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Days | BS Description E | ICD | IOS BS | CPT | PACKAGE | Price | Center |
---|---|---|---|---|---|---|---|
0 | Quality assurance testing and radiometric survey for C-arm Equipment | 900010 | 3,000.00 | ||||
0 | Quality assurance testing and radiometric survey for | 900011 | 5,000.00 | ||||
Computed Tomography Equipment | |||||||
0 | Quality assurance testing and radiometric survey for Dental | 900012 | 3,000.00 | ||||
Panoramic Radiography Equipment | |||||||
0 | Quality assurance testing and radiometric survey for Digital | 900013 | 4,000.00 | ||||
and Conventional X-Ray Equipment | |||||||
0 | Quality assurance testing and radiometric survey for Fluoroscopy Equipment | 900014 | 5,000.00 | ||||
0 | Quality assurance testing and radiometric survey for Mommogram Equipment | 900015 | 4,500.00 | ||||
0 | Quality assurance testing and radiometric survey for Portable X-ray Equipement | 900016 | 3,000.00 | ||||
0 | Whirlpool whole body | 760087 | 97022 | 200 | |||
0 | ANTI-TETANUS | 92148-00[1881] | 780001 | 9214800 | 90 | ||
0 | BCG VACCINE | 92145-00[1881] | 780002 | 9214500 | 90 | ||
0 | DI TE ANATOXAL (ADULT) D/T | 780003 | 40 | ||||
0 | DI TE ANATOXAL (CHILD) | 780004 | 40 | ||||
0 | DI TE PER (1 DOSE) | 780005 | 80 | ||||
0 | DPT | 92149-00[1881] | 780006 | 9214900 | 100 | ||
0 | DT | 780007 | 70 | ||||
0 | ENGERIX-B PEDIA (1 DOSE) | 780008 | 90 | ||||
0 | GLOBUMAN BERNA 2 ML | 780009 | 110 | ||||
0 | GLOBUMAN BERNA 2ML | 780010 | 100 | ||||
0 | Haemophilus influenzae HIB | 780011 | 90 | ||||
0 | HAVRIX VACC (HEP A) | 92169-00[1883] | 780012 | 140 | |||
0 | HAVRIX VACCINE (HEP-A) | 92169-00[1883] | 780013 | 9216900 | 100 | ||
0 | HEP.B - ADULT | 92168-00[1883] | 780014 | 9216800 | 100 | ||
0 | HEP.B - CHILDREN | 92168-00[1883] | 780015 | 9216800 | 100 | ||
0 | HEPUMAN BERNA 2 ML(400 UNIT) | 780016 | 900 | ||||
0 | HIB | 780017 | 90 | ||||
0 | Influenza | 780018 | 100 | ||||
0 | M.M.R. (1 DOSE) | 92156-00[1882] | 780019 | 90 | |||
0 | MEASLES (MONO) | 92153-00[1882] | 780020 | 60 | |||
0 | Meningitis | 780021 | 100 | ||||
0 | MMR | 92156-00[1882] | 780022 | 100 | |||
0 | MORUMAN 100 I.U(ANTI MEASLES) | 780023 | 60 | ||||
0 | PARUMAN 100 I.U.(ANTI PAROT.) | 780024 | 250 | ||||
0 | PNEUMOCOCCAL CONJUGATE VACCINE | 92165-00[1883] | 780025 | 90 | |||
0 | POLIO- 1M.INJ. | 92150-00[1882] | 780026 | 60 | |||
0 | POLIO-ORAL | 92150-00[1882] | 780027 | 40 | |||
0 | RHESUMAN BERNA 250 MG | 780028 | 340 | ||||
0 | RUBEATEN (ANTI RUBELLA) | 92155-00[1882] | 780029 | 90 | |||
0 | RUBEUMAN BERNA 5 ML 30000 UNT. | 780030 | 410 | ||||
0 | TETANUM 250 I.U.(TETANUS IMMU) | 780031 | 220 | ||||
0 | TETANUS TOXOID | 92148-00[1881] | 780032 | 60 | |||
0 | The 3 shoot of hepatitis for IQAMA (HBV ) | 780033 | 150 | ||||
0 | Typhoid Fever | 92144-00[1881] | 780034 | 100 | |||
0 | Typhoid Vaccine | 92144-00[1881] | 780035 | 150 | |||
0 | vaccine (Rabies - snake - scorpion) | 780036 | 100 | ||||
0 | VARICILLA | 92157-00[1882] | 780037 | 60 | |||
0 | Yellow Fever | 780038 | 200 | ||||
0 | Dosimetry personal card | 900001 | 35 | ||||
0 | EXTENSION OF THE DATE OF THE SANITATION CERTIFICATE FOR EACH SHIP | 900002 | 500 | ||||
0 | ISSUING A CERTIFICATE OF SANITATION FOR EACH SHIP | 900003 | 1,000.00 | ||||
0 | Loss of card measuring the dose of radiation | 900004 | 500 | ||||
1 | MOBILE HEAVY EQUIPMENT OPERATOR CHECK-UP | 900005 | Y | 1,350.00 | |||
0 | PERMISSION TO GRANT FREE ACCESS TO CARGO | 900006 | 200 | ||||
SHIPS | |||||||
0 | PERMISSION TO GRANT FREE ACCESS TO PASSENGER | 900007 | 400 | ||||
SHIPS | |||||||
0 | Provide TLD card to workers for maesuring the dose of radiation | 900008 | 500 | ||||
0 | Quality assurance testing and radiometric survey for Angiogram Equipment | 900009 | 5,000.00 | ||||
rehabilitation conditions Per Day | |||||||
0 | It includes Twelve (12) sessions of speech therapy within a | 760047 | 6,100.00 | ||||
month | |||||||
0 | It includes Twelve (12) sessions of speech therapy within a month. | 760048 | 6,100.00 | ||||
Duration: 45-60 minutes for each session. | |||||||
(The types of Rehabilitation and Nursing Services will be identified according to patient�s | |||||||
0 | It provides twelve (12) sessions of advanced nursing care | 760049 | 6,700.00 | ||||
(wound | |||||||
0 | It provides twelve (12) sessions of advanced nursing care | 760050 | 6,700.00 | ||||
)wound management, Foley�s catheter, bladder management and taking care of feeding tube) within a month. | |||||||
0 | K.A.F.O. Orthosis | 760051 | 9609100 | 6,000.00 | |||
0 | Knee Joint Replacement Surgery Program | 49518-00[1518] | 760052 | 70,000.00 | |||
0 | LAPAROSCOPIC - DIAGNOSTIC OF LIVER WITH BIOPSY | 760053 | 4,400.00 | ||||
0 | LAPAROSCOPIC - DIAGNOSTIC OF LIVER WITHOUT | 30390-00[984] | 760054 | 3,200.00 | |||
BIOPSY | |||||||
0 | Manual Massage (15 minutes) | 96162-00[1908] | 760055 | 9616200 | 60 | ||
0 | Medical and Nursing care for non-ventilated patients Per Day | 760056 | 220 | ||||
0 | Medical and Nursing care for ventilated patients Per Day | 760057 | 2,800.00 | ||||
0 | Medical Shoes for Foot Amputation | 760058 | 300 | ||||
0 | Medical Shoes for foot deformity | 760059 | 300 | ||||
0 | Milwaukee Brace | 96092-00[1870] | 760060 | 9609200 | 3,500.00 | ||
0 | Paraffin Wax | 760061 | 97018 | 75 | |||
0 | Pelvis Replacement Surgery Program | 760062 | 73,000.00 | ||||
0 | Pelvis replacement surgery program (Both sides). | 760063 | 124,000.00 | ||||
0 | POST NATAL EXERCISE | 96129-00[1876] | 760064 | 9612900 | 50 | ||
0 | Recovery program (early intervention for stroke) Per Day | 760065 | 2,800.00 | ||||
0 | Renting Operating Room For the first Hour | 760066 | 3,500.00 | ||||
0 | Renting Operating Room For the Second hour or more | 760067 | 2,500.00 | ||||
0 | REPAIR - LIVER LACERATION | 30422-00[954] | 760068 | 4,400.00 | |||
0 | Shortwave | 760069 | 97020 | 75 | |||
0 | Shoulder surgery program. | 760070 | 71,400.00 | ||||
0 | Spinal Cord Injuries, TBI, Vertebrarium, GuillanBarre , | 760071 | 2,800.00 | ||||
Rehabilitation ventilated patients , General Rehabilitation conditions of children Per Day | |||||||
0 | STROKE PATIENT EXERCISE | 760072 | 95875 | 100 | |||
0 | Strokes , Paraplegia,Neuropathies , Patients with Heart Clots | 760073 | 2,600.00 | ||||
, Respiration , Pain Management , Developmental Delay in Children Per Day | |||||||
0 | Taylor Brace | 96092-00[1870] | 760074 | 9609200 | 800 | ||
0 | THERAPUTIC EXERCISE | 96129-00[1876] | 760075 | 9612900 | 75 | ||
0 | THERAPUTIC EXERCISE whole body | 96129-00[1876] | 760076 | 9612900 | 150 | ||
0 | Three (3) sessions of physiotherapy or occupational therapy.Three (3) sessions of nursing care.The duration is (45- 60) minutes for each session.(Rehabilitation therapy and | 760077 | 1,900.00 | ||||
nursing services will be ide | |||||||
0 | Through Ankle Lower Limb Prosthesis Saymes | 760078 | 3,000.00 | ||||
0 | Through Knee Lower Limb Prosthesis (Modular) | 760079 | 8,000.00 | ||||
0 | Through Wrist U.L. Prosthesis (Dynamic) | 760080 | 4,000.00 | ||||
0 | Through Wrist Upper Limb Prosthesis (Cosmetic) | 760081 | 4,000.00 | ||||
0 | TILTING TABLE | 760082 | 100 | ||||
0 | Twelve (12) sessions of physiotherapy or occupational therapy.Twelve (12) sessions of nursing care.Two (2) sessions with nutrition specialist.The duration is 45-60 minutes for each session.(The types | 760083 | 8,000.00 | ||||
0 | Ultra Violet | 14053-01[1609] | 760084 | 1405301 | 60 | ||
0 | Ultrasonic | 760085 | 97035 | 75 | |||
0 | Whirlpool one part | 760086 | 100 | ||||
0 | Above Elbow U.L. Prostheses (Cosmetic Hand) | 760002 | 5,000.00 | ||||
0 | Above Elbow U.L. Prostheses (Dynamic Hand) | 760003 | 10035 | 6,000.00 | |||
0 | Above Knee L.L. Prosthesis (Hydraulic) | 760004 | 10047 | 20,000.00 | |||
0 | Above Knee Lower Limb Prosthesis (Hydraulic w/ poly ethylene socket) | 760005 | 10045 | 20,000.00 | |||
0 | Above Knee Lower Limb Prosthesis (Modular) | 760006 | 12,000.00 | ||||
0 | Above Knee Lower Limb Prosthesis (Wood) | 760007 | 6,000.00 | ||||
0 | Adult Plastic Splint Orthoplast | 96092-00[1870] | 760008 | 9609200 | 600 | ||
0 | Adult Plastic Splint Polypropylene | 96092-00[1870] | 760009 | 9609200 | 400 | ||
0 | ALL BEDSIDE THERAPY | 760010 | 100 | ||||
0 | ANTI-NATAL EXERCISE. | 760011 | 50 | ||||
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 | |||
0 | CPM (CONTINUES PASSIVE MOTION) | 760025 | 50 | ||||
0 | Different Medical Insole | 760026 | 10013 | 50 | |||
0 | Electrical Massage | 96162-00[1908] | 760027 | 9616200 | 50 | ||
0 | Electrical Stimulation | 13400-00[1890] | 760028 | 1340000 | 75 | ||
0 | Electrotherapy | 30195-06[1612] | 760029 | 3019506 | 60 | ||
0 | H.K.A.F.O. Orthosis | 760030 | 9609100 | 8,000.00 | |||
0 | HEPATITIS B IMMUNOGLOBULIN INFUSION SESSION [ HBIG ] (INCL; DRUG PREP, CONSULT SUPERVISION,ACCOM, IVFLUIDS,SUPPLIES, NURSE | 13706-05[1893] | 760031 | 2,600.00 | |||
CARE, W/OUT MED) | |||||||
0 | HEPATORRHAPHY [ REPAIR OF LIVER LACERATION ] | 30422-00[954] | 760032 | 3,200.00 | |||
0 | Hydrotherapy | 96153-00[1880] | 760034 | 9615300 | 100 | ||
0 | IN PATIENT PHYSIOTHERAPY (PARTIAL) | 95550-00[1920] | 760035 | 9555000 | 100 | ||
0 | Includes an assessment by Rehabilitation Consultant. Twelve | 760036 | 5,400.00 | ||||
-12 | |||||||
0 | Includes an assessment by Rehabilitation Consultant.Twelve | 760037 | 7,300.00 | ||||
(12) rehab sessions within a month.Two (2) hours for each session, which includes either physiotherapy, occupational therapy , speech therapy | |||||||
0 | Includes examination in joints replacement surgical clinic, labora | 760038 | 1,800.00 | ||||
0 | Includes examination in joints replacement surgical clinic, laboratory tests, and basic radiology. | 760039 | 1,800.00 | ||||
0 | Includes three (3) sessions per week. One (1) hour for each | 760040 | 900 | ||||
sessi | |||||||
0 | Includes three(3) sessions per week. One (1) hour for each session, which includes either physiotherapy or occupational therapy or speech therapy or all of them together as patient�s need | 760041 | 900 | ||||
0 | Infra Red | 32135-01[941] | 760042 | 3213501 | 60 | ||
0 | Initial Assessment of patients which is counted unless the | 760043 | 1,600.00 | ||||
patien | |||||||
0 | Initial Assessment of patients which is counted unless the patient is admitted in the City for one of the rehabilitation | 760044 | 1,600.00 | ||||
program. | |||||||
0 | Inpatient Rehabilitation Program Joints | 760045 | 2,500.00 | ||||
replacement.Prostheses. | |||||||
0 | Inpatient Rehabilitation Program Joints replacement.Prostheses.Rheumatic conditionsGeneral | 760046 | 2,500.00 | ||||
0 | OCCUPATIONAL THERAPY/SESSION | 95550-02[1916] | 750072 | 9555002 | 260 | ||
0 | ORGANICITY BATTERY | 750073 | 240 | ||||
0 | PARAFFIN WAX | 750074 | 97018 | 90 | |||
0 | PELVIC TRACTION | 750075 | 97012 | 90 | |||
0 | PERCEPTUAL TESTING FOR LEARNING DISABILITY | 750076 | 9611000 | 320 | |||
0 | PERSONALITY QUESTIONNAIRE | 750077 | 240 | ||||
0 | PHOBIC SCALE | 750078 | 240 | ||||
0 | PHYCHOMETRIC TEST (I.Q.) | 95550-03[1916] | 750079 | 95550003 | 440 | ||
0 | PHYSICAL THERAPY INSTRUCTIONS | 95550-03[1916] | 750080 | 9555003 | 60 | ||
0 | PHYSIOTHERAPY AT HOME/SESSION | 750081 | 390 | ||||
0 | PORTEUS MAZES TEST | 750082 | 240 | ||||
0 | PROGRESSIVE MATRIAS TEST | 750083 | 240 | ||||
0 | PROGRESSIVE MUSCLE RELAXATION | 750084 | 240 | ||||
0 | PSYCHIATRY EMERGENCY CONSULTATION | 750085 | 600 | ||||
0 | PSYCHIATRY EVALUATION ADMINISTRATIVE FEE | 750086 | 200 | ||||
0 | PSYCHIATRY FOLLOW-UP | 750087 | 280 | ||||
0 | PSYCHIATRY HOME VISIT | 750088 | 1,600.00 | ||||
0 | PSYCHOLOGICAL COUNSELLING | 750089 | 360 | ||||
0 | PSYCHOTHERAPY, EACH SESSION | 750090 | 240 | ||||
0 | RAIVEN PROGRESSIVE MATRICAS | 750091 | 120 | ||||
0 | REH PK/DAY INC INVS EXC MEDS/SUPPLIES | 750092 | 1,600.00 | ||||
0 | REH. PACK/DAY EXCL INVS/MEDS/SUPPLIES | 750093 | 1,000.00 | ||||
0 | RIGHT- LEFT ORIENTATION TEST | 750094 | 9611300 | 120 | |||
0 | RORSCHACH TEST | 750095 | 280 | ||||
0 | SENTENCE COMPLETION TEST | 750096 | 120 | ||||
0 | SHORT WAVE | 750097 | 29450 | 90 | |||
0 | SOCIAL WORKERS ASSESS./VISIT | 750098 | 260 | ||||
0 | SOMLEC THERAPY SESSION | 750099 | 440 | ||||
0 | SPEECH THERAPY/SESSION | 95550-05[1916] | 750100 | 9613500 | 260 | ||
0 | STANFORD -BINET INTELLIGENCE SCALE | 750101 | 440 | ||||
0 | TAYLOR ANXIETY SCALE | 750102 | 120 | ||||
0 | TENS | 750103 | 90 | ||||
0 | THEMATIC APPRECEPTION TEST | 750104 | 360 | ||||
0 | THERAPEUTIC EX | 750105 | 80 | ||||
0 | THERAPEUTIC EX 30 MIN.SESSION | 750106 | 150 | ||||
0 | TRAIL MAKING TEST | 750107 | 160 | ||||
0 | TUNNEL P.U.V.A. | 750108 | 96912 | 80 | |||
0 | ULTRA VIOLET | 750109 | 96912 | 80 | |||
0 | ULTRASONIC | 90908-00[1950] | 750110 | 9090800 | 90 | ||
0 | VINELAND ADAPATIVE BEHAVIOR SCALES | 750111 | 200 | ||||
CERVICAL TRACTION
90
CHILDREN APPRECEPTION TEST
240
CLOCK DRAWING TEST
200
CLOCK FACE TEST
120
COGNISTAT,NEUROBEHAVIORAL EXAMINATION
280
COGNITIVE BEHAVIOR THERAPHY
360
COLD PACK
80
CONTRAST BATH /PER SESSION
60
COUPLE ( MARITAL) THERAPHY
440
CPM 3 SESSION
190
XOLAIR SUBCUTANEOUS INJECTION 150 MG 1 Vial
2,114.70
XYLOCAINE(R) TOPICAL SPARY 10 % Sprays
7.35
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