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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 | ||||
Yellow Fever
200
Dosimetry personal card
35
EXTENSION OF THE DATE OF THE SANITATION CERTIFICATE FOR EACH SHIP
500
ISSUING A CERTIFICATE OF SANITATION FOR EACH SHIP
1,000.00
Loss of card measuring the dose of radiation
500
MOBILE HEAVY EQUIPMENT OPERATOR CHECK-UP
1,350.00
PERMISSION TO GRANT FREE ACCESS TO CARGO
200
SHIPS
PERMISSION TO GRANT FREE ACCESS TO PASSENGER
400
SHIPS
Provide TLD card to workers for maesuring the dose of radiation
500
Quality assurance testing and radiometric survey for Angiogram Equipment
5,000.00
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