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Days | BS Description E | ICD | IOS BS | CPT | PACKAGE | Price | Center |
|---|---|---|---|---|---|---|---|
0 | BURN DRESSING - MEDIUM (GA) | 90676-001 | 640011 | 2,200.00 | |||
0 | BURN DRESSING - SMALL | 90676-001 | 640012 | 110 | |||
0 | BURN DRESSING - SMALL (GA) | 90676-001 | 640013 | 1,300.00 | |||
0 | BURN DRESSING -MEDIUM | 90676-001 | 640014 | 160 | |||
1 | BURSOTOMY OF HAND | 90568-01[1559] | 640015 | 9056801 | Y | 3,168.00 | |
0 | CARTILAGE GRAFT | 45593-001 | 640016 | 6,500.00 | |||
0 | CLEFT LIP (BILATERAL) | 45683-001 | 640017 | 7,700.00 | |||
0 | CLEFT LIP (UNILATERAL) | 45677-001 | 640018 | 6,200.00 | |||
0 | CLEFT PALATE - EACH STAGE | 45707-001 | 640019 | 4,600.00 | |||
0 | CLEFT PALATE (COMPLETE) | 45707-001 | 640020 | 9,000.00 | |||
0 | CLEFT PALATE (INCOMPLETE) | 45707-001 | 640021 | 6,500.00 | |||
0 | CROSS FINGER FLAP - GA | 45707-001 | 640022 | 5,400.00 |
BURN DRESSING - MEDIUM (GA)
2,200.00
BURN DRESSING - SMALL
110
BURN DRESSING - SMALL (GA)
1,300.00
BURN DRESSING -MEDIUM
160
BURSOTOMY OF HAND
3,168.00
CARTILAGE GRAFT
6,500.00
CLEFT LIP (BILATERAL)
7,700.00
CLEFT LIP (UNILATERAL)
6,200.00
CLEFT PALATE - EACH STAGE
4,600.00
CLEFT PALATE (COMPLETE)
9,000.00
CLEFT PALATE (INCOMPLETE)
6,500.00
CROSS FINGER FLAP - GA
5,400.00
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