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Days | BS Description E | ICD | IOS BS | CPT | PACKAGE | Price | Center |
|---|---|---|---|---|---|---|---|
0 | CONJUNCTIVOPLASTY- W/CONJUNCTIVAL GRAFT | 42641-00[255] | 420067 | 4264100 | 2,000.00 | ||
(AUTOGRAFT) | |||||||
0 | CONJUNCTIVOPLASTY/ RECONSTRUCTION W/ CONJUNCTIVAL GRAFT | 42641-00[255] | 420068 | 4264100 | 3,600.00 | ||
0 | CONJUNCTIVORHINOSTOMY W/ INSERTION OF TUBE/ STENT | 90092-00[247] | 420069 | 9009200 | 4,000.00 | ||
0 | CORNEA TATOOING | 90066-00 | 420070 | 1,700.00 | |||
0 | CORNEA ULCER TREATMENT (CHEMO/THERMO CAUTERIZATION/ CHELATING AGENT) | 42677-01[168] | 420071 | 4267701 | 2,800.00 | ||
0 | CORNEAL FB DEEP(G.A.) | 42644-04 | 420072 | 2,600.00 | |||
0 | CORNEAL FB SUPERFICIAL (L.A.) | 30061-021 | 420073 | 390 | |||
0 | CORNEAL GLUEING | 42632-001 | 420074 | 860 | |||
4 | CORNEAL GRAFT SUTURE REMOVAL | 64-00[173]42668-00[ | 420075 | 9006400 | Y | 2,250.00 | |
4 | CORNEAL GRAFT W/ CATARACT EXTRACTION | 64-00[173]42698-02[ | 420076 | 9006400 | Y | 13,500.00 | |
4 | CORNEAL GRAFT(P. KERATOPLASTY) | 90064-00[173] | 420077 | Y | 13,500.00 |
CONJUNCTIVOPLASTY- W/CONJUNCTIVAL GRAFT
2,000.00
(AUTOGRAFT)
CONJUNCTIVOPLASTY/ RECONSTRUCTION W/ CONJUNCTIVAL GRAFT
3,600.00
CONJUNCTIVORHINOSTOMY W/ INSERTION OF TUBE/ STENT
4,000.00
CORNEA TATOOING
1,700.00
CORNEA ULCER TREATMENT (CHEMO/THERMO CAUTERIZATION/ CHELATING AGENT)
2,800.00
CORNEAL FB DEEP(G.A.)
2,600.00
CORNEAL FB SUPERFICIAL (L.A.)
390
CORNEAL GLUEING
860
CORNEAL GRAFT SUTURE REMOVAL
2,250.00
CORNEAL GRAFT W/ CATARACT EXTRACTION
13,500.00
CORNEAL GRAFT(P. KERATOPLASTY)
13,500.00
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