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Annexure II (applicable if the condition does not fit in Annexure I)

S.NO. Treatment/Procedure Proposed rates


HEAD & NECK
ESIC-1 Cervical Rib Excision 10500.00
ESIC-2 Parathyroidectomy 21000.00
ESIC-3 Hemimandibulectomy 17500.00
ESIC-4 Segmental Mandible Excision 17500.00
ESIC-5 Partial Glossectomy 10500.00
ESIC-6 Wedge Excision& Vermilionectomy 14000.00
ESIC-7 Isthmectomy 14000.00
ABDOMEN
ESIC-8 Duodenal Perforation 28000.00
ESIC-9 Gastrostomy Closure 14000.00
ESIC-10 Ileostomy Closure 14000.00
ESIC-11 Colostomy 14000.00
Gallbladder
ESIC-12 Lap.Cholecystectomy 21000.00
ENT SURGERY
EAR
ESIC-13 Temporal Bone Excision 35000.00
THROAT
ESIC-14 Phono Surgery For Vocal Cord Paralysis 17500.00
ESIC-15 Exision Of Tumors In Pharynx 14000.00
NOSE
ESIC-16 Endoscopic Sinus Surgery 10500.00
ESIC-17 Stapedectomy - Veingraft 10500.00
ESIC-18 Excision Of Benign Tumour Nose 10500.00
OPHTHALMOLOGY SURGERY
CORNEA and SCLERA
ESIC-19 Double Z-Plasty 2800.00
ESIC-20 Amniotic Membrane Graft 4900.00
VITREO-RETINA
ESIC-21 Vitrectomy 4200.00
ESIC-22 Removal Of Silicon Oil Or Gas 4200.00
ESIC-23 Photocoagulation for Retinopathy 1050.00
ORBIT
ESIC-24 Socket Reconstruction 4900.00
ESIC-25 Proptosis 42000.00
PEDIATRIC OPHTHALMIC SURGERY
ESIC-26 Photocoagulation For Retinopathy Of Prematurity 5250.00

ESIC-27 Glaucoma Filtering Surgery For Paediatric Glaucoma 10500.00


GYNAECOLOGY AND OBSTETRICS SURGERY
Obstetrics
Eclampsia With Complications Requiring Ventilatory
ESIC-28 Support 14000.00
ESIC-29 Abruptio-Placenta With Coagulation Defects(Dic) 14000.00
Gynaecology
ESIC-30 Vaginal Hysterectomy With Pelvic Floor Repair 21000.00
ESIC-31 Cystocele ,Rectocele & Perineorraphy 14000.00
ESIC-32 Mc Indo-S Repair For Vaginal Atresia 21000.00
ESIC-33 Vault Prolapse Abdominal Repair 21000.00
ESIC-34 Vault Prolapse Abdominal Repair With Mesh 28000.00

1
ESIC-35 Laparoscopic Recanalisation 14000.00
ESIC-36 Laparoscopic Adhesolysis 17500.00
ORTHOPEDIC SURGERY AND PROCEDURES
Fracture Correction Surgeries/Procedures
ESIC-37 Ilizarov Ring Fixator Application 28000.00
ESIC-38 Ctev Neglected . Jess Fixator 21000.00
Bone and Joint Surgery/Procedures
ESIC-39 Arthroscopy . Operative Meniscectomy 17500.00
ESIC-40 Arthroscopy - Acl Repair 21000.00
Avascular Necrosis Of Femoral Head (Core
ESIC-41 Decompression) 10500.00
Soft Tissue Reconstruction Procedures For
ESIC-42 Joints/Osteotomy 21000.00
Spine Surgery
ESIC-43 Costo Transversectomy 21000.00
ESIC-44 Spinal Ostectomy And Internal Fixations 28000.00
ESIC-45 Neurolysis/Nerve Suture 17500.00
TUMOR SURGERY
Excision Of Bone Tumours . Deep With Re-
ESIC-46 Construction With Conventional Prosthesis 28000.00
SURGICAL GASTRO ENTEROLOGY
Emergency
ESIC-47 Surgery For Bleeding Ulcers 28000.00
ESIC-48 Surgery For Obscure Gi Bleed 42000.00
Hernia
ESIC-49 Diaphragmatic Hernia (Gortex Mesh Repair) 28000.00
PANCREATIC SURGERIES
ESIC-50 Distal Pancreatectomy 70000.00
ESIC-51 Enucleation Of Cyst 52500.00
ESIC-52 Whipples Any Type 52500.00
ESIC-53 Triple Bypass 17500.00
ESIC-54 Other Bypasses 17500.00
Oesophagus
ESIC-55 Colonic Pull Up 21000.00
ESIC-56 Lap Heller.S Myotomy 21000.00
ESIC-57 Lap Fundoplications 31500.00
Stomach
ESIC-58 Distal Gastrectomy For Gastric Outlet Obstruction 28000.00
ESIC-59 Surgery For Corrosive Injury Stomach 35000.00
Small Intestine
ESIC-60 Lap Adhesiolysis 28000.00
Large Intestine
ESIC-61 Extended Right Hemicolectomy 24500.00
ESIC-62 Anterior Resection With Ileostomy 35000.00
ESIC-63 Hartman.S Procedure With Colostomy 31500.00
ESIC-64 II Stage-J - Pouch 21000.00
ESIC-65 III Stage-Ileostomy Closure 14000.00

ESIC-66 I Stage- Sub Total Colectomy + Ileostomy + J - Pouch 56000.00


ESIC-67 Ii Stage- Ileostomy Closure 14000.00
Liver
Hepato Cellular Carcinoma(Advanced) Radio
ESIC-68 Frequency Ablation 42000.00
Haemangioma Sol Liver Hepatectomy + Wedge
ESIC-69 Resection 52500.00
ESIC-70 Cyst Excision + Hepatic Jejunostomy 31500.00
ESIC-71 Lap.Cholecystectomy 21000.00

2
ESIC-72 Hepatico Jejunostomy 31500.00
Spleen
Splenectomy + Devascularisation + Spleno Renal
ESIC-73 Shunt 42000.00
ESIC-74 Spleenectomy For Space Occupying Lesion 24500.00
Pancreas
ESIC-75 Lap- Pancreatic Necrosectomy 70000.00
ESIC-76 Lateral Pancreaticojejunostomy(Non- Malignant) 70000.00
ESIC-77 Pancreatic Necrosectomy (Open) 70000.00
ESIC-78 Distal Pancreatectomy + Splenectomy 70000.00
ESIC-79 Central Pancreatectomy 70000.00
ESIC-80 Cysto Jejunostomy 28000.00
CARDIAC AND CARDIOTHORACIC SURGERY
CARDIAC INTERVENTIONS / PROCEDURES
ESIC-81 Device Closure 42000.00
ESIC-82 Single Coil 14000.00
ESIC-83 Multiple Coils 21000.00
ESIC-84 Temporary Pacemaker Implantation 7000.00
CARDIAC INJURES
ESIC-85 Surgery Without CPB 28000.00
ESIC-86 Surgery With CPB 52500.00
VASCULAR SURGERIES
ESIC-87 Peripheral Embolectomy Without Graft 17500.00
ESIC-88 Excision Of Arterio Venous Malformation - Large 52500.00
ESIC-89 Excision Of Arterio Venous Malformation - Small 28000.00
ESIC-90 Arterial Embolectomy 14000.00
ESIC-91 A V Fistula At Wrist 7000.00
ESIC-92 A. V Fistula At Elbow 14000.00
ESIC-93 D V T - IVC Filter 70000.00
ESIC-94 Vascular Tumors 28000.00
ESIC-95 Small Arterial Aneurysms - Repair 10500.00
ESIC-96 Medium Size Arterial Aneurysms - Repair 35000.00
ESIC-97 Aorto Billiac - Bifemoral Bypass With Synthetic Graft 87500.00
ESIC-98 Axillo Bifemoral Bypass With Synthetic Graft 70000.00
ESIC-99 Femoro Distal Bypass With Vein Graft 42000.00
ESIC-100 Femoro Distal Bypass With Synthetic Graft 56000.00
ESIC-101 Axillo Brachial Bypass Using With Synthetic Graft 45500.00
ESIC-102 Brachio - Radial Bypass With Synthetic Graft 35000.00
ESIC-103 Carotid Artery Bypass With Synthetic Graft 70000.00
CARDIOTHORACIC AND VASCULAR SURGERIES
ESIC-104 Aneurysm Resection & Grafting 87500.00
Intrathoracic Aneurysm -Aneurysm Not Requiring
ESIC-105 Bypass (With Graft) 45500.00
ESIC-106 Dissecting Aneurysms 52500.00
ESIC-107 Annulus Aortic Ectasia With Valved Conduits 105000.00
ESIC-108 Arterial Switch 105000.00
ESIC-109 Carotid Embolectomy 35000.00
ESIC-110 Surgery For Intracardiac Tumors 52500.00
ESIC-111 Ruptured Sinus Of Valsulva Correction 66500.00
ESIC-112 Systemic Pulmonary Shunts With Graft 14000.00
ESIC-113 Systemic Pulmonary Shunts Without Graft 14000.00
LUNGS
ESIC-114 Pneumonectomy 35000.00
ESIC-115 Lobectomy 35000.00
ESIC-116 Decortication 35000.00
ESIC-117 Lung Cyst 35000.00
ESIC-118 Sol Mediastinum 35000.00

3
ESIC-119 Thorocoplasty 35000.00
ESIC-120 Myoplasty 35000.00
ESIC-121 Transpleural Bpf Closure 35000.00
CHEST SURGERY
DIAPHRAGMATIC INJURIES
ESIC-122 Thoracotomy, Thoraco Abdominal Approach 28000.00
BRONCHIAL INJURIES/FB
ESIC-123 Repair Surgery For Injuries Due To Fb 28000.00
OESOPHAGEAL INJURY/FB
Gastro Study Followed By Thoracotomy & Repairs For
ESIC-124 Oesophageal Injury For Corrosive Injuries/Fb 35000.00
VASCULAR INJURY
Surgery Without Graft For Arterial Injuries Venous
ESIC-125 Injuries 7000.00
Vascular Injury In Upper Limbs -
Axillary,Branchial,Radial And Ulnar - Repair With Vein
ESIC-126 Graft 28000.00
ESIC-127 Major Vascular Injury -In Lower Limbs-Repair 42000.00
ESIC-128 Minor Vascular Injury Repair- Tibial Vessels In Leg 14000.00
ESIC-129 Minor Vascular Injury Repair -Vessels In Foot 14000.00
ESIC-130 Surgery With Vein Graft 10500.00
ESIC-131 With Prosthetic Graft 28000.00
ESIC-132 Neck Vascular Injury - Carotid Vessels 70000.00
Abdominal Vascular Injuries - Aorta, Illac Arteries, Ivc,
ESIC-133 Iliac Veins 70000.00
ESIC-134 Thoracic Vascular Injuries 105000.00
PEDIATRIC SURGERIES
PAEDIATRIC CONGENITAL MALFORMATIONS
ESIC-135 Hypospadias Single Stage 28000.00
ESIC-136 Velo-Pharyngeal Incompetence 10500.00
ESIC-137 Microtia/Anotia 21000.00
CONGENITAL MALFORMATIONS
ESIC-138 Hamartoma Excision 14000.00
ESIC-139 Hemangioma Excision 17500.00
ESIC-140 Lymphangioma Excision 28000.00
HEAD AND NECK
ESIC-141 Congenital Dermal Sinus 21000.00
CHEST
ESIC-142 Thoracoscopic Cysts Excision 28000.00
ESIC-143 Thoracoscopic Decortication 28000.00
ESIC-144 Thoracic Duplications 28000.00
ESIC-145 Thoracic Wall Defects- Correction 35000.00
ABDOMEN
ESIC-146 Paediatric Splenectomy (Non Traumatic) 24500.00
ESIC-147 Surgeries On Adrenal Gland In Children 17500.00
ESIC-148 Gastro Esophageal Reflux Correction 21000.00
ESIC-149 Hydatid Cysts In Paediatric Patient 28000.00
ESIC-150 Intestinal Polyposis Surgical Correction 35000.00
ESIC-151 Paediatric Acute Intestinal Obstruction 28000.00
GENITOURINARY SYSTEM
ESIC-152 Undescended Testis 17500.00
ESIC-153 Nephrectomy 28000.00
ESIC-154 Scrotal Transposition Repair 14000.00
ESIC-155 Laparoscopic Orchidopexy 17500.00
GENITO URINARY SURGERIES
RENAL TRANSPLANTATION

4
Post Transplant Immunosuppressive Treatment From
ESIC-156 1st To 6th Month After Transplantation 35000.00
LITHOTRIPSY PROCEDURES
ESIC-157 Cystolithotripsy 7000.00
ESIC-158 ESWL 14000.00
ESIC-159 URSL 17500.00
ESIC-160 DJ SHUNT 3500.00
Other Corrective Surgeries/Procedures
ESIC-161 Reconstruction Procedure 35000.00
ESIC-162 Turbt 21000.00
ESIC-163 Renal Cyst Excision 10500.00
RENAL STONE SURGERY/THERAPIES
CORRECTIVE SURGERIES
ESIC-164 Anderson Hynes Pyeloplasty 28000.00
ESIC-165 Closure Of Urethral Fistula 17500.00
SPINE
ESIC-166 Anterior Discectomy & Bone Grafting 28000.00
ESIC-167 Discectomy With Implants 45500.00
ESIC-168 Corpectomy For Spinal Fixation 49000.00
ESIC-169 Spinal Fixation Rods And Plates, Artificial Discs 59500.00
ESIC-170 Syringomyelia 45500.00
SOFT TISSUE and VASCULAR SURGERIES
ESIC-171 Temporal Lobectomy Plus Depth Electrodes 98000.00
SURGICAL ONCOLOGY
HEAD & NECK
ESIC-172 Composite Resection & Reconstruction 42000.00
ESIC-173 Wide Excision 17500.00
ESIC-174 Orbital Exenteration 17500.00
ESIC-175 Cranio Facial Resection 49000.00
Ca. Nasopharynx
ESIC-176 Resection Of Nasopharyngeal Tumor 35000.00
Ca.Soft Palate
ESIC-177 Palatectomy Any Type 21000.00
ESIC-178 Tracheal Resection 36400.00
Ca. Trachea
ESIC-179 Sternotomy + Superior Mediastinal Dissection 31500.00
ESIC-180 Tracheal Resection 28000.00
Ca. Parathyroid
ESIC-181 Parathyroidectomy 21000.00
ESIC-182 Closure Of Ileostomy 14000.00
Ca.Rectum
ESIC-183 Posterior Exenteration 35000.00
ESIC-184 Total Exenteration 52500.00
GASTROINTESTINAL TRACT
ESIC-185 Whipples Any Type 52500.00
ESIC-186 Triple Bypass 17500.00
ESIC-187 Other Bypasses-Pancreas 17500.00
Ca. Gall Bladder
Retroperitoneal Tumor
ESIC-188 Resection Of Retroperitoneal Tumors 31500.00
Abdominal wall tumor
ESIC-189 Abdominal Wall Tumor Resection 24500.00
ESIC-190 Resection With Reconstruction 31500.00
Gynaec Cancers
ESIC-191 Radical Trachelectomy 28000.00
ESIC-192 Radical Vaginectomy 28000.00
ESIC-193 Radical Vaginectomy + Reconstruction 31500.00

5
Ca. Cervix
Radical Hysterectomy +Bilateral Pelvic Lymph Node
Dissection (Bplnd) + Bilateral Salpingo Ophorectomy
ESIC-194 (Bso) / Ovarian Transposition 31500.00
ESIC-195 Anterior Exenteration 42000.00
ESIC-196 Posterior Exenteration 35000.00
ESIC-197 Total Pelvic Exenteration 52500.00
ESIC-198 Supra Levator Exenteration 49000.00
Ca. Endometrium
Total Abdominal Hysterectomy(Tah) + Bilateral
Salpingo Ophorectomy (Bso) + Bilateral Pelvic Lymph
ESIC-199 Node Dissection (Bplnd) + Omentectomy 24500.00
Soft tissue /Bone tumors . Chest wall
ESIC-200 Chest Wall Resection 14000.00
ESIC-201 Chest Wall Resection + Reconstruction 21000.00
Bone / Soft tissue tumors
ESIC-202 -Without Prosthesis 28000.00
ESIC-203 -With Custom Made Prosthesis 35000.00
ESIC-204 -With Modular Prosthesis 52500.00
Nephroureterectomy For Transitional Cell Carcinima
ESIC-205 Of Renal Pelvis 35000.00
GENITO URINARY SYSTEM
ESIC-206 Total Penectomy 17500.00
ESIC-207 Partial Penectomy 10500.00
ESIC-208 Inguinal Block Dissection One Side 10500.00
Testes cancer
Retro Peritoneal Lymph Node Dissection Rplnd As
ESIC-209 Part Of Staging 14000.00
ESIC-210 Mediastinal Tumor Resection 35000.00
Lung
ESIC-211 Lung Metastatectomy . Solitary 35000.00
ESIC-212 Lung Metastatectomy . Multiple 42000.00
ESIC-213 Sleeve Resection Of Lung Cancer. 63000.00
Esophagus

ESIC-214 Oesophagectomy With Two Field Lymphadenectomy 63000.00

ESIC-215 Oesophagectomy With Three Field Lymphadenectomy 70000.00


ESIC-216 Micro Vascular Reconstruction 31500.00
GYNAECOLOGICAL ONCOLOGY
ESIC-217 Surgery For Ca Ovary Early Stage 17500.00
ESIC-218 Surgery For Ca Ovary Advance Stage 28000.00
SKIN TUMORS
ESIC-219 Skin Tumors Wide Excision 7000.00
ESIC-220 Skin Tumorswide Excision + Reconstruction 14000.00
ESIC-221 Skin Tumorsamputation 14000.00
SOFT TISSUE AND BONE TUMORS
ESIC-222 Soft Tissue And Bone Tumors Wide Excision 10500.00
Soft Tissue And Bone Tumors Wide Excision +
ESIC-223 Reconstruction 17500.00
LUNG CANCER
ESIC-224 Lung Cancer Pneumonectomy 35000.00
ESIC-225 Lung Cancer Lobectomy 35000.00
ESIC-226 Decortication 35000.00
Surgical Correction Of Bronchopleural Fistula.
ESIC-227 Thoracoplasty 35000.00
Surgical Correction Of Bronchopleural Fistula.
ESIC-228 Myoplasty 35000.00

6
Surgical Correction Of Bronchopleural Fistula.
ESIC-229 Transpleural Bpf Closure 35000.00
Full Thickness Buccal Mucosal Resection &
ESIC-230 Reconstruction 35000.00
MEDICAL ONCOLOGY
Methotrexate Vinblastine Adriamycin
ESIC-231 Cyclophosphamide (Mvac) 3500.00
5-Fluorouracil-Oxaliplatin Leucovorin (Folfox) (Stage Iii
ESIC-232 Only) 7000.00
OSTEOSARCOMA/ BONE TUMORS

ESIC-233 Adriamycin Bleomycin Vinblastine Dacarbazine (Abvd) 2800.00


Lymphoma ii) NHL
MULTIPLE MYELOMA
ESIC-234 Vincristine, Adriamycin,Dexamethasone(Vad) 2800.00
ESIC-235 Thalidomide+Dexamethasone(Oral) 2100.00
ESIC-236 Melphalan Prednisone (Oral) 1050.00
WILMS TUMOR
ESIC-237 Siop/Nwts Regimen(Stages I Iii) 4900.00
HEPATOBLASTOMA- OPERABLE
ESIC-238 Cisplatin Adriamycin 10500.00
CERVICAL CANCER
CHILDHOOD B CELL LYMPHOMAS
ESIC-239 Variable Regimen 8400.00
NEUROBLASTOMA ( STAGES I-III )
ESIC-240 Neuroblastoma ( Stages I-Iii ) Variable Regimen 7000.00
RETINOBLASTOMA
ESIC-241 Carbo/Etoposide/Vincristine 2800.00
HISTIOCYTOSIS
ESIC-242 Histiocytosis Variable Regimen 5600.00
RHABDOMYOSARCOMA
Vincristine-Actinomycin-Cyclophosphamide(Vactc)
ESIC-243 Based Chemo 6300.00
EWINGS SARCOMA
ESIC-244 Ewings Sarcoma Variable Regimen 6300.00
ACUTE MYELOID LEUKEMIA
ESIC-245 Induction Phase 42000.00
ESIC-246 Consolidation Phase 28000.00
ESIC-247 Maintenance 2100.00
ACUTE LYMPHOBLASTIC LEUKEMIA
ESIC-248 Induction 1st And 2nd Months 35000.00
ESIC-249 Induction 3rd, 4th, 5th 14000.00
ESIC-250 Induction Maintenance 2100.00
FOR UNLISTED REGIMEN
ESIC-251 Palliative Chemotherapy 3500.00
Acute Lymphoblastic Leukemia - For Terminally ill Cancer Patient
ESIC-252 Palliative And Supportive Therapy 2100.00
VULVAL CANCER
ESIC-253 Vulval Cancer Cisplatin/5-Fu 3500.00
Colo Rectal Cancer Stage 2 and 3
ESIC-254 Xelox Along With Adjuvant Chemotherapy Of As-I 2800.00
MULTIPLE MYELOMA
Zoledronic Acid Along With Adjuvant Chemotherapy
ESIC-255 Of As-I 2100.00
FEBRILE NEUTROPENIA

7
1st Line Iv Antibiotics And Other Supportive Therapy (
Third Generation Cephalosporin, Aminoglycoside
ESIC-256 Etc.,) 6300.00
2nd Line Iv Antibiotics And Other Supportive
Therapy(Carbapenems, Fourth Generation
Cephalosporins, Piperacillin, Anti-Fungal . Azoles
ESIC-257 Etc.,) 21000.00
VAGINAL CANCER
ESIC-258 Vaginal Cancer Cisplatin/5-Fu 3500.00
OVARIAN CANCER
ESIC-259 Carboplatin/ Paclitaxel 7350.00
OVARY- GERM CELL TUMOR
Ovary- Germ Cell Tumor Bleomycin-Etoposide-
ESIC-260 Cisplatin (Bep) 5600.00
Gestational Trophoblast Ds.
ESIC-261 Weekly Methotrexate 420.00
ESIC-262 Actinomycin 2100.00
High risk
Etoposide-Methotrexate-Actinomycin /
ESIC-263 Cyclophosphamide Âvincristine (Ema-Co) 4200.00
TESTICULAR CANCER
Testicular Cancer Bleomycin-Etoposide-Cisplatin
ESIC-264 (Bep) 5600.00
PROSTATE CANCER
ESIC-265 Hormonal Therapy 2100.00
RADIATION ONCOLOGY
ESIC-266 Adjuvant Treatment 10500.00
ESIC-267 Microtia/Anotia 21000.00
ESIC-268 TM Joint Ankylosis 28000.00
POST BURN CONTRACTURE SURGERIES FOR FUNCTIONAL
IMPROVEMENT(PACKAGE INCLUDING SPLINTS, PRESSURE GARMENTS
AND PHYSIOTHERAPY)
ESIC-269 Mild 14000.00
ESIC-270 Moderate 21000.00
ESIC-271 Severe 28000.00
PLASTIC SURGERY
ESIC-272 Hemifacial Microsmia 35000.00
ESIC-273 Leprosy Reconstructive Surgeroy 14000.00
ESIC-274 Nerve And Tendon Repair + Vascular Repair 21000.00
Corrective Surgery For Congenital Deformity Of Hand
ESIC-275 (Per Hand) 10500.00
ESIC-276 Corrective Surgery For Craniosynostosis 35000.00
ESIC-277 Cup And Bat Ears 14000.00

ESIC-278 Flapcover For Electrical Burns With Vitals Exposed 35000.00


ESIC-279 Reduction Surgery For Filarial Lymphoedema 14000.00
ESIC-280 Hemifacial Atrophy 21000.00
POLY TRAUMA
OTHER SMALL BONE FRACTURES-K-WIRING (TO BE COVERED ALONG
WITH OTHER INJURIES ONLY AND NOT AS EXCLUSIVE PROCEDURE)
Surgery For Patella Fracture (To Be Covered Along
With Other Injuries Only And Not As Exclusive
ESIC-281 Procedure) 3500.00
Small Bone Fractures-K-Wiring (To Be Covered Along
With Other Injuries Only And Not As Exclusive
ESIC-282 Procedure) 3500.00

8
ESIC-283 Surgical Correction Of Pelvic Bone Fractures. 14000.00
ESIC-284 Cochlear Implant Surgery 364000.00
AUDITORY-VERBAL THERAPY
ESIC-285 Initial Mapping/Switch On 35000.00
Post Switch On Mapping/Initiation Of Avp And Training
ESIC-286 Of Child And Mother - First Installment 14000.00
Post Switch On Mapping/Initiation Of Avp And Training
ESIC-287 Of Child And Mother - Second Installment 14000.00
Post Switch On Mapping/Initiation Of Avp And Training
ESIC-288 Of Child And Mother - Third Installment 14000.00
Post Switch On Mapping/Initiation Of Avp And Training
ESIC-289 Of Child And Mother - Fourth Installment 14000.00
HEARING IMPAIRED
ESIC-290 Behind Ear Analogue Hearing Aid 7000.00
CRITICAL CARE

ESIC-291 Acute Severe Asthma With Acute Respiratory Failure 31500.00


ESIC-292 Copd Respiratory Failure (Infective Exacerbation) 49000.00
Acute Bronchitis And Pneumonia With Respiratory
ESIC-293 Failure 35000.00
ESIC-294 ARDS 56000.00
ESIC-295 ARDS With Multi Organ Failure 70000.00
ESIC-296 ARDS Plus DIC (Blood & Blood Products) 84000.00
ESIC-297 Poison Ingestion Requiring Ventilatory Assistance 21000.00
ESIC-298 Septic Shock(Icu Management) 35000.00
GENERAL MEDICINE
ESIC-299 Thrombocytopenia With Bleeding Diathesis 14000.00
ESIC-300 Hemophilia 35000.00
ESIC-301 Other Coagulation Disorders 35000.00
ESIC-302 Chelation Therapy For Thalassemia Major 14000.00
ESIC-303 Cerebral Malaria 14000.00
ESIC-304 TB Meningitis 21000.00
ESIC-305 Snake Bite Requiring Ventilator Support 35000.00
ESIC-306 Scorpion Sting Requiring Ventilator Support 17500.00
ESIC-307 Metabolic Coma Requiring Ventilatory Support 21000.00
INFECTIOUS DISEASES
ESIC-308 Tetanus Severe 14000.00
ESIC-309 Diphtheria Complicated 17500.00
ESIC-310 Cryptococcal Meningitis 14000.00
PEDIATRICS
NEONATAL INTENSIVE CARE
Term Baby With Culture Positive Sepsis- Non
ESIC-311 Ventilated Hyperbilirubinemia 17500.00
30 To 32 Weeks Preterm Severe Hyaline Membrane
Disease Clinical/Culture Positive Sepsis Patent Ductus
Arteriosus - Medical Management Mechanical
ESIC-312 Ventilation Hyperbilirubinemia 63000.00
Less than 30 Weeks Preterm Severe Hyaline
Membrane Disease Clinical/Culture Positive Sepsis
Patent Ductus Arteriosus - Medical Management
ESIC-313 Mechanical Ventilation Hyperbilirubinemia 63000.00

Term Baby With Persistent Pulmonary Hypertension


ESIC-314 Ventilation Hyperbilirubinemia Clinical Sepsis 56000.00
Term Baby With Severe Perinatal Asphyxia - Non
ESIC-315 Ventilated Clinical Sepsis Hyperbilirubinemia 17500.00

9
Term Baby With Severe Perinatal Asphyxia -
ESIC-316 Ventilated Clinical Sepsis Hyperbilirubinemia 28000.00

ESIC-317 Term Baby Severe Hyperbilirubinemia Clinical Sepsis 17500.00


ESIC-318 Term Baby With Seizures Ventilated 17500.00
Necrotising Enterocolitis, Clinical Sepsis Non
ESIC-319 Ventilated Hyperbilirubinemia 17500.00

Term Baby, Fulminant Culture Positive Sepsis, Septic


ESIC-320 Shock, Ventilated, Hyperbilirubinemia Renal Failure 28000.00
33 To 34 Weeks Preterm Baby Severe Hyaline
Membrane Disease Clinical Sepsis Bubble Cpap
ESIC-321 Hyperbilirubinemia 28000.00
33 To 34 Weeks Preterm Baby Severe Hyaline
Membrane Disease Clinical Sepsis Mechanical
ESIC-322 Ventilation Hyperbilirubinemia 42000.00
35 To 36 Weeks Preterm Mild Hyaline Membrane
Disease Culture Positive Sepsis Nonventilated
ESIC-323 Hyperbilirubinemia 24500.00
33 To 34 Weeks Preterm Mild Hyaline Membrane
Disease Culture Positive Sepsis - Nonventilated
ESIC-324 Hyperbilirubinemia 31500.00

33 To 34 Weeks Preterm Severe Hyaline Membrane


Disease Culture Positive Sepsis Mechanical
ESIC-325 Ventilation/ Bubble Cpap Hyperbilirubinemia 42000.00
30 To 32 Weeks Preterm Severe Hyaline Membrane
Disease Clinical/ Culture Positive Sepsis Mechanical
ESIC-326 Ventilation Hyperbilirubinemia 63000.00
<30 Weeks Preterm Severe Hyaline Membrane
Disease Clinical/ Culture Positive Sepsis Mechanical
ESIC-327 Ventilation Hyperbilirubinemia 63000.00
33 To 34 Weeks Preterm Severe Hyaline Membrane
Disease Clinical/Culture Positive Sepsis Patent Ductus
Arteriosus- Medical Management Mechanical
ESIC-328 Ventilation Hyperbilirubinemia 49000.00
PEDIATRIC INTENSIVE CARE
ESIC-329 Severe Bronchiolitis (Non Ventilated) 10500.00
ESIC-330 Severe Bronchiolitis ( Ventilated) 14000.00
ESIC-331 Severe Bronchopneumonia (Non Ventilated) 10500.00
ESIC-332 Severe Bronchopneumonia ( Ventilated) 21000.00
ESIC-333 Acute Severe Asthma (Ventilated) 24500.00
ESIC-334 Severe Aspiration Pneumonia (Non Ventilated) 14000.00
ESIC-335 Severe Aspiration Pneumonia ( Ventilated) 17500.00
ESIC-336 Ards With Multi-Organ Failure 70000.00
ESIC-337 Ards Plus Dic (Blood & Blood Products) 84000.00
ESIC-338 Severe Myocarditis 28000.00
Congenital Heart Disease With Infection (Non
ESIC-339 Ventilated) 21000.00
Congenital Heart Disease With Infection And
ESIC-340 Cardiogenic Shock (Ventilated) 35000.00
ESIC-341 Cardiogenic Shock 35000.00
ESIC-342 Infective Endocarditis 35000.00
ESIC-343 Meningo- Encephalitis (Non Ventilated) 28000.00
ESIC-344 Meningo- Encephalitis ( Ventilated) 42000.00
ESIC-345 Status Epilepticus 35000.00
ESIC-346 Febrile Seizures (Atypical- Mechanical Ventilated) 17500.00
ESIC-347 Intra Cranial Bleed 28000.00

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ESIC-348 Acute Gastro Intestinal Bleed 21000.00
ESIC-349 Acute Pancreatitis 35000.00
ESIC-350 Acute Hepatitis With Hepatic Encephalopathy 35000.00
ESIC-351 Acute Renal Failure 28000.00
ESIC-352 Diabetic Ketoacidosis 21000.00
ESIC-353 Septic Shock 35000.00
ESIC-354 Snake Bite Requiring Ventilatory Assistance 35000.00
Scorpion Sting With Myocarditis And Cardiogenic
ESIC-355 Shock Requiring Ventilatory Assistance 17500.00
Poison Ingestion/ Aspiration Requiring Ventilatory
ESIC-356 Assistance 28000.00
GENERAL PEDIATRICS
Acute Broncho/ Lobarpneumonia With Empyema/
ESIC-357 Pleural Effusion 14000.00
Acute Broncho/Lobarpneumonia With Pyo
ESIC-358 Pneumothorax 14000.00
Urinary Tract Infection With Complications Like
ESIC-359 Pyelonephritis And Renal Failure 10500.00
Congenital Heart Disease With Congestive Cardiac
ESIC-360 Failure 10500.00
Acquired Heart Disease With Congestive Cardiac
ESIC-361 Failure 10500.00
ESIC-362 Viral Myocarditis 10500.00
Steroid Resistant Nephrotic Syndrome Complicated Or
ESIC-363 Resistant 17500.00
ESIC-364 Acute Renal Failure 7000.00
ESIC-365 Acute Renal Failure With Dialysis 14000.00
ESIC-366 Thalassemia Major Requiring Chelation Therapy 14000.00
ESIC-367 Haemophillia Including Von Willibrands 14000.00
ESIC-368 Anemia Of Unknown Cause 7000.00
ESIC-369 Pyogenic Meningitis 24500.00
ESIC-370 Neuro Tuberculosis 7000.00
ESIC-371 Neuro Tuberculosis With Ventilation 14000.00
ESIC-372 Enteric Fever Complicated 7000.00
ESIC-373 Cerebral Malaria (Falciparum) 7000.00
ESIC-374 Convulsive Disorders/Status Epilepticus (Fits) 7000.00
ESIC-375 Stroke Syndrome 14000.00
ESIC-376 Encephalitis / Encephalopathy 10500.00
ESIC-377 Guillian-Barre Syndrome 42000.00
CARDIOLOGY
Acute MI (Conservative Management Without
ESIC-378 Angiogram) 14000.00
Acute MI (Conservative Management With
ESIC-379 Angiogram) 21000.00
ESIC-380 Acute Mi With Cardiogenic Shock 21000.00
ESIC-381 Acute Mi Requiring Iabp Pump 35000.00
ESIC-382 Refractory Cardiac Failure 21000.00
ESIC-383 Infective Endocarditis 17500.00
ESIC-384 Pulmonary, Embolism 21000.00
ESIC-385 Complex Arrhythmias 66500.00
ESIC-386 Simple Arrythmias 49000.00
ESIC-387 Pericardial Effusion, Tamponade 17500.00
NEPHROLOGY
ESIC-388 Acute Renal Failure-(ARF) 14000.00
ESIC-389 Nephrotic Syndrome 10500.00
ESIC-390 Rapidly Progressive Renal Failure (RPRF) 24500.00
ESIC-391 Chronic Renal Failure 1 (CRF) 10500.00
ESIC-392 Maintenance Hemodialysis For CRF 7000.00

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NEUROLOGY
ESIC-393 ADEM Or Relapse In Multiple Sclerosis 14000.00
ESIC-394 Neuropathies (GBS) 24500.00
ESIC-395 Optic Neuritis 7000.00
ESIC-396 Immunoglobulin Therapy - LV 70000.00
ESIC-397 CIDP 5600.00
ESIC-398 Hemorrhagic Stroke/Strokes 17500.00
ESIC-399 Ischemic Strokes 14000.00
ESIC-400 Myopathies - Acquired 10500.00
ESIC-401 Neuroinfections -Fungal Meningitis 28000.00
ESIC-402 Neuroinfections -Pyogenic Meningitis 17500.00
Neuroinfections -Viral Meningoencephalitis ( Including
ESIC-403 Herpes Encephalitis) 17500.00
ESIC-404 Neuromuscular (Myasthenia Gravis) 10500.00
PULMONOLOGY
Bronchiectasis With Repeated Hospitalisation>6per
ESIC-405 Year 14000.00
ESIC-406 Lung Abscess ,Non Resolving 10500.00
ESIC-407 Pneumothorax ( Large/Recurrent) 24500.00
ESIC-408 Interstitial Lung Diseases 21000.00
ESIC-409 Pneumoconiosis 17500.00
ESIC-410 Acute Respiratory Failure ( Without Ventilator) 17500.00
ESIC-411 Acute Respiratory Failure ( With Ventilator) 35000.00
DERMATOLOGY
ESIC-412 Pemphigus /Pemphigoid 17500.00
ESIC-413 Toxic Epidermal Necrolysis 21000.00
ESIC-414 Stevens- Johnson Syndrome 14000.00
RHEUMATOLOGY
ESIC-415 SLE (Systemic Lupus Erythematosis) 10500.00
ESIC-416 SLE With Sepsis 35000.00
ESIC-417 Scleroderma 10500.00
ESIC-418 Mctd Mixed Connective Tissue Disorder 10500.00
ESIC-419 Primary Sjogren'S Syndrome 10500.00
ESIC-420 Vasculitis 7000.00
ENDOCRINOLOGY
ESIC-421 Pyelonephritis 14000.00
ESIC-422 Lower Respiratoy Tract Infection 14000.00
ESIC-423 Fungal Sinusitis 28000.00
ESIC-424 Cholecystitis 17500.00
ESIC-425 Cavernous Sinus Thrombosis 28000.00
ESIC-426 Rhinocerebral Mucormycosis 28000.00
OTHER ENDOCRINAL DISORDERS
ESIC-427 Hypopitutarism 70000.00
ESIC-428 Pituitary - Acromegaly 10500.00
ESIC-429 Cushings Syndrome 21000.00
Delayed Puberty Hypogonadism(Ex.Turners Synd,
ESIC-430 Kleinfelter Synd) 8400.00
GASTROENTEROLOGY
ESIC-431 Corrosive Oesophageal Injury 14000.00
ESIC-432 Acute Pancreatitis (Mild) 52500.00
ESIC-433 Acute Pancreatitis (Severe) 105000.00
ESIC-434 Acute Pancreatitis With Pseudocyst (Infected) 21000.00
ESIC-435 Chronic Pancreatitis With Severe Pain 14000.00
ESIC-436 Obscure Gi Bleed 35000.00
ESIC-437 Cirrhosis With Hepatic Encephalopathy 21000.00
ESIC-438 Cirrhosis With Hepato Renal Syndrome 28000.00
ESIC-439 1)Post Op Stent 35000.00

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ESIC-440 2)Post Op Leaks 52500.00
ESIC-441 3)Sclerosing Cholangitis 52500.00
ESIC-442 Oesophageal Foreign Body 3500.00
ESIC-443 Oesophageal Perforation 17500.00
ESIC-444 Achalasia Cardia 4900.00
ESIC-445 Oesophageal Varices,Variceal Banding 7000.00
ESIC-446 Oesophageal Varices, Sclerotherapy 3500.00
ESIC-447 Oesophageal Fistula 21000.00
ESIC-448 Gave (Gastric Antral Vascular Ectasia) 14000.00
ESIC-449 Gastric Varices 10500.00

Care has been taken to finalize the list(Annexure II). If any package
treatment is also available in CGHS rates (Annexure I) the same
and the T&C of CGHS shall be applicable and not in the nnexure II.
The package rates given in Annexure II are applicapable for non
NABH accredited hospitals. 10% charges shall be paid extra to
NABH acredited and super speciality hospital if treatment is availed
at these hospitals after proper referral/permission

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