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Days | BS Description E | ICD | IOS BS | CPT | PACKAGE | Price | Center |
|---|---|---|---|---|---|---|---|
0 | SPLIT SKIN GRAFT APPLICAT(M)GA | 90668-011 | 640128 | 3,000.00 | |||
2 | SURGICAL EXCISION OF WART | 30189-01[1619] | 640129 | 3018901 | Y | 750 | |
0 | SYNDACTYLY 2 FINGERS | 90673-001 | 640130 | 4,000.00 | |||
0 | SYNDACTYLY 3 FINGERS | 90673-001 | 640131 | 5,600.00 | |||
0 | SYNDACTYLY 4 FINGERS | 90673-001 | 640132 | 9,500.00 | |||
0 | TANGEN EXC BURN & SSG MODERATE | 90675-001 | 640133 | 5,400.00 | |||
0 | TENDON GRAFT (ADDED) | 45439-00 | 640134 | 2,700.00 | |||
0 | TENDON GRAFT (SINGLE) | 45439-00 | 640135 | 7,500.00 | |||
0 | EAR RECONSTRUCTION - STAGE II | 45206-03 | 640035 | 9,700.00 | |||
0 | EAR RECONSTRUCTION - STAGE III | 45206-03 | 640036 | 9,700.00 | |||
3 | ELECTOCAUTERY OF WART | 30189-01[1619] | 640037 | 3018901 | Y | 450 | |
0 | EXCISION OF NEUROMA | 90676-001 | 640038 | 4,300.00 |
SPLIT SKIN GRAFT APPLICAT(M)GA
3,000.00
SURGICAL EXCISION OF WART
750
SYNDACTYLY 2 FINGERS
4,000.00
SYNDACTYLY 3 FINGERS
5,600.00
SYNDACTYLY 4 FINGERS
9,500.00
TANGEN EXC BURN & SSG MODERATE
5,400.00
TENDON GRAFT (ADDED)
2,700.00
TENDON GRAFT (SINGLE)
7,500.00
EAR RECONSTRUCTION - STAGE II
9,700.00
EAR RECONSTRUCTION - STAGE III
9,700.00
ELECTOCAUTERY OF WART
450
EXCISION OF NEUROMA
4,300.00
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