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Days | BS Description E | ICD | IOS BS | CPT | PACKAGE | Price | Center |
|---|---|---|---|---|---|---|---|
PHACOEMULSIFICATION, ASPIRATION | |||||||
0 | CDCR | 42629-001 | 420053 | 5,600.00 | |||
0 | COLOR FUNDUS PHOTOGRAPHY/PICTU | 420058 | 92250 | 80 | |||
0 | CONJ F B SUPERFICIAL | 30061-041 | 420059 | 130 | |||
0 | CONJ. PAPILLAE REMOVAL | 42683-001 | 420060 | 430 | |||
0 | CONJUCTIVOPLASTY- W/ BUCCAL MUCOUS | 90093-00[255] | 420061 | 9009300 | 3,600.00 | ||
MEMBRANE GRAFT | |||||||
0 | CONJUNCTIVAL AUTOGRAFT | 42641-011 | 420062 | 1,500.00 | |||
0 | CONJUNCTIVAL SWAB | 90089-001 | 420063 | 60 | |||
0 | CONJUNCTIVAL WOUND REPAIR G.A. | 42632-02 | 420064 | 1,800.00 | |||
0 | CONJUNCTIVAL WOUND REPAIR L.A. | 42632-02 | 420065 | 650 | |||
0 | CONJUNCTIVO DACRYOCYSTORHINOSTOMY | 42623-00[247] | 420066 | 4262300 | 4,000.00 |
PHACOEMULSIFICATION, ASPIRATION
CDCR
5,600.00
COLOR FUNDUS PHOTOGRAPHY/PICTU
80
CONJ F B SUPERFICIAL
130
CONJ. PAPILLAE REMOVAL
430
CONJUCTIVOPLASTY- W/ BUCCAL MUCOUS
3,600.00
MEMBRANE GRAFT
CONJUNCTIVAL AUTOGRAFT
1,500.00
CONJUNCTIVAL SWAB
60
CONJUNCTIVAL WOUND REPAIR G.A.
1,800.00
CONJUNCTIVAL WOUND REPAIR L.A.
650
CONJUNCTIVO DACRYOCYSTORHINOSTOMY
4,000.00
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