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Days | BS Description E | ICD | IOS BS | CPT | PACKAGE | Price | Center |
|---|---|---|---|---|---|---|---|
2 | UNILATERAL PROBING OF LACRIMAL PUNCTUM1 | 42614-01[241] | 420446 | 4261401 | Y | 2,475.00 | |
2 | UNILATERAL REPAIR OF ECTROPION OR ENTROPION1 | 42581-00[239] | 420447 | 4258100 | Y | 2,970.00 | |
2 | UNILATERAL TRABECULECTOMY AB-EXTERNO (INTRA CAPSULAR)1 | 42746-04[191] | 420448 | 4274604 | Y | 4,950.00 | |
0 | VISION CHECK-UP - BOTH EYES | 420449 | 9603800 | 160 | |||
0 | VISUAL FIELD EXAMINATION- EXTENDED EXAMINATION | 420450 | 1122100 | 200 | |||
0 | VITR. TAP | 42740-011 | 420451 | 710 | |||
0 | VITRECTOMY � POSTERIOR | 42722-01[207] | 420452 | 3,200.00 | |||
0 | VITRECTOMY � SUBTOTAL | 42722-01[207] | 420453 | 4272201 | 4,000.00 | ||
0 | VITRECTOMY- ANTERIOR | 42719-01[207] | 420454 | 4271901 | 2,800.00 | ||
0 | VITREOUS TAP/ ASPIRATION | 42740-05[204] | 420455 | 1,600.00 | |||
0 | ATTEND HIGH RISK DEL PAED CONS | 430001 | 200 | ||||
0 | ATTEND HIGH RISK DEL PAED REG. | 430002 | 100 |
UNILATERAL PROBING OF LACRIMAL PUNCTUM1
2,475.00
UNILATERAL REPAIR OF ECTROPION OR ENTROPION1
2,970.00
UNILATERAL TRABECULECTOMY AB-EXTERNO (INTRA CAPSULAR)1
4,950.00
VISION CHECK-UP - BOTH EYES
160
VISUAL FIELD EXAMINATION- EXTENDED EXAMINATION
200
VITR. TAP
710
VITRECTOMY � POSTERIOR
3,200.00
VITRECTOMY � SUBTOTAL
4,000.00
VITRECTOMY- ANTERIOR
2,800.00
VITREOUS TAP/ ASPIRATION
1,600.00
ATTEND HIGH RISK DEL PAED CONS
200
ATTEND HIGH RISK DEL PAED REG.
100
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