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Days | BS Description E | ICD | IOS BS | CPT | PACKAGE | Price | Center |
|---|---|---|---|---|---|---|---|
0 | ORTHODONTIC RECORDS | 320203 | 800 | ||||
0 | ORTHOGNATHIC SURG MAXILLA LEFORT | 320204 | 16,100.00 | ||||
0 | ORTHOGNATIC SURG MAND ADV/PUSH | 320205 | 16,100.00 | ||||
0 | OSTEOTOMY - FACIAL BONE, COMPLEX | 320206 | 4,000.00 | ||||
0 | OSTEOTOMY - FACIAL BONE, SIMPLE | 320207 | 3,200.00 | ||||
0 | PANORAMIC RADIOGRAPHY (OPG) | 320208 | 220 | ||||
0 | PANORAMIC X-RAY WITHOUT EXAM | 320209 | 160 | ||||
0 | PARA POST FOR ROOT CANAL | 320210 | 450 | ||||
0 | PARTIAL DENTURE REMOVAL (FOR CHILD) | 320211 | 400 | ||||
0 | PARTIAL FIXED APP./ARCH | 320212 | 2,900.00 | ||||
0 | EXTRACTION - SINGLE TOOTH, REQUIRING INCISION | 320119 | 2004240 | 360 | |||
OF OVERLYING SOFT TISSUE, ELEVATION OF FLAP, REMOVAL OF BONE + SECTIONING |
ORTHODONTIC RECORDS
800
ORTHOGNATHIC SURG MAXILLA LEFORT
16,100.00
ORTHOGNATIC SURG MAND ADV/PUSH
16,100.00
OSTEOTOMY - FACIAL BONE, COMPLEX
4,000.00
OSTEOTOMY - FACIAL BONE, SIMPLE
3,200.00
PANORAMIC RADIOGRAPHY (OPG)
220
PANORAMIC X-RAY WITHOUT EXAM
160
PARA POST FOR ROOT CANAL
450
PARTIAL DENTURE REMOVAL (FOR CHILD)
400
PARTIAL FIXED APP./ARCH
2,900.00
EXTRACTION - SINGLE TOOTH, REQUIRING INCISION
360
OF OVERLYING SOFT TISSUE, ELEVATION OF FLAP, REMOVAL OF BONE + SECTIONING
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