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Days | BS Description E | ICD | IOS BS | CPT | PACKAGE | Price | Center |
|---|---|---|---|---|---|---|---|
0 | ORTHO TREATMENT OF EXTRACTION | 320194 | 15,500.00 | ||||
CASE(PREMOLARS) | |||||||
0 | ORTHO TREATMENT U/L FIXED (COMPLEX) | 320195 | 15,500.00 | ||||
0 | ORTHO TREATMENT U/L FIXED (MODERATE) | 320196 | 12,900.00 | ||||
0 | ORTHO TREATMENT U/L FIXED (SIMPLE) | 320197 | 10,300.00 | ||||
0 | ORTHO TREATMENT U/L FIXED W/ | 320198 | 18,100.00 | ||||
IMPACT.TOOTH(BILATERAL) | |||||||
0 | ORTHO TREATMENT U/L FIXED W/ | 320199 | 15,500.00 | ||||
IMPACT.TOOTH(SINGLE) | |||||||
0 | ORTHO, FOLLOW UP/ MAINTENANCE FEE | 320200 | 240 | ||||
0 | ORTHODONTIC - COPY OF X-RAY AND MOLD | 320201 | 200 | ||||
0 | ORTHODONTIC � REMOVABLE | 320202 | 3,200.00 |
ORTHO TREATMENT OF EXTRACTION
15,500.00
CASE(PREMOLARS)
ORTHO TREATMENT U/L FIXED (COMPLEX)
15,500.00
ORTHO TREATMENT U/L FIXED (MODERATE)
12,900.00
ORTHO TREATMENT U/L FIXED (SIMPLE)
10,300.00
ORTHO TREATMENT U/L FIXED W/
18,100.00
IMPACT.TOOTH(BILATERAL)
ORTHO TREATMENT U/L FIXED W/
15,500.00
IMPACT.TOOTH(SINGLE)
ORTHO, FOLLOW UP/ MAINTENANCE FEE
240
ORTHODONTIC - COPY OF X-RAY AND MOLD
200
ORTHODONTIC � REMOVABLE
3,200.00
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