PACKAGE LIST JAIPUR CITY Package Code Package Name …

1 PACKAGE CodePackage NameNABL Rate NABH RateNon NABL RateNon NABH Rate1 Consultation OPD1351351351352 Consultation for Inpatients2702702702703 Dressings of wounds585845454 Suturing of wounds with local anesthesia11211297975 Aspiration Plural Effusion Diagnostic1381381201206 Aspiration Plural Effusion Therapeutic2002001741747 Abdominal Aspiration Diagnostic3583583113118 Abdominal Aspiration Therapeutic4764764144149 Pericardial Aspiration39339334234210 Joints Aspiration32832828528511 Biopsy Skin23823820720712 Removal of Stitches3737323213 Venesection12912911211214 Phimosis Under LA135713571180118015 Sternal puncture17917915615616 Injection for Haemorrhoids42942937337317 Injection for Varicose Veins36236231531518 Catheterisation50050042542519 Dilatation of Urethra51851845045020 Incision & Drainage44944939039021 Intercostal Drainage13013011311322 Peritoneal Dialysis151715171319131923 Excision of Moles35835831131124 Excision of Warts32132127927925 Excision of Molluscum contagiosum13513511711726 Excision of Venereal Warts16616614414427 Excision of Corns14514512612628I/D Injection Keloid(Intralesional Injection)100100878729 Chemical Cautery (s)

2 114114999930 Subconjunctival/subtenon s injections in one eyes7171626231 Subconjunctival/subtenon s injections in both eyes14314312412432 Pterygium Surgery632563255500550033 Conjunctival Peritomy6060525234 Conjunctival wound repair or exploration following blunt trauma379537953300330035 Removal of corneal foreign body12012010410436 Cauterization of ulcer/subconjunctival injection in one eye7171626237 Cauterization of ulcer/subconjunctival injection in both eyes14314312412438 Corneal grafting Penetrating keratoplasty595159515175517539 Corneal grafting Lamellar keratoplasty575057505000500040 Cyanoacrylate /fibrin glue application for corneal perforation71471462162141 Bandage contact lenses for corneal perforation47647641441442 Scleral grafting or conjunctival flap for corneal perforation238123812070207043 Keratoconus correction with therapeutic contact lenses1380138012001200 PACKAGE LIST JAIPUR CITYOPD PROCEDURESTREATMENT PROCEDURE SKINTREATMENT PROCEDURE OPTHALMOLOGY44 Ultraviolet (UV) radiation for cross linking for keratoconus186318631620162045 EDTA for band shaped keratopathy89489477777746 Arcuate keratotomy for astigmatism289828982520252047Re suturing (Primary suturing)

3 Of corneal wound119011901035103548 Penetrating keratoplasty with glaucoma surgery1257012570109301093049 Penetrating keratoplasty with vitrectomy1257012570109301093050 Penetrating keratoplasty with IOL implantation1413414134122901229051 DALK Deep anterior lamellar keratoplasty1785417854155251552552 Keratoprosthesis stage I and II1190311903103501035053 DSAEK Descemet s stripping automated endothelialkeratoplasty17259172591500815 00854 ALTK Automated lamellar therapeutic keratoplasty1707817078148501485055 Probing and Syringing of lacrimal sac in one eye7171626256 Probing and Syringing of lacrimal sac in both eye14314312412457 Dacryocystorhinostomy Plain297629762588258858 Dacryocystorhinostomy Plain with intubation and/or with lacrimal implants10091100918775877559 Dacryocystorhinostomy conjunctival with implant952295228280828060 Caliculoplasty238123812070207061 Dacryocystectomy198419841725172562 Punctal plugs for dry eyes13513511711763 Refraction4141363664 Indirect Ophthalmoscopy6969606065 Orthoptic check up with synoptophore4646404066 Lees charting or Hess charting104104909067 Orthoptic exercises5858505068 Pleoptic exercises5858505069 Perimetry/field test Goldman15015013013070 Perimetry/field test automated15015013013071 Fluorescein angiography for fundus or iris95295282882872 Ultrasound A Scan89489477777773 Ultrasound B Scan23823820720774 Fundus Photo Test20720718018075 Indocyanin green angiography95295282882876 Corneal endothelial cell count with specular microscopy23823820720777 Corneal topography34334329829878 Corneal pachymetry23823820720779 Auto refraction3737323280 Macular function tests4646404081 Potential acuity metry11511510010082 Laser interferometry17917915615683 OCT Optical coherence tomography220022001913191384 HRT

4 Heidelberg s retinal tomogram15515513513585 GDx Nerve fibre layer analyzer101101888886 UBM Ultrasound bio microscopy15515513513587 Non Contact tonometry (NCT)5252454588 IOP measurement with schiotz3131272789 IOP measurement with applation tonometry5252454590 Three mirror examination for retina606052529190 D lens examination5252454592 Gonioscopy6060525293 chalazion incision and curettage in one eye41441436036094 chalazion incision and curettage in both eyes44644638838895 Ptosis surgery with fasanella servat procedure238123812070207096 Ptosis surgery with LPS resection one lid569356934950495097 Ptosis surgery with Sling surgery one lid690369036003600398 Ectropion surgery one lid161016101400140099 Ectropion surgery both lids2875287525002500100 Epicanthus correction1604160413951395101 Cantholysis and canthotomy596596518518102 Entropion surgery one lid1428142812421242103 Entropion surgery both lids2070207018001800104 Tarsorraphy748748650650105 Suturing of lid lacerations1190119010351035106 Lid retraction repair1760176015301530107

5 Concretions removal120120104104108 Bucket handle procedure for lid tumors358358311311109 Cheek rotation flap for lid tumors7142714262106210110 Orbitotomy8332833272457245111 Enucleation3105310527002700112 Enucleation with orbital implants and artificial prosthesis3105310527002700113 Evisceration3571357131053105114 Evisceration with orbital implants and artificial prosthesis5893589351245124115 Telecanthus correction5357535746584658116 Orbital decompression5951595151755175117 Exenteration5951595151755175118 Exenteration with skin grafting7142714262106210119 Fracture orbital repair9522952282808280120 Retinal laser procedures1553155313501350121 Retinal detachment surgery (RDS)11903119031035010350122 Retinal detachment surgery (RDS) with scleral buckling14283142831242012420123 Buckle removal1190119010351035124 Silicone oil removal2898289825202520125 Anterior retinal cryopexy1203120310461046126 Squint correction for one eye5175517545004500127 Squint correction for both eyes7763776367506750128 Trabeculectomy7935793569006900129 Trabeculotomy7142714262106210130 Trabeculectomy with Trabeculotomy107121071293159315131 Trephination2381238120702070132 Goniotomy358358311311133 Glaucoma surgery with Glaucoma valves7256725663106310134 Cyclocryotherapy1190119010351035135 YAG laser iridotomy1553155313501350136 YAG laser capsulotomy11321132984984137 ALT Argon laser trabeculoplasty1719171914951495138 PDT Photodymic therapy3571357131053105139 TTT Transpupillary thermal therapy3450345030003000140 PTK Phototherapeutic keratectomy7763776367506750141 Argon/diode laser for retinal detachment1190119010351035142 Intralase

6 Application for keratoconus5951595151755175143 EOG electro oculogram932932810810144 ERG Electro retinogram822822715715145 VEP visually evoked potential920920800800146 Vitrectomy pars plana11903119031035010350147 Intravitreal injections of antibiotics1190119010351035148 Intravitreal injections of Ranibizumab excluding cost of drug3105310527002700149X Ray orbit127127110110150CT orbit and brain1840184016001600151 MRI Orbit and brain3571357131053105152 Dacryocystography366366318318153 Orbital angio graphical studies1725172515001500154 Extracapsular cataract extraction (ECCE) with IOL3968396834503450155 Small Incision Cataract Surgery (SICS) with IOL5175517545004500156 Phaco with foldable IOL (silicone and acrylic)/PMMA IOL111581115897039703157 Pars plana lensectomy with/without IOL107121071293159315158 Secondary IOL implantation AC IOL PC IOL or scleral fixated IOL7142714262106210159 Cataract extraction with IOL with capsular tension rings(Cionni s ring)

7 13973139731215012150160 Optic nerve sheathotomy7763776367506750161 Iridodialysis repair or papillary reconstruction5175517545004500162 Iris cyst removal880880765765163 Lid Abscess incision and Drainage1760176015301530164 Orbital Abscess incision and Drainage3105310527002700165 Biopsy476476414414166 Paracentesis238238207207167 Scleral graft for scleral melting or perforation2898289825202520168 Amniotic membrane grafting1150115010001000169 Cyclodiathermy2381238120702070170 Intraocular foreign body removal193193168168171 Electrolysis238238207207172 Perforating injury repair4658465840504050173 Botulinum injection for blepharospasm or squint2588258822502250174 Flap Operation per quadrant373373324324175 Gingivectomy per quadrant269269234234176 Reduction & immobilization of fracture Maxilla Under LA932932810810177 Reduction & immobilization of fracture Mandible Under LA3623362331503150178 Splints/Circummandibular wiring under LA587587510510179splints/Circummandibula r wiring under GA11391139990990180 Internal wire fixation/plate fixation of Maxilla under LA3450345030003000181 Internal wire fixation/plate fixation of Maxilla under GA4600460040004000182 Internal wire fixation/plate fixation of Mandible under LA4025402535003500183 Internal wire fixation/plate fixation of Mandible under GA4600460040004000184 Extraction per tooth under LA92928080185 Complicated Extraction per Tooth under LA115115100100 TREATMENT PROCEDURE DENTAL PROCEDURES186 Extraction of impacted tooth under LA184184160160187 Extraction in mentally retarded/patients with systemicdiseases/patient with special needs under short term GA972972845845188 Cyst & tumour of Maxilla /mandible by enucleation/excision/ marsupialisation upto 4 cms under LA281281244244189 Cyst & tumour of Maxilla / mandible by

8 Enucleation / excision / marsupialisation size more than 4 cms467467406406190 Cyst & tumour of Maxilla/mandible by enucleation/excision/marsupialisation size more than 4 cms under GA1150115010001000191TM joint ankylosis under GA7763776367506750192 Biopsy Intraoral Soft tissue388388337337193 Biopsy Intraoral Bone430430374374194 Hemi mandibulectomy with graft21735217351890018900195 Hemi mandibulectomy without graft21735217351890018900196 Segmental mandibulectomy with graft3910391034003400197 Segmental mandibulectomy without graft11391139990990198 Maxillectomy Total with graft2875287525002500199 Maxillectomy Total without graft2243224319501950200 Maxillectomy partial with graft3105310527002700201 Maxillectomy partial without graft2588258822502250202 Release of fibrous bands & grafting in (OSMF) treatment under GA1725172515001500203 Pre prosthetic surgery Alveoloplasty575575500500204 Pre prosthetic surgery ridge augmentation1380138012001200205 Root canal Treatment(RCT) Anterior teeth(per tooth)575575500500206 Root canal Treatment(RCT) Posterior teeth (per tooth)

9 805805700700207 Apicoectomy Single root575575500500208 Apicoectomy Multiple roots748748650650209 Metal Crown per unit575575500500210 Metal Crown with Acrylic facing per unit805805700700211 Complete single denture metal based1553155313501350212 Complete denture acrylic based per arch10931093950950213 Removable partial denture Metal based upto 3 teeth805805700700214 Removable partial denture Metal based more than 3 teeth932932810810215 Removable partial denture Acrylic based upto 3 teeth575575500500216 Removable partial denture Acrylic based more than 3 teeth / Per tooth304304264264217 Amalgam restoration per tooth230230200200218 Composite Restoration per tooth anterior tooth288288250250219 Glass Ionomer filling per tooth230230200200220 Scaling & polishing311311270270221 Removable Orthodontics appliance per Arch805805700700222 Fixed Orthodontics per Arch1323132311501150223 Space maintainers Fixed575575500500224 Habit breaking appliances removable920920800800225 Habit breaking appliances Fixed1725172515001500226 Expansion plate1150115010001000227 Feeding appliance for cleft palate1725172515001500228 Maxillo facial prosthesis (sal/auricular/orbital/facial lostpart)3623362331503150229 Functional orthodontic appliances3450345030003000230 Obturator (Maxillo facial)1725172515001500231 Occlusal night guard(splint)920920800800232 Pure Tone Audiogram178178155155233 Impedence with stepedeal reflex238238207207234 Short Increment Sensitivity Index (SISI)

10 Tone Decay137137119119235 Multiple hearing assessment test to Adults120120104104236 Speech Discrimination Score93938181237 Speech Assessment124124108108238 Speech therapy per session of 30 40 minutes136136118118239 Cold Calorie Test for Vestibular function178178155155240 Removal of foreign body From Nose358358311311241 Removal of foreign body From Ear238238207207242 Syringing (Ear)171171149149243 Polyp removal under LA596596518518244 Polyp removal under GA880880765765245 Peritonsillar abscess Drainage under LA1500150013041304246 Myringoplasty7142714262106210247 Staepedectomy9522952282808280248 Myringotomy with Grommet insertion4761476141404140249 Tympanotomy8927892777637763250 Tympanoplasty14283142831242012420251 Mastoidectomy15473154731345513455252 Otoplasty16664166641449014490253 Labyrinthectomy14283142831242012420254 Skull Base surgery25875258752250022500255 Facial Nerve Decompression17854178541552515525256 Septoplasty5951595151755175257 Submucous Resection7570757065836583258 Septo rhinoplasty16664166641449014490259 Rhinoplasty Non cosmetic11903119031035010350260 Fracture Reduction of Nasal Bone4600460040004000261 Intra nasal Diathermy1190119010351035262 Turbinectomy5951595151755175263 Endoscopic Dacryocystorhinostomy (DCR)