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Days | BS Description E | ICD | IOS BS | CPT | PACKAGE | Price | Center |
|---|---|---|---|---|---|---|---|
1 | BRONCHOSCOPY WITH BRUSH BIOPSY | 41892-00[544] | 320051 | 418900 | Y | 6,750.00 | |
0 | CASTABLE CERAMICS ONLAY,SINGLE TOOTH | 320052 | 1,440.00 | ||||
0 | CASTED GOLD PONTIC | 320053 | 1,600.00 | ||||
0 | CASTED N/P METAL CROWN/RETAINR | 320054 | 1,300.00 | ||||
0 | CEMENTING MOLAR BAND | 320055 | 2008693 | 390 | |||
0 | CERAMIC FACIAL VENEER | 97672-00[473] | 320056 | 20029621 | 1,200.00 | ||
0 | CERAMIC REPAIR EACH | 320057 | 20015101 | 240 | |||
0 | CHARGES FOR G.A. (DENTAL) | 320058 | 1,300.00 | ||||
0 | CHEMICAL DESENSITIZATION PER TOOTH | 320059 | 2009110 | 130 | |||
0 | CHILD PROPHYLAXIS | 97111-00[453] | 320060 | 2001120 | 120 | ||
0 | CHILD PROPHYLAXIS, OH FLOUR | 320061 | 2001201 | 280 | |||
0 | CLASS I MALOCCLUSION CROWDED W/ROT-FIXED | 320062 | 10,300.00 |
BRONCHOSCOPY WITH BRUSH BIOPSY
6,750.00
CASTABLE CERAMICS ONLAY,SINGLE TOOTH
1,440.00
CASTED GOLD PONTIC
1,600.00
CASTED N/P METAL CROWN/RETAINR
1,300.00
CEMENTING MOLAR BAND
390
CERAMIC FACIAL VENEER
1,200.00
CERAMIC REPAIR EACH
240
CHARGES FOR G.A. (DENTAL)
1,300.00
CHEMICAL DESENSITIZATION PER TOOTH
130
CHILD PROPHYLAXIS
120
CHILD PROPHYLAXIS, OH FLOUR
280
CLASS I MALOCCLUSION CROWDED W/ROT-FIXED
10,300.00
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