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Days | BS Description E | ICD | IOS BS | CPT | PACKAGE | Price | Center |
|---|---|---|---|---|---|---|---|
2 | ANTERIOR VITRECTOMY | 42719-01[207] | 420004 | 4271901 | Y | 5,250.00 | |
0 | ANTERIOR VITRECTOMY GA. | 42719-011 | 420005 | 3,900.00 | |||
0 | ANTERIOR VITREOUS TRIP | 420006 | 4271901 | 1,500.00 | |||
0 | AQUEOUS SHUNT TO EXTRA OCULAR RESERVIOR | 420007 | 4275200 | 2,800.00 | |||
0 | OTHER INCI OF VUL & PERI-LA | 90446-001 | 400172 | 540 | |||
0 | OTHER INCISION OF VULVA OR PERINEUM (2 DAYS | 400173 | 9043900 | 4,400.00 | |||
PACKAGE) | |||||||
0 | OTHER INTRAUTERINE DIAGNOSTIC PROCEDURE ON FETUS OPD | 400174 | 9048700 | 2,400.00 | |||
3 | OVARIAN CYSTECTOMY - | 35713-04[1244] | 400175 | 3571304 | Y | 7,425.00 | |
0 | OVARIAN CYSTECTOMY (LAP.) | 90431-031 | 400176 | 6,000.00 | |||
3 | OVARIAN CYSTECTOMY(LAP) | 35638-04[1244] | 400177 | 3563804 | Y | 10,500.00 | |
0 | OVARIOTOMY | 400179 | 3571701 | 4,800.00 |
ANTERIOR VITRECTOMY
5,250.00
ANTERIOR VITRECTOMY GA.
3,900.00
ANTERIOR VITREOUS TRIP
1,500.00
AQUEOUS SHUNT TO EXTRA OCULAR RESERVIOR
2,800.00
OTHER INCI OF VUL & PERI-LA
540
OTHER INCISION OF VULVA OR PERINEUM (2 DAYS
4,400.00
PACKAGE)
OTHER INTRAUTERINE DIAGNOSTIC PROCEDURE ON FETUS OPD
2,400.00
OVARIAN CYSTECTOMY -
7,425.00
OVARIAN CYSTECTOMY (LAP.)
6,000.00
OVARIAN CYSTECTOMY(LAP)
10,500.00
OVARIOTOMY
4,800.00
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