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Days | BS Description E | ICD | IOS BS | CPT | PACKAGE | Price | Center |
|---|---|---|---|---|---|---|---|
0 | Aspiration or Joint Injection | 50124-01[1552] | 760012 | 5012401 | 150 | ||
0 | Below Elbow U.L. Prostheses (Cosmetic Hand) | 760013 | 4,000.00 | ||||
0 | Below Elbow U.L. Prostheses (Dynamic Hand) | 760014 | 4,000.00 | ||||
0 | Below Knee Lower Limb (Modular) | 760015 | 5,000.00 | ||||
0 | Below Knee Lower Limb (Wood) | 760016 | 5,000.00 | ||||
0 | Boston Brace | 96092-00[1870] | 760017 | 9609200 | 800 | ||
0 | Both Knees Joints Replacement Surgery Program | 49519-00[1518] | 760018 | 106,400.00 | |||
0 | Chest Physiotherapy | 95550-03[1916] | 760019 | 9555003 | 60 | ||
0 | CHEST PHYSIOTHERAPY+BREATH. EX. | 95550-03[1916] | 760020 | 9555003 | 50 | ||
0 | Children Plastic Splint Orthoplast | 96092-00[1870] | 760021 | 9609200 | 300 | ||
0 | Children Plastic Splint Polypropylene | 96092-00[1870] | 760022 | 9609200 | 300 | ||
0 | CHOLEDOCHOSCOPE ( INTRAOPERATIVE) | 30442-00[957] | 760023 | 3,200.00 |
Aspiration or Joint Injection
150
Below Elbow U.L. Prostheses (Cosmetic Hand)
4,000.00
Below Elbow U.L. Prostheses (Dynamic Hand)
4,000.00
Below Knee Lower Limb (Modular)
5,000.00
Below Knee Lower Limb (Wood)
5,000.00
Boston Brace
800
Both Knees Joints Replacement Surgery Program
106,400.00
Chest Physiotherapy
60
CHEST PHYSIOTHERAPY+BREATH. EX.
50
Children Plastic Splint Orthoplast
300
Children Plastic Splint Polypropylene
300
CHOLEDOCHOSCOPE ( INTRAOPERATIVE)
3,200.00
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