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Days | BS Description E | ICD | IOS BS | CPT | PACKAGE | Price | Center |
|---|---|---|---|---|---|---|---|
3 | UNILATERAL REPAIR OF CRUCIATE LIGAMENT (ARTHROTOMY | 49539-00[1522] | 620825 | 4953900 | Y | 11,880.00 | |
2 | UNILATERAL SIMPLE MASTECTOMY | 31518-00[1748] | 620826 | 3151800 | Y | 9,504.00 | |
0 | 1ST STAGE - GASTROSCHISIS/OMPHALOS | K25.9 | 630001 | 5,000.00 | |||
0 | 2ND STAGE - GASTROSCHISIS/OMPHALOS | K25.9 | 630002 | 5,600.00 | |||
0 | ANAL FUSTULOTOMY | 90315-01[933] | 630003 | 3215900 | 1,800.00 | ||
0 | ANAL SKIN TAG-EXCISION | 31205-00[1620] | 630004 | 3214200 | 1,700.00 | ||
0 | ANORECTOPLASTY - HIGH | 43966-00[938] | 630005 | 4396600 | 6,200.00 | ||
0 | ANORECTOPLASTY - LOW | 43966-00[938] | 630006 | 4396600 | 3,900.00 | ||
0 | APNOEA ALARM / DAY | 43801-00[916] | 630007 | 80 | |||
0 | BAKER'S CYST EXCISION | 30114-00[1505] | 630008 | 3011400 | 3,300.00 | ||
0 | BRANCHIAL CYST/FISTULA EXCISION | 30286-00[421] | 630009 | 3028600 | 4,600.00 | ||
0 | BROVIAC INSERTION (PER-CATH) | 34528-02[766] | 630010 | 3452802 | 2,000.00 |
UNILATERAL REPAIR OF CRUCIATE LIGAMENT (ARTHROTOMY
11,880.00
UNILATERAL SIMPLE MASTECTOMY
9,504.00
1ST STAGE - GASTROSCHISIS/OMPHALOS
5,000.00
2ND STAGE - GASTROSCHISIS/OMPHALOS
5,600.00
ANAL FUSTULOTOMY
1,800.00
ANAL SKIN TAG-EXCISION
1,700.00
ANORECTOPLASTY - HIGH
6,200.00
ANORECTOPLASTY - LOW
3,900.00
APNOEA ALARM / DAY
80
BAKER'S CYST EXCISION
3,300.00
BRANCHIAL CYST/FISTULA EXCISION
4,600.00
BROVIAC INSERTION (PER-CATH)
2,000.00
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