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Days | BS Description E | ICD | IOS BS | CPT | PACKAGE | Price | Center |
|---|---|---|---|---|---|---|---|
(ICCE) W/O IOL1 | |||||||
1 | BILATERAL LAMELLAR KERATOPLASTY WITH AUTOGRAFT1 | 59-00[173].42659-00[ | 420017 | 4265900 | Y | 12,375.00 | |
1 | BILATERAL OHACO + IOL + TRABECULECTOMY1 | 02-05[197]42746-04[ | 420018 | 4270206 | Y | 13,860.00 | |
1 | BILATERAL PENETRATING KERATOPLASTY | 53-00[173]42653-00[ | 420019 | 4265300 | Y | 13,098.00 | |
1 | BILATERAL PHACOEMULSIFICATION and ASPIRATION WITH IOL | 98-02[197]42698-02[ | 420020 | 4269802 | Y | 11,385.00 | |
1 | BILATERAL PHACOEMULSIFICATION *ASPIRATION OF CATARACT W/ O IOL1 | 98-02[197]42698-02[ | 420021 | 4269802 | Y | 8,910.00 | |
1 | BILATERAL PROBING OF LACRIMAL PUNCTUM1 | 42615-01[241] | 420022 | 4261501 | Y | 2,970.00 | |
3 | BILATERAL REPAIR OF ECTROPION OR ENTROPION1 | 26-00[239]45626-00[ | 420023 | 4562600 | Y | 4,455.00 | |
5 | BILATERAL TRABECULECTOMY AB-EXTERNO (INTRA | 46-04[191]42746-04[ | 420024 | 4274604 | Y | 7,425.00 | |
0 | BIOPSY � CORNEA | 42692-01[169] | 420025 | 4269201 | 480 | ||
0 | BIOPSY - EYE LID | 30071-02[232] | 420026 | 3007102 | 1,280.00 | ||
1 | BIOPSY EYEBALL AND ORBIT | 42533-01[224] | 420027 | 4253301 | Y | 7,500.00 |
(ICCE) W/O IOL1
BILATERAL LAMELLAR KERATOPLASTY WITH AUTOGRAFT1
12,375.00
BILATERAL OHACO + IOL + TRABECULECTOMY1
13,860.00
BILATERAL PENETRATING KERATOPLASTY
13,098.00
BILATERAL PHACOEMULSIFICATION and ASPIRATION WITH IOL
11,385.00
BILATERAL PHACOEMULSIFICATION *ASPIRATION OF CATARACT W/ O IOL1
8,910.00
BILATERAL PROBING OF LACRIMAL PUNCTUM1
2,970.00
BILATERAL REPAIR OF ECTROPION OR ENTROPION1
4,455.00
BILATERAL TRABECULECTOMY AB-EXTERNO (INTRA
7,425.00
BIOPSY � CORNEA
480
BIOPSY - EYE LID
1,280.00
BIOPSY EYEBALL AND ORBIT
7,500.00
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