS01700002 Excision of Warts 567 Daycare
Excision of
292 17 Skin Procedures SS01700003 567 Daycare
Molluscumcontagiosum
293 17 Skin Procedures SS01700004 Excision of Veneral Warts 567 Daycare
294 17 Skin Procedures SS01700005 Excision of Corns 405 Daycare
295 17 Skin Procedures SS01700006 I/D Injection Keloid of Acne 405 Daycare
296 17 Skin Procedures SS01700007 Chemical Cautery (s) 405 Daycare
257

Packages Swasthyasathi 3-1-2017

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Packages Swasthyasathi 3-1-2017

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Assurance

Single chamber As Advised by

Double chamber As Advised by

Prosthetic valve As Advised by

3.c Tissue Valves

As Advised by Rate as per

Arch As Advised by Includes

Gastroenterolog As Advised by Includes

Gastroenterolog As Advised by Includes

Gastroenterolog As Advised by Includes

Gastroenterolog As Advised by Includes

Gastroenterolog As Advised by Includes

Gastroenterolog As Advised by Includes

Gastroenterolog As Advised by Includes

Gastroenterolog As Advised by Includes

Open reduction As Advised by Includes

Antero-lateral As Advised by Includes

Spinal stabilizati As Advised by Includes

Posterior As Advised by Includes

Radiotherapy IGRT WITH 4D As Advised by Includes

Heart failure Medical As Advised by Attending Includes standard

Infective endocarditis As Advised by Attending Includes standard

Deep vein thrombosis As Advised by Attending Includes standard

Pulmonary embolism As Advised by Attending Includes standard

Drug eluting stents

Simple arrhythmias As Advised by Attending Includes standard

Pericardial effusion As Advised by Attending Includes standard

As Advised by Attending Includes fluid analysis

Coronary angioplasty Drug eluting stents

As Advised by Attending Includes standard

Permanent pacing Single As Advised by Attending

Permanent pacing Single

Mitral balloon As Advised by Attending Includes standard

Pulmonary balloon As Advised by Attending Includes standard

Prosthetic valve leaks - As Advised by Attending

Coarctation of aorta - 65,000 stent and As Advised by Attending

Transcutaneous MAPCA As Advised by Attending

35,000 for DES, With Baloon-105000

35,000 for DES, As Advised by Attending

CTVS or a. Abdominal aorta

Complicated Ext. per Includes standard

Root canal treatment Includes standard

3 Days/As advise by Includes standard

Amalgam Filling/Tooth Includes standard

Amalgam Filling/Tooth Includes standard

Dento Alveolar Fracture

Dialation Of Whartons Includes standard

Direct/ Indirect Pulp Includes standard

Floride Application (Per Includes standard

Intra Articular Inj. Of Includes standard

Post Core/ Tooth (Cast

Preformed Carbonate Includes standard

Reduction Of Dislocation 1 Day/As advise by Includes standard

Reimplantation (Per 1 Day/As advise by Includes standard

Repair Of Facial Soft 1 Day/As advise by Includes standard

Repair Of Facial Soft

Sialolithotomy For Small Includes standard

Surgical Removal Of Soft

Aural polypectomy As Advised by Attending Includes standard

Tympanoplasty+ As Advised by Attending Includes standard

Removal of foreign body As Advised by Attending Includes standard

As Advised by Attending Includes standard

Total Amputation &

As Advised by Attending Includes standard