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Days | BS Description E | ICD | IOS BS | CPT | PACKAGE | Price | Center |
|---|---|---|---|---|---|---|---|
2 | TOTAL DACROCYSTECTOM1 | 42596-01[246] | 420421 | 4259601 | Y | 4,950.00 | |
0 | TOTAL VITRECTOMY | 42719-011 | 420422 | 5,000.00 | |||
0 | TRABECULECTOMY- AB EXTERNO | 42746-04[191] | 420423 | 4274604 | 2,800.00 | ||
2 | TRABECULECTOMY W/ PERIPHERAL IREDECTOMY | 46-04[191]42764-04[ | 420424 | 4274604 | Y | 9,000.00 | |
2 | TRABECULOTOMY | 42746-04[191] | 420426 | 4274604 | Y | 7,500.00 | |
0 | TRABECULOTOMY- AB EXTERNO | 42746-04[191] | 420427 | 2,000.00 | |||
0 | TRABUCULECTOMY -( FOR GLAUCOMA ) | 42746-04[191] | 420428 | 2,400.00 | |||
0 | TRICHIASIS CRYOPEXY | 42587-001 | 420429 | 590 | |||
0 | TRICHIASIS ELECTROLYSIS | 42587-021 | 420430 | 590 | |||
0 | TRICHIASIS EPILATION | 42587-04 | 420431 | 130 | |||
0 | REMOVAL- ORBITAL CONTENTS | 42536-00[225] | 420338 | 4253600 | 4,400.00 | ||
0 | REMOVAL POST CATARACT SUTURE / OR CORNEAL | 42668-00[166] | 420339 | 4266800 | 280 |
TOTAL DACROCYSTECTOM1
4,950.00
TOTAL VITRECTOMY
5,000.00
TRABECULECTOMY- AB EXTERNO
2,800.00
TRABECULECTOMY W/ PERIPHERAL IREDECTOMY
9,000.00
TRABECULOTOMY
7,500.00
TRABECULOTOMY- AB EXTERNO
2,000.00
TRABUCULECTOMY -( FOR GLAUCOMA )
2,400.00
TRICHIASIS CRYOPEXY
590
TRICHIASIS ELECTROLYSIS
590
TRICHIASIS EPILATION
130
REMOVAL- ORBITAL CONTENTS
4,400.00
REMOVAL POST CATARACT SUTURE / OR CORNEAL
280
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