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Days | BS Description E | ICD | IOS BS | CPT | PACKAGE | Price | Center |
|---|---|---|---|---|---|---|---|
0 | SCHIRMER S TEST | 42503-001 | 420386 | 60 | |||
0 | SCHIRMERS TEST | 420387 | 40 | ||||
0 | SCLERAL FB DEEP | 42644-021 | 420388 | 2,800.00 | |||
0 | SCLERAL FB SUPERFICIAL | 30061-031 | 420389 | 320 | |||
0 | SCLERAL GRAFT | 90072-001 | 420390 | 6,500.00 | |||
0 | SCLERAL WOUND REPAIR | 42551-011 | 420391 | 2,600.00 | |||
2 | SECONDARY INSERTION OF I.O LENS PROSTHESIS | 42701-01[193] | 420392 | 4270101 | Y | 4,653.00 | |
W/O VITRECTOMY1 | |||||||
0 | SEVERING ADHESIONS OF ANTERIOR CHAMBER, | 90073-00[186] | 420393 | 9007300 | 1,200.00 | ||
LASER TECHNIQUE | |||||||
2 | SHORTENING PROCEDURE ON ONE EXTRAOCULAR MUSCLE | 42833-00[216] | 420394 | 4283300 | Y | 4,950.00 | |
0 | SLITLAMP EXAMINATION | 420395 | 80 |
SCHIRMER S TEST
60
SCHIRMERS TEST
40
SCLERAL FB DEEP
2,800.00
SCLERAL FB SUPERFICIAL
320
SCLERAL GRAFT
6,500.00
SCLERAL WOUND REPAIR
2,600.00
SECONDARY INSERTION OF I.O LENS PROSTHESIS
4,653.00
W/O VITRECTOMY1
SEVERING ADHESIONS OF ANTERIOR CHAMBER,
1,200.00
LASER TECHNIQUE
SHORTENING PROCEDURE ON ONE EXTRAOCULAR MUSCLE
4,950.00
SLITLAMP EXAMINATION
80
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