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Days
BS Description E
ICD
IOS BS
CPT
PACKAGE
Price
Center
0
Aspiration or Joint Injection
50124-01[1552]
760012
5012401
150
0
Below Elbow U.L. Prostheses (Cosmetic Hand)
760013
4,000.00
0
Below Elbow U.L. Prostheses (Dynamic Hand)
760014
4,000.00
0
Below Knee Lower Limb (Modular)
760015
5,000.00
0
Below Knee Lower Limb (Wood)
760016
5,000.00
0
Boston Brace
96092-00[1870]
760017
9609200
800
0
Both Knees Joints Replacement Surgery Program
49519-00[1518]
760018
106,400.00
0
Chest Physiotherapy
95550-03[1916]
760019
9555003
60
0
CHEST PHYSIOTHERAPY+BREATH. EX.
95550-03[1916]
760020
9555003
50
0
Children Plastic Splint Orthoplast
96092-00[1870]
760021
9609200
300
0
Children Plastic Splint Polypropylene
96092-00[1870]
760022
9609200
300
0
CHOLEDOCHOSCOPE ( INTRAOPERATIVE)
30442-00[957]
760023
3,200.00
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