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Days | BS Description E | ICD | IOS BS | CPT | PACKAGE | Price | Center |
|---|---|---|---|---|---|---|---|
0 | COMPOSITE 1 SURFACE | 97521-01[466] | 320079 | 2002650 | 240 | ||
0 | COMPOSITE 2 SURFACE | 97522-01[466] | 320080 | 2002651 | 320 | ||
0 | COMPOSITE 3 SURFACE | 97523-01[466] | 320081 | 2002652 | 400 | ||
0 | CORONOIDECTOMY - BILATERAL | 320082 | 21070 | 11,600.00 | |||
0 | CORONOIDECTOMY - UNILATERAL | 320083 | 21070 | 5,800.00 | |||
3 | CORRECTION OF CLEFT PALATE1 | 45707-00[1690] | 320084 | 4570700 | Y | 9,900.00 | |
0 | CRYOTHERAPY OF NERVE | 52824-00[78] | 320085 | 2009212 | 2,600.00 | ||
0 | CYST REMOVAL � LA | 320086 | 2007450 | 960 | |||
0 | CYST REMOVAL �GA | 320087 | 2007450 | 1,600.00 | |||
0 | DEBONDING OF ORTHODONTIC APPLIANCE | 320088 | 20015101 | 650 | |||
0 | DECIDIOUS REST. G.I.C 1 SURFACE | 97551-01[466] | 320089 | 2002385 | 160 | ||
0 | DECIDIOUS REST. G.I.C 2 SURFACE | 97552-01[466] | 320090 | 2002385 | 200 |
COMPOSITE 1 SURFACE
240
COMPOSITE 2 SURFACE
320
COMPOSITE 3 SURFACE
400
CORONOIDECTOMY - BILATERAL
11,600.00
CORONOIDECTOMY - UNILATERAL
5,800.00
CORRECTION OF CLEFT PALATE1
9,900.00
CRYOTHERAPY OF NERVE
2,600.00
CYST REMOVAL � LA
960
CYST REMOVAL �GA
1,600.00
DEBONDING OF ORTHODONTIC APPLIANCE
650
DECIDIOUS REST. G.I.C 1 SURFACE
160
DECIDIOUS REST. G.I.C 2 SURFACE
200
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