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Days | BS Description E | ICD | IOS BS | CPT | PACKAGE | Price | Center |
|---|---|---|---|---|---|---|---|
0 | B/B-PERCUT TREPHINE UNSPECIED | 620166 | 1,700.00 | ||||
0 | B/I-REM WIRE SCREW STAPLE BOLT | 620167 | 3,800.00 | ||||
0 | BIFOCAL BONE LENGTH/TRANSPORT | 620168 | 19,400.00 | ||||
2 | BIL.BUNIONECTOMY and OSTEOTOMY FIRST METATARSA; | 3-00[1547]$49833-00[ | 620169 | 4983300 | Y | 6,930.00 | |
2 | BIL.EXC. OR DESTR. OF LESION SUBMUCOUS DIATHR. | 74-00[374]$41674-00[ | 620170 | 4167400 | Y | 2,970.00 | |
3 | BIL.OPEN REDUCT. OF # W/ INT. FIX. (RADIUS and | 4-02[1429]$47384-02[ | 620171 | 4738402 | Y | 13,365.00 | |
3 | BILATERAL ARHTROSCOPIC ACL RECONTRUCTION | 9-00[1522]49539-00[ | 620172 | 4953900 | Y | 16,335.00 | |
INCLUDE. SH | |||||||
3 | BILATERAL ARTHROSCOPIC ACL RECONTRUCTION + | 9-00[1522]49539-00[1522] | 620173 | Y | 18,810.00 | ||
3 | BILATERAL ARTHROSCOPY and SHAVING (ANY JOINT)1 | 8-00[1503]49558-00[ | 620174 | 4955800 | Y | 7,920.00 | |
2 | BILATERAL CALDWELL LUC. ANTROSTOMY1 | 10-00[387]41710-00[ | 620175 | 4171000 | Y | 5,445.00 | |
2 | BILATERAL CORRECTION SYNDACTYLY1 | 3-00[1655]90673-00[ | 620176 | 9067300 | Y | 8,910.00 |
B/B-PERCUT TREPHINE UNSPECIED
1,700.00
B/I-REM WIRE SCREW STAPLE BOLT
3,800.00
BIFOCAL BONE LENGTH/TRANSPORT
19,400.00
BIL.BUNIONECTOMY and OSTEOTOMY FIRST METATARSA;
6,930.00
BIL.EXC. OR DESTR. OF LESION SUBMUCOUS DIATHR.
2,970.00
BIL.OPEN REDUCT. OF # W/ INT. FIX. (RADIUS and
13,365.00
BILATERAL ARHTROSCOPIC ACL RECONTRUCTION
16,335.00
INCLUDE. SH
BILATERAL ARTHROSCOPIC ACL RECONTRUCTION +
18,810.00
BILATERAL ARTHROSCOPY and SHAVING (ANY JOINT)1
7,920.00
BILATERAL CALDWELL LUC. ANTROSTOMY1
5,445.00
BILATERAL CORRECTION SYNDACTYLY1
8,910.00
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