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Days
BS Description E
ICD
IOS BS
CPT
PACKAGE
Price
Center
0
POLYDACTYL 2 FINGERS
47906-01[1632]
640091
4790601
5,600.00
0
POLYDACTYLY (1 FINGER)-SIMPLE
47906-01[1632]
640092
4790601
1,900.00
0
PROMINENT EARS (BILATERAL)
45665-021
640093
7,700.00
0
PROMINENT EARS (UNILATERAL)
45665-021
640094
5,200.00
0
PTOSIS (BILATERAL)
45588-001
640095
5,800.00
0
REFASHIO.OF AMPUTATION STUMP
90675-001
640096
4,800.00
0
RELEASE CONTRACT.BY SG (MAJ)
45519-001
640097
7,700.00
0
RELEASE CONTRACT.BY SG (MED)
45519-001
640098
5,800.00
0
RELEASE CONTRACT.BY SG (SM)
45519-001
640099
3,200.00
0
RELEASE CONTRACT.Z-PLAST(SM)
45519-001
640100
2,600.00
0
RELEASE CONTRCT.ZPLASTY(MAJ)
45519-001
640101
5,600.00
0
RELEASE CONTRCT.ZPLASTY(MED)
45519-001
640102
4,000.00
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