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THE GUJARAT CANCER & RESEARCH INSTITUTE

AHMEDABAD

Cancer is Curable If Detected Early

HOSPITAL CHARGES
Updated on 24/01/2022

New Civil Campus, Asarwa, Ahmedabad-380016

Phone : 91-079-22688000 # Fax : 91-079-22685490
Web.:www.gcriindia.org E-mail : director@gcriindia.org

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THE GUJARAT CANCER & RESEARCH INSTITUTE

AHMEDABAD

STANDARD CHARGES / HOSPITAL RATE

1. General Category: General category patients are charged minimum possible.

Gen. category patients will be given 50% subsidy of standard charges.
2. Bed Charges :

GENERAL WARD Standard

Charge
per day

1. Bed charge in General Ward Patient except BPL category. 50/-

SPECIAL ROOM Standard

Charge
per day

1. Special Room A/C Ground Floor (Single Occupancy) 2200/-

2. Special Room A/C First Floor (Single Occupancy) 2200/-
3. Special Room A/C First Floor (Double Occupancy) 1100/-

4. Special Room Non-A/c (Second Floor)(Single Occupancy) 1100/-

5. Neuro Special Room (Third Floor) 2200/-
6. BMT Patient Room 3000/-
7. New BMT Recovery Cot No-1 & 2 1000/-
8. Day Care Chemotherapy Room (8.00am to 8.00pm) 600/-
Note : 50% Charges to be charged from patients who require
special room for chemotherapy administration upto 8 hours.

Patient who wants to go for special room will be entitled for treatment at special
room premisefs. Special room patient will be provided special attention in the
OPD as well as priority in all investigations including CT Scan, Ultrasound,
Radio Isotope Care. Special room A/C patients will have to deposit an advance
amount of Rs. 5000/- before admission while special room Non-A/C patients will
have to deposit Rs. 3000/-.

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3. State Government patient will be given services as per rules and regulations
of the State Government. They will be provided treatment of the special or
general category as per the desire of the patient. The cashless services for
State Govt. Patients is under process with the Gujarat Govt.

4. B.P.L : B.P.L. will be given free treatment planned by the Head of respective
Units.

5. GCRI staff will be given all free treatment of the cancer. GCRI staff members
who are treated by GCRI doctors for minor ailment will be treated free at GCRI.
Treatment which is not available at GCRI, and requires indoor treatment they
will be referred to concern hospital for treatment. They will be eligible for
reimbursement of the treatment charges as per hospital rules. However, GCRI
staff and their dependent who require special investigation available at GCRI
will be provided free.

6. Advance Payment : Patient is required to pay advance as follows for hospital

services including Investigation, drugs, room charges etc:
Sr. Gen. Ward Special Room
1 Indoor Patients 2000/- 10000/-

Post Op. & Medical

ICU CHARGES

Sr. General Ward Special Room

1 ICU Charges ( Post Op.) 300/- 600/-
2 Medical ICU Charges 300/- 600/-

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VENTILATOR CHARGES
Ventilator Charge General Charges Standard Charge
Per Day per day
General Ward 600 0
Special Room 0 2200

ECG CHARGES (no change in proposal)

General Charges Standard

ECG Charge
Per Day Charge per day
General Ward 60 0
Special Rooms 0 110/-

ECHOCARDIOGRAPHY CHARGES

General Ward 300 0

Special Rooms 0 550

CHEMOTHERAPY Administration Charges Per Day

General Ward Rs .110

Special Rooms Rs .220
• NO charge for Intra muscular chemotherapy.

Physiotherapy charges

Standard
Charge per day
Pre-Operative Physiotherapy Rs.100/per week
Post-Operative Physiotherapy Rs.220/per week
Out door Patient (Non GCRI) Rs.100/per day
• NO charge for Intra muscular chemotherapy.

VISITOR CHARGES (Free visiting hours 4pm to 6pm in waiting hall of ward
only, No visitor is allowed in Ward except one attendant.)

General Ward : One attendant free. For other visitor pass charge Rs.10/- per
person (Except Free Visiting Hours)

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Post Operative Ward, ICU, OT patients & DSU (Endoscope) Room : One
attendant free, for additional pass Rs.10/- per person

Chemotherapy ward : One attendant free, for additional pass Rs.10/- per
person.

Special Room : Two attendant free. For other visitor charge Rs.100/- per
person. (Except Free Visiting Hours ie. 4pm to 6pm)

Follow up charge for Special Room Patient is Rs.100/-

SPECIAL OPD FOLLOW UP FEES –(Medical/ Gynec/ Surg/ R.T) Rs.300/-

DRUGS CHARGES

All patients of the hospital are provided drugs at very subsidized charges from the drug
store of The Gujarat Cancer & Research Institute OR Dr.T.B. Patel Drug Bank. run by
The Gujarat Cancer Society.

SURGICAL CHARGES
N.B. : This will include Anaesthesia charges, operation theatre charges, routine suture material. This will not
include special instruments like stant, Jt.Stapler specialized suture material and Histopathology report. For
histopathology charge Doctor In-charge has to fill the form and advise to pay amount and then form with
specimen should be sent to Pathology Dept.

Sr.N Minor, OPD , Daycare Procedures Charges General Rates Special Rates
o

1 ECG 60 110
2 ECHOCARDIOGRAPHY 300 550
3 CHEMOTHERAPY (Administration Charges) 110 220

PHYSIOTHERAPY / PROSTHETIC
4 Pre-Operative Physiotherapy (Per Week) 100 100
5 Post-Operative Physiotherapy (Per Week) 110 220
6 Out Door Patient (Non GCRI) (Per Day) 50 100
7 Prosthetic Lab 60 110
eus
General Procedures
8 Bone Marrow Biopsy 830 1,650
9 Debridement 660 1,320
10 Dressing 60 110

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11 Excision Bx 1,100 2,200

12 FNAC 400 700
13 Hickman Catheter Removal ( 830 1,650
13A Hickman Catheter Removal ( Under Local Anesthesia) 200 400
14 Hopkins's Examination 220 220
15 Insicion & Drainage 660 1,320
16 Insicional Bx 830 1,650
17 Knife Bx 830 1,650
18 L.N. Bx (Lymphnode Biopsy) 1,100 2,200
19 Punch Bx 100 200
20 Resuturing 660 1,320
21 Ryle's Tube Insertion 550 1,100
21A Ryle's Tube Insertion ( Under Local Anesthesia) 50 100
22 Scoop Bx 100 200
23 T' Stomy Insertion 100 200
24 T' Stomy tube Change 100 200
25 Tooth Extractor under Ga 660 1,320
26 Trucut Bx 100 200
27 Wide Local Excision (WLE) 2200 4400
28 Foley's Catheterisation 60 110
29 BONE BIOPSY 700 1400
30 Bone Marrow Aspirate 550 1,100
31 Nerve Block with use of ‘C’ arm 400 800
Surgical Procedures (Minor)
32 Carotid Ligation 1,100 2,200
33 Colostomy 2,200 4,400
34 Colostomy Closure 2,200 4,400
35 Fistula Closure 1,100 2,200
36 Flap Cutting 1,100 2,200
37 ICD Insertion 660 1,320
38 ICD tube Change 220 220
39 Ileostomy Closure 2,200 4,400
40 Jejunostomy 2,200 4,400
41 Port Removal 830 1,650
42 Tapping (Pleural or Ascites) 830 1,650
43 Tracheostomy 830 1,650
44 Venesection 420 830
45 Node Biopsy 660 1,320
46 Resuturing 660 1,320
47 Dilatation of Urethra 1,100 2,200
140 280
48 THORACOCENTESIS

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Endoscopy Procedures
48A DLB + Bx under Ga 660 1,320
49 EUA under Ga 1,100 2,200
50 Proctoscopy Bx 830 1,650
51 Sigmoido Scopy Bx 1,100 2,200
52 Suspension Laryngoscopy Bx 1,100 2,200
53 D.L.B. & Tracheostomy 1,100 2,200
54 Cystoscopy 1,100 2,200
55 Nesophrayngoscopy 1,100 2,200
56 Bronchoscopy (Rigid) (B'Scopy) 1,100 2,200
57 Mediastinoscopy 1,100 2,200
58 Esophagoscopy (O'Scopy) 1,100 2,200
59 Triple Endoscopy 1,100 2,200
59A Pleuroscopy 1,800 3,600
Polypectomy/Stenting/Endoprosthesis/Banding**(Esophagosco
59B py/Gastroscopy/Colonoscopy/ERCP etc.) 500 1000
Minor Procedures by Anesthetists
60 Cavafix 830 1,650
61 Certofix 830 1,650
62 Epidural Catheter Insertion 830 1,650
63 L.P. Procedure 830 1,650
64 PICC 830 1,650
65 S.P. Block 630 1,650
65A S.P. Block (in D.S.U under Local Anesthesia) 50 100
66 Viggo Insertion 60 110
67 P.F.T Charge 280 550
68 Central Venous Catheterisation (CVC) 830 1,650
Endoscopy at IVTC Center with HPE
69 Bronchoscopy 1,400 2,750
70 Colonoscopy 1,400 2,750
71 E.R.C.P 2,750 5,500
72 Fibroptic Gastroscopy 1,400 2,750
73 Gastroscopy - Endoprothesis Procedure (* Prosthesis Charge Extra) 1,400 2,750
74 Intra Luminal R.T 1,400 2,750
75 PEG-IVTC Procedure 1,650 3,300
76 RT-Insertion Charge (Wire guided) 550 1,100
76A
Anesthesia for Minor Procedure at GCS 500 500
Gynaec Procedure
77 Leep/Biopsy/EUA/D&C 660 1,320
78 Cone Biopsy 660 1,320
79 Pyometra Drainage 660 1,320
80 Resuturing 660 1,320

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81 Gynec Endoscopy Procedure 830 1,650

82 D. & C. 660 1,320
Others Charges
83 File Missing Charges 50 50
84 Frozen Section Procedure Charge 1000 1000
85 Outside Frozen Section Charge (Thr. Pathology Dept) 2000 2000
86 Additional Outside Frozen Section Charge per Section Extra 500 500

ONCOLOGY OPERATIONS
MINOR OPERATION
12 O_MINOR1 Lumpectomy, STG, Resucturing, Minor excision with 4400
primary closure, minor Intra Oral excision,
SOHD, Ophrectomy, Orchidectomy, Gastrostomy,
Jejunostomy, Colostomy C.J, G.J. or Colonic bypass, 2200
D&C laser
Uro Oncology :Dilatation-Internal Urethorotomy ,
Cystoscopy, Cystoscopic biopsy, Bilateral
Orchiectomy, Partial amputation of penis
13 O_MAJOR_A MAJOR OPERATION_A : 8800
Major excision with node dissection, simple
composite resection, RND, MND, MRM, RM or CBS, 4400
Thoracotomy, THE, Gastric, Thyroid surgery,
Ovarian, Vulvectomy, RPLND, Nephrectomy
amputation, disarticulation.
14 O_MAJOR_B MAJOR OPERATION_B : Lung resection, Colonic or 6600 13200
Rectum resection.
15 O_S_MAJOR SUPRA MAJOR OPERATION 11000 22000
Commando with flap reconstruction, Breast
reconstruction, oesophagectomy, Pneumanectomy,
Chest wall resection with reconstruction, Gastric
resection with reconstruction, Hepatic resection,
Pancreatic resection, Orthopaedic reconstruction,
Cystectomy with diversion +
16 O_S_MAJOR Free Flap 4400 8800
+
17 Harmonic Harmonic Scalpel 4000 4000
Sca
18 Vessel Seal Vessel Sealing 4000 4000
19 Water Jet Water Jet 4000 4000
20 Argon Argon Plasma Coagulation 4000 4000
Plasma
21 C.U.S.A. C.U.S.A. 4000 4000

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I.V.T.C. DEPT.

SR. CODE DETAILS GENERAL STANDARD

CHARGES CHARGES
01 Hemoclip Hemoclip ( per piece ) 8820 8820
02 EUS Procedure EUS Procedure 3000 6000
03 FNA Needle FNA Needle 3000 3000

URO ONCOLOGY OPERATION

SR CODE DETAIL General Standard
Charges Charge
1 OUMAJOR MAJOR OPERATION 3300
6600
TUR-Bladder tumor, Total amputation of penis
2 OUS_MAJOR SUPRA MAJOR
Radical Nephrectomy, Radical Cystectomy with diversion, Radical
Prostatectomy, Laparoscopic Radical Nephrectomy, Amputation of 11000 22000
penis with groin dissection, RPLND, Pelvic exenteration, Supra-Renal
tumor Surgery

GYNAEC ONCOLOGY OPERATION

3 GY_SCOPY Cervical vaginal & Vulval biopsies, -Colposcopy with HPE Report 550
1100

MINOR OPERATIONS with General Anaesthesia and HPE Report

4 GY_LEEP -LEEP / Biopsy / EUA / D&C 660 1320
5 GY_CON -Cone biopsy 660 1320
6 Hysteroscopy Hysteroscopy 2500 5000
Hysterectomy (Abdominal/Vaginal) with or without BSO
8 GY_HYS_LAP -Staging Laparotomy 6600 13200
9 GY_HYS_BX -Diagnostic laparoscopy with or without biopsy 6600 13200
10 GY_HYS_VULV -Simple Vulvectomy 6600 13200
11 GY_HYS_INOP -Inoperable 6600 13200
12 GY_HYS_HERN -Hernia repair 6600 13200
SUPRA MAJOR OPERATIONS
13 GY_SM_RED -Redical hysterectomy (Werthims, Meigs with RPLAND 9900 19800
14 GY_SM_RED_VUL -Redical Vulvectomy with bilateral groin dissection 9900 19800
15 GY_SM_OVERY -Primary/Interval/Secondary cytoreductive surgery for overian cancer 9900 19800
16 GY_SM_ENDO -Carcinoma endometrium surgeries 9900 19800
Ultra radical Surgeries
17 GY_EXT Extententions (Anterior/Posterior) 16500 33000

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PLASTIC SURGERY OPERATION

SR CODE DETAIL General Standard
Charges Charge
SIMPLE MINOR
1 M_FLAPS FLAP SIMPLE MINOR 3300 6600
2 M_MICROS MICRO SIMPLE MINOR 6600 13200
3 M_ SKULLE EXTRACRANIAL SKULL BASE (SIMPLE) 13750 27500
Complicated extra Major
4 M_FLAPC FLAP COMPLICATED EXTRA MAJOR 8250 16500
5 M_MICROC MICRO COMPLICATED EXTRA MAJOR 19250 38500
6 M_SKULLC SKULL BASE COMPLICATED EXTRA MAJOR 22000 44000

NEURO ONCOLOGY DEPARTMENT

SR CODE DETAIL General Charges Standard Charge
1 N_MINOR MINOR OPERATION 2200 4400
2 N_MAJOR MAJOR OPERATION 7700 15400
3 N_SUPRAM SUPRAMAJOR 11000 22000
4 N_SELE SELECTIVE 13800 27500
5 N_DSA DSA 4400 8800
6 N_SRS SRS 44000 88000
7 N_SRT SRT 30300 60500

ORTHOPADIC DEPARTMENT
SR CODE DETAIL General Charges Standard Charge
1 O_WIDEEX WIDE EXCISION 1650 3300
2 O_AMPU AMPUTATION 1650 3300
3 O_DIS DISARTICULATION 2200 4400
4 O_NAIL NAILING 3300 6600
5 O_NAILBO NAILING BONE GRAFTING 4400 8800
6 O_JOINT JOINT REPLACEMENT 11000 22000

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LAPAROSCOPY
SR CODE DETAIL General Charges Standard Charge
1. O_LAP_D Diagnostic Laparoscopy / Thoresoscopy 6600 13200
2. O_LAP_S Laparoscopic / Thorecoscopy Surgery 13800 27500

OTHER CHARGES
SR CODE DETAIL General Standard
Charges Charge
1 HEALTH HEALTH CHECK UP CHARGES 2000 2000
2 HEALTH HEALTH CHECK UP CHARGES – FEMALE 2200 2200
3 LIC_1 MEDICLAIM FORM PROCESSING FEES 100 100
4 LIC_2 DEATH CLAIM FORM PROCESSING FEES 200 200
5 LIC_3 INSURANCE CO/CONSULTANT PROCESSING FEES 500 500

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DEPARTMENT OF ONCO PATHOLOGY & CANCER CELL BIOLOGY

DEPARTMENT OF ONCO PATHOLOGY
* Biochemistry
General Special
No Test name Code charge charge
1 24 hours urinary Protein P-1 80 120
2 Serum Acetone P-2 40 70
3 Adenosine deaminase (ADA) Level P-3 225 350
4 Albumin P-4 40 70
5 Alkline Phosphatase (ALP) P-5 40 70
6 Alpha Fetoprotein (AFP ) P-6 300 600
7 Amylase P-7 70 140
8 Ascitic Fluid –Biochemistry P-8 60 100
9 Bilirubin P-9 60 110
10 Blood Sugar - fasting (FBS) P-10 30 50
11 Blood Sugar - Random ( RBS) P-11 30 50
12 Blood Sugar- Post Prandial (PPBS) P-12 30 50
13 Blood Urea Nitrogen (BUN) P-13 50 80
14 CA 125 P-14 400 800
15 CA 15- 3 P-15 500 990
16 CA 19- 9 P-16 500 1000
17 Total Calcium P-17 110 220
18 Carcinoembryonic Antigen (CEA) P-18 300 600
19 Cholesterol ( Total) P-19 50 90
20 Cholesterol, HDL direct HDLD P-20 70 140
21 Cortisol- Six Estimation P-21 900 1200
22 Cortisol- Three Estimation P-22 500 700
23 Cortisol- Two Estimation P-23 400 600
24 Cortisol-Single Estimation P-24 300 500
25 Creatinine P-25 50 80
26 CSF – Biochemistry(Sugar , Protein, Chloride) P-26 100 150
27 Cyclosporin (Cyclo) Estimation P-27 1000 2000
28 Drain Fluid for Amylase P-28 70 140
29 Electrolytes P-29 110 220
30 Estradiol (E2) P-30 300 600
31 Ferritin P-31 220 350
32 Folate ( Folic) P-32 320 400
33 Follicle Stimulating Hormone ( FSH ) P-33 300 600
34 Free T3 ( FT3 ) P-34 225 450
35 Free T4 ( FT4 ) P-35 225 450

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36 Growth Hormone (GH) P-36 500 900

37 Growth Hormone-Five Estimation P-37 1200 2000
38 Growth Hormone-Four Estimation P-38 1050 1750
39 Growth Hormone-Three Estimation P-39 900 1500
40 Growth Hormone-Two Estimation P-40 750 1250
41 HbA1c P-41 150 300
42 HE-4 P-42 800 1200
43 Human Chorionic Gonadotropin – ( β-HCG ) P-43 300 600
44 IgA P-44 180 250
45 IgG P-45 180 250
46 IgM P-46 180 250
47 Immunofixation ( IFX ) P-47 3000 3500
48 Iron P-48 110 220
49 LDH P-49 110 220
50 Leutinizing Hormone (LH) P-50 300 600
51 Light Chain Kappa P-51 450 900
52 Light Chain Lambda P-52 450 900
53 Lipase P-53 150 250
54 Lipid Profile P-54 150 200
55 Magnesium P-55 110 220
56 Methotrexate (MTX ) Estimation P-56 550 1100
57 Other Fluid -Biochemistry P-57 60 100
58 Parathyroid hormone (PTH ) P-58 500 1000
59 Phosphorous P-59 110 220
60 Pleural Fluid -Biochemisty P-60 60 100
61 Prolactin (PRL) P-61 300 600
62 Total Protein P-62 40 70
63 Prostate Specific Antigen, Total (PSA ) P-63 300 600
64 Protein Electrophoresis (PEP) P-64 350 450
65 SGOT / AST P-65 60 110
66 SGPT /ALT P-66 60 110
67 T3,T4,TSH ( TFT) P-67 250 550
68 Testosterone (Testo) P-68 300 600
69 Thyroglobulin ( TG ) P-69 350 800
70 TIBC / UIBC P-70 110 220
71 Total Protein & A/G Ratio P-71 80 120
72 Total T3 P-72 100 250
73 Total T4 P-73 100 250
74 Triglyceride P-74 40 80
75 TSH P-75 100 250
76 Uric Acid P-76 90 170
77 Urinary B. J. Protein P-77 50 80

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78 Vitamin B12 P-78 350 500

79 Vitamin D Total P-79 725 900
* Cytopathology
1 Brush Cytology P-80 400 700
Cytology - Fluid (Pleural fluid, Peritonial, Pericardial,
2 Urine, CSF, other aspirated fluid, BAL) P-81 120 200
3 Fluid Cytology - Fluid + CELL BLOCK P-82 500 800
4 Sputum Cytology P-83 150 300
5 Cytology slide review FNAC/FLUID/PAP - outside P-84 800 1000
Cytology slide review PAP (Conventional / LBC) –
6 outside ( Pap Smear Slide for review) P-85 400 600
7 FNAC - CT guided P-86 400 700
8 FNAC - USG guided P-87 400 700
9 FNAC P-88 400 700
10 FNAC- EUS guided P-89 400 700
11 Pap smear (Conventional) P-90 100 200
12 Pap smear (LBC) P-91 450 600
13 Scrape- Cytology P-92 400 700
14 Nipple discharge -Cytology P-93 400 700
* Hematology
1 Acticated Partial Thromboplastin Time (APTT) P-94 100 160
2 Ascitic Fluid –R/M P-95 50 80
3 Bone marrow + Triphine Biopsy P-96 1250 2500
4 Bone marrow- aspiration P-97 600 1200
5 Bone Marrow –Slide Review P-98 200 350
6 CSF R/M P-99 50 80
7 D- Dimer P-100 900 900
8 ESR - Manual method P-101 30 60
9 Foetal HB - Haemoglobin (HBF) P-102 110 220
10 Fibrinogen Degradation Test (FDP)- Qualitative P-103 170 330
11 G6PD - Qualitative P-104 110 220
12 HB-TC-PC-DC (Hemogram) / CBC P-105 80 150
13 Iron (Perl) Stain P-106 140 280
14 Lupus Erythematosus (L.E. Cell) P-107 70 140
15 Manual DC P-108 0 0
16 Osmotic fragility test , RBC fragility test P-109 140 280
17 Other Fluid – R/M P-110 50 80
18 Plasma Fibrinogen (Clauss Method) P-111 250 500
20 Pleural Fluid –R/M P-112 50 80
21 Prothrombin Time (PT) P-113 70 140
22 PS for MP and Morphology – Peripheral Smear/MP P-114 100 120

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23 Reticulocytes Count (RC) P-115 70 140

24 Sickling Test P-116 60 110
25 Stool – R/M - Stool Examination P-117 60 110
26 Sucrose Lysis Test (PNH screening test) P-118 70 140
* Hematology
27 Triphine Bone Biopsy P-119 700 1400
28 Urine Examination- R/M P-120 50 100
* Histopathology
1 Biopsy - Small / Cell block ( 1 -2 Block ) P-121 500 800
2 Biopsy - USG / CT guided P-122 500 800
3 Biopsy outside of Medicity P-123 1200 1200
4 Frozen - additional per bits charge - Out side Medicity P-124 500 500
5 Frozen Section & Histopathology in neurology surgery P-125 1200 2000
6 Frozen section - In house of Medicity P-126 1500 3000
7 Frozen section - Outside P-127 2000 2000
8 Histopathology Slide / Block review outside P-128 1000 1200
9 Operated Specimen- Major ( more than 10 Block 8) P-129 1800 3000
10 Operated Specimen- Minor ( up to 10 blocks) P-130 600 900
11 Specimen Reporting ( outside of Medicity ) P-131 2000 2000

DEPARTMENT OF CANCER BIOLOGY

* Molecular Oncology Laboratory
General Special
No. Test Name Code Price Price
1 M-BCR-ABL Fusion gene by Quantitative Real Time PCR CB-1 3300 6600
2 m-BCR-ABL Fusion gene by Quantitative Real Time PCR CB-2 3000 4000
3 PML-RARA Fusion gene by Quantitative Real Time PCR CB-3 3000 4000
4 FLT-3 Mutation by PCR-RFLP CB-4 3000 4000
5 JAK-2 (V617F) Mutation by RT-PCR CB-5 5000 6000
6 C-Kit Mutation by Real Time PCR CB-6 5000 6000
7 HPV 16 and HPV 18 genotyping by PCR CB-7 1500 2000
* Clinical Carcinogenesis
1 IDH1/2 Mutations CB-8 7000 9000
2 IDH1 R132H Mutation CB-9 2500 3500
MGMT Methylation (O6 Methylguanine - DNA
3 Methyltransferase) CB-10 2500 3500
* Tumor Biology Laboratory
1 HLA A,B,DR (includes Procedures & Reporting) CB-11 6000 8000
* Cytogenetics Laboratory
1 FISH Test 9-22 CB-12 3500 4000
2 FISH Test 8-21 CB-13 3500 4000

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3 FISH Test 15-17 CB-14 3500 4000

4 FISH Test 12-21 CB-15 3500 4000
5 FISH Test 16-16/inv(16) CB-16 3500 4000
6 FISH Test 11q/MLL Rearrangement CB-17 3500 4000
7 FISH Test del7q CB-18 3500 4000
8 FISH Test del5q CB-19 3500 4000
9 FISH Test X-Y CB-20 3500 4000
10 FISH Test HER-2 NEU CB-21 6000 8000
11 Karyotyping Leuk Test CB-22 2000 2500
* Stem Cell Biology Laboratory
EGFR Mutation analysis Test from FFPE/ cell free DNA
1 sample [30 Mutations (Exon 18-21)] CB-23 8000 9000

* Flow Cytometry
1 Acute Leukemia Panel CB-24 5500 7500
2 Chronic Lymphoproliferative Disorder CB-25 5500 7500
3 PNH by FLAER CB-26 2000 3000
4 Stem cell Enumeration CB-27 1100 1500
* Immunohistochemistry
1 ER-PR CB-28 1250 1500
2 Her-2 neu CB-29 625 800
3 ER, PR, Her-2 neu CB-30 2000 2250
4 Lung Cancer Panel CB-31 3125 3750
5 Metastatis of unknown origin (10 markers) CB-32 5000 6000
6 Malignant round cell tumor (10 markers) CB-33 5000 6000
7 Hodgkin's Disease CB-34 3750 4500
8 Non-Hodgkin's Panel (10 markers) CB-35 5000 6000
9 Five marker panel CB-36 3125 3750
10 Single marker CB-37 625 800

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NUCLEAR MEDICINE ( RADIO ISOTOPE ) – ROOM NO. 52

SR CODE DETAIL General Charge Standard Charge
1. RISO_BOSC BONE SCAN 970 1930
2. RISO_BRSCP BRAIN SCAN PLANAR 1100 2200
3. RISO_BRSP BRAIN SPECT 1100 2200
4. RISO_DRCG DRCG 550 1100
5. RISO_HIDA HIDA SCAN (HEPATOBILLIARY SCAN) 1100 2200
6. RISO_I131W I-131 WHOLE BODY SCAN (Special Test) 2800 2800
7. RISO_I13110 I-131 THERAPY ( 10 mCi ) (Special Test) 5000 5000
8. RISO_I13160 I-131 THERAPY ( 60 mCi ) (Special Test) 6600 6600
9. RISO_I13180 I-131 THERAPY ( 80 mCi ) (Special Test) 11000 11000
10. RISO_I131100 I-131 THERAPY ( 100 mCi ) (Special Test) 13500 13500
11. RISO_I131150 I-131 THERAPY ( 150 mCi ) (Special Test) 17000 17000
12. RISO_LIV LIVER SCAN 1100 2200
13. RISO_MECK MECKLE’S GI BLEED SCAN 1100 2200
14. RISO_MECE MECKLE’S GI BLEED SCAN (EMERGENCY) 1100 2200
15. RISO_MIBI MIBI PARATHYROID SCAN 1950 3850
16. RISO_MUGA MUGA SCAN 1100 2200
17. RISO_RENEC RENAL SCAN ( EC ) 1100 2200
18. RISO_RENDM RENAL SCAN (DMSA III) 1100 2200
19. RISO_RENDT RENAL SCAN (DTPA RENAL SCAN) 1100 2200
20. RISO_RENTR RENAL TRANSPLANT STUDY 1100 2200
21. RISO_SR89 SR-89 THERAPY(Special Test) 66000 66000
22. RISO_THY THYROID SCAN 550 1100
23. RISO_THYDM TYHROID SCAN (DMSA V) 1100 2200
24. RISO_MAG3 MAG-3 1400 2750
25. RISO_LUNG LUNG PERFUSION SCAN (MAA) 850 1650
26. RISO_MTBG MIBG SCAN (Special Test) 9000 9000
27. RISO_32P 32P THERAPY(Special Test) 9000 9000
28. RISO_MPI MP1 (STRESS TEST) (Special Test) 5000 5000
29. RISO_MYOCA MYOCALDIAL VIABILITY STUDY 1100 2200
30. Sentinel Node Sentinel Node Maping 1500 3000
31. Lymphoscinti Lymphoscintigraphy 1500 3000

(updated 24 –January – 2022)


Hospital Charges- Page :-18

BLOOD BANK – ROOM NO. 48

SR CODE DETAIL General Charge Standard Charge
1 GR BLOOD GROUPING 45 90
2 IRRADIATION CHARGES FOR BLOOD 415 415
/COMPONENT FOR RED CROSS SOCIETY
3 B_TRANSFUS BLOOD TRANSFUSION CROSS 90
MATCH/BOTTL 170
4 COO COOMB’S TEST 75 120
5 BLD_IRR BLOOD IRRADIATION CHARGES 830
(OUTDOOR PTS) 830
6 IRR_PCV IRRADIATED PCV 700 1200
7 IRR_PLAT IRRADIATED PLATELE 300 600
8 PCV (PACKED CELL VOLUME /WHOLE
B_PCV 600 800
BLOOD
9 B_PLT_CON PLATELET CONCENTRATE 200 300
10 B_FRZ_PLSM FRESH FROZEN PLASMA 300 400
11 B_CRYO CRYOPRECIPITATE 300 400
12 Apheresis Apheresis Charges (Special Test) 8000 8000
12 SDP Irradiated SDP 8200 8200
13 OSDP Outside patients Irradiated SDP 10000 10000
14 Apheresis Apheresis Charges with PAS 8400 8400
15 Irradiated SDP Irradiated SDP with PAS 8600 8600

PHYSIOTHERAPY
SR CODE DETAIL General Charge Standard Charge
1 Phy_Gen.Exe Phy_Gen. Exercise Outdoor Patient per day 50 100
2 Phy_Gen.Exe Phy_Gen.Exercise 7 days Outdoor Patient 100 200
3 Phy_Gen.Exe Phy_Gen.Exercise (Outside Reference) per day 100 200
4 Phy_ICU Phy_ICU per day 25 50
5 Phy_Sp.Room Phy_Sp. Rooms A/c & Non A/c per day 0 100
6 Phy_Gen.ward Phy_Gen.wards per day 20 50
7 Phy_Gen.Exe Phy_Gen.Exercise Outdoor (Non GCRI) Patient 0 50
8 Phy_Semi Phy_Semi Special Room Patient 0 100
9 Phy_Special Phy_Special Room Patient 0 100
10 Phy_Breast Phy_Breast Surgery 100 200
11 Phy_Thorax Phy_Thorax Surgery 200 400
12 Phy_Head Phy_Head & Neck Surgery 200 400
13 Phy_Abdom Phy_Abdominal Surgery 100 200
14 Phy_Ortho Phy_Orthopaedic Surgery 100 200
15 Phy_Neuro Phy_Neuro Surgery 100 200
16 Phy_Others Phy_Others 0 50

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Hospital Charges- Page :-19

PROSTHESIS

Sr. Prosthesis (Silicon Material ) Rates Rates

no General Special
1 Ear (M_S_Ear) 2100 4100
2 Eye 2000 3300

3 Eye with Cheek 3800 7400

4 Nose 2000 3300
5 Lip 1300 2500
6 Chin 1600 3300
7 Cheek 2100 4100
8 Neck 2100 4100
9 For Head 2100 4100
10 Thumb 1800 3300
11 Finger 1600 3300
12 Palm 5500 5500
13 Hand 8000 to 11000 8000 to 11000
14 Toes 3300 3300
15 Insole 5500 5500
16 Heel Support 5300 5300
17 Foot 11000 to 15000 11000 to
15000
18 Medial Adhesive 750 750
Sr. Prosthesis (Acrylic Material ) New Rates New Rates
no General Special
1 Ear (M_AM_Ear) 450 800
2 Eye 250 500
3 Eye with Cheek 550 1120
4 Orbital 250 500
5 Ocular 250 500
6 Nose 500 800
7 Lip 250 500
8 Chin 250 500
9 Cheek 250 500
10 Neck 250 500
11 For Head 250 500
12 Dental Palate 300 500
13 V Mould 250 500
14 Breast (UForm) (M_S_B) 80 150

(updated 24 –January – 2022)


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RADIOLOGY – Room No. 106,107,114,117,129

SR CODE DETAIL General Charge Standard Charge

1. R_ANG_PERI ANGIOGRAPHY (PERIPHERAL) 2200 4400

2. R_ANG_EMBS ANGIOGRAPHY+EMBOLIS.SUPERSELECTIVE 6600 13200
3. R_ANG_EMB ANGIOGRAPHY+EMBOLISATION 3300 6600
4. R_ANG_ENBO ANGIOGRAPHY+EMBOLISATION OUTSIDE PT 3850 7700
5. R_BAR_ENE BARIUM ENEMA 250 500
6. BA BARIUM SWALLOW 140 300
7. R_BIL_STE BILIARY/OTHER STENTING(EXC STENT CH 1380 2750
8. R_BAR_MEA BRARIUM MEAL FOLLOW THROUGH 250 500
9. R_BAR_STO BRARIUM MEAL(STOMACH+DUODENUM) 200 390
10. R_COL_DOP DOPPLER WITH FILM 280 550
11. R_COL_DOPW DOPPLER WITHOUT FILM 280 550
12. EC ECHOCARDIOGRAPHY 300 550
13. R_FISTU FISTULOGRAM/LOOPOGRAM/GASTROGRAFFIN 220 440
14. R_IVP_IO IVP(WITH IONIC) 330 660
15. R_IVP_NIO IVP(WITH NONIONIC) 550 1100
16. M MAMMOGRAPHY 280 550
17. R_MAMO_DUC MAMMOGRAPHY+DUCTOGRAPHY 330 660
18. R_MAM_NEDL MAMMOGRAPHY+NEEDLE 1400 2750
LOCAL.INCL.NEEDL
19. R_MAM_STBX MAMMOGRAPHY+STBx 1400 2750
20. MEMMO_REVI REVIEW OF MEMMOGRAPHY 25 50
21. R_MYE_NEDL MYELOGRAPHY NEEDLE COST EXTRA 550 1100
22. R_MYLE MYLEOGRAPHY CT 550 1100
23. O OPG 200 390
24. R_PCN PCN 1100 2200
25. XRAY-PLAIN PLAIN X-RAY(INC.PORTABLE)PER PLATE 100 200
26. XRAY-PLAIN-E PLAIN X-RAY(INC.PORTABLE)PER PLATE (IN 170 330
EMERGENCY)
27. XRAY_REVIE REVIEW OF X-RAY 25 50
28. R_PTBD PTBD 1380 2750
29. R_PTC PTC 550 1100
30. R_RGU RGU/CYSTOGRAM/URETHROGRAPHY 280 550
31. R_SKEL SKELETAL SURVERY 330 660
32. R_SVC SVC GRAPHY 1100 2200
33. UGG Guided USG GUIDED PROCEDURE & 100 200
Procedure DRAINAGE
34. U USG WITH FILM 220 440
35. UW USG WITHOUT FILM 170 330
36. R_USG_PORT USG (PORTABLE) 220 440
37. PROC_REVIE REVIEW OF SPECIAL PROCEDURE 25 50
@BARIUM SWALLOW,BARIUM MEAL, IVP
38. RADIO_STENT Self expanding metallic Stent (procedure of
36,750 40,000
percutaneous billiary stenting )
39. USG GUIDED USG GUIDED TRUE CUT BIOPSY 700 1400
40. USG Guided
100 200
FNAC & FNAB USG GUIDED FNAC & FNAB

(updated 24 –January – 2022)


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C T SCAN – ROOM NO. 101

SR CODE DETAIL General Charge Standard Charge
1. CT_PLAINWOC CT SCAN PLAIN SINGLE REGION (W/O 900 1800
CONTRAST)
2. CT_PLAIN_IO CT SCAN PLAIN+IONIC CONTRAST 2200 4400
SINGLE REGION
3. CT_PLAIN_NIO CT SCAN PLAIN+NON IONIC CONTRAST 2200 4400
(SINGLE REGION)
4. CT_PLAIN2WOC CT SCAN PLAIN ANY TWO REGION (W/O 1700 3300
CONTRAST)
5. CT_PLAIN_2RE CT SCAN PLAIN+IONIC CONTRAST ANY 1700 3300
G TWO REGION
6. CT_PLAIN_N2R CT SCAN PLAIN+NON IONIC CONTRAST 2800 5500
EG ANY TWO REGION
7. CT_PLAIN_N3R CT SCAN PLAIN+NON IONIC CONTRAST ANY 3900 7700
EG THREE REGION
8. CT_PLAIN_M3R CT SCAN PLAIN+IONIC CONTRAST MORE 2800 5500
EG THAN THREE REG.
9. CT_PLAIN_NM3 CT SCAN PLAIN+NON IONIC CONTRAST 5000 9900
REG MORE THAN 3 REG.
10. CT_ANG_NIO CT ANGIOGRAPHY WITH NON IONIC 3300 6600
CONTRAST
11. CT Guided True 1600 3200
cut Biopsy CT GUIDED TRUE CUT BIOPSY
12. CT_BX_NIO CT GUIDED BIOPSY WITH NON IONIC 2200 4400
CONTRAST
13. CT_COEL CT GUIDED COELIAC BLOCK 1400 2700
14. CT_REVIEW CT SCAN REVIEW REPORT 170 330
15. CT_EMERG EMERGENCY CT SCAN 2800 3300
16. CT_EMERG_CO EMERGENCY CT SCAN +NON IONIC 2800 5500
N CONTRAST
17. CT_OUTSIDE_E 3900 7700
ME OUT SIDE- EMERGENCY CT SCAN
18. CT_RFA CT GUIDED RFA (Lesion More than 4cm) 11000 22000
19. CT_BONE_BX CT GUIDED BONE BIOPSY 1400 2800
20. PLAIN CT PLAIN CT SCAN FOR RT PLANNING 700 1400
21. PLAIN & CONTR PLAIN & CONTRAST CT SCAN FOR RT 1400
2800
PLANNING
22. CT Guided FNAB 900
1800
& FNAC CT Guided FNAC & FNAB

(updated 24 –January – 2022)


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M.R.I. Centre
SR CODE DETAIL General Charge Standard Charge
1. MRI_PL MRI PLAIN SINGLE REGION 1700 3300
2. MRI_PL_CON MRI PLAIN CONTRAST SINGLE REGION 2400 4600
3. MRI_PL_2REG MRI PLAIN ANY TWO REGION 2500 4900
4. MRI_PL_C2REG MRI PLAIN + CONTRAST ANY TWO 3300 6400
REGION
5. MRI_PL_3REG MRI PLAIN ANY THREE REGION 3300 6600
6. MRI_PLC3REG MRI PLAIN + CONTRAST ANY THREE 4100 7900
REGION
7. MRI_PLM3REG MRI PLAIN MORE THAN THREE REGION 4100 7900
8. MRI_PLM3C MRI PLAIN + CONTRAST MORE THAN 4600 9000
THREE REGION
9. MRI_CT_PACK MRI CT SCAN PACKAGE ( SINGLE 3300 6600
REGION)
10. MRI_CT_PACK2 MRI CT SCAN PACKAGE ( TWO 3900 7700
REGION)
11. MRI_EMER EMERGENCY MRI 2200 4400
12. MRI_EMER_CO 3500 6800
N EMERGENCY MRI WITH CONTRAST
13. MRI_OUT_CON OUT SIDE -EMERGENCY MRI – 3000 5700
CONTRAST
14. MRI_SCRE MRI SCREENING PER REGION 600 1100
15. MRI_SCRE_OU OUT SIDE - MRI SCREENING PER 1100 2200
T REGION
16. MRI_REVIEW MRI SCAN REVIEW REPORT 170 330
17. MRI_ANGIO MR ANGIO 1100 2200
18. MRI_ANGIO_BR MR BRAIN + ANGIO 2200 4400
19. MRI_STUDY MRI CONTRAST STUDY PLAIN STUDY 700 1100

(updated 24 –January – 2022)


Hospital Charges- Page :-23

RADIOTHERAPY – Room No. 53 & 55

SR CODE DETAIL General Charge Outside Patient
Standard Charge
& Special
Category Charge
1 RT_BR_WGA BRACHYTHERAPY WITH GA 1400 2800
2 RT_BR_WOGA BRACHYTHERAPY WITHOUT GA 850 1700
3 RT_CTP CT SCAN PLANNING 5500 11000
4 RT_CAST RT + CAST+SIMULATOR (if required) 4400 8800
5 RT_SIMU RT + SIMULATOR 4400 8800
6 RT_TPS RT + TPS PLANNING 4400 8800
7 RT_CURATIV RT CURATIVE 4400 8800
8 RT_PALLIAT RT PALLIATIVE 2800 5500
9 RT_SIN_FRA RT SINGLE FRACTION 1100 2200
10 RT_SRS SRS * 75000 75000
11 RT_SRT SRT * 85000 85000
12 RT_CTPSP 6100
CT SCAN PLANNING + SPECIAL ORFIT CAST 12100
13 RT_CASTSP RT + SPECIAL ORFIT CAST 5500 11000
14 RT_SIMUSP RT + SIMULATOR _ SPECIAL ORFIT CAST 5500 11000
15 RT_TPSSP RT + TPS PLANNING + SPECIAL ORFIT CAST 5500 11000
16 RT_3DCRT 3-D CONFORMAL RADIOTHERAPY 28000
28000
PACKAGE(Special Test)
17 RT_IMRT INTENSITY MODULARTED RADIOTHERAPY- 39000 39000
PACKAGE*
18 RT_REIRR REIRRADIATION CHARGE 2800 5500
19 RT_RETREAT RETREATMENT CHARGE 2800 5500
20 IGRT IGRT 55000 55000
21 Electron Cura Electron Curative therapy 4400 8800
22 Electron Cura Electron Curative therapy with ORFIT/CAST 5500 11000
23 Post op/Adjuv Post op/Adjuvant therapy with Electrons 4400 8800
24 Post op/Adjuv Post op/Adjuvant therapy with Electrons with
5500 11000
ORFIT/CAST
25 Electron Pallia Electron Palliative therapy 2800 5500
26 Boost with Elec Boost with Electron/5-10 fraction 1100 2200
27 Boost with Elec Boost with Electron/5-10 fraction >10 fractions 4400 8800
28 Photon Electron Photon Electron combination/Adjuvant therapy 4400 8800
29 Acrylic cast Acrylic cast (used in head & neck region) 500 1000
30 Thermo (orfit) Thermoplastic material (orfit) for brain and Head
1100 2200
and Neck
31 Thermo (orfit) Thermoplastic material (orfit) for abdomen, chest &
1500 3000
breast
32 IGRT with res IGRT with Respiratory Gating 65000 65000
33 TOMO TOMOTHERAPY 55000 55000
34 ART/ADAPT ART/Adaptive Radiotherapy (Linac/Tomo) 65000 65000
35 EXTRACOR EXTRACORPOREAL RADIOTHERAPY 28000 28000

(updated 24 –January – 2022)


Hospital Charges- Page :-24

MICROBIOLOGY – Room No. 402

Sr. General Special
Test Code Test Name
No. Charges Charges
1 BC_1 Blood Culture Peripheral Vein 1300 2000
2 BC_2 Blood Culture Central Catheter 1300 2000
3 BC_3R Blood Culture Central Catheter (Red Lumen) 1300 2000
4 BC_3W Blood Culture Central Catheter (White Lumen) 1300 2000
5 BC_3B Blood Culture Central Catheter (Blue Lumen) 1300 2000
6 BC_3Y Blood Culture Central Catheter (Yellow Lumen) 1300 2000
Blood Culture Peripheral Vein & Central
7 BC_4 2600 4000
Catheter (Both)
8 FC_5 Fungal Culture (any Specimen) 700 900
9 NS_6 Nasopharyngeal swab C/S 1000 1500
10 SW_7 Sinus washings C/S 1000 1500
11 SBS_8 Surgical Biopsy Specimen C/S 1000 1500
12 SPP_9 Swab of posterior pharynx C/S 1000 1500
13 ST_10 Swab of Tonsils C/S 1000 1500
14 S_11 Sputum C/S 1000 1500
15 BS_12 (BAL) C/S 1000 1500
16 TS_13 Transtracheal Secretions C/S 1000 1500
17 LA/B_14 Lung aspirate/ Biopsy C/S 1000 1500
18 T_15 Tooth C/S 1000 1500
19 GDB_16 Gastric / Duodenal Biopsy (H. pylori) 100 150
20 StS_17 Stool Specimen C/S 1000 1500
21 RS_18 Rectal Swab C/S 1000 1500
22 U_19 Urine C/S 1000 1500
23 UC_20 Urine –Catheterized C/S 1000 1500
24 SAU_21 Suprapubic Aspiration of urine C/S 1000 1500
25 EPD_22 Eye- Purulent Discharge C/S 1000 1500
26 AD_23 Aspirate of Drainage C/S 1000 1500
27 DSPD_24 Deep swab of Purulent discharge C/S 1000 1500
28 POD_25 Post operative discharge C/S 1000 1500
29 FP_26 Frank Pus C/S 1000 1500
30 JA_27 Joint aspirate C/S 1000 1500
31 SB_28 Synovial Biopsy/Fluid C/S 1000 1500

(updated 24 –January – 2022)


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32 BS_29 Bone specules C/S 1000 1500

33 US_30 Urethral swab C/S 1000 1500
34 PF_31 Pleural fluid C/S 1300 1800
35 AF_32 Ascitic fluid C/S 1300 1800
36 UCS_33 Uterine Cervix Swab material C/S 1000 1500
37 VS_34 Vaginal swab C/S 1000 1500
38 ET_35 Endotracheal Tube C/S 1000 1500
39 CT_36 Catheter tip C/S 1000 1500
40 TSTS_37 Tracheostomy Tube / Swab C/S 1000 1500
41 TM_38 Any Tissue Material C/S 1000 1500
42 CSF_39 Cerebrospinal fluid C/S 1300 1800
43 SOL_40 Aspirate from SOL C/S 1000 1500
44 BTM_41 Brain Tissue material C/S 1000 1500
45 Flurosent Flurosent Stain Auromin (TB) 100 200
46 Calcoflour Calcoflour (Fungus) 100 200
47 SARS_COVID RTPCR TEST FOR SARS COVID – (FREE OF COST) 800 800
Blood Culture Peripheral Vein (Bac_Fun)_BC
48 BC_1+MyF 2600 3000
fungus
Blood Culture Central Catheter (Bac_Fun)_BC
49 BC_2a+MyF 2600 3000
Fungus
BC_2a+P_C_
50 Blood Culture Peripheral + Central + Fungus 3900 4200
MyF
Microscopy
Sr. General Special
Test Code Test Name
No. Charges Charges
51 WP_42 Wet Preparation 100 150
52 WP_42a KOH Preparation 100 150
53 GS_43 Gram’s stain 100 150
54 ZN_44 ZN stain 100 150
55 TO_45 Toludine Blue ‘O’ stain (Pneumocystis Carinii) 100 150
56 S-OC_46 Stool for Ova/Cyst 150 200
Serology
Sr. General Special
Test Code Test Name
No. Charges Charges
57 HBs_47 HBsAg 60 120
58 HBsP_48 HBsAg Positive 60 120
59 HIV_49 HIV only 80 150
60 HIV-P_50 HIV Positive 350 350
61 HCV_52 HCV 70 130
62 HCV-P_53 HCV Positive 70 130
63 antiHBs_54 anti – HBs 220 300

(updated 24 –January – 2022)


Hospital Charges- Page :-26

64 HBe_55 HBeAg 250 300

65 antiHBe_55a anti – HbeAg 250 300
66 antiHBc_56 anti – HBc 250 300
67 CMV-IgG_57 CMV – IgG 250 300
68 CMV-IgM_57a CMV – IgM 250 300
69 CRP_59 C- Reactive Protein ( CRP ) 50 150
70 WT_62 WIDAL Test 100 120
71 BM_63 ß2 Microglobulin 400 500
72 D-IgG/M_64 DENGUE IGG/IGM 250 300
73 MT_65 MALARIA 100 150
74 PCT_66 Procalcitonin 1300 3000
75 Chikungunya Chikungunya 250 300
76 CMV_RT CMV Real Time PCR - Quantitative 2000 2250
77 HBV_RT HBV DNA RT PCR - Quantitative 2000 2250
78 HCV_RT HCV RNA RT PCT - Quantitative 2250 2500
79 EBV_RT EBV DNA RT PCR - Quantitative 2000 2250
80 HSV_RT HSV DNA RT PCR - Quantitative 2250 2500
81 MICRO_BK BK POLYMYXO VIRUS 2500 2500
82 CMV_RT CMV RT PCT – Qualitative 1000 1000
83 CLOSTRIDIUM DI CLOSTRIDIUM DIFFICILE 1200 2400

(updated 24 –January – 2022)


Hospital Charges- Page :-27

RATE CHARGE OF STOMA CLINIC DEPARTMENT

CHARGES OF STOMA NEW RATES

ITEMS
Sr. Name of Items Specifications
Category
No.
General Special/Outside
Patient
1 Stoma bag close end 38 mm system one 40 50
with belt hook. piece. Reusable
2 Stoma bag close end 45 mm system one 40 50
with belt hook. piece. Reusable
3 Stoma bag close end 50mm system one 40 50
with belt hook. (Blue piece. Reusable
Stoma beg)
4 Stoma bag close end 60 mm system one 40 50
with belt hook. piece. Reusable
5 Stoma bag close end 75 mm system one 40 50
with belt hook. piece. Reusable
6 Colostomy belt One piece system 80 100
7 Stoma drainable bags 38mm system one 40 50
with belt hook piece. Reusable
8 Stoma drainable bags 45mm system one 40 50
with belt hook piece. Reusable
9 Stoma drainable bags 50mm system one 40 50
with belt hook piece. Reusable
10 Stoma drainable bags 60mm system one 40 50
with belt hook piece. Reusable
11 Stoma drainable bags 75 mm system one 40 50
with belt hook piece. Reusable
12 Pouch two piece system 45mm 200 250
45mm with Wafer or
flange
13 Pouch two piece system 57 mm 200 250
57mm with Wafer or
flange
14 Pouch two piece system 100mm 400 450
100mm with Wafer or
flange
15 Permatype ileostomy Used with face plates 50 60
bag for Adult

(updated 24 –January – 2022)


Hospital Charges- Page :-28

16 Urostomy bag used Reusable 90 100

with Face plate
17 Face plate 32mm 60 70
18 Face plate 38mm 60 70
19 Face plate 45mm 70 80
20 Urostomy belt used Reusable 90 100
with face plate
21 Double sided Disk -DSD 4 X 4 INCH 40 50
22 Urostomy pouch two 38mm 300 350
piece system
23 Urostomy pouch two 44mm 300 350
piece system
24 Urostomy pouch two 57mm 300 350
piece system
25 Clips – Closure Clips 30 30
26 Karaya Powder 20gm 140 160
27 Colostomy irrigator with 650 700
disposable Cone
28 Colostomy Disposable 330 380
Cone for use with
irrigator
29 Pouch Drainable with 90mm one piece 140 160
barrier upto 90mm One systems
piece
30 Pouch two piece system 70mm 200 220
70mm Wafer or flange
31 Wound Manager 156mm to 228mm 1400 1500
(Medium Size)
32 Pouch drainable with 60mm cutting 90 100
Adhesive with skin
barrier 60mm
33 Pouch drainable with Disposable 220 250
Adhesive for Paediatric
34 Stoma adhesive paste 60gm 380 420
35 Appliance Deodorant 70 90
36 Wound Manager for 110mm cutting 600 650
Fecal Fistula
37 Wound Manager Large 208mm to 297mm 6500 7000
Size
38 Wafer or Flange 45mm 130 140
39 Wafer or Flange 70mm 130 140
40 Pouch two piece system 45mm 80 90
41 Pouch two piece system 70mm 80 90
42 Pouch Cover 100 100
43 Ostomy Bath Appron 70 80
44 Pouch two piece system 100mm 400 450
45 Stoma Barrier Wafer or 140 160
Skin Barrier 4 x 4
46 Wafer or Flange 100mm 550 600

(updated 24 –January – 2022)


Hospital Charges- Page :-29

RADIOTHERAPY DEPT. - CHARGES OF DENTAL

SR DENTAL PROCEDURES GENERAL STANDARD

RATES RATES
1 50.00 100.00
I.O.P.A.R (Intra Oral Periapical Radiography)
2 Amalgam Filling 50.00 100.00
G.I.C (Glass Ionomer Cement Filling )
3 100.00 150.00
Restoration
4 L.C.F (Light Cure Filling) 200.00 350.00

5 Temporary Filling 50.00 70.0

6 Emergency endodontic (R.C.T) (including 3 sitting) 350.00 450.00

7 Extraction of Teeth 50.00 100.00

8 Surgical Extraction 150.00 250.00

9 Scaling 150.00 250.00

10 Guide Flange 450.00 550.00

11 Obturator (Surgical) 450.00 550.00

12 Obturator (Interim) 550.00 650.00

13 Obturator (Permanent) 2300.00 2500.00

14 Soft Reliningof Dentures & Obturators (per arch) 200.00 300.00

15 Complete Denture (upper & lower dentures) 2300.00 2500.00

16 Special tray fabrication (for Denture/Obturator) 350.00 450.00

17 Record base & Occlusal rim 450.00 500.00

18 Teeth arrangement Premadent 350.00 450.00

19 Teeth arrangement Acryrock 550.00 650.00

20 Processing of Denture & Obturators 1250.00 1400.00

21 R.P.D. with one teeth + Rs.20/ per tooth 450.00 500.00

(updated 24 –January – 2022)


Hospital Charges- Page :-30

22 F.P.D. (Crown & bridge, single unit) - Metal 250.00 300.00

23 F.P.D (Crown & bridge, single unit) – PFM 650.00 700.00

24 Implant abutment 2200.00 2400.00

25 Post & Core custom made 550.00 650.00

26 Metallic Coping for Over Denture 250.00 350.00

27 Alveoplasty (per quadrant) 150.00 250.00

28 Incision & Drainage ( I & D) 150.00 250.00

29 Tooth Supported extra Oral Prosthesis 350.00 450.00

30 Gingivoplasty & Gingivectomy 150.00 250.00

31 Topical Fluoride application (per arch) 400.00 500.00

32 Bleaching of teeth Vital (Single) 500.00 600.00

33 Bleaching of teeth Non Vital (Single) 150.00 250.00

34 Implant placement (Single) (Including Implant Cost) 6500.00 7000.00

35 Direct & Indirect Pulp Capping 200.00 300.00

36 Selective teeth grinding Free Free

(updated 24 –January – 2022)


Hospital Charges- Page :-31

Hospital charges will be applicable as per below mentioned table to diff.

category:
Category Name Applicable for Applicable for
Standard Subsidized
charge Charge
State Government (If admitted in Special Room ) Yes No
State Government (If admitted in General ward ) No Yes
Referred from Railway, Bank, CGHS etc. No Yes
ESIS, School Health, SC/ST, ESIC & BPL, No Yes
Pensioners, Prisoners.

• Subsidy will not be applicable on special test.

• Standard charges will be applicable for patient taking treatment under special
category.

(updated 24 –January – 2022)


Hospital Charges- Page :-32

LIST OF SPECIAL TEST

Charges
NAME OF TEST without
Subsidy
Nuclear Medicine (Radio Isotope) Room no.52
I-131 Whole body scan (RISO_131) 2800
I-131 Therapy (10 mCi) 5000
I-131 Therapy (60 mCi) 6600
I-131 Therapy (80 mCi) 11000
I-131 Therapy (100 mCi) 13500
I-131 Therapy (150 mCi) 17000
SR-89 Therapy 66000
MIBG SCAN 9000
32P THERAPY 9000
MP1 (STRESS TEST) 5000
SAMERIUM-153 Therapy 10000
PET CT SCAN TEST - Rs.9900 Gen. Category 9900
PET CT SCAN TEST - Rs.9900 Special Category 9900
PET CT SCAN REVIEW Charge- 1000
PET CT Guided biopsy charge- 2500
PET CT Bone Scan 2000
Octreotide Scan charges 14000
Trodat Scan Gen. Category 13000
Trodat Scan Special Category 15000
Blood Bank Room no.48
Apheresis charges (SDP) 8000
Irradiated SDP 8200
Outside patients Irradiated SDP 10000
Radiotherapy Room no.53 & 55
SRS 75000
SRT 85000
3D Conformal Radiotherapy Package 28000
Intensity Modulated Radiotherapy Package 39000
Cell Biology Department Room no.302
Fish Test Multiplex 11000
Karyo Leuk Test -Outside Patient 2500
MicroBiology Department Room no.402
Blood Culture 1100
Blood Routine Culture 900

(updated 24 –January – 2022)


Hospital Charges- Page :-33

Central Clinical Pathology Lab– Room No. 404

D-Dimer 900
Radiology Self expanding metallic Stent (procedure of 36,750(Gen.Rate)
percutaneous billiary stenting ) 40,000(Sp.Rate)

Following tests are performed at SNGEN Lab,Surat

Sr. Test Name General Special

No Rate Rate
1 X & Y Chimerism 2500 2500
2 VNTR Chimerism Study 2000 2000
3 BCR/ABLQUANTITATIVE [Mbcr-CML]/[mbcr-ALL] 3000 3000
4 PML/RARA QUANTITATIVE 3000 3000
5 Parvo Virus QUALITATIVE 2000 2000
6 FISH Her-2 Neu (H2N) 5000 5000
7 FISH PDGFR α 3000 3000
8 FISH BCR/ABL 3000 3000
9 FISH PML/RARA 3000 3000
10 Imatinib Resistance Mutation Analysis[IRMA] 5500 5500
11 FLT3 3000 4000
12 JAK2 5000 6000

(updated 24 –January – 2022)