ANNEXURE - I

ACCEPTED TARRIF FOR THE PROCEDURES BETWEEN NEORETINA EYE CARE

INSTITUTE AND APSRTC
w.e.f 01.08.2012

NEORETINA EYECARE INSTITUTE

(A Unit of Vishwanethra Health Services Pvt Ltd)

PRICE LIST FOR SURGICAL PROCEDURES / INVESTIGATIONS FOR ONE EYE

w.e.f 01.08.2013
FOR A.P.S.R.T.C.
CORNEAL PROCEDURES A.P.S.R.T.C
P-1 RATES
SNO Service Code PROCEDURE NAME AMOUNT
1 OFF015 CORNEAL FOREIGN BODY REMOVAL 250.00
2 OFF016 ANTERIOR STROMAL PUNCTURE (ASP) 500.00
3 OFF017 CORNEAL SCRAPING 310.00
4 OFF018 GLUE 600.00
5 OFF019 BCL 1,200.00
6 OFF020 GLUE + BCL 1,500.00
7 OFF021 CORNEAL SCRAPING + GLUE + BCL 1,810.00
8 OFF022 PUNCTAL PLUG (ADD MATERIAL CHARGES) 1,100.00

GENERAL PROCEDURES A.P.S.R.T.C

RATES
SNO Service Code PROCEDURE NAME AMOUNT
1 OFF023 EXAMINATION UNDER ANESTHESIA 1,500.00
2 OFF024 METHYLPREDNISOLONE INJECTION 250 MG IV 460.00
3 OFF025 METHYLPREDNISOLONE INJECTION 500 MG IV 910.00
4 OFF026 METHYLPREDNISOLONE INJECTION 750 MG IV 1,440.00
5 OFF027 METHYLPREDNISOLONE INJECTION 1000 MG IV 1,830.00
6 OFF028 DEXAMETHASONE INJECTION IV 240.00
7 OFF029 CYCLOPHOSPHAMIDE INJECTION 250 MG IV 240.00
8 OFF030 CYCLOPHOSPHAMIDE INJECTION 500 MG IV 270.00
9 OFF031 CYCLOPHOSPHAMIDE INJECTION 750 MG IV 360.00
10 OFF032 CYCLOPHOSPHAMIDE INJECTION 1000 MG IV 450.00
11 OFF034 MANNITOL INJECTION IV 475.00
12 OFF035 TRANS SEPTAL STEROID INJECTION 230.00
13 OFF036 SUB TENON STEROID INJECTION 230.00
14 OFF037 SUPRA TARSAL STEROID INJECTION 230.00
15 OFF103 REFRACTION SERVICE 50.00
16 OFF 104 YAG CAPSULOTOMY 1,200.00
17 OFF 105 YAG IRIDOTOMY PER EYE 1,200.00
18 OFF 107 CLINICAL PHOTO PER EYE-FUNDUS PHOTO 600.00
19 OFF 109 DVT DIVISIONAL VARIATION OF IOP PER EYE 300.00
A.P.S.R.T.C
GLAUCOMA PROCEDURES RATES
AMOUNT
SNO Service Code PROCEDURE NAME
1 OFF038 5-FU INJECTION 250.00
2 OFF039 BLEB BLEEDLING + 5 FU INJECTION
3 OFF040 DIURNAL IOP VARIATION 500.00
4 OFF041 TSCPC 2,000.00
5 OFF041 TSCPC 2,000.00
6 OTH011 OCT - ONE EYE 1,000.00
6 OFF106 HUMPHREY VISUAL FIELDS 570.00
7 OFF117 GDx NERVE FIBER ANALYSIS
7 OTHO13 CCT FOR ONE EYE(pachymetry) 360.00
 PAGE-2 REFRACTIVE PROCEDURES A.P.S.R.T.C
RATES
SNO Service Code PROCEDURE NAME AMOUNT
1 OFF083 PTK PER EYE 14,000.00
2 OFF084 PRK PER EYE 15,000.00
3 OFF085 LASIK PER EYE 15,000.00
4 OFF086 CUSTOMIZED LASIK PER EYE 17,500.00
1 OTHO48 C 3 R PER EYE-KERATOCONUS

RETINAL AND VITREOUS PROCEDURES A.P.S.R.T.C

RATES
SNO Service Code PROCEDURE NAME AMOUNT
1 OFF087 CRYOPEXY RETINA 2,000.00
2 OFF088 ANTERIOR RETINAL CRYOPEXY (ARC) 2,000.00
3 OFF089 LASER INDIRECT OPTHALMOSCOPY / SLIT LAMP DELIVERY 1,200.00
4 OFF090 TRANSPUPILLARY THERMOTHERAPY (TTT) 2,850.00
5 OFF091 PARACENTESIS 340.00
6 OFF092 IOAB 1,500.00
7 OFF102 B SCAN 350.00
8 OFF101 FLUORESCEIN ANGIOGRAPHY 1,000.00
9 OFF110 INTRA OCULAR - IVTA 1,500.00
10 OFF111 ICG ANGIOGRAPHY
11 OFF112 ELECTRO RETINOGRAM (ERG)
12 OFF114 PHOTODYNAMIC THERAPY PROCEDURE AND LASER CHARGES
A.P.S.R.T.C
OCULAR SURGACE PROCEDURES RATES
AMOUNT
SNO Service Code PROCEDURE NAME
1 OFF001 CUSTOM OCULAR PROSTHESIS 8,550.00
2 OFF002 PROSTHESIS MODIFICATION 850.00
3 OFF003 POLISHING 400.00
4 OFF004 REGULAR CONFORMER 855.00
5 OFF005 STEM CONFORMER 1,700.00
6 OFF006 PRESSURE CONFORMER 1,700.00
7 OFF007 IRIS PAINTED CONFORMER 1,700.00
8 OFF009 SOCKET EXPANDER 1,700.00
9 OFF010 ORBITAL PROSTHESIS ACRYLIC 28,500.00
10 OFF011 ORBITAL PROSTHESIS SILICON 28,500.00
11 OFF012 SILICON GLUE 420.00
12 OFF013 CRUTCH GLASSES 1,700.00
13 OFF014 RUBBER PLUNGER 80.00

OPTHALMIC PLASTIC SURGERY & ONCOLOGY PROCEDURES

A.P.S.R.T.C
RATES
SNO Service Code PROCEDURE NAME AMOUNT
1 OFF042 CHALAZION INCISION AND CURETTAGE 500.00
2 OFF043 ELECTROLYSIS 570.00
3 OFF044 FNAC + REPORT 1,140.00
4 OFF045 USG - GUIDED FNAC + REPORT 2,280.00
5 OFF046 INCISION AND DRAINAGE 580.00
6 OFF047 INTRALESIONAL STEROID INJECTION 550.00
7 OFF048 TORSORRHAPHY 1,200.00
8 OFF049 SUTURE TARSORRHAPY 550.00
9 OFF050 TENSILON TEST 550.00
10 OFF051 NEOSTIGMINE TEST 1,000.00
11 OFF052 EVERTING SUTURES 1,800.00
12 OFF053 SYRINGING UNDER ANESTHESIA ONE EYE 1,000.00
 A.P.S.R.T.C
P-3 RATES
AMOUNT
13 OFF054 SYRINGE UNDER ANESTHESIA BOTH EYES 1,800.00
14 OFF055 SYRINGING AND PROBING ONE EYE 1,000.00
15 OFF056 SYRINGING AND PROBING BOTH EYES 2,000.00
16 OFF057 SYRINGING AND PROBING WITH SILICON TUBE ONE EYE 2,500.00
17 OFF058 SYRINGING AND PROBING WITH SILICON TUBE BOTH EYES 5,000.00
18 OFF059 THERAPEUTIC PROBING 290.00
19 OFF060 DIAGNOSTIC ENDOSCOPY 290.00
20 OFF061 PUNCTOPLASTY ONE EYE 1,140.00
21 OFF062 PUNCTOPLASTY BOTH EYES 1,800.00
22 OFF063 PUNCTAL OCCLUSION ONE EYE 500.00
23 OFF064 PUNCTAL OCCLUSION BOTH EYES 1,000.00
24 OFF065 CANLICULAR CURRETAGE 1,200.00
25 OFF067 ETHANOLAMINE OLEATE SCLEROTHERAPY 3,250.00
26 OFF068 DACRYOSCLEROTHERAPY 3,250.00
27 OFF069 TUMOR CRYOTHERAPHY 1,800.00
28 OFF070 TUMOR LASER PHOTOCOAGULATION 1,150.00
29 OFF071 TUMOR LASER TTT 2,400.00
30 OFF072 CHEMOTHERAPY 5,700.00
31 OFF073 CHEMOTHERAPY + EUA 5,700.00
32 OFF074 CHEMOTHERAPY + EUA + TTT 8,000.00
33 OFF075 CHEMOTHERAPY + EUA + TTT + CRYPTOTHERAPY 8,100.00
34 OFF076 PERIOCULAR CHEMOTHERAPY 2,280.00
35 OFF077 INTRATHECAL CHEMOTHERAPY 1,700.00
36 OFF078 BOTULINIUM TOXIN INJECTION PROCEDURE (ADD UNIT CHARGES) 1,200.00
37 OFF079 BOTULINIUM TOXIN INJECTION PER UNIT 230.00
38 OFF080 BOTULINIUM TOXIN INJECTION FOR SQUINT 2,850.00
39 OFF081 PUNCTAL CAUTERY 1,000.00
40 OFF082 CONJUCTIVOPLASTY 2,280.00

IN-PATIENT SERVICES

ANTERIOR SEGMENT SURGERY A.P.S.R.T.C

RATES
SNO Service Code PROCEDURE NAME AMOUNT
1 ANT001 PARACENTESIS IN OR 1,710.00
2 ANT002 HYPHEMA DRAINAGE 2,200.00
3 ANT003 AC WASH + INTRACAMERAL ANTIBIOTIC 2,280.00
4 ANT004 AC REFORMATION 750.00
5 ANT005 DIAGNOSTIC AC TAP (INCL. MICROBIOLOGY / CYTOLOGY) 2,280.00
6 ANT006 ANTERIOR SEGMENT RECONSTRUCTION 3,420.00
7 ANT007 IRIS ABCISION 2,280.00
8 ANT008 SYNECHIOLYSIS 3,250.00
9 ANT009 IRIS BIOPSY (INCL. HISTOPATHOLOGY) 3,420.00
10 ANT010 IRIDECTOMY 2,280.00
11 ANT011 PUPILLOPLASTY 3,420.00
12 ANT012 ANTERIOR VITRECTOMY 5,000.00
 P-4 A.P.S.R.T.C
RATES
SNO Service Code PROCEDURE NAME AMOUNT
1 CAT001 ICCE 3,500.00
2 CAT002 ICCE + IOL 5,500.00
3 CAT003 ECCE 3,500.00
4 CAT004 ECCE + IOL (IMPORTED LENS) 6,500.00
5 CAT005 SICS + IOL ( IMPORTED LENS) 9,000.00
6 CAT006 PHACOEMULSIFICATION + IOL (RIGID) 9,000.00
7 CAT007 PHACOEMULSIFICATION + FOLDABLE IOL (INDIAN) 9,000.00
8 CAT008 REMOVAL OF LENS MATERIAL 3,000.00
9 CAT009 EXCHANGE OF IOL 9,000.00
10 CAT010 SECONDARY IOL 3,000.00
11 CAT011 SCLERAL FIXATED IOL 7,500.00
12 CAT012 ENDO CAPSULAR RING (IN ADDITION TO PROCEDURE) 2,500.00
13 CAT014 ECCE + IOL SYNECHIOLYSIS + PUPILLOPLASTY 8,000.00
14 CAT015 IOL REPOSITION 750.00
15 CAT016 IOL EXPLANATION 5,000.00
16 CAT017 PPV + SECONDARY / AC IOL 14,000.00
17 CAT018 PEDIATRIC ECCE 9,500.00
18 CAT019 PEDIATRIC PHACOEMULSIFICATION 13,000.00
19 CAT020 PEDIATRIC PHACOEMULSIFICATION + IOL 14,000.00
20 CAT021 PPC + AV (ADD TO PACKAGE) 4,000.00
21 CAT022 SURGICAL POSTERIOR CAPSULOTOMY 3,000.00
22 CAT023 PEDIATRIC ND: YAG CAPSULOTOMY 750.00
23 CAT024 POSTERIOR CAPSULE POLISHING 4,000.00
24 CAT025 PEDIATRIC ECCE + IOL 11,500.00
25 CAT026 PHACOEMULSIFICATION + FOLDABLE IOL (IMPORTED HYDROPHILIC) (GALAXY FOLD) 17,000.00
26 CAT028 PHACO + NON FOLDABLE (IMPORTED SURFACE MODIFIED) - HSM AMO 14,250.00
27 CAT029 PHACO + FOLDABLE IMPORTED SILICONE - SI 40AMO 17,100.00
28 CAT030 PHACO + FOLDABLE IMPORTED HYDROPHILIC ACRYLIC - AKREOS ADAPT 20,425.00
29 CAT031 PHACO + FOLDABLE IMPORTED HYDROPHOBIC ACRYLIC - AMO SENSOR 16,000.00
PHACO + FOLDABLE IMPORTED HYDROPHOBIC ACRYLIC ASPHERIC - ACROSOF IQ SINGLE PIECE
30 CAT032 ASPHERIC 24,000.00
31 CAT033 PHACO + FOLDABLE IMPORTED MULTIFOCAL SILICONE - ARRAY 33,250.00
32 CAT034 PHACO + FOLDABLE IMPORTED MULTIFOCAL ACRYLIC REZOOM AMO 57,000.00
33 CAT035 LIMBAL RELAXING INCISION (IN ADDITION) 1,900.00
34 CAT036 PHACO + NON FOLDABLE (IMPORTED SURFACE MODIFIED) - HSM B&L 14,250.00
35 CAT037 PHACO + FOLDABLE IMPORTED SILICONE - SOFLEX B&L SQUARE EDGE 17,100.00
36 CAT038 PHACO + FOLDABLE IMPORTED HYDROPHILIC ACRYLIC - ACRYSOF THREE PIECE 16,000.00
37 CAT039 PHACO + FOLDABLE IMPORTED HYDROPHOBIC ACRYLIC - ACRYSOF SINGLE PIECE 22,000.00
38 CAT040 PHACO + FOLDABLE IMPORTED HYDROPHOBIC ACRYLIC - ASPHERIC - TECHNIS ACRYLIC 33,250.00
39 CAT041 PHACO + FOLDABLE IMPORTED HYDROPHOBIC ACRYLIC ASPHERIC - TECHNIS ACRYLIC 57,000.00
40 CAT042 PHACO + FOLDABLE IMPORTED MULTIFOCAL ACRYLIC - RESTOR ALCON 50,000.00
41 CAT043 PHACO + FOLDABLE IMPORTED MULTIFOCAL ACRYLIC - TECHNIS MULTIFOCAL AMO 50,000.00
42 CAT044 PHACO + FOLDABLE IMPORTED ACRYLIC (ULTRA SMART) 17,500.00

43 CAT045 PHACO + FOLDABLE IMPORTED HYDROPHILIC (AKREOS AO B&L) 24,000.00

44 CAT046 SICS + PC IOL (IMPORTED ALCON CRYSTAL) 13,000.00
45 CAT047 PHACO + FOLDABLE HYDROPHILIC INDIAN 13,500.00
46 CAT048 PHACO + FOLDABLE HYDROPHILIC INDIAN STANDARD 16,500.00
47 CAT049 PHACO + FOLDABLE HYDROPHILIC INDIAN DELUXE 17,500.00
48 CAT050 PHACO + FOLDABLE HYDROPHILIC IMPORTED 24,500.00
49 CAT051 PHACO + FOLDABLE HYDROPHILIC (SQ RYCF - IOCARE) 13,000.00
50 CAT052 SICS + PC IOL EZE (IMPORTED B&L) 13,000.00
51 CAT053 PHACO + FOLDABLE HYDROPHILIC (IMPORTED - ACRYSOF EXT SERIES 27,550.00
52 CAT054 SICS + IOL 5,000.00
53 CAT055 ENDOWMENT
54 CAT060 PHACO + FOLDABLE IMPORTED ASPHERIC MICROINCISION LENS (B&L) 35,150.00
55 CAT061 PHACO + FOLDABLE PCIOL IMPORTED MULTIFOCAL ZEISS MF4 36,100.00
56 CAT062 PHACO + FOLDABLE PCIOL ALCON TORIC HYDROPHOBIC IMPORTED 38,000.00
57 CAT063 SICS + PCIOL IKON 13,300.00
58 CAT064 SICS + PCIOL (GALAXY PMMA) 12,600.00
59 CAT066 TECHNICX ACRYLIC 26,600.00
60 CAT069 ALCON TORIK LENS 41,800.00
61 CAT070 PHACO + FOLDABLE ZEISS MULTIFOCAL ASPHERIC MICS LENS 45,600.00
 P-5
A.P.S.R.T.C
CORNEAL SURGERY RATES
AMOUNT
SNO Service Code PROCEDURE NAME
1 COR001 PENETRATING KERATOPLASTY OR THERAPUETIC PK 17,000.00
2 COR002 PEDIATRIC PENATRATING KERATOPLASTY (AGE<12) 34,000.00
3 COR003 PERIPHERAL CORNEAL GRAFT 17,000.00
4 COR004 CORNEAL PATCH GRAFT 3,000.00
5 COR005 ROTATION AUTOGRAFT 17,000.00
6 COR006 LAMELAR KERATPLASTY 3,000.00
7 COR007 DEEP LAMELLAR CARATOPLASTY 29,000.00
8 COR008 PK + CATARACT SURGERY 18,000.00
9 COR009 PK + CATARACT SURGERY + IOL 18,000.00
10 COR010 SUPERFICIAL KERATECTOMY 1,000.00
11 COR011 CORNEAL BIOPSY 4,300.00
12 COR012 CORNEAL SCRAPING + AC REFORMATION + GLUE + BCL 3,310.00
13 COR013 AC REFORMATION + GLUE + BCL 3,000.00
14 COR014 CONJUCTIVAL RESECTION 3,500.00
15 COR015 CONJUCTIVAL RESECTION + GLUE + BCL 4,800.00
16 COR016 CONJUCTIVAL RESECTION + CORNEAL SCRAPING + GLUE + BCL 5,000.00
17 COR017 CONJUCTIVAL RESECTION + AC REFORMATION + GLUE BCL 5,700.00
18 COR018 CONJUCTIVAL RESECTION + CORNEAL SCRAPING + AC + REFORMATION + GLUE + BCL 7,000.00
19 COR019 CORNEAL FOREIGN BODY REMOVAL IN MAIN OT 1,100.00
20 COR020 REMOVAL OF CORNEAL PLAQUE OR CLASIFIE DEPOSIT 1,100.00
21 COR021 CHELATION WITH EDTA 2,200.00
22 COR022 DESCEMETOPEXY 1,500.00
23 COR023 WOUND RESUTURING 2,200.00
24 COR024 WOUND REVISION 2,200.00
25 COR025 COLLAGEN CROSS LINKING(C3R)

A.P.S.R.T.C
GLAUCOMA SURGERY RATES
AMOUNT
SNO Service Code PROCEDURE NAME
1 GLA001 TRABECULECTOMY 4,500.00
2 GLA002 TRABECULECTOMY + MMC 4,500.00
3 GLA003 TRABECULECTOMY + 5FU 4,500.00
4 GLA004 TRABECULECTOMY 8,000.00
5 GLA005 TRABECULECTOMY + TRABECULECTOMY 12,000.00
6 GLA006 TRABECULECTOMY + TRABECULECTOMY + MMC 15,000.00
7 GLA007 BLEB NEEDLING + 5FU INJECTION IN OR 2,500.00
8 GLA008 5FU INJECTION IN OR 500.00
9 GLA009 BLEB REVISION OR REPAIR 1,500.00
10 GLA010 BLEB REPAIR + AMG 6,000.00
11 GLA011 BLEB REPAIR + CONJUCTIVAL AUTOGRAFT 6,000.00
12 GLA012 BELB REPAIR + SCLERAL PATCH GRAFT 6,000.00
13 GLA013 MOLTENO IMPLANT (ADD MATERIAL CHARGES) 22,000.00
14 GLA014 BAERVELDT IMPLANT (ADD MATERIAL CHARGES) 22,000.00
15 GLA015 AHMED VALVE IMPLANT (ADD MATERIAL CHARGES) 22,000.00

A.P.S.R.T.C
OCULAR SURFACE SURGERY RATES
AMOUNT
SNO Service Code PROCEDURE NAME
1 OCU001 SYMBLEPHERON RELEASE 9,500.00
2 OCU002 AMNIOTIC MEMBRANE GRAFT > 30 MINUTES 4,500.00
3 OCU003 LIMBAL BIOPSY 4,500.00
4 OCU004 LIMBAL TRANSPLANTATION 11,500.00
5 OCU005 STEM CELL TRANSPLANT 22,000.00
6 OCU006 PTERGIUM EXCISION 1,500.00
7 OCU007 PTERGIUM EXCISION + CONJUCTIVAL AUTOGRAFT 3,500.00
8 OCU008 PTERGIUM EXCISION + AMG 6,000.00
9 OCU009 CONJUCTIVAL FLAP 4,200.00
10 OCU010 SCLERAL PATCH GRAFT 3,000.00
11 OCU011 EXCISION OF LIMBAL DERMOID 2,500.00
12 OCU012 EXCISION OF LIMBAL DERMOID + LAMELLAR KERATOPLASTY 5,500.00
13 OCU013 EXCISION OF LIMBAL DERMOID + PENETRATING KERATOPLASTY 35,000.00
 P-6
REFRACTIVE SURGERY A.P.S.R.T.C
RATES
SNO Service Code PROCEDURE NAME AMOUNT
1 REF001 RADIAL KERATOTOMY
2 REF002 COMPRESSION SUTURES 10,800.00
3 REF003 RELAXING INCISION 11,000.00
4 REF004 ASTIGMATIC ANNULAR KERATOTOMY 11,000.00
5 REF005 PHAKIC IOL PER EYE 40,000.00
6 REF006 PHAKIC IOL - TORIC ICL 50,000.00

RETINAL & VITREOUS SURGERY A.P.S.R.T.C

RATES
SNO Service Code PROCEDURE NAME AMOUNT
1 RET001 SCLERAL BUCKLING (SB) 9,000.00
2 RET002 BUCKLE REMOVAL 1,000.00
3 RET003 INTRAOCULAR FOREIGN BODY REMOVAL (IOFB) (IN ADDITION) 4,500.00
4 RET004 PARS PLANA LESECTOMY (PPL) 11,400.00
5 RET005 MEMBRANECTOMY 3,500.00
6 RET006 CRYOPEXY RETINA 4,800.00
7 RET007 ANTERIOR RETINAL CRYOPEXY (ARC) 4,800.00
8 RET008 ENDOLASER 3,420.00
9 RET009 LASER INDIRECT OPHTHALMOSCOPY (LIO) 2,280.00
10 RET010 TRANSPUPILLARY THERMOTHERAPHY (TTT) 4,560.00
11 RET011 PNEUMATIC RETINOPEXY 13,680.00
12 RET012 PARS PLANA VITRECTOMY (PPV) 17,000.00
13 RET013 PPV + EL 22,800.00
14 RET014 PPV + MP + EL 23,000.00
15 RET015 PPL + PPV 20,000.00
16 RET016 PPV + BB 25,080.00
17 RET017 PPV + PPL + BB 27,360.00
18 RET018 PPV + SOI/FGE + MP + EL 23,000.00
19 RET019 PPV + PFCL + SOI/FGE + MP + EL 23,600.00
20 RET020 PPV + PPL + PFCL + SOI/FGE + MP + EL 26,000.00
21 RET021 PPV + BB/SB + SOI/FGE + EL 28,500.00
22 RET023 PPV + PPL + BB/SB + SOI/FGE + EL 33,000.00
23 RET024 PPV + BB/SB + SOI/FGE + MP + EL 28,500.00
24 RET025 PPV + PPL + BB/SB + SOI/FGE + MP + EL 28,050.00
25 RET026 PPV + BB/SB + PFCL + SOI/FGE + EL 33,000.00
26 RET027 PPV + PPL + BB/SB + PFCL + SOI/FGE + EL 34,200.00
27 RET028 PPV + PPL + BB/SB + PFCL + SOI/FGE + MP + EL 33,000.00
28 RET029 SOR + FGE + EL + MP 5,000.00
29 RET030 FAE + EL + SOI 13,680.00
30 RET031 MEMBRANE PEELING (MP) (IN ADDITIONAL) 5,700.00
31 RET032 ICG - ASSITED MP (IN ADDITIONAL) 5,700.00
32 RET033 PPV + NUCLEUS REMOVAL (IN ADDITION) 17,100.00
33 RET034 PPV + PFCL + NUCLEUS REMOVAL 20,520.00
34 RET035 SILICON OILINJECTION (SOI) (IN ADDITION) 11,400.00
35 RET036 SILICON OIL REMOVAL (SOR) (IN ADDITION) 3,000.00
36 RET037 SILOCON OIL EXCHANGE (SOE) (IN ADDITION) 4,980.00
37 RET038 FLUID GAS EXCHANGE (FGE) (IN ADDITION) 5,700.00
38 RET039 FLUID AIR EXCHANGE (FAE) (IN ADDITION) 5,700.00
39 RET040 PFCL INJECTION (IN ADDITION) 5,700.00
40 RET041 INTRAOCULAR STEROID INJECTION 1,500.00
41 RET042 INTRAOCULAR ANTIBIOTIC INJECTION (IOAB) 1,500.00
42 RET043 VITREOUS BIOPSY 10,800.00
43 RET044 VITREOUS BIOPSY + IOAB 14,820.00
44 RET045 PPV + IOAB 22,800.00
45 RET046 PPV + PPL + IOAB 15,600.00
46 RET047 PPV + IOL EXPLANATION + IOAB 25,080.00
47 RET048 PPV + IOL EXPLANATION 20,520.00
48 RET049 VITREOUS LAVAGE 11,400.00
49 RET050 INTRAVITREAL AVASTIN INJECTION 5,000.00
50 RET051 C3F8 PER-EYE-ENDOTAMPONADE 8,400.00
 P-7
SQUINT SURGERY A.P.S.R.T.C
RATES
SNO Service Code PROCEDURE NAME AMOUNT
1 SQU001 RECTUS MUSCLE SURGERY ONE MUSCLE 9,000.00
2 SQU002 OBLIQUE MUSCLE SURGERY ONE MUSCLE 9,000.00
3 SQU003 RECTUS MUSCLE SURGERY TWO MUSCLES 12,000.00
4 SQU004 OBLIQUE MUSCLE SURGERY TWO MUSCLES 12,000.00
5 SQU005 RECTUS MUSCLE SURGERY THREE MUSCLES 15,000.00
6 SQU006 RECTUS MUSCLE SURGERY FOUR MUSCLES 17,000.00
7 SQU007 MUSCLE TRANSPOSITION 22,800.00

TRAUMA

A.P.S.R.T.C
RATES
SNO Service Code PROCEDURE NAME AMOUNT
1 TRA001 CORNEAL TEAR REPAIR < 30 MINUTES 5,000.00
2 TRA002 CORNEAL TEAR REPAIR > 30 MINUTES 17,000.00
3 TRA003 SCLERAL TEAR REPAIR < 30 MINUTES 5,000.00
4 TRA004 SCLERAL TEAR REPAIR > 30 MINUTES 17,000.00
5 TRA005 CORNEOSCLERAL TEAR REPAIR 5,000.00
6 TRA006 CORNEAL TEAR REPAIR + CATARACT SURGERY 8,500.00
7 TRA007 CORNEAL TEAR REPAIR + CATARACT SURGERY + IOL 10,000.00
8 TRA008 EXPLORATION + SCLERAL TEAR/SCLERAL + CORNEAL TEAR REPAIR 8,500.00
9 TRA009 SCLERAL TEAR REPAIR +BB 22,800.00
10 TRA010 EXPLORATION + SCLERAL TEAR REPAIR + BB 27,360.00
11 TRA011 EYELID TEAR REPAIR SMALL OR MARGINAL 5,700.00
12 TRA012 EYELID TEAR REPAIR DIRECT 5,000.00
13 TRA013 EYELID TEAR REPAIR FLAP 17,100.00
14 TRA014 EYELID TEAR REPAIR WITH MONOCANALICULAR STENT (ADD MATERIAL CHARGES) 13,600.00
15 TRA015 EYELID TEAR REPAIR WITH BICANALICULAR STENT (ADD MATERIAL CHARGES 14,820.00
16 TRA016 CONJUCTIVAL REPAIR 6,500.00

OPHTHALMIC PLASTIC SURGERY & ONCOLOGY

SNO Service Code PROCEDURE NAME

1 OPT001 BONE MARROW BIOPSY 2,400.00
2 OPT002 MEDICAL CANTHOPLASTY 2,500.00
3 OPT003 LATERAL CANTHOPLASTY 2,500.00
4 OPT004 SYMBLEPHARON RELEASE OCULOPLASTY 13,000.00
5 OPT005 AMNIOTIC MEMBRANE GRAFT OCULOPLASTY 4,500.00
6 OPT006 SYMBLEPHARON RELEASE OCULOPLASTY + AMG 22,800.00
7 OPT007 SKIN GRAFT 22,800.00
8 OPT008 CARTILAGE GRAFT 18,240.00
9 OPT009 HARD PLATE GRAFT 18,240.00
10 OPT010 FASCIA LATA GRAFT 18,240.00
11 OPT011 SCLERAL GRAFT OCULOPLASTY 14,000.00
12 OPT012 MUCUS MEMBRANE GRAFT 18,500.00
13 OPT013 EYELID FOLD FORMATION 6,840.00
14 OPT014 Y-PLASTY OR Z-PLASTY 11,500.00
15 OPT015 EYELID RECONSTRUCTION DIRECT REPAIR 11,400.00
16 OPT016 EYELID RECONSTRUCTION FLAP 16,500.00
17 OPT017 EYELID REPAIR WITH MONOCALCICULAR STENT 14,000.00
18 OPT018 EYELID REPAIR WITH BICALCICULAR STENT 13,680.00
19 OPT019 EYELID RECONSTRUCTION CUTTLER BEARD STAGE 1 22,800.00
20 OPT020 EYELID RECONSTRUCTION CUTTLER BEARD STAGE 2 4,560.00
21 OPT021 EYELID RECONSTRUCTION TENZEL 17,100.00
22 OPT022 ECTROPION CORRECTION 2,000.00
23 OPT023 ENTROPION CORRECTION 2,500.00
24 OPT024 TARSAL STRIP PROCEDURE 2,500.00
25 OPT025 BLEPHAROPHIMOSIS CORRECTION 22,800.00
26 OPT026 EPICANTHUS REPAIR 10,800.00
27 OPT027 CORRECTION OF EYELID RETRACTION 5,000.00
28 OPT028 FASANELLA SERVAT PROCEDURE 19,000.00
29 OPT029 LPS RESECTION 19,000.00
30 OPT030 LPS EXPLORATION AND REINSERTION 19,000.00
31 OPT031 LPS PLICATION 19,000.00
32 OPT032 ADJUSTABLE SUTURE LPS RESECTION 21,000.00
33 OPT033 TRANSOFRONTAL SLING ONE EYE ETHIBOND 3,600.00
34 OPT034 TRANSOFRONTAL SLING BOTH EYES ETHIBOND 14,000.00
35 OPT035 TRANSOFRONTAL SLING ONE EYE SILOCONE 8,500.00
36 OPT036 TRANSOFRONTAL SLING BOTH EYES SILOCONE 24,000.00
37 OPT037 TRANSOFRONTAL SLING ONE EYE FASCIA LATA 23,000.00
38 OPT038 TRANSOFRONTAL SLING BOTH EYES FASCIA LATA 35,000.00
39 OPT039 CANALICULAR REPAIR 14,000.00
40 OPT040 CANALICULAR REPAIR WITH MONOCANALICULAR STENT 14,000.00
41 OPT041 FISTULECTOMY 3,000.00
42 OPT042 DIVERTICULECTOMY 9,000.00
43 OPT043 DCR 4,000.00
44 OPT044 DCR CANALICULAR 20,000.00
45 OPT045 DCR CONJUCTIVAL WITH JONES TUBE 22,000.00
46 OPT046 DCR WITH INTUBATION 5,000.00
47 OPT047 DCR WITH MMC 20,000.00
48 OPT048 DCR ENDONASAL ENDOSCOPIC 18,500.00
49 OPT049 DCR ENDONASAL ENDOSCOPIC WITH INTUBATION 20,000.00
50 OPT050 DCR TRANSCANALICULAR LASER 20,000.00
51 OPT051 DCR WITH FISTULECTOMY 16,500.00
52 OPT052 DCT 2,500.00
53 OPT053 DCT + FISTULECTOMY 10,000.00
54 OPT054 RECANALIZATION OF CANALICULUS + BICANALICULAR INTUBATION 12,000.00
55 OPT055 RECANALIZATION OF CANALICULUS + MONOCANLICULAR STENT 14,000.00
56 OPT056 FESS 18,240.00
57 OPT057 TURBINECTOMY 4,350.00
58 OPT059 ORBITOTOMY 22,800.00
59 OPT060 ORBITAL FOREIGN BODY REMOVAL 22,800.00
60 OPT061 ORBITAL FRACTURE REPAIR 22,800.00
61 OPT062 ORBITAL FRACTURE REPAIR WITH POREX SHEET 22,800.00
62 OPT063 ORBITAL DECOMPRESSION 22,800.00
63 OPT064 BLEPHAROPLASTY 13,680.00
64 OPT065 BROW LIFT 13,000.00
65 OPT066 FORNIX FORMATION SUTURE (FFS) 4,500.00
66 OPT067 SOCKET RECONSTRUCTION 8,700.00
67 OPT068 SOCKET RECONSTRUCTION + FFS 13,680.00
68 OPT069 DERMIS FAT GRAFT 2,400.00
69 OPT070 EVISCERATION 2,000.00
70 OPT071 EVISCERATION + IMPLANT 18,240.00
71 OPT072 ENUCLEATION 2,000.00
72 OPT073 ENUCLEATION + SILICONE IMPLANT 18,240.00
73 OPT074 ENUCLEATION + POREX IMPLANT 27,360.00
74 OPT075 ORBITAL EXENTERATION 27,360.00
75 OPT076 EXCISION OR INCISION BIOPSY < 15 MINS 2,500.00
76 OPT077 EXCISION OR INCISION BIOPSY < 30 MINS 9,200.00
77 OPT078 EXCISION OR INCISION BIOPSY < 1 HOUR 5,000.00
78 OPT079 EXCISION OR INCISION BIOPSY < 2 HOURS 20,000.00
79 OPT080 EXCISION OR INCISION BIOPSY > 2 HOURS 28,000.00
80 OPT082 DEBUCKLING 11,000.00
81 OPT083 EYELID TUMOR EXCISION 11,000.00
82 OPT084 CONJUCTIVAL TUMOR EXCISION 11,400.00
83 OPT085 CONJUCTIVAL TUMOR EXCISION + CRYOTHERAPY 13,680.00
84 OPT086 CONJUCTIVAL TUMOR EXCISION + AMG 18,240.00
85 OPT087 CONJUCTIVAL TUMOR EXCISION + CRYOTHERAPY + AMG 22,800.00
86 OPT088 TUMOR CRYOTHERAPY 3,420.00
87 OPT089 TUMOR TTT 4,560.00
88 OPT090 RU 106 PLAQUE BRACHYTHERAPY 27,360.00
89 OPT092 CHEMOMYECTOMY 11,400.00
90 OPT093 GOLD WEIGHT IMPLANT 18,240.00
91 OPT094 GOLD WEIGHT IMPLANT + SCLERAL GRAFT 22,800.00
92 OPT095 GOLD WEIGHT IMPLANT + LTS 22,800.00
93 OPT096 GOLD WEIGHT IMPLANT + SCLERAL GRAFT + LTS 22,800.00
94 OPT097 GOLD WEIGHT IMPLANT + LOWER EYELID SPACER 22,800.00
95 OPT098 GOLD WEIGHT EXCHANGE 13,680.00
 P-9
GENERAL PROCEDURES

SNO Service Code PROCEDURE NAME

1 GEN001 GENERAL ANESTHESIA 1-15 MINUTES 1,500.00
2 GEN002 GENERAL ANESTHESIA 16-30 MINUTES 3,000.00
3 GEN003 GENERAL ANESTHESIA 31-60 MINUTES 4,000.00
4 GEN004 GENERAL ANESTHESIA 61-120 MINUTES 6,000.00
5 GEN005 GENERAL ANESTHESIA 121 MINUTES AND ABOVE 6,000.00
6 GEN006 AUTO REFRACTOMETER TESTING 50.00
7 OTH049 APLANATION TONOMETRY 50.00
8 OFF147 INDIRECT OPHTHALMOSCOPY 100.00
9 OFF148 90 D/70 D EXAMINATION 100.00
10 OFF 149 BIOMETRY/ A SCAN 500.00
11 OFF 150 SYRINGING/ NLD 500.00
12 OFF151 INTRAVITREAL INJECTION PROCEDURE CHARGES 4,000.00
13 OFF152 PHAKIK IOL - ICL (INCLUDEING COST OF LENS) 60,000.00
14 OFF153 PHAKIK IOL - ICL TORIC (INCLUDING COST OF LENS) 75,000.00
15 OFF154 C3R(ISO) (INCLUDES 3 POST OP SCANS) 25,000.00
16 OFF155 LUCENTIS INJECTION 26,625.00
17 OFF156 OZURDEX INJECTION 28,000.00

ROOM AND SERVICE CHARGES

1 GEN006 ROOM CHARGES 750.00

 RATES RATES RATES
RAL PROCEDURES Neoretina Medivisi Pushpagi
till 1/08/13 NEW NEW
16 OFF 104 YAP CAPSULOTOMY 1200
17 OFF 105 YAG IRIDOTOMY PER EYE 1200
18 OFF 107 CLINICAL PHOTO PER EYE-FUNDUS PHOTO 600
19 OFF 109 DVT DIVISIONAL VARIATION OF IOP PER EYE 300

GLUCOMA PROCEDURES
7 otho13 CCT FOR ONE EYE(pachymetry) 360

REFRACTIVE PROCEUDRES & SURGERY

1 OTHO48 C 3 R PER EYE-KERATOCONUS 32000
RATES
Neoretina
NEW rates
1200
1200
600
300

360

32000